Intersections

Some editions of the Disability Blog Carnival have talked about intersections. The intersection between disability and feminism or religion for example. I've always had a hard time with these and usually skip those.

But today, today I learned something about the intersection of bipolar and CP that is invaluable to me. I shouldn't go to the gym when I'm manic. But of course I wasn't manic in the least this morning. I got home though and the first thought that came into my head was "I feel like death." Not anywhere near the way I felt like death here, but on that spectrum. I haven't slept in 2 days. And even before then I was sleeping enough but it wasn't quality sleep. I was tired but AWAKE! A feeling I HATE! And when I got home I was both more revved up and more worn out. OOPS...

I've realized that there's a delicate balance of energy expenditure when you have CP. Don't use enough and you won't get good quality sleep. You also won't produce enough serotonin. Your body wasn't meant to be sedentary. Use too much and you'll be nonfunctional. Yes this is true for any human being, but for us spazes the tipping point is more sensitive, the balance more precarious. Ok, not new news, but manic episodes can be like bowling balls, and I realized today that I should try very hard not to nudge the ball towards the pins. A spaz does not fall down gracefully, but rather with a thud :-D

My lack of sleep will gently nudge that ball. Each morning I wake up early pushes the ball closer and closer to the pins. So why tempt things? Why expend any more energy then I have to? As much as I need to go to the gym, my personal trainer appointment was probably a bad idea. As much as I need to keep moving (if I wasn't typing I'd be fidgeting), I need to try to keep still. I need to counterbalance the lack of sleep. Slow down the ball, not speed it up.

~~~~~~~~~~~~~~

I had put in a call to my latest psychiatrist yesterday to discuss something different, but of course said, "I'm going away on Friday and I'm manic. what do I do?" instead.

"When did this start? I just saw you."

"Today," I simply answered. I wanted her to think I woke up this way, not that it started 3hrs before she called. I needed her take me seriously.

But she didn't take me seriously. Not enough time. "How do you know?"

How do I articulate it within a 7min phone call, most of which was spent telling her why she can't prescribe anything a psychiatrist would prescribe as the 1st line of defense. Tried them. Don't work. It's taken me well over an hour to write this post; to gather my thoughts.

All I could think of was "I feel like I was run over by a truck." I told her I didn't sleep for the past 2 days (me get up at 6:45? SCARY) and that I know I won't sleep tonight as I have too much energy. She wasn't any help to me because she doesn't understand the intersection of CP and bipolar. She doesn't understand the presentation of my atypical manic episodes and panic attacks. Heck I did say I was irritable for no reason the other day, didn't I? Although I really don't think this is what that stemmed from.

All I have to say to my shrink is "I feel like I was run over by a truck," and somehow she understands. She doesn't even have to say anything. Just a look. A look that says, Uh Huh. Add in 6:45am for good measure, and she'll say "you're probably right."

But my psychiatrist is the 4th psychiatrist who's told me that 6.5hrs of sleep sounded like enough sleep to her. She's the 4th psychiatrist to not understand that when I say that I need 9-10hrs of sleep I mean I need 9-10hrs of sleep a night. She's the 4th psychiatrist to apparently not have any training in chronic fatigue. Does she need to see me a mess to really understand?

I had 1 pdoc who still didn't understand. The pins were down, but the balls kept coming 1 after another without stopping. Couldn't get even 1 pin set up because they were coming so fast I had to keep my hand out of the way! Still she'd just throw up her hands, blame it on me. Blame me for trying to stop the balls using anything I could think up.

I'm trying to be proactive this time. Catch it before the 1st ball has started rolling. Right now it's just about to drop to the ground. Do something to stop it now! To put it back on the shelf, not down the lane.

So how do I know?

Well, I'm generally annoying when I'm manic, and after not being able to stop talking for the previous hour, and suddenly finding my mind racing about nothing in particular, no racing thoughts, just pent up mental energy, my brain screaming "DO SOMETHING!" I put the 2 together immediately and said to myself, OMG I'm manic! Make it stop now! Just those 2 things were enough, combined with the lack of sleep. Add in some long rambling emails within the last couple of days, and the length of this blog post (taken be about 2hrs to do) and you have the cherry on top!

Now is not a good time. Maybe later? After the 9 days straight where I have to be able to sit through meetings or airplane rides without constantly interrupting people, which I do all the time when I'm manic. OK? Can you do that for me brain? Pretty PLEEZZZE?

