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Book Review: Surviving Manic Depression by E. Fuller Torrey September 3, 2012

Posted by Crazy Mermaid in Bipolar Disorder, Book Reviews.
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I just finished reading Surviving Manic Depression: A Manual on Bipolar Disorder for Patients, Families, and Providers by E. Fuller Torrey, M.D. and Michael B. Knable, D.O.   I’ve read books devoted to exploring Bipolar Disorder, but none of them hold a candle to this one.  I heard about this book when a gentleman from NAMI graciously provided me with the name of this book after I asked him how Manic Depression re-branded itself to “Bipolar Disorder”.  Dr. Torrey meticulously wades through society’s current beliefs, making a compelling argument that Manic-Depressive is a more accurate term and should be brought back into general use.  Besides providing an excellent platform for his argument, the book delivers on many different levels.

I found my hardcover copy at Amazon.com, for about $4 plus $4 in shipping in the Used Books section.  The publication date of my copy is 2003, but there is a 2005 paperback version that I can’t speak to. Anyone with information on the newer book is welcome to send me your thoughts. I’d love to hear them.

Dr. Torry wrote his first book on Schizophrenia (which I haven’t read yet), which qualifies him to compare the two illnesses with authority.  He takes advantage of his knowledge to bring his audience on an expedition to explore those differences in great depth.  When I finished the book, I had a better working knowledge of Schizophrenia, which I wasn’t expecting from a book on Manic Depression.

My only complaint is that he doesn’t really get into depth on definitions until Chapter 3, and I would have liked to see that done right up front in Chapter 1.

Risk factors, causes, medications, and treatment strategies are all areas I’ve found in other books, but this one is done better than most I’ve read. He uses the lens of the Scientific Method to standardize knowledge, allowing him to easily gut some of the urban myths that have grown up around Manic Depression, while moving others from that urban myth category into reality. No sleight-of-hand here.

The coup d’gras is the appendix section. It’s amazing. He’s done a review on every major book I’ve ever heard of having to do with manic depression as well as on ones I never would have known about any other way. He’s reviewed websites, and in the process opened my eyes up to organizations I’ve never heard of but want to explore now that I know about them.  This part, at the very end of the book, is worth the price of the book. He wraps up the book by declaring that we need a 21st century Dorothea Dix- someone to research and meticulously take note of the existing system and shine a public spotlight on the broken parts.  I couldn’t agree more.

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Which Medical Condition Is Worse? November 20, 2011

Posted by Crazy Mermaid in Bipolar Disorder, mental illness.
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Which Medical Condition is the Worst?

If you had to guess which medical condition was the worst, which one would you pick?

Most people’s thoughts would go immediately to the most widely publicized: the disease advertised as the most painful and deadliest of all diseases. Cancer.  With pancreatic cancer, the victim suffers prolonged agony, relieved only by colossal injections of pain medication, until finally he expires, leaving his cancer-ridden body once and for all.  The worst possible disease, some would say.

Many would choose Alzheimer’s disease as the worst disease.  Your mind slowly loses memory, forgetting things and people and places. Eventually, your heart “forgets” to beat, and you pass on, leaving a wake of pain and suffering by your loved ones.  Because you generally become less aware of your surroundings as time goes by, and because the deterioration happens over years or even decades, the pain and suffering are felt more by your family and friends than you.

Some would say that Lou Gherig’s Disease, also known as ALS, is the worst. Like Alzheimer’s, your body slowly forgets to function, but unlike Alzheimer’s, your mind works perfectly.  The result is a little like waking up in the middle of a surgery, and being unable to communicate to the staff that you are awake. Your body is paralyzed, but your brain is wide awake. Thankfully (or not), death is generally relatively quickly.

Others would say that a stroke is the worst, for reasons similar to ALS. Your mind is generally awake, but your body is unable to communicate that awareness to the world at large. Thinking that your brain has turned to mush because you undergo the humility of wearing diapers and eating baby food,  your family may treat you like you’re a piece of furniture, or as if you’re an infant. Unable to communicate your complete awareness to them, you suffer for years or even decades in silence.

As the worst possible disease, mental illness isn’t even on most people’s radar. But consider, for a moment, the facts.

