The Mixed State

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I often sit down to write a post and wonder what might be the most useful thing to elucidate.  Milly, my ASD girl, is struggling a bit, and Grace’s daily journey is always full of unexpected twists and turns.  I do not want to indulge “victim thinking” so I try to reframe circumstances.  I’ll admit that I have, at times, slipped and fallen in this area.  I have had the occasional “Why us?”, but I am hopeful that I have moved past that part of the grieving process.  Our normal changed.  Adapt.

So, what have I learned in the past month? What can I share with another parent, friend, or caregiver who might have or know a child struggling with schizophrenia or even bipolar disorder because this would apply as well.  I want to talk about the “mixed state” for a moment.  What is a mixed state?

In the context of mental disorder, a mixed state, also known as dysphoric maniaagitated depression, or a mixed episode, is a condition during which symptoms of mania and depression occur simultaneously, such as agitationanxietyfatigueguiltimpulsivenessirritability, morbid or suicidal ideationpanicparanoiapressured speech and rage. Typical examples include tearfulnessduring a manic episode or racing thoughts during a depressive episode. One may also feel incredibly frustrated or be prone to fits of rage in this state, since one may feel like a failure and at the same time have a flight of ideas. Mixed states are often the most problematic period of mood disorders, during which susceptibility to substance abusepanic disorder, commission of violence,suicide attempts, and other complications increase greatly. (online source)

In general, a mixed state is a term applied to mood disorders, but what happens when a person has a psychotic disorder in addition to a mood disorder? Remember, schizoaffective disorder is a schizophrenia spectrum disorder meaning the positive, negative, and cognitive symptoms of schizophrenia might be at play at any time along with symptoms of a mood disorder (see The Lingo).  A person might have schizoaffective disorder-depressive type, for example.  Grace has schizoaffective disorder-bipolar type.  Our biggest struggle in stabilizing her has been controlling her mixed states.  They are torturous and very difficult to manage.  They wreak havoc on our family life and terrify our children. Containing her during these times has been a challenge.  We usually have to isolate her and put our other children elsewhere.  These states can last for hours upon hours.

In cooperation with her many treating psychiatrists, what we have realized is that Grace’s mixed states are a state of psychosis.  Why have we come to that conclusion? Grace is always hallucinating during these episodes.  She is also cycling rapidly between depression and mania.  When I say rapid cycling, I mean 10 minutes between both.  Very high to very low with no attachment to reality for hours on end.

Grace’s antipsychotic medications are maxed out, and she still hallucinates.  She is still mildly paranoid as well.  The Lithium is doing a good job keeping her mood relatively stable, but I have seen evidence of the dreaded mixed state trying to emerge.  Grace describes its onset as “Restless Leg Syndrome in my brain.”  So, what can you do to stop a mixed state? This was the question I put to her last psychiatrist.  He was very thoughtful and paced the room back and forth in his Italian leather shoes and funky socks.

What I have observed in Grace’s recovery from the mixed state is that sleep resets her.  I don’t know what sleep does to her brain, but a few hours of deep sleep brings increased stability.  After much rumination, Dr. Klerpachik’s recommendation was a PRN (as needed) dose of Seroquel; in other words, use Seroquel as a rescue medication at the onset of a mixed state.  Seroquel is another atypical antipsychotic used to treat schizophrenia and bipolar disorder.  It is used a lot for treating acute bipolar mania and bipolar depression.  Also, it is very soporific.

You wouldn’t know it from my blog, but I’m not a fan of throwing drugs at all forms of human suffering so I was nervous to add yet another drug to Grace’s “Better Living Through Pharmacology” regimen.  There came a time, however, to try the Seroquel.  What happened? Er…hmmm….well, the mixed state was prevented.  She was a drooling idiot within 45 minutes of her first 50 mg dose of Seroquel.  She will sleep for 4 hours when given one PRN dose of Seroquel and wake up stable.  This has become our solution to preventing a mixed state.

One question that often comes to mind is: How do I know that this is the onset of a mixed state? The clue is the beginning of rapid cycling.  There is the presence of hypomania and depressive symptoms almost simultaneously as well as psychotic symptoms in the form of paranoia and hallucinations.  She usually starts crying and grabbing her head, saying, “I can’t decide, I can’t decide, I can’t decide.”  Then she stops immediately, gets a crazed look on her face akin to one of our cat’s expressions right before they start ripping around the house, and declares that she knows what she wants.  This is followed up by tearfulness and declarations of feeling like she’s being watched.  For Grace, these symptoms are the harbinger of the mixed state.

