Who Gets To Be The “Good Schizophrenic”?

Check out Who Gets To Be The “Good Schizophrenic”? by Esmé Weijun Wang over on Buzzfeed. I saw this make the rounds a while ago but I've only today had the time to read it properly. 

It’s kind of nice that I read this today, since I've been really pre-occupied with work stress. Wang talks about being able to work a 9 to 5 as a benchmark for being a functional mentally ill person. Things at work for me are sketchy. They don’t have enough work for me, so I keep losing hours. But I’m also exhausted and I just don’t know what to do.

2013 was also the year that I surrendered my last benchmark of sanity, otherwise known as my full-time job at a fast-paced start-up company. For years, holding down an office job had been what I believed sincerely, and perhaps a bit desperately, separated me from others of my ilk, but I stepped away from my 9-to-5 because my job, despite its accommodations and allowances, exacerbated my illness.

It’s so difficult to identify what is a “bad day” and what is a job that isn't right for me. There’s also the stress of needing to work. I need an income. I am not on disability, and from what I understand I wouldn't qualify. For years I was trying to get an official diagnosis, but nothing has really changed, and I still feel like there are parts of me that transition and evolve. I have periods of heightened anxiety. Periods of deep depression. Periods I feel manic. Periods I feel despondent and sub-human. There are days I cannot focus. I can’t actively listen. I have trouble focusing my eyes. It’s just a shit show sometimes.

In Blue Nights, Joan Didion remarks, “I have not yet seen that case in which a ‘diagnosis’ led to a ‘cure,’ or in fact to any outcome other than a confirmed, and therefore an enforced, debility.” Living under the shadow of a new “code” bore no curative function, but it did imply that to be high-functioning would be difficult, and it warned me that to live beyond that code would be a tricky gambit. A therapist had already told me in my mid-twenties that I was her only client who was able to hold down a full-time job. Having a job, among psychiatric researchers, is considered one of the major characteristics of being a high-functioning person.

I don’t consider myself high-functioning. I'm functioning. But I'm exhausted and it takes all of my energy.

Read Wang's piece. Schizophrenia doesn't get much representation, and when it does it's usually used to put other mental illness struggles "into perspective." 

The more representation there is of living with and working with mental illnesses, the more there will be an understanding of flexible work-lives, different strengths, and ideally there will be a societal conversation regarding working conditions and ways of supporting the mentally ill and listening to what they need to work and support themselves. Ourselves.

Optimism, once removed.

Yesterday I took the day off. I had an appointment with Dr. Rishi, and a dentist appointment. So, all the travelling meant it made more sense to just take the day off. This past weekend I was in Bromont with S, "taking it easy" so it was nice to have the extra day to putz around.

It was a nearly incomprehensible doctor's appointment. As usual, Dr. Rishi was engaged and talkative. We talked about some of the literature I mailed him (legit mailed to him, since his office doesn't work with e-mail). I had sent him a report on ECT (and explained that I like knowing it's an option if things get bad again) and also mentioned my readings on hypersomnia and inflammation.

I talked about my wanting an official diagnosis, because I feel it adds legitimacy to my struggle, and that in the future if there's ever a need for official documentation, I want my struggle to be legitimate. He thinks I suffer from Major Depressive Disorder and Hypersomnia. This is what I would have self-diagnosed as, but it's nice to have a confirmation of my own readings.

The conversation was lightning fast and dense. He asked that I book another appointment for him at the beginning of November, since he's off all of October. We decided to keep me on my current dose of Effexor, and stabilize, to re-assess if an additional increase is necessary. 

The conversation ended with Dr. Rishi focusing on goals. This is still off-putting to me, and kind of shocking since being goal-oriented has not been something I've felt for years. In fact, he used the word ambition and I probably stared at him like:

Look, I understand words are important, but so are gifs. They can say things words can't. I mean, it's faster. Whatever. Gifs.

Rishi started talking about short-term goals. Since our next session would be in November, he wanted for me to have goals in regards to my physical health. To find ways to exercise. He also wanted me to schedule my trip to Victoria in February to visit C, since he says having something to look forward to would be good for me, and also leaving Montreal for Victoria in February would be a nice mood booster, since it'll be -30 here and spring-like in Victoria.

It's just all so odd. So alien. I have been taking things "one day at a time" and really just managing my life day to day. 