One of the problems is that unlike cancer, mental illness has a lousy public relations campaign. It doesn’t have a public personality attached to it- at least nobody positive. There’s no Lou Gherig or Lance Armstrong or Stephen Hawking to bring a sense of empathy to the masses. Unlike breast cancer, hundreds of millions of dollars aren’t spent on events to publicize mental illness- events like the Susan G. Komen Walk for the Cure – where the color pink has come to symbolize breast cancer in everything from headbands to hand mixers. Unlike Lance Armstrong’s Livestrong cancer campaign, where yellow bracelets signify triumph over cancer, there is no little plastic bracelet color for mental illness awareness. In fact, because of its enormous stigma, you would be hard-pressed to find victims and family members willing to take the spotlight for mental illness.

Everyone recognizes that the term “cancer” is a blanket term for a multitude of illnesses all sharing the same basic characteristic: improper cell division. Unlike cancer, the general public doesn’t perceive mental illness as a blanket name for illnesses caused by improper brain chemistry. Both are breakdowns of normal bodily functions, yet cancer doesn’t have the reputation of being a character flaw or a sign of moral bankruptcy that mental illness does.

Patients with cancer are not embarrassed to tell their friends and family their diagnosis. They aren’t afraid of being thought less of as a person for that diagnosis, that somehow they fell short. But with mental illness, the stigma is so great that the fear of rejection and isolation is a legitimate concern.  You just don’t tell anyone.

Because their loved one’s illness isn’t associated with moral bankruptcy and character flaws, friends and relatives of cancer victims don’t have the same incentives to keep anyone from knowing their loved one has cancer. Protecting themselves from the unspoken charge of moral bankruptcy by association isn’t a top concern of the families of cancer patients.

Other diseases, like cancer or ALS or a stroke, don’t cause its victims to commit heinous crimes.  You don’t see a breast cancer victim as the lead-in story on the nightly news because she murdered a bunch of school children. You don’t hear about a stroke victim trying to assassinate the President. A lung cancer victim doesn’t jump off a bridge to get away from the voices in his head. And yet the connection between these types of actions and mental illness, if the news media even bothers to make one, is voyeuristic rather than sympathetic.

No legitimate insurance company would dare decline to authorize or pay  for mainstream treatment of a cancer victim, but most insurance companies have little or no such coverage for mainstream treatment of mental illness, reasoning that it isn’t, after all, a real physical illness. If they do cover it, it’s under a separate policy from “physical” health, called “Behavioral Mental Health”.  We don’t see major insurance companies splitting off cancer from a list of diseases, calling it “Cell Divisional Health”, severely restricting its access, and farming out its administration to an entirely separate company.

When it comes time for hospitalization, there isn’t a question of whether a cancer victim or stroke victim even needs to go to a hospital. If they’re seriously ill, a cancer patient doesn’t have to be at death’s door before he’s admitted to the hospital. But a mentally ill victim has to either be about to hurt or kill himself or others (as determined by a third party) or needs to have tried (and failed) to kill himself before a mental hospital will consider admitting him.

If they’re hemorrhaging, but not near death, a cancer patient isn’t turned away for lack of space. Cancer patients don’t have to wait until there’s room for them at a hospital. Unlike hospital space for the mentally ill, hospital space for cancer victims hasn’t decreased over the past 20 years.

Alzheimer’s patients aren’t routinely discharged from hospitals onto the streets, left to fend for themselves. Cancer patients aren’t routinely discharged before they are stabilized. And yet the mentally ill are routinely discharged out onto the streets all of the time. Who do you think the homeless people are?

The cancer patient doesn’t have to give up his civil rights in order to be treated. He can leave the hospital whenever he wants to. But in order for a mentally ill patient to be treated, he has to give up his civil rights. Mental patients are locked in, physically unable to leave the hospital until someone else- the attending psychiatrist- says they can go- however long that takes.

Once in a hospital, a cancer patient has the option to discontinue medication at any time. Again, a cancer patient doesn’t have to give up his civil rights in order to be treated.  Mentally ill patients, on the other hand, must leave their civil rights at the door when they enter a mental hospital. Whether they want to or not, they are forced to continue medication while they are hospitalized.

Comparing the physical pain of the cancer or the effects of cancer treatment with the effects of mental illness is in some ways like comparing apples to oranges.  Whereas the cancer victim fights for her life, the severely depressed victim fights to kill herself.  Is the physical pain of cancer worse than the emotional pain of continually hearing voices in your head nonstop? Is radiation sickness worse than lithium side effects?  Is prostate cancer preferable to schizophrenia?

I’m not trying in any way to minimize the pain and suffering that these diseases engender. My point is that each of these diseases –all of them- including mental illness-engenders tremendous pain and suffering. None of them- including mental illness- is any less severe than any other.

