Wednesday, August 25, 2010

Emotion versus Mental Illness

My favorite commenter, "Anonymous," wrote in to my Duckiness post to say that it was good I could post something totally silly without being told I need more meds. Oh, if life were that simple. And it is true that once someone has a diagnosis of bipolar disorder, not only does the world question their emotions in a black & white "are you sick again?" kind of way, but patients don't trust themselves to feel for it's own sake.

If you're not sick, then being asked if you took your meds is insulting and degrading. And so I thought I'd put together some guidelines for Emotion versus Mental Illness. I'm inventing this as I go, with no evidence-based anything, so take my suggestions at your own risk.

  • If you are ultra-successful, rich, brilliant, gorgeous, famous, and comfortable with your diagnosis, you may want to consider telling people you have a mental illness because it decreases stigma and people like being with the ultra-successful rich, famous, brilliant and gorgeous and won't care that you have a mental disorder. It helps even more if you're charming.
  • If you're not ultra-successful, you may want to pick and choose who you tell that you've been ill and are on medications. This isn't always possible, especially if your illness is evident to others or if the presentation of your symptoms resulted in a hospitalization. It's good to tell close family members.
  • If multiple people are looking at you strangely, or commenting on your behavior, or saying you need medications, you might want to at least entertain the option that you could be sick. Unfortunately, poor insight and judgment are symptoms of mania.
  • Tell the people close to you not to make medication jokes. It confuses the issue if you seriously do need medication changes, and it's rude, degrading, dismissive, and disrespectful. There, I said it.
  • If you want to be silly, go for it. Be silly when you're well so that being silly is part of your baseline personality and no one equates this with being out-of-character. You'll note the duck invaders did not come after me, rather they said, "There's Dinah posting yet another stupid duck post." If I'd posted about why chocolate should be outlawed and made into a controlled substance, those same duck invaders would be asking "What's wrong with Dinah?"
  • Mental illnesses come as constellations of symptoms. There is no "Sending out silly duck stuff" as a symptom. People think about mania when the ducks are combined with more energy, racing thoughts, a decreased need for sleep, increased mood OR irritability, and other symptoms of mania. Know the list and if someone bothers you, say, "I posted about ducks, I do not have any other associated symptoms." Recite them if necessary. If you do have the other symptoms, refrain from posting about ducks. I don't want Posts Duck Blog Posts to show up anywhere in DSM-V and these days you just never know.

  • No one controls how any other person thinks of them or judges them and it's not reasonable to live life ruled by a desire to be perceived in a certain way . It's another form of poultry, but Don't Let the Turkeys Get You Down. There are a lot of turkeys out there.

Moods happen on a spectrum. Some people have large variations in their mood---large enough or severe enough such that it causes suffering, and we call it an illness. Some people don't have much variety to their moods and live in a calm, even-keel place, and it's great that we have such people. But, I absolutely promise you that if we lived in a world where everyone had a very narrow range of mood, this would be one terribly boring planet. We should celebrate our diversity, not condemn those who like ducky stuff.


Sunny CA said...

My psychiatrist says I am fine, but a friend who is one of the few who knows I was hospitalized will admonish me if I get excited over something. For example, if I am happy I just got a job (I did just get a teaching job after 54 applications and 7 interviews over 4 months in a state that laid off nearly 30,000 teachers in March), she will said you are pretty excited, you should calm down and lower your voice. Meanwhile, when I called my psychiatrist with the news, HE was whooping with delight. The "SUSHHHH you need to be calm and subdued all the time" attitude bugs the heck out of me. OTHER people get excited and are happy when something good happens. Why should I try to be morose in the face of a life-changing happy event?

Dinah said...

Sunny Ca:
So how do you know that your friend's reaction has anything to do with your history of hospitalization? Maybe she doesn't like when people (any people) get loud or excited?

I have friends who come over in the mornings for is a bit on the Chipper side (see video in earlier post). She can be loud and enthusiastic and oh, some of the days I've just gotten up and I still have the kitchen light off and the coffee hasn't yet gotten to all the right receptors and she's turning on the light and talking a bit too loud and way too happy looking for someone who wants to ease the mornings in with muted tones and the dogs are all barking...
No clue if friend has any psych history, but it would be okay to turn the volume down a few notches.
My free association.

Sarebear said...

