Fact-checking. What’s Real?

I’ve had doctors who were surprised that I can distinguish most of my hallucinations from reality, so I’m led to believe it’s not common, but I am not a professional.

I know when I’m in a psychotic episode and I can use logic to detect most hallucinations. I call it “fact checking”.

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If I’m in the car and I hear the driver (I don’t drive. I have a license, but it scares my family. It’s disheartening at times.) singing along with the radio, I look at the driver’s mouth to see if it’s moving. Sometimes it is, and I’m hearing them singing. Sometimes it isn’t, and then I realize I’m just hallucinating them singing.

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Once, I saw a young, blonde-haired boy in a blue and orange swimsuit floating motionlessly near me at the bottom of the pool. I panicked, yelled “Help!” and dove down to grab him and bring him to the surface. When I reached out to grab him, he disappeared. I returned to the surface with a pounding heart and told the lifeguard that I was mistaken, nothing was wrong and thanked him for coming to help. My whole body was shaking for the next hour. Finding out you’ve had a hallucination is comforting in that the problem it presented is not really there, but your adrenal system will continue to flood you with panic chemicals long after you’ve found out.

I frequently have visual disturbances, the most common of which is smoke or bent light in the air. Imagine billowing smoke, and then take the same curves and lines you would see and turn that into light. It’s a lot like the reflection of light at the bottom of a swimming pool. It doesn’t obscure my vision, it just passes over it. This is usually the first sign I’m having psychosis.

Following the billowing light, I usually become very frightened, with the cause being some vague danger, a threat to my loved ones’ or my safety. I frequently ask if we’re safe (anyone in my life knows to expect this, and fortunately the answer is always “yes”) and sometimes need my fiance to search the house for strangers on my behalf. This fear is paranoia. I actually consider myself lucky for not having more specific fears. The more specific the fear I’ve had in the past, the more intimidating it was. Sometimes, if I’m in public during a psychotic episode, I will believe that I can hear everyone’s thoughts and that they can hear mine. I’m afraid I’ll think the wrong thing and everyone will hear me and get upset. That’s a great example of a paranoid delusion. In this state, I know I’m in an episode, which allows me to continue to move through the world looking a little bit normal (with the guidance of a loved one) even though I’m inside of an absolutely insane situation. I can experience it as real, the way I’m being forced to experience it, but pretend that nothing is happening and just do the things I’m told to do, like walk next to someone, get in the car, or stand in a line. This level of coping with psychosis is ninja-level. I cannot express how hard I have worked to get to the point where I can actively fear for my life and stand in line at the grocery store at the same time.

Being 12 years into my treatment for bipolar, nothing now is nearly as scary as it used to be. I used to be completely entranced by horrific hallucinations and believed completely that they were real. I once sat next to Satan on an American Airlines flight (I really was on an airplane). He had a little boy in his lap, and I was trying to figure out how to signal to the stewardess that the boy needed help, but I was nearly paralyzed by fear. I looked down between my feet so he couldn’t see me crying, and the floor of the aircraft had disappeared. I was sitting 40,000 feet above the earth with nothing between me and the tiny lights below but air. That was real to me.

By 3 years ago, I’d come around to being aware of almost all my hallucinations. I once saw a flock of black angels/bird people flying over the car I was riding in. I knew it was a hallucination, but it still mattered to me. I wasn’t at all afraid. It was beautiful. I watched them swoop and dive around each other. They were fast and graceful. I watched until they disappeared. That memory is still special to me. That experience was only mine. No one else in the world can possibly have that memory, not even the people that were there.

