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  • The Hardest Goodbyes

    The beginning of my journey with mental illness was shrouded in secrecy.  It was kept quiet for numerous reasons, all completely valid at the time. We had no idea what was wrong. Was I just a complex case of post-partum depression requiring ECT treatment to jumpstart my neurotransmitters into talking to each other properly again? Was it something more when in the subsequent months new and equally perplexing behaviors crept in? We had young children to shelter from the storm inside their mother’s brain, we had a professional reputation to try to protect and we were trying to integrate within a new community. Therefore, it was only natural we stayed quiet and to ourselves. Our circle was small, tight and with a few friends allowed in meant to bring joy versus serve as confidantes.

    When the knowledge of a mental illness goes public, be it by personal choice, accidental leak or a less than private display of symptoms; it is often said one finds out who will stand by them, remaining true and who is going to walk away. The always honest and eloquent Nicole Lyons once posted this graphic online some time ago, and I saved it, thinking “Yes! And how! And how much better I am for it. “

    Which is the truth. My new circle is small. It consists of family, friends from kindergarten, some from graduate school and a few dear friends here in my tiny rural town. I wouldn’t trade them for the world. They have been there, reached out, texted me, celebrated special days with me. They know with a single look that my brain may not be okay that day. They are incapable of anything but love.

    Does it mean it hurts any less on the days you recognize someone walked away? Someone YOU cared about, YOU invested time in, YOU laughed with, YOU may not have spoken to in some time, but as the saying goes:

    Needless-to-say, I’m realistic enough to know people have walked in the face of my bipolar disorder. Some I metaphorically waved as the door hit them in the ass on the way on out. Some have crept quietly away and their absence is still not noticed.

    This absence stings. It hurts. I cried for the very first time ever over the loss of a person. I don’t even know how long they have been gone. It was the realization today. The realization that they didn’t simply quit social media like I once believed. I was simply just de-friended. (Who DOES that when there is a mute button?). I am de-friended and my husband was kept on as a friend. I am not worthy of “hello” when we see each other. I now understand why texts to get coffee or lunch went unanswered. Or plans got cancelled last minute and why I quit trying after a time. All by the only non-family member to ever visit me in the hospital when I was down. It hurts.

    People change. I get that. I do. We grow, we evolve, and we are busy with children and commitments. My heart doesn’t change. My brain chemistry cannot help the changes it made.  You do not have to be my friend and I do not ever to know the specifics why, but you hurt me.

     

     

  • Let's Talk About Illness over Health This May

    Every year I talk about how much I love mental health awareness month, held during May. I enjoy the time we get to spend discussing accomplishments and achievements made in the mental illness community over the past year. It warms me to have for 31 days, a focus on mental illness. This year is different. There is a change I’ve noticed. It’s subtle, smoldering underneath the shiny signs and banner we metaphorically wave decrying stigma and asking for acceptance. My Facebook feed isn’t as filled as compared to last year. I don’t see lime green washing over society in waves the way October shimmers in pastel pink.

    I could spend hours waxing poetic on theories why. It was a rough year for me. I left a position of nearly 5 years, after working with one of my surgeons for nearly a decade of my life and chose to move on to a field that stimulates me both personally and professionally. While I have never regretted the choice, I left good people behind and have a small hole in my large heart for those I no longer see. I found myself this winter in a depressive episode that was severe, rendering me incapable of doing anything beyond showing up for work. I lost two months of family time, hidden away safely in my bed under the covers. The light dimmed. Not wanting to talk or interact with the world.

    I cried multiple times a day, trying to figure what I did wrong. What I could possibly have done to feel so black and empty despite making lifestyle changes that excited me? How did I fall into a black hole? And the truth is: nothing. It is my disease. There will be times when I cannot control the onset of symptoms regardless of how hard I fight and adhere to my medications as well as non-pharmacologic management techniques as well. What a bitter pill to swallow, the notion that one can do everything properly and that mood episodes can and do still ensue.  And how does this relate to the lack of chatter on Facebook and absence of bright lime green? Perhaps others are having a challenging year as well. 

