Daily Archives: May 28, 2015

psizing up psychosis

Psychosis can happen out of the blue, to anyone, and no one knows why. Not even the best doctors on the planet. (Jeanine Garsee)

I like the following song a lot; it looks at perceptions during psychosis, in a calm, first person voice (also, sad boy with guitar, yey). Thanks for posting it, Annie. I’ve also added it to my manic depressong playlist.

Who are you calling psychotic?

Psychosis seems to fascinate almost everyone, although a lot of people think it means out of control batshit crazy behaviour and/or severely disturbed criminals. Those misperceptions are frequently totally devoid of malice, but of course they still hurt. I find myself saying experiencing psychosis far more than I ever say psychotic. Psychotic appears to provoke an almost visible frisson in the sort of person who dresses up in Einstein hair and a straitjacket at Halloween. Obviously we can thank the film Psycho and its repulsive iconic stabby shower scene and that fucking eee eee eee soundtrack for much of it; people apply it to psychotic and psychopath until those terms mix and muddy. I’m tired of insanity porn. Fuck off and dress up as an Ebola patient next Halloween. And if psychotic is used as an offensive term, would everyone be okay with me saying things like you cancerous little fuck? No. That’d be a cuntly thing to do, wouldn’t it? You peptic ulcer! Holy fuck but we are an extremely illogical species and we do love to victimise…

It holds a fascination of a different flavour if you experience it, or love somebody who does.

Part of the loss of reality then was an over-projection of meaning and exaggerated concentration on some aspect of reality that most of us, by consensus, choose to ignore.


A few reputable websites use the standard dictionary definition of psychosis to explain it, which makes less than no sense to me. Unless we’re hanging out with Norman Bates, please let’s use a medical dictionary? All it is really, is loss of contact with reality (hallucinations, delusions) and when we’re experiencing it, we either know it’s not real (this is known as insight), or we don’t. Different cultures tend to have different types of content in psychosis; the most negative seems to occur in Western developed countries and the theories I’ve read so far, cite the media and the individual-focused society as influencing factors. My psychiatrist tells me that, besides the emotional etc effect on the sufferer, the content of psychosis is absolutely irrelevant. If that fact was proven, a lot of hippies would be unhappy. *waits to be lynched by wind-chime wielding mobs*

When does a strong idea take on a pathological flavor? How does a metaphysical crisis morph into a medical one? At what point does our interpretation of the world become so fixed that it no longer matters “what almost everyone else believes” [part of the definition of ‘delusion’ in the DSM]? Even William James admitted that he struggled to distinguish a schizophrenic break from a mystical experience. (Aviv 2010: 37)

My trainee-psychiatrist therapist, on the other hand, seems intrigued by the content of mine. I blogged the memories I dredged up about my stuff as the memories surfaced, here’s the list so far.

I am the shit (of the bat)!

1996: my gecko tattoo attracting skinks, the skinks were real (on a path along a bay) the rest was delusion, it was a one off.
2000: being stuck in a video game, total sensory immersion, hallucination and delusion. It was a platform game and there was a lot of dusky blue around. I never remembered much afterwards, but slept for around 14hrs as a result, feeling as though I were uncomfortably drugged). I had 10 one day and felt totally fucked for days. They stuck around at various levels of frequency until 2009.
2007: the sea speaking to me, not sure how long it lasted – either days or weeks. It was purely auditory and extremely reassuring, I miss it.


2010: 7ft chrome praying mantis. Purely visual and delusion. He’d stand behind me, usually in an almost dark room, I’d be sitting on a dark, straight backed chair, at a dark table (the whole thing was a hallucination). He’d quietly use his chrome pincers to efficiently snip my spinal chord, and it was an utterly painless, peaceful and reassuring thing. He lasted about a year, was frequent, and I miss him. (And yes, after my dog goes, I’d welcome euthanasia by 7ft chrome mantis.)
2014: hearing music and footsteps, seeing lights in a wave and hearing music come from it. The music was quiet and seemed to come from various places where it most certainly wasn’t. The footsteps sounded like those above a flat my mother and I lived in once. The wave stuff was beautiful and sparkly and merry and I’d love more of it.
2015: a reef I know very well and have explored for years, suddenly looked as though it had had the top of it sliced off cleanly. I knew it wasn’t real, I tried so hard to get rid of it and couldn’t. Eventually I had to crawl off it and I’ve no idea how I got home.