Knowing I’m having hallucinations is much easier than knowing I’m having paranoia or delusions. Paranoia and delusions are less tangible. Seeing something is easy to disprove, especially if it disappears while I’m watching it, which is frequent with my visual hallucinations. If the person is singing in the car, I can watch their mouth. But if I believe I’m not “safe”, for whatever vague, paranoid reason, it is very hard, and sometimes impossible, not to trust my gut. Instead, I have to trust someone else’s gut. My fiance is my partner in life, and we have been through enough episodes together to have each other trained in what to do. If he’s the person I’m with, which is usually the case, I have to ask him questions, sometimes repeatedly, about the nature of actual reality as he is experiencing it. I use him to check what is real. I ask him about the validity of things I see, hear, and think. I will ask him if we’re safe, and he’ll say yes. If I don’t calm down, he will describe why we are safe. If I’m far enough gone that I can’t calm down, it’s probably all terror-crying from that point on anyway, so he just takes me home, stays with me and reiterates that we are safe. I much prefer hallucinations, as you can imagine. They, at least, can sometimes be fun. Paranoia, so far, has never been fun for me.

I am self-aware enough now that I know when I’m in an episode most of the time. Sometimes someone else will point it out before I’ve figured out what’s happening, but as soon as I realize it, I am able to stay grounded in that knowledge. Knowing that I’m in an episode and that I can’t stop it sometimes feels like falling, only I never land. It just goes and goes, without my permission, and I can’t change it. The intensity of it can be ridiculous. Humans shouldn’t be able to manufacture that level of intensity, especially with no external source. It can be quite incredible, in the original meaning of the word. In fact, that incredibility is part of why fewer people understand or validate mental illness. It sounds made-up.

Knowing I’m experiencing psychosis keeps me grounded and safe during episodes. I know to alert my fiance or family, and I follow their lead, at least until I get out of public. At home, I am better able to cope with whatever counter-reality comes my way.

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“How Can People On The Internet Help Me With Severe Depression?”

All people on the internet can do for you is to listen and respond. We can offer our support through words and remind you that you are not alone. We will be here in the middle of the night. We will hear you, and we will try to help.

 

Move forward with the hope of treatment and remission. You need to be seeing a psychiatrist and a therapist. Depression is hard, and you may not have much energy or functionality today. That’s okay. Make your one task for the day “Make an appointment with a psychiatrist”, and even if there is a long waiting list, set the appointment and put it on your calendar so that you will have help in the future. Do the same thing tomorrow, only with a therapist.

 

If you already have a psychiatrist and therapist, stay vigilant in keeping your appointments and taking your medicine. Start to build your toolbox of coping strategies,(that link is to a list of all of my coping tools) and use it when you’re in pain, even if that Sunflower CCmeans you are using it all day, every day. You cannot be cured, but your pain can be managed. For your next appointment, take any notes you can on your symptoms, triggers, medicine effects/side-effects, sleep problems, eating problems, and daily moods. There is no wrong way to take these notes, just write down information every couple of days about things you experience in your illness. The important thing is that you have everything written down for the doctor. The doctor will only be as good as the information you give them, and you are your best and only advocate as the patient. Don’t rely on only your memory to communicate with your doctor, because memory is fickle and fallible, and doubly so with Continue reading

The Ultimate Guide To Taking Psychiatric Medication

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When you first start psychiatric medication, you honestly don’t know what you’re doing. I wish that there was a class on how to be a good and helpful patient that anyone could take for free when they get their first script, but instead, I will write out the things I believe are crucial in order to make significant progress aided by meds.

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Patient Skills For a Lifetime

Although I am not a doctor or any sort of health professional, I do consider myself a “professional patient,” due to the past 13 years of dealing with bipolar disorder, major depressive disorder, and generalized anxiety disorder. All that time, I have been in treatment with psychiatrists, psychologists, therapists, general practitioners, and specialists in various fields. The following is what I’ve learned.