Here is the pertinent issue: There are no perfect medications for children with psychotic and mood disorders.  It’s crucial to remember that when trying to get help for a child who is suffering with something as burdensome as one of these disorders.  Talking to your child’s psychiatrist about a PRN dose of a neuroleptic drug like Seroquel is valuable because it’s something you can keep in your back pocket for the inevitable mood crisis.  A child’s brain is growing and changing.  How they metabolize these drugs is always changing, too, and the dose of these drugs will have to be tweaked for years until they reach adulthood.  Waiting to see a child’s psychiatrist in order to discuss medication dosage changes often comes at the expense of the child and, hence, their family.  Having a rescue medication on hand to increase the likelihood of their stability until an appointment can be made to discuss emerging symptoms is invaluable not only to the child’s well-being but to their family life as well.

This is certainly not a panacea, but it’s one strategy in managing this form of mental illness in children where the rubber meets the road.

Grown-Up Land

I don’t like filing paperwork, managing finances, dealing with insurance companies (Satan’s left testicle), and keeping track of every minute scrap of paper that must be set aside for tax purposes.  That is, however, part of that strange amusement park called Grown-Up Land that I thought would be so awesome as a kid yet now I often wish so terribly to leave.  How often did my young, impertinent self proclaim to a frustrated adult, “Well, when I’m a grown-up…”.  Was I blind to my mother’s stress? No, I just think that I believed, as all kids do, that adulthood was easier and more fun because you get to do what you want like buy candy and MSG-laced Doritos when you really should be buying fruit and…something green and leafy.  Children don’t really know about Grown-Up Land because you can’t understand it until you get an entry pass.  And, that only happens when you reach adulthood.

Of course, there is that express lane into Grown-Up Land which no one wants to stand in even if they think they do–teen pregnancy.  The rides that come along with a new baby regardless of a parent’s age are designed to break a person and teach one crucial lesson : “You are not the center of the universe! If you aren’t a grown-up yet, then grow up now! You’re responsible for a human being’s well-being and happiness.”  There’s the Colic Carousel, Sleep Deprivation Double Shot, and the Collaboration Cliffhanger.  In fact, the Collaboration Cliffhanger is a ride no one is dying to go on, new baby or not.  Getting married couples on that ride is tough because they have to survive the Communication Chairlift first.  Of course, Grown-Up Land does have the Tunnel of Love and Fetish Fireball so it’s not always a bleak place.There are rewards for surviving rides like In-law Hayride and Tax Tornado.

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Welcome to the Collaboration Cliffhanger

There is a relatively recent cultural phenomenon wherein men in their late 20s and 30s try very hard to hold onto their adolescence, and they continually try to escape from Grown-Up Land as if it were Alcatraz.  There is no escape from this place for adults so one sees them attempting to ride the same rides over and over again avoiding specific ones.  Their profile seems to be the same.  Married or not, these men seem to love the In-law Hayride.  They will often fall asleep on this ride and demand to ride it repeatedly.  If they are married, then you will frequently see their wives crying and begging the ride operator to let them off.  The longest line in Grown-Up Land is formed by these guys, and, no, surprisingly it’s not for Fetish Fireball.  They want to go on the solo ride Gamers Mountain again and again and again.  After that, they’ll hit Fountain of Fun food court, followed up by the Lazy River for some sleep.  You’ll find their wives and girlfriends commiserating across the park at How To Be Happy Hollow.  A few of them are stuck on the Passive Aggressive Power Surge, and the married women with children might never get off Wipeout.  It looked fun in the beginning, but now they all just really want to ride the Collaboration Cliffhanger as awful as that once sounded.  If they’re ever going to stop riding the Debt Black Hole and stand in line for Money Management Madhouse, then someone has to stop the cycle and ride a different and new ride.  No more In-Law Hayride! Please, God, no more In-Law Hayride!

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Mwahahahahahahahahahah!

