That's me. It's apparently Mental Health Awareness Week and a friend inspired me to do something for it. Specifically, this is a coming out of sorts. I've alluded to some mental health problems, but I haven't outright owned this stuff to all that many people.
I'm weird. I know I'm weird. But I think I'm normal-weird, not going-to-shoot-up-a-school weird. People who struggle with what I do often get ignorantly tarred as the latter category. So I guess I'm here to say: Hello, my name is Rachel, and I'm a perfectly mostly harmless lunatic.
There are names for what my damage is. I have bipolar disorder with mixed and psychotic features, rapid cycling and complex post-traumatic stress disorder. They're labels, they make it easier to grasp what I'm dealing with due to its similarities to what afflict other people, but they're just labels. Let's break down what they actually mean.
Bipolar disorder: My moods can vary wildly, and I don't mean the garbage people call a "mood swings." I mean they can vary between weeks-to-months-long suicidal depression; or grandiose, sleepless hyperactivity; or uncontrollable hair-trigger rage; or unquenchable lust with an unstoppable sex drive; or batfuck insanity (it's a technical term); or any combination thereof. Sometimes things can trigger it, like sleep deprivation or emotional trauma or just the change of seasons. Sometimes it just happens because fuck you, that's why. When it does happen, I can see it happening, but that doesn't diminish its power at all. So I know I'm easily angered - great, that doesn't make me any less easily angered. I have to be constantly on guard against my emotions, my sleep patterns, my energy levels, and my libido. If any of them get too high or too low, too much or too little, that's a sign of an episode. And episodes always end poorly sooner or later, one way or another.
Mixed features: This means I have the kind of bipolar where I can get "mixed" episodes - manic and depressed at the same time. These are the most dangerous bipolar episodes, because they combine the suicidal feelings of depression with the manic impulsivity. You have the depression to want to kill yourself and the energy and inclination to actually do it. It can also involve rapid fluctuation in the span of seconds. Laughing and crying at the same time is pretty stereotypical, especially if you combine that with dancing and howling in rage. If you're mixed, you're all over the damn place, and really only get the worst of both the mania and depression, none of the redeeming qualities.
Psychotic features: I hallucinate. I have delusions. I hear music, whispers, muffled voices, chanting - none of them actually there. I see shadow people moving in the edges of my vision, or sneaking around outside my window when I'm not looking directly out of it. They're not really there, not even visually; they're just kind of there, always just at the edges of my ability to discern them. I'm sure my activities are being tracked by someone, my every click and scroll on the computer, the time I spend on what page, by some entity who wants to use it to (successfully) divine my inner thoughts and feelings. Yes click on this, that'll look good; don't click on that, they'll figure you out. Anything feminine or female-oriented used to be in the latter category - I didn't want them to know I wished I was a girl. This kind of thing tends to happen when I'm manic. I'm not schizoaffective (I don't think... there are troubling signs I might be somewhere in the vicinity), but I do get raging psychosis and inward-turning antisocial patterns in some of my manias.
Rapid cycling: Strictly speaking, this means I can have four or more depressive, manic, mixed, or hypomanic episodes in the span of a year. As a practical matter it means that I might be in a euphoric mania and a couple weeks later I crash into crippling depression when it burns out, only to fly into a psychotic, dysphoric mania after a month of stability. When I'm not medicated, I probably average 5-10 episodes of various sorts per year, ranging from a few weeks to a few months, with stability sometimes in between them. A good chunk of my life is spent jumping from episode to episode if I'm not treated.
Complex post-traumatic stress disorder (C-PTSD): A variant of PTSD with some distinct differences. For starters, it doesn't happen from a single traumatic event. Instead, it's from prolonged trauma without hope of escape, or at least the perception of no escape. It's most common in two groups of people: torture survivors / POWs, and domestic abuse survivors. It has a lot in common with PTSD - night terrors, hypervigilence (being hyper-alert to danger and "jumpy"), dissociation, amnesia or hypermnesia (the opposite, where the memories are unnaturally vivid), and flashbacks. The flashbacks tend to be different, however - not always, but usually. "Atypical flashbacks." Sometimes called "emotional flashbacks," instead of hyper-realistically re-living the experience, you re-live the emotions and feelings of the experience, as though experiencing it all over again. It can be completely debilitating when it happens. My cat has had to snap me out of the dissociated sobbing of these flashbacks by nuzzling her cold nose to my face. Another "feature" distinct to C-PTSD is attachment issues. It causes sometimes crippling problems with the ability to form and maintain relationships. All of them are tainted by the relationship with one's captors or abusers. It results in a push-pull not unlike borderline personality disorder, due to a tension between defense mechanisms (push) and a sort of echo of Stockholm syndrome (pull). It can promote dependency and co-dependency. It can cause one to seek a rescuer or savior to liberate them from the pain and isolation. Basically, it can cripple the ability to have healthy relationships.
Your bloghostess has suffered most of these effects. Without medication, I wake up screaming almost every night, sometimes multiple times a night. Some painful memories are hyper-vivid and others are dissociated to the point of being remembered in the third person. Without medication, I practically jump out of my skin if I hear a sudden noise behind me. It took me a long time to be at all okay with human touch; it was panic-inducing and the opposite of comforting. And my ability to form and maintain relationships is something I continue to struggle with; in some regards, my development is stunted at an adolescent level on that front.
I tried to "hack" some of these things for a while, turn them to my advantage as I stupidly thought possible. You know, things like deliberately triggering, prolonging, and exacerbating hypomania to avoid sleep and be extra productive. Makes sense, right? Of course, I'd always crash even harder when it inevitably ended, and I dropped out of school after being reckless and all over the place for years.
