Thursday, December 22, 2011

Psychiatric Synergy

I've been thinking a lot lately about psychiatric synergy (for lack of a better term).  In other words, when are you merely a collection of symptoms, and when are you something greater (or worse, as the case may be)?

For example, when I was hospitalized last month, I went through the admission assessments, as always, to figure out what to put on the admissions forms for diagnosis/reason for admission.  One symptom I had been displaying at the time that was a little bit odd for me was excessive irritation and anger.  My "breaking point" was very low, and it didn't take much provocation for me to lose it and have a full-on temper tantrum.  At one point I got angry at one of my kids, and I inexplicably took it out on the freezer; before I knew what I had done, I had emptied the freezer in one manic tantrum, its contents strewn all over my living room.  There were peas everywhere, and my husband found a package of butter two weeks later behind a chair.  On a positive note, my five year old painstakingly picked up all the peas without being asked, and it kept her busy for quite a while.

In general, I'm not prone to tantrums, especially since I started taking antidepressant and antipsychotic meds.  So when I was being admitted to the hospital, I felt the need to mention this incident and a few other similar incidents to the admitting nurses.

I'm sure that psychiatric nurses and psychiatrists are trained to be facially neutral when talking to patients, but it seems like there are a few "key words" that make them light up like a Christmas tree when they hear a patient mention them.  "Tantrum," "rage," and "anger" seem to be some of those words.  They hear that I have a problem controlling my anger and it's like a big checkmark on a mental list, and you can almost feel them tuning out anything you have to say after that.

Now, I agree that trashing my kitchen is a little bit of a red flag that something is wrong.  What bothers me, though, is the fact that nobody bothered to ask what else was going on in my life.  I was trying to potty-train a three-year-old; trying to deal with two kids' birthdays in three weeks, still recovering from gall bladder surgery, gearing up for Christmas, etc.  In other words, I had a lot of other stress-inducing incidents going on in my life, so maybe it was premature to chalk everything up to mania/hypomania/mixed-mania-depression.   But the nurses seemed to seize on those incidents like dogs with bones.

This isn't the first time something like this has happened, when I dropped a "keyword."  Just mention either of the words "adopted" or "divorce" to a psychiatrist, and you can see the mental gears clicking into place.  Add in any--even minor --issues with alcohol, and you'll be lucky if you ever get out of that office.

I don't deny that our experiences make us who we are; but why are some of us "mentally ill" and others are just "stressed out parents"?  I know a lot of people who would have temper trantrums after telling a three-year-old to sit on the toilet, then five minutes later having to clean poop out of her underwear for the umpteenth time.  Why do I get stuck in a mental health facility for a week and get my brain zapped with electricity, and other people get taken out for sympathy margaritas?  I admit, I was the one who brought up the incidents, who told the nurses about getting angry.  Perhaps what is most telling was that the incidents bothered me -- I didn't like trashing my kitchen, I don't like yelling at my kids.  But, for better or for worse, I have three little kids, and they can be irritating.  What level of irritation is "normal" and what is cause for concern?  Some days I wonder how any mother of little kids can get through a day without a serious dose of Xanax.

Part of me thinks that the fact that I am concerned about the incidents means that I've got at least a marginal grip on reality.  Isn't that was Lucy says to Charlie Brown in A Charlie Brown Christmas?  Something about "as they say on TV, the fact that you think you need help means that you're not too far gone" (I'm paraphrasing).  But it annoys me when every little personality quirk or flaw takes on heavy meaning, when maybe it is just what it is -- a bad day, a bad minute, an overstressed instant.  It's like I can't lose my temper without it taking on some huge meaning.

In other news, I have my last "acute" ECT treatment tomorrow (which means 3X a week).  After that I'll probably start on "continuation" treatments, which  means once a week for a month, then "maintenance" treatments, which is once a month for a while.  I'm really, really looking forward to being done with these things.  I do think they've helped, but they're a monumental pain in my ass (and head). 

And I finished another Kuku doll, and am currently blocking my headwarmer.  I had been meaning to make myself some fingerless gloves for a while, but I was at the Gap last night and found a cute pair or cable-knit gauntlets for $8 -- I couldn't buy yarn for that amount of money.  So, Merry Christmas to me.


  1. I find it odd that you posted about this as my partner and I were talking about it last night. It's like if I have a bad minute, or get overwhelmed or frustrated than thats it - its because Im depressed, its because Im bipolar - its because of my mental illness and not because its just a personality quirk, and its not because I have any real reason to be. As a result I give up on me, or the moment, or the day - and as does my partner and its even harder to recover from those episodes. Its tough - historically, when I'd have a rough moment that would be the end of my day so I can see where she is coming from.
    When is the disease acting up, and when is it something else? When do we become more than our illness, and more than our treatments?

  2. Exactly! If we didn't have this over-arching issue, it would be, "oh, I had a bad day." But since we have this label, it's like "oh, no, I'm sliding into a depressive/manic phase and it's all downhill from here." Maybe the bottom line is we have to be more forgiving of ourselves, I don't know. I just know that label makes things a lot worse.

  3. Glad to have found your blog.
    I'm bipolar too.
    Recently I had a VERY low spark point, resulting, after a stressful week, in a big blow up at a wedding. AAARGH! Can't bear big occasions like that, but couldn't get out of it. It was my brother's wedding and he and I ended it by shouting and swearing at each other and me storming out. OMG. Then I'm left thinking, is that the real me?

    Hope your Christmas is going well :)

  4. Amy, Hope you had a great holiday and you are doing okay. Happy New Year!

  5. Same to you, Stephana! Also, I haven't forgotten your book, I just haven't gotten to the post office to send it yet. Soon!

  6. Thanks for posting this Amy. My friends and I discuss this often too: when is it part of coping and when is it something else. Distinguishing between mental health and typical adjustment is messy and makes me wish that it was easy as a lot of physical health concerns: easy to tell when someone has a twisted ankle or a broken one.

    Keep on keeping on!