    I chose not to participate in my state’s annual NAMI walk this May for a myriad of reasons, however through emails encouraging participants I noticed two things. First, with sixteen days left before the walk there are over 50% less teams than goal participation and less team participation overall than last year. Last, the state chapter has raised less than 50% of their fundraising goal for the walk which helps bring programming to families and affected loved ones throughout the state. How is that possible in a day and age when there should be more discussion, more participation than ever?

    If I am becoming more selective in groups I support, perhaps others are as well. I think the bottom line is, for mental health awareness, which is really a way of avoiding saying mental ILLNESS awareness; we need to find our voice, find our message to be loud, clear and effective. For me I can no longer pretend it is strictly a stigma issue, but it is an issue in which we do not care for our own the manner in which we would want ourselves cared for with any other disease process. With mental illness, those who are the most ill, in need of the most care are ignored and passed over in favor of the less acute with less needs. With mental illness, those who are the most ill have the most trouble finding insurance coverage and obtaining the mythical parity we discuss on a daily basis. With mental illness, those who are the most ill are left to discriminatory practices in the workforce, with housing and from providers themselves based on personal bias not concrete evidence. We need to change that and talk about the most seriously ill. Would we leave the septic patient in need of critical care management homeless and on the street? Would we leave the cancer patient in a neutropenic crisis unable to fight off infection without care because they are too needy? Would we or would YOU accept anything less than our very best for any other disease. If your answers are no, then get familiar with the plight of those with serious mental illness among us and start talking.

    It’s mental illness awareness month, after all.

     

  • The Season of New Beginnings

    Pinch me. I think I’m dreaming. What I mean to say more accurately is “Pinch me, for I’m positive I’m dreaming.” The last medication change to pull me out of that deep dark depression I was in this winter has really worked. Mentally, I feel great. Most days I feel like me. Sounds like a bit a paradox, doesn’t it? However I mean I am finally starting to feel like the “me” pre-pregnancy with my oldest. I am feeling like me. No hypomania, no mania, no depression, just pure Ann. Before you get all excited and start jumping up and down like a wide receiver in the end zone, I am very much still vigilant and here’s why.

    My treatment team hasn’t completely bought into the unconventional cocktail I pushed them into trying. And that’s okay, as long as we all stay open with the communication channels at all times and discuss when there are changes in mood or other symptoms which may be concerning or have the potential to be concerning. I may be a provider in my day job, but when it comes to matters of my own health I need to always remember I am the patient. I am THE PATIENT. Being the patient means I get to have a voice at the table and advocate for myself. It additionally means I need to learn to sit back and take my provider cap off and trust my team’s judgment. I chose them to treat my brain for a reason. We’ve been on this journey together, managing to avoid hospitalization for the last three years because of a sound collaborative relationship of trust. They trust me to be open and honest about what is really happening on the inside. I trust them to do what’s needed to fix mood episodes or to keep me stable.

    I get antsy still when I do not sleep well. We have discussed here before about how poor sleep for me is a known trigger for hypomania. I have been experiencing more restless sleep and incredibly powerful, vivid, disturbing dreams since the medication change. For a while I thought I was going to have to stop following the current election cycle because each night I was stuck in a different candidate’s campaign. I was questioning my TV choices before bed given the raw, ripped from the headline cult-esque kidnapping style dreams my sleep took. Only I’m prone to revisit Gossip Girl on Netflix whenever I get bored with a show. My dreams have been plagued with people from the past, and not even individuals who I thought had significant meaning at the time. With the restlessness comes daytime fatigue, and with the daytime fatigue comes increase caffeine intake and with the increased caffeine intake comes an incredible fear of hypomania or mania. Only, I’m not. I’m just sleeping in a restless fashion and the dreams are now dissipating. I’m just me. Getting up and going through my day.