I

For too long, mental illness has been a quiet disease. Quietly terrible, but still quiet.  This is a disease- or a family of diseases- on par with cancer and ALS and strokes, and yet there is a huge vacuum out there. Nobody even thinks about mental illness as a true physical disease. It’s not even on the radar. This needs to change. We need to raise people’s consciousness about mental illness, and give it the parity it deserves.  We’ll know we’ve done our job when “mental illness” takes its rightful place on the list of Terrible Diseases in the public consciousness.

(reprinted from earlier blog entry)

 

Mental Illness and Stalking April 26, 2011

Posted by Crazy Mermaid in Bipolar Disorder, Delusions, mental illness.
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Stalking is a matter of perspective.  From the standpoint of the stalker who is stalking a celebrity,  the stalker is convinced  that he has a very real, very personal connection to the person he’s stalking. He would be shocked to learn that what he’s doing- trying to fulfill the celebrity’s perceived request for that contact-  is viewed by law enforcement as well as the celebrity in question as stalking. How can it be stalking, he reasons, when the person he’s accused of stalking wants desperately to see him? It must be a misunderstanding.

When I was slipping into the final stages of my delusion (right before I was involuntarily committed to a mental hospital) I was absolutely convinced that I had Extra Sensory Perception (ESP), and that Bill and Melinda Gates were among my many powerful friends-friends that included the Dalai Lama and Oprah Winfrey-  who talked with me via ESP. When they talked with me, it came through as a voice in my head.  For those not familiar with the Gateses, they are some of the richest people in the world.  Anyway,  one of my hobbies was making jewelry, so it wasn’t surprising that (as part of my delusion) Bill and Melinda Gates begged me to make them some jewelry.

I agreed to their request for some of my fabulous jewelry, provided they give me direction on their tastes.  One of the capabilities of people who shared ESP with me was their ability to see the world through my eyes. Literally. It’s kind of complicated to explain, but suffice it to say that they looked out through my eyes and saw everything that I saw.  So it was perfectly natural for Bill and Melinda to wander around the bead shop with me, picking out beads for their own special necklaces as if they were actually in the room with me.  When Bill began picking out expensive stones, I balked. But Bill assured me that price was no object, since he (the richest man in the world) would be reimbursing me in the very near future for the money I spent.  With that guarantee from the richest man in the world, I allowed him to choose whatever stones he wanted.  So at his direction, I purchased expensive stones for the necklaces of him and his wife Melinda.

“We”  returned to my home where I spread the expensive loot  out on my kitchen table and began putting the necklaces together with “their” direction.  When “we” finished the jewelry,  “we” discussed how they were going to get the necklaces from me.  Should I mail them?  Should I send them via UPS?  Should I send them to their house in Medina? Or to Microsoft’s campus in Redmond?  At first,  “they” directed me to mail them to the Gates’ in care of their (real) nonprofit organization, The Bill and Melinda Gates Foundation. After further discussion, “we” agreed that I would give the necklaces to them when I met them in person, which was going to be in the very near future.  In the real world, I live about 20 minutes from the Gateses. So the thought of driving to their home didn’t seem out of reach at all. Fortunately for all of us, I ended up in the mental hospital before I could do any real damage.

It is easy for a delusional person to cross the line into what appears to the real world as “stalking”.  I had lost touch with reality to the point where I was convinced that the Gateses wanted their jewelry so badly that had “they” insisted, I would have, without question,  driven to their home in Medina (about 20 minutes from my home) with the intent of personally delivering the necklaces to them as they had requested. I would have been absolutely convinced that they were desperate for my jewelry, and wouldn’t have believed anyone who tried to tell me differently.

Had I followed that plan of action (rather than wait to meet them as we finally agreed), I would have been carted off to jail, labeled a stalker.  But in my mind, I would have been absolutely certain that the Gates’ were dying to see me, and I would have insisted that this was so.

In revealing this very personal and embarrassing episode that was part of my psychotic delusion, I hope to show how easy it is for someone suffering from delusions to become a stalker. I ask for the law profession to understand that when they are investigating a stalker, in reality they’re likely with a delusional mentally ill person.  I ask for them to show that “stalker” some compassion by getting an immediate psychological evaluation before sending him off to jail. With proper medical intervention, their  delusion, like mine, will evaporate and the psychotic individual will return to the real world.  And when it’s all over and they’re medicated and back in their right mind, they, like I, will be extremely embarrassed and ashamed of their behavior.

