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a safe haven for Partner Dylan

A space offered with no expectations or demands.  Not even interaction. Not with a demand to “talk things through,” “figure things out,” try to impose at all.  A space to withdraw, spend time alone, be in a real home, not together, not completely alone in a dark, one room studio apartment if only evidenced by the presence of a stray cup of tea found in the shower.  Just a space to be at times and in a period of reflection and safety.  A real house.  Spaciousness.   Working opposite hours.  Not the pressure of a relationship.  Even on Saturdays, not there all day and late into the night.  His.

I saw more clearly the other day.  I think I exhausted Partner Dylan.  My texts, calls, pleads, demands, longings, even things that happened around therapy.  I did not fully get that.  I did not fully get how he was/is feeling or maybe how he has been the past few months.  How much pain.

Because my Fearful/Vigilant part came across as demanding more needs from him.  Attacking.  Unsafe.  Confusing. Very hurtful.  Something to run from to save his sense of Self.

I could see in his sadness recently that my love or care does not necessarily feel like love to him or safety.  It feels like something he must do or respond and do.  Something like a ticking time bomb.  That makes sense to me.  He is basically between pain and pain.  Safe respite alone, or respite that is inconsistent, scary, and unsafe, overwhelming, hurtful, or not alone enough for what he needs.

Partner Dylan has always tried so hard to please me.  At times when he has revealed just how much, I have felt sad that he was working or feeling the need to work so hard.

I would hear him use worker-terms–“trying to get back to a good place,” “Sisyphean,”  he said.

Almost like there would be no respite for him, no safe space, no nurturance until he had “fixed” something. 

That makes me really sad.  That he would feel like that.  That I am a danger or someone who could hurt his heart.  Because it is true, or was true for several months overtly.  More lessened at times prior.  Not intentional, but hurtful.  I haven’t lost my mind since I made sense out of a lot of it and still am ongoing.  I love him.  Making sense out of things inside has always been what regrounds me and brings me more peace in life.

Whether or not Partner Dylan wants to be in a relationship with me is separate from my values of loving him and offering what I have:  a peaceful space to be most of the time alone in a real place, with a real bed, and a loud animal stubbornly intent on cuddling.

I think one of the biggest definitions of safety is that sometimes we just need a safe bedroom, lights off, tucked in, loved.

Peace. 

Rest.

He has provided that for me in ways no one ever had.

It matters not if it is used for 5 minutes or 5 days.  It is there.

parts

In the different parts of self that my therapist often talks about, I recognize that with Partner Dylan that I have several including a Compassionate part, a Vigilant/Protective/Fearful part, and a tremendous Love/Values part.

The one at the end of the day is what my therapist would call my Wise One.  That essentially is the space we come back to in ourselves when grounded.  That being in touch with this Wise One is what can organize, empower, or calm the others.  The Wise One is essentially the core self connected.  The more any of us can get in touch with that, the more options we see available to us in how to respond to things in a way that is in line with our values in our personal selves.

Partner Dylan is one of my values, conscious to love.  I am also one of my values, conscious to love. Compassion in general is also something in myself that rarely goes away.  I like this.

I want him to have the space available to use as an Airbnb.  He can choose to or not, but it is here.

Love wash over a multitude of things

 

 

 

 

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my birthday

Four weeks.

For weeks until my birthday.

The emotion, the empathy, the ease of problem solving, calm, the no more depression, the energy, the laughter.  The rapid reflecting and processing of both intellectual and emotional content.  How I miss his playfulness that he lost.  He lost it almost with anyone everywhere.  He lost his facial expressions.  He kept sinking.

His disposition is playful a lot.  Walking home with him chatting about his day at work at a job he did not even like but liked the people.  So energetic.  Always coming to tell me something that he saw that was funny.

He had so much energy, calm, enthusiasm, less reactive, less sadness, softness, vulnerability.

Where is that guy who would play in the snow?  Could emotionally never leave me?  Could work through anything?  Would lay on top of me for weight when I was anxious?  Threw fits over monopoly?  Played apples to apples?  Tickled?  Had four hundred and twelve plans for the weekend?  Climbed our arch when finals were finished?

Stayed up all night talking with friends at diners?  Badminton?  Helping a friend with his roof?

Held me.  Cuddled.  Felt something.  Couldn’t stand to think of life without me.  Couldn’t stand to not see me and hold me.

How could he leave this and survive it.

That is Partner Dylan feeling better.  Letting me (and others) near him.

God how I miss that.  I wonder if the present drugs will even let him remember himself.  The Partner Dylan we have all known for 15+ years.

I hope his anxiety can come down enough to see he is loved.  Deeply, deeply loved.

I will be 38 in four weeks.  10 years since I began my relationship with Partner Dylan.  We have been through a ton of amazing times, sad times, learning times, with lots and lots of affection, play, and holding.

The only thing I would like most in the world is for Partner Dylan to feel better.  To become him again.

It’s a large ask for my birthday.  But it is all I want.

And regardless, whatever place Partner Dylan is in right now, to let me near him to hold and be held by.

Even without words.

 

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same team. didn’t know it. love wash over a multitude

 

 

 

 

 

background for text

He must have been terrified.  In absolute anguish.  Must have been close to his worst nightmare.  Must have been in so much pain.  Must be in so much pain.

When I play it back, run it down.  So unfair.  I feel so sad about his pain.

What Partner Dylan does not know (and did not) is that there are would have been 75-85% less fights from me.  It was the confusion that gave me anxiety, the reactivity at times.  Not always the topic.  It was the emotional response, however subtle.  I could feel it.  I grew up on a war zone, so not understanding an emotional shift no matter how subtle i start to get significant anxiety, then frustration, then confusion, then blame, usually in that order.

I can think all the way back and realize when I would jump to a conclusion.  I would ask, but not necessarily openly.  It is often tied to my own trauma and panic.  I felt this split in not understanding and reading him.  And I felt the need to fill that lack of information to settle my anxiety of the puzzle.

It must have hurt his feelings again and again.  It was somewhere in recognizing how this would occur after the fact that I developed the mantra:  Partner Dylan always does what is right in the end.  I would say it because in the middle of sensing a shift and getting agitated, I had a difficult time understanding what conclusion to come to.

So I learned that in the end he would let me see his heart.  And over and over again I would realize how it was not what it appeared.

We tried picking apart issues over process and the more subtle things that did not make sense to me.  So it seemed like more and more issues kept piling up, even though all this time–it was that my radar of a shift in emotion or mood or even behavior that was the sole alarm for me.

I want to be clear that most of the time it was not the shift that had occurred as the problem–it was in my not understanding and panicking, coming up with reasons about it that sounded nefarious.

It’s like okay, there may be a wider range for some people than others in feeling, but it is my not understanding of it that can cause the issue for me.  It’s not some sort of judgment on if a feeling or perspective is valid or not.  It’s not like “oh, it’s PMS” and shit like that.  Feelings are feelings.  And Partner Dylan’s are valid and should be regarded as such.

It is difficult to explain to others how to anyone with PTSD or any sort of trauma, that not understanding where that sound came from will prompt a million questions.  Frantic.  If you grew up with harmful explosions from men like I did, you learned to hear a pin move a millimeter before even being pulled from the grenade.

Second nature.

I imagine that is why he was and is so overwhelmed.  Or that he was part of a remodel program or an experiment with various tests.  So his summarizing that “he must not be the one for me” or that something feels overwhelming and futile would make more sense that he would feel that.