He ended up writing a bunch of stuff down for me, he pretty much said that he's worried things'll get worse for me in the winter, since statistically speaking they do. Seasonal Affective Disorder compacts whatever mental illness we're already living with. So he said I'll have to make an effort to go outside and walk around, to get some daylight in. 

Obviously (to me), I also need to figure out exercise. It's been difficult to commit to anything because of how far I have to go. He'd like to see me have something I can commit too that might be kind of social, like a class. I'm not sure about that, since I don't have much money. I have to figure out what might work for me. It's important that it be regular. Maybe I could just start going to the gym again - but the gyms in my area are such bummers. Douche-nation.

He also said to focus short-term, and to let go of my planning. Basically, try and take steps to cope with the winter as best I can, and then to re-evaluate in the spring. Which technically, is when I'd be looking to move out, anyway. Ideally. 

I always walk out of my appointments with him as if I've been spun around in an office chair. I haven't had a family doctor in over a decade. The doctor experiences I have had have been primarily negative. This is the first time in a really long time I feel handled. 

He's very optimistic about my diagnosis, and my ability to move forward. Sure, the optimism isn't mine, but it's optimism. Just having optimism in my bubble is discombobulating.

Psychache.

So I was reading a report on the use of electro-convulsive therapy in Quebec from 2002. In it there was a good overview of major depressive disorder:

Major depression is a chronic illness. Approximately 80% of patients will have at least one other episode of depression in their lifetime. On average, the episodes last approximately 20 weeks, and most patients recover temporarily. The economic and social impact of major depression is considerable. 

Worldwide, depression ranks fourth in the world’s disease burden, immediately after respiratory infections, diarrhoeal diseases and perinatal conditions. The social and economic burden it entails is greater than that of ischemic heart disease, cardiovascular disease and tuberculosis. 

There is also an immense psychological burden. According to a systematic literature review, depression appears to substantially increase the risk of cardiovascular-disease mortality, but the quality of the studies available does not establish either the actual level of increase or the causal mechanisms. Psychological suffering, also called psychache (or psychic pain), is so great that suicide often appears to be the best means of escaping it.

I'd never heard the term psychache before. The term is used to describe psychological, psychic pain. Something I suffer from and usually refer to as psychological pain. 

There's no doubt that all the reading and research I'm doing is helping in my able to write, and talk about my illness, but I don't know how helpful it is in experiencing the pain. The suffering is here regardless of the intellectualizing I use to frame it. 

What good is psychache to me? Can I call in it to work with it? Is it recognized by the medical community? By employers? By our greater culture? 

Carrie Fisher on being bipolar.

 
 
 
 

I crossed this set of gifs of Carrie Fisher describing what it is to be bi-polar to a child.

I checked out her Wikipedia entry, and it does mention her being open about her drug and alcohol addiction and her bipolar disorder. She's even spoken publicly about ECT (electro-convulsive therapy) treatments, and how she gets them every 6 weeks.

P.S. Her episode of 30 Rock is a magical jewel.

Undercurrents: A Life Beneath the Surface.

I just finished Undercurrents: A Life Beneath the Surface by Martha Manning. I'd seen the book on a few mental-illness themed book lists, I read it in under a week, it's a pretty quick read. It's a memoir written by a woman who by day is a psychologist. A woman in her 30's who slowly becomes increasingly depressed, as expressed in her journal. There are a ton of quotes that I highlighted, so I'm going to write them here, and respond to them.

She talks about the initial conversations she had with friends, and how their attempts at encouragement often alienated her even more.

I love them for caring, but I want to run from it. I have lost their language, their facility with words that convey feelings.

I know language, and the ability to really express what I'm feeling, and what how it feels is something I've struggled with. I kept reading, and I became fascinated by language and learning as much as I could vocabulary wise in order to be able to represent my struggle successfully. But when I'm down, when the depression sinks in, that part of me shuts off.

Some struggles are so solitary that they drown in words.

I often try and use the term guttural. It becomes so deeply basic, so harshly, brutally, pre-human. How do you represent it? Manning references physical pain, and a swollen ankle as something that almost relieved those around her:

It is a preference relief to have a "real," visible hurt. A hurt that people can recognize and understand. They wince in sympathy and know just what to do and what not to do. People can deal with this kind of pain. It all makes sense.

I can relate tot his, tremendously. Sometimes I fantasize about physically hurting myself, in order to have a physical, exterior focus to my pain. I remember as a teenager often pushing things too far when it came to pain toleration to the point where it would disturb my friends. But for me, it came with a kind of satisfaction. I relished it.

