Category Archives: Dual Diagnosis Issues

A Familiar Conversation

Those who share some of my issues will be relieved to know that I am taking steps to obtain a supply of my bipolar meds again. Having dropped the ball during the previous months and the stresses I’ve been having, I have been without them for nearly a month now…and it’s not good.

At last, I became resigned to using precious funds on a visit to my old psychiatrist, because my plans to find a new one hadn’t panned out and there was no longer any time to lose. However, when I called the number, I found out the practice had just closed. Turns out he is still in practice, but with a new group clinic. So I called the number, and was told I need to go through the standard intake process before I can be given an appointment with him or anyone else. On the bright side, they might be able to match me with someone who will take my insurance for part of the cost.

So, yesterday, I found myself participating in an intake conversation. This feels weird on a couple of levels: first, it always feels overwhelming for me to try to summarize my present and/or past condition (can I just give them the address of this website, please?)  Second, the questions on the intake are familiar to me from both ends: before my diagnosis, I worked at a counseling center and did phone intakes regularly.

I know why they have to ask certain questions, and I know what answers they are looking for. I know what red flags they are trying to spot. I know the clinical descriptions of the things they describe. And although I know these things, I need to answer the questions like a patient and not a co-clinician.

Something else about this, for my readers who share my issues with addiction: the intake person asked me about any history of substance abuse. If it hadn’t been on the form, I would have brought it up myself. Whoever I end up seeing will, like my old psychiatrist, be fully informed about my history of addiction and recovery. I can’t overstate how important this is: one of the drugs I used to abuse came from a psychiatrist years ago. It wasn’t their fault, but as a person in recovery it’s my responsibility to make sure doctors of any kind know that certain drugs are not appropriate for me.

At the end of the questions, I was told they need to consult my insurance before they can schedule me an appointment. They will call me back, the intake person said. I promised myself I’d wait at least until tomorrow before calling again, but I feel anxious because some medical “we’ll call you back” things have not gone well lately.

So that’s what’s going on. Nothing very fun or inspirational right now, but I know many of my readers have been there. Part of living with our conditions is sometimes doing that footwork, one step at a time, and dealing with the frustration of not doing it very well.

Discount Psych Ward

I’m not afraid of going to a psych ward for help. I’ve been there before, and I know it’s thoroughly undramatic compared with the way it’s portrayed in the media. The downside to going there is the same for me as the downside to going anywhere else: it’s expensive, and I wouldn’t be around to help my family. Especially my daughter.

It’s the money first, really, since stays in the ward tend to be pretty short these days. You need to be an immediate danger to yourself or others to go in for any length of time. I could qualify, if I shared some of my inner landscape with admissions people–but I know myself, and I know I don’t really qualify. Not yet.

I’m in the gray area–messed up enough to be potentially at risk but not messed up enough to be in immediate danger. The gray area’s an uncomfortable place to be, and a hard place to explain to those around me. But the gray area’s also a place of opportunity–if I take it seriously, and get others to do the same, I have a chance to stay out of the hospital.

I call my attempts the Discount Psych Ward. And I’m not trying to make
Iight of treatment–if you have to go, you have to! But for me, arranging a DPW can sometimes work long enough to get me through the worst part of an episode.

I knew I needed one when I saw my therapist last week. I talked with him about some of what I’d been doing or thinking, and one thing I confessed to him was how much I’ve been thinking of cutting myself. I have a weird thing about cutting–you see, I’ve never actually done it. I just think about it. But not being able to stop hurting myself with food has me so frustrated that I’ve been wondering if cutting could be a viable, noncaloric way of acting out.

So I told him about how I’d been contemplating what sites on my body would be best, and whether razor blades are the best or should I try to get a scalpel, and do drugstores even sell plain razor blades any more. And because he knows me well, he didn’t freak out (very much.) He just wanted to know if I’ve been in touch with the psychiatrist lately and what my plan was for taking care of myself in the short term. So we agreed that I’d carry out this DPW scheme I’ve used a few times before.

The DPW requires the help of my family, and that’s the tough part. Each member of my family has a tough and stressful life lately, and asking them to put all that aside and focus on me feels so selfish. I have to keep remembering that it’s in their best interests as well to keep me out of the hospital.

