Category Archives: Read Along

Autism and Mental Illness

 

One of the big debates in the neurodivergent world is how autism and mental illness should be classified. Are they unrelated to each other? Do they – or should they – come under the same heading? Is autism a mental illness or not?

Cara Nissman of Autism After 16 hits the nail on the head when she says, “Part of the reason it is so hard to separate out mental illnesses from autism is that autism is still not fully understood and looks different in each person.”

David Rettew, M.D., writing in Psychology Today, expands on this idea:

This debate has surfaced many times before and in many venues.  It is a difficult one to resolve because there really is no scientific basis on which to separate a psychiatric disorder from a neurological or developmental one.

Certainly there are some things that feel different when considering autism, especially in its more severe forms, relative to things like depression or anxiety.

But what is it that feels different? The DSM-V, the comprehensive reference manual for psychiatrists, lists Autism Spectrum Disorder among its diagnoses. But that does not automatically mean that autism is a mental illness. After all, at one time homosexuality was listed in the DSM as one.

According to the NIMH, “Autism spectrum disorder (ASD) is a developmental disorder that affects communication and behavior.” That implies that autism is a matter of neurodivergence – that the autistic brain is “wired” differently from those of neurotypical people.

But isn’t that true of various mental illnesses as well? My bipolar brain is wired differently too and I consider myself neurodivergent. Schizophrenia is clearly related to brain wiring. And all of these conditions can be affected, it is currently thought, by genetic and/or environmental components – including both mental illnesses and ASD.

The website itsnotmental.blogspot.com begs to differ. That site, in promoting the idea that autism is not a mental illness, argues that:

the term “mental illness” is not a diagnosis. It is jargon – a term society uses to refer to some, usually severe and persistent biologically-based, disorders of the brain such as schizophrenia or bipolar disorder which are in the psychiatric manual of symptoms and labels for sets of symptoms arising from some malfunction of the brain, regardless of cause.

So far so good. But It’s Not Mental contradicts itself by espousing the idea that true mental illnesses are based on psychological and emotional components. That’s a point of view I cannot wholly accept, given what we know of biochemistry, neurotransmitters, the brain, and disorders such as bipolar.

Besides, might there not be psychological and emotional factors associated with autism spectrum disorders? Even if the causes (still largely unknown) are developmental or neurodivergent in nature, the effects of ASD can certainly include psychological and emotional problems. Fear, anxiety, and depression can all occur in children or adults who feel they are “different” or are seen as such.

There is also the problem of co-morbidity, or both conditions occurring within the same individual. Nissman sees it as “a growing challenge in the autism community”:

A number of people with autism also have some form of mental illness and the illness can go inadvertently untreated if believed to be just another characteristic of autism.

Indeed, studies within the past 15 years have shown about 70 percent of people with autism spectrum disorders may meet criteria for what are known as comorbid mental health disorders described in psychiatry’s diagnostic manual.

What’s the answer? Right now, it’s a big “We don’t know.” If we’re talking brain wiring and neurodivergence, autism and mental illness have a number of commonalities. If we’re talking about developmental disorders, they’re probably not related to each other.

But we certainly shouldn’t ignore the possibility of the two occurring together. While psychological therapy and medication may not be the first line of treatment for ASD, it seems clear that at least some persons with autism might benefit from them as an addition.

And that, to me, is the bottom line – not how we define the conditions, but how we care for the people who have them.

 

References

http://autismafter16.com/article/09-24-2012/when-autism-and-mental-health-issues-collide

https://www.psychologytoday.com/us/blog/abcs-child-psychiatry/201510/is-autism-mental-illness

https://www.nimh.nih.gov/health/topics/autism-spectrum-disorders-asd/index.shtml

http://itsnotmental.blogspot.com/2007/12/autism-is-not-mental-illness.html

Visual hallucination.

 

A strange night, warm and humid. I slept badly, as always. The difference with last night (in the early hours) is that I had a visual hallucination.

