Seeing anger where there is none

I went to my second appointment with tdoc today.  We talked about how I think people are mad at me even when they are not.  Especially with people close to me (read: husband, parents) I then ask them over and over whether they are mad at me and have a hard time believing them when they say they are not.

Tdoc thinks I am more sensitive to emotions and little non-verbal signals people give off than a lot of people are, but that instead of just noticing them, I immediately assume these ‘i’m having a bad day’ signals are directed toward me or because of me.  I think I pretty much agree with this.

Besides feeling like people I love are mad at me and not being able to trust/believe them, for me this can also lead to paranoia, anxiety or even a complete meltdown depending on my mood-state at the time, whether I’m having a mood episode and any number of other conditions.

Talking about this got me to wondering if it’s a common trait of people with bipolar disorder to sense anger (specifically toward them) where there is none, or if it’s an obsessive thing or something else entirely.  Then I read this bog entry on mentalhelp

Bipolar Kids See Agression When It Isn’t There

In a study reported on by the National Institue of Mental Health, kids with bipolar disorder were WAY more likely to say people in photos were angry than kids who were ‘healthy’ (their language, not mine).

Some interesting thoughts from the blogger Mark Dombeck PhD (director of mentalhelp):

Bipolar kids may have an inborn vulnerability for having a “hair-trigger” for determining other’s aggression. They may be so ready to see hostility that they read it in when it is not objectively present. If this is the case . . . Bipolar children ought to be observably picking fights with other kids at a higher rate than other kids . . . or to be fearful at a higher rate than other kids, for instance.I’m left wondering if there is any possible connection between this finding (of a tendancy for bipolar kids to see threats where they dont’ exist) and a tendancy towards paranoia, particularly during a manic state (when true psychosis is possible and even likely). Paranoia, of course, is the name given to the behavior a patient displays when he or she comes to believe that others . . . are out to get them. It is normally associated with paranoid schizophrenia, but a very severe mania can also result in paranoid symptoms. This would be a really interesting finding if it resulted in our learning more about how paranoid states are set up or created by underlying biological brain conditions.

I don’t know that paranoia only occurs in severe mania.  It’s totally there in psychotic depression too.  Still, interesting finding and shows even more that a: although they may manifest differently, everyone with bipolar disorder has the same symptoms and b: it IS a biological disease.  It’s also good to have some empirical evidence that as a kid I wasn’t just ‘sensitive’ or ‘paranoid’ or ‘emotional’.  I WAS bipolar, and my feelings and experience, although distorted, were not based in psychology or fear or weakness.  They were valid.  And those distorted thoughts were and are symptoms of a disease, not some sort of neurosis.

Will healthcare reform do anything useful for those with MI?

I haven’t really paid attention to this whole healthcare system overhaul business.  It’s because I’m pretty much of the opinion that unless you go one way or the other (i.e. full government control or full market control) nothing’s really going to change much, except that it will get more complicated and probably raise taxes.  I’m not necessarily opposed to raising taxes if I, or at least someone, gets something useful out of it, and we actually look into *not* spending more money than we have as a government, but there you are.  I didn’t think increased government programs, in this case, would help anyone.

And parity in coverage for Mental Health services had supposedly passed already anyway.

The health insurance I have is pretty affordable compared to what a lot of people I know pay.  This is because I get it through my husband’s job.  And I thought the coverage was good until I moved and tried to find tdocs and pdocs here that take said insurance.  What a hassle!  And frustrating!

I did have to sort-of-lie about being a student to keep my parent’s coverage before I got married (this whole bipolar thing kept me from having a stable job with benefits, if you know what I mean).

So, I have encountered problems.  And many people with mental illnesses have encountered worse.

I got to thinking, I shouldn’t write this whole thing off as useless without actually researching it.  Maybe it could solve some of the problems I’ve faced.  Maybe it could help other people who’ve faced much worse while looking for medical care.  I doubted it would close the ridiculously large holes in the system regarding care more intense than pure outpatient and less intense than hospitalization or a residential program, but still.  It was hypocritical of me not to do my research, I thought.