For me it was hardly the issue, past, present, even some future.  I was confused about myself too.

75-85% of a misfire.

I think know I did recommend he see four hundred and twelve different things.  He probably felt like it would never stop.  Like I kept trying to “change” him.

I was actually afraid I was losing him.

And it looked more like “I don’t want you, as you” rather than I love you more than anyone ever.

When I play it back as him, I can get why he would be so overwhelmed.  So afraid.  So doubting his relational abilities.  Doubt of me, what had happened.

Doubt of even my perspective of his past, present, future.  If it was mean and judgmental which in my panic of flashing back over and over again to sociopathology, I jumped to worst case scenario again and again and running through his life a with a machete in panic.

I hope when the fog clears, he will know that I do not feel those things about any part of his heart.  Of his life.  I don’t think he does with me either.

malpractice and negligence

By the time of the arrest –which is absolute malpractice and negligence that his psychiatrist let it get there–I was incredibly alarmed.  I feared deeply. I was in shock, horrified.

In this case, we need to almost view the arrest as we would a suicide attempt.

It would be like if a psychiatrist prescribed benzos and kept seeing his client become more hopeless, sad, catatonic.  Kept talking about how they wanted to kill themselves and the psychiatrist just kept almost trying to solve problems around the benzos he was issuing.

If that client had a suicide attempt, you would go after that psychiatrist’s ass.

I feel similarly to an arrest in this case.  The agitation was right there.  It was regularly discussed.  It had been brought up by his spouse.

It had been brought up countless times by him.  It was made fun of.

It just never should have happened.

And every last thing that contributed to the build up when you think about it out of incredible fear, anxiety, anger, and pain.  Leading to lying, behavior that confused him, the fatigue in processing, communicating it, processing internal emotional content, my increasing anguish and responses to not grasping and jumping to worst case scenario.

Had I known.  My response would have been as it is now.  More me.  I have seen and heard him amp up in pain and panic several times since then, never responded that way again.

I saw and see him now trying to get the past few months of outright climactic war organized.  Trying to figure out what happened, how to bracket it, get it to where it feels under control.  How to trust.

I deeply hope that if any relationship gets destroyed and bracketed, it is the one that just let him to suffer.  Not the one person on his team and who loves him deeply.

That he will entertain the idea that now it does not have to be taxing or drudging through the mud, reliving things, but just being here now.  With more calm.

Because understanding shared softly in two persons is life-giving rather than taxing.

Like a healing breath of air.  And an exhale of relief.  Slowly testing the water.

brutal stories

I cannot believe how often I hear this story now.  That there is an actual book about it with thousands of reviews.  About how many partnerships almost did not make it after a psychiatrist didn’t do the goddamn job, took up the pen, and got on the usual train home in the evening.

a story I cannot tell

There is a PTSD story that massively erupted in this from prior, but I noticed that I cannot tell it. I wrote it, but dissociated so many times in the telling, I cut it out of this post.

Partner Dylan is honestly one of the most forgiving and patient people with someone he loves.

The absolute hardest part for me is that right now, he feels his only safe way is to put a literal frame around me:  physical, psychological, emotional, mental, sexual, regional, my heart, his heart.

To allow any of those things to move outside the frame feels like it could be deadly emotionally and psychologically.  And I get why.  To have come to some sort of conclusion that he is not loved, accepted, and cherished and therefore will not be okay.  This too is completely understandable.

I just hope he will peek a bit out to test the waters that my presence now need not be about “processing,” and overwhelming, but could be life-giving, loving, affirming, renewing.

It’s taken a lot of processing for sure for me.

I miss him so much.  His blue sweatshirt and hugging him. His smell.

I need him.  Even just silently in the same space.

we were both on the same team; we both just didn’t know it.

social justice and negligence

This malpractice justice issue seems to keep following me everywhere I go.  Personally, professionally, colleagues.  Keeps popping up in my orbit of the systemic problem. Negligence by psychiatrists who take up the pen.  Not meaning harm, not uncaring, but that is not the rubric in this field.

A 69% failure rate.

An owner, colleague, and friend of another practice who knows this psychiatrist in particular just randomly gave me the name of a lawyer that works with this. Should their be the desire to sue for malpractice later.  Should Partner Dylan ever want to for damages, risk, witnessing increased suffering and not listening, psychological distress at arrest, fees of expungement, co-pays, prescriptions, extra therapy, etc.

It happens too much.   This was egregious.  Currently there is a case being heard in the supreme court by the spouse of someone who went through this and unfortunately did severe damage.

Additional damage and confusion is additionally because the psychiatrist was practicing therapy without a therapy license (allowed) and likely one year in one therapeutic theory (also allowed).  Same is allowed for neuropsychologists and I would not let my cat near several of the ones I used to work with.  One year.  One year of one theory.

The majority Partner Dylan’s psychiatrist’s published research was in dentistry.

To be very clear about what is being said–it has nothing to do with someone becoming “crazy” or whatever.  That Partner Dylan is and has still been Partner Dylan.

That is the point.

Our psychiatry’s rubric should not be to wait until someone is hospitalized, in jail, addicted, or dead to alleviate suffering.

It is about narrowing that goddamn bell curve where the range is not between suffering and suffering.

We all are flexible, inconsistent, and shift all of the time.  That is part of being humans.  Beautiful in fact.  It is this that draws us to one another and exactly this that draws me to Partner Dylan.  He is deeply emotional, a deep feeler and thinker.  It is an enormous quality and I could not be with anyone who wasn’t.

It was this that I fell in love with.

He should not have had to suffer at times outside the standard deviations of suffering and suffering.

______________________

The impulsive responses to an ex-girlfriend that confused even himself, the lying, the anger, the life draining out of him, the decreasing attention span.  The arrest, cost of expungement fees, co-pays, medication co-pays, therapy fees, time spent in rehab, therapy, fees of acupuncture to quit smoking–the body’s intuition of nicotine being a biphasic stabilizer, the discouragement of struggling to quit and self-doubt.  Psychological trauma of arrest.  Psychological trauma in partnership.  Shame, pain, confusion, isolation, delay of going to school due to rehab, delay of asking for help due to incredible anxiety.  Exhaustion from trouble sleeping.

The conviction of “badness.”

The feeling depressed each evening since a teenager at dusk due to the light shifting.

The enormous fear of calling creditors, the low self-esteem, the history of random indiscretions, the heroin, the fears during school, job hunting, the low self-esteem.  The fear he was “stupid.”  The suicidal drop sometimes bi-annually.

The increasing anger, the loss of meaning and “purpose” he would often say.  The long hours in front of a screen.  The decreasing in laughter, not wanting to do much outside the house.  The narrowing of topics.  The increasing overwhelm in processing emotional content.  The distress that would happen prior to bedtime for him.  The fear.  The incredible fear of my anger.

That makes me sad.

The constant fear that I was taking advantage of him, didn’t really love him.

Would reject him.

Would leave him.

Of course he would feel that I was constantly displeased.  That I had shamed him.  Because the last few months I had.

It should have never gotten to this place.

He was already doing the right things.  Seeing a therapist, seeing a psychiatrist.

So of course he would have felt confused and hurt.  If he didn’t know that he was coming across as cold and hardening, and his heart was soft underneath, I just feel so much incredible pain and compassion for him.  Because as per usual prior, I would match him pound for pound in dialog.  If he was coming across harshly, he would know it almost before I did.