It was a figure, in the darkest part of the room, a yard from my head. The figure was an exaggerated one; marching on the spot, monochrome, side-on to me.

(“All colours will agree in the dark.” – Francis Bacon)

It didn’t appear human. Without lifting my head from the pillow I reached out my hand to touch it, a couple of times. Nothing solid, and no reaction. As unusual as this was, I wasn’t afraid and was too sleepy to react further. I turned over, facing the opposite direction, and fell asleep again. Next time I woke in the night there was no figure there.

 

The Ghost of a Flea c.1819-20 by William Blake 1757-1827

William Blake, ‘The Ghost of a Flea’.

 

Processed Meats Associated with Manic Episodes

https://www.technologynetworks.com/neuroscience/news/processed-meats-associated-with-manic-episodes-306398

An analysis of more than 1,000 people with and without psychiatric disorders has shown that nitrates—chemicals used to cure meats such as beef jerky, salami, hot dogs and other processed meat snacks—may contribute to mania, an abnormal mood state. Mania is characterized by hyperactivity, euphoria and insomnia.

The findings of the Johns Hopkins Medicine study, which was not designed to determine cause and effect, were published July 18 in Molecular Psychiatry. Specifically, it found that people hospitalized for an episode of mania had more than three times the odds of having ever eaten nitrate-cured meats than people without a history of a serious psychiatric disorder.

Experiments in rats by the same researchers showed mania-like hyperactivity after just a few weeks on diets with added nitrates.

While a number of genetic and other risk factors have been linked to the manic episodes that characterize bipolar disorder and may occur in other psychiatric conditions, those factors have been unable to explain the cause of these mental illnesses, and researchers are increasingly looking for environmental factors, such as diet, that may play a role.

The researchers say that their new study adds to evidence that certain diets and potentially the amounts and types of bacteria in the gut may contribute to mania and other disorders that affect the brain.

“Future work on this association could lead to dietary interventions to help reduce the risk of manic episodes in those who have bipolar disorder or who are otherwise vulnerable to mania,” says lead author Robert Yolken, M.D., the Theodore and Vada Stanley Distinguished Professor of Neurovirology in Pediatrics at the Johns Hopkins University School of Medicine.

Mania, a state of elevated mood, arousal and energy that lasts weeks to months, is generally seen in people with bipolar disorder, but can also occur in those with schizoaffective disorder. Manic states can lead to dangerous risk-taking behavior and can include delusional thinking, and most of those affected experience multiple hospitalizations in the course of their psychiatric illness.

Bipolar disorder affects an estimated 1 to 3 percent of the population of the United States and costs an estimated $25 billion a year in direct health care costs, according to a study in the Journal of Affective Disorders.

Yolken, trained as an infectious disease expert, was originally interested in whether exposure to infections such as viruses transmitted through food might be linked to any psychiatric conditions. Between 2007 and 2017, as part of an ongoing study, he and colleagues collected demographic, health and dietary data on 1,101 individuals aged 18 through 65 with and without psychiatric disorders. Approximately 55 percent of the participants were female and 55 percent were Caucasian, with 36 percent identifying as African-American.

Those with psychiatric disorders were recruited from patients receiving care at the Sheppard Pratt Health System in Baltimore. Individuals with no history of psychiatric disorders were recruited from posted announcements at local health care facilities and universities in the region.

A study of their records between 2007 and 2017 showed that, unexpectedly, among people who had been hospitalized for mania, a history of eating cured meat before hospitalization were approximately 3.5 times higher than the group of people without a psychiatric disorder. Cured meats were not associated with a diagnosis of schizoaffective disorder, bipolar disorder in people not hospitalized for mania or in major depressive disorder. No other foods about which participants were queried had a significant association with any of the disorders, or with mania.

“We looked at a number of different dietary exposures and cured meat really stood out,” says Yolken. “It wasn’t just that people with mania have an abnormal diet.”

