This Week in Mentalists (58)

It’s the first weekend of December, so here’s a Christmas-themed edition of This Week in Mentalists, so get you all in the spirit of the season. This post will be as Christmassy as mince pies, reindeer and the entire Woolworths chain going completely down the shitter.

Aethelred the Unread discusses mood disorders at Christmas.

I think that’s one of the main reasons I have such a problem with christmas. Not the lousy presents – even I don’t hold a grudge that long – but the fact that you have to pretend to be happy even when you’re not. If you think about it, all christmas is about is mood. If you ask someone ‘Did you have a good christmas?’, what you mean is ‘Were you happy?’ Any other event – a holiday, for example – there are other ways of judging it, like if the weather was good, what the hotel was like, etc. Christmas is all about doing the same things with the same people at the same time, so the question of whether it’s good or not comes down, essentially, to whether you felt happy while you were doing them.

I would guess that’s a nightmare for anyone with any kind of mood disorder, but it certainly is for me with my depression. Sometimes I have no control over my mood, and it has no connection to what I’m doing. If I’m going through a bad patch, then everything about christmas could be utterly perfect and I’d still spend the whole time wishing I was dead. But, of course, I can’t admit to it, and so I have to start pretending. I’ve had quite a lot of practice of it over recent years. It was always unspoken, but for the last few years my mum had been in very poor health, and there was always a concern that each christmas might be her last, or at least the last that she was able to take pleasure in, and so there was always a huge obligation to go and make sure it was fun for her.

Teenage Misanthropy has a similar view of Christmas.

So, guess how my mood is. Go on, guess. ‘Scale of one to ten’? Take that scale and [Bad Alex! No! - ed.], CAMHS. There is no value between one and ten that accurately represents ‘contemplating committing horrific violence upon my own person with the nearest sharp object*’ or ‘dicing myself up like a [Even worse - ed.] in an abbatoir’.
All that being said, it may surprise you (or not, you might quite reasonably not care) that so far I’ve actually managed to avoid introducing Mr. Arm to Mr. Razor and Professor Antiseptic (I am, however, striving to come up with ever more imaginative and in-poor-taste references to self-harm). So that makes over two months without, now. Problem is, the nights are closing in, everyone’s supposed to be festive and FESTIVE PEOPLE WITH FESTIVE SPIRIT DO NOT HURT THEMSELVES, THEY GO OUT AND PRETEND TO BE HAPPY

The Wife of a Schizophrenic does have some Christmas cheer though. She lists six reasons to be happy.

1. I am definitely happy that Mr Man is still alive, recovering, and keeping himself busy and happy with various hobbies. (Does that count as three? )
2. I am also happy that I have found some hobbies that I enjoy and that help to bring me peace.
3. I am happy that my Mum is trying to give up smoking.
4. I am happy that my brother is recovering from alcoholism.
5. I am happy that my sister has conquered her drug addiction and has returned to being the caring and generous spirit that she always was.
6. Seeing my nieces and nephews always makes me happy, but I am happy to see that some of them want to share hobbies with Mr Man and I

Speaking of Christmas, what do you lot want as presents? Coloured Mind and Scattered Thoughts has a wishlist.

I want to go to bed without my ritual argument in my head about how awful I am, I want to walk past a chemist without wanting to go in and look at the things I shouldn’t buy, I want to not know what an acute ward looks like, I want to have sat all my Alevels, I want to drink full fat coke without tasting suicide, I want to be ignorant about mental illness, I want to not know what CAMHS and CMHT stands for, I want to wear my hair parting on the otherside and not have scars to hide underneath my hair, I want to have the concentration to sit and read a chapter of a book, I want to find enjoyment in something I can commit to, I want to not have to worry about where my mood will take me next, I want to have the confidence to talk to a room of people, I want to sleep naturally, I want my family not to have to tiptoe around me, I want all of this to have never happened. I want my future back.

Christmas is a time for being with others. Crazy Nurse is starting group psychotherapy.

There were some group members, and two staff members there, plus myself and three other potential new group members. It works on the principle of being a democratic theraputic community and from what I could work out (and I must admit I am still a bit confused about what actually happens) each group member is answerable to the group. There were some quite enforced guidelines, for example no alcohol or illicit substances to be consumed after midnight the evening before, no missing more that one session a month (a day is composed of 4 sessions), complete confidentiality within the group etc etc. Choices are made by a vote; so everything is a group decision.

It’s important to think of the children at Christmas. The Cockroach Catcher is deeply skeptical of the use of antipsychotics for childhood bipolar disorder.

Even before the arrival of the newer Atypical Antipsychotics, their predecessors were used for behaviour control, in Russia and elsewhere. Why else should it be known as chemical lobotomy?

Many doctors feel more comfortable in prescribing Atypicals because of their purportedly better side-effect profiles. I do not mean to criticise the majority of busy Child Psychiatrists, for we have a long tradition of relying on publications of esteemed colleagues around the world.

Unfortunately, the big Pharmaceuticals too know of our trust in our colleagues, and over an extended period of time have engineered publications of favourable papers speaking for licensed and more frequently off-label use of the new drugs, especially Antipsychotics. It should not take a genius to work out that psychosis is a chronic condition that requires life long treatment, thus guaranteeing future income for pharmaceuticals.