But he didn’t fully know this time of how he was increasingly coming across.  And by the time it grew so big, my PTSD completely set off.  I was disoriented.  Then panicked he would abandon me.

And my deepest places got hit.

I was used to generally a 90% predictable response in conflict for years and years.  We are passionate for sure, but we would stop and talk it all the way through.

By May, I felt nearly blindsided with what was in front of me.  Sure it was the trigger of an event–but it was all of the inexplainable shifts prior and then in reaction.  

It just wasn’t our Partner Dylan.

I started dissociating regularly, hysterical, couldn’t figure out what was happening to me, had bad panic attacks, had a surreal experience of what was happening in general.

It was the not knowing what was happening.

I took so much personally.  When he didn’t want to go for walks anymore, hike, play, stopped laughing, started wanting more and more control.  I felt pushed out and like he was in his own world.  I would watch him pull on his hair and I knew that was anxiety.  He became increasingly distressed about a sleep schedule.

Finally he felt really hurt.  Like I was always telling him there was something “wrong” with him.  Because I thought there was.  I just figured it was character or insensitivity or just being mean and dismissive .

All I wanted was my Partner Dylan back.  Even if he didn’t necessarily do or resume some of what was listed above that he used to, I just wanted to make sense out of the emotional response.  I wanted to understand.  When I couldn’t, it was worst case scenario.

Afterward, the night in the parking lot, I shook it out.  I cried.  He didn’t know why.

The relief.  Partner Dylan was still Partner Dylan.  He didn’t know just how much made sense then in terms of suffering and range of emotion not being narrowed from suffering to suffering. 

How even to this day more keeps making sense. 

scared him badly, a partner’s finest moments

I tell this next session not because I enjoy having to ever think or remember it again— it has been the willingness of other couples to tell the tale, any tale of triumph really, that gives me hope and a path to look at.

So here are some of my proudest moments of my trigger.

A few times times I was so alarmed and the never again from my sibling came and I felt had to get him out of “my” house.  Outside of violence I panicked and tried whatever I could to get the threat out.  Even to the extent of taking out some of his things hoping he would follow them out or I would not feel so powerless or something.  Once he even locked me out. Another time when i didn’t know what was happening in his emotional response that looked so cold,  he would not leave “my” home and I was so incredibly afraid to a panic, I (cringe) even poured some water on his face to try to summon him to get up and leave the premises.

That one goes in and out of memory.  I had large memory gaps around these times of panic and not knowing what was happening.  I just split in the confusion.  I had another where he walked off and I was in so much pain and he seemed like he just did not care at all.  I just had not idea how that could be happening.  He walked away and locked himself in the bathroom at which point in panic I attempted to break it down.  It was not to hurt him, it was because I felt so abandoned and yet the need to be close to him, to not be shut out.  I was longing for him to help me reground.  And it definitely did not appear that way.  During the worst of the triggers, I went in and out from hysteria, to sadness, to feeing suicidal, to enraged (mainly fear), to attempting any which way to access him.  Any which way.  Either through pleading, asking, and finally in saying mean things.  I kept hoping something would break through that wall to wear I could grab my anchor again.

Again–didn’t exactly look like I was reaching for the person I love more than anyone.

In the moment it absolutely seemed like the right option to attempt to get myself to safety.  He just was not Partner Dylan which translated to me mean the only other thing I had known–sociopath.  And the “never again” in me fired rapidly with every shocking response he had.

sadness to his heart behind that wall even if it didn’t look like it 

It honestly looked like he had entirely split.  It was so convincing.

It makes me so sad that he was under there.

I am so sorry to Partner Dylan’s heart.  He did not know what I saw and the fearful confusion at it.  And I am starting to realize what he saw.

We were lost. Really lost.  Couldn’t figure out who the other was.

Stopped.  was getting it.  on the same team.  didn’t know it.

I stopped reacting that way after that night with trying to get him to leave “my” house.  Never reacted like that again.

Actually stopped in the moment.  Didn’t wait until something was “solved” or he had become someone looking like Partner Dylan again.  But in that moment I finally knew the ground I was standing on and I knew him.  Even if I couldn’t “see” him, I could sense him and that was a more familiar feeling.  It helped me to see other choices where previously I had not seen almost any because of the fear.  I could come back into my own body and feel like me. I could make choices out of my values and him again.  Not perfectly, but more like me again.

Because I had started to get some things which regrounded me.

He didn’t see the him that I saw.  And I didn’t necessarily see the me that he saw.  After some time now, 2 1/2 months, I do.

And after that time, I can somewhat get inside of his shoes and feel his pain.

one of the two most painful times I saw his heart surface in the middle of the war zone.  it breaks my heart to even recollect it.

During one of those times when the outside of him was looking very different than the inside person (he seemed like an opposite–like somebody else), I saw “him” break through and was shattered inside to see his suffering from me.  From me reacting to the “him” in front of me and utilizing language to that person and not to him.  But he was the one under there getting hurt.

I was supposed to go see our couples therapist, I saw a response in Partner Dylan that was again like the switch and I lost it on him.  The more I didn’t understand his response, the worse I became.  I suddenly saw tears in his eyes in response to something I had said, like just all of a sudden there they were– and my heart broke. There he was.  His heart was in there. And I was hurting this person I love so much and didn’t know what was under there.

I stopped and went over and just hugged him.  I was tearful on my way to the therapist that night, felt like I had hurt him–my Dylan–not this other guy I was trying to impact.

I didn’t know what was happening.  I didn’t know how there could be almost sarcastic apathy–and a crying Partner Dylan underneath.

It breaks my heart.  It was such a mind fuck for me in not understanding what I am getting now.  And my response started matching the mind fuck.  Probably a lot worse.  I was in full self-defense mode reacting to a time I was no longer in.  I was essentially searching for a schema to attach the trauma to.

It was an inaccurate attachment.

pain and chaos  mounting:  gut wrenching memories, injuries, and deep, deep love

Love wash over a multitude 

How incredibly hurt his heart must be regarding me.  He probably thought I had turned into his unpredictably explosive mother.  Why does she keep losing it on me and saying such horrible things—such chaos? Hitting him in his most vulnerable places in his heart imaginable.

I didn’t know he was him inside.

I didn’t know. 

When I look back, especially on the time when it seemed so clear that he “just didn’t care,” I can see how afraid he was, how much he was hurting so much inside.  Poor Partner Dylan.

And he probably thought I did not care either.  It’s a mind fuck for sure that someone saying something as horrendous as “i hate you” (painful cringe again) is really a level 10 distress cry for the person you love (think yelling at a partner while in childbirth).

I hope Partner Dylan is strong enough to see my heart too.

I think there is enough suspicion now that I imagine he would think I am now just reiterating, “see?  There is something wrong with you”.

Except I do not feel that way and I love it that I do not.

It makes me happy again.  An anchoring feeling.  Feel closer to him even when he is keeping me almost entirely shut out.

That is in the 75-85%.

Not the rest of things in the percentage that I myself am learning independently–hopefully like any other couple does ongoing.  Hopefully he too will be able to bracket the chaos into a flexible scaffolding to where he can clear away the debris and see that I am the same person who deeply, deeply loves him.  More deeply than I could say.  And that there is grace enough for that too.

love wash over a multitude

I hope that we can tell this story to another couple one day. A couple where we have been in some regard.  Where our friends have been before us in very different ways, but no less feelings of pain, hopelessness, powerlessness, anguish, isolation, longing for our loved one in our arms on the same side of the ocean again.

