Major Depression on World Bipolar Day

Your diagnosis is major depression. So what does World Bipolar Day have to do with you?

I mean, what a relief to just have major depression, right? Isn't bipolar another level of crazy? Well. . .

First, a reality check. Whatever level of crazy you are now, you can call it whatever you want, your mental health struggles will not get worse if your diagnosis changes. Actually, you might get better. I'll get back to that.

Second--and why people who are diagnosed with major depression should be paying attention--half of those with severe MDD eventually are diagnosed with bipolar. So, your chances of having the wrong diagnosis right now are 50/50. A 50% chance that you are taking antidepressants that are not working, or will stop working, and meanwhile are making your prognosis worse.

What?!? I mean, WTF?!?

Doctors have all kinds of explanations for this diagnostic failure. But when I was in grade school, people who scored 50% got a grade of: F.

But they have their explanations. The list starts with: Bipolar is hard to diagnose. That's it. This test is just too hard!

They continue with reasons that basically make it the patients' fault. Not that they are blaming us. It's just that our behavior is responsible. Not theirs. We fail to make an appointment when we are exhibiting symptoms of mania/hypomania. We don't report our symptoms. We fail to give the right answers to their questions.

Now, all of that is true. When we feel good, it does not occur to us that we have symptoms of bipolar. We tend to think that the doctor's treatment is working. When we are in the doctor's office, we don't remember feeling good. We don't give the right answers to questions we don't understand. When my doc asked me, "Are you manic?" I said, "I'm not manic. I'm excited!"

Framed from this perspective, identifying the problem as the patients' responsibility, there is an answer. Patients just need to become doctors! We need to study up on bipolar and how it manifests before we ask doctors to diagnose us. If we would only diagnose ourselves, then we could answer the doctors' questions. And they could improve their grade.

I mean, WTF?!?

The thing is, the correction has been sitting in the literature for two decades. The research gives doctors plenty of tools to better their grade without having to find better patients. As I have been checking and rechecking the bibliography of my book, I tear my hair out at the dates of these articles, 2003, 2006. . . Today I will name three ways that doctors can fix their grade.

First, the Structured Clinical Interview for the DSM is structured wrong. The thing works like a tree. The doc asks a series of questions. If the answer is yes, the doc continues along that branch of the tree with more questions. If no, that branch is lopped off and the doc explores a different possibility.

The stem question for bipolar is about mood. Have you ever had an unusually elevated or irritated mood for an extended period of time? Or as my doc put it, Have you been manic? Almost inevitably, the patient answers no, and they move on to unipolar depression.

BUT, if the first question is about activity, Have you ever had a period when you got a whole lot more done than usual? people do remember and are able to acknowledge overactivity. The interview continues and indeed, lots more people who have bipolar are diagnosed with it in time to treat it and limit its damage.

The other two ways actually are how patients can protect themselves from misdiagnosis, self assessments: the Mood Disorder Questionnaire and the Bipolar Spectrum Diagnostic Scale. They get permanent place of honor at the top of my blog, under Screening Tools. In an ideal world, the docs would use these diagnostic tools before giving you an antidepressant with its 50/50 shot of making your condition worse.

You can't diagnose yourself. But these tools give you something to show your doc, a cheat sheet, if you will, to help the doc improve his/her grade.

That's how I got my diagnosis. After six failed antidepressant trials (and a psychiatrist eager to try a seventh), I had deteriorated to the point of disability. I found the MDQ, told my next psychiatrist about it, had my wife come to an appointment to confirm my extended period of overactivity, and we switched to mood stabilizers.

And I got better. Not right away. By that point my baseline was pretty low. But I got better.

That's why you don't want to cling to your socially acceptable diagnosis of major depression if you actually are on the bipolar spectrum. Because when you stop taking the wrong medication and start taking the right one, you have a shot at getting better.


via GIPHY

That, my friends, is my mission: to help you find the information that helps you get better. That is why I wrote Prozac Monologues: A Voice from the Edge. It is why I write this blog. It is why I keep World Bipolar Day. I want you to get better.

photo of red shoes by author
clipart from Microsoft

Where Is My Therapist?

I could have talked to my therapist yesterday by phone. She's not on vacation. But this week I decided to forgo an appointment. That may have been a mistake. . .