So I asked my husband to stay home all weekend, and I explained to my daughter about what was going on. I’m always worried about asking things of her–during my psychology education I heard the term “parentified child” so often I hated the idea that my conditions affected her. But there are times, especially now that she is a teenager, when honesty is the best policy.

The rules: my food needed to be controlled, because the inconsistent/destructive behaviors I’ve been doing were definitely making my symptoms worse. All attempts to return to healthy status quo had failed within a couple of days lately, so being in the DPW was also meant to help me through the difficult first few days of that. Other than not eating anything off my plan and not doing anything harmful to myself, I was to have no responsibilities. I was to spend little or no time alone, even during the times when I would normally retreat to my room to be anxious by myself.

It went pretty well. We played a lot of video games. I hyperventilated a lot. My daughter did her schoolwork without much help or drama, a much appreciated contribution. I prowled through the house, hungry, and complained at great length about how hungry I was. I did not try to be mature. When my husband and I were alone, I talked more frankly than usual about my dark thoughts.

He went back to work on Monday, but I can tell that both of them are still making an effort to check in with me and not stress me out too much. I’m doing better than last week, and still sticking to the food plan. I’m grateful to have a family to help me combat my isolation, and I’m aware that not everyone like me has this. I would be foolish–and ungrateful–if I let my pride keep me from using it.

I don’t know how the coming days or weeks will go. I may end up needing a higher level of care, a level I haven’t needed since before Not This Song began. I hope not, but if it does happen it won’t be a failure, nor will it negate everything good I have written and experienced.

Ave Atque Vale, Robin Williams

Friends, we’ve lost another one. It’s been ten minutes since I heard about the death of Robin Williams, and I’m starting this with the tears still on my face because I have to begin expressing it.

Robin…oh, God damn it, Robin, not you. Please let it not really be you. You know I’d never judge you for doing it, but could you please just sit up and tell us it was all a colossal joke?

Depression gets mentioned a lot in the articles about this, but I know your picture was broader than this–you lived with bipolar disorder and a decades-long history of addiction, making you dual diagnosis like me. Although I feel kinship with every addict and everyone battling mental health issues, I can’t help but feel a special empathy for those who live with the intertwined duality as I do.

The circumstances of your death are going to be rehashed a lot in the upcoming weeks–and as I wrote about your fellow actor Philip Seymour Hoffman in Goodbye Again, there’s going to be a lot of shock that doesn’t really belong. What’s happened to you isn’t that shocking, because it’s happening all over the world to others with these conditions. Your talent, imagination, resources and incredible spirit bought you time, but they didn’t make you immune.

Others will list and praise the diverse elements of your awesome body of work, as well they should. But I want to praise the work nobody saw.

Robin, I know–someone knows–what you had to do to stick around as long as you did. Some of that journey got expressed in your art, but much of it was solitary. Some of it happened in the dark watches of the night, or rang in a piece of music you listened to over and over again, or got traced in invisible lines on the places you may have thought of cutting but didn’t, day after day and year after year. Signatures on admission papers, choosing life over pride several times. Drugs untaken, drinks unpoured. Hours with family and friends, setting aside panic or despair to try to interact for a while.

You inspire me (present tense) to continue trying to release my creativity and my weirdness in recovery. You remind me to value passion above propriety.

Many are grieving over you today, and I believe some of them will come away with more of a gut-deep comprehension of the nature of depression and other issues. They might grasp the contradiction for a moment, and see that someone can be all of the things you were and be this too. Maybe they’ll remember it if they ever need some help.

You’re my hero, Robin. I hope you knew some people who identified with you and made you feel less alone. I wish I could have been one. I wish I’d been famous, or published, or something, so that maybe you could have seen something I wrote. Don’t judge yourself for what’s happened. Don’t belittle what you achieved. Don’t you dare.

Dishes Lie

Don’t trust the dishes.

Don’t get me wrong–I’m proud of being able to wash dishes. For years, it was a task shuffled off to my spouse; even more so than other mundane tasks because the specific posture and movements dishes require triggered my lower back pain intensely. Today, he can come home and have anywhere from a 50% to 95% chance of finding the sink and counter clear. Maybe not clean, but at least clear of objects.