Catherine Zeta-Jones and Mental Illness April 13, 2011

Posted by Crazy Mermaid in Bipolar Disorder, mental illness.
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Mental Illness can happen to anyone in any situation, given enough stress.  The latest victim is a very public figure: Catherine Zeta-Jones.  The tabloids say that the stress of her personal life pushed her into what used to be called a nervous breakdown.  Nowadays it has a name, and that name for her is Bipolar Two.

While Catherine appears to have entered the facility voluntarily, I’m sure that she and her family considered their decision carefully and deliberately before deciding that hospitalization would be the best course of action.  A terrible dilemma- whether to go or not- was magnified by her status as a celebrity.

The celebrities who told the world about their mental illness and escaped the situation unscathed are few and far between. Not only is she a beautiful woman who is getting older, but now she has the label “unstable” attached to her name forever.

Anyone who has been diagnosed with a mental illness knows it isn’t good for the ego to be labeled as damaged goods.  “I should have been stronger. I should have been able to shoulder my responsibilities without cracking.”  These thoughts and more come bubbling to the surface when the diagnosis of mental illness is made.  Like the rest of us, she will think it is her fault that she broke under pressure.

I think things will be worse for her in some ways than they were for me when I was admitted to a mental hospital.  Admittedly when I was diagnosed I didn’t exactly yell it from the tree tops. But I also didn’t have to sneak into the hospital as quietly as I could, aware that a crowd of paparazzi waited in the wings to make money on my personal trauma.

The good news is that her illness will serve as crash course in mental illness to a very large audience.  People who had vaguely heard the term Bipolar will now learn about the illness. They will hopefully recognize mental illness simply for what it is: an illness.

The bad news is that her illness will almost certainly be thought of as a sign of weakness and possibly even moral bankruptcy.  She will probably lose some of her fan base because of her perceived weakness.   Producers might not want to risk their money on an unstable celebrity.  So her “outing” may be the end of her career.

Like her husband and his lung cancer, I hope she will choose to use her illness as a “teaching moment” to the world at large, rather than try to hide from it.  The cat’s out of the bag. What to do about it is the next question.

The World Is Flat October 17, 2010

Posted by Crazy Mermaid in Bipolar Disorder, Medication, mental illness.
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It’s an obvious point, but the point of mood stabilizers is to stabilize moods.

What’s not so obvious is the unintended consequences of mood stabilization.  When your mood is stabilized, it makes life flat. Nothing makes you sad, but nothing makes you happy either.  That fact hit me squarely in the face this week when we bought a new house.

While the purpose of the mood stabilizer is to avoid manic or depressive episodes that are so characteristic of bipolar disorder, there is a down side to the medication.

When you get ready to purchase an object of the magnitude of a new home, a normal person goes through various stages of emotion.  The process of finding a home should  be filled with excitement, both good and bad.  Excitement at finding that perfect place to live. Excitement at seeing that perfect house for the first time in person.  Excitement at going through that perfect house for the very first time. Excitement at making the offer, then getting the offer accepted by the seller.  All of these processes elicit a roller-coaster of emotion in the normal person.

But in the medicated, stabilized bipolar person, these emotions are missing. Where there should be trepidation at undertaking such an enormous obligation as a house payment, there is an absence of fear.  There is no thrill of getting a good deal, of finding the perfect place to live. There’s just nothing there. It’s flat.  Neither up nor down.

In the old days before my illness, I would have taken a great amount of interest in the whole house-hunting process. The thought of spending that much money would have sped me into action, to make sure that we got a good deal for our money, to make sure I wanted the house.  But this absence of emotion has had a profound effect on the degree of my involvement in the whole house-hunting process.

When I can’t get excited about the house-hunting process, I can’t get emotionally involved in it either.  I stand apart, waiting for my husband to make all the moves, all the decisions, in this major undertaking.  I watch, like a spectator, rather than as a partner, as he signs us up to the bottom line of a major monetary commitment. It simply doesn’t matter any more.

I miss the old days, when I had the rush of excitement of the hunt.  Looking for the perfect house, excitement at finding a possibility. The thrill of stepping over the threshold of what might prove to be our next home.  Will this be someplace I would want to live? Do I like the house? Love it? Or hate it? How do I feel about it?  How do I feel about the entire process of house-hunting?  About committing the money to purchasing it?

The answer to these questions is: nothing. I have no feelings about any of it.

While the mood stabilizer keeps me on an even keel, able to avoid manic and depressive episodes, it also keeps my life flat.