Nitrates have long been used as preservatives in cured meat products and have been previously linked to some cancers and neurodegenerative diseases, so Yolken suspected they may also explain the link to mood states such as mania.

The dietary survey did not ask about frequency or time frame of cured meat consumption, so the researchers couldn’t draw conclusions about exactly how much cured meat boosts one’s risk of mania, but Yolken hopes future studies will address this.

To get at the roots of the association, Yolken collaborated with researchers studying the impact of nitrates on rats.

Kellie Tamashiro, Ph.D., associate professor of psychiatry and behavioral sciences, and M.D./Ph.D. student Seva Khambadkone, both of Johns Hopkins, and others divided a group of otherwise healthy rats into two groups: one received normal rat chow, and the other received both normal chow and a piece of store-bought, nitrate-prepared beef jerky every other day. Within two weeks, the rats receiving the jerky showed irregular sleeping patterns and hyperactivity.

Next, the team worked with a Baltimore-based beef jerky company to create a special nitrate-free dried beef. They repeated the experiment, this time giving some rats the store-bought, nitrate-prepared jerky and others the nitrate-free formulation. The animals that ate the nitrate-free meat behaved similarly to a control group, while the animals that consumed the nitrates once again showed sleep disturbances and hyperactivity similar to that seen in patients with mania—increased activity during normal sleep times and in new environments.

The results were then replicated with a specially formulated rat chow that had either nitrate added directly to the chow, or no nitrate.

Importantly, the amount of nitrate being consumed on a daily basis by the rats¾when scaled up to the size of a human—was equivalent to the amount a person might eat for a daily snack, such as one beef jerky stick or hot dog.

“We tried to make sure the amount of nitrate used in the experiment was in the range of what people might reasonably be eating,” says Yolken.

When the group analyzed the gut bacteria of the different groups of rats, they found that animals with nitrate in their diet had different patterns of bacteria living in their intestines than the other rats. Moreover, the animals had differences in several molecular pathways in the brain that have been previously implicated in bipolar disorder.

While the team also cautions that it’s too early to take any clinical messages from the results, and occasional cured meat consumption is unlikely to spur a manic episode in most of the population, Yolken says the findings add to evidence of the multiple factors that contribute to mania and bipolar disorder.

“It’s clear that mania is a complex neuropsychiatric state, and that both genetic vulnerabilities and environmental factors are likely involved in the emergence and severity of bipolar disorder and associated manic episodes,” says Khambadkone. “Our results suggest that nitrated cured meat could be one environmental player in mediating mania.”

Yolken’s group recently published results of a separate study showing that when people with bipolar disorder are given probiotics—which can change the composition of gut bacteria—after a manic episode, they are less likely to be rehospitalized in the following six months. “There’s growing evidence that germs in the intestines can influence the brain,” says Yolken. “And this work on nitrates opens the door for future studies on how that may be happening.”

This article has been republished from materials provided by Johns Hopkins Medicine. Note: material may have been edited for length and content. For further information, please contact the cited source.

Reference
Nitrated meat products are associated with mania in humans and altered behavior and brain gene expression in rats. Seva G. Khambadkone, Zachary A. Cordner, Faith Dickerson, Emily G. Severance, Emese Prandovszky, Mikhail Pletnikov, Jianchun Xiao, Ye Li, Gretha J. Boersma, C. Conover Talbot Jr., Wayne W. Campbell, Christian S. Wright, C. Evan Siple, Timothy H. Moran, Kellie L. Tamashiro & Robert H. Yolken. Molecular Psychiatry (2018), https://doi.org/10.1038/s41380-018-0105-6.

It’s All About The Birthday Girl

I will spare the usual rant except to say…I’m going under here battling depression, anxiety, and how deeply in debt the move and all has made me. This isn’t about me. This is about her. A sneak peak at the page to show that this time it’s different, not my babbling. I was too scatter brained to start a new page, so only $10 for Spook has been raised thus far. We are grateful for every act of kindness, every click of the share button.