There is also another aspect. What if the actual diagnosis of psychosis is suspect? We are entering a new era, when medical ethics seem not so important. I am not alone in doubting the validity of some of the diagnosis of childhood Bipolar Disorder. To put it plainly, the two thirds of the so called Bipolars may be just having behaviour problems and Antipsychotics are prescribed simply to control their behaviour.

Christmas is also a time for caring. Fighting Monsters looks at standards in private care homes for people with dementia.

Again, I’d take a look at exactly WHY the majority of care homes are privately run. It doesn’t surprise me a lot are either closing down or refocusing on less intensive care needs. Provision of specialist care, as I mentioned yesterday, cannot be provided ‘on the cheap’. It is very very difficult to provide anything approaching a quality service with overriding budget constraints.

This isn’t to say that good quality care can’t be provided by private companies. It can be but the boroughs have to be willing to pay for it. What can’t be provided is quality care at a knock-down price.

At Christmas time, we look back on the past year. Life From the Sofa reminisces about life before medication.

The pills have taken away the aggression and panic. I know I should see that as a good thing but I have nothing to replace those feelings with. Everyday is the same. I still have no motivation to change things. I think about getting a volunteer job or going for a haircut or making a nice meal. But instead I veg out on the sofa or go back to bed. And it’s not depression which is making me hide like this. It’s sedation. I’m beginning to wonder what the point of my existence is, but have no energy to do anything about it. I want to tap into those negative feelings so that I can overdose or cut, but I can’t be bothered. There is a whole side to myself, a negative angry juvenile reactive side which I can’t access. I miss it.

Yet I vaguely remember how horrible it was to be me before Quetiapine. I would have done anything to make those feelings go away. So it surely makes no sense to want them back? To those of you who are struggling at the moment, I must seem ridiculous, even ungrateful. I can’t really explain it. I’ve lost who I am and at least the old me existed. Now I’m just on the periphery, watching life pass by but completely unable to engage in it. Yet if I read through some of my old posts I would know that isn’t always true. It’s how it feels right now though. I know I should be looking at positive things I can do to make life interesting again. But I don’t want to. It all seems so shallow and is only masking the bad underneath. I want to let the monster out again for a while.

Useless CPN would like to spread the spirit of goodwill to social workers.

Let’s all vilify Social Workers over Shannon Matthews.

I had to turn off the news today because I just cannot stand it. I moan about Social Workers all the time. I may even do so on this blog occasionally. But they do an important and under-appreciated job. Very well 99.9% of the time. I wouldn’t want to do that job. ‘News’ reports just confirm that to me more and more every day.

At this period of feasting, Marine Snow is trying to break the binge-purge cycle.

The key to breaking the binge and purge cycle, or at least as I am always telling everyone else, is to get back on the hungry horse as soon as possible. Ideally that means doing the last thing you feel like doing after a binge, and eating something. Essentially this lobs a spanner in the ED works. It reduces the chance of falling back into that self defeating routine of starve-binge-purge, which all purgers will know pretty well. You mess up one day, vow to any and every god ever mentioned that:

“Hell, that is IT! No more, OK. I’m done. NO. MORE. EATING. Period”

And then generally after a short period of starvation, away you go again. The best thing to do is to get some sustenance down your neck asap (You have to say that the US way of A-sap, not the UK way of A.S.A.P, because it sounds way cooler: A-sap – I mean business, like the military) If I had a quid for every time I have pledged never to purge again, I’d be rich enough to pay for a brain transplant, and I’d be cured, cured I tell you!

As I steadily run out of tenuous links between Christmas and blog posts, Not Another Nursing Student has a suggestion about infection control.

I understand the theory behind infection control. I am fully aware of how to wash my hands effectively (which I will demonstrate through 10 observed assessments whilst on placement. Yes folks, we get tested on how we wash our pinkies). I also would very much like to wash my hands effectively, to prevent me catching or distributing any lurgie.

However, I would also like to be able to wash my hands under a tap that is not going to either

a. Scald the skin from my bones, or

b. Freeze the skin from my bones.

Why the hell is the hot tap always too hot to hold a hand under?!

The mixer tap surely is the greatest asset to infection control, and I DEMAND that all clinic rooms/bathrooms be fitted with them posthaste.

And finally, giving up on the tenuous Christmas links altogether, Mentally Interesting: The Secret Life of a Manic Depressive is testing the theory of “Do I have a mental illness?”

I’ve also tried to test my diagnosis. Often, I wonder if I do really have manic depression. The people around me scoff at this; if you have known me in person for some time, it is almost embarrassingly obvious that I do (I can be almost textbook), but I need to know for sure that I’m just not wasting everyone’s time. Or that it’s bad enough to be worth treating.

So I’ve stopped taking medication and challenged doctors and it never ends well. But I’m actually for “testing the theory”. I think people need to find out for themselves how treatment is, or isn’t, affecting them. But I see people who are clearly unwell doing it and think, “DURRRRRRRRRRRRR”. Then again, I’m sure people have had similar head slapping thoughts when I’ve proudly declared that I am, in fact, fine, and I’m going to stop taking all my medication to prove it. And suffer all the hellish withdrawal symptoms that follow. (Withdrawing from Lamictal cold turkey, which I had to do, was absolutely awful. I felt like I had flu for a week). I just think that we don’t see ourselves properly.