Even if it’s a new or different ocean as trauma needs fresh linens and air to heal and begin generating cells anew.  If we live together again (with a puppy), we would not live in this apartment.  It would need to be new.  We survived a hurricane here.

I hope we can tell this story to another couple who is terrified, hopeless, desperately trying to safely connect and show love, panicked.

Even depressingly convinced it is over for them.

And that it isn’t.

 

 

 

unintended expertise part 2: education and empowerment: clinical watchdogs and rabbits

rabbit

If you have not read Part One, start there.

And you’re back.

For the sufferers reading this post, I am not going to tell you anything you do not already know on psychiatrist negligence; you come into my office every day, you are my friends who meet me for lunch, my colleagues who share your personal stories that motivate you to now advocate for your clients, and something I experienced personally.

However you may not know some of the malpractice and negligence laws listed at the end of this post as a case example of Partner Dylan’s experience thus far.

Nor do you probably realize just how right you were after barely scraping through suffering in thinking, good god there is no excuse for missing this

For reference examples, I have put in some the specifics of Partner Dylan referenced loosely in Part 1.  These examples are unfortunately not uncommon and, could likely substitute with a different name the experiences are so similar to others’.

Ten years ago, I was trained in the same archaic fashion of diagnostics in bipolar struggles (banning the term disorder)–

–that when the record shows there has been a hospitalization, an arrest, and/or substance addiction–then maybe look for a struggle with bipolar.

Which is bullshit.

It should never have to get that far if in the care of a psychiatrist prior.

And good psychiatrists and therapists know to keep current beyond archaic diagnostics.

Nearly 70% of sufferers from bipolar are misdiagnosed.  One third of those for up to 10 years.

Ten years.  

Do you know what happens in ten years?  Do you  know how the illness progresses in that amount of time?

Unfortunately, like any of the 6 million Americans struggling with this, you do know.

A child of one parent with bipolar disorder has a 15%- 30% percent chance of struggling with it.  In my experience, it rarely skips a generation.

If both parents have bipolar disorder, that jumps to 50% – 75%. 90% of all marriages fail when one (or both) partners are untreated for bipolar disorder. Non medical compliance or clients not initially seeing the need for medication is incredibly high and can be sporadic.

25%-60% of patients with bipolar disorder will attempt suicide at least once.

Many persons struggling with untreated bipolar become increasingly isolated as family and friends do not understand what is happening in untreated symptoms (i.e. money, insults, entitlement, abandonment, angry panic, lying due to increased anxiety, increased convincement that the spouse or family member are nefarious, annoying, controlling, invalidating, and are sometimes scapegoated for some of the unhappiness (in Part 3 we will go into the “if only” struggle), and become too hurt to draw close.

If a sufferer is choosing to not take medication and is harmful to loved ones, okay–sometimes a spouse must leave for their own safety and/or wellbeing. But if the sufferer is undiagnosed or mismedicated ongoing by treaters? That is negligence on the part of treaters.

Special note:  this is not to say that spouses cannot be in fact nefarious, annoying, controlling, and invalidating.  We know that is not the case.  What is being specified here is the enormous complex overlap when there is untreated bipolar where different versions of one spouse is apparent to the other.  Then there is the reaction of the other spouse to that version which can be alarming.  A cycle can be created.  In Part 3, I will go into some relationship dynamics complicated by clinical negligence.

Harm, jail, homelessness, bankruptcy, divorce, addiction should not be the litmus test for accurate relief from suffering from bipolar symptoms. Such extremes rarely appear overnight as is shown in films such as Michael Clayton and The Informant.

However a psychiatrist especially is trained to spot it.

The onus of diagnostics should not be left to friends and loved ones to persist on quality care.

The error in early diagnostics is not due to the stealth of the illness. It is due to negligence.

Sometimes laziness.

competent, compassionate care

Initially, diagnosing a patient with bipolar versus unipolar depression or anxiety means several important check-ins, positive, empowering conversations, and utilizing motivational interviewing to raise medication compliance and seeking high quality care.

It means more psychoeducation, teaching coping and values based skills, addressing shame, reducing stigma, encouraging reaching out when avoidant, and incorporating loved ones or family members for maximum support, healing, and remission from suffering–and preferably before those family members are either abandoned, bankrupt, or gone.

It means as a psychiatrist keeping their cell phone on as medication adjustments begin. It means addressing the trauma underneath as bipolar onset is generally related to trauma getting triggered later in life due to a high, extensive stressor.

It means your patient may be terrified and you will need to walk closely alongside and empower until they feel it in themselves.

It means breaking down the stigma and the “hopeless” way it was presented in the past in treatment (totally not at all now–with the right treatment and provider!)

It means you will miss the train home in the evening.

That’s the job.

Psychiatry should not be a cushy job. It is tampering with lives, relationships, health, even finances. Controversial as it is, it is scientific fact that emotion and mood significantly influence nearly aspect of our lives from the physical body (fatigue, weight, food changes, exercise, going out, fun plans, putting energy into relationships) to relational intimacy (lowered anxiety to express, tolerate, show and grow in vulnerability.

Further anxiety impacts allowing a parter to be close without reactive, intermittent, attachment due to high anxiety which we will cover more in Part 3.This is partially due to the nervous system, the frontal lobe, and the limbic system.

The way I think of hypomanic and manic symptoms (prior to the end zone of full blown psychosis to extremes such as believing one can fly) with fear being the driving factor to decisions thus shrinking the capacity and flexibility of the internal and external world for the sufferer, I think of a rabbit.

baby rabbit

i’ve decided to fill this page with rabbits

cute rabbitalert rabbit

They are constant in freeze or flight mode.  So their life experience is rather limited.  You will not find a rabbit willing to come up and let you talk to it, pick it up, it will not follow you home, go to the movies with you and sit next to you in the chair, or enjoy concerts.  It will not be willing to risk being thrown up in the air and caught in play.

Every chance it gets it will try to run away.

Why?  Because the rabbit is just too afraid.  It knows it is prey. It knows from the moment it is born it must be either running or freezing in order to survive in constant vigilance.

This is the struggle and enormous suffering of the unmedicated.  The world gets smaller, relationships become limited, exploring and experimenting in life lessens, it is impossible to have a calm, quiet moment by the fire, impossible to be close to an intimate partner because the brain is convinced it is constant prey and fear is what we are primarily wired to use to survive. The environment is constantly being scanned and ready to enact flight, freeze, or in the case of humans as both prey and predator– fight.

Mood controls motivation, survival, to love, to processing emotional content, to fatigue, to relationships, to job performance, to perceptions of dichotomous thinking (i.e. “I have always been depressed and always will be. Everything is horrible and always will be. I am a total failure. I am not cut out for close relationships. Something is wrong with me. I have made too big of a mess and should just walk away. Everyone hates me. I am unloveable. I am inferior. The closest to me are trying to control me. I must become totally alone. No one thinks I am credible. Everyone thinks I am insane. No one believes my feelings are to be respected and credible and my perspective as well. If I accept treatment it will mean I am “giving up and giving in.”  I should be able to will this away.  The rest of my life is over. I will become just like..>insert unmedicated person, extreme tv character, catastrophize<)”

Notice all of the black and white thinking there?  Like the rabbit, it is freeze or run, nothing of conversation, flexibility, reaching out to check out those beliefs.

on high percentage of medication non-compliance or seeking quality care:

Support persons often ask why the lack of medication compliance and not insisting on quality care is so high in this particular illness. Interestingly enough, during the “high” or “irritable” side of the pole, a unique chemistry shift in the frontal lobe happens called Anosognosia. Anosognosia continues to grow with the intensity of the shifts.