Click either pic to go to the actual page to donate or share. Thanks.

Off Kilter And The Bad Thoughts Are Knocking At The Door

As mentioned in my previous post, due to my own inadvertent screw up, I am facing another financial set back, not to mention the entire family turning against me and even dragging my daughter into it. (Seriously, this was an adult problem between me and my sister, and she dragged even my 8 year old into it, as if I wasn’t feeling shitty enough, now my kid is going to judge me. For an honest albeit stupid mistake.) I spent last night alternating between tears of self loathing and doom and nervous throwing up. It’s bad enough when you fuck up and it creates a rift between you and another person, but now the entire family knows and I am in the hot seat. I will remain there even if I by some miracle manage to juggle some expenses and correct my fuck up. It’s like a family lynch mob with me as the lynch-ee. Maybe I deserve it. Though I fail to see why my sister had to drag everyone, including my kid into it.

Today I am on edge, unfocused, freaking out, my stomach is churning. I want my kid home but either way if they bring her home or I go fetch her, I will be facing down my lynch mob. God, I want a normal family where things aren’t used as fodder to start wars within amongst us all. And dear god, if feeling like crap had a monetarily value, I could pay off bills for the entire family. It’s gotten so bad, the Bad Thoughts are lurking in the shadows, knocking on the door. Reminding me that hey, I gave it my best shot but obviously I am never going to get everything right so why bother sticking around.’

I have to reject this. I have to toughen up, deal with my mistake and the fall out, but my prior trust issues inasmuch as my sister handling it between just the two of us are metastasized. Good people don’t drag an 8 year old into adult matters this way. And my family has always done the two face back stabbery since I was a kid so this isn’t new, I just had hope as we got older, that fucked up dynamic might change. It hasn;t and once I correct my mistake…I think it’s time to go back to my minimal contact with them policy. Because even without this fuck up, I am always on some shit list they have and I am fed up. Fighting depression and anxiety are hard enough with the people who ‘love’ me making it even worse.

I am willing to sacrifice, scrimp, cut corners, even let the internet get turned off (though it’s year long contract so I’d still owe them)…I used to dodge my responsibilities and mistakes back during the manic days but I have busted my ass and my brain becoming a better person. I thought I was getting there. I was apparently wrong but I can’t let myself give up and I cannot give power to the Bad Thoughts.

While I am willing to sacrifice and scrimp…

I am praying for a few kind people to donate to Spook’s fundraiser She deserves a birthday and the necessary stuff for the start of school. So if you have a heart at all, help Spook. I’ll try to clean up my mess and keep current on the bills, but…she shouldn’t be punished cos her mom doesn’t always get it right.

Even if you can’t donate…just a share shows you care. Spook is just a little girl about to turn 9 and enter 4th grade. Her getting some clothes, supplies, and even a half decent birthday is every bit as worthy a cause as donating to some soulless political candidate or a campaign to ban plastic straws. Show her there are some decent people out there.

I am trying to be a decent person but falling a bit short. I won’t ever stop trying, though. That little girl is the light of my life and even if my family and the rest of the world deems me to be an evil spawn of satan…All that matters is that my kid keeps seeing me as ‘a good mom.” Just need a little help right now.

Yes, I have a ‘mental disorder.’ But it’s not being transgender.

Many of the people who still insist that being transgender is a 'disorder' don’t actually care about our mental health.

Survival Of The Scared Shitless

Well, I had a couple of ‘decent’ days. Spook and I had a decent prepaid meal at the park the other day.
She managed to eat two cheesesticks before declaring that she was bored and it all sucked. I enjoyed it, but then, I’m used to boredome and everything sucking, I truly do appreciate the gift of a pizza Mr. M bestowed upon us. Made me feel kinda….ugh, hopeful, like perhaps I’m not a complete waste of space.

