I’ve been thinking a lot about diagnoses and whether or not the label of a mental illness really matters. Within the mental health community and advocacy work, we like to separate the person from the disorder. We encourage people to say: “I have bipolar disorder,” instead of “I am bipolar.” You would never say “I’m cancer,” but you would say, “I have cancer.”

Some mental health professionals believe that that diagnostic labels don’t matter, as long as you’re receiving treatment that’s right for you. However, I would suggest that learning about your particular illness in conjunction with studying yourself you can learn a lot about what triggers particular episodes. So when my psychiatrist told me that I “do not have bipolar disorder,” I felt like a piece of me had been ripped out.

It’s no secret that I have no love for psychiatrists. I have yet to meet one that I have connected with or felt like they cared about my well being. This psychiatrist is no different.

I was introduced to him the way I am normally introduced to a psychiatrist: in crisis. When I met this particular doctor, my depression was at its lowest and suicide was a serious option in my mind. My husband brought me to the emergency room and I was seen by whatever psychiatrist was on call. I left his office with a script for lithium and an appointment to see him in a month.

In preparation for my next appointment I tracked my mood over the course of the month. I created a plus or minus 7 point mood scale (i.e. -1 was a moderately low mood and -3 was suicidal. +1 was slightly happier than usual and +3 was hypomanic). Over the course of the month I weighed and graphed my mood. Giving each day not only a number, but also noting how I slept and what I was feeling. By the end of the month when I graphed the results, the ups and downs were astonishing and irregular even for me.

When the day of my appointment finally arrived I felt proud and secure that I had done my due diligence by coming so prepared, despite the crippling depression and flighty highs. How many patients are actually willing and able to make an Excel spreadsheet and graph their mood?  I wanted to prove to him, and myself, that I’m not some malingerer who wants to be sick. I want to live a full and productive life that is happy and healthy.

After waiting for over an hour for my appointment, my name was finally called. I entered his office feeling confident.

“So, how are you?” He asked, not looking up from my folder. HIs tone was curt.

“I’ve been better to be honest, I don’t think the lithium is working for me.”

“Why?” He demanded, still not looking at me.

“I have graphed my moods,” I said, digging in my purse. “As you can see,” I handed him the graph, “my moods are particularly unstable. This is irregular even for me.”

He glanced at the chart and pronounced: “You are not bipolar. This,” he motioned to my graph, “are not the highs and lows of someone with bipolar disorder.”

“Well, like I said, this is irregular even for me,” I attempted to explain.

“This type of mood shift is more like someone with borderline personality disorder,” he responded, tossing my graph aside.

I was stunned by how little my work meant to him and how quickly he had come to his decision. Borderline Personality Disorder (BPD) was one label that had never been thrown my way. Psychiatrists diagnosed me with depression and anxiety before they discovered I was bipolar, but never BPD.

A diagnosis with BPD is the life sentence of diagnoses. People with BPD are the most stigmatized by mental health professionals and is one of the hardest disorders to treat. I have lived the past ten years with the understanding that I have bipolar disorder. I understand the illness. I understand my mood fluctuations. I understand how my medication works. And I have just begun to identify my triggers. And now some doctor who saw me twice was telling me I wasn’t bipolar?

“Surely when I’m more stable we’ll see more regular patterns of mood shifts.”

“Lithium isn’t working for you?” He asked, leaning back in his chair and putting his hands on his head.

“No, I feel like a zombie. All I have been doing is sleeping.”

“If lithium doesn’t work. You are not bipolar.”

Now I know this isn’t the truth, but I was too stunned to say anything. I have many bipolar friends who aren’t on lithium. There are better drugs than lithium to treat bipolar disorder now, particularly bipolar disorder II. Lithium may be the oldest, but it’s not necessarily the best.

I was shocked that this doctor who had only seen  me twice was telling me I wasn’t bipolar. It was like the rug being pulled out from underneath me. I left his office questioning everything I have understood about myself over the past ten years. As I said earlier, some mental health professionals argue that labels don’t matter, but without knowing your illness how do you learn your triggers? I learned that with bipolar disorder sleep and stress are two common triggers. From that, I studied myself and it was true. If I was exhausted or over stressed my moods would shift dramatically. I understand these aspects of myself because of my label. I may not be bipolar disorder, but it is an intrinsic part of me.