It is in this region that we evolved our capability of “reflecting about reflecting.” It is where we get a sense of self and self evaluation in real time.

When this becomes less active, we essentially see ourselves at the time prior to the shift. Not during. Hence—why bother with medication unless feeling excruciating pain or confusion of noticing a significant difference in ourselves. The only time a “difference” is first sensed (until skills are taught), is during significant depression. However during a high or significant irritability and numbness, no difference is noted. The words “okay, fine, great, maybe a little down, overall good” are often heard when asked.

It is important to note that this lack of self reflection begins not solely when the mania becomes so severe that a person may feel they can fly, that the CIA is following them, or that they are jesus christ.  Again, those are extremes and counting on that as a  marker does no service to anyone suffering.  It’s like saying that we begin to diagnose depression after a suicide attempt.

The anosognosia begins immediately.  Meaning from a subtle irritability here or there, increasing fatigue, distractibility, becoming increasingly focused on one thing for long periods of time (i.e. online shopping or online “window shopping,” video games, fixation on certain celebrities, musicians, a specific topic, types of music, art, etc.).

It shows up in increased black and white thinking particularly of others and others’ perception of them lessening the ability to tolerate conflict, the sufferer may begin to lie in order to escape the anxiety of it, the lack of insight in it, or the fatigue for it. “Zoning out,” periods may increase as in missing certain details such as bills, recalling emotional conversations, memory, or household and work tasks.  Flattened affect, speaking of painful things in a detached, unemotional, even shocking way, or erratic behavior (i.e. frequent changing of plan based on mood, fear, fatigue, impulsivity).

These are the more accurate and early signs.

The gradual onset of the anosognosia explains the “what are you talking about, I have not changed, am not irritable, distracted, etc.” loop. Or in the case of other struggles operating in the same hemisphere, it is the “why do others keep saying I have an eating disorder, am addicted to alcohol, or seem cold and detached.”

 

Patients misdiagnosed and mismedicated will often progressively worsen into full blown mania, extremes will worsen in faster cycles and according to these statistics, apparently the Cavalry will be resting at home on their laurels until someone is in the hospital, jail, or attempting to harm themselves.

Sometimes, as in the case with Partner Dylan, not even then.

It will not get better on its own. And life will continue to deteriorate, the world becoming smaller.

This is unacceptable to miss when it is literally the sole job and focus of a psychiatrist.

Medication for the lessening of suffering is only good if taken.

on responsibility:

It is NOT the patient’s fault that symptoms worsen or for struggling at all. It does not mean the person’s feelings are not real, accurate in places, or that they are not to be respected, loved, listened to, and credible. It does not mean they are “crazy” or some other lowly insult. Everyone struggles with their feelings to varying degrees.

It is inhumane for the error statistic in this degree to be as high as almost 70%

People deserve better. Yes, once diagnosed it is the patient’s responsibility to gain skills to lessen responses based off of emotion, to insist on quality care, and especially to take medication and establish support in knowing that there may be times when it will seem silly to do so.

But this is no longer the diagnosis it once was even 15 years ago. The dark ages of lithium are behind us. This is usually a simple anti-seizure drug with the side effect being feeling better and placing overwhelm and suffering into remission where thoughts can go beyond tomorrow.

ESPECIALLY catching it early could stop further extremes and destruction.

People deserve better than a 69% doctor failure rate. People deserve to not lose 10 years of their lives and wellbeing.  Perhaps with more reporting of said psychiatrists to the Board, the Department of Professional and Financial Regulations, and even malpractice suits, fewer will lose their lives and livelihood to this illness.

Ending Malpractice Case Example:  Partner Dylan

As as special note:  the report at the bottom uses clinical language which can appear stale, stagnate, absolutist, if not offensive in summary however the clinical tone is important in clinical and legal notes.  Please note that the word “paranoia,” contrary to the insulting portrayal by the media, is utilized here in clinical terms which is defined as:  anxiety that has become extreme and outside of normal limits though appearing logical to the client.  

One of the biggest ethics is to “do no harm.” The research painfully points out how in 69% of cases, this is not the case.

Malpractice Law

A.  Making an improper diagnosis: Check.  Generalized Anxiety Disorder with Depressive features. 

B.  Administering improper treatment or prescribing improper medications: Check.

  1. Anti-depressant Cymbalta
  2. Anti-depressant Trazodone.

C.  Failing to notice or diagnose a harmful condition:  Check. 

     1.  After introducing Cymbalta and Trazodone, a few months later, client reported to psychiatrist monitoring spouse’s use of household items as a measurement for authentic care or “respect” for client.   Client asserted a written tally of spouse’s use of household items was not kept, however acknowledged keeping a mental tally.

2.  Client exhibited increasing irritability in sessions to which the psychiatrist often joked with words to client such as “asshole, emotionally autistic, not quite sociopathic, rage, defensiveness.” Psychiatrist said to client that client’s spouse “may be feeling insecure because ‘you’re you'” to client, thus implying client was somehow a negative.

3.  Client continually asserted feelings of superiority resulting in increased anger in regard to others despite not noticing similar behavior in self.

4.  Client reported feelings of anxiety pertaining to “reality” specifically in reference to spouse.  For example, if client and spouse lived in the “same reality.”

5.  Client continually bought books pertaining to the same relative topics and frequently discussed anger and rumination with psychiatrist.

6.  Genetically, client’s great aunt, mother, and possibly cousin suffer from Bipolar 1.  Father likely suffers from depression and significant anxiety.  Client’s sister, though undiagnosed exhibits symptoms of Bipolar 1 in paranoia/anxiety, excessive talking, excessive activity, high reactivity, erratic behavior, fixations on singular topics, dichotomous thinking, perceptions of superiority, expressing irritability at behavior in others though unaware of similar behavior in self.

Pattern in client’s family of excessive anxiety and paranoia thus resulting in anti-vaccinations, gun hoarding, homeschooling, limited social interactions and exposure to society, religious indoctrination and extremes, physical abuse in the name of religion, ostracization, high control, and shunning of members not in adherence to similar beliefs.

D.  Failing to warn third parties of threats from current patients as required to or allowed by law:  Yes.

  1.  Client increasingly focused on fearfulness of spouse being “controlling” of client “waking up one day no longer himself,” due to not staying vigilant in monitoring spouse’s influence on client.
  2. Despite client’s behavior in session and aggressive language in regard to others, the insistence on being “right,” and of surveying environments for “control” in order to soothe anxiety, psychiatrist did not inform spouse of increasing agitation nor check in with spouse on behavior at home.

Criteria for establishing malpractice:

A.  There was a doctor-patient relationship. 

  1.  Yes. For 3 years.
  2. Additionally psychiatrist conducted one-on-one therapy sessions with client in addition to medication management.