What if that ::gulp:: other part of Grown-Up Land is opened up to you? Special Needs Circus? Everyone hears rumors about what’s under the Big Top, but no one wants to visit.  There are weird noises and strange crying sounds.  People often go in and never return.  Everyone’s heard rumors about the rides in that part of the park:  Health Insurance Helter Skelter, Prescription Pendulum, Diagnosis Dive Bomber, Family Freefall, Spousal Spin Out, IEP Kamikaze, Bully Bumpers, and the In-Law Mechanical Bull.  Wait…what? The In-Law Mechanical Bull?  There are more in-law rides? Does this park know no end? No, it doesn’t.  There’s also the In-Law Jump and Smile, In-Law Octopus, In-Law Twist, In-Law Shoot the Chute, In-Law Sky Swat, and, of course, the In-Law Black Hole.

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Attempting to please his mother-in-law, Cletus rode The Bull, and, once again, The Bull bested him…just like his mother-in-law. Every damn year.

Why we were dying to get into Grown-Up Land as children, I just don’t know.  Grown-Up Land is one of those closely guarded secrets, but it shouldn’t be.  If we were better prepared for what life in Grown-Up Land was actually like, then we might spend a lot less time standing in line and more time riding the rides we want.  Sure, we all have to ride the Tax Tornado.  Most of us, at one time or another, have to participate in a ride or two that we wouldn’t choose–The Corporate Love Fest Fun Slide, anyone? There is, however, a ride that if one learns to like early enough in life, then one’s experience in Grown-Up Land can be rewarding and fulfilling no matter what part of the park is opened up to you–The Delaying Gratification Gravitron.

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This is a stupid ride! When can I get off?

Delaying gratification is one of the most important psychological tools for healthy cognitive and social development.  What does it mean to delay gratification? Essentially, it means that one voluntarily postpones immediate gratification and persists in goal-directed behavior in favor of a later outcome.  In other words, “I will reward myself after I have completed this task.”  When people don’t know how to do this, they tend to struggle with self-control and a host of other problems that affect their general success in their job as well as their relationships.  The result of this is what you see in the present phenomenon known as the “man-child”.  He is portrayed in movies and sitcoms as an intelligent, technologically savvy dude who either still lives with his parents or with an equally lovable but idiotic man-child.  He can’t maintain a stable relationship or job, but this is what makes him funny.  His humor and intelligence always save the day, and someone else always pays his way because he always knows the answer.  Oh, and he’s kind of an asshole, too.  I know women married to this man.  They refuse to grow up and embrace adulthood.  They still secretly want to go back to Mom and Dad, and they want their wives to take care of them.  At the same time, they resent it.  By the way, they are almost all exclusively gamers.  There is no sense of “reward time” as in you need to do your job, take care of your familial obligations, raise your children, tend to your relationship with your wife, and be present, and, only then, do you reward yourself.  The gaming comes first.  The gratification is always #1 on the list.  These men do have jobs, but that seems to just be a hassle.  They work in order to get to the good part–the gaming.  The wives? Oh, well, they’re there for the sex, of course! These guys never learned to delay gratification and were probably products of the Self-Esteem Movement.  Incidentally, the founder of that movement has now come forward and said to scrap it all.  Self-control, self-discipline, and delaying gratification are what is needed to raise a healthy child.  Go figure.  Delaying gratification is an ever present problem in my own marriage, and I am consistently pointing out the Delaying Gratification Gravitron to my own husband who reluctantly stands in line for his turn.  I, on the other hand, was raised by a pathologically strict parent who taught me to delay gratification to such a point that I never gratified myself.  My job is then to actually stop working at a set time and learn to relax.  Balance and moderation in all things is important.

There are ways to make our experience of our life in Grown-Up Land wonderful even if you’re in the Special Needs Circus or living with a man who won’t get off the In-Law Hayride.  I did something last week to make my issues with filing better.  I have a ridiculous amount of a paperwork to file and have on hand at all times because of Grace’s ongoing issues.  I hate cluttered surfaces, and these files were just sitting out in view.  It was driving my Swedish sensibilities to the brink of insanity.  I no longer have an office having given up my space so that my daughter could have her own bedroom.  So, I decided to buy pretty file folders and filing boxes so that I might actually enjoy the process of handling the paperwork.  Guess what? It worked! It looks so lovely, and I enjoy looking at my little space now.

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My new file folders! (Stationery by Paperchase)

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Organized and colorful.

