The Bipolar Parent’s Saturday Morning Mental Health Check in: Lightbox Edition

How are you? I genuinely want to know. My week has been busy.

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Hello, hello! Welcome to the Bipolar Parent’s Saturday Morning Mental Health Check in: Lightbox Edition!

How are you? Have you been getting some sun this week? How’s the weather holding up for you? How’s your mood been this week? What are you struggling with recently? What challenges have you been facing in parenting? Please let me know in the comments; I genuinely want to know.

The Bipolar Parent's Saturday Morning Mental Heatlh Check in: Lightbox Edition - CassandraStout.com

My Week

My week has been busy.

On Tuesday, I had an appointment with my primary care physician, who ordered blood tests to see if there are physical causes to my depression. I wasn’t fasting (I’d eaten snack at toddler group with my kiddo before the appointment), so I couldn’t take the blood tests until Wednesday, which I did.

On Thursday, I saw my psychiatrist. He boosted my dose of antidepressant (Wellbutrin), prescribed an anti-anxiety med (which starts with a B, but I can’t recall the name), and told me to get a lightbox, as I probably have seasonal affective disorder. He said the lightbox will probably cost $150-500 and may be reimbursed by insurance.

I told my husband about the lightbox, and his immediate response was, “Okay, I’ve ordered one on Amazon. It should be here tomorrow.” He told me that the one I needed (with 10,000 lux, or units of light) was on sale for $30. A second lightbox was on sale for $25, so he bought that one, too. So now I have two, one for my bedroom and one for my desk. I adore my husband.

On Friday, I walked to the store, pushing Toddler in the stroller, to pick up my prescriptions. Apparently the pharmacy only received orders for the antidepressant. I called my psych doc and left a message asking the office to re-fax the prescription order. I always play phone tag with them, which is extremely frustrating.

Taking care of my mental health is so difficult and expensive. There are multiple doctors involved, and our insurance has a high deductible which just reset this January. The antidepressant prescription was $51. So, with the addition of the lightboxes, that’s over $100 spent just this week, not to mention the cost of the doctor’s appointments.

I’ve also eaten out for lunch every day this week. Not because I couldn’t plan ahead and pack sandwiches, but because I’m depressed, and one of the ways I find myself trying to feel better is going to restaurants. It works in the moment, but afterwards I feel buyer’s remorse as each fast food meal is forgettable, unhealthy, and expensive.

Spending this much on myself makes me weak in the knees. My husband would say that I am worth the cost, and “it’s just money.” Having grown up below the poverty line, I am struggling with prioritizing my own wellbeing.

But I need to, if not for me, then at least for my kids. They deserve a mother who is sound in mind and body. I need to prioritize my own contentment. And stop going out to eat unless it’s a special treat, like our family Sunday brunch.

Wish me luck.

The Bipolar Parent's Saturday Morning Mental Heatlh Check in: Lightbox Edition - CassandraStout.com

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9 Things I Learned in the Mental Hospital

9 Things I learned in the mental hospital - Cassandrastout.comAfter the birth of my son eleven years ago, I suffered a postpartum psychotic breakdown and committed myself to a mental hospital. I later wrote a book detailing the experience, and how I reacted at the time. I learned many things during my five-day stay, and I’d like to share some of them with you today. Here are 9 things I learned at the psych ward:

  1. Anger is common. The most surprising lesson I learned during my stay at the mental hospital was that anger is shockingly common for patients at first. While there, the doctors seem to be your enemies who want to keep you there. It’s not true. Your doctors want to help you exit the facility successfully. Couple the us vs. them mentality with emotional and mental distress, and it’s not suprising that patients tend to respond with anger. But the heightened emotion tends to dissipate over the length of the stay, as the medication starts working.
  2. Inpatient treatment is a stopgap. A stay in a mental hospital is similar to a stay in the physical hospital for surgery: you don’t fully recover while you’re there. A mental break or depressive episode can’t be solved in a day, no matter how good the meds are.
  3. The patients are human. One of my main mistakes during my stay in the mental hospital in the mental hospital was dismissing the other patients as “crazy.” But the patients in a mental hospital are human, with all of humanity’s weaknesses and strengths. Everyone has a story. Everyone is suffering more than you know. I learned that I shouldn’t dehumanize or dismiss people because they’re suffering from mental illnesses–including myself.
  4. The staff is human, too. Learning that the patients were human was hard, but what was even harder was recognizing that the staff were human, too. At first, I believed the doctors and nurses were out to get me. But the staff are all individuals, and human. Some of them are kind and compassionate, while others are just working a shift. I learned to accept the flaws and foibles of all the nurses and psychiatrists, and that made the stay more bearable.
  5. Boredom reigns supreme. After my anger diminished, I was bored out of my skull. I was manic and depressed–suffering from a mixed episode–and restless. The only distractions available were coloring sheets, an ancient, derelict computer, reading old issues of Reader’s Digest, and (gasp!) talking to the other patients. I was far too revved up to engage in coloring or sloooow web surfing or reading, so I talked the ears off of my roommate.
  6. Even while psychotic, I was aware of how people treated me. Even during my psychotic break, I was able to pick up on other people’s moods. I don’t know if that’s just a “me thing,” or if everyone psychotic is that in tune with others, but I knew when people were mistreating me. Be careful when dealing with psychotic people, and treat them with respect.
  7. Boundaries, boundaries, boundaries. During my stay in the mental hospital, I grew close to my roommate. Too close. I struggled to separate myself from her, even feeling shocked and betrayed that she would vote for a different presidential candidate than I would. I genuinely believed we shared the same thoughts. Learning boundaries was extremely difficult for me, but everyone benefited.
  8. The nurses draw your blood after every meal. The other patients and I were required to sit in a garish, orange chair after every meal and “donate” blood. The nurses drew our blood thrice daily, and it wasn’t until the middle of my stay that I realized they were checking to see if the medication was up to acceptable levels.
  9. If you commit yourself, the doctors cannot legally hold you.  Missing the first few weeks of my infant’s life was devastating. I was desperate to go home and take care of him. It wasn’t until my fifth day that I learned, through a slip of the tongue from a nurse, that, since I committed myself, I was able to go home anytime. I left against medical advice the day after that–potentially a mistake, as my recovery time from my mixed episode was probably longer than it would have been because I didn’t allow the doctors to do their jobs. Thankfully, God was with me and I did, eventually, recover (see lesson #2).9 Things I learned in the mental hospital - CassandraStout,cin

Final Thoughts

My stay in the mental hospital was literally life-saving. I learned more about myself there in six days than I learned in a year’s worth of therapy prior to that. I learned how to manage myself, other people, and my expectations of those people. I managed my surprising anger. I learned that dehumanizing others is easy and a bad habit to slip into. I learned that mental hospitals sound like scary places, but they’re actually really boring. Above all, I learned that I can handle anything life throws at me.

If you’ve dealt with a stay in a mental hospital, what have you learned?

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Book Review: Breakdown: A Clinician’s Experience in a Broken System of Emergency Psychiatry

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The front cover of Breakdown: A Clinician’s Experience in a Broken System of Emergency Psychiatry (affiliate link*), by Lynn Nanos, featuring a police car shining its headlights on a sleeping homeless person wearing a green hoodie. Credit: Lynn Nanos.

*Disclosure: Some of the links below are affiliate links, meaning, at no additional cost to you, I will earn a commission if you click through and make a purchase. Thanks for supporting the work at The Bipolar Parent!

America’s mental health system is broken. It has failed millions of people suffering from mental illness and will continue to do so unless sweeping changes are made. That’s the premise of Lynn Nanos’ Breakdown: A Clinician’s Experience in a Broken System of Emergency Psychiatry (affiliate link*).