B.  The doctor breached the duty of reasonable care (i.e., was negligent). Yes.

  1. When client was suicidal following arrest, psychiatrist did not see client in person for 5 consecutive days.  
  2. Doctor informed by spouse that irritability was escalating and out of character several months prior.  Doctor stated to spouse that client was “anxious” to account for irritability.  Doctor informed spouse that client’s behavior was “really him.”
  3. Doctor informed individual client that client’s spouse was “not the one for him” and that his two goals should be to “get a new job” and “move out.”  Thus breaching the ethics code of couple’s counseling without a couple, advising, and irresponsibly encouraging isolation when both client and spouse could be in danger.
  4. Doctor did not do thorough medication evaluations in each session.  Doctor solely relied on client’s self analysis without deeper probing into symptoms and questioning loved ones.  Doctor solely asked before closing session, “are you okay on medication?”
  5. After client’s arrest, doctor stated to client to “talk in the future” about a possible medication alteration due to adverse effects of antidepressant of increasing onset of hypomania; ultimately doctor doubled the dose of the same antidepressant and prescribed no mood stabilizer despite the contraindications of present medication.
  6. When seeing client in session 5 days following arrest, doctor informed client that the arrest and violence was due to “not taking advantage of support more” and the need to “spend some time alone and reflect.”

C. The patient was injured (physically or mentally).  Yes.

  1.  He was arrested.
  2. Psychological distress due to arrest.
  3. Psychological distress due to harm to spouse.
  4. Psychological distress regarding confusion at impulsive behavior and increasing anxiety relating to work, partnership, finances, legal and employment implications
  5. Psychological distress regarding going to psychiatrist for medication management and therapy ongoing with symptoms worsening and attempting to make sense out of life in the middle of overwhelming symptoms.
  6. Psychological distress in self-concept of being therapized as “less-than,” “different,” “not capable,” or “not like everyone else.”

D. There was a causal link between the negligence and the injury. Absofuckingutely.

  1. Misdiagnosis
  2. Prescribing inappropriate drugs exacerbating symptoms
  3. Witnessing increasing irritability in sessions and failure to medically assess ongoing.
  4. Failure to do a proper interview each session with client.
  5. Seeking a release to incorporate family members as per hospital criteria for client’s maximum alleviation of suffering.
  6. Making jokes to client reinforcing the irritability and instability.
  7. Ongoing and presently prescribing same drugs after arrest.
  8. Spouse stating concern that client was “not himself” and increasingly “irritable.” Psychiatrist asserted to spouse that client’s irritability was merely “anxiety.”
  9. No formal interviewing on financial status, possible areas of deception indicating overwhelming anxiety, impulsivity, and energy levels.
  10. Being a spectator to suffering and not an active agent of healing.
  11. Allowing client’s irritability to escalate to such an extent it reached the point of arrest.
  12. Following arrest of client, psychiatrist was contacted by the spouse stating suspicion and full diagnostic criteria for bipolar, the request to reevaluate and consider a mood stabilizer due to the irregularity, and being confirmed by client’s friends’ (knowing him 8-20 years) of extremely out of character behavior prior to the arrest with onset of shifts  increasing dating back one year.
  13. Psychiatrist received and acknowledging message with gratitude from spouse.
  14. Spouse asserted right to be informed of medication changes per Tarasoff Case for safety prior to spouse returning home after 72 hours.  Spouse was not informed.  Nor was client met with for 5 days.
  15. Client went for second evaluation of high caliber psychiatrist and professor of psychiatry.  Second evaluation psychiatrist, diagnosed the clinical error and stated the inaccuracy of current psychiatrist and diagnosis. Client’s diagnosis:  Bipolar Disorder, most Recent Episode Hypomanic.  Inaccurate diagnosis:  Generalized Anxiety Disorder with Depressive Features.
  16. Second evaluation psychiatrist conducted client interview and evaluation based solely off of information given by client in thorough diagnostic interview and by client’s written assessment measurements.
  17. Second evaluation psychiatrist recommended mood stabilizer Lamictal to begin at 25mgs @ 2 weeks, 50mgs @ 2 weeks, 100mgs @ 1 week, 200mgs ongoing.  At 200mgs of Lamictal, client then to be safely weaned off of symptom inducing Cymbalta and Trazodone completely.
  18. Second evaluation psychiatrist per ethics did not push client into changing psychiatrists despite knowing the importance to do so.
  19. Current psychiatrist upon seeing client in person five days later after arrest and feelings of suicidality, told client that psychiatrist attributed client’s escalation and arrest due to client “not reaching out to resources enough.”
  20. Presently current psychiatrist continues to write more symptom inducing medication at an increased dose stating that the client  “looked okay.”

E.  Damages to client due to negligence

  1. Experiencing escalating and at times, debilitating anxiety.
  2. Psychological distress to client in arrest.
  3. Harm to client’s spouse.
  4. Financial damages in paid therapy sessions, office copays, and prescription copays
  5. Possible impact to client’s career.
  6. Fees covering expungement.
  7. Fees covering housing during 72 hour no-contact following arrest.
  8. Encouraging client to move out of spouse’s home thus violating ethics code, and further causing client financial damages and relational destabilization.
  9. Destabilization of client and unnecessary psychological distress.
  10. Allowing and normalizing an inhumane level of suffering in client.

 

References

http://users.phhp.ufl.edu/rbauer/Intro%20CLP/walcott_cerundolo_beck_01.pdf

https://www.psychiatrictimes.com/uspc2014/bipolar-disorder-keys-improving-compliance

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2945875/

https://www.verywellmind.com/will-my-child-inherit-my-bipolar-disorder-380477

https://psychcentral.com/blog/being-married-to-a-person-with-depression-or-bipolar-6-survival-tips/

https://www.psychologytoday.com/us/blog/so-sue-me/201506/when-sue-your-psychiatrist-malpractice?fbclid=IwAR2Qd5SzAXCcpfoWvtvy1IyRFsSLmxGkUosvgp4qFEG7iz-OzdzzaqO-85k

https://www.nami.org/learn-more/mental-health-conditions/related-conditions/anosognosia

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unintended expertise: part one

Attachment Injury

My Brain is Hurting My Feelings

 

I often resent that my best therapy comes at my own expense–things I did not want to have to learn, have to suffer, things that did not pay me back in my own life but on the other side of the therapy chair may for someone else’s.

I guess not all hope is lost.  I am alive, so there is always hope that it will benefit me as well.

I have always sought knowledge.  To a certain extent it was knowledge that saved me.  Studying science, human behavior, different beliefs and spirituality, sociology, even meteorology (may the goddesses bless Tom Skilling).

Sometimes I sit in front of a client that was diagnosed early with bipolar disorder, talking about how medication compliant they are, how they made it through god-awful psychiatrists and are now with someone helpful, how good they are at self-monitoring because they have been taught it, how easily they identify to me, “I noticed a bit of mania last week, but…”  How much they value their therapy and relationships and gaining skills in them.

How it’s just not a huge thing to them anymore.

It’s like how my supervisor in the middle of meetings will scan some sort of implant in her arm that beeps if she needs a shot.  And we’ll just keep talking whether she shoots herself up or not.

When I sit with persons on the other side of it, across from my therapy chair, I feel this pain all over again.

Why didn’t he get that level of care?

In sessions past he had had good care.  Had he been sitting in front of her, or one of his previous seasoned therapists, he could be as free now as this client sitting across from me.

But the system failed, and he is not the only one that it did.  In fact almost 70% of the time in this the system fails.  Hospitalizations, arrests, substance addiction, job losses, divorces, family members who will no longer speak to them because they could not understand—these dear clients had to do inexplicably hard time to get the accurate hope too.