So, I present to you, what I’ve found:

The three bills currently floating around congress have a lot in common.  A number of issues they all address, while not directly related to Mental Health, would help MI people get coverage.  Some of the stuff I’m talking about (found on the Bazelon Center for Mental Health Law website):

–Insurers could not deny coverage for a pre-existing condition
–Insurers could not charge people with poor health more than others
–Insurers could not discriminate based on person’s mental or physical disability(ies).
–Young Adults (up to age 26) must be allowed to stay on their parents’ health insurance (if their parents so desire)
–Individuals making up to 400% of the poverty level will be eligible to receive subsidies to afford coverage.
While these policy changes improve access to health insurance, they don’t necessarily improve access to mental health care or the quality of that care. . .let’s see if there’s more.

Medicaid often offers more services for people with mental illnesses than private insurance does.  However, single and childless adults as well as those not qualifying for ‘disabled’ classification have often not been eligible for medicaid.  While the income amounts and other requirements for medicaid eligibility have made less restrictive in all the bills, the house bill would have the most benefit.  It would allow individuals with incomes up to 150% of the poverty level to qualify, even if they are not recieving SSI or Disability.  So there’s some improvement in access to care. . .as long as medicaid continues to cover a wide range of mental health services.

More on access to care:  All the bills require insurance parity, but the senate bill has rather vague language.  The other two bills require coverage for hospitalization, ER services, Outpatient and rehabilitation services and psychiatric perscriptions.  Exactly what these services include isn’t outlined, however.  The good thing is, no one will have to worry that their health plan covers mental health services.  Somehow I think we’ll still have to wonder how good our coverage is though. . .

The bills also tell the government to develop a national Mental Health strategy.  um. . .what?  They also provide grants and such to increase coordination of care between providers of physical health services and mental health services as well as increasing the resources community mental health centers have so they can strengthen their continuum of care.  The house bill would help fund mental health centers that meet certain qualification requirements, such as providing peer support, rehabilitation, intensive community support and medical and primary care services.

All the bills ‘encourage’ research and training in a number of mental health-related areas.  ‘Encouraging’ things is nice, but all it does is make us feel good.  It doesn’t get anything done.  You can’t enforce ‘encouragement’.

here is a link to the PDF file I based a lot of this on.  As I said before, it’s from the Bazelon folks.

Hope this helps!

Silver Ribbon

I’m sure you’ve seen the pink ribbons all over creation, plastered on anything that can have something plastered on it.  And there are yellow ribbons for supporting the troops, and puzzle ribbons for autism, and red ribbons for AIDS on and on it goes.

I get pretty upset about this.  Not because I don’t think the causes are worthy, but because it’s such a trend.  And because so many companies jump on this bandwagon for what seem to be purely profit-related reasons.

And I also get upset because there aren’t any cars driving around with magnetic ribbons that say “Support Bipolar Disorder Research” or “Mental Illness Awareness”.  I used to think they didn’t exist, or that maybe people with MI and those that care about them just don’t want to advertise.

One day, three summers ago, when I was walking on the street in Albany, I saw a little green ribbon stuck to a light pole.  It said “Children’s Mental Health Matters.”  I had been having a bad morning.  In fact, I was anxious, sad and crying while on that walk.  And then I found that ribbon.  It made my day!

I still have it on my fridge.

As it turns out, there is a ribbon for all mental illnesses.  It’s the silver ribbon, and it’s actually for all brain disorders.  I think lumping them in together is a fantastic thing.  It has the potential to increase public acceptance of Mental Illnesses as legitimate biological disorders.

The silver ribbon campaign is promoted by the silver ribbon coalition.  It’s a coalition (duh.) of lots of different organizations that deal with specific disorders.  Lots of celebrities support the coalition too.  Among other things, you can buy one of those nifty car magnets on their site (it says “Brain Research”) and you can find ways to get involved and info about many brain disorders.