    However, with my day I daresay (and my husband would agree) old habits are incredibly hard to break. Being ill and symptomatic for so long I developed routines that would allow me to feel secure and comfortable. Were they functional? Not entirely. Were they useful to anyone other than myself? No. But I could do my job. I could get dressed. I could feel. And I could hide when the feels got to be too much for me. These old habits that helped me in the seemingly dark days are not what I need now. I need to learn to break them and live more in the moment. Breaking dysfunctional routine or changing old habits is extremely uncomfortable for even the best adjusted of us in society. I, on the other hand, need patience, kindness, patience, gentle reminders, patience, encouragement, patience, praise and did I mention patience to keep me moving forward with uncomfortable change. I am capable of it: self-awareness is the first step.

    And with that, I bring you the best Spring of my life. The season of New Beginnings.

  • Presidential Campaigns and Mental Illness

    In the days of my depression, in my absence from writing I was able to fill my time in isolation with reading and watching the political atmosphere of our current presidential primary election season. I’ve been paying closer attention than usual for a few reasons. The first reason is having a candidate I really admire in the race and have wanted to see run for the better part of a decade is both exhilarating and refreshing. Yet most importantly, my husband and I work behind the scenes to talk to congressional representatives about the importance of mental health reform and passing law that will make a real impact on care for those who need it. It is vital to me, as a citizen of this country with a serious mental illness (SMI) that our next President of the United States be not only well-versed on the issues facing the mentally ill in our country but also be equally committed to foment tangible reform.

    We can argue each candidate is equally unsuitable for the bombastic and rash uneducated remarks they have all said in the heat of debates or for a great sound bite to have the press repeat over and over and over. Which they have gladly and citizens have whipped themselves into a frenzy over on social media, the most recent example being Senator Bernie Sanders referring to the Republican debates as an example for the need of more spending on mental health reform. I chose to write a long letter to the senator explaining why his remark was in poor form and sent it to his campaign where it was well received. Which raises the question: instead of Twitter or Facebook bashing the candidates for their gaffes, are we educating them on why reform is needed and how what they say matters?  Which isn’t to say I’m not guilty. I recently posted on article on Rep. Paul Ryan remarking he gave up anxiety as a character defect for Lent. It bothered me. He may have meant it in the context of choosing not to focus on worry and “Let go and let God” however it’s not what he said and not how it was presented in the article. I should have written his office and educated him in hindsight.

    The House and the Senate both currently have bills this session looking to pass various types of reform. The House bill, HR 2646, is the stronger bill by far of the two. It works to comprehensively deliver better care to the more seriously ill in our country. It is not a one size fits all bill and never has been. It protects those who do not meet criteria for hospital admission, but desperately need treatment. It protects those who cannot understand they are ill but desperately need treatment, allowing their families to get them help instead of watching helplessly. It allows for families to have conversations with their psychiatrists, therapists and others on the treatment team that they were previously unable to without completely violating their right to privacy at the same time. Something that my husband would tell you had he been able to do, my last suicide attempt – the one that landed me unconscious on a ventilator for three days – could have been prevented. Critics of HR2646 want you to believe human rights are being taken away. Those critics are the ones that this bill does not apply to and have nothing to fear from its passage. This bill as a matter of fact does not apply to me in my current health state, yet I argue for it because it once did and someday might again. My family will need to have options for me. My husband and I want other families to have those options we did not. Congress, President Obama and a new incoming president (regardless of party affiliation) will need to understand this.

    The previous Senate bill, SB1945 worked to begin to address this, however when the bill went to markup the committee started over and created a new compromise bill with a number of amendments. The new version, SB2680 is sorely lacking in what is needed most. It has no reform for the most seriously ill among us. It has no provisions for HIPAA and allowing families to have dialogue with providers. The Senate is championing reform for changes in substance abuse prescribing practices now allowing for mid-level providers to participate in buprenorphine clinics and expansion of the number of patients that the clinics will be allowed to treat annually. My biggest fear is should HR 2646 make it the Senate and vice versa, treatment for the most seriously ill will be “compromised” right out of any reform bill.

    Unless we pass real, significant reform that is based on scientifically-proven treatment that works, I don’t see the system of our citizens who have a real illness being forced into the streets and jails changing. No other disease process is treated like this in our country, and SMI is no exception. Imagine if cancer patients were turned away for a lack of beds or for not meeting criteria for hospitalization?