According to the research of iMRI scans (#NeuroNerdAlert), the amygdala (fear hub) continues to grow thus compromising the limbic system (amygdala, hippocampus, cingulate gyrus) being able to calm, and regions of the temporal and frontal lobes begin eroding which is where we get our ability as highly evolved mammals to “reflect about reflecting.”

MRI brain

Fig 1: Advanced phenotyping in BPAD: Reduction of grey matter volume (frontal and temporal regions) in patients with BPAD

The unfairness of this particular struggle is that basically the worse it gets, the less you know it.  Because of the over-involvement of the amygdala and the under-involvement in the frontal and temporal lobes, it inhibits self analysis, recognizing when something has significantly shifted, processing emotional content, fatigue, numbness, and memory.

Both the fascination and the cruelty of this particular struggle with the amygdala triggered and the frontal and temporal lobes decreasing is that the self-concept does not “update” in real time.

Instead, the self-concept held is of the self prior to the current episode.  It is why family and friends will hear from someone suffering, “What do you mean I have changed?  You are the one who has changed.  You must not love me for who I really am since you now have a problem with me.”

This loop also increases the fear activity of the amygdala which would make sense.  Now there is more fear–“my loved one no longer loves me.”

In this state of the amygdala and frontal lobe shifts, the not “updating” is not due to someone being “crazy” nor that they do not have an accurate understanding of themselves.  They do.  Just not while in the episode.

To a certain extent pre-menstrual syndrome or pre-menstrual dysphoric disorder can have the same effect.  The estrogen crash causes the severe depression that may seem regular at the time, but once the episode is over, it becomes clear that there is a significant difference.

Also with intoxication.  We may have an idea that we are inebriated, but don’t fully  know it until we are not.

You still know “you” to a certain extent in both states as you have not had a psychotic break–just not as clearly.  Alcohol also puts to sleep the frontal lobe which causes the same lack of full self-awareness, emotion, impulse, and decision making.

amydala

The good news is that with bipolar struggles, it does not have go this downward route nor does it need to stay that way.  The same scans show that only 4 weeks on a mood stabilizer like Lamictal or even Lithium ….the erosion will begin to grow back and calm the amygdala again.   

The fMRI’s of our modern scientific age show that even facial recognition due to the increased size of the amygdala begins to skew toward seeing hostility in a face that is potentially neutral.  That makes sense.  When my fear center is overwrought, it is difficult to not feel like I am under constant threat.  It has been found that early trauma can cause this initial activation in the amygdala, but with actual therapy and medication, the pain and struggle go into remission.

left amygdala

left amygdala in facial recognition

Essentially, the person lives again.  The lights turn back on.  Emotional content can be processed again. Because let’s face it, none of us can process a goddamn thing, see any hope, or even potential for emotional shifting when we do not feel our best.

Give me too little sleep and I easily become Stuart Smalley in a downward spiral.

stuart smalley

the psychiatrist said i struggle with what

The scientific synopsis is probably polarized in and of itself–relieving and validating and also terrifying.  While in a depressive state, someone is relieved to hear there is help.  When in a hypomanic state, offense and denial are usually more common.  This again is not the person’s fault and is not isolated to only bipolar, but many things.

When I was told I had anorexia and exercise addiction and that I was going to have to either go get specialized treatment or die, I laid face down on my bed in that horrible asylum and cried, hard.  I could not believe it.  I was going to have to change therapists, see a specialized psychiatrist and go into a treatment program.

People were going to tell me that in one aspect of my life, I had had a lot of brainwashing and that in one area, I could not fully trust myself to have an accurate read.

Outside of this right now with Partner Dylan gone, going into treatment was one of the most difficult things I have ever done.

And I am really proud of myself that I did it because I know just how hard the wars I fought in there were and still can be.

But that initial diagnosis is a blow.

good psychiatry

“There is no need for labels,” the good psychiatrist said.  And she is right.  A person does not have to be ill or “sick” to feel better.  Sometimes you just want to feel better. Don’t we all?

On the flip side, names can also sometimes be a relief much like when the word depression is often used.  Now a person has a name for it. A way to organize it.  It is no longer this cloud that descends and erodes the person’s view of self, others, and the world.  Hypomania is no different.  Significant anxiety, irritability, fatigue, numbness, trouble processing emotional content, memory, anger, and just an overall sense of not feeling well all are often in play, sometimes all at once.

But this word carries such stigma.  Especially if a person you have known with it was not diagnosed correctly, was not medicated properly, did not attend therapy, and just let it get worse and stay that way.

I was thinking of Partner Dylan’s mother on this.  She would fucking lose it on him.  And she felt so justified.  She would get super anxious, irritable, obsessed with god and then do the damage.  Often spouses leave for this reason because they do not understand –or because the spouse refuses good care.  You want to talk about a rapid firing amygdala, it is Partner Dylan’s mother.

She was fully convinced she was right to do so every time she hurt him.  And somewhere I think he believed that as well.  Why wouldn’t he?  She is his mother.  How would he know differently?

She had the same with dropping three grand in a day.  Her frontal lobe was not as active as the anxiety and therefore it seemed like a logical idea.  Until the episode was over.

Or when this guy I loved many years ago became essentially homeless and lived in a friend’s vacant factory warehouse where there was a recording studio.  It just made sense to him.  At the time.

It was hard to make sense out of since he was basically Hendrix and lived like it.  He was really far gone though.  As is Partner Dylan’s mom.  He is one of the most extreme however and like any other family, it never skipped a generation yet.  It is important to say though that he was never accurately medicated, had accurate therapy, or even the family support to do so.

The severe cases above did not and do not have to be.  But the progression allowed by not getting good care and medication made it impossible for them to see that that option was what could save them.

To end the stigma, I want to be clear that most people struggling with bipolar, depending on accurate care and accurate medication, live lives in remission the same as diabetes and good care.  Several in my practice struggle with bipolar and are fantastic therapists and people.  And they had to go through a lot of negligent and malpractice hell to get there.

Like so many of my clients.

legitimate

Unfortunately, the stigma still remains though getting less.  Like someone is “crazy,” “not credible,” “has lost touch with reality,” “cannot trust themselves overall,” worry their feelings, perceptions, will become minimized across the board (i.e. “it’s just your bipolar talking”).

It’s all bullshit of course.  The dark ages.  A person left to extremes.  Like saying that every diabetic has no limbs.  That’s an extreme case of negligence.  A huge part of this is on the failure of psychiatrists.

A million things happen prior to worsening to such an extent. It’s like saying everyone with depression is dead from suicide.  It’s ridiculous. Just like depression, the worsening here can not only be stopped, but reversed.  It is a struggle, not an identity.  The same as anyone else.  The same as me.

Therapist and author Julie A. Fast’s speaks in her book, Loving Someone with BiPolar Disorder, about her own experience in first hearing the words and fearing the implication.  She is a therapist and she mentioned that it took things getting much worse over several years to recognize the need to address it.  But one of her primary reasons to not addressing it and taking so long was the fear that somehow she would realize she did not or had not known her own identity.  And that would feel terrifying if it was true.  That she had been living and reacting to something uncredible. She feared she would take the medication and realize in horror that she was indeed someone else.

That too is bullshit and thank god she realized it was.  You do not become less of yourself.  You become more of it.

I have had many clients express this about antidepressants, “I don’t want to become someone else,” they tell me.