I have jumped on board and started making silver ribbon pins.  I got some extra-shiny ribbon (visibility! sparkle!) from a craft store and attached safety pins.  I hope to give them out to lots of people and convince them to wear them to social events where people might ask about them.  I wear mine around, but, not being overly social, no one has asked about it.  It can’t be that they haven’t seen it!  It’s shiny!

In any case, this is a rather disjointed post, but I wanted to tell you about silver ribbons before I forgot.  If we can get the whole mental illness community to adopt the silver ribbon as our symbol of hope and awareness, people will begin to recognize it, talk about it, and maybe learn more about MI, accept us, and get help if they need it.

Down with shame and stigma, up with shiny ribbons!  And lets see some of those celebs with their silver ribbons on at their next press conference or award show.

OCD

I went to my first appointment with my new psychologist (tdoc) last Wednesday.  I was telling her about these intrusive thoughts I have.  They are usually about hurting myself or others and they are very persistent and graphic. And i’m not actively thinking them.  It’s like they just put themselves in my mind and I can’t get rid of them.

I also told her about how sometimes, if someone leaves my house, like my mother or something, I am convinced they will be in a car accident and die on the way home.  I can reduce this feeling if I make sure I see them to the door, say certain things every time (“I love you” and “be safe”, preferably multiple times) and watch them drive away and wave until they are out of site.  If I don’t do all these things I am terrified the person will die on the way home and it will be caused by the fact that I did not prevent it by doing these things.

I previously thought the first one was a form of psychosis (I get that sometimes during mood episodes.  Usually delusions, occasionally voices)

I thought the second was paranoia.  I have a lot of that too, like, people are following me, watching me, there is a bug in my house and it will bite me in the night, etc.  In the past, tdocs and psychiatrists (pdocs) have said this being terrified by people leaving thing had something to do with BPD (borderline personality disorder).  They figured I had that because I self-injure(d) and they didn’t want to go any deeper.

In any case, as soon as I told my new tdoc these things she said “oh, that’s OCD”.

Now, you’d think I wouldn’t be too happy to have this additional disorder added to my list of illnesses, but really, it has brought me a bit of peace.  I now realize I’m not crazy for having these thoughts.  I know why I feel this way and engage in these behaviors, why I have this ‘magical thinking’.  My dad also has some OC tendencies, so there’s some genetic stuff going on and I don’t feel like it just fell out of the blue.

In general, I just think it feels good to have something explained, to know where to look to find people with similar experiences (I wasn’t seeing these aspects of me reflected in the writings of Bipolar people), to feel like I’m not bad or evil because I think about stabbing myself in the eye with a fork that just happens to be sitting on the table in front of me.  I mean, immediately, automatically and graphically.  Or seeing images of terrible things happening to my family and feeling somehow responsible.

It’s good to know that doesn’t make me nuts.  Or, at least it makes me a certain kind of nuts that other people are as well.  You know what I mean.

Some other Obsessions and Compulsions of mine:
-I have to say a certain group of things and have certain responses repeated back to me before going to bed or else it is very hard to go to sleep (sometimes I think if this doesn’t happen I or the person I’m saying the things to will die in their sleep)
-I have to try very hard not to compulsively scratch my head or pull out my eyebrows (technically impulse-control issues, but on the OCD spectrum)
-Constantly checking things about my body and my possessions to make sure they haven’t changed/there are the same number.
-General discomfort regarding things that are lopsided and even numbers (I only recently got over the need to set only odd numbered times on the microwave. . .as in 1:31 instead of 1:30)
-Engaging in repetitive actions/motions/self-injury to silence or reduce the obsessive/intrusive thoughts
-Getting one word, phrase or concept stuck in my head and thinking about it obsessively (recently it was ‘macular degeneration’ and it was stuck in my head for a couple of weeks.  I had not even read it anywhere, and then there it was.  It eventually went away after I saw it mentioned in a newspaper.  Apparently that was closure?)

Well, there you are.  Anyway, I’m happy tdoc mentioned OCD to me because it gave me a great deal of solace regarding all this crap that I couldn’t explain and that persists between mood episodes.  If I think of more Os and Cs I’ll put them in another post as well as any work I do on dealing with this business.