So, here I sit in our showroom in Pittsburgh, waiting for some things to finish up before I can go back to the hotel. I didn’t get in until really late last night and found out that my appointment today had cancelled and that the sales rep didn’t decide to tell me until he sent me a text at about 10:30 last night. He likely knew this early in the day and I could have saved myself the late drive and a night at the hotel. I’d much rather be going home to see my wife tonight and sleep in my own bed, but that’s just not going to happen. Anyway.. Enough bitching about that..
I had a long conversation yesterday with a friend of mine on my drive here and we got on the subject of doctors; more specifically, psychiatrists and treatment options. My friend has bipolar I and I have bipolar II. (If you’re interested in the difference, you can read up on it here.) In my experience it seems that many psychiatrists have their own opinions on how the mind and body work and relate to each other. It’s nearly dogmatic with some. So, having a decent rapport with your provider is important. You need someone that at the very least that you feel comfortable with sharing whatever is going on with you, then you need to trust their judgement enough to actually diagnose and treat you. All of that after the initial 45-60 minute appointment where you meet, introduce yourselves to each other, uncomfortably talk to them about your deepest and darkest points in your life ranging from past or present trauma, family relationships, insecurities, self-image, depression, suicidal or homicidal feelings, quirks, ticks, sexual problems, health problems, medications, level of exercise, how your current relationship is going (if any), past relationships, your job and whatever other rather intrusive things you or your potential psychiatrist can come up with in that hour. Try to get that all in then, too. They may give you a new diagnosis, or confirm the previous one. If you’re a long-timer like myself, you’ll go over the list of what medications (the many, many medications) you’ve been on, how they’ve effected you and what has worked in proportion of benefit vs side effects (why does it almost always effect my man parts?!), and then present what you’re looking for in the way of medication without sounding like you’re drug-seeking. “I’m pleased to meet you, too, person I found in an insurance directory and picked because your name didn’t sound like the type given to a complete asshole.”
One of the many things that suck about having bipolar is that on average it usually takes a decade or more to get accurately diagnosed. This was the case with me as well, at closer to two decades. Regardless, in that pre-accurate diagnosis time you’re in limbo. You go to the psychiatrist, tell them whatever you’re feeling at the moment, how absolutely extreme it is and they give you some other diagnosis. In my case it was Treatment-Resistant Major Depression. At least the name kind of reflects the condition.. Anyway, if you don’t have some deep, dark secret or some form of thought distortions (no, the world really is out to shit on my parade!), the best a psychiatrist can do is throw medication(s) at it and possibly suggest you go to therapy to learn any number of other ways to cope. If all else fails, you can try ECT, TMS or Ketamine injections. That’s all assuming you have health insurance that would cover any of them, the latter two having little to no chance of insurance covering at all. ECT is expensive enough considering that it often takes multiple treatments, TMS is even more costly and Ketamine treatment if you’re lucky enough to find someone willing to do so is roughly the same cost as an ECT treatment. If those numbers aren’t depressing enough, the treatment not being effective for you can leave you feeling just as bad, but several hundred/thousand dollars in debt to some lender that is rather predatory in nature, provided you aren’t independently wealthy.
During that whole misdiagnosis decade, you’ll be given medications that may actually make your condition worse. Though controversial, it’s commonly believed that some psychotropic medications can actually start a manic or depressive cycle in people suffering from bipolar. I was lucky in this regard, as I only had one medication in the many years of trying different ones that caused a horrific depression that was unimaginably worse than the one I was already in. Usually the meds just had sexual side effects, and even then, that wasn’t many of them. Some made it hard to get hard, some made made me Mr. Premature, some made it nearly impossible to finish; which guys, this sounds far more cool than it is. For one, you can’t finish no matter what you do. It’d likely take a belt-sander to make you have enough stimulation to actually finish. Not to mention, your lady may think this is really cool – for the first 20-30 minutes. After that, they start to take it personally and/or they start to get sore to the point that no amount of lube can help and your purple-headed friend stares up at you as hard as Chinese algebra laughing maniacally (Robin Williams joke – RIP). I speak from experience on all of the above..