The Rules

  1. One psychiatric medication does not work the same on everyone. And if you’re already telling other people about your meds (what works for you and what doesn’t), then please read the disclaimer that needs to come before any advice you hand out.
  1. Sometimes a psych med has the effect of causing health problems, making things worse, or affecting you in a way opposite of its intended purpose. An example is that for some people, some antidepressants can cause suicidal ideation, and some antipsychotics can cause hallucinations. These effects happen to a small minority of people, so this doesn’t mean you shouldn’t try them. Because…
  1. Psychiatric medication can save your life. A med can bring you back from the brink. A med can improve you enough to be able to use coping skills, which is difficult in a nonfunctional place…
  1. Doctors are stabbing in the dark when you begin treatment. This means that you will probably have to try more than one medication before you find one that works. Once you find one that works, then you will need to…
  1. Adjust your dosage and time of the dose with the guidance of your doctor. Often, a medication that works for you a little bit can work for you a lot after you figure out what time(s) of the day make you feel best. This is often called “tweaking the dose.”
  1. To learn how the dose needs to be tweaked, you will need to KEEP NOTES. Print out a mood chart from the internet (search “mood chart”-it’s easy). Go to Kinko’s or the library if you don’t have access to a printer. I know some apps do the same thing, so look for those instead if you’re inclined. Or just keep a notebook. It doesn’t matter how you do it as long as you have the following information in an easy to read way:
    • Your daily mood status
    • What you are taking, what time and how much (you don’t need to write down the things that don’t change every day)
    • Your mental illness symptoms, especially anything severe or unusual for you
    • Other health problems
    • Any problem behaviors or events (like self-harm or episodes)
    • Any insight you notice about how you are being affected
  1. Bring your notes with you to the doctor. Some doctors’ appointments are as short as 10 minutes, so every sentence counts. Having all the information on hand eliminates the need for telling long, rambling stories full of irrelevant details. This is probably the most important thing to do in your relationship with your psychiatrist.

Continue reading

How I Learned That Change Is Always On The Way (or Hope In Water)

 

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One time, about 5 years ago, I was on an antipsychotic medication that was known for being very safe and having few side effects. I will not name it here, because I don’t believe that telling others about my bad experiences with medication is safe or appropriate. This medicine helps millions of people; I was just in a minority of people who had horrible, devastating, contraindicative effects from it. This effect is possible because each medicine reacts uniquely in each person’s brain. A medication is prescribed based on the typical reaction it produces, but the typical reaction doesn’t happen to everybody. For me, this medication was very harmful, and it took several months for my doctor and me to connect the dots between my ever-worsening depression, insomnia, paranoia, delusions, hallucinations, and mixed-state bipolar episodes to that medicine.

I was on this medication for five months, growing progressively worse. Every time I got worse, my doctor increased my dosage. I stopped sleeping more than 4 hours a night and fell deeper and deeper into a dark hole that was filled with overwhelming sadness and psychosis. By the time I got to the point where I had felt sincere suicidal desires for about a week, I started making plans.

I did this most waking hours. Bread knife across the throat, hanging myself with an electrical cord from a tree in the park, strangling myself with duct tape, and buying a gun were all considered. I was hurting so badly that all I wanted was out. The breadknife across the throat was the most troubling because when I was lying awake at night with my soul on fire, that was a legitimate plan for exit; all I had to do was walk to the kitchen to end it. I remember literally “white-knuckling it,” clutching my bedding so hard that my hands cramped. Continue reading

Scared of What’s Next

Over the past month, I’ve been declining.

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The other night, my husband made a minor comment that made me feel bad, and I fell into a thought spiral on the thought “It’s not supposed to be this hard.” I started crying. I sank deeper into dark ideas, feelings of hopelessness and worthlessness and meaninglessness. When the sadness became too great for my brain, it turned to pure fear instead. My mind’s solution to fear is often to ascribe meaning to it that isn’t there, just because it needs to have a reason to be afraid. This time, my mind picked ghosts. The room around me was full of ghosts. They all stood still, with their hands at their sides, all silent, all staring at me. There must have been at least 30 of them. There was not enough space between any of them for me to leave the room or even get off the couch.

 

I called out to my husband to help me and told him about the ghosts. He tried to help me fact-check by telling me that there couldn’t be ghosts because ghosts are not real. That didn’t work this time. I could see them. I could feel them looking at me. My husband is a creative problem-solver when I’m in crisis, so he was on top of the situation. He told me that there were no ghosts in the bedroom, so we could go in there and be safe. He made a path through the ghosts with his body so that I could follow behind him without touching them. It worked. The ghosts stayed out of the bedroom, so I stayed in it. I moved on to other troubling beliefs, but none as bad as the audience of 30 translucent spirits in the living room.