Judgement

It's the end of the year. My insurance has an out of pocket maximum, after which point you no longer have copays for visits of any sort or medications. I received a $13,000 powerchair at the end of April, and unlike last year when we met the cap in Dec, this year all of a sudden in the beginning of July my whole family got practically free healthcare. We still had to pay the monthly premium, but we all began thinking up ways to capitalize on this. I continued to go to physical therapy past the point where it was useful, because it was free and a trainer costs $. After 6 or 7 years of talking myself out of getting new AFOs, because most years I've worn them less then half a dozen times, so what's the point, I got casted for a new pair last week, just under the wire. I also decided to try out a new primary care physician, since it'd been 14mos since my last physical, even though the plan had been to wait until April. I also managed by fate to get my annual follow up with my physiatrist moved from January to December.

Oddly both of those appointments, although not originally scheduled this way, ended up being yesterday. I really like my new primary care physician (PC), and even though I never plan on seeing her because I am the healthiest person I know, it's nice to know that I found someone I am comfortable with. Although I noticed slight judgement in her voice. If both of those appointments hadn't ended up on the same day I wouldn't have noticed the same judgement from my physiatrist, whom I have seen just over half my life.

PC doc who saw me walking down the hall, came in and almost immediately said "the baclofen & valium are for muscle spasms from cerebral palsy?" which wasn't noted on my paperwork because there wasn't a line next to "other."

"yes."

"What's the lamictal for?" I was a little surprised she didn't ask me if I had seizures, as 1 in 3 people with CP do. Maybe that was on the list and I didn't check it

"bipolar." That wasn't listed on the form either, so I had checked both depression and anxiety instead.

The next question she asked me was who my psychiatrist is, and then she asked me how I was doing in respect to that. My physiatrist asked me the same question although the conversation went like this. "J. M---. I have a new one again and I don't like her all that much either." And I got a look, which was fine then, but not the next one, when she asked me how I was doing. Actually, it was really the tone in her voice when she asked me. She has every right to give me all the looks she wants. I didn't name this blog "Uppity Crip" for nothing. She knows half the time she tells me not to do something I do it anyway. Flashback to my Aug appt: "You really should have consulted me before you did that." "I did. I didn't like your answer." :-)

Anyway, the tone in her voice was the same tone I'd gotten that morning. It was as if to say that I'm not capable of doing what I should be doing, that I don't know. It was as if to say that people with this diagnosis don't have the capacity to make responsible, smart decisions. That we're all a mess 100% of the time. PC doc doesn't have a right to make that judgement. The other one knows just how much of a mess I've been over the years, but I'd still like some credit.

I mentioned this to my shrink this afternoon in less words, and she gave me a look. It was a different look. It maybe had a hint of exasperation. So I replied with "I know what I should be doing..." Infer from that what you will, but I do try.

This isn't enough to send me looking for another PC doc, because it was a tone of concern from both of them, not a tone of fear. Not a tone of "all people with this diagnosis are violent," but to me it was still a tone of well meaning prejudice.

Well meaning prejudice, you ask? How can there be such a thing as a well meaning prejudice? Well meaning prejudices are "permissible prejudices," statements or thoughts that are so ingrained in society that they are taken for granted as truth. Mary Johnson does a fantastic job of discussing permissible prejudices as they relate to disability in her book Disability Awareness -- Do it Right! The inferiority of black people used to be a permissible prejudice. Now even racists know that society frowns upon them even if they don't give a damn about it. See this page for the definition of a permissible prejudice as it relates to homophobia. In my google search I noticed people referring to homophobia as the last permissible prejudice. What about prejudices against fat people? What about ableism, which encompasses every disability, including this one? I beg to differ with that blanket statement.

It rubbed me the wrong way, being judged by smart people who I'd hope would know better. But if they really don't know better, if they had no clue they were giving off a vibe, is it really right for me to judge them for judging me? It's what I'm trying to figure out, but I so far have no conclusion. Because if you really know me and you judge me on the basis of me being me, you might be right, even if it doesn't feel good.

I Take Responsibility (a Repost)

Originally published Feb 2010, I hope the links still work. Something I found today and really needed to be reminded of.

Thanks Beth for pointing me to two GREAT articles recently, one of which I will just mention briefly. Debate Over Cognitive, Traditional Mental Health Therapy from the LA Times touches on whether or not therapists should be designing treatment plans within the context of the medical model. But it is the other article, or rather part of it, that is really the focus of this post. The Americanization of Mental Illness from the New York Times also focuses on the medical model, but more extensively.