Manning also describes her relationship to suicidal ideation that sounds very similar to mine:

I find myself preoccupied with thoughts of death. In some moment of emptiness or pain, an image of dying comes to me: a car accident, a heart attack, a vicious and quick-killing disease. In the psychiatric vernacular these are called "passive thoughts of death." But in my mind these thoughts are quite active. Rather than feeling the revulsion and fear that would have resulted from thinking about these things several months ago, now I find them strangely comforting.

I would never kill myself intentionally. I couldn't do that to my family, my friends... But to have fate step in and give me a shove, that's a different matter. Then I have the exit, without the guilt. I am ashamed of myself for thinking like this. But more than anything, I am frightened that it makes me feel so much better to think about it. Somehow it eases the terror, the sense and I am condemned eternally to this hell.

And she describes how an understanding of suicide isn't necessarily hate and anger based`:

I don't want to die because I hate myself. I want to die because, on some level, I love myself enough to have compassion for this suffering and to want to see it end. Like the spy with the cyanide capsule tucked in a secret pocket, I comfort myself with the thought that is this ordeal gets beyond bearing, there is a release from it all.

This is the quote that initially had me googling her name:

Depression is such a cruel punishment. There are no fevers, no rashes, no blood tests to send people scurrying in concern. Just the slow erosion of the self, as insidious as any cancer. And, like caner, it is essentially a solidarity experience. A room in hell with only your name on the door. I realize that every person, at some point, takes up residence in one or another of these rooms. But that realization offers no great comfort now.

Once you start understanding your depression, coming to terms with it remains a struggle. Sometimes, I feel as if my depression is all that I am.

I think about the difference between having something and being something. They are only words, but I'm stuck by how much they convey about the manner in which the short-hand of mental illness reduces the essence of people in ways that labels for other serious illness do not.

How much of this disease is me? How much of it is my character? Are there any redeeming qualities to the disease?

All the romantic nonsense about depression somehow making one into a creature of unique sensibilities is easy to agree with when I feel good. Then I'm sharper, superior for having weathered something terribly difficult, or just plain pleased at having narrowly gotten away with something once again--like the snow day after the night's homework I didn't do. All of it stands up to the light, but it's bullshit in the shadows. I don't care about unique sensibilities. All I care about is surviving. My goal in life is just to get through the days.

Interesting comment on religion and existential dread:

She tells me that in AA they say that religion is for people who are afraid of going to hell. Spirituality is for people who have already been there.

A truth for me:

... my baseline for awful will never be the same.

The value of quiet. Something I was just talking to Ranjana about. How it isn't necessarily only a coping mechanism, but something that I enjoy.

I find myself growing quieter over time. But I'm so unused to it that I still equal it with being overwhelmed or depressed--a default in the continual cycle of inundation and backing off. And yet the quiet is part of who I am. Not just a result of the circuits blowing and the computer shutting down. It has merit all by itself.

The book definitely has interesting passages that spoke to me. Last weekend while staying with my brother, a friend of my sister-in-law's came over. She was discussing the state of her 20 year-old-son, who doctor's say was pushed into some type of psychosis due to extreme drug use. She said after hospitalization and electro-shock therapy, he is now back at home.

What I knew as electro-shock therapy is now referred to as electroconvulsive therapy or ECT. This was a shock to me, since I didn't know this was still in use. I thought it was out-dated and barbaric, since it's often the way it's represented in books and film that discuss mental-illness-related hospitalization. I've never seen One Flew Over The Cuckoo's Nest, but I know the seminal electro-shock scene well. Funnily enough, I just saw an article about how much damage was done to the reputation of ECT because of it.

Manning's book also goes into detail about ECT. She was hospitalized (willingly) and underwent five treatments. It seems to be the turning point of her depression. This affected me in a way I didn't expect. It's almost as if it opened a window. Maybe if things continue to be bad, it's an option for me.

It comes with risks. Memory loss. Confusion. But potentially also relief. It has a success rate of about 50%. And it is not a cure, but a treatment.

Historically it also seems to have been a treatment for "hysteria," if you're at all well-versed in feminist literature, you know that hysteria was a catch-all when treating women medically for hundreds of years, and was often used to silence and discredit women, and often hospitalize them against their will.

I'm going to ask my doctor about it when I see him next. It might be a viable option if things get worse.