Fully qualified psychiatrist reckons the presence of insight in my psychoses is a very positive sign.

I tried hard to change the ones I didn’t like, and never managed at all. The good ones felt too good to lose. I wonder why I’m discussing them all in the past tense. I’m interested in your psychoses almost as much as I am in my own (grin, it’s the truth), I’d love to hear about them. I don’t have any tidy conclusions to make, I am, as usual, simply reading, writing and thinking, in order to clarify things in my own febrile mind. And apparently I like doing it best while perched upon my own personal soapblog.


And another thing…

Here’s a quote I found fascinating, but couldn’t think of a way to include without offending and alienating my religious friends. Sorry guys, feel free to comment and tell me your thoughts.

When a ‘false belief’ is not ‘delusional’
For me, religion brings up much more complicated questions for the delusional, however. As Koenig (2009: 287) points out in an off-handed way: ‘Psychiatric patients with psychotic disorders may report bizarre religious delusions, some of which can be difficult to distinguish from so-called normal religious or cultural beliefs.’  Especially where there is a marked ‘religion gap’ between a patient population and psychiatrists — where psychological health care workers are much more likely to be agnostic or atheist than the people for whom they care — it can be difficult to decide when a ‘false belief’ is delusional and when it’s just, well, the normal kind of irrational (like believing that a person can expect others to read long blog posts).

It’s all so very meta round here innit.


I’ve been far too flippant.

I can joke; I’ve earned the right by living through things that, before I had them defined for me, frequently convinced me that I was genuinely losing my mind and that I’d lose myself entirely in the process. It taught me that the misconception that going nuts would be some kind of relief, an escape, is so far from the excruciatingly agonising truth, that to express that opinion is insulting at best. I’ve gone a joke too far today, perhaps. Psychosis is serious.

This is not comfortable viewing and it is not entertainment. Proceed with caution.

Sources, resources and interesting reading:

Slipping into psychosis: living in the prodrome. (a brilliant intro to psychosis, most of the quotes I used are from it, it contains stuff that’s rather wtf too.)
Delusions odd & common: living in the prodrome. (psychosis and culture)
Both of the above focus on SZ.

The prodrome is: the aura that precedes a psychotic break by up to two or three years. During this phase, people often have mild hallucinations—they might spot a nonexistent cat out of the corner of their eye or hear their name in the sound of the wind—yet they doubt that these sensations are real. They still have “insight”—a pivotal word in psychiatric literature, indicating that a patient can recognize an altered worldview as a sign of illness, not a revelation. 

Which way madness lies: Can psychosis be prevented? (download pdf)
Twitter can trigger psychosis (does what it says on the lid)
Crazy talk: we’re too quick to use “mental illness” as an explanation for violence. (those quotation marks make me very, very, very happy)
Bellwethers & Outliers Inc. (my sort of tongue in cheek take on people like us vs society) tl;dr the lunatics really are taking over the fucking asylum.

I think this is the third time I’ve blogged this video. I found it the day my psychiatrist casually informed me I’d experienced psychosis. I sent it to her and she now uses it as a resource. It’s completely reassuring. And I like badgers a lot.

A dream within a dream

Take this kiss upon the brow! 
And, in parting from you now,
Thus much let me avow-
You are not wrong, who deem
That my days have been a dream; 
Yet if hope has flown away
In a night, or in a day,
In a vision, or in none,
Is it therefore the less gone? 
All that we see or seem
Is but a dream within a dream.

I stand amid the roar
Of a surf-tormented shore,
And I hold within my hand
Grains of the golden sand-
How few! yet how they creep
Through my fingers to the deep,
While I weep- while I weep! 
O God! can I not grasp
Them with a tighter clasp? 
O God! can I not save
One from the pitiless wave? 
Is all that we see or seem
But a dream within a dream? 