The presence of clean dishes can, like laundry or a walked dog, be diagnostic. It can mean that I’m doing well enough physically and mentally to take positive actions. It makes sense that someone who loves me is pleased to see it.

But sometimes dishes tell gleaming, ceramic lies.

Sometimes clean dishes don’t mean anything at all, and the effort that produced them has nothing to do with how I am doing. Sometimes they’re the one task I do that day, not as a small accomplishment but as a ritual of guilt. Sometimes doing the dishes was just a postcard to a distant land where what I do means anything.

So, if your loved one is living with significant depression, don’t believe their foamy sales pitch. Don’t let the dishes convince you that things aren’t that bad. Understand that those duplicitous cups and plates don’t mean that your loved one washed their hair lately, or took their medicine, or had a day free of harming themselves.

And it’s not just dishes that can be lying bastards. Anything can. I used to meet weekly with a woman living in the most crushing, despairing gray mental landscape imaginable. The only time she left her cluttered and neglected home was for appointments related to her physical and mental health issues, but when she arrived to see me she was nicely dressed, clean and made up. Once a week, she’d dragged herself through a misleading shower, put on false-tongued cosmetics and walked into the world for a short outing before reverting to what was real for her.

People can love us, but they can’t save us. So I’m not saying that it’s anyone’s job to read our minds–I just want us, those who suffer both directly and indirectly from these scourges of the mind–to know that there’s often more going on than meets the eye.

You don’t have to have a diagnosis for this to be true, of course. Your boss who seems so full of himself cried like a baby in his therapist’s office earlier today. The guy who sold you a car spent last night compulsively masturbating to Internet porn, missing his wife who left him over his addiction. The prom queen’s bulimic, the football captain was molested; pretty much everyone has a disconnect between how they seem and how they are really doing.

I try to be pretty honest about how I’m doing–at least to the degree that I am able to be honest with myself. Even so, it’s just not possible to brief my loved ones in depth constantly; they’d be unable to function in their own lives if I did. When a family member asks how I am, the answer they get is never the whole story, and when I say goodnight in the evening there are always unread chapters.

Yes, I and others do sometimes make cries for help. It isn’t much of a stretch to imagine that my recent writing partially serves that purpose. But we do the opposite too. We try to look better, just a little, because we hate being a burden. Because we’re sick of trying to describe how we feel, and we imagine that the people we love are just as sick of hearing about it. We try to tough it out, and we try to do something, anything, to inject a little normalcy into the lives of those around us.

We do the dishes. And that’s a good thing, to do something. It’s better than staring at the wall.

But dishes lie.

Bipolar Cuddle Time

I try to write holistically about living with my combination of conditions, but like a mother with several children, it’s good to give them some individual attention once in a while. I am a dually (triply, if you count the eating disorder) diagnosed person. One of these diagnoses is something that would affect and shape my life even if I had never practiced any self-destructive behavior: I am bipolar. Bipolar II with cyclothymic features, if we are being technical.

What does my diagnosis mean to me? I’m not the only one to wonder…it’s a recurring theme I see when I read the writings of others who have been diagnosed with some form of bipolar disorder. They wonder whether it defines them, or how it will change the way they see themselves, or how others will interpret it.

Is my condition something I have, like diabetes? Or is it something I am? My own experience and intuition lean toward the second…whatever it is, I would not be the same person without it. Even with the more overt symptoms being appropriately treated, I just don’t think my brain works the way a non-bipolar brain does.

Is my condition part of what fuels my creativity? Links between mental illness and creativity have been suggested, and many examples exist, but it’s not a requirement for being a creative or artistic person. Populations of writers, poets and artists have a far higher incidence of bipolar disorder than the general population, but the cause and effect are unclear…such people may have, like me, gravitated toward such work out of need. In other words, we might not be that unusually talented but rather more desperately motivated to express what talent we have.

Getting my current diagnosis, in 2009, didn’t improve my life much right away, because I wasn’t in recovery yet. But in the last few years, it’s been of enormous benefit to have a diagnostic label that fits me better. I know that diagnostic labels are prone to misuse, overuse and stigma, but…it helped me. It gave me a lens to look through that made more sense of the previous decades of my life. It explained why the attempts at treating me for depression in the past had been ineffective or worse (many SSRI’s, for instance, can make bipolar symptoms worse in some patients, and I am one of them.)