So I turn to a rerun from eight years ago, For When Your Therapist Goes on Vacation. I think I'll be focusing on humor for the next few weeks. Keep coming back! If you've got any good jokes, put them in the comments (click on the little envelope icon at the bottom.)


*******************************************

I have two therapists and they were both on vacation the week I got home from my mother's funeral and all those issues and all the family and all those issues. And still on vacation the week after that! My brother-in-law subbed - thank you, Darryl - with the following email. I offer it as a resource for when your therapist picks a lousy time to go on vacation.

For extra entertainment value (my entertainment, anyway), I have identified which ones I hear Michael telling me with >>, and which ones I hear Liz telling me with **. One of them regularly irritates me. I'll let you guess which. Irritating or not, I have to keep both, because the double-teaming seems to help.

Wisdom Learned From the Seat of a Tractor

Your fences need to be horse-high, pig tight, and bull-strong.

Keep skunks and bankers at a distance.

**Life is simpler when you plow around the stump.

A bumble bee is considerably faster than a John Deere tractor.

Words that soak into your ears are whispered, not yelled.

Meanness don't just happen overnight.

>>Forgive your enemies; it messes with their heads.

Do not corner something that you know is meaner than you.

**It don't take a very big person to carry a grudge.

You cannot unsay a cruel word.

**Every path has a few puddles.

>>When you wallow with pigs, expect to get dirty.

The best sermons are lived, not preached.

**Most of the stuff people worry about ain't never gonna happen anyway.

Don't judge folks by their relatives.

>>Remember that silence is sometimes the best answer.

Live a good and honorable life. Then when you get older and think back, you'll enjoy it a second time.

**Don't interfere with something that ain't bothering you none.

>>Timing has a lot to do with the outcome of a rain dance.

>>If you find yourself in a hole, the first thing to do is stop digging.

Sometimes you get, and sometimes you get got.

**>>The biggest troublemaker you'll probably ever have to deal with watches you from the mirror every morning.

>>Always drink upstream from the herd.

>>Good judgment comes from experience, and a lotta that comes from bad judgment.

Lettin' the cat outta the bag is a whole lot easier than putting it back in.

If you get to thinking you're a person of some influence, try ordering somebody else's dog around.

Live simply, love generously, care deeply, speak kindly, and leave the rest to God.

Don't pick a fight with an old man.
If he is too old to fight, he'll just kill you.

And finally...


That's me, waiting for next week's appointment...

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Seriously, if you need help now, NAMI has a crisis text line going 24/7 at https://www.crisistextline.org/ 

Their HelpLine can be reached Monday through Friday, 10 am–6 pm, ET.1-800-950-NAMI (6264) or info@nami.org

And suicide helplines and other resources from my page are here.

Keep your stick on the ice. We're all in this together.

photos ripped from an email.  I have no idea where they came from

Normal/Not Normal at Prozac Monologues

How are you all doing?

Image may contain: 1 person, sitting and indoorMe, I am trying to imagine that at least some things will be sorted by the end of summer in time for publication of Prozac Monologues: A Voice from the Edge. So here I am, working in my New Normal Coffee Shop to meet my next deadline, a deadline that COVID-19 has not erased.

This stage is called "first pages." In the photo I have in front of me a printout of the design people's first version of the book pages, the interior of the book. I am working at the dining room table, my current coffee shop in the new normal, because my office doesn't have a table.

Actually right this minute I am standing in front of my standing desk where I write. It's in my New Normal Bar, a function of my office that has risen now that other local establishments have moved to take-out only. Though I can't figure out the take-out martini. 

Not drinking martinis lately. I allow myself a daily wee dram from my whisky/whiskey collection you see at the left. My favorite recent acquisition (I'm more of a collector than a drinker) is an Irish whiskey called "Writer's Tears."

What with book events being cancelled right and left, and book stores shuttering their doors or turning like restaurants to take out and delivery, it's an uncertain time in the book business. But we carry on and search for alternative ways. My local bookstore, Paulina Springs Books in Sisters, Oregon has never delivered books before. But they are happy to do so now. They continue their excellent service of recommending titles, albeit over the phone. They are also happy to ship books to you too, when you order from their site.

You can also still order books from your own local bookstore. Go to Indiebound.org, fill in your zip code, and there you go, a way to support a local business from the safety of your own home. Not to mention filling in your own time by reading a good book while sitting in your own New Normal Coffee Shop or Bar. Their logo is on the left of this blog.

