Oh, Oh, Where'd You Go, Psychiatrist?

[Warning:  self-reflective diatribe ahead]

In looking back over previous posts, it occurs to me that way too many of my titles are in the form of a question.  Maybe I watch too much Jeopardy!, but I think the larger reason is that a lot of my posts are, indeed, questions.  When I teach Freshmen Composition, we learn that one way to "enter a conversation" about a specific topic is to raise questions about what has already been said in that conversation. For example, if you wanted to write a research paper on inane children's TV programs, you could say, "Experts believe that The Fresh Beat Band helps children learn about music and friendship.  But who are these experts?  And why isn't anyone beating them with a sock full of pennies?"

He he he -- guess someone else hates Twist too!

(Sorry, I hate The Fresh Beat Band.)

Anyhow, that's how I sort of view this blog:  an attempt to enter the conversation about mental health care and mental illness (and knitting) through question-raising and providing jumping off points for new conversations.  Of course, that's very ambitious, and I know that it takes a lot more than one loser posting random rants about Nick Jr. TV shows, but I'm trying.

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ANYHOW, on to the real topic of this post.  I got a letter in the mail this week informing me that my psychiatrist -- the one it took me months to find and get an appointment with this past winter -- is leaving private practice to work at a local University.

Well, shit.

Good for her and all, but what the hell do I do now?  This winter, when I needed a doctor, I honestly asked anyone that would listen who I should go to for psychiatric care, and nobody (read:  NOBODY) had any good suggestions.  I've been through several therapists and psychiatrists already, and have heard various negative things about more doctors in the area. Let me say, pickings are slim.  For heaven's sake, my OB-GYN's office was calling me to recommend a psychiatrist for a patient a month ago.  That should speak volumes about the number of doctors in the area.

I went through a lot of blood, sweat, and tears to try to find a doctor this past winter, and now it seems I have to start the whole process over again.  Not only am I unhappy about it, I'm a little overwhelmed.  And pissed.  I know there is no benefit to being angry and upset, but I can't help it.  I'll get myself together and try to start making calls in the next day or two, but right now, I'm just going to let myself wallow in the injustice of it all.

Okay, that's a little dramatic -- how about if I just let myself rant?  Damn you, doctor!  Damn you, mental health care system!  Damn you, Dayton, Ohio!

I feel a little better now.  On with the show.

Surgery anxiety? Knit it away!

Last week, I mentioned that I had to have my gallbladder removed.  Because I was getting stressed about the surgery (I also mentioned in a post that I was diagnosed with medical PTSD a while ago), I started knitting.

I haven't really poured myself into a project in a while.  Maybe it's because I have three little kids running around, who are fascinated with pulling the stitches off the needles (or "noodles," as my two year old calls them).  Or maybe I've just been lazy.  Or whatever. 

No matter.  To deal with the anxiety, I started a cool knitting project.  I wanted to make a scarf, but I have about a billion scarfs, so I wanted something different.  I found this pattern on knitty.com, which is an ultra-cool site that has a lot of nifty patterns. The scarf is worked in entrelac, and I've never worked a pattern in entrelac, but it's not nearly as difficult as it looks.  

The pattern also works great with some yarn that I bought that had no specific intention for, a new line of yarn (I think it's new) by Vickie Howell, the host of the show Knitty Gritty.  I can't find the wrappers for the yarn, but I think it's the "Love" line.  I got it at JoAnn Fabrics for like, $4 a skein, so the price was right.  I'm not sure yet how many skeins I'm going to need, but I don't think it'll be more than 6 or so.

The gallbladder surgery went well, so hopefully my anxiety will start to abate.  Til then, though, I'll just keep working on my scarf.

Mental and Physical Illness: What's the Link?

Tomorrow, I am to have my gallbladder removed because of some serious pains I've had over the past two or three months. I'm not looking forward to it -- let's face it, who looks forward to surgery? And in light of the surgery, I've been thinking about the link between mental and physical health.

A happy little green gallbladder

Doing a little research on the internet, it looks as though quite a few studies have been conducted on the topic of physical health in patients with schizophrenia. This article concludes that schizophrenic patients have more physical illness problems than those without schizophrenia.  It's not clear from the article, though, if schizophrenia causes the physical illness, or the other way around.

This web page from the UK talks about the link between depression and physical illness, discussing how physical illness can cause mental illness.  There's an entire book which is a collection of essays about the link between the two, called Depression and Physical Illness (Amazon.com has it listed at $108, so I wouldn't recommend picking up a copy).