 

Those ghosts were a psychotic symptom, somewhere in a mix between hallucination, delusion, and paranoia. Mental illness symptoms are rarely simple or plain. Everything is a mixture of gradients. It’s been a long time since I’ve had such a striking and problematic psychotic episode.

 

I also had a night when I put together many pieces of “evidence” that my husband was cheating on me. It was full-fledged paranoia. I was seeing meaning and clues in everything. I spent the afternoon in a perpetual fit of Continue reading

Memories That Almost Break Me

Yesterday in therapy I told the story of the last days with Sophie and my first days of incapacitating mental illness, just before I was officially diagnosed. I was surprised at how upset I became in therapy, and by the clarity of my often faulty memory. Timeline was:

 

I started to feel like I was becoming invisible in October, right after I started dating Sophie, right when I turned 19.

 

My depression increased. I started to disappear.

By Christmas, I knew something was wrong with me, but I didn’t know what. I remember saying “Something is really wrong with me,” to my mom when I came home for Christmas break. When my folks drove me to Austin at the New Year to put me on a plane back to Ohio, my dad gave me a giant teddy bear in the parking lot, and I hugged him and cried very hard. My mom took a picture of us that I have here in my house. Our eyes are red, even though we’re smiling. His arm is around my shoulder, and we both look like we’re holding our breath.

 

January was something called “Winter Term,” which exists because it’s basically too cold to live in Ohio in January. The campus empties out. Everyone did an individual project during Winter Term, appropriately called a “Winter Term Project,” and you could complete your project anywhere in the world. Oberlin is mostly wealthy, so students would do their projects in Hawaii or Barbados or Portugal. Wherever they wanted, basically. A tiny minority of students would stay on campus, so the ice-laden, snow-covered campus stayed partially open. The libraries had some limited operating hours, and one of the cafeterias was kept functioning. I chose a listening/research project on mezzo-sopranos of the last century. My roommate, Laura, went away somewhere for the month, so Sophie and I had a giant room to ourselves. We hid inside, only leaving to find food or go to the conservatory to research. Baldwin had a large, round practice room on the first floor with a piano in it, directly below my own round room, so we didn’t even need to go to the conservatory to practice. There were two places near us that delivered food: a Chinese place on Main Street and a Dominos about 30 miles away. With temperatures severely below zero, it was worth the money and the wait to not have to leave the house. We binge-watched TV and movies on her laptop, ate takeout, and existed naked with the radiators cranked. The sky was only ever grey or black.

 

I started to think that I would marry this girl, and soon after I had that thought, I started Continue reading

I Am Disabled

Conv Bloodshot Earth.jpegI don’t like that I’m not supposed to say that I’m disabled. I was told recently that what I’m supposed to say is “person living with a disability.” I was told this by a healthy person with healthy privilege. Something is not right here.

I don’t know for sure, but I’d bet my cat on the idea that a healthy person coined the idea of  “people living with disabilities.”

I am completely supportive of trying to make the world a kinder place, and if saying only “a person living with a disability” instead of “a disabled person” is what we need to do to make people with disabilities (which I am not opposed to saying as long as “disabled person” is still something people can call themselves) feel more accepted, safe or supported, I will do it. But I will not give up my right to call myself disabled.

The word “disabled” is incredibly powerful to me. It took me years to accept that I am truly limited in a way that most people aren’t. Before I accepted that I was disabled, I measured my life against healthy standards instead of standards that are realistic for someone with my disorders. Because I did not yet acknowledge Continue reading

What to Expect in a First Therapy Appointment

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When you see a therapist, it’s good to go in with goals in mind. Those goals can be big or small, broad or narrow. Some of my goals in the past have been “reduce depression”, “cope with anxiety”, “build a healthier relationship with food and lose weight”, “learn assertiveness skills”, “set firm boundaries with parents”, and “minimize psychotic episodes”. At your first therapy appointment, be ready to set one or more goals. Your therapist may ask you directly what your goals are, or they might let you direct the session. Either way, let them know what your goals for therapy are.