It’s given me a language for the cycles that go on in me, and made them less frightening. It’s helped me seek treatment that works more effectively. It’s helped me give a name to the Indy 500 of racing thoughts in my head. It’s helped me be kinder to myself and even appreciate what I have accomplished a little more.

Because the popular perception of bipolar disorder has tended to equate it with severe cases of Bipolar I, often with extreme mania and psychotic features (think Brad Pitt in 12 Monkeys), people tend to view my diagnosis with a skeptical eye. Bipolar II is kind of trendy at the moment, which makes it worse. Sometimes I’m afraid people will see me as someone who “rides the bandwagon” in order to get more sympathy or be more excused from the chores of ordinary life. As someone who did make a lot of excuses when in my addiction, I’m sensitive to that.

Clinically, I’ve come to agree that my current diagnosis is as accurate as possible right now. Emotionally, I feel more peaceful about this condition being a permanent part of my life. Spiritually, I believe that this, like anything else about me, has the potential to be a path for growth. There’s no denying that it can be frustrating, frightening and baffling, not only to me but to those in my life. As such, learning to live with it as gracefully as possible can teach me humility, patience, creativity, courage, and more humility.

Fairy Cake, Please

All is well. As well, at any rate, as it can be in the middle of this depressive episode. Today I went to one of my regular meetings, and managed not to stare through everyone too oddly. It’s hard to be around people when I feel this way, but I know that missing too many meetings is not a good idea, so I forced myself to show up. To those who asked, I tried to reply very matter-of-factly that I am going through an episode, am getting appropriate help, and have faith that it will pass.

I feel less of the intense shame and despair that shadowed my last post, although I am still emotional. My biggest symptom now is one of my least favorites: I have that feeling.

It’s my name for it, chosen because I can’t describe it well. The closest term I’ve found in my psych books is depersonalization, or perhaps derealization.

“Individuals who experience depersonalization feel divorced from their own personal physicality…Often a person who has experienced depersonalization claims that things seem unreal or hazy. Also, a recognition of self breaks down (hence the name). Depersonalization can result in very high anxiety levels, which further increase these perceptions.” Wikipedia

Derealization is similar, but in this case it is the outside world that seems unreal or “other.” That feeling is like a mix of both for me. I remember a day in 2004: I was on a family trip, standing in a hotel gift shop, when it hit. Every physical sensation I had was now coming through a filter: it was not my jacket sleeve brushing against my wrist, but the jacket sleeve of some character who was standing where I thought I was standing. The thoughts and feelings I was having were no longer mine, but those of a character in a play written by a temperamental playwright. I had no anchor. The shelves and knickknacks around me seemed to become translucent, letting unreality shine through and around them.

Drugs can cause such phenomena or make someone more prone to them. Unfortunately, so can conditions such as bipolar disorder, so it still happens to me in recovery. The frequency with which I get that feeling is diagnostic for me. It can happen even when things are going well, but it is rarer.

Today, I flip back and forth between having a sense of self and not: even as I write this, it happens. One minute it’s me writing it, and the next minute it’s as if the camera pulls back, and back, and back until there’s a picture of the galaxy and who knows where I am, or if there’s an “I” at all.

Call it intense existential anxiety. Call it a taste of Douglas Adams’ Total Perspective Vortex. Or just call it a cab and get it the hell away from me. It’s one of the hardest feelings for me to tolerate, because it strips away many of my coping mechanisms. If I’m not real–if none of this is real–what does anything I write, or say, or do, matter? What does it matter if I eat something, or take something, or do something to make this disorienting illusion more bearable? What is this strange concept called cause and effect?

This is a moment when ritual comes in handy. When talismans are useful. When a healthful habit can be my friend. I went to the meeting this morning because it’s my custom to attend that one: I negotiated, so to speak, that I/we/it/unknown were going to go whether the meeting actually exists or not. During the meeting I found myself staring at my tattoo, remembering when I got it done and why, telling myself the story of it. Linking a physical thing with a story to make it seem more real.

If past (presumably real) experience is a guide, the intensity of this episode should respond to the (presumably real) meds adjustment pretty soon. But I wanted to check in, so that my (presumably real) readers continue to get an honest picture of living with a dual diagnosis.