I have seen this psychiatrist approximately five times now and each session he asserts that I do not have bipolar disorder. He has thrown around diagnoses like BPD, obsessive compulsive personality disorder (OCPD), anxiety, depression, schizoaffective disorder, and one time he had the audacity to say that I didn’t have a mental illness at all, despite writing a script for more medication.

In the end, I still truly believe that I have bipolar disorder and in mid-September I will be having an assessment at a Bipolar Clinic where my label will hopefully be established once and for all.

What do you think? Do labels matter? Leave your answers in the comments section.

This summer I participated in an 8-week out-patient program during which, I was required to participate in group therapy sessions twice a week. For me, group therapy was a combination of two things that make me anxious: sharing my feelings and people. Once during the session, I equated group therapy to waiting in line for the guillotine. Sharing your issues with a group of people that you barely know while two psychologists take notes isn’t exactly the easiest thing to do.

That’s when I started to think: being in therapy takes guts and for those of us in therapy, I don’t think we acknowledge how brave we are for baring our souls to individuals who are essentially complete strangers.

Here are 5 reasons I think being in therapy takes courage.

1.  You’re asking for help.

This may not seem like a big deal, but for a person like me who is extremely independent and who doesn’t want to burden anyone, asking for help is extremely difficult. For so long I’ve had the deluded idea that asking for help is a sign of weakness, but I’m slowly learning that it’s a sign of strength. It takes courage to ask for help when you’re feeling vulnerable.

2. You’re admitting you have a problem.

By admitting that you’re struggling you’re making the problem real. Often by admitting there’s something wrong in your life or in your behaviour means getting over yourself. Letting go of your ego isn’t an easy thing to do.

 

 

3. You’re being vulnerable to a stranger.

I have major trust issues. There are very few people that I trust enough to open up to, and they’re mostly in my immediate family. I have been betrayed by people close to me so many times in my life that I’ve developed a fear of sharing my feelings.

Opening up in therapy means getting over yourself and the fear of judgement. Speaking to a therapist, especially in the first few sessions, means exposing yourself to a complete stranger. Despite knowing about client confidentiality, I often wonder if the therapist talks about me to other people. I wonder if they think I’m crazy, or worse I wonder if they believe me.

4. You’re confronting your issues.

Maybe you have problematic behaviour that’s hard to come to terms with. Like, maybe you drink or do drugs and don`t want to admit to yourself that you have a problem, let alone admitting it to a stranger with a notepad.

But more often than not, therapy sessions require you to rehash a hurtful past and this often drudges up feelings that you have long buried. I often dread going to therapy because I know I will be emotionally drained by the end of the session.

5. You’re trying to change.

Change is scary, especially if you’ve behaved a certain way your entire life. You’ve adopted coping skills that have helped in times of extreme stress or danger and maybe those skills are no longer necessary. For me, I’m trying to work on my trust issues, assertiveness, and perfectionism. These coping mechanisms have worked to protect me in the past, but now they are interfering in my life. Addressing these issues are hard and changing them is even more difficult.

So, if you’re in therapy right now, I commend you because you are one badass motherfucker.

 [Author’s note: The International Bipolar Foundation published a great article about finding a good therapist.]

 

My original plan for this blog post was to talk about my horrible psychiatry appointment. It was among the worst I’ve had and included the advice to “have more sex and love your boyfriend.” Med changes have left me with a brain that feels like a washing machine that has become unbalanced, words jumbling about and I’m unable to catch them. (I’m struggling to put this short piece together).

To bring you up to date, I was prescribed Abilify about a month ago and it has left me jittery, agitated, anxious, unable to sleep or sit still. I keep trying to read, but it’s a fruitless pursuit.

It has been almost two weeks since I have had a solid nights sleep. I spent 7 days, lying wide awake at 3:30 a.m. unable to go back to sleep. My energy was hypomanic high. But then I got that wired and tired feeling. I was physically exhausted, but my brain was buzzing.

After a consultation with my psychiatrist, we decided to take me off of the Abilify for 2 weeks and let the medication leave my system. Then we’re going to restart the medication at a lower dose to see if I would still suffer from the same side effects.

All of this being said, I’m going to try and write later in the week when my brain clears. I just wanted to let you all know that I’m thinking of you and hope to be back at it soon.

Love & light to you all,

M
xo

You know when you’re in a job interview and the employer asks, “What’s your biggest weakness?” and the cliched answer is, “I’m a perfectionist,” We respond this way because people equate perfectionism with attention to detail, care, hard work, and dedication. It’s an asset rather than a weakness. Well, I’m here to tell you that it is absolutely a weakness and it impedes both my life and recovery.

