The Stigma Of Treatment

All the important people in my life know I struggle with my mental health. That’s old news. I’m not even overly anxious about sharing some of my struggles with the right people at the right time.

On the other hand sharing what treatment I’m receiving for my mental health is so much more anxiety provoking and worrisome.

I’m on three psychotropic drugs, and there’s plenty of judgement and stigma from people about that. I need these medications to function, if anyone has a problem with that, they can get lost.

I’m seeing a therapist weekly. At this point in time the therapist is a psychiatrist. In the past they’ve been psychologists, clinical psychologists, and counsellors. Therapy is a really good way to help me manage my mental health. Again, if people have a problem with that, they can get lost.

Then there’s the inpatient psychiatric admissions. Five in the last two years. Most of them for about three weeks. Not all in times of crisis, but of great stress, and with multiple crappy coping strategies being used.

I’m heading for my seventh admission with the same doctor at the same hospital. I trust my doctor, and I trust the nursing staff. I know the admission will be helpful, they always are, but I’m scared to tell anyone.

I worry so much more about what people might think about me being in a psychiatric hospital, than being on medication, or in therapy.

Is it really that bad that I need to be in hospital?
Yes. Doing the same amount of work in therapy outpatient is impossible. Plus I’m stuck, again. DID chaos, and multiple shit storms brewing beneath the surface. That doesn’t even cover the issues I’ve had with mood (both hypomania and depression in the last month). It is that bad.

Can’t I just get over it? Isn’t therapy enough? Can’t they give you medication?
I’m doing the therapy, and taking the meds. I’m still struggling. As for getting over it? Get lost.

I know hospital is a safe place to crash land. I can be a mess, be emotional, struggle in any kind of way and it’s okay. I don’t have to keep it together. I don’t have to keep smiling. Staff are kind and supportive. I have time and space to unleash the chaos, work through it, and put myself back together again.

I’ve still only told a few people. I’m so fearful of their reaction to, and judgement of inpatient treatment that I stay silent.

I think the stigma associated with psychiatric or psychological treatment can often be so much worse than the stigma associated with a diagnosis.

It’s okay to not be okay, and it’s even more okay to get whatever help you need to be okay again.

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This Is What Depression Can Look Like

Depression.

Depressed.

Someone curled up in bed, hidden under the covers. Sunlight peeking in through the drawn curtains. Phone calls and voicemails ignored. Text messages unread. A dirty plate, and empty, coffee stained mug on the bedside table.

That sounds like fairly stereotypical depression, right? It is. The trouble is, not everyone with depression struggles like that.

What about the person who smiles, and chats happily to friends and family. Who cleans the house, keeps up with chores, and pays all the bills. The dishes are done, there’s food and leftovers from a home cooked meal in the fridge, and the fruit basket is full.

Is that person depressed? If that person is me, then right now, yes. It’s just so well hidden.

I smile and chat with family and friends because I adore them, but I also don’t want to burden them with my sucky (technical term!) mental health. I busily keep up with chores  so I have less time to think about how much I detest myself, my life, and everything about me. Keeping busy keeps me safe. Leftovers in the fridge are from a meal I cooked when I felt like eating. I swing between having no appetite and comfort eating.

No one sees the tears that slip out when I’m finally alone, or on the way home from visiting friends and family.

No one sees the self-hatred, pain, hopelessness, and defeat that flood my mind when I finally stop doing chores.

No one sees the torment that fills my mind over needing to eat, having no food, then ordering groceries, and not wanting to eat.

I usually manage to function until I’m extremely depressed and suicidal. On the way down into that pit of doom very few people know or see that I’m struggling.

Not being able to see it doesn’t mean that I’m not depressed.
Not being able to see it doesn’t mean that I’m not struggling.

Depression looks like many things for many people. Ask before you pass judgement on whether someone is depressed, or how depressed they are.

Differing Abilities, and Special Talents in a DID System

We all know that different people are good at different things. You might be excellent at baking, whilst a friend is a star football player, and another has impressive communication skills. Everyone is different, and everyone has their own strengths and weaknesses.

What about strengths and weaknesses in someone with DID? This is where it gets interesting! I don’t think there’s much research to be found on it, but it seems that, within someone with DID, there are many talents, strengths, and special abilities.

In my system Miss and Mr Mid-twenties are excellent communicators, as well as being very patient, and nurturing. Mr Mid-twenties also has an amazing talent for organising, and managing day-to-day life.

Miss 5’s playful, and cheeky nature are things that I see as strengths. She can have fun, play, and enjoy life in a way that I struggle to do.

I’ve discovered that Miss 19 is our resident poet. I knew someone could write poetry, but had no idea who. I couldn’t string a poem together to save my life! However, when Miss 19 is out the words flow much more smoothly than anything I could write. I’m better at more academic type writing, which is how I do so well with university study.

Her latest poem (and one we’re both quite proud of) is about Bipolar II. It’s a diagnosis that’s becoming more, and more likely as time goes on. Repeated hypomanic episodes, followed by either periods of depression, or more stable mood continue to point towards this diagnosis. All of that roller coaster of a journey is for another post though.

 

Merry-go-round

Happy, smiling, laughing, free
Cranky, upset, guilty, needy
Crashing, crying, sad, and low
Up or down, you never know

Today is amazing
You’re high, not low
Tomorrow is looming
You still don’t know

It could be filled with fun and delight
Or you could be crying ready to die
Up and down, on and on
A merry-go-round you can’t get off

Fuck the world, I’ve had enough
Nothing is okay, nothing is right
I’ve had enough, keep out of sight
Watch out, I’ll explode with empty rage

Happy again, smiling too
Creative, energised, ready to go
Ideas, plans, so much to do
Anxiety gone, nothing to lose

Sad and low, hopeless too
Crashing, burning, going under
Ready to die, don’t care anymore
Wanting out, tired of existing.