 

Mental Illness, Hypersexuality and Tiger Woods September 8, 2010

Posted by Crazy Mermaid in Bipolar Disorder, mental illness, Therapy.
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Bipolar Magazine had an issue that discussed the hidden symptom of mania: sex.  As in lots of it.  BP Magazine’s September 9, 2009 issue “Confronting Mania’s Secret Symptom” addressed the issue of sex as it relates to manic behavior.   It is a well-known but rarely discussed fact that many people in the middle of manic episodes have a very high level of sexual energy, and they use that energy in different ways. This high degree of focus on sex is called hypersexuality.  It’s way beyond regular sexuality. Check out the article at  http://www.bphope.com/Item.aspx?id=522

Mental illness has been known to break up many marriages and family relationships simply because the relationships couldn’t withstand the emotional devastation that this particular symptom caused. That’s not even considering the health risks of sexually transmitted disease, AIDS, and pregnancy resulting from that risky behavior.

If someone has been diagnosed to have a particular mental illness with hypersexuality as one of its symptoms, it would probably help many marriages and relationships heal if they could view the sexual hypersexuality in the context of being a symptom of a mental illness. It is worth it to at least rule out the possibility that the person exhibiting that behavior might have a mental illness. If they are found to have a mental illness, the hypersexuality symptom needs to be viewed as another symptom of mental illness, just like hearing voices might be a symptom of someone with schizophrenia or forgetting people might be a symptom of Alzheimer’s.  Putting the hypersexuality symptom in that perspective might save relationships.

That doesn’t mean that every philanderer has a mental illness.  But those exhibiting the hypersexuality behavior so characteristic of someone with a mental illness should be assessed. The more flamboyant the actions, the greater number of partners, the more symptoms of hypersexuality a person demonstrates, the more important it is to rule out mental illness as the cause of their over-the-top behavior.

One of the most famous cases of possible undiagnosed mental illness is Tiger Woods.  His larger than life hypersexuality behavior gives one pause.  Is this a symptom of a mental illness?

According to the news media, right after Tiger was “caught” by his wife having sex with numerous women, he went into treatment for a sex addiction in an (unsuccessful) attempt to save his marriage. At that time, after learning of the large number of women that he was having sex with (I think the number got to 12 before I stopped paying attention), I wondered if he had been assessed for a mental illness.  It certainly wouldn’t be surprising, given the circumstances of his stressful life in a fishbowl.

Because of the stigma of having a mental illness, Tiger isn’t likely to come out in public with any mental illness diagnosis that he might have received.  I can only hope that, if he indeed was diagnosed with a mental illness, his wife would have waited for his treatment plan to kick in (including any medication) before throwing in the towel.  Theirs is a scene played out privately all over the world on a daily basis.

With the education of people that hypersexuality may be a symptom of a mental illness, I hope it will encourage people to seek out help before giving up on their marriage or relationship. “In Sickness and in Health” were part of their wedding vows.  This is the “Sickness” part.

Depression versus Bipolar Disorder August 24, 2010

Posted by Crazy Mermaid in Bipolar Disorder, Depression, Medication, mental illness, Mental Illness and Medication.
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The stigma of having a mental illness has hit in yet another tangible way.

For the second time in a row, a friend who has suffered for years from depression went to a psychiatrist because her medication was no longer working for her  Or at least it was no longer working well enough for her.  She had been on an anti-depressant for about 15 years, but had wearied of the side effects. So she had gradually weaned herself off all but a tiny amount of the medication.  When she recently encountered a tremendous amount of stress, she got very depressed and a severe panic disorder reared its ugly head.  In desperation, she went to see her General Practitioner, who referred her to a psychiatrist.  She made an appointment with that psychiatrist but the earliest she could see her was 2 weeks out.  So she waited it out, trying her best to work though her bouts of panic disorder and depression.

Two weeks later, arriving at her new psychiatrist’s office, she was given a battery of questions and interviewed at length by the psychiatrist. Finally, after much interrogation, she was diagnosed with Bipolar Disorder Type 2.She wasn’t devastated at the news but she was definitely unpleasantly surprised as she relayed the turn of events to me. She had expected her new psychiatrist to simply regurgitate the previous diagnosis of depression, and it hadn’t occurred to her that her diagnosis might be something else.

In her mind, she had depression. End of subject.  She never considered the possibility that she might have anything else. In most people’s minds, depression doesn’t really qualify as a mental illness. It isn’t spoken of in the same breath as schizophrenia or Bipolar Disorder, which are both generally accepted by society as full-blown mental illnesses. With depression, it’s socially acceptable to admit you have it and that you’re taking medication for it because nobody considers you to have a mental illness. But with Bipolar Disorder you can’t hide from that label “mentally ill”.