I didn't post anonymously, but I've always had a huge problem accepting my silliness. My mania actually makes me EXCESSIVELY silly, ridiculously so. I kind of think of it like, some drunks are violent drunks, some drunks are loud drunks, some drunks are funny drunks, etc. Me, when I get manic, I get silly.

I know that whole drunk analogy for comparing to how some people behave when manic might offend some. It works for me to help explain my silliness, not that I know what being drunk is like, though.

Most of my life, I did NOT know about my bipolarness, so I did not know why I'd get so excessively silly at times, and so a huge degree of SHAME built up around it.

I have taken a variety of measures to try to accept it as part of myself, like the title of my blog, my email address of queenofsilly, and other things, but it is still difficult for me because so much of my life I didn't know WHY I was behaving as I did, and then there would always be shame after, and my family frowned on my behavior too.

So it was like, Be anything BUT yourself, and being silly is STUPID with a capital S.

Like I say, I've tried to relax and accept my "natural" silliness, the puns and all, the best I can, and try to notice when the mania is escalating things, but with a lifetime of messages of shame, silliness for me can have a sharp edge of shame to it. Then I tell myself, if there's one thing the world needs, it's a bit MORE silliness, so go ahead and have at it, be yourself . . . .

(struggling hard to try, anyway . . . .)

Sarebear said...


moviedoc said...

It's sad but for the past many years, if a psychiatrist diagnoses you with bipolar disorder, you should take it with a grain of salt - and I don't mean lithium.

If someone jokes about your medication, or even you, laugh right along. It's the best medicine. And it might take the wind out of their sails.

Anonymous said...

Nice post. It's ironic sometimes, when the person who says it to you literally need help themselves. I got diagnosed with uni polar depression in my early adult years. Months and months later after the first episode of depression I had ever experienced, once I had recovered I grew extremely infatuated with a boy, it was heaven and like pay back for feeling depressed. I saw my shrink to follow up. He was very happy for me, and gave me his congratulations and wished me all the best for the date I was going to go to.

My mum appears to have some sort of an undiagnosed mental illness, I won't go into details, but my psychiatrist agrees with me and explained some possible diagnoses after I listed a few extremely unusual behaviors - paranoia, delusions, trauma and loss as a child and bizarre obsession with spirituality. She wont get help either, she typically thinks that there is nothing wrong with her.

I went and saw the young man had dinner with him, he kissed me before I left and made sure he had my number. I came home running and saying at the top of my lungs "HE KISSED ME, HE KISSED ME!!! HE KISSED ME!!!"

My mum told me I needed to see a psychiatrist ...

Anonymous said...

"I don't want Posts Duck Blog Posts to show up anywhere in DSM-V and these days you just never know."

That made me laugh. I have Asperger's and have heard that will be lumped into one big murky jumble with autism. Clearly the disorders are related, but there are important differences. Seems to me a label of autism won't mean much if this happens. I'm in favor of more DSM-V jokes.

Also congratulations to people who got jobs or kissed.

Anonymous said...

If someone tells you normal emotions are mania, tell that person they are being incredibly ignorant.

If your only manic symptom is happiness and excitement, you are not manic. You are happy and excited.

Regarding overdiagnosis of bipolar, totally agree, it seems like doctors/psychologists throw this out as if it were a not-otherwise-specified diagnosis.

Although, interestingly enough, sometimes the medication can help in spite of a lack of bipolar disorder. Family member was diagnosed with "bipolar", she's never had a real manic episode, just random insane behaviors.
Trust me when I say she's never had a "manic episode", instead she has had transient manic-like symptoms that last a day or so, which seem to flux in and out of being a normal human being... and this is true over her entire life. It's her personality.

Lithium has stopped that and she's normal almost all the time. Still crazy in other ways but the insane cackling has ceased. Like I can't remember the last time I found her just blinking a mile a minute while laughing and baking at 4 in the morning. That used to happen a lot in the past... scary crazy behavior that would gel to more normal behavior a short while later, as a part of her personality it seemed. It's like she has a manic personality, without lithium at any given time she is vulnerable to go wacko, and the lithium does help a ton at keeping her from acting weird over a long period of time.

The lithium also does a lot to make her less aggressive. She is EXTREMELY aggressive without lithium, which often occurs with the insane behavior.