I had two days of being functional. I swept, mopped, did laundry, cleaned cat boxes…which is difficult for me as every part of me feels coated in dried concrete 24-7. I treasure the days I am in the mind frame-and body-to get shit done. I wish I felt that way more often. Some people are all too happy to give advice on what works for them and makes them a high functioning superhero but…sadly, it’s never worked that way for me.

Today seemed not so bad but then SPLAT. I learned that my sister got slapped with an old bill from our old address and it damaged her credit rating. I was paying on the bill (I thought) albeit slowly, only to learn…I was using the wrong account number and paying on a bill that belonged, well to The One Who Shall Not Be Named. I fucked up, big time, and I am humiliated and now on the family shit list and further in the hole. I will fix it, I made the mistake (however unintentional) because my sister was helping us by putting that bill in her name when we found ourselves abandoned and fucked on that front…My last wish was to do something to screw her over but…here we are. And of course, she will tell the entire family, so I will be persona non grata and maybe that’s what I deserve for being a screw up. I could make a dozen excuses and explanations and they’d all be valid, honest, and for real. It doesn’t change anything though. Until I fix it, I am gonna be on the ‘evil bitch’ shitlist with the entire family. And even then, I’ll remain there as her credit as impacted.

The level of embarrassment and shame are enormous. Worse, my kid is staying at their house tonight so who knows what venom they’re spewing to her about me. I’ll have to pick her up and face their wrath and since I am mid-curse, hormonal, and have to also face the donor in court Monday…It will be a miracle if I don’t end up on lockdown in hard restraints. I am just to that point where I have tried so damned hard and I still can’t get it right or be cool, calm, and collected…and I am not whining, I own my screw up, but my precarious mental state kind of goes without saying. In my family, “sorry” and “I will fix it” count for nothing. Everyone is out to tear everyone down. And it is infuriating because my sister has been married to “Beavis” for 20 years, he doesn’t work, doesn’t even mow the damned lawn, and she thinks the sun shines out of his ass.

He idolizes Hitler and Charles Manson, and in a way, that’s how I view him. He’s so charismatic, to a certain faction of gamers and wanna be bikers, he has people willing to pay for weekend white water rafting trips and they loan him $10,000 Harleys to drive but he can’t be bothered to help around the house, EVER, and while he can always wheel and deal for money to take care of their cats or get weed and Marlboros, he’s never given a damn if his kid had no milk for cereal or the whole house was starving. I have nursed my dislike and resentment for 20 years, trying to respect my sister and her ‘he’s my true love, no one else gets me him like I do” but…Honestly, what kind of dickbag has his son come home all proud that he made the honor roll and says, “So what, anyone can make the honor roll these days.” And pretty much EVERYONE in the family hates him, but his mom owns the house my sis and mom and nephew live in, so of course, all lips kiss the ass of the queen. Who enables Beavis to do nothing and yet my sister is constantly having to clean our dad;s house to earn money for food….

So yeah, I fucked up and I will fix it, and I feel positively like shit, but what about that fucking lump? No one holds him accountable, ever, and she preaches his awesomeness and he has a dozen friends who all but worship him but then, that’s his base, the fellow people who when fired from a job sign their final paycheck “fuck you”. So I wouldn’t want to really be accepted in that crowd because, well, douchebaggery isn’t cool even if it is prevalent. So’s Katy Perry and Lady Gaga on the radio, doesn’t make it right or mean I have to endure it.