Grown-Up Land can be a tough place because, strangely enough, we raise our children there although they don’t know it.  They do, however, enter into adulthood with a bias based upon how we behaved and what we told them about the rides in Grown-Up Land.  Even the kids with special needs have to go to Grown-Up Land one day, and that epiphany is enough to make any parent with a special needs child want to ride the Denial Turbo Drop incessantly.  All is not lost though.  There’s something else in Grown-Up Land, too–the Resource River. It flows throughout the park twisting and turning through every dip, corner, and valley.  The sound of its flowing waters are heard throughout every corner of Grown-Up Land.  Whenever anyone gets lost, they need only find the river and follow it.  It will always lead them to a familiar place wherein they will find help.  Often getting lost in Grown-Up Land is what leads us to the Friendship Ferris Wheel, Relationship Rainbow, or, even better, I Want Something Better Island which is a park within the park.  People go there and return transformed with a grounded sense of identity and purpose.  Surprisingly, there are abundant resources in Grown-Up Land.  There’s even the Rescuing Red Baron when you get into trouble.  Who knew? I guess Grown-Up Land isn’t such a bad place after all.  Now if only I could get off Dirty Laundry Matterhorn...

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I can’t breathe up here. The air is too thin.

Resources:

Delay of Gratification in Children Mischel, Walter; Shoda, Yuichi; Rodriguez, Monica L Science; May 26, 1989; 244, 4907; Research Library pg. 933

The Trouble with Self-Esteem, New York Times

“I Don’t Wanna Eat!”

I like to try to write about interesting or helpful things in the context of what I am discovering on my journey with Grace, and I don’t want to forget about my other girls.  I have learned all sorts of things from Milly, my ASD girl, and even my other two daughters.  Attempting to live in the moment, practicing mindfulness, and learning gratitude in the midst of something like childhood-onset schizophrenia are things that are re-shaping how I view others and circumstances.  None of this is easy, but I am submitting to this process.

I have learned something new recently, and it has surprised me.  It’s associated with a word ripe with meaning.  What’s the word? Anorexia.  Most of us have probably heard that word.  Perhaps you think of Karen Carpenter or the pro-ana movement.  Maybe you or someone you know has struggled with anorexia nervosa.  I’m not, however, talking about anorexia nervosa.  I’m talking strictly about anorexia which is defined as the lack or loss of appetite resulting in the inability to eat.  This sort of “medical anorexia” is different from the eating disorder and mental illness anorexia nervosa.

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The red bracelet worn by those who identify with the pro-ana movement as well as identifying as ED friendly (eating disorder friendly).

For example, anorexia is not uncommon in certain illnesses like advanced cancer.  The appetite decreases, and one simply can’t eat.  I take a medication for migraine and seizure control that acts like an appetite suppressant, and anorexia is actually listed as a side effect! Every time I see my neurologist she always gives me her scariest neurologist look akin to the scary Mother Look, and says, “How’s your weight?” She’s well aware that Topamax causes anorexia, and, admittedly, I do struggle with it.  I can drink one cup of coffee in the morning and feel no urge to eat for ten hours.  My appetite has diminished to almost nothing.  It finally caught up to me a few months ago, and I became malnourished because I was…anorexic.  I simply was forgetting to eat because I had lost my appetite, and the stressors in my life along with an illness had finished off what the drug had not.  A friend of mine told me that I looked emaciated.  I probably did, and it wasn’t purposeful.  I am now in the middle of attempting to fix the problem, but it’s hard.  I don’t want to eat.  I’m not hungry.  I quite literally have to force myself to eat, and this isn’t an eating disorder.  I’m not purposefully depriving myself of food due to a desire to lose weight or because I need to exercise control over something in my life.  I simply have no appetite and haven’t for years thanks to the side effect of a drug that has allowed me to reduce my migraines from 20 a month to less than 10.

Why discuss this? Grace is exhibiting signs of anorexia.  She doesn’t want to eat either, and I’ve recently learned that anorexia is common among psychotic disorders as is anorexia nervosa.  I didn’t know this.  When Grace’s psychosis is under control, she is more willing to eat.  When she is not feeling well, however, she refuses.  If I can get her to eat half a piece of toast, then I have accomplished something quite amazing.  This morning, she awakened in a very sad mood.  She went to bed last night with one of her migraine-like headaches which is always indicative of mood instability.  She refused to eat anything for breakfast, but Grace is experiencing hypoglycemic symptoms which means that she must eat.  I practically had to threaten to take her back to the hospital if she didn’t choke down one piece of toast with peanut butter and Nutella (it’s the Nutella that convinced her to eat).  She stabilized a bit and apologized for “being difficult”.  I get it.  It’s hard to eat when the food just looks so damn unappealing.  I live with this daily.  When I go out to lunch with my friends, they all tell me that they feel like “pigs” because they eat a normal amount of food while I struggle to finish a side salad.  It’s not a good thing.  My hair was falling out! I thought it was stress.  It wasn’t.  It was malnutrition.