Edgar Allan Poe, 1849

RAND Study Results

  Infographic from Each Mind Matters Study by RAND CorporationFiled under: About Mental Health, Discrimination, Mental Illness, Recovery, Stigma Tagged: California Well-Being Survey, CalMHSA, Each Mind Matters, RAND California Study

Well, We’ll See.

Just found out that I’m not the one selected to be in the Woman’s Day article about suicide and reaching out to others with mental disorders.  But the writer said she loved my story and would try to pitch it to another outlet, so there may be hope yet.  I’ll just have to chalk it up to not being God’s will as of yet.  So we will see.

My oldest is going on a job interview this afternoon for a summer job at a local restaurant.  I hope this one comes through.  She could use the money and she needs something to keep her occupied during the day.  She’s taking another summer class, but it’s online and goes for the full summer term so it should not keep her as busy as she needs to be.  She had a quick interview with another local eatery a few weeks ago and never heard anything back, so we assume that fell through. So we will pray that she can have an opening here–it’s owned by good Christian people who aren’t open on Sunday, so she’s excited about that.

Not much else to report–we’re having The Boyfriend over on Sunday, which doesn’t give me much time to clean up.  But we’ll manage it.  Menu’s changed to steak, mashed potatoes, green beans, and rolls since we’re having burgers and fries tonight.  I’m looking forward to it–we have her friends over a lot so it’s not unusual to have teenagers hanging around.  But this time’ll be a little different I think.

Hope everyone has a great weekend!


The Seroquel Withdrawal Blues

Let me tell you a little story (da da da da dum) About the Seroquel blues (da da da da dum) Those pills are mighty powerful stuff and they’ll make you constantly snooze (da da da da dum) Seroquel was … Continue reading

The Little Dancer

three little dancers

Is there a painting or sculpture you’re drawn to? What does it say to you?

Just for a change of pace, I thought I’d write on a prompt.

Now if you know a lot about art, this is not the post for you. I’m no expert, even though I spent thirteen years as a docent at the local art museum. (If you’re new to art, a docent is someone who “teaches” about art. In actual terms, I gave tours and talks and slide shows.)

Every Friday, for thirteen years I attended a lecture on art. And I can tell you, I know very little. The more you learn about art, the more you realize how little you know. But I digress….

I was able to go to Paris with the docents and that is where I saw the sculpture that spoke to me. It was The Little Dancer by Edgar Degas. (The above image shows three different views of the sculpture.)

I was riding pretty high during this time in my life. I had three kids, but they were very young. My mother-in-law was around a lot and she would watch them so I could go to the art museum and get out. It worked well.

So I get to Paris. And we went to the Louvre and many other “artistic” sites. But my favorite museum was the Musee’ D’Orsay. That was where I saw my first close up of The Little Dancer.

I do NOT mean to talk down to anyone about art, but some explanation is maybe necessary here. Degas made a LOT of sculptures. And these were cast over and over. So you will see and hear of “Little Dancers” in several different museums. Of course, Degas did paintings too and I’ll show you my favorite a bit below.

The Little Dancer was fourteen when she modeled for this sculpture. I don’t know how you looked at fourteen but I was a little scary. I had buck teeth with a big gap between them. I had size 10 feet. (Still do). I had no chest. So I get the idea that some people did not like this sculpture. It was too realistic for them.

Degas made this piece out of yellow wax. His eyesight was failing and he preferred the soft wax to ceramic or bronze at this time in his life. She dates between 1879-1881 and was first exhibited in 1881 at an exposition. She was not well received. People didn’t like the fact that she had “real” fabric clothing on her. She was too skinny, had a protruding belly, and showed too much jaw. Some said she looked like a monkey or an Aztec.

The French ballet was sort of an all-time low during this period. From what I’ve read, the dancers had “patrons” who supported them. I think these were patrons with benefits. Of course, this model would have been young for that sort of thing, but you get the idea.