I’m sure it all sounds too stupid to be true and I just sound bitter cos I fucked up and now I have to own it, but I was feeling this way long before today. Beavis dared to say something about how I don’t take good care of my cats since we had to rehome some of them due to the move and my brain about popped out of my skull. Those cats went to live on like ten acres of farm land where they are fed and watered twice a day and have tons of room to roam and catch mice. I didn’t rehome them out of choice but at least I had the decency to make sure they went to a good place where they’d be cared for. The man has homed several strays I found over the years and they’re all healthy and plump. So to have that p.o.s who doesn’t do a damned thing but play video games all night and piss into empty soda bottles kind of sent over the edge. I’m not making him a caricature like some Mike Judge cartoon, he really is just that….awful. And I hate feeling that way because I love my sister and I don’t want it to come between us, we’ve always been pretty close and on cool footing. But I can’t help but feel the way I do and I’ve felt that way for 20 years. My turning point was when they were doing meth and he actually took her dentures, put them in the toilet and pissed on them. Maybe she can forgive that shit, but man, I’d probably be in prison if he’d done that to me cos I’d have bashed his head against the toilet.

BREATHE.

I’ve never given my blog link to anyone I know in person because years ago, I made that mistake and my sister read some of my thoughts on our fucked up family and she was very hurt and didn’t speak to me for awhile. I don’t want that but bottling it up is poisoning me. Besides…her and mom were pretty smug about knowing from the get that the donor was a fake who would walk out on me and Spook. They have their judgments, same as me. Difference is, I admitted they were right when they were proven right. I’ve been proven right a hundred times about Beavis but I end up being the villain. So much for self awareness and objectivity. I don’t need to be loved that much that I would put up with that shit. If a guy wants to be a house husband and stay home to do housework and child care while the woman works to make money, cool. But a guy who makes the woman work and take care of the kid and take care of the house while he plays video games and rides motorcycles with his wanna be MC…Just writing it makes me need to vomit.

Anyway…Before this all happened…I was having mega anxiety attacks because I realized…OMFG, Spook’s 9th birthday is August 7th. Plus she needs some school clothes plus school supplies…and I can’t do it all and keep the bills paid and now I have this new thing on me….So survival of the fittest and the scared shitless. YEP, another fundraiser. But this one….Just check it out, it’s short and sweet and based on Spook’s own words. I get bogged down with her defiance and anger but the other day when her little friend was here and acting up, she tried to calm him and said, “Listen to my mom. She’s a good mom.”

It’s those little moments you live for, but if I want to keep the power on, it’s not going to get her a Minecraft cake. This one matters a lot, guys, it’s for a little girl who never asked for any of this. She just wants to have a happy birthday and go to school wearing clothes without stains and holes. With all the mindless political fundraisers going on out there..surely a 9 year old girl is worth a $5 donation. Not for me. For Spook.

Pretty please with pegacorn vomit and unicorn farts on top?

Another Appointment

Went to see the dermatologist this morning and that went well.  Got a new cream for my neck and face that’s not a steroid so it’s safe to use long term and we wills see how it works.

I’ve come up with an idea for new fiction but have to settle down and actually start writing on it.  I’ve been generating ideas for a short story collection and have about 10 ideas so far.  Just need to put pen to paper.  ANd I think they’ll be funny ones rather than the really weird ones I was writing for a long time.  But we will see.

My youngest has gone to visit a friend today so I have the house to myself.  Not sure what I’m going to do with it besides laundry.  I need to finish Bob’s and do my own today as well.  So that will keep me busy.

My oldest is enjoying herself at Disney World–she bought herself a limited edition set of stuffed animals from the new Winnie-the-Pooh movie so she is proud of those.  She seems to be really making an impression on her higher-ups because they have asked her to train new people coming in.  So that sounds like positive feedback.

My middle one has run into a class she has to actually STUDY FOR (gasp).  SHe made a 96 on her Calculus II test but says she is having to actually spend time outside class on it, which is a new thing for her :).  But she has a long way to go in the maths department so I told her she just need to get used to it.

SO that is how everyone in my house is doing.  Hope everyone has a good weekend, and see you back next week!