    I am not suggesting you drop everything and support my candidate of choice. I am saying we all need to be comfortable that the person we each support individually will do the best job for the mentally ill in our country. If you believe with all your heart, yes, then perfect. If you have questions on where your candidate stands, reach out to the campaign. Get them answered in detail. As a voting citizen you deserve that much.

  • Surviving the Holidays with Mental Illness

    Have a holly, jolly Christmas; it’s the best time of the year… Unless you are me. Then you would treat the days between Thanksgiving and Christmas with dread and apprehension. I find myself often gasping, completely anxiety riddled and unable to cope with my emotions during those days and weeks.

    “What is the matter with you?” You might ask. You might tell me to focus on my three handsome little boys who spent their time eagerly awaiting the arrival of Santa, meticulously plotting, and writing out wish lists hoping they were on the nice list. And I do focus on them. In fact, the only reason I get out of bed during these days is for them. If it were not for them, I would gladly crawl into bed following Thanksgiving dinner and come out on New Year’s Eve avoiding the whole holiday hullaballoo altogether.

    This year, fortunately, I stayed on my mediation unlike last year when I stopped my medications in a fit of self-consciousness regarding weight gain. That was horrible and a Christmas I would rather not repeat. Despite remaining on my medication this year and having a ton of self-awareness in how the holidays affect me, I still found myself ill-tempered and short with people. The symptom of irritability remained high.

    It is a challenge for me to explain to loved ones how much I dislike the holidays, particularly when they themselves are so full of joy and excitement. I dislike the expectation, the pressure, and the obligation when I really need a day that I can be stress and worry free. I will always start to lash out and try to control anything that seems tangible enough to have any control over in order to internally maintain a sense of calm amid chaos. I need those who know me best to be able to sense when I get tense, or anxious, or irritable and have the ability to pull me inward and keep me calm. I need those who know me best to not react to my irritability with anger or tension of their own; as it will always escalate any negative symptom I might be experiencing. (Screaming back at me when I am ranting like a lunatic – yes, a lunatic – over scotch tape will never get me back to a level state of emotion.)

    It is a challenge for me to tell people what I need. Sometimes it is as simple as I don’t know what I need. Other times, the words escape me. Other times, I just isolate instead of facing my stressors head on because the stress is too overwhelming. And other times, I am too scared to verbalize what I need. I fear my needs will stress an already overloaded plate. I fear that my needs will sound irrational. I fear that no one will understand my need to regulate my brain and it’s current emotional capacity. 

    So how did I survive the holidays this year? I’m still figuring that out. I stayed on my medication. I managed to keep my sleep hygiene in check. I had the ability to take a quick time-out on Christmas Day and run to Starbucks when I needed to reset myself. A good friend texted me during the day to tell me how much she loved me. My husband did his best to recognize on Christmas Day when I would get over-stimulated. Lastly, I know at the end of the year, I will have all the time in the world for self-care once again.

    I think I did all right for holidays 2015 in the end. And I have 11 months before I have to think about it again.

  • Lockdown, Security Drills and Mental Illness

    “Good Morning. Please pardon the interruption. The school is on lockdown. The school is now on lockdown.” 

    As a parent, it always puts a lump in my throat when I get the courtesy emails to share that the school had a lockdown drill to prepare for the day someone has entered the building to cause harm. Mass school shootings have become commonplace in our society and many of us feel powerless to stop them given the congressional gridlock. However, it one thing to get a casual email to prepare parents for inevitable questions our children may come home with after a drill but entirely another to be physically present in the school and hear those very words I quoted above.

    I looked around nervously and was told it was only a drill and I followed the words of the staff meant to keep me safe. I made a joke or two about being caught inside for the drill, but my insides felt anything but calm or humorous.

    I have bipolar disorder. Many, many situations make me anxious. I never enter a room without knowing all my escape routes, where the nearest bathroom is and when I can, exactly who I am going to be dealing with. If I have to sit, I will sit near an exit. I will avoid conversation with strangers. And I might be constantly glancing around a room to take in my surroundings and assess the ever-changing situation. I did not used to be this way. I have accepted this is my reality and I have learned to adapt.