With Bipolar Disorder, society in general puts that problem into the mental illness category.  There’s no getting around the fact that it’s a genuine mental illness.  And with having a mental illness comes all of the stigma associated with such a thing.

Furthermore, the use of an anti-depressant for treating depression is commonplace.  There’s even a book called “Prozac Nation” that intimates that many, many people are on Prozac. It isn’t viewed as a mental illness in part because too many people have it.  A mental illness is thought by the general public as being something that is uncommon.  Depression is not uncommon.

According to her new psychiatrist, the medication for Bipolar Disorder Type 2 is a mood stabilizer. The concept of being put on a mood stabilizer rather than an anti-depressant is bad, because of the stigma associated with a mood stabilizer.  By definition, it means that your mood needs to be stabilized.  That your mood is unstable. That your mind is unstable.  That you are unstable.  All of the negative ramifications of having an unstable mind come to the forefront.

It’s okay to suffer from depression, which doesn’t have the connotation of instability.  You might feel terrible- possibly like committing suicide- but at least you’re not considered to be unstable or out of your mind.  But Bipolar Disorder Type 2 is another story. With Bipolar Disorder, you’re unstable.  That’s why you need a mood stabilizer.  And, as the theory goes, people who are unstable have all kinds of problems. They’re not to be trusted.

No matter than with the mood stabilizers the thoughts of depression go away.  No matter that they feel better than they have for years.  The important thing, in their mind, is the stigma associated with having to take a medication that makes them stable. It means that they weren’t stable to begin with.

It will take my friend awhile to come to grips with this new reality.  In fact, she plans to visit another psychiatrist to get another opinion. In the meantime, although she can hope that her diagnosis is wrong, I hope that she will continue to take her mood stabilizer.

Psychotic Wife Tests Marriage August 5, 2010

Posted by Crazy Mermaid in Bipolar Disorder, Delusions, Hallucinations, Involuntary Committment, Mental Hospital, mental illness.
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My nervous breakdown tested my marriage in a major way.  I’m very lucky that my marriage has survived that horrible ordeal- at least for the present.

From the time the voices started in February to the time I was hospitalized in late May, the voices tried to convince me to divorce my husband of 25 years.

The first reason that the voices told me to divorce him was to protect my newly acquired $1.5 million jewelry collection. This collection included a supposedly “yellow diamond” ring acquired at Target for $20, which the voices assured me was actually a real yellow diamond ring worth a million dollars (not true) and an abalone bracelet that I bought from Goodwill that the voices said was an antique bracelet once owned by my Great-grandmother Mermaid and now worth $500,000 (also not true).

The second reason they said I should divorce him was that he was the real behind-the-scenes person responsible for locking me up in a mental hospital, and he was going to keep me there as long as he legally could (not true) and that my only chance of escape from my “prison” was to divorce him as soon as possible. So the first chance I got at the mental hospital I called my attorney to get the divorce proceedings started.  But as the medication began to take effect, I lost the ability to follow through with my actions because I became lethargic and confused. Finally, as the medication began to cause the delusions and hallucinations to go away, I came to realize that my husband wasn’t really trying to keep me locked up, and that I really didn’t have a $1.5 million jewelry collection for him to go after.

After I returned home and began to realize the magnitude of the damage I inflicted both personally and financially, I became convinced that he was going to divorce me, and that he was just waiting for me to get well enough to divorce him. After all, why would he stay?

Besides the paranoia about what I perceived as my impending divorce, I was undergoing a major medication-induced identity crisis.

The reality was that Bob was free to divorce me at any time, and many less patient men would have simply walked away from me at numerous points. Some husbands would have left back in February or May, when I started talking about wanting a divorce, or in late May when I was spending tens of thousands of dollars. Others would have served me divorce papers in the hospital, as happened to some of my fellow patients.  Still other spouses would have waited until I was on my feet again, able to take care of myself, before cutting the cord.

He put up with the trials of living with a woman going through a severe break with reality, including the delusions and paranoia that accompanied the break. He watched helplessly as an out-of-control woman who was legally still his wife but whom he didn’t recognize begin to dismantle his financial future by spending thousands of dollars on clothes and plants and even a $50,000 Lexus convertible.