I’m trying to help Grace see the value in eating nutritious food even when she doesn’t want to eat, but she’s positively intractable when her mood bottoms out.  The problem with this is that her mood lability is caused, in part, because she’s not eating.  This is similar to me and my migraines.  I have to eat to maintain a stable blood sugar level, and that stability helps prevent migraines.  If my blood sugar bottoms out, I’ll probably get a migraine so I need to eat something every two hours…just like Grace.  Chronic migraine disease is managed through diet, exercise, and sleep much like mood disorders.  The brain is a funny thing.

So, what can I do to get my kid to eat when she’s resistant which is almost daily? When I see the hypoglycemic crash, hence, the mood crash I give her hot chocolate right away in the form of a trip to our local hangout, Caribou, wherein we are regulars.  She will outright refuse to eat or drink a damn thing I offer her at our house.  If you think I’m spoiling her, then think again.  Try bargaining with a schizophrenic child in the middle of a sugar crash.  Her decision-making faculties are completely shut down at this point, and she’s usually snurping and crying when I bring her into the ‘Bou.  The baristas know us all by name, and most of them know that Grace is not well.  A few of them know her issues, and they know why we’re there if Gracie is crying.  She’s there for her hot chocolate fix.  They whip up a kid’s cocoa replete with whipped cream and tiny milk chocolate chips.  It’s usually done in record time, ready for her trembling hands, and met with my relieved face.  In five minutes, Grace is usually much improved, mood stabilized, and ready for some real food–“I think I’m hungry! I’m sorry, Mom.  I don’t know what my problem is.”  This is how I get her to eat when she outright refuses because, so far, it always leads to her becoming willing to.

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Our saving grace…

I have done some research, and I think I will be booking an appointment for both Grace and me to consult with a dietician rather than asking my neighbor for a drive-by opinion.  After reading a fair amount of articles on anorexia and schizophrenia as well as observing Grace’s emerging disordered eating patterns, I want to get ahead of this now.  The more I can educate her while she’s young and still believes me, the better.  Plus, I really need to get a handle on the side effect of my own medication.  It’s simply not good for me particularly since my fasting glucose number was high.  That’s what comes of having big babies.  Grace was just shy of ten pounds at birth, and Doireann was a little over nine.  Yeah, they looked like tiny Michelin men.  And, yeah, OOOOOOOOOOW!!!!!

Resources:

Eating Disorders in Schizophrenia

The Anxious Man

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I should rename this blog something like “Our Crazy Life” because it feels very harried and too busy most of the time, and I don’t subscribe to the American view that busy=good.  I agree with Socrates on the topic of the busy life: “Beware the barrenness of a busy life.”  Apparently, the ancients even had an issue with it.

Since my husband’s return from Boston, he has hardly been home.  Now I remember why I felt so alone in managing our household and so very alone in raising our children.  The man is simply never here, and when he is here he’s trying to unwind from being gone all day.  It’s not easy for him either.  Everyone in our house, except for Doireann, has an Axis I diagnosis.  I just realized that yesterday–even my husband, and everyone takes a medication.  Grace’s needs are obviously the most profound with Milly coming in at a close second.  Eadaoin is starting to display her bipolar colors more and more.  She hasn’t been able to sleep, and her creativity is at an all-time high.  I take medication, too, and it slows down my brain so I have no access to my hypomania anymore.  Honestly, I miss it.  I used to get a lot done.  My husband has an anxiety disorder, and it felt like the third party in our marriage.  He didn’t leave home without it, and when it peaked his alter ego, Lizard Man, would emerge and harass the entire family.  Lizard Man was purely amygdala driven–cold, mean, and humorless.  Some of the fringe products of the amygdala driven brain are things like excuses, rationalization, procrastination and avoiding commitment or social contact.  When it’s extreme, you might even experience gaslighting.  You’ll know when you’re interacting with the lizard brain because reptiles have no sense of humor, and they eat their young.  They go for the throat in fights and take no prisoners.  The amygdala is typically called to action by fear and anxiety, and this part of the brain is incapable of empathy and intimacy. It actually shuts down higher brain functions associated with emotional intelligence and reasoning.  In demeanor and personality, my husband was nothing like the man I married, and I grew to hate and pity Lizard Man at the same time for his lack of empathy, coldness, and inability to communicate.

