By Tim Kuss, LADC, LMFT
I’m talking about denial of bipolar disorder and the need to take medications daily.
I believe that failure to take meds is, ultimately a denial of bipolar disorder—mine in particular. It’s not that I never had denial. In 1974, I left a psychiatric ward on pass and signed myself into a long-term chemical dependency treatment. It was easier for me to admit chemical dependency than “mental illness”. I had been in a state hospital twice, on commitment, and while there, had learned that others had been there for 20-30 years or more.
Today, we don’t see a lot of lengthy mental health stays. But two 5-month stays back then scared the be Jesus out of me. Fortunately, my treatment center did not insist that I take those horrid anti-psychotics, which they had prescribed because I had been misdiagnosed with schizophrenia. At that point, I had 25 years of sobriety with no medications and no hospitalizations for addiction issues per se. However, I had had plenty of problems with hypomania over those years, resulting in divorce, breaking up with several partners, and losing several jobs.
When I was FINALLY diagnosed with Bipolar Disorder in 1999, I believed it, but did no truly understand it. I had taken myself off anti-psychotics (and anti-depressants) in the past, and eventually went off my mood-stabilizer. I was hospitalized again in 2002. This time I almost died. My mania had me running myself ragged physically and my blood pressure was dangerously high.
I have been “med compliant” now for 8 years. I think of it as an insurance policy. My body has aged and no longer can take the physical exertion of mania. I used to go days with little or no sleep, walk for miles for days on end, and eat very little food usually with no attention to its nutritional value. Plus, I never liked psychiatric units, or the loss of freedom.
My meds do not provide negative side effects. I read about possible negative effects today, but could find none for the dose I’m taking. So why should I have denial.
I work as a chemical dependency counselor. I have seen literally hundreds of clients hospitalized because they would not accept that their chemical use has contributed to psychosis (“going crazy”). I have also seen clients try to manage without medications. My freedom requires 2 small concessions: 1. don’t use; and 2.I take my meds.
I have a pretty good life. I think I’ll keep it.
Monday, June 28, 2010
Friday, June 25, 2010
Doomed or Can We Reach a Level Playing Field?
My blogmate, Tim Kuss, recently emphasized accepting one's mental illness-in our case, this is bipolar disorder-just as much as building and maintaining sobriety. You know, it's worked for Tim, I daresay, and for me especially since we both have been clean and sober for an impressive amount of time, take our medications deliberatively, and “take an active role in the design and delivery" of our care.
I really love Mathew Mattson and Sue Bergeson of the Depression and Bipolar Support Alliance (DBSA)'s remonstration that "the ultimate goal of treatment should be to engender hope." However, sometimes I wonder how that can actualize if we realize that we will continue to always have a chronic illness that will be there to haunt us especially if we do not walk the straight and narrow.
Dr. Jeffrey L. Sussman, in The Primary Care Companion to the Journal of Clinical Psychiatry, waxes profound when he notes, " The goal of treatment (for bipolar disorder) has changed in recent years from one of symptom abatement to one of recovery; that is returning patients to their level of functioning prior to the onset of illness."
Mover and shaker psychiatrist, Dr. Nada Stotland, allude to "moving beyond symptomatic recovery to also encompass functional recovery" She advocates ways to make this happen: (1) She wants “ policy and system changes to facilitate recovery.”
(2) She asks for “ improved funding for recovery-oriented care.” (3) She wants “implementation of recovery-oriented, collaborative care models that bring together psychiatrists and primary care providers.” Lastly, (4) She wants the “dissemination of improved tools for monitoring changes in symptoms and level of functioning.
Mattson and Bergeson emphasize that “the ultimate goal of treatment must be recovery” and that “consumers should take an active role in the design and delivery of their own care"
I want to dig deeper because I am not convinced the majority of practicing clinicians buy into this view. Many behavioralists, I suspect, focus on the "flavors" of one or the other presentations of bipolar disorder: are you manic and depressed, just a little off the wall, or rapidly cycling between ups and downs? The DSM IV has a diagnosis that fits you.
There are plenty of naysayers who would suggest that there is a greater tendency to define and treat in this New Age of twenty-minute Psychiatric visits. Is there a fiscal relationship between the plethora of psychotropics on the market and how many the average bipolar patient now takes? Does the tail wag the dog? Has "pushing" psychotropics to whatever extent supplanted interactive psychiatry?
Is there a financial impropriety based on the incredible profits engendered by so many medications? Have psychiatrists literally been "bought out" by the mega pharmaceutical companies?
