passerine: Picture of Sparrow from Dykes to Watch For (Default)
There is where I am, and there is where I should be.

I can see where I should be from where I am. Usually, I have a clear and unobstructed view.

What I do not have is a clear path. There is always some sort of canyon in between, and I know that to fall down it would at the very least seriously disable me, and could quite possibly destroy me entirely.

Some days, the canyon is huge and there's no way I could even consider crossing it.

Some days, it's a river instead, and I almost think that swimming it would be worth the risk. Almost.

Some days, it's a small but definite crack in the world, and I should be able to just jump over it, but what if I can't? And then I hate the cowardice of not trying.

When I first got the naproxen and the Strattera, right before All The Shit Happened last winter/spring, it was like "Oh hey, there's this log nearby that maybe I can push and roll over to where this gap is and I can finally cross the damn thing!"

Then All The Shit Happened, and it was like watching myself lose control of that log and have it fall into the abyss, which left me thinking about what it would have been like if I had fallen into the abyss. Didn't exactly incline me to go looking for another log.

And it frustrates me because sometimes it seems like people jump over this thing without a second thought, and I wish I could do it too.
passerine: Picture of Sparrow from Dykes to Watch For (Default)
[Trigger warnings: people being stupid about mental illness, child abuse, near-misses with suicide, self-harm, some unpleasantness related to sex.]

[personal profile] kaigou has done an excellent job over here, talking about what it's like to be the person who wants to be more like all the successful friends who totally rock the world but somehow something in their brain just keeps getting in the way - and that something is ADD. (Seriously, if you want to know what it's like to be in my head, read through the "things your daughter will probably face" part. I 100% see myself in that.)

So I'm not going to talk about that piece because it's already been done. Instead I'm going to talk about what it's like to be the partner of a funny, charismatic, creative person who lives with brainweasels that are best described as Bipolar Disorder type II.

Those trigger warnings? I'm not kidding. Last chance to avoid. )
passerine: Picture of Sparrow from Dykes to Watch For (Default)
1) Help the Hamiltons. I hate seeing families with kids who have severe special needs fall through the social-service cracks. Part of my job is to prevent this from happening - these people aren't in my state, so there is little I can directly do to intervene, but I sent my dollar via PayPal and am getting the word out.

2) Fifteen Minute Festival. All about giving and receiving anything that can be done in about 15 minutes, because we can all use that kind of thing, right?
passerine: Picture of Sparrow from Dykes to Watch For (Default)
I don't know why, but I've got this head full of modern-day Mary Sues who make brilliantly wonderful lives for themselves against the most devastating adversity. And I don't ever write their stories. No, that would be too easy and too silly. Instead, I keep on figuring out how they *could* accomplish these miraculous feats of luck-mixed-with-determination, using knowledge that I don't know how they could have gained. And the space they take up in my head is taking away from using that sort of resourcefulness in my very own life, and then it gets worse because I berate myself for failing to be a Modern Mary Sue.

I guess this is something I need to "call the Thought Police" on. :P
passerine: Picture of Sparrow from Dykes to Watch For (Default)
If I could rewrite the DSM, I'd have the current Axis IV (environmental conditions) be the most important section. I'd also put a lot more emphasis on differential diagnosis (yes, there's some, but there needs to be more).

Some selected points:

- A young person who is LGBTQ, avoiding school due to bullying related to being LGBTQ, and not getting along with heterosexist parents does not have Oppositional Defiant Disorder, most likely.

- Likewise, someone who is enduring constant harassment/bullying/stalking may well develop PTSD as a result, but trying to claim that the victim is paranoid/delusional or has a personality disorder? Um, no. Can we say "blaming the victim"?

- CULTURAL COMPETENCY, PEOPLE. "Magical thinking" consistent with a person's culture and subculture is NOT a symptom of mental illness. Active involvement in a religious community is one of the 40 developmental assets or "protective factors" against various problems in adolescence and early adulthood. (There are reasons this particular fail is so common. They merit their own post later.)

- Postpartum depression is very easy to both overdiagnose and underdiagnose because so many symptoms of depressive episodes are just part of life when you have recently given birth and have a newborn baby. (Lack of sleep - check. Fatigue - check. Weight changes - check. It wouldn't be difficult to also have loss of interest/pleasure in formerly enjoyed activities and difficulty concentrating in the immediate recovery-from-childbirth period. OTOH, it's easy to accept this as "normal" and not help someone who is in need of help.)