 

Good Day So Far

Went to see Dr. Bishop this morning–said I was doing fairly well.  He renewed all my prescriptions and we talked for a bit.  Told him I’m looking forward to school and what not.  And I am in a way.   I just wish I could feel better about my chances with my writing.  I got a big rejection today that I was halfway expecting since I hadn’t heard anything around mid-July.  So that was a bit grim.  But I am trying to stay positive and seeing what more I can do.

Took my youngest shopping for a new purse for the school year–all of hers are small and she wanted something larger with more pockets to take to school this year.  So we did that and also bought a wedding present for a shower I’m going to Sunday.  SO we’ve accomplished a lot today all before lunch.

I go back to my dermatologist tomorrow and my skins has cleared up with the steroid cream so that will be a good report.  I just need to keep washing my hair and staying up with that treatment.  That’s difficult since I am so out of the habit of washing my hair every day. But I’m getting better.

Hope everyone has a good end to their week and is looking forward to a good weekend.  We will see how it all turns out.  Happy Thursday!

 

Follow Up

Well, I got the news this morning that I wasn’t looking forward to: I have to stay on the higher Zyprexa dose for the foreseeable future. Dr. Goodenough is even faster at returning phone calls than Dr. Awesomesauce was; I called the office to leave a message on how I was doing at 0935, and he was on the phone by 0955. I continue to be impressed by how responsive he is. However, I was not thrilled about the terminology he used to describe my problem, e.g., he called it “rapid cycling”. I don’t want to be one of those patients who rapid-cycle. But with all the flipping in and out of hypomania these past four months, I don’t know what else he’s supposed to call it. I guess I hadn’t thought of it that way.

I’m also not thrilled about staying on the 7.5 mg, even though it obviously works because I’ve been sleeping like a baby for the past week and am settling down nicely. It’s just that I’m going through one of those phases where my brain has betrayed me again and I’ve had it up to my ass with this stupid illness, and it wants me to do something that’s totally against my best interests. I want to DECREASE meds, dammit, but it’s not going to happen.

I posted a little whine to this effect on Facebook, whereupon a number of my friends brought it to my attention that my behavior is following a pattern they are all too familiar with, seeing as how (as one put it) I go through these episodes two or three times every year. They want to know why I wish to be on less medication since I tend to decompensate when my needs change. They also want to know why I seem to see it as a failure on my part when something quits working well and I need more medication, not less.

I had to think about that one.

In fact, I’m still thinking about it. This is why it’s good for people to have friends and loved ones who can see clearly and ask the hard questions. Why DO I see it as a personal failure when my brain shits the bed and the antipsychotic dose goes up? As my constant  readers know, it’s long been an issue for me that I need to be on more than one of those drugs…it’s like I’m stigmatizing myself. I keep thinking that I should be like a lot of bipolar patients who manage the condition on a mood stabilizer, an antidepressant and one AP.

And I guess on some level, I’m still in a bit of denial. It’s been two years since I’ve needed a med increase, and it’s been relatively easy to forget how serious bipolar 1 can be. Even though these recent dalliances with (hypo)mania have been minor, they remind me that I have a dangerous illness which can flare out of control at any time, and the only things standing between me and disaster are these fistfuls of sanity. I don’t mind taking the extra dose so much as I mind what it stands for—the fact that without heavy-duty psych meds, I would probably be a hot mess. Or worse.

It’s been so easy during the stable times to become complacent. It happens to a lot of bipolar people, even though we almost always get slapped upside the head by reality. I take some comfort in the fact that I am far from being the only one to fall victim to this kind of stinkin’ thinkin’. There are many, many tales of unfortunates who, believing they’re cured, stop taking some or all of their meds; or who (like me) get enough relief  that they think they really aren’t that bad off, and can act like so-called “normal” people who can stay out late or be up all night watching TV and playing on the computer.

In the meantime, I’ll just keep taking the pills in the doses prescribed for me and try not to look at the situation as a reason to beat myself up. I was raised in a family where mental illness either didn’t exist or was the patient’s fault, and it’s hard to get past that. I guess I’ll have to do a better job of it.