So what is the incentive that anyone with bipolar illness will actually ever "get better?" I am not advocating that the bipolar patient as soon as they feel good again stop taking their medications. Sussman advocates utilizing an effective treatment team. I heartily agree with him and feel, to the bottom of my soul, that collaboration between the patient and physician is crucial. Such an approach demands mutual communication between physician and someone with bipolar disorder. Also, collaboration between primary care providers and specialists (psychiatrists, psychotherapists) is proven to have better outcomes.
Those lucky enough to have been treated collaboratively admitted better attitude about taking their medications and how bad they felt. They also just functioned better. Here again, these innovative psychiatrists are directing our attention toward returning to a level playing field; that is, somewhere before we began our struggle. Is that possible?
We circle around to the question whether someone like myself with known bipolar disorder can ever function normally again? "But you demonstrate compromise of executive and cognitive function on psychometric testing," they may tell you. However, the same psychologist may have performed testing under less than ideal emotional circumstances or under stressful conditions possibly contaminating the results.
In summary, it is my opinion also that a bipolar patient, collaboratively with appropriate medications from a perceptive yet vigilant psychiatrist and a knowledgeable therapist with co-occurring issues in check (anxiety, alcohol and drugs) CAN return to a level playing field.
I really love Mathew Mattson and Sue Bergeson of the Depression and Bipolar Support Alliance (DBSA)'s remonstration that "the ultimate goal of treatment should be to engender hope." However, sometimes I wonder how that can actualize if we realize that we will continue to always have a chronic illness that will be there to haunt us especially if we do not walk the straight and narrow.
Dr. Jeffrey L. Sussman, in The Primary Care Companion to the Journal of Clinical Psychiatry, waxes profound when he notes, " The goal of treatment (for bipolar disorder) has changed in recent years from one of symptom abatement to one of recovery; that is returning patients to their level of functioning prior to the onset of illness."
Mover and shaker psychiatrist, Dr. Nada Stotland, allude to "moving beyond symptomatic recovery to also encompass functional recovery" She advocates ways to make this happen: (1) She wants “ policy and system changes to facilitate recovery.”
(2) She asks for “ improved funding for recovery-oriented care.” (3) She wants “implementation of recovery-oriented, collaborative care models that bring together psychiatrists and primary care providers.” Lastly, (4) She wants the “dissemination of improved tools for monitoring changes in symptoms and level of functioning.
Mattson and Bergeson emphasize that “the ultimate goal of treatment must be recovery” and that “consumers should take an active role in the design and delivery of their own care"
I want to dig deeper because I am not convinced the majority of practicing clinicians buy into this view. Many behavioralists, I suspect, focus on the "flavors" of one or the other presentations of bipolar disorder: are you manic and depressed, just a little off the wall, or rapidly cycling between ups and downs? The DSM IV has a diagnosis that fits you.
There are plenty of naysayers who would suggest that there is a greater tendency to define and treat in this New Age of twenty-minute Psychiatric visits. Is there a fiscal relationship between the plethora of psychotropics on the market and how many the average bipolar patient now takes? Does the tail wag the dog? Has "pushing" psychotropics to whatever extent supplanted interactive psychiatry?
Is there a financial impropriety based on the incredible profits engendered by so many medications? Have psychiatrists literally been "bought out" by the mega pharmaceutical companies?
So what is the incentive that anyone with bipolar illness will actually ever "get better?" I am not advocating that the bipolar patient as soon as they feel good again stop taking their medications. Sussman advocates utilizing an effective treatment team. I heartily agree with him and feel, to the bottom of my soul, that collaboration between the patient and physician is crucial. Such an approach demands mutual communication between physician and someone with bipolar disorder. Also, collaboration between primary care providers and specialists (psychiatrists, psychotherapists) is proven to have better outcomes.
Those lucky enough to have been treated collaboratively admitted better attitude about taking their medications and how bad they felt. They also just functioned better. Here again, these innovative psychiatrists are directing our attention toward returning to a level playing field; that is, somewhere before we began our struggle. Is that possible?
We circle around to the question whether someone like myself with known bipolar disorder can ever function normally again? "But you demonstrate compromise of executive and cognitive function on psychometric testing," they may tell you. However, the same psychologist may have performed testing under less than ideal emotional circumstances or under stressful conditions possibly contaminating the results.
In summary, it is my opinion also that a bipolar patient, collaboratively with appropriate medications from a perceptive yet vigilant psychiatrist and a knowledgeable therapist with co-occurring issues in check (anxiety, alcohol and drugs) CAN return to a level playing field.
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