    In the darkened room, I smiled and made polite conversation as the drill was discussed. I offered a sentence or two on our fears since the Paris attacks last Friday, November 13. My brain was running a marathon with thoughts, and my heartbeat was fast, and running in second place. I wondered how everyone could be so calm. How they could be so sure it was only a drill? A lockdown situation would occur quickly and the announcement would be made without warning. How could they know? I wondered what if something is happening in another area of the building and we don’t know it? What if. What if. What if. I was a mess of what ifs. What if the silence really was danger approaching? What if the sounds of a door opening to announce all clear what someone who meant harm? I was incapable of shifting my brain away from these intruding ideas. How were my children coping? Is this how they feel? Are they wishing they were home? What about the children who cannot understand why we do this? What about the children whose brains work like mine does? How are they processing this? Are their little, beautiful hearts as frightened as mine?

    We assume that the drills will protect us and prepare us for the actual emergency. I understood rationally the goal of the exercise. My relief when the all clear came was not externally shared, I felt drained by the experience. And triggered.

    I have all these coping mechanisms when I place myself in public scenarios and events. I have them so that I know I can do what I need to do to take care of my brain. When I do not feel adequately mentally prepared I often get my husband to attend events with me as an added layer of protection. I didn’t have that option this morning, living in a household with two parents who work. I was unable to send a text to get reassurance. Participating in the drill meant not worrying about where my bag with my phone was. It meant being extraordinarily uncomfortable and not being able to talk about it. It meant treating the situation as real as it felt.

    National security has weighed heavily on our minds since Friday. Now we need to think about how to approach the subject with the sensitivity those with mental illness deserve and how we can allow them/us/me to feel safe and prepared for these events when we have days we are incapable of feeling prepared to step out of bed.

  • The Forgotten Journey

    I just came home from spending three days in Washington DC and Baltimore. I went down with my family to spend time with our extended family, attend advocacy events, a conference regarding schizophrenia and speak directly to our elected representatives in Washington regarding my feelings on the current bills on mental health reform in both the House and the Senate. It was thrilling, exhilarating and emotionally exhausting. I plan to share that experience with you in a few days.

    I left Maryland and came home with a sense of melancholy as the final day and a half we spent hanging around our old hometown where we lived with our children as a “young” married couple. That melancholy is what I want to immediately discuss. I do not remember the towns of Ellicott City, Columbia or Jessup. The neighborhoods of Baltimore are so fragmented and come to me in shattered bits and pieces. You see, prior to the diagnosis of Bipolar disorder when we were struggling with the severe post-partum depression I had a course of electroconvulsive therapy (ECT) over the course of several months in 2012.  It without a doubt saved me at the time. It also without a doubt wreaked havoc on my memory, most notably, Maryland.

    Here is what I do know. I know I was happy living there. However it’s like Christmas morning in some regards. “Oh! We ate there?!? It looks so nice…” “What?!?! There’s an aquarium!!! Oh. It’s always been there? Oh. We took Liam there? Oh. Are you sure?” “What is that arena? When the heck did they build that?!? Oh. I guess you are right. We did see Blue Man Group there.” Or pulling into two separate shopping centers over the weekend and experiencing me looking around in utter amazement with my husband staring at me, explaining to me that we used to frequent both the centers a couple times a week at different periods of our lives based on the location of our home. All I could muster in response was genuine shock that I could not recall ever being at either plaza before. The memory is GONE.

    We’ve known that for sometime now. We’ve known by the innocent remarks I would make to my husband such as wanting to see Seal in concert should he ever tour again. He would look incredulously at me and share with me that he and I saw Seal together at the Merriweather Post Pavilion in Columbia. We’ve known from the arguments we have had over my insistence that I have never gone places or done things I did, even if he can cite the date and exactly whom we were with.