I know it sounds like my family member is a bipolar from what I've said but really she's never had a proper manic episode, it just bobs in and out of her personality like waves in an ocean... she has these behaviors over a chronic course and she never has periods where they are not there at all. The doctor never gave her any sort of type of bipolar specification, just "bipolar". But the lithium does help a lot, anyway.

So, anyway, the point I'm making is, I think one of the reasons the bipolar diagnosis is so popular is because it has become the new "not otherwise specified" when it comes to mood and coping problems. The medication used for bipolar seem to help all types of insanity, whereas this really isn't true for depression or any other diagnosis. If you throw antidepressants at it and antiepileptics and lithium and antipsychotics, odds are it will get a little more manageable, whatever it is. The bipolar diagnosis allows for all types of medication to be used, which is why it is so popular I think.

Anonymous said...

But you know, same anon as above... I do agree with the anon in the duck post. That duck crap was crazy, and if a bipolar person started talking that way, people would be wondering if he or she was manic. But a normal person (or a person who is manic and never diagnosed) totally has the luxury of acting that way and having it be ignored, or just attributed to "my wacky friend bob" as that is his personality to be wacky or whatever.

I mean, this is interesting, because I was diagnosed bipolar and while I won't dispute whether or not I am bipolar (I really don't care because if I am bipolar it is clearly not severe enough to ruin my life which probably means I'm not bipolar)... but I will say that when I WAS "bipolar" in the eyes of a psychiatrist, the last session I had with her before I this session she totally dismissed my rational emotions, completely ignored the content of what I said, and labeled all of my feelings and expression as mania. She didn't take the time to investigate what I was feeling or saying all she knew was I stopped taking my medication and I was agitated and emotional and that was it case closed.

And in that split moment, where I was saying words and not even being heard, it really felt like I had no voice. Do you know what it feels like to have no voice? It is the same feeling as trying to talk when everyone thinks your crazy. Like having no voice at all. Like throwing fists into the air.

Like those old time movies where someone is declared insane and they are locked away even though they are totally sane and rational. It is a very strange experience when someone calls you insane and proceeds to completely ignore everything you are saying because they think you are insane. Even if you're not insane. And I would add this was a doctor not a friend or an ignorant person, a supposed educated specialist.

Another interesting thing about being "bipolar" in the eyes of a doctor is they instantly treat you like a mental invalid, a child, someone with no input into their treatment, nothing relevant to say in regard to medication, etc. Because you are insane.

I found all of this amusing and bizarre as outside of this office I was entirely functional and intelligent and people respected me and came to me for advice and depended on me, but in this office I was a crazy person without a voice.

Anonymous said...

One of the first things this made me think is that you've captured part of the problem-- individual symptoms being taken as proof of a disorder, even without the rest of the symptoms that make up the disorder.
A major problem I've had is that a huge number of people, psychiatrists among them, are unable to understand the importance of causes of symptoms. I've encountered a few psychiatrists who were completely unable to grasp the difference between insomnia and the decreased need for sleep that goes with mania. I have never slept normally. In utero, I did not sleep normally. When I say that if I don't take benadryl I don't sleep, it doesn't mean that I don't still need sleep, it simply means that I'll be a miserable sleepless wreak desperately in need of sleep.

Is this confusion something that drug companies encourage? It seems a bit like it could be a marketing thing, where they pull the "if someone mentions this symptom, use our drug!" bit, twisting what it's actually used for by giving statistics of increased sleep among people treated with the drug for mania as "proof" that anybody with insomnia should take the drug.
I've learned the hard way that even among intelligent people, the ability to understand, analyze, and properly contest a misleading statistic is incredibly rare. It's disturbing the number of doctors who seem to have this problem.

(Is it irritable of me to get annoyed at all of those "come buy our generic viagra!" links in comments that say "Interesting post, I liked it."? I maintain, as I always have, that without censorship, the internet would be nothing but one huge viagra ad.)

Retriever said...

Good stuff. I think one aspect of this is how, growing up w several bipolar first degree relatives, one can grow to fear any and all extremes of emotion. Thus, if one is sad one fears that it is depression like one's sib. Or, if one is giddily happy (cute guy asked one out)one wonders "am I manic like mom?" Terror. As a result, one can live in armor, encased, rigid, trying not to be extreme, because of what one's relative's moods have done to one's life.