Last November, after nearly 17 years of marriage, I put my foot down and demanded that my husband see a doctor about his anxiety.  It was time to take Lizard Man out back and give him the Old Yeller treatment.  I was not asking.  I was telling.  He finally overcame his own pride and sought help and returned with a shiny Zoloft prescription.  His doctor had him fill out the standard “How Anxious Are You?” questionnaire, and he ranked as moderately anxious.  They then went on to have an honest discussion about anxiety, and he left with an anxiety disorder diagnosis.  He seemed earnestly surprised by this turn of events.  I wanted to foam at the mouth and roll around on the floor, run from the house screaming while keying cars and knocking over flower carts.  I had known that he was anxious for years! I had borne the brunt of his panic attacks and anxious sulks since the first day of our marriage! Damn that third-party credibility!  Alas, his journey had brought him to this enlightened place, and he finally knew.

A month into taking his SSRI he felt transformed.  He would often say, “I don’t know why I didn’t do this sooner! I feel so much better.”  I would grind my back molars at these random declarations of mental well-being, thinking, “I have been asking you to get help for 15 years!” Better late than never.  That became my mantra.

As he has relaxed more, easing into a new experience of life, his sleep has changed.  Firstly, he can sleep now which is new for him; he could never sleep before.  He dreams now as well, and some of these dreams are rather vivid.  In the middle of the night last night, he was dreaming.  I was sleeping peacefully, and something painful awakened me.  I realized that he was kicking me quite hard so I tried to turn over and move away simultaneously.  As I began to move, his closed fist punched me directly in the face.  I was half-awake and stunned.  I didn’t know if it hurt or why he had punched me.  I think I yelled or cried out, and that was enough for him to wake up.  “You punched me!”  He was very apologetic.  Apparently, he was dreaming that people were breaking into the house, and he was fighting them.  I find it a bit humorous now although my jaw doesn’t think so.  He never dreamed very much until he began taking an SSRI.

Anxiety disorders tend to run in families so it’s no wonder that Grace is anxious.  Milly has an anxiety disorder, too, as does Eadaoin.  Doireann is an overachieving perfectionist so you can guess what she struggles with.  It took Grace, Milly, and Eadaoin receiving diagnoses as well as medication for their respective issues to motivate my husband to get help for his.  Oh, and my foot firmly planted in his arse.

Generally speaking, I do wonder if it’s harder for men to admit that they need help than for women.  On some level, women are expected to be hysterical and needy.  Statistically, women present with far more somatic complaints than men, and histrionic disorders are more common among women.  How many comedians have made jokes about women going on PMS rampages or being sexually frigid? How about that woman who’s the “office bitch”? Someone usually says, “Oh, that bitch needs to get a shrink! She needs to take a pill and chill out!”   In other words, culturally, it’s a foregone conclusion that most women will need mental health supports at some point because we are “the weaker sex”–overly emotional, prone to histrionics, and mentally affected.  It’s a stereotype that’s continually perpetuated, but it does make it easier for women to seek help because we can use it to our benefit.

What’s the reality for men? My husband won’t tell anyone that he takes an SSRI for anxiety, and my husband isn’t a macho kind of guy.  I know a few guys who struggle a lot with mental health problems, but they refuse to get treatment.  Why? Shame.  It’s perfectly fine for their sisters and mothers to go to therapy and seek treatment, but they would never do such a thing.  It’s just not masculine.  It’s admitting weakness.  Then, there’s their father’s response: “Not my son!” To me, this sounds a lot like poor differentiation in a father-son relationship.  Girls can be emotional, needy, and weak, but boys can’t? Obviously, I could write a PhD thesis on this topic, and I imagine people have already done that.  The point here is that men ought to feel free to pursue wholeness, too, and part of that is stepping over the stigma associated with mental health problems.  Every time a man decides to make a choice towards his own betterment regarding his mental health, he is punching a hole in the stigma that surrounds mental health in our culture.  He is setting the standard for other men, and this encourages others to step out of the shadows of generational and culturally imposed shame to pursue their own health and wholeness, too.