    And I am such a phony about my experience with this in the moment. I will try to hide my authentic experience and not let anyone see how frightening it truly is to not remember. Driving around Baltimore Thursday evening it was like everything changed or nothing had changed. I genuinely don’t know. There were only three things I knew for sure: Kooper’s Tavern in Fell’s Point looks exactly the same and I had my first date with my husband there. The building with tourist shops and the Cheesecake Factory on the Inner Harbor is still standing. (Who goes there anyway?) And there is a shiny new J. Crew in Fell’s Point that was not there when I lived there. Surely, I would have known about that beauty. Everything else is up for grabs. And it scares me. It scares me to talk about it and it scares me to write about it.

    My absolute worst fear would have been to run into someone who isn’t on Facebook that would have recognized me. What if I didn’t know them anymore? In some ways social media is a blessing, allowing me to hold onto names, faces and glimpses of precious memories that might otherwise be lost.

    Perhaps that is why it has been so seemingly easy for me to turn my back on a chapter of my life that was neither unhappy nor eventful nor disastrous. It is because I simply cannot remember.

  • It's about the Small Victories

    Most of us living with some form of mental illness or another would agree on this one truth. It is all about the little victories we get. Every small victory we achieve brings hope. And for me, hope is all I need to get through another day of stability and keep stacking the days up, 24 hours at a time.  With my recent post talking about the changing seasons and medications, I thought perhaps small victories were behind me for a while.  I still manage to surprise even myself every day.

    I might choose to miss out on fun events that I had planned carefully, eagerly anticipated because at the last minute anxiety does get the best of me. But then I can turn around and handle a crowd like a boss without needing medication to cope. So what if I needed a nap later? I got through the moment and that is all that matters. It is comforting to know my toolbox is getting full enough that a nap might be sufficient for the day’s self-care.  (small victory)

    I met with my team last to discuss my recent medication change and the new set of side effects I’ve been dealing with. My husband even opted to join us as he was finding the angrier, more anxious version of me intolerable. We talked about how likely I was not on a high enough dosage for what I needed and that it would get better. My husband would get his wife back with a little more patience on all our parts. (small victory)

    I’ve been discussing the ongoing battle with nutrition and medications, dealing with a significant amount of weight gain as a side effect. Being caught in a vicious neurotransmitter cycle and eating to soothe it. When I’m depressed I don’t have enough serotonin and my medication works to increase serotonin and increases appetite. As a person with a perennial sweet tooth, the dopamine receptors in my brain learn to associate the sweet treats and carbohydrates with a false reward and thus eating becomes pleasurable. Perhaps even in a time when I may feel I have limited pleasures, thus creating the vicious serotonin-dopamine-food cycle. I’ve been avoiding shopping for a long time and refusing to know exactly what clothing size I am out of self-loathing. What I do know is the pair of “big girl” jeans I bought last winter are now too big and this weekend I purchased a pair of size 14 skinny jeans (curvy cut) from Old Navy and I look amazing.  (bigger victory)

    While my weekend may not be exactly how I planned, and I may have only accomplished a quarter of things I set out to do; I am left with filled with hope. For me, hope is essential to stability. 

  • Changing Seasons, Changing Meds, Changing Moods

    There is a question that begs to be asked: when one has done remarkably well with mono-therapy with a single drug why shift gears? And by remarkably well, I am referring to a lack of inpatient stays in nearly 2.5 years, a lack of intensive outpatient treatment in the same time frame, a lack of needing to visit a psychiatric emergency room and a general lack of any increase in care needs beyond routine visits with one’s treatment team for standard follow-up. So why shift gears?

    I looked my psychiatrist in the face nearly a month ago and told him “I can be fat, I can be bald. But I draw the line at being fat and bald.”  Over the last several months I have been experiencing profuse hair loss and after extensive blood work showing my thyroid to be completely normal (a concern on lithium), I realized that alopecia (hair loss) can be a side effect of lithium. I found the side effect that was intolerable and where I drew my personal line. So we came up with a plan. We changed my medication.  I have not been enjoying the ride since.

    First came the insomnia. So, I played around with timing of when I take my medication to decrease insomnia. I hate taking pills, so when possible, I try to take them all for the day and be done with it at night.  And when sleep does come, it is filled with extraordinarily vivid dreams and nightmares. All known, listed side effects.