- Being an adoptee (and thus "obviously" having "issues around abandonment") is not grounds to change diagnosis from Bipolar II to Borderline Personality Disorder. Yes, I know the diagnostic criteria are similar on the surface but seriously, what? Oh, and insert rant here about the practice of using BPD as a slur diagnosis for "intelligent and self-aware patient that I don't want to deal with."

- Screen for hypothyroidism before you put someone with "treatment-resistant depression" on lithium to augment an SSRI, plzkthnx.
passerine: Picture of Sparrow from Dykes to Watch For (Default)
I don't think it's impossible to raise social class, some doomsayer predictions to the contrary. At least, I think that it is possible to go from, in GURPS terms, Poor to Average, or Struggling to Comfortable. (Anything beyond Comfortable is another matter.)

However, it's a bit like Finding The Right Psych Meds For You, if you are one of the people who is in need of such things. There are many options out there. However, as far as the usefulness of any given option, if I remember my reading correctly the best numbers I've seen (assuming correct diagnosis and yadda yadda) for a specific drug working to provide significant symptom control without intolerable side effects is about 40%. The chances that you'll get that drug on the first try...not necessarily so good, especially since that 40% number is for an oldie-but-goodie (lithium to treat Bipolar I) that doesn't rake in the dough for Big Pharma. And well, some drugs make things much worse if you attack the wrong problem - say, your "depression, insomnia and anxiety" is really bipolar disorder, or your "treatment-resistant atypical depression" is really hypothyroidism. People can also have drugs not just not work but make things actively worse - paradoxical reactions, allergic reactions, serious weight gain (or loss), and other truly unacceptable physical consequences are all possibilities.

And of course, because of the horror stories out there about particular drugs and their possible side effects (the 1-in-3000 chance of getting hit with the Lamictal Rash, the prospect of gaining 100 pounds on Zyprexa, the you'll-never-have-or-want-sex-again-and-btw-good-luck-trying-to-get-off-this-stuff horror stories of Paxil, etc etc) or because a given person thinks that "solving problems" with medication is ALWAYS morally wrong, some people who can barely function are continuing to barely function out of fear that they will lose what little function they have, or lose their pride in "making it on [their] own."

But anyway, this is about being poor, not about psychopharmgeeking.

and when talking about poverty, most of these issues have parallels )
passerine: Picture of Sparrow from Dykes to Watch For (Default)
I actually like some of the writing I did for my Human Behavior class, so I'll be making a few posts based on it.

this is a slightly edited version of my discussion-thread post for the Schizophrenia module )
passerine: Picture of Sparrow from Dykes to Watch For (Default)
A DSM diagnosis is not a personality trait.

No, seriously. It's not.

Please stop with the Facebook quizzes and the OKCupid memes and everything else that has "ADD" and "OCD" and "bipolar" listed in with random innocuous personality traits like, say, "friendly".

There is enough difficulty now with getting people to understand the continuum between, "Sure I understand depression - I cried when we had to put my cat to sleep when I was twelve!" and, "OMG you mean they let Crazy People out of the hospital?! Won't they, like, hurt us and stuff?"

Misplacing your keys doesn't mean you have ADD.

Alphabetizing your DVDs doesn't mean you have OCD.

Having good days and bad days DOES NOT make you bipolar, unless the good days involve things like you spending two months of rent money spontaneously in two hours, or thinking you have superhuman abilities, or things like that...and the bad days involve intrusive thoughts of all the creative ways you could end your miserable existence.

Seriously. This is incredibly offensive to the people who actually HAVE these sorts of problems, and the people who care about them.

Please. Stop.
passerine: Picture of Sparrow from Dykes to Watch For (Default)
I've had some of these thoughts in the back of my mind for some time now, based on everything from some of my own past relationships to the work I do with domestic violence programs for the state. What brought them forward was some of the reading and discussion in my Human Behavior class this semester.

The summary: What one of the readings called "the language of codependency" is, in my view, anti-feminist in the extreme as well as imprecise and easy to misapply. This language is on my list of Things To Avoid As A Clinician.

The long version follows:

Part 1: One Term, Too Many Definitions )
Part 2: Problems With The Original Definition )
Part 3: Codependency Is A Woman's Job! )
Part 4: Co-option of co-dependent )
Epilogue: By The Way, Why Doesn't She Just Leave? )

EDIT TO ADD: I was actually able to find an online copy of one of the articles used in my class. If you don't mind doing the somewhat more scholarly reading involved, you can look at it here. The article proposes "over-responsible" and "under-responsible" as alternative terminology, which I find useful. (Sort of like how I find my concept of "Depressed Logic" more useful than defining depression-induced thoughts that contradict objective reality as "irrational".)

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