It took my husband a long time to take responsibility for his mental health issues, and his daughters paved the way for him to do that.  But, he did it, and he’s not looking back.  He wishes that he would have done it years ago.  We’ve lost a lot in our marriage because of his anxiety-induced behaviors.  Because of Lizard Man.  I encourage you to ask for the help that you need–even if you are afraid or ashamed–because, contrary to what it feels like, it takes far more strength to step into the light than it does to hide in the dark, and that’s always the courageous, strong, and healthy thing to do.  Isn’t strength, courage, and health part of what defines holistic masculinity? It’s something worth considering.

The Bonsai Child

We are home now.  Spring Break is over.  My husband is home.  ::Happy dancing::  Life is feeling normal again except that my husband looks really happy when he takes out the trash.  Gratitude and good sex will do that to a person.  I know I’m looking rather thrilled when he’s taking out the trash.

Grace saw Dr. Awesome today for her monthly check-up.  Grace is experiencing a new symptom.  She is smelling odors that aren’t there–olfactory hallucinations.  She also has a history of hearing music that isn’t playing–auditory hallucinations.  Combine these two symptoms, however, and psychiatrists get very nervous because this creeps into a neurologist’s territory.  Temporal Lobe Epilepsy (TLE) runs in our family.  I have TLE, and as a child I frequently experienced auditory, visual, and olfactory hallucinations but usually on the cusp of sleep.  I had no idea that I was experiencing seizures.  I only knew that whatever it was, it was terrifying, and it always ended with my wetting the bed.  I never told a soul.  I sensed that it would end badly so I hid it and secretly washed my bedding during the day when no one was home.  I experienced seizures for years and was officially diagnosed with TLE when I was in my late twenties during my second pregnancy.

Grace has already had two MRIs and three EEGs all of which were clean.  EEGs are notoriously tricky because they only record what the brain is doing during a specific time.  If the brain doesn’t seize during that time, then nothing is documented.  It can be very frustrating for the patient and the physician as well, but there are other ways to diagnose a seizure disorder like abnormal posturing (i.e. dystonia in the hands, lower and upper arms) which was how I was finally diagnosed in the end.

Dr. Awesome is deeply troubled by Grace’s olfactory hallucinations as olfactory hallucinations are very specific to TLE.  Grace has also had what appears to be absence episodes in the past.  Grace gets crippling migraine-like headaches, and she struggles with a generalized anxiety disorder which is only getting worse over time in addition to her schizophrenia.  She is also developing hypoglycemia.  This is new, and this is not good because diabetes is a side effect of her drugs.  Hypoglycemia means that her pancreas is struggling.  I have to work very hard to get her to eat, and she is experiencing hypoglycemic episodes almost daily.  She becomes extremely labile, sad, and terribly intractable.  It requires a herculean effort on my part to get that kid to eat or drink a thing.  Dr. Awesome turned her chair around and took a firm but gentle tone with Grace, her East Indian accent emphasizing her seriousness:

Grace, listen to me.  You must obey your mother and eat a variety of foods.  If you do not, you will become a Bonsai of a person! Do you know what a Bonsai is? They are very small plants that a person feeds only what is required to keep alive so they never grow.  They just stay small.  I don’t want that for you.  I want you to grow up to be strong and tall.  If you don’t eat well and often, you will be a Bonsai child, and this will do no one any good.  Do you understand this?

Grace’s eyes were wide, and she looked very serious trying to understand what it might mean to become a Bonsai child.  She somberly nodded her head and promised to obey me and eat.  I thanked Dr. Awesome for her third-party credibility, and we ended our meeting with the important question of what to do with the emergence of the olfactory symptoms.

“What do you say about increasing the Neurontin?” 

I was thoughtful.  “Well, if she’s having seizures it might address that.  I took Neurontin for seizure control, and it worked well.  It will address her anxiety possibly.  It will continue to treat her Restless Leg Syndrome, and Neurontin is used to treat headaches so it might help get those headaches under control, too.  I’m all for increasing it.”

She smiled and nodded.  “Yes, let’s increase this to 600 mg then.  I want to see her in May.”

I am seriously thinking of making an appointment with a nutritionist.  I think a one-hour consultation with a certified dietician would do a world of good for Grace.  I want her to feel empowered and in control of the things that she actually can control, and when and what she eats are two of those things.  If she is truly developing hypoglycemia, then we can do something about that with sound education.  It just so happens that a dietician lives directly across the street from me.  I might just knock on her door this week.  Oddly, her cats are the fattest on the block.  Go figure…

Obese-cat

Mario could only aspire to be this big…