Then, he suffered through the three weeks I spent at a mental hospital, unable to share that fact with anyone due to the tremendous stigma attached to that fact. As if the fact that I was at a mental hospital wasn’t shocking enough, he found the courage to visit me on a daily basis, despite my less-than-pleasant reception ( I thought he was holding me there on purpose against my will). He didn’t understand what kind of world I inhabited, but realized that I wasn’t really “there” when he visited me, but nevertheless suffered through his daily visits with me anyway. He watched as I tried to take up smoking. He listened when I continued to ask him for a divorce, even listening patienly as I gave him a piece of paper that represented a preliminary breakdown of the assets I planned to receive in our upcoming divorce settlement.

Even when he saw that I was not getting better, and when I ignored him when he visited, he still hung in there. He understood the very real possibility that my mind might be forever locked up in my fantasy world, unable to return to the real world. He realized that he might have to take care of me – what was left of me- alone, might have to raise our kids- alone.

My real road to recovery didn’t begin to materialize until several weeks after I was released.  But as the medication that would bring me back to the real world began to take effect, the side effects from the medication were another nightmare. Depression, suicide thoughts, Parkinson’s disease symptoms, grogginess, fainting, constant crying, weight gain, and a myriad of other medication-induced symptoms became the norm. I couldn’t read, couldn’t drive, could barely walk, had balance problems, couldn’t comb my hair or peel a banana or make my bed. I was anxiety-riddled, having to have my days planned out to the last minute or I’d become miserable. I was almost totally helpless, and there was no guarantee that my physical health would ever return. He supported me through that horrible period without complaint. He was always there for me.

As my side effects slowly began to diminish over time, and as I again returned to the land of the living, some of the pressure is off.  But without the love and support of him and my family, I would still be in the psychotic world, disconnected from reality, for the rest of my life. I’m one of the few lucky ones who has managed to find their way back.

Anosognosia Symptom: Lack of Insight into Mental Illness June 22, 2010

Posted by Crazy Mermaid in Bipolar Disorder, Involuntary Committment, mental illness, Schizophrenia.
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4 comments

It’s a crying shame that I had never even heard of the term ansognosia until I read Dr. E. Fuller Torrey’s latest book, The Insanity Offense (2008), since it’s such an integral part of understanding how the symptoms of mental illness interfere with a person’s ability to get help.

The term anosognosia is derived from the Greek words “nosos” which means disease and the word “gnosis” which means knowledge. The “an” prefix notates the negative.  A person who suffers from anosognosia is unaware of the existence of their mental illness.

This lack of insight into their illness, associated with damage to the right hemisphere of the cerebral cortex or the frontal lobe,  is a problem of major proportions because it’s the main reason why people with certain mental illnesses such as schizophrenia and bipolar disorder refuse to take their medications.   They aren’t trying to be a pain in the ass: they truly believe that they’re not ill.  And if they’re not ill, there’s no reason to take medication. Period. End of Story.

If a patient can be made to take their medication, a large percentage of them will improve their awareness of their mental illness and thus continue taking their medication on their own.  But under the current laws, forcing a patient to take necessary medication is illegal, in a large part because the law refuses to take into account anosognosia in making decisions regarding who should be forced to take medication and who should not.

It’s not easy to convey to the average person what it means to be unaware that you have an illness. How can someone who is sick not know it, especially when their symptoms are so obvious to others? Because it’s not like any other illness. It’s the brain, rather than other parts of the body, that is the problem.

In the case of the paranoid schizophrenic, there is another layer of difficulty to add to the equation. The paranoid schizophrenic lives in a world where the universe is out to get him.  So he views any attempt to get him help as simply another attempt at persecution.  He distrusts anyone who tries to get him help. It’s a magnification of anosognosia.

Unfortunately, treatment of a patient whose symptoms include anosognosia is impossible, since treatment for an illness requires admission that there is in fact an illness and cooperation by the patient in treatment of that illness. The law of the land is written around the concept that a person is capable of deciding whether or not he is ill, and therefore whether or not treatment for that illness is appropriate. The law, in other words, has never heard of the symptom called anosognosia, which makes it impossible for the patient to believe that he is mentally ill, and therefore makes it impossible for him to believe that he needs treatment. The result of this failure of the law to consider this singular symptom is that the patient goes about his business believing that he is not ill, living in his own world. How is this a problem?

Instead of being able to treat those people whose symptoms include anosognosia, families of people with mental illness live in fear of their  loved ones, aware they’re living with a ticking time bomb. They know it’s only a matter of time before their loved one hurts or kills someone, but they’re unable to prevent the atrocity from happening because the law ties their hands.