My perfectionism isn’t the reason for my mental illness, but it does exacerbate my bipolar disorder. I put so much pressure on myself to perform to an invisible standard that even the smallest mistake is worth crucifixion. Even as I write this, it’s almost impossible to write past the voice in my head that’s saying:

“Your writing is shit.”

“Nobody is going to want to read this.”

“This isn’t going to measure up to half the things that other people are writing.”

“Why do you even bother?”

My perfectionism is impeding my recovery because I expected that by the end of the eight-week day-hospital program that I’ve been participating in, I would be better. I would be fixed. I have tried so damn hard in the program, but I keep wondering: could I have done more? I showed up everyday, did the work, yet I’m still not myself. I’m still broken.

I put all my hope into this program fixing me and it hasn’t, despite my best efforts. I expressed this feeling during my group therapy and I was met with a chorus of compliments on what I have overcome in the past two months: I’ve become more social, I finished reading 2 books, I started driving again, I took the metro, I went to Costco, and began writing. The fact that I showed up to the program everyday, weather permitting, by bicycle, despite side effects from medication and the heaviness of depression, represents the sheer will that I have to get better.

Except I keep thinking that these successes are small, ordinary, and regular. This belittles the Herculean effort it took to complete these tasks and the time and energy I have put into my recovery. Without these champions of my success I would have exited the program thinking I had achieved nothing.

My inability to see my achievements, not only in this program, but in life in general has prompted me to start a positivity journal. This sounds corny, but I figure that if I can pick out one or two things that I did successfully everyday, I may realize that I am making progress. I’m really talking about the smallest of positive moments:  grocery shopping with minimal anxiety, socializing, writing a blog post, etc.

I have had to remind myself that there is no magic pill, no cure-all, no quick fix for mental illness. I won’t suddenly be cured of bipolar disorder or of my perfectionism. All of my achievements will build upon one another brick-by-brick until I build myself back up to be strong. But until then, I’m still just a girl in progress.

As many of you know I have been going through an out-patient therapy program at a local mental health institution in Montreal. Monday’s and Friday’s consist of group therapy sessions that are heavy and loaded with emotion. We go around a circle and talk about our week, set therapeutic goals, and generally talk about what we’re struggling with. Tuesday’s are a psychoeducational group of some kind. They teach us therapeutic techniques, whether it’s visualization, setting values and goals, and learning how to make changes. Wednesday and Thursday we have physical activities that we’re obligated to participate in (for the non-athlete like me, this is a painful experience), and following that we do more psychoeducation.

The focus for many of these groups have centred around mindfulness. For the uninitiated, mindfulness is a practice whereby you accept, in a non-judgmental way, the thoughts and emotions that come into your mind. There are different techniques to practice mindfulness — like really paying attention to what you are eating. What are the tastes? How does it smell? What textures do you feel as you chew? Other strategies for mindfulness involve imagining your thoughts on various items and letting them float away. For example, pretend you’re holding a bunch of balloons and every time a thought comes into your mind, mentally write it on that balloon and let it go. The idea is that you acknowledge the feeling and let it go. It’s not about suppression but a general acceptance of the way you’re feeling and being.

In theory, this sounds like a great practice. I think we would all benefit from being more mindful of the world around us and the thoughts that spin through our heads. Except, what happens when it doesn’t work? I have been struggling with the idea of mindfulness because I can’t seem execute it. Speaking with my therapist on Monday, she said it takes practice but for an impatient perfectionist like myself — I need it to work, like, yesterday. My mindfulness practice ends up with me frustrated and giving up. First, I have a hard time acknowledging the thoughts that pop into my head. So, to theoretically write them on balloons and let them go is difficult when I don’t even know what I’m thinking about.

Ultimately, I think mindfulness would be useful to me but I feel like I’m stuck or blocked. I don’t know if this is a part of mindfulness, but I have started colouring intricate designs (thank you Sarah for introducing this to me). I pop my earbuds in and focus all of my energy into choosing colours and organizing the patterns in the picture. And for that short time that I am colouring, the negative monologue that is on a loop in my head stops and I’m able to breathe.

What do you think of mindfulness? Is it a useful technique? Are some of us hardwired for it to not work? Is it just a matter of practice? I’d love to hear your thoughts.