    Then came the evening when returning from a walk with a neighbor, I crapped my pants. I mean like Toddler’s diarrhea-type crapped my pants. There was nothing I could do about it at the time. It just happened. And I made my way home in the dusk-quickly-turning-black light barefoot to avoid messing my stark white shoes, trying not to step on anything. I called my husband from our front stoop hysterically crying, asking for a towel. He showed up at the door and looked at me. All I could do was sob uncontrollably “My medicine made me shit my pants and I have to wipe my leg and get upstairs before the kids see me.” Later that evening, I cried more on the couch about how “this” wasn’t how I envisioned life and how all I did was trade in one lousy set of side effects for another, as diarrhea is a known, listed side effect. Fortunately I have learned, the second my stomach starts to rumble – MOVE!!

    Next are the anxiety and the irritability. I am honestly having difficulty sorting the two out at times. My heart and my thoughts race constantly. I am left feeling like I have two options. One, I want to hide from the world in bed in a safe cocoon with Netflix because I can’t face anything and being around people brings out an anxiety and insecurity the likes of which would put the seventh-grade me to shame.  Or two, I want to go all Hulk Smash on everything in my path as I find myself brimming with rage over I don’t even know what, if I’m really honest. Angry. Anxious. Angry. Anxious. Angry, anxious Ann.

    This weekend was a difficult one. I was already upset and anxious over a number of issues I cannot control and I lost it with my family over a simple non-issue. She-Hulk came out to play and I started screaming irrationally at my husband, at my children and when I walked away I had so much raw emotion pent up that I was unable to process all I could do was slam the door over and over saying “I hate everyone”. I was loud and out of control. I was unable to calm down and my husband wouldn’t leave me alone despite my screaming at him to leave the room. (I was unable to process that he was trying to gauge if my doctor needed to be called, or a trip to the emergency department was in order). I screamed and screamed and screamed and screamed some more. I finally walked out of the house with my cell phone and car keys.

    After fueling up at Starbucks because caffeine is always a fantastic idea in that sort of state, I was driving from parking lot to parking lot trying to figure out what to do. I finally picked up the phone and called someone, sobbing to listen. I told them how my med change isn’t sitting well with me and I didn’t understand what was happening. I was able to go and sit with a non-judgmental person for a couple hours without rehashing the gory details, without having to be anything other than shell-shocked and silent. Once my husband and I started texting and communicating, I went home.

    I share this because this is the reality of how medication changes can go on occasion. It takes patience. And love. My love for both myself and my family keep me moving forward until my team can get the medication cocktail right. Perhaps even for me, it takes a dash of guilt too. For I will always be my own worst critic and the internal flogging I give myself as a mother is worse than anything anyone could ever do to me. The guilt over my illness and its potential toll on my kids keeps me pushing for a solution. I will be seeing my provider this week and getting it sorted out, likely with my husband at my side.

  • Military Mental Health: How do you know if the stress will affect you. Part II in a series

    Today's post is part two of a series on military mental health brought to us by Crystal Shelton, an LSCW now out of uniform. Last post she gave a basic intro primer to get the conversation going. This entry gets the conversation going a bit further, as military mental health is a complex multi-faceted topic. 

    Just about everyone who has been in uniform has had a similar early interaction with mental health in the military: someone—a recruiter or possibly a medical officer at Military Entrance Processing Station will ask, “any history of mental health issues?” and if you want to stay in (of course you do, you just got here!) you will say “no!” A history of mental health treatment has long been a non-starter for military service.  Why? Well, from day one you will be yelled at, made to march sleeplessly through the night, armed, and yelled at some more. You will be given live grenades and expected to throw them in a direction opposite from the people who have been yelling at you.  You will be intentionally stressed and stressed some more and once you graduate from your training you will be expected to be emotionally, physically, financially, and mentally ready to follow orders while under fire in a combat zone.