Here is a Degas painting called The Dance Class. You can see the difference between the beautiful ballerinas here and the lowly sculpture above. This is the sort of thing people enjoyed and were used to.

So why am I drawn to the sculpture? It reminds me of my status in life at about fourteen. I was living with an abusive stepfather and had nowhere to go. I wasn’t one of those perfect girls at high school. I wanted desperately to fit in.

I’m not going to tell you my life in high school was hell. Actually, school was a welcome respite from life. I was bright and got a lot of attention for that. I was on the pom line and to some I am sure, that seemed a bit glamorous. But I was so terribly insecure. And those were the years I started alternating mania with bouts of depression. Lonely…I was lonely.

Does the sculpture look happy? Not really. She looks very sad and resigned to me. As if she is waiting for her ballet instruction to start…but her heart isn’t in it. And her clothes…they are the minimal needed for her lesson. Nothing beautiful.

I wonder how she came to be a ballerina with all of her flaws. By fourteen, I would think she’d have a better figure. (Ballerinas in those days were not stick thin.) She certainly shouldn’t have a belly that sticks out. And yet she does. She’s dressed up, ready to go, and will probably give it her all at the hands of some taskmaster.

I think ballerinas and dancers have to have a bit of mania. They have to get “up” for performances. But they also get down. That’s me.

So there you have it. My piece of art that speaks to me. Anything out there that speaks to you?


Are you even trying to get better??

This is a video called ” If Physical Health Problems Were Treated Like Mental Health Problems” also known as “Are You Even Trying To Get Better?” It is absolutely Brilliant and funny and gets the point across in such an obvious, duh, “oh my god why didn’t I realize this before” way, everyone needs to see this and internalize this! And stop asking depressed people or anxious people, or mentally ill people “Are you even trying to get better?” We also need to stop doing that to ourselves. Easier said than done, sometimes it’s difficult to realize that you are again in the grips of your mental illness. And sometimes, situational things feel like illness and it’s hard to distinguish. But we must try, all of us, the sick, the well, and even the in between. :-)

Sensory Overload

I’ve been awake an hour now. The kittens were biting my fingers demanding their gravy and crunch nom breakie, so I had to get up with them. The kid was torturing, um, playing with Pantera, so I had two whole minutes to go pee before she started in with her complaints and whining. She cut herself. I try to put a band aid on her, except she can’t find the cut now but she is still sure she’s going to lose all her blood. Then it was breakfast but she was goofing off and the cat ran off with her pancakes. The wardrobe argument was next. Not even 8 a.m. and she was yelling, “When can I go outside and play?” I told her to brush her hair, she asks, “What prize do I get if I do it myself?”

Meanwhile, Alchemy is crying because he wasn’t ready to be weaned so unless he has someone holding him or next to him, he cries. Absinthe has a cold in her eyes so I have to keep treating her, but at least she’s taking to the solid cat food finally.

Spook just keeps making noise, non stop. Nothing sensical. Just noise. Repeating the same sounds, letters, mommy, mommy, mommy. Give me this. I want that. I’ve heard Mommy twenty six times in the last hour. It’s like being poked with a stick.

The car is on E. I may have enough gas to get her to school and me to my dr appointment tomorrow. The housework remains undone. My eardrums feel like they are about to burst from too much input. I want to scream and swear and I think it may be time to get out my voodoo stress doll and stab it with enormous sewing pins.

I read a blog post about the DSM 5 and it (the DSM) gives me fucking headaches. We are all doooomed. If you don’t fit some neat little box of symptoms, which by the way, changes every single year, then you’re not getting a diagnosis and basically they’re just shoving pills at you while gathering around the water cooler and laughing about how everyone thinks they’re bipolar or depressed and we’re all just delusional losers…

What can I say. Some days I handle the sensory overload better than others. This is not starting out well. The kid is bawling that brushing her own hair makes her legs hurt.  I don’t even know what that means…

THIS. This is why people drink. Get me a fucking pill that can slow my mind and dull my sensitivity to noise enough to handle this shit called life, and I will never take another drink in my life.