Oh, and 500 geek points to anyone who gets the meaning of this entry’s title.


In my recovery it’s important for me to look honestly at how my addictive or self-destructive behavior has affected my daughter, no matter how much I want to tell myself that I tried to minimize the impact of it. For addicts like me, this duty can all too easily be twisted into a weapon with which to beat ourselves. For me personally, it gets harder when I also worry about my mental health issues, which are more severe than I knew when I chose to become a mother. I worry that I’ve handed down bad genes for these as well.

Mixing honesty with clarity and compassion is tricky, and I’d be lying if I said I knew how to do it well all of the time. I still get defensive, ashamed and rebellious. Again and again, I have to almost physically yank back my perspective and see my daughter and myself from a more spiritual angle. Get back in touch with the awareness of her as a metaphysical entity with a past, a future, and a divine component of her own.

I say “back in touch” because I have always known this about her. The day after she was born, we had our first real conversation. I’d been moved to a room with a window, which after days in the dark labor room seemed like emerging from the underworld. Propped up in bed, I held her closely and looked into her gray-blue newborn eyes. It was weird. Of course I loved her. I’d expected that. But what I didn’t expect was the strong awareness of something alien in her gaze. I looked at her, and something looked back at me. Something that was not a baby at all.

One day, when she was about two and a half, she turned to me in the middle of a Blue’s Clues episode and said “Mommy, I want to go home.” I refrained from replying that we were, in fact, in our living room, and said instead “Where is your home, sweetie?” “Up in the sky,” she replied matter-of-factly. A year later, she started mourning for her cat, who ran away and disappeared in the forest. Comforting her was made more complicated by the fact that we’ve never had a cat. When she was four, she cried in my arms one night, saying she wanted her mommy. She knew I was her mother, but she missed someone else in that moment–someone she could only describe as her “real, realest mommy.”

What could I say? I felt so powerless. Thinking it might be a past life thing, I just said that I believed she would be with that mommy again someday, but I had been chosen to be her mommy for this stay on Earth. That I loved her very much, and I would try to be the best mommy I could. Later, I wondered if the “realest mommy” was not so much a past life memory as a reference to the archetypal Mother, a feminine Divine. I kind of wish I had thought of that at the time, and talked about how we can seek that Mother (or whatever we want to call a loving Source) even while we are here.

Whatever the context, the lesson I took away from these incidents is that my daughter didn’t arrive into this world a tabula rasa; she came with some of her own stuff. As much as I regret my shortcomings, it would be the height of arrogance and blindness for me to think that my good or bad performance created all of the complex and changing being she is.

The selfish, prideful, or guilt-ridden parts of me sometimes wish that my daughter could be more “normal.” That she would feel comfortable around others, function well on a campus, or not have the traits that make me worry about her future in terms of mental health. That she was not quite so much like me. But the truth is, we have a lot in common. Not everything–she finds the learning issues that skipped me to be especially frustrating–but she is clearly closer to me than to mainstream folks, and would be so even if I had never had any challenges as a parent.

Then there’s the other side of my feelings about it; the side that is awed by her imagination and growing depth. The side that rejoices at the idea that we share the positive traits that can come with some of these hardships.

But damn, I really don’t want her to suffer. Or struggle, or know despair, or be lonely, or feel left out.

What would I choose, if the choice were mine? It’s not, and it never was, but would I try to change her? Or would I have the courage to say: Yes, your life will be hard. You’ll have to choose your work, your friends and your relationships carefully, and you will have times of loneliness. You may have to battle your own mind and/or an addiction just to do things that other people take for granted. But, if you are lucky and you persevere, your path will open you to your creativity and to seeking the Divine. You’ll have a chance to experience moments of blinding wholeness and scatter love like light through a prism. You’ll reel from the impact of beauty, drink in the sunlight after each time of darkness; even have glimpses through the veil of linear time.

This is your birthright; I and my fears have no right to deny it to you.

I want to believe that I’d have the courage and the humility to stand back and let her God decide, and I’d willingly take on any pain and hardship coming my way.  But who knows? I am no hero. Fortunately, I don’t need to be one. The decision was made long ago, and not here, and not by me.