    The early stages of a military career are a crucible designed to prepare one to carry out the tasks of national defense. Sometimes these tasks are unimaginably tedious; other times we strap a shoulder mounted rocket launcher to the back of a nineteen year old who is only as focused and as psychiatrically sound as any nineteen year old in your neighborhood. The pressures of performance, dedication, and focus are immediate in the military: they happen long before the first deployment.  Stress is intentionally created and recreated and simple endeavors like stashing gear or taking inventory can feel like high-pressure, life-or-death operations. The logic, well supported I should add, is: complacency kills.  So whether you are taking inventory or loading mortars, Do Not Relax!!!

    In the same way you don’t wait for the first day of a marathon to try out jogging, stress and anxiety are *practiced* in garrison in order to be able to respond to it when it matters.  This might account for a portion of the elevated number of military suicides in our soldiers, Marines, and sailors who haven’t deployed.  It is both a compliment and an indictment of the military as an institution, too, that it does not have a better process for culling out people who display an early tendency to become worn down and injured under stress. Drill Instructors, platoon sergeants, battalion commanders, medical officers—everyone involved with evaluating and maintaining operational readiness in the military—seem to believe the military is genuinely good for most people and discharging someone simply because its not a good fit is ultimately a failure on the part of all parties. 

    Major mental health concerns are supposed to get weeded out fairly early but I have a story for you! I worked in a clinic that served students who had just completed USMC basic training and who were on their way to the second half of their professional education. Understand, these students were fresh off the bus from basic training.  In a period of 6 months I saw not one but two infantry students who were floridly psychotic.  Think about that. At least one reader here has thought, man, I thought about joining the military but boot camp just seemed way too hard.  Whatever you believed about the early career component of the military, it probably didn’t include a system so orderly and free from abstraction that it could be completed even in the midst of a first-break psychosis. It is a telling story, too, because it really reminds us that there is no reliable way of knowing what will injure someone’s psychological health.  I can say that for one of the unfortunate young men I had to separate due to psychosis, the order and concreteness were probably the only things that allowed him to maintain himself for so long.  Getting yelled, struggling with task completion, these were of no consequence to him.

    There is no simple way of predicting what will be the thing that unravels an individual who was otherwise able to hold up well under stress.  As I noted, there isn’t always a strong correlation between a mental health diagnosis and poor stress response.  I’ve met a non-inconsequential number of senior enlisted and officers who have hallmark traits of Bipolar II, their chests full of ribbons denoting meritorious service. It is as if their ability to work longer hours, obsess over details, their seemingly endless reserve of waking hours and episodes of grandiosity are precisely what has aided them in their notable career progressions. It only becomes an issue when what was once irritability becomes aggression and what was once feeling a little down becomes can’t get out of bed. Conversely, even someone with a fairly hearty psyche who has shown few outward signs of distress can be surprised to find that going to the grocery store or taking out the trash suddenly causes a panic attack.  This can start long before deployment.

    Resilience is a poorly defined and measured concept, but if I had to take a stab at it I would have to say it is rooted in our self-talk. The people who are more vulnerable to anxious distress can say some incredibly crappy things to themselves when faced with a difficult task.  They can tell themselves they suck, they can call themselves a failure, they can even tell themselves that everyone knows they are a failure (because even when we believe we are terrible at everything else, we always believe we are world-class mind readers).  People who are more insulated from anxiety and anxious distress tend to take a different approach to self-talk.  This includes my young psychotic Marine.  When faced with something difficult, the approach is more like: one foot at a time; one foot at a time; one foot at a time.

    This kind of self talk will matter a great deal once someone deploys.  In the next post we will look at a number of things that can cause psychological injury during deployment and after.  Some of these things can result in what we classically associate with PTSD.  But there are a number of things, which fall under the current rubric of PTSD that probably shouldn’t.  What matters, for now, is that we keep an open mind about the etiology and meaning of combat stress disorders so we can more fully evaluate and treat them in the future.

    About the author: Crystal Shelton is a clinical social worker and a former Naval officer.  She has served as an embedded mental health expert with the USMC School of Infantry and as the Divisional Officer of the USMC Wounded Warrior Battalion-East Mental Health Clinic.  She is now out of uniform and working on her doctorate from University of Pennsylvania.