It sucks to not be able to feel anything good and yet the bad stuff is in my bloodstream, making my eardrums cringe, putting my fight or flight alarm on red alert.

Meh I had a good two day run of not being a lunachick. But it was only two days so I’m not bipolar one or two, or psychotic, or maybe all my symptoms are because I smoked a joint back in 1999 or ate mac and cheese with fatal orange food coloring in it…

So tired of jumping through hoops. There is something wrong with me, and I don’t give a damn what they want to label it. It’s not my personality. I think anyone whose kid yells at them for ten solid minutes and they ignore it and it still keeps going…Yeah, that’s gonna aggravate the steeliest nerves, let alone someone who’s fight or flight response is a raw nerve.

I know I should probably just draft this because I’m showing just how erratic and nutso I can get and I will probably not be in this place a couple of hours from now but I think it’s important to show the good, the bad, the REALITY. And for those of you who are behind in reading and apologizing for not being able to keep up…Don’t worry about it, I post a lot, I know. But I’d get systemic poisoning if I didn’t vent this shit regularly.

Now…Today’s anthem…

The Long & Winding Woad

It's the leaves that make you blue, not the flowers

It’s the leaves that make you blue, not the flowers

“Our ancestors were not stupid.” – A friend

The things that comfort me at times of trouble may seem strange to some: a Youtube clip from Doctor Who. The way a crow lands in the local park, when I’m walking home from work. My rat, swearing like a tiny, rodent Father Ted. (1) The excitement of waiting for the first foxglove to bloom.

Or this chap, and his insubstantial friend:

Male blackbird and his flighty friend

Male blackbird and his flighty friend

I’m blogging whilst waiting for my care worker to make a significant – to me – visit about moving me one more step along that service user’s highway. It’s a step I’ve attempted before, only to fumble, stumble, and crumble to bipolar bits.

It’s not as though the highway has been smooth, or I haven’t fallen on my rather substantial arse many a time. But – unless I’ve had one of those terrifying “blank” bits, such as at the heights of mania – I haven’t broken any laws, or limbs.

Mine, or anyone else’s.

As usual, I have enough plans and projects to stuff several crane-skin bags: coursework; paperwork to finish & post; a short story collection to complete, and publish; and a novel to finish, and send for a critique. Plus, of course, work, and my little family of husband, a pet rat, and a Dalek.

Not, perhaps, the “hard working family” beloved of politicians’ speeches. Still, with the exception of the rat, and the Dalek, we seem to be keeping fairly busy.

I found myself thinking (2) this morning, as I was feeding and watching the birds, about blackbird’s place in Celtic myth. As I understand it, he is the first of the “Eldest” animals. The others, in order of age, are Stag, then Eagle, and finally Salmon.

Protected by green

Protected by green

As a disorganised Pagan who is obsessed with reading and telling stories, I sometimes interpret life through such myths. Does it matter if I never progress past blackbird, in my quest for knowledge? For wisdom? If the moment when I finally meet the salmon in the pool never actually happens?

We live in a time of sound bites, and limited attention spans. Of slogans: though, gods know, those have been around for years.

Anyone else remember: “Keep on truckin’”? Or, if you want something both old, and new, how about: “Keep calm and carry on”?

Hmm, I don’t think so, either.

What about: “Stop, and watch the blackbird” ?

That’ll do.

For my less reflective moments, there's always tea, and cake.

For my less reflective moments, there’s always tea, and cake.

(1) Some would say my rat doesn’t swear: I do. Well, feck that.
(2) Always dangerous!

check check, bipolar 1, 2…

There’s so much outdated information and misinformation out there about bipolar that either ignores or misinterprets the changes from DSM IV to 5 (bizarre to change the numbering system of the whole thing too, innit?). The difference between bipolars 1 and 2 is the thing I find most vague and variable online, so I looked at the diagnostic criteria first.


||source|| (well worth reading)

I always need to break stuff like that info right down.

My simple understanding of the differences between Bipolar 1 and 2 from the above is as follows:
Bipolar I: mania, possible mixed episodes, 
Bipolar II: hypomania, no mania or mixed episodes.