I attempted suicide twice in one day when I had a psychotic mixed episode. I tried to slit my wrists, then I hanged myself. It made perfect sense at the time. It was the only way out of my intractable situation of constant chronic pain and a hopeless, meaningless life. The psychosis and mania took me from thinking it might be a good idea to knowing it was the one right thing to do and impulsively acting on it. (It's fortunate I was so out of my mind that I was ineffectual and able to be stopped.)
I almost committed suicide again in another mixed episode. Everything just hurt so bad, life hurt so bad; everything was hopeless and miserable and lonely. So I was going to jump off a ~20 story building. I was fortunate a friend talked me down.
I came close to attempting a fourth time in yet another mixed episode. I was going to take everything in my medicine cabinet and try to overdose. It made complete sense, even though it shouldn't have. My future was looking up for once. I was back in school with a shot at real research. I was finally me - Rachel, not Ryan. I had a loving and supportive girlfriend for the first time in my life. Life was good. But it didn't feel good. It felt absolutely miserable and terrible and hopeless. Life felt so awful I wanted - really wanted - to die. My girlfriend got me to delay my plan - just postpone it. Then she dragged me to my psychologist.
Suicide, and the constant prospect of feeling suicidal, is a normal part of my life. You'll notice all those were mixed episodes; that's when I have the inclination to do something with those feelings. But when just plain depressed, or my C-PTSD is triggered, the thought is always there. When I'm sane, like now, I know I'd want anyone to beat me into submission if they had to in order to save me from myself. But when I'm feeling it, it's what I "really" want - to die. "Just fucking kill yourself," directed at myself, has spilled out of my mouth unbidden more times than I can count.
That last close call, I was already fairly well medicated - all that was missing from the cocktail was my antipsychotic (see below). It's what's called a "breakthrough episode" - it breaks through the otherwise effective medication. Even stable now, I always have to fear that prospect. And if it happens, I have to fear that it will render one or more of my medications ineffective for me from then on. There are indicators I look for. One is that I have trouble sleeping and staying asleep. Another is that my legs become painful and hypersensitive once again. These are indications of mania. Or maybe everything stops being pleasurable and I can't sleep less than 12 hours. That could indicate depression.
So that's my damage. I'm a wreck. Or I would be without the lovely friends I have helping me. No, I don't mean therapists and the like (though they are helpful). I mean my medications. They patch me up and hold me together. With them, I have no flashbacks, no night terrors, minimal hypervigilence, no depression, and no mania. I'm on 7 (count 'em), plus 2 I take as needed. Let's go through what it takes to keep a lunatic sane, shall we?
Lamictal: I actually take this for two things. First and foremost, it acts as a mood stabilizer, primarily warding off depression but also combating mania. I also take it to deal with "partial" seizures in my temporal lobes that cause hallucinations and synaesthesia, and may trigger bipolar episodes.
Lithium: The classic bipolar medication. I take this as a mood stabilizer that primarily works to combat mania, also working less so against depression.
Viibryd: This is my antidepressant, which also generally reduces anxiety (like the hypervigilence). So for both my bipolar and C-PTSD. My psychologist calls it Prozac+BuSpar. This is a new one still under patent, so it costs an arm and a leg. (All the rest of these are out of patent, mostly long out of patent. Like, generic since the 70s.)
Risperdal: An antipsychotic. Ooh, scary! It wards off my psychosis and helps keep my mania in check. It also probably helps with the C-PTSD related dissociation and flashbacks.
Prazosin: I take this to get rid of the night terrors (thing super-nightmares) that wake me up. It's a goddamn miracle drug.
Estradiol and Spironolactone: These actually aren't for insanity - they're to make me hormonally female. The spironolactone eliminates testosterone from my system and the estradiol is metabolized into estrogen.
Propranolol: I take this as needed for "actute" (short-term/spike in) anxiety. It works like a charm. I was shaking and my voice quivering while practicing before a presentation, then it kicked in and I gave the actual presentation no problem. I also take it if I get a fine motor tremor, which can happen if I don't drink enough water with the lithium.
Benztropine: One problem with Risperdal is that increasing the dose, especially too quickly, can cause a painful neck spasm. This eliminates that spasm, so I take it whenever I increase my Risperdal dose.
That's a lot of drugs, but I wouldn't give any of them up. On a day to day basis, I have zero side effects. These drugs are just perfectly compatible with me. It's a pharmacological miracle.
That wasn't always the case. I've had some terrible experiences with drugs. Neurontin, Elavil, Paxil, Zyprexa, Depakote, Seroquel... It took a lot of trial and error to get things right. And it was hell at times. I gave up on treatment for years when I wasn't given other options, and I'm still not sure there was anything wrong with that decision. Paxil landed me in the psych ward and Depakote robbed me of my ability to feel feelings, think thoughts, or do anything but shamble around like the walking dead.
But being unmedicated was its own kind of hell, and I will never go back to that. While still figuring out what your own special pharmacology is, though, it's really a matter of picking your poison. Want to kill yourself, or be unable to brain? Hallucinate and have paranoid delusions, or be an emotionless zombie? Decisions decisions...
There's also therapy, but that only goes so far. Traditional therapy works great for my gender dysphoria issues, and my C-PTSD has significantly improved with the help of exposure therapy and cognitive behavioral therapy. But a lot of things just aren't amenable to that. There ain't no therapy in the world gonna do shit about my psychosis or episodes. Might help me cope with the mild ones, might help me identify the others, but that's as far as it goes.
Anyway, now you know just how crazy I am. I can stop trying to soft-pedal it or conceal any of it.
This is me. This is who I am. I'm not proud of it, I don't like it, but this is an honest picture of me.
I hope I don't frighten you too much.
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