I was offered a copy by the author in exchange for an honest review, which after reading the book, I am thrilled to provide. Nanos is a clinician in the field of emergency psychiatry in Massachusetts with over twenty years of experience in the field. She is uniquely qualified to write this book, having spent much of her life caring for the sickest of the sick.

According to Nanos, there are three core problems in the broken psychiatric system: a lack of inpatient beds due to deinstitutionalization; malingerers, who falsify claims of mental illness to request inpatient treatment; and that patients are “dying with their rights on.” The latter means that a prioritization of patients’ rights causes people suffering from psychosis who refuse treatment due to a lack of insight into their mental illness to be discharged from hospitals too early. These patients are often homeless and vulnerable to being attacked on the streets. Nanos’ solution to these problems is to promote a program called Assisted Outpatient Treatment (AOT), a court-ordered program which forces patients suffering from psychosis to comply with treatment when living in the community.

Nanos describes a condition called ansognosia, where patients have a lack of insight into their mental illness. This book has special significance for me because I have bipolar and have endured psychosis, like the patients in the many case studies Nanos covers in Breakdown. When I suffered a psychotic break, I had no insight into my mental illness, like many of the patients suffering psychosis that Nanos describes. I was fortunate in that, as I complied with treatment, I gained such insight and was able to take steps towards recovery before I left the hospital. Like Nanos points out, this is not the case with the majority of others.

What Doesn’t Work Well in Breakdown

Because I don’t want to end on a negative note, I’ll start with one item that didn’t work well for me in Breakdown.

  • Disclaimers: The opening chapter is full of disclaimers about what the book does and does not cover. These disclaimers are vital to understanding how the rest of the book works, but they make for dry reading, especially for a first chapter. However, I don’t know how else Nanos would have structured this. These disclaimers are necessary, and they need to be placed upfront.

That’s it. That’s all I didn’t like. If a reader can get past the tedious first chapter, the meat of Breakdown is brilliant.

What Does Work Well in Breakdown

As promised, here’s what does work well in Breakdown:

  • Fulfilled Promise: In the opening chapter, Nanos promises a solution to the issues she raises later on, and she delivers on this promise. The writing is accurate and engaging, with case studies of patients offering an emotional look into people who suffer psychosis and their mental illnesses. The book is a blend of clinical information and painfully personal writing, which is another part of what Nanos promises and delivers.
    Research-Backed Opinions: Nanos’ commitment to scientific research is admirable. She cites approximately 300 studies, and the last chapters of Breakdown are especially filled with mental health statistics, which back up her claims.
    Professional Formatting: Despite being self-published, Breakdown is professionally formatted. The cover, featuring a presumably homeless man being confronted by police while lying on a sidewalk, is well-drawn and fabulous. Not that I’m saying to judge a book by its cover, but Breakdown is visually pleasing inside and out.
    Case Studies: The most arresting parts of Breakdown are the case studies. Nanos demonstrates why psychotic patients need treatment through the examination of her encounters with them in a clinical setting. Some examples are: a woman who traveled from Maine to Massachusetts because a spirit called “Crystal” ordered her to, a man who smeared dead insects on his neighbors’ doors to help purify toxins in their apartments, and Lily, a woman who delivered dead dogs to strangers, among other stories. Most of these people refused adequate treatment due to ansognosia. A great number of them bolted before Nanos was able to arrange for transportation to hospitals. Some of them were violent, and a few went on to assault their loved ones, with two specific cases ending in death. The case studies are the most effective parts of Breakdown, and demonstrate why the AOT program is so important.

Final Thoughts

Breakdown: A Clinician’s Experience in a Broken System of Emergency Psychiatry (affiliate link*) is a fascinating book. It’s professionally written and formatted, research based, and effectively delivers its message. The case studies were especially enlightening, and are the heart of Breakdown.