And the commonalities:
Major Depression.
Mood symptoms not due to Schizoaffective Disorder, or part of other disorders such as Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder NOS.

The above helped me understand how and why I was diagnosed, as well as the reasons for the initial diagnosis being Bipolar II. I presented with Major Depression initially, as well as early signs of psychosis (low volume constant music auditory hallucinations). Once I’d worked out that I’d had previous psychosis stretching back to the late 90s at least, my psychiatrist updowngraded the diagnosis to Bipolar I. As the months went by, some more labels were slapped on. Rapid Cycling Bipolar I with Mixed and Psychotic Features.


Having received the first Bipolar II diagnosis while experiencing those early signs of psychosis, I was puzzled by all the info I found telling me that psychosis is a Bipolar I thing. So was early psychosis possible in Bipolar II, while full blown psychosis was Bipolar I, or what? Obviously I googled.

Part 1: Bipolar with Psychosis
Bipolar disorder is an illness that affects a person’s ability to regulate their moods. The two main mood swings are mania and depression and most people familiar with the illness have at least a basic understanding of these two symptoms. But when it comes to bipolar psychosis, knowledge can be limited and this very complex and very normal part of bipolar disorder is often underreported or missed until it’s too late. One reason for this is that there are still many people who don’t know that psychosis is common for people with Bipolar I (one) during manic and depressive episodes and is often present in Bipolar II (two) depression as well. But the main problem is that the general public has such a distorted view of bipolar psychosis, it’s difficult to find real and helpful information regarding this fascinating and often very destructive symptom of bipolar disorder.

For those who desire the srs bsns side of it, this is for you.

But there’s a ton of info that says that psychosis is only present in Bipolar I, so wtf is the reality? I googled for results within the past year and found more precise explanations, which confirmed and expanded upon the above. For example (there are many more) …

Psychotic symptoms are often present in the mania of Bipolar I disorder. The symptoms can also occur during depression and in many other disorders. The presence of psychosis automatically rules out a diagnosis of hypomania. Thus, people with both Bipolar 1 and Bipolar 2 can experience psychosis, but in Bipolar 2 they only appear during depressive episodes.

*Oprah voice* Eeeeeeeverybody’s getting psychosis!!!

(O joy, o rapture etc.)


Anyway, I thought I’d hunt down another sensible analysis of it all. One site did well until it included Bipolar NOS, which was one of the changes, there were other sites that did far better, but I thought a more academic approach might be the way to go, so here’s what the International Journal of Bipolar Disorders has to say, and it’s by a Swiss dude with the best name for his field ever – click the link for the full article. One thing I like about it, is that it points out some shortfalls in the Disturbing Specifications Manual.

From Bipolar disorders in DSM-5: strengths, problems and perspectives, by Jules Angst.

The main lines of the DSM-5 definition of major depressive episodes (MDE), basic to the diagnoses of both bipolar I and bipolar II disorders, are similar to those of DSM-IV: presence of five of nine diagnostic symptoms with a minimum duration of 2 weeks and a change from previous functioning. However, it is now possible to specify both depressive disorders and bipolar disorders with mixed features.

The definition of both manic and hypomanic episodes have been radically revised, which will impact on both bipolar diagnoses. The main changes are three: (1) a problematic change concerning the gate questions (criterion A), (2) a welcome reduction in the number of exclusion criteria and (3) a vigorous effort to operationalize bipolar subthreshold syndromes, hitherto unified under the NOS heading.

Gate questions for mania and hypomania

Where DSM-IV required, as criterion A, the presence of one of the two mood symptoms (elation/euphoric or irritable mood), in DSM-5, ‘the mood change must be accompanied by persistently increased activity or energy levels’. This new rule is, of course, more restrictive and excludes all individuals who report only one of the three entry symptoms and those with both elated and irritable mood. Thus, for no apparent reason, DSM-5 classifies some patients as having subthreshold bipolar disorders who would formerly have been diagnosed with manic episodes or bipolar I or II disorders. This strict new rule is not based on data, indeed it contradicts available evidence. As the international Bridge Study of 5,635 patients seeking treatment for major depressive episodes demonstrated clearly, any of those three gate questions is valid on its own, according to the criteria established by Robins and Guze (1970) and Angst et al. (2012).