Back to the discussion with my friend..
I’ll spare a long backstory, but my childhood sucked. All of it. There was far from mild abuse throughout the entirety of my youth up until I moved out. My best friend took her own life when I was in my early 20’s and I was already a mess with PTSD and such. The earliest I remember feeling suicidal was when I was still very young.. Five, maybe? Either way, I knew what death was; as in having a full understanding of it. I lived on a farm and saw this rather regularly. I remember saying on several occasions that I wanted to die, and fully understood and meant what I was saying. I was quickly told by my mother to not say or even think things like that. This would continue until I eventually just kept my thoughts to myself; about everything. Anyway, that whole suicidal thought process has always been there. That’s followed me throughout my life.
I’ve only seen this psychiatrist for a few months now, so I’ve probably only seen her 5 or 6 times (I’d have to look). I’m rather frank about things, which seems to surprise her. For her to be able to do her job with me effectively, I need to be honest and forward with what’s going on with me. That mixed with giving exactly zero fucks what nearly anyone thinks about me really helps in that regard. Anyways, she and my friend both are concerned about the constant suicidal thoughts/images. Though I’ve explained that both are very common for me, they are still very concerned about this. It’s been a constant for many years, so much so that it rarely registers in my actual thought process. It’s kind of hard to explain… As I sit here, I see the occasional mind’s eye flash of me doing any number of things that would be fatal. Using a razor to slice the carotid artery in my neck, shooting myself, crashing my car, etc. It’s a flash that happens in a fraction of a second. It’s just that, though. A flash. I also think about what I need to do tomorrow at work; what I’ll listen to on my drive to Cleveland tomorrow evening; if I’ll get laid this weekend (I sure hope so); how my wife is doing and if she still has a migraine (she did this morning); how the little bastards (cat and dog) are doing; if I’ll remember to get a razor from the front counter at the hotel so I’m not all stubbly in the morning for work, etc. Basically, it’s very low on the things that register in my brain. It’s nothing more than a passing thought. Yet, there’s this concern.
Yes, having these flashes all the time isn’t pleasant, but it’s not as bad as it must sound to someone who doesn’t have them. This is normal for me. It’s just hard for others to conceptualize. If you see someone missing a limb from birth, you immediately think of how much more difficult things must be for them. Even for the points that you come up with that are accurate, it’s likely not at the forefront of their mind. They’ve adapted accordingly and that’s just their reality. It doesn’t weigh on me. The psychiatrist and my friend though believe this to be a significant problem. Objectively, I get it. If the imagery is there, and the urge is there, then there’s something underlying going on. As true as that is, years of therapy hasn’t coaxed whatever that thing/reason is out, and likely won’t. I could obsess about it or go on with my life. I choose the latter. Do I want to go through with it? Deep down, I mean? Yeah.. Sometimes, if I’m being completely honest. But it’s just that – a passing thing. I also know it’ll pass, so even if the urge turns into need, I know it will pass. Am I feeling the need as I write this right now? Yes. Very much so, but I’ve also been slowly falling into a further depression for weeks now and fighting it to the best of my ability. I’ve added medications on and have a treatment course set up with my psychiatrist. If things get completely and utterly unmanageable I’ll check into a psych ward. Considering the alternative, I can deal with being in a psych ward until the desire, turned need, passes.
Is this constant stream of thought normal? Of course not. Am I normal? No more or less than anyone else thinks they are different. Doesn’t everyone think they are different somehow? So, here I sit and write, hoping that someone else can relate to this. There’s nearly 7 billion people in the world – someone else must feel like this and experience this. Somewhere out there, my emotional doppelgänger is thinking, feeling and wondering the same things. This is my “normal.” It could be better, but it could be a hell of a lot worse, too. Hopefully tomorrow I’ll wake and that thought/urge/need will be less prominent.