Prisons are full of people with anosognosia who commit crimes- sometimes horrendous crimes. Had they been forced to seek treatment for their mental illness, they might have lived full and productive lives. Instead, they fill our prisons, unmedicated, costing taxpayers tens of thousands of dollars a year. Or they murder police officers or random people before being apprehended and found to be not guilty by reason of insanity, then locked up in mental hospitals.

The streets of every major city in the United States are full of people with anosognosia who refuse to believe they have a mental illness. Instead of being forced to get treatment, they wander the streets, victims of crime, living off the streets, eating out of dumpsters, and living a horrible life simply because they cannot believe they are in need of medical help.

We have to change our laws, taking into consideration this terrible symptom.  We have to make it easier to involuntarily commit those with this symptom, thus improving the quality of life of those with anosognosia and making the world a much safer place for all of us.

(Note: Research for this article was done with the help of articles by the following: Dr. Kevin Thompson, PhD http://www.mentalmeds.org/articles/anosognosia.html ; Treatment Advocacy Center http://www.treatmentadvocacycenter.org/index.php?option=com_content&task=view&id=27&Itemid=56; Pages 112 and 113 of Dr. E. Fuller Torrey’s new book, The Insanity Offense (2008) among other sources)

The Cost of Generic Drugs VS Name Brands: Lamictal June 9, 2010

Posted by Crazy Mermaid in Bipolar Disorder, Health Insurance and Mental Illness, Healthcare, Medication, mental illness, Mental Illness and Medication.
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The Cost of Generic Drugs versus Name Brands:  Lamictal

Although first approved by the FDA for treatment of  epileptic seizures in December 1994, Lamictal wasn’t approved for maintenance treatment of Bipolar 1 Disorder until June 2003. The first drug since lithium that was approved for this use, it is also used “off-label” for treatment of schizoaffective disorder, Bipolar II Disorder, borderline personality disorder, and Post-Traumatic Stress Disorder.

I was started on Lamictal in the mental hospital to treat the symptoms of Bipolar I, but my supply of medication ran out about 1 week after I was discharged.  When I got my prescription filled for a 30 day supply of Lamictal, I was shocked beyond belief to learn that the cost for that one month supply of 300 mg  was in the neighborhood of $450, or $5,400  a year.

In July 2008, Teva Manufacturing began offering a generic form of Lamictal in the 150 mg doses that I require.  Previously, it only made 25 mg and 50 mg doses, so it wasn’t practical for me to take 12 pills at a time in order to get the required 300 mg dose. When Teva began making the 150 mg pills in July 2008, it became practical to take two of them to equal my 300 mg dose.  At that point, my insurance company insisted that I change from the name brand Lamictal to the generic lamotrigine.  The cost of my medication was reduced from $450 per month to about $150 per month for 300 mg, or about $1,800 per year- a substantial savings of $3,600 a year,  but still out of the realm of most people’s idea of a bargain.

Now, almost 2 years later, I’m paying $14 for a one month supply, or $168 for a year’s supply of yet another generic form of  lamotrigine, this one manufactured by Cadila (Zydus). This drug is available to me through a mail-order prescription drug company, Medco, which is part of our insurance package. So what happened?  How can a drug cost go from $5,400 per year to $168 per year within a two year period of time?

In one word: generics.

But are they safe?  Are the generic formulas the same as the name-brand formulas?

To answer that question, I went onto the Federal Drug Administration’s website http://www.fda.gov/Drugs/DevelopmentApprovalProcess/ucm079068.htm#Reference%20Listed%20Drug to learn how the generic assessment is done. In a nutshell, the generics are tested on people just like the original brand-name drugs were tested, though the number of people they were tested on isn’t as large.  In the end, the FDA decides whether the test results are good enough to grant the manufacturer of the generic form of the drug approval to sell his drug, and makes that determination available online to the general public. In the case of lamotrigine, each dose, by manufacturer, has been tested and approved by the FDA (see http://www.accessdata.fda.gov/scripts/cder/ob/docs/obdetail.cfm?Appl_No=077633&TABLE1=OB_Rx).

In the final analysis, it’s up to the patient to decide whether the generic brand works as well as the name brand, but according to the FDA, the active ingredients are the same.

Is $450 a month an appropriate amount of money to pay for a medication?  Is it appropriate that the cost of the same medication varied from $5,400 a year to $168 a year within a two year period of time?  Is it any wonder that our health care costs are out of control?