Not to mention one's own demons. Once one has recovered from, say, a depression one overreacts to the slightest "normal"reactions of irritation or sadness or forgetfulness or stress eating or loss of appetite or sleeplessness or sleeping too much orlack of focus, or anhedonia, or feeling blah etc. Because we are all told to monitor ourselves and be sure we "catch" ourselves if that old Black Dog starts gnawing away at us again. It's bad enough to feel bad, without worrying what it may mean or presage...

Anonymous said...

I am the anon from the duck post. I fall into more than one of your categories in that I am successful and yet have also had several hospitalizations. Many people do know of my illness and many would never dream of looking askance if I sent them a long silly email, or of saying," go back on your meds", unless they had a really good sense that I was unwell. That said, there are a good number of people who cannot seem to tolerate, as one person discussed in their own comment, even so much as NORMAL expressions of excitement when something exciting happens in my life or of sadness when something sad happens. Of course, having a silly side with them is out of the question. So, I know there are people around whom I cannot be myself and I know that is related to my illness and I also know that if I had diabetes I could laugh and cry like other people without being questioned about it. I know because I have other health conditions that require different sorts of medications and no one ever seems interested in whether I have stopped those. My point the other day was precisely what another anon said today: if a bipolar person posted that duck stuff out of the blue, people would wonder.
I am tired of being shushed by people in the midst of a lively debate when I am not the loudest person in the room. I am tired of walking into a room, sick with a bad cold, looking like hell and having people assume I am depressed.

sara said...

My eldest son is bi-polar...I only use the label to understand why raising him was often hard. It doesn't define him...or his future. It is something he deals with, is learning how to understand, and is actively growing with. As a young man, it isn't the first thing he tells people...maybe not even the last thing...because, in the end, it doesn't matter. He is who he is. His moods fluctuate. His energy fluctuates. He see's it. He pays attention. We all have ups and downs though his are more severe. In the end, if it matters to people who want to label him as "ill" instead of seeing him for who he IS...that's their loss.

Sunny CA said...

You may very well be right. The friend I mentioned tends to be down much of the time, so I am probably overly chipper, overly loud for her state.

THANKS! This is a big deal for me. School starts Monday and I am still organizing my classroom in the daytime. I just got done with 5-6 hours working on lessons for next week and beyond. This is my "job for life" if I can do a good job this year.

Anonymous said...

Well I'm actually bipolar (no real doubt about the diagnosis) and I almost always swing manic. I've always been eccentric and the "Oh, You so crazy!" comments (it was a catchphrase on the Martin Lawrence show/ and theme song years ago)did not bother me. I have a hyperactive sense of humor and I love whimsy. Still do. Therefore, I defy anyone who really understands mental illness to tell me that the 3 wind-up toys I have on my desk at work mean I'm out-of-control. I like to watch the little puppy dog do a back flip or the monkey clang his cymbals. I'm an overgrown kid some times!

George Carlin had a routine about excess verbiage--terms that are cluttering up America's speech, like "Tell me in your own words . . ." (who elses's words would they be? Shall I make up a new language?) and Carlin in the routine has this one in there that he criticizes, it's the term "More Than Happy." I'd be more than happy to show you my daughter's portfolio, etc. And he says, "That sounds like a serious illness. More than happy! We had to put Dave in the mental home; he was More Than Happy!" My husband and I quote this Carlin bit all the time. We laugh about mania. If it's the REAL THING, we get serious.

Dinah, I love what you said about celebrity and charisma and speaking out if you have mental illness. I totally agree with this. One charismatic actor on General Hospital asked that his character also be given the same disorder he's liivng with (bipolar disorder) and the show's writers obliged. In the hospital and newly diagnosed, I refused all meds but demanded lithium because that was what the guy on General Hospital takes! And that really saved me.

Dr. Psychobabble said...

Agreed. Agreed. Agreed.

Anonymous said...

Hi, My 5 cents worth,

I am seeing my patient, first consult, has hx of anorexia is on prozac. There are some new symptoms, different she says. Her pdoc sends in in for some tests.

She feels like she has to convince me (on prozac bupropion myself and feeling damn fine and highly capable) You wont pick me out from the others. I say, I''s Ok I understand what you are telling me. Let's see what we can do. Yup there is a problem. Short synacten test shows a problem. I trusted what she was telling me, because I it's a life I know. She was for real and and she was spot on the money.Low adrenal function.

How many of us primary care or specilaists on these drugs? It's more than you think. Mine are prescribed by my specialist and monitored really well.

Hand up if you dare