Exclusion criteria

One important and amply justified change in DSM-5 concerns the diagnosis of bipolar II disorder. In DSM-IV, the change of major depression into hypomania under antidepressant treatments (ADs) was in principle an exclusion criterion. In DSM-5, that change – provided it persists at fully syndromal level beyond the physiological effect of the treatment – is explicitly a criterion for bipolar II disorder. DSM-5, like DSM-IV, allows some scope for clinical judgment as to causality. In addition, DSM-5 provides new formal criteria for substance/medication-induced bipolar and related disorder.

On the basis of the Bridge Study data (Angst et al. 2012), we can estimate that DSM-5 bipolar II disorder will be diagnosed about twice as often as heretofore and have a prevalence approaching that of bipolar I.

A more frequent diagnosis of bipolar II disorder is both justified and logical: a milder condition (in this case hypomania) is usually more prevalent than a severe one (mania). Over the long-term course of their illness, bipolar patients spend much more time in milder conditions, mainly minor depression, than in major syndromes (Phillips and Kupfer 2013).

Two exclusion criteria survive in DSM-5, namely ‘substance/medication-induced bipolar and related disorder’ and ‘bipolar and related disorder due to another medical condition’. Both clearly rely on questionable causal attributions based on partial co-occurrence with substance or medication use or full co-occurrence with another medical condition.

Other specified bipolar and related disorder (DSM-5)

DSM-5 has fortunately replaced DSM-IV’s vague group NOS by defining MDE with several subthreshold conditions of bipolarity, for instance, allowing a duration of 2 to 3 days for hypomanic episodes, as suggested by child psychiatrists, or fewer than four symptoms of hypomania during 4 days, or, for cyclothymia, specifying shorter manifestations (more than 24 months). A further important step is the recognition that dysthymia can co-occur with hypomania which is considered as a co-morbid condition, but why – one might ask – is it not allocated to cyclothymic disorder?

Depression, Ugh!!!

My comment (below) to a post I read about a blogger who is feeling severely depressed, yet is afraid to tell anyone, and this blogger doesn’t have a doctor!

“It sounds like you are suffering from severe depression, that’s what depression does, it makes you feel like a shadow of your former self :-( I also read you post “————————” Please see a psychiatrist, they can help you. I have bipolar disorder, but with medication, I am living a good life, with ups and downs, yes, but still good. There is help for you, the test results were not a slap in your face, they were just telling you that you are not well at the moment. It is not your fault that you are depressed, it is an illness! And guilt and feeling awful are a part of this terrible illness. I am so glad that you are not even thinking about suicide, that shows how strong you are! Please go see a doctor and tell them how you’re feeling, they will help you. Best wishes for a speedy recovery. xxxxoooo”

God! Depression! What it makes you feel like. Like you’re nothing, like it’s your fault you’re feeling depressed, the guilt is overwhelming. It makes you feel like a failure, you feel like nothing, you haven’t amounted to much, and you’re never going to amount to anything. This evil disease, it robs you of your personality, your joy, your optimism, even your will to live. I feel awful for this blogger, I will keep an eye on them and keep encouraging them to seek help. In my deepest, darkest, abysmal depression, a song saved me, my aunt saved me, my psychiatrist saved me, my medication saved me, and ultimately I saved myself. I hope so much that this blogger will be able to save herself. And if I can offer her any words, comfort or advice that will help her, I will be overjoyed. Each of us is so precious. There will only ever be ONE of you, one of me, one of any of us. That, all by itself, is a miracle. With help from each other, we can and will be saved. In the face of depression, a song, a word, a friend, a doctor, help from even a stranger can turn it around. Have faith, at such a faithless time, be strong, even at such a weak time. You are not weak, it is your depression making you think you are. Don’t listen to it. Stay strong, get help, and live and shine like the unique, joyous, loving and beloved human being you are.