Anybody that watches TV knows that there's also a link between depression, anxiety, and fibromyalgia.  Doctors consider depression and anxiety to be a symptom of fibromyalgia, And this study discusses a link between rheumatoid arthritis and depression.

I guess my question is, which comes first?  Is mental illness (depression, bipolar disorder, schizophrenia) more likely to cause physical problems, or vice versa?  With depression, it seems like it could be obvious:  you feel like crap physically, so mentally you start to feel like crap. In my post about World Mental Health Day, I mention that doctors estimate upwards of 50% of cancer patients suffer from depression.  Well, I'd be depressed, too, if I had cancer.  

Of course, physical illness isn't the only reason people suffer from depression (and sometimes, there is no reason -- it's an illness all to itself).  But is is possible for chronic mental illness to cause chronic physical illness?

I know in my own experience, when I am in a bad phase, I definitely tend to neglect myself.  I don't eat right, I don't exercise, I sleep a lot, I avoid doctors (and pretty much everyone else).  Inevitably, this kind of neglect leads to physical complaints.  I usually get headaches, muscle aches, and stomach problems associated with my depressive episodes.

I wonder, though, can the mere fact of having a mental illness can be linked to physical illness?  Like, are people with chronic depression more sensitive to pain?  We always hear about neurons in the brain being blamed for depression -- is it possible these neurons that are "faulty" could be causing physical pain, too?  Or, if I'm bipolar, could my weird chemical shifts that cause it also cause shifts in my physical feelings as well? 

Admittedly, I could probably do some deeper research to answer these kinds of questions right now.  And maybe later I'll look into it.  But I feel kind of lazy at the moment, so I'm just sort of reflecting. 

And, for the record, I don't think my anxiety or bipolar depression caused my gallbladder problems. 

I blame my kids.

World Mental Health Day: Where's My Ribbon?

Happy World Mental Health Day! 

Yep, today is World Mental Health Day, designed to "raise public awareness about mental health issues" (per the World Health Organization).  Incidentally, it is also Columbus Day and World Homeless Day.  And, unless you live under a rock, October is Breast Cancer Awareness Month, designed to raise awareness (and raise funds, and sell pink crap) for breast cancer.

I'm not saying these other issues aren't important -- well, maybe I am saying that Columbus Day isn't that important, except to people who get off work and school because of it -- because, let's face it, cancer and homelessness are both major concerns in our society today.  In fact, if most people had to prioritize, I'm sure that cancer would be number one, homelessness number two, and mental health number three.  And I understand that.  But let's look at statistics.

According to the American Cancer Society (cancer.org), almost 570,000 people died of cancer in America in 2010, and a little over 40,000 of those deaths were from breast cancer.  Incidentally, lung cancer comprised 157,000 of those deaths, and I don't see a month dedicated to that.  You can see all the statistics here. 

Turning to look at the stats on mental health, this interesting article from the founder of PsychCentral.com, Dr. John Grohol estimates that around 33,000 people die each year in the world of untreated mental illness.  That statistic may be low, too, because there's little information from third-world countries about mental illness mortality.

Though it's hard to find hard statistics on homelessness and mortality, it isn't hard to find statistics on the link between homelessness and mental illness.  According to the National Coalition for the Homeless, as many as 25% of homeless people are mentally ill -- compared to 6% of the general population.

Lastly, in a big "well, duh" statistic, this snippet from the National Alliance on Mental Health reports that experts estimate upwards of 50% of cancer patients suffer from depression, anxiety, and other serious mental health issues.

That's a lot of statistics, and it's obvious that cancer kills a lot more people a year than mental illness does.  But we also have consistent, pervasive awareness of cancer, and a buttload of funds going to cancer (well, at least some types of cancer), every year.  And if someone learned they had cancer, I can guarantee that it wouldn't take them three months to get in to see a doctor, and they wouldn't have family members telling them that it's all "in their head."

Out of curiosity, I did a google search for "October 11, 2011" and nothing about World Mental Health Day came up.  A lot of stuff came up about Judgement Day (should that be capitalized?) and the end of the world, which I'll have to read about later.  But as far as awareness goes, I think the US has a long road ahead.  Mental illness isn't sexy.  Nobody has a "Bipolar Disorder 5k Fun Run."  Very few people, if any, have a "Mental Illness Awareness" ribbon stuck to their car -- let alone their water bottles, wrist bands, or Swiffer Sweeper refills.  In fact,  I'm not even sure there is a mental health awareness ribbon; a google image search for "Mental Illness Awareness Ribbon" comes up with multiple colored ribbons -- some blue, some green, and hey, even a pink one comes up. 