Mental health issues affect all of us, whether we suffer from mental illness, have loved ones who do, or are impacted by the mentally ill people all around us. Read this book and see how you, too, can join the mental health discussion.

*Disclosure: Some of the links above are affiliate links, meaning, at no additional cost to you, I will earn a commission if you click through and make a purchase.

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Which Mental Health Professional Should You Use?

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Credit to flickr.com user Jonas Bengtsson. Used with permission under a Creative Commons license.

Mental health professionals come in all types. When making the decision as to which doctor to start a treatment plan with, keep in mind that you can try several–as many as you can afford, that is. Your primary care physician can refer you to one or many of these mental health professionals.

 

Psychiatrist

A doctor trained in the medical field of psychiatry, including the diagnosis, prevention, and treatment of mental and emotional illnesses. The most important job of a psychiatrist is to prescribe medication for you. Unlike psychologists, psychiatrists are medical doctors. You will likely be referred to a psychiatrist at least once in your mental healthcare journey.

Child/Adolescent Psychiatrist

Just like it says on the tin, a child/adolescent psychiatrist is a medical doctor specifically trained to treat mental illnesses or behavioral problems in children. These professionals can and will prescribe medication.

Psychologist

A psychologist is a mental health professional with a doctoral degree in psychology who can diagnose and treat mental illnesses with courses of therapy. Unlike psychiatrists, psychologists do not prescribe medication. There are two forms of psychology: applied psychology, which includes “practitioners,” and research-oriented psychology, which includes “scientists.” Psychologists are trained as researchers and practitioners.

Clinical Social Worker

A clinical social worker is a counselor with a master’s degree in social work who provides individual and group counseling. The social workers have three years or more of supervised experience. They do not prescribe medication.

Licensed Professional Counselor

A licensed professional counselor (LPC) is a counselor with a master’s degree in psychology and several years of supervised experience who offers individual and group counseling. In the U.S., the title varies by state, but the most common next to LPC is licensed mental health counselor (LMHC). The counselors do not prescribe medication.

Certified Alcohol and Drug Abuse Counselor

A certified alcohol and drug abuse counselor is a mental health professional with specific training in substance abuse treatment. The counselor can provide individual and group counseling. The counselor does not prescribe medication.

Marital and Family Therapist

Marital and family therapists are professionals specializing in relationships between families, or couples. The therapists emphasize familial relationships as important to consider for your mental health. The counselors have master’s degrees in psychology and related fields, and do not prescribe medication.

Several types of mental health professionals are available to help you. These are just a few of them. A lot of the counselors seem interchangeable, but they all have different approaches, tailored to you.

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How to Get a Psychiatric Evaluation

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Credit to flickr.com user Lisa Brewster. Used with permission under a Creative Commons license.

Mental illnesses are common–roughly 1 in 5 American adults have one–but people with depression or bipolar disorder can sometimes take up to ten years before they seek out care for themselves. Are you ready to take the first steps towards getting a potential diagnosis? Read on to find out where to seek help.

 

Where to Find Help

  • Ask your primary care physician for a referral to a mental health professional. Other people who can refer you are crisis centers, or a local Mental Health America office. Ask for more than one doctor, so you can comparison shop.
  • To get an evaluation, try the psychiatry department of a university. Psychiatrists at a college will be up-to-date on cutting-edge research, and be more willing to stick with proven drugs such as lithium because they’re well-researched.
  • Contact your health insurance plan to find providers covered under your plan.
  • If you are a veteran, try the U.S. Department of Veterans Affairs, located online at www.va.gov/health. You can also call 1-877-222-8387. Veterans who already have benefits through the department can visit www.va.gov/directory to find a mental health professional covered under the VA’s plan.
  • The Substance Abuse and Mental Health Services Administration is also a great place to check for mental health professionals. The department is located online at http://www.samhsa.gov/treatment. You can also call 1-800-662-HELP (4357).
  • If you work for a large company, you may have an employee assistance program (EAP) available. Contact Human Resources to find a provider under the EAP.
  • What about Medicare and Medicaid? Check Medicare at www.medicare.gov. Mental health professionals who accept Medicaid might be listed by your state’s Medicaid office. Click on the name of your state at http://www.benefits.gov/benefits/browse-by-category/category/MED.