For my own book, I am in a season of hurry hurry hurry wait, currently the hurry hurry hurry part. I have a boatload of work to do this week. Find the typos. Find the wonky formatting. Then I send it off to them and wait for them to send me another boatload of work to do. The next boatload is called "second pages." Isn't that clever.

Given that stage, I confess my blog doesn't get a whole lot of depth analysis of issues psychiatric this week. I am cutting myself a break, and urge you to do the same where you can. Let's all of us cut each other a break so as not to push anybody who is on the edge over the edge.


With that in mind, giving myself a break, I draw your attention to the labels section of this blog on the right. I have noticed that my readership has gone up lately, and that people are reading not just recent posts, but from my archives as well. The labels section can guide you to what interests you most. There are about a hundred of them ranging across specific brain parts, particular scientists and authors, therapies, concepts from the mental health field, spirituality, humor... Click on an item, up will pop the posts that address that topic in some way. If you find a broken link, let me know. I'll try to fix it.

Meanwhile, how are you doing? How are you spending your time? What do you want to say? Click on the word "comments" below this post and add your thoughts.

Peace --

Social Distancing and Sabbath


Pandemic

What if you thought of it
as the Jews consider the Sabbath—
the most sacred of times?
Cease from travel.
Cease from buying and selling.
Give up, just for now,
on trying to make the world
different than it is.
Sing. Pray. Touch only those
to whom you commit your life.
Center down.


And when your body has become still,
reach out with your heart.
Know that we are connected
in ways that are terrifying and beautiful.
(You could hardly deny it now.)
Know that our lives
are in one another’s hands.
(Surely, that has come clear.)
Do not reach out your hands.
Reach out your heart.
Reach out your words.
Reach out all the tendrils
of compassion that move, invisibly,
where we cannot touch.


Promise this world your love--
for better or for worse,
in sickness and in health,
so long as we all shall live.
Lynn Ungar 3/11/20

Sabbath is one of God's best gifts to us, a weekly reminder that we are not God. It became my habit this year to take a social media Sabbath every Sunday. And I will again tomorrow, trusting and giving thanks for doctors and nurses who will be working and that electricity and water will be on, remembering people around the world who are suffering, but knowing my tweets and posts will not change that.

Resting my troubled spirit will renew me to begin again on Monday. Instead on Sunday I will embrace the sky. I will play. I will probably do a bit of work on my taxes, just a bit.

And because I am a person of faith, I will go to church online. (You're invited, too, if you are so inclined. That link will take you to the National Cathedral, live, March 15, 11 AM EDT.) I will listen to a preacher whom I know will provide a balm in Gilead. And I will pray for all of you.

Tonight, this is the prayer I will pray:

Keep watch, dear Lord, with those who work, or watch, or weep this night, and give your angels charge over those who sleep. Tend the sick, Lord Christ; give rest to the weary, bless the dying, soothe the suffering, pity the afflicted, shield the joyous; and all for your love's sake. Amen.

You don't have to believe. If you don't, take it as my sending you good vibes or however you want to frame it. Whatever we believe, we are all in this together.



My friends -- Peace.
Two candles by Labtron, used under the Creative Commons license
Earth photo by NASA, in the public domain

Early Praise for Prozac Monologues

While waiting for willgoodfellow.com to come online, here is an early opinion:

Willa Goodfellow has written a clear, compelling, and helpful guide for people experiencing clinical depression. Ms. Goodfellow's book is, at once, a vividly written personal narrative and a kind of Baedeker (travel guide) to the often confusing territory of mood disorders. She is especially helpful in describing "bipolar spectrum" disorders, and the risks of using antidepressants for these conditions.

Mental Illness Humor - A Manifesto

Is mental illness funny?

Depends on what you mean and who and you ask.

If it's not, well there goes my career. And indeed, in some corners, my career never got out of the gate. But here's my story.

Humor serves several functions for us loonies. The first for me was as a coping mechanism.

Under Construction

This sight is a work zone this week. Pardon my mess during the remodel.

Meanwhile, here is Stephen Fry, The Secret Life of a Manic Depressive.

Also coming soon: WillaGoodfellow.com, with lots of info about Prozac Monologues: A Voice from the Edge, to be published by She Writes Press, August 25, 2020.


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