I'm not going to sum up the entire article as it is super long (totally worth reading the whole thing though) but I am going to pull out two parts. The discussion on the stigma of viewing mental "illness" within the framework of the medical model ("brain-disease"), as "... an illness like any other" (quote from page 3), something purely with a biochemical origin, versus as something originating from situational triggers ("psycho-social") is primarily located on page four. I'm not going to comment on this section anymore except to say GO READ THIS NOW (I'll wait) because I feel like I'd be repeating myself ad nauseam -- especially lately -- as well as because the opinion is substantiated by scientific studies and isn't just my verbal diarrhea.

There is this one quote from page 3 though that really stuck with me and that I will comment on fully.

"Mental illnesses, it was suggested, should be treated like 'brain diseases' over which the patient has little choice or responsibility." emphasis mine

Little choice or responsibility. Wha? Huh? Seriously? I didn't have little choice over whether or not to be bipolar, I had NO choice. It's not like I woke up one day and said "Gee I think I want to have a major mood disorder." I didn't know until high school that my dad is bipolar and this runs rampant in that side of my family. I just drew the short genetic straw so to speak.

[image description: tiles made by elementary school students in CA (found by google images) surround and illustrate the word Responsibility]

However, I DO have full responsibility over what I do with this information.

I AM responsible for the choices I make, although I often do not practice what I preach.

I AM responsible for the decision to take my medication or not, to go to my support group / therapy / medication appointments or not, to go to the gym or not.

I am NOT responsible for the fact that I will have repeated bouts of depression for the rest of my life.

I am NOT responsible for my panic attacks, especially when I have the ones that start in my sleep.

But, I AM responsible for how I decide to handle this, how / when / if I get control over the episode or if I decide to relinquish my power to my states indefinitely.

Little responsibility? How is that little responsibility? That is BIG responsibility.

Star Stickers: A Winning Strategy!

I say this now, ask me in a few months...

Last fall/winter I quit all my meds for 6mos. Don't ask me why. Since then it's been a bit of a struggle. Mid May to mid June was abysmal, but from mid June to mid July I can tell you I took one of my meds 80% of the time. Fantastic for me & even my shrink agrees, although the new psychiatrist wasn't so pleased. The other med I've never restarted. Anyway, it's becoming harder to remember how many pills I've actually taken as I've been increasingly running over them. It's a good thing I built up some reserve over the time I wasn't taking it, but the issue is I can't just look at the sleeve and count them.

Back the very end of June I bought a planner. Now sometimes I buy them and sometimes I don't, because I never use them. When you have executive functioning issues, every shrink will repeatedly tell you to use one, but as far as I was concerned, I'd just sit there and roll my eyes. Not my thing. But the thing is that from June-August my horseback riding lessons were few and far between, and my PT appt times are sporadic. Then there've been the Care Congress, more CAG commitments, a few work trainings, "medicaid cost containment" public hearings, MFP subgroup meetings, frequent conference calls, and a botox appt thrown in the mix. I have a history of knowing and remembering exactly when thing A is and knowing and remembering exactly when thing B is, but not realizing until the last second that they are at the same time, and my trainer was doing me a favor and dragging her kids along with her to the barn. The last thing I wanted to do was double book her! Hence the planner...

My shrink, who at this point has known me 4 years, was practically speechless when I showed this planner to her with things written in it. The fact that there's more and more in there, I mean, you should just see the look on her face!

Back to the meds and not knowing when I've taken them, I think you see the connection between that and a planner and the title of this post. She went out of town and my appointments were 2 weeks apart. One of the first things she asked me was "are you still taking your meds?" I looked at her and said "Eh." "How much," she asked. "I have absolutely no idea," I replied, "this time I didn't start with a full pack. But I'm sure it's less then 80%"

I have in the past had a thing for stickers. In my apt I have unopened packs of pony stickers and "Incredibles" stickers that say things like "Good Job!", "Way to go!", and "You're INCREDIBLE!" The thing is that my planner is on the smaller side, as you can see, and they're all too big. So I said to her last week, "You know those gold star stickers, the ones that come in the packs with the silver ones and whatever? As long as I'm actually using this planner, I might as well go buy those [see right]. I just can't seem to get motivated enough to actually go get them."

That's a really good idea!" she said. Now that look of shock and the sound of utter amazement that an idea such as this would ever come out of my mouth, I don't know if I've ever seen that. "Plus, you're giving yourself a gold star for taking them!" OK, *eye roll*, cheezy!

A few hours ago I