It takes a lot of reassurance for them to believe that they will not become a different person than they already are–they will just feel better.  Usually after trying it for a couple of months, the fears greatly lessen.

I get what Fast is saying.  And she said something truly helpful about this.  She talked about the concept of constants.  I could relate in my own experience with anorexia and PTSD when I had to face it. What if I am either this or that, but only me in one?  What if I look back in panic?  What if I look forward and panic?  

The concept of constants is the truth that essentially, whatever struggle whether in remission or not, there are constants to us and in us and that is what helped Fast be able to take a step toward feeling better.

I remember being first admitted to the asylum (unworthy of being called a hospital) and they took all my clothes.  When Partner Dylan brought me my own things, though it may sound silly unless you have been there, it reminded me that I was exactly the same person I had always had been.

Every reaction I had, every conflict I had with him, everything was the same.  Due to the fear regarding him though, that I blissfully learned was not accurate.  I thought he did not care about me, that he would leave me, that he wouldn’t be there if I could not contribute for a long time, that he would think less of me the way I did, that he would think I was crazy just like…insert someone untreated.

I was convinced that I had been abandoned so many times before and barely survived it, why would he be any different?  What was the point of trying?  To go on miserable and abandoned, fighting to survive always alone and rejected?

One of the most helpful things that Partner Dylan did that helped me breathe again was when I was an inpatient in the program I transferred into, he brought Monopoly.  We played and he was him and I could see I was me.  It was something we always did and we joked the way we always had and he was his spirited self that I always knew.  It was just accepted by him that I was me.  I recalled  I had not heard myself laugh in a long time.  I just had not felt like it and did not even fully know it.

In simply playing an enthusiastic game with me, I realized that I may struggle inside with something, but I reminded him of me.   I remember feeling so relieved.  I truly smiled for the first time in a long time.

He probably never knew that about the monopoly that day, but it was a reminder to me that I may be learning to face something, but that something had not eroded who I am.  If anything, facing or learning about it enhanced it.  Because it was hiding large aspects of me. And the more I came into the light fearing that he would only see darkness, the more he cheered for me.

I was constant. 

Medicated or not, struggle or not, Partner Dylan is constant too.

Here are some constants that I, our close friends, children, and dogs love about him:

Partner Dylan is a really, really passionate person.  I have always loved this about him.  He could talk for days about something, all night if necessary.  When not suffering, he often would get so excited about something (could even be hummus) that he would give me what I call “shaken baby syndrome.”  He would grab my shoulders in so much excitement and shake me with enthusiasm.

He deserves to be that way again.  Sure, when depressed he isolates and gets worse progressively as the nature of this struggle is to continually worsen, going to higher extremes like the two I mentioned above, and deteriorate accurate self analysis.  But at least outside of the 70% error rate, he now he knows he does have a different choice.

How grateful I am that my clients and friends found that and embraced it.  I would likely not be seeing them if they had not.

There is now the option of expressing more constants.  He can live again. Laugh again.  Think and process quickly again.  Not feel that 10pm is the middle of the night. Talk really fast again, shaking his hands in zeal, rocking the couch with gestures adamantly, and also lovingly about something he was excited or passionate about.  He could integrate both.

He used to take care of this dog we both love.  They would walk and walk and play and he would blow on her paws when she was cold or got salt on them in the snow.  He would talk and talk after he got back from work about his crazy day.  He would randomly pick me up flowers and his co-workers told me he talked highly of me regularly.  He would  “crocogater” the blankets when it was cold to take them off of me in play.

He would feel pain in his heart if he saw a little kids wrestling internally with something.  Feel pain if one of his friends was hurting their spouse.  Get tears in his eyes realizing he had hurt my feelings.  Put a homeless person in the back of the car and take them to the ER.  Leave his car unlocked so people did not always have to live in a world with locks protecting everything.

He would get so involved in a topic that we would write all over a tablecloth in a restaurant.  He would read a million books on hope and making the world better, more humane, more equal, more loving.

He has been living under this cloud for so long, under such horrific negligence and it was so gradual that he has forgotten what it is like to live without it.

I would put money that Partner Dylan does not remember the tablecloth, the energy, the laughing, the laughing at his own jokes, the passion, the heart, the loyalty, the love, the earnestness, the patient nature, understanding and forgiving nature, the drive toward love in resolving conflict–the ability to do so.  The staying power out of love and heart.  He probably does not remember the bleeding heart compassion, the focus, the purpose.

But I do.

He may have even forgotten or maybe the view is down the street a little further.

But I have not.

Sources Cited:

https://www.bipolar-lives.com/bipolar-brain-imaging.html

https://jamanetwork.com/journals/jamapsychiatry/fullarticle/204822

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2945875/

http://www.science.ngfn.de/6_148.htm

https://www.psychologytoday.com/us/blog/so-sue-me/201506/when-sue-your-psychiatrist-malpractice?fbclid=IwAR2Qd5SzAXCcpfoWvtvy1IyRFsSLmxGkUosvgp4qFEG7iz-OzdzzaqO-85k

https://www.bipolar-lives.com/bipolar-brain-imaging.html

https://www.nami.org/learn-more/mental-health-conditions/related-conditions/anosognosia

Loving Someone with Bipolar Disorder: Understanding and Helping Your Partner

 

 

 

Malfeasance

mackenzie thorpe dog

The hardest part for me is the creation of the narrative around it: psycho

I listen for a living

we are taught

Bio

Psycho

Social

Cultural

Spiritual

keep going

 

Always begin with bio

always begin with bio

the honed ABC in the emergency,

airway, breathing, circulation

you will never forget the lesson if you are lucky

after someone ran out of air

a brilliant malfeasance permanent

 

the broken mother’s heart

the savings, the divorce, the death, and you’d better pray that ash becomes a phoenix

the sun-burned relationships underhydrated, the glare of catatonic

the repetition, ambition, the rising suspicion

the missing

 

How many men is he seeing, how many

how many webs is he spinning, for that black widowed spouse

how many home addresses is she insisting

americans

Cloud and Townsend, land surveyors, the pink ribbons

lines of millions, guaranteed insurance

for that bandaid over his now necessary amputation

 

those solaced rooms, never left, digging holes in basements

wrongly prescribed

the boundary of this mess

 

of blood all over the floor

the guts she spilled out, the yell of childbirth,

it was so very easy,

you were in the front row

and you read a book instead

 

alcohol laced nyquil, a marriage plague fixer

yes you will get to the top of that mountain

and come the marvel of daylight—

you will have bled out

 

rightly prescribed for occupation, infatuation, the sociopathic

the end of a fist, the empty bottle, the model, the mother in law drama

the online brothel

the third and fourth generation of the sons of their fathers

 

But for the magnitude

of that degree, you forgot the C, circulation

no airway, no breathing, now the carefully surveyed 90 degree angles of a goddamn casket

ungiven mouth to mouth you called a trespass

of “boundaries”

that foolishly positioned deadly stake

cost a man everything

 

I hope malpractice pays for the lesson you assigned “psycho”

the stereotypic male, a passing description, the sociologically retarded, the cultural burn out

the burned down, burned out, the charred

that hollowed out house

that killed him

 

For the rest of the life that you get to keep,

I hope you never forget the heartbeat of the heart that you missed

You’d better pray that a phoenix flies out of his ashes

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Chasmic

The Broken Specs

His heart tried to bury her deep.
Little did He know that She was a seed. ❤

Tweeting: @thebrokenspecss

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