Just because there are no ribbons, no fun fund-raising events, and no pervasive marketing for it, mental illness is still a very real problem in this country and world-wide.  I guess we don't need a ribbon to understand that fact.

Postpartum Post-Traumatic Stress Disorder

When I was pregnant with my first daughter, I dutifully read my baby and pregnancy books.  Anyone who has read any of these books knows that they totally freak you out -- in the "potential complications" chapter (or whatever the chapter is called) the book always details horrible problems that could occur during and after delivery for both mom and baby, like "your uterus will rupture and then attack the nurse" or "your baby will be born with a full set of teeth you'll need to diligently floss."  And, even though these complications were rare, like most first-time mothers, I visualized all these scenarios with horror.  I began to think maybe the old-fashioned method of just knocking the mother out during delivery was not a bad idea.

One potential problem that I remember reading about, though, was postpartum post-traumatic stress disorder (PTSD).  I remember thinking, "How the hell could having a baby be so traumatic?  People have been doing it for a long time."

Oh, how very innocent I was.

I had a traumatic birth, but I'll omit the gory details.  And I didn't realize till maybe a year later that I did have PTSD as a result.  Every time I'd drive by the hospital where my daughter was born, or come anywhere near the office where my (I-can't-stress-enough former) OB-GYN was, I'd have panic attacks.  I also had serious postpartum depression, and I do, in retrospect, attribute at least some of the cause to PTSD. 

It turns out that an estimated 1-6% of women have postpartum PTSD, according to Postpartum Support International.   Some of the causes could be unplanned c-sections, forceps or vacuum extraction (both of which I had), and/or problems with the baby.  (See the NIMH page on PTSD here.)

Most people associate PTSD with people who have been in war zones, or victims of violent attacks.  That's what I thought.  I honestly never thought, when I was looking through all those "potential complications" in the baby books, that I would end up with PTSD from childbirth.  (Neither did this woman, whose story on Salon.com is engrossing).

Recently, a psychiatrist suggested I had medically-induced PTSD, as a result not only of my birth experience, but other hospitalizations since then.  In my last pregnancy, I was hospitalized a whopping four times, once in the psychiatric unit and three times in the perinatal unit.  And if you were wondering, the perinatal unit had WAY better food -- and, surprisingly, a lot less moaning. 

A google search for "medically-induced PTSD" doesn't really turn anything up, so I'm not really sure if this is a legitimately recognized condition, or if it's more like saying "you have chicken-induced PTSD," if you were attacked by a chicken.

Regardless if it's a real condition or not, though, I've seen a lot of doctors lately -- body ones, not brain ones -- and my anxiety level is definitely starting to go up.  And, frankly, I'm annoyed.  I have a lot of other sh*t to deal with, but medical PTSD isn't one I need.  I'm starting to wonder if it's too late to go back and sue the doctor that delivered my oldest daughter.

But then I'd probably end up with "legal PTSD," and I really couldn't handle that.

Antidepressants and anger

About a month or six weeks ago, I had the opportunity to join a DBT (Dialectical Behavioral Therapy) session at a nearby hospital.  I went in for the initial assessment, but ultimately decided not to do it.

There were a few reasons why I decided not to participate, not the least of which is that I'm lazy and have commitment issues and couldn't see myself hauling across town every single Tuesday for the next six months.  There was another, more specific reason, though, that doesn't have anything to do with my personal shortcomings.

During the assessment, the therapist was asking about anger, and what happened when I got angry, and how I coped.  One of the most significant and consistent benefits I've noticed about antidepressants and mood stabilizers, essentially since I started taking them almost ten years ago, is that my anger episodes have all but disappeared.  I still get angry, but it's more mild irritation than blinding rage (except when we're talking about the people putting the new roof on my house, but that's another story).

I used to get so mad, it would be hard to see; I'd stammer and get all shaky.  I'd throw things (shoes were my favorite thing to throw, I don't know why) and slam doors.  It was ugly.  And, seriously, when I started on medication, those episodes sort of floated away.

This brings me back to the DBT assessment.  The therapist asked what happened when I got really angry, and I told her I used to have serious anger problems, but since I started antidepressants and mood stabalizers, those episodes went away.  She looked at me in a kind of condescending manner and said, "Well, I can tell you, medication rarely helps manage anger.  But therapy can."  She then moved on to the next part of the interview.

