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.

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.