What to Expect

You will first talk to your referred mental health professional on the phone. Ask them about how they like to approach therapy and medication. Make an appointment if you feel comfortable with them during the phone interview.

At the appointment, your psychiatrist or psychologist should refer you to a lab to check your thyroid levels and rule out other physical causes of mental illness symptoms. Your doctor will ask you why you called him or her, what you think the problem is, and about your job and living situation. You may be given a few questionnaires to evaluate your mental health and any adverse symptoms. This testing can take hours.

Sometimes, a mental health professional may want to interview your family and friends. Your doctor cannot interview them without your consent. Consider asking your loved ones if they’d be willing to submit to an interview.

After that, be patient! Getting a diagnosis–and an accurate one, no less–takes time, but it’s an important part of developing a treatment plan, including therapy and/or medications.

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The History of Bipolar Disorder

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Credit to Feedspot

A quick housekeeping note: I was recently awarded the nineteenth spot on Feedspot’s Top 100 Bipolar Disorder Blog list. The blogs were ranked by a editorial panel based on Google search rankings, popularity on social media websites, and quality and consistency of posts.

Thank you. We now return to your regularly scheduled post, The History of Bipolar Disorder.


 

The history of bipolar disorder is a fascinating study of a mental illness that goes back to the second century. The ancient Greeks and Romans found that lithium salts in baths eased the symptoms of what they termed “melancholia” and mania. Aretaeus of Cappadocia demonstrated a link between the two mood states, a finding that would go unrecognized for several hundred years. Many mentally ill people were executed at this time based on fears about demon possession.

Early Chinese authors recognized bipolar disorder as a mental illness. In his Eight Treatises on the Nurturing of Life, Gao Lian (c. 1583) outlines the disorder. Avicenna, a Persian physician, established the disease in 1025, separating it out from other forms of madness, like rabies.

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Credit to flickr.com user Jessi RM. Used with permission under a Creative Commons license.

In 1854, French psychiatrist Jules Baillarger coined the term “dual-form insanity,” describing the oscillating symptoms of depression and mania. Two weeks later, Jean-Pierre Falret called the same disorder “circular insanity” while detailing that the disease clustered in families, proving a genetic link.

Emil Kraepelin was the next psychiatrist to address the illness, in the early 1900s. He coined the term “manic-depressive psychosis” to differentiate it from schizophrenia and to describe the relatively symptom-free intervals in the course of the untreated disorder. Carl Jung made a distinction in 1903 between bipolar I and bipolar II, focusing on psychotic states vs. that of hypomania.

John Cade, an Australian psychiatrist, then discovered the calming effect of lithium on patients with manic-depressive illness in 1949. But it took until 1970 for the U.S. Food and Drug Administration to approve of lithium’s use.

In 1952, the idea that the disorder ran in families was revisited in an article published in the Journal of Nervous and Mental Disorder, termed “manic-depressive reaction.” Then, Karl Leonhard introduced the terms bipolar (with mania) and unipolar (with depressive episodes only) in 1957.

People with bipolar disorder at this time and throughout much of the 1960s were institutionalized due to manic-depression not being recognized as an illness. That changed in the early 1970s, and in 1979 the National Association of Mental Health (NAMI) was founded.

The term “bipolar disorder” didn’t appear in the Diagnostic and Statistical Manual of Mental Disorders, third edition (DSM-III) until 1980, but it has quickly been accepted as less stigmatizing than “manic-depressive illness.” The history of the condition is a captivating look into the evolution of how we as a society treat mental illnesses.

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