Now, I'm sure she's much more well-versed in all this kind of stuff than I am, but I know for a fact that my anger has lessened a lot since I started my meds. I guess it could be a coincidence, or maybe just mellowing out with age, but it seems awful odd that the two would coincide so completely and not be related. 

That's about the point I lost a lot of confidence in the DBT program.  I got the feeling it was going to be a "meds are bad, therapy is good" kind of situation, which isn't totally a bad thing; but what's more, I got the impression that I was going to be told my perceptions of my situations were "wrong," and that the therapists and facilitators are "right."  And let's be honest; if I wasn't wrong about a lot of my perceptions, I probably wouldn't need DBT.  But I'd like the facilitators to at least listen to me and not dismiss my ideas out of hand because they didn't fit with their notions of therapy or treatment.

In retrospect, maybe I was too quick to judge the situation.  I have learned, however, if I get a certain "vibe" or feeling about something, it's often right -- no matter how quickly I get that feeling. 

I think I made the right decision.

Or maybe I am just really lazy and didn't want to haul all the way across town every week.  Whatever.  At least I'm not going to get mad about it.

Will another mental health facility help?

Last week, I wrote a post about the lack of mental health care both in Dayton, Ohio, and in general.  An article from the Dayton Daily News today discussed the grand opening of a new psychiatric hospital in the area, which sounds like a step in the right direction.

Or is it?

Access Hospital Dayton is a for-profit facility, opening where a state hospital (Twin Valley Behavioral Health Center, or TVBH) used to be, until it closed in 2008.  It is run by a private company, owned by two psychiatrists.  It will have 28 beds initially, and the director hopes to expand to over 100 when it's all said and done.  I can't find a website for it (which doesn't mean it doesn't exist, but it's not obvious), and all the information I'm getting is coming from the DDN and from the Dayton Business Journal.

The facility will not take anyone on Medicare or Medicaid; it will only take patients with private insurance that will cover the costs, or patients who are willing to pay for the care themselves. It sounds like, from the Dayton Business Journal article, the owner plans to expand to accept Medicare and Medicaid, but that's a future plan.

[Side note:  In my opinion, 28 beds sounds pretty paltry, so I tried to do a comparison.  I looked up the Linder Center of Hope, a facility down in Mason, Ohio, that I visited (ha, sounds so pleasant) this spring.  It has 48 acute inpatient rooms for adolescents through adults, and has capacity for 16 people to stay long-term in their Sibcy House.  They also have various outpatient programs.  And they take Medicare and Medicaid.]

Maybe this is good news for Dayton.  We need mental health care, and that's 28 beds that Dayton didn't have before, right?  Well, at least since 2008, when the TVBH closed down.

And that's where things get a little more grim.  TWBH was a state hospital, and had an over 100 bed capacity.  They were a state hospital, so they took Medicare and Medicaid.

What's also significant is that over half of their patients at the time of their closure were forensic patients -- that is, people who were in some phase of the criminal justice system.  Now, those patients will either be transferred for care out of the area -- if care can be found -- or shuffled back through the criminal justice system.  Or, worse yet, released without treatment back into society, sure to end up back in front of a judge at some point.  (Statistics come from an articled called "Reopening of Mental Hospital Won't Help Uninsured Patients" from the Dayton Daily News -- may not be available when you click on it).

According to the National Alliance on Mental Health, "64 percent of local jail inmates, 56 percent of state prisoners and 45 percent of federal prisoners have symptoms of serious mental illnesses" (From "Department of Justice Study:  Mental Illness of Prison Inmates Worse than Past Estimates").  

It's been proven, then, that there is a high percentage of mentally ill inmates, and it's no secret that Dayton's crime rate is pretty bad.  From neighborhoodscout.com:

• Dayton's "Crime Index," with 100 being the safest, is 5 -- this means that Dayton is safer than 5% of the cities in the country
• An individual's chance of being a victim of violent crime in Dayton is 1 in 98; in Ohio it is 1 in 287
• The murder rate per 1000 people is .21; the national average is .05
• Note:  all these stats are from neighborhoodscout.com:  click here to see how they got them) 

Is there a correlation here?  I have to think there is.

So, hip hip hooray that a new mental health facility is opening in town.  Obviously, Dayton (and the country in general) needs all the help it can get.  But, contrary to their name ("Access Hospital"), this facility won't serve the segments of the population most in need.

I guess we still have a ways to go in mental health care for the area, and the country.