“Oh, DID, that’s really rare, isn’t it?”

I was officially diagnosed with Dissociative Identity Disorder in 2010. I say “officially” because a diagnosis from a psychologist seems to mean very little to the government employed mental health professionals in Australia. My private psychologist had told me back in 2009 that I had DID, but it wasn’t until 2010 that a private psychiatrist confirmed the diagnosis.

Since then I hear, on a regular basis, how “rare” or “unusual” this disorder is. I’m aware of the unusual, weird, crazy factor! DID is strange. It’s not something most people know about, let alone are comfortable contemplating.However, “rare” is absolute rubbish.

I’ve done some digging on various sites and have come up with some statistics for you. It’s a bit difficult to compare given that some are new cases diagnosed per year and some are given as a percentage prevalence. However, it does give an idea on numbers. All of the following statistics are for the Australian population. Population calculations (calculating number of people from percentages) are based on the 2011 statistics from The World Bank which gives the population of Australia as being 22,620,600.

Breast Cancer: 14,610 people diagnosed with breast cancer in 2012. (Breast Cancer Network Australia)
Prostate Cancer: 20,000 new cases diagnosed each year. (Prostate Cancer Foundation of Australia)
Stroke: 60,000 new and recurrent strokes estimated for 2011. Stroke Foundation
Bipolar I Disorder : 226,206 people with five times (over 1,200,000) being at risk of Bipolar II Disorder. (Black Dog Institute)
Dissociative Identity Disorder: 226,206 people. (International Society for the Study of Trauma and Dissociation)
Diabetes: Nearly 1,000,000 people are currently diagnosed with Diabetes (type 1 and type 2) in Australia. (Diabetes Australia)
Eating Disorders: 2,035,854 Australians struggle with an eating disorder.(National Eating Disorders Collaboration)
Mental Illness: 3,200,000 people (aged sixteen to sixty-five) will experience a mental illness in any one year. (Black Dog Institute)
Depression: 3,231,541 Australians will experience depression in their lifetime. (Black Dog Institute)
Cardiovascular Disease: 3,400,000 Australians are affected by Cardiovascular Disease. (Heart Foundation)

Dissociative Identity Disorder isn’t as rare as people make it out to be. It certainly seems to be rather unheard of and approached with confusion and disbelief, but it is not particularly rare. Ask a few people if they’ve heard of Bipolar Disorder and if they know what it is. Most people have heard of it, have a vague idea of what it means. Same prevalence as DID. It’s just less well known which does not make it rare.

So those are some interesting statistics. Now, I’m sure if you go digging you’ll find some different statistics. Wherever you go, numbers will differ. Prevalence isn’t black and white. How different organisations collect their information will vary, but as a starting point – wow.

What shocked me most was that the stats for mental illness were incredibly high compared to some physical illnesses. However, I know the physical ones do tend to have high mortality rates and huge impacts on health. That’s not to minimise the burden of living, long term, with a mental illness – it’s huge. Plus there’s the higher risk of suicide associated with most mental illnesses. I have no stats on that and it does vary from illness to illness, but it’s known to exist.

More people in Australia struggle with an Eating Disorder than Breast Cancer. Both of these conditions can kill you, yet it would seem more money and research goes into Breast Cancer than Eating Disorders. It’s alarming, to be honest – 139 times more people will suffer with an eating disorder than will have breast cancer. I haven’t researched or compared mortality rates. I’d imagine Breast Cancer has a higher mortality rate, however, given that more people suffer from eating disorders…. well, who knows.

It seems that most people have a cause, an organisation, or something else that they support. Cancer survivors (and their families) tend to support organisations that helped them. Those with a mental illness may support an organisation relevant to their condition. Animal lovers will support a local zoo by sponsoring an animal or donating to an animal shelter. Sports fans may support a local team. There’s causes and organisation for absolutely everything.

It saddens me that so little funding and research goes into mental illness. Perhaps it’s similar to physical conditions, I don’t know, but it doesn’t seem that way. Even treatment for a mental illness is hard to access and is very limited (unless you have an endless supply of money). No one limits the number of treatment sessions for a physical illness yet the Australian government is limiting Medicare sessions with a psychologist to ten for 2013. If a cancer patient was limited to ten sessions per year, with their treating doctor and told that, after that, they’d have to privately fund the rest of their treatment or wait until the following year for treatment there would be public outrage. How is mental illness any different?

Hypomanic… Again.

Oh my goodness! I was awake at 5:30am… wide awake despite being physically exhausted. My brain woke up and is all go.

Tidy your room. Fix your squeaky bed. Clean out the fish tank. Research Cupramine and maintaining copper levels in the tank. Finish your jewellery box. Tidy EVERYTHING. Clean out the wardrobe some more. Sort out old uni books to sell/give away. Tidy, tidy, tidy!

My response – screw this. Seriously, screw this. I’ve had enough. I’m sick of the ups and downs. Although, the downs have not been to the point of being suicidal, they’re still not nice. The hypomania is wearing me out. I’m already exhausted – I can not keep going!

I’ve decided to come off the Prozac. I’ve halved my dose again, now it’s only 5mg which is a tiny, tiny dose. I do worry that coming off it completely will leave me feeling very low, suicidal and unsafe, but I can not handle the hypomania any longer.

I’m going to call my psych registrar this morning and discuss it with her, but I’m done. Had enough. Shortly I’ll take some seroquel and hopefully that will slow my brain a little. I won’t hope for sleep, that’s a bit ambitious, but slower would be very much appreciated!