It’s important to see a therapist with whom you are comfortable, but most people are not comfortable with their therapist for the first handful of appointments with them. It’s perfectly normal to be nervous and uncomfortable in therapy at first. The hope is that you will gradually learn that you can trust your therapist. If you have a deep dislike or disrespect for your therapist right away, leave. But if you’re just nervous, awkward, or uncomfortable, then try giving them 4 sessions before you decide whether you need to find someone else. Therapy is awkward at first, especially if you grew up in an environment where it wasn’t okay to openly and honestly express emotions. If you grew up in an emotionally accepting family, therapy will be easier to dive in to. If you didn’t, then it might be a little hard to open up, but there is nothing you could say or express to a therapist that would be inappropriate or out-of-bounds. This is the one person who legally must keep your secrets and is not there to get anything out of your relationship other than employment. They are only there to help you, and they have chosen that as their life’s work.

You can say as much or as little as you want in a therapy session. I encourage you Continue reading

What is EMDR?

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EMDR, or Eye Movement Desensitization and Reprocessing, is a partially physical treatment in psychotherapy used to reduce psychological pain associated with trauma. It involves watching a light move back and forth, tapping your hands on your legs, or holding two small vibrating paddles, one in each hand, while letting your brain relive a traumatic event. The physical component (be it the moving light, the tapping hands, or the vibrating paddles), causes bilateral stimulation. When combined with the brain’s amazing ability to make sense of complicated feelings and situations, effective healing can occur.

We have two hemispheres in our brains; the right hemisphere and the left hemisphere. They are connected in the middle by a part of the brain called the corpus callosum. The corpus callosum does the job of communicating thoughts, memories, emotions, and other information between the two hemispheres. When you experience a traumatic event, your brain makes a fixed memory, including all of the physical and emotional feelings you had at that moment. This is sometimes referred to as a “flashbulb memory” (flashbulbs were used with old cameras as the necessary light source for a photo), because the image is frozen in your mind in great detail, and details will remain there, largely unchanged, for years. It is important to note that most memories are extremely flimsy and subject to change, even from hour to hour. Flashbulb memories are different. They are “stuck” in a neural memory network in a specific part of your brain and are cut off from the rest of your brain. Anything that comes in contact with this “stuck” part of your brain will be negatively affected by your trauma. The stuck trauma can cause negative thoughts, feelings, and behaviors. This is where EMDR comes in.

Bilateral stimulation means that both hemispheres are stimulated alternatingly (right brain, then left brain, then right brain, then left brain, and so on). Bilateral stimulation is the crucial element in EMDR because it aides the corpus callosum in communicating between Continue reading

On Gaining Weight. And Losing weight. And Gaining Weight…

conv meditation.jpegTrigger Warning: This article discusses weight loss, severe weight gain, and disordered eating.

Psychiatric drugs make weight gain so, so easy. My first antipsychotic made me feel like I was never full for the first year and a half that I took it. I would eat seconds, thirds, fourths, dessert and second dessert. I would get the feeling that my stomach hurt from being so overly filled, and I would stop at that point. I would have a stomach ache for the next hour, and I was still hungry. This was when I was at Oberlin and had access to a cafeteria. Yikes.

The weight gain was slow at first, but over the years I grew to a size that was unacceptable to me. A big problem I have is using food as a pleasure button that I push to entertain myself. Eating makes me feel good, so I want to do it more often than is healthy. Sometimes I go on binges and don’t purge afterward. I’ve also gone through years in my life with symptoms of anorexia. Eating disorders are real mental illnesses, and while I’ve only been informally diagnosed by my therapist as having some sort of disordered eating, I know how complicated my relationship with food is, and that it’s not a healthy relationship at all.

I have had a period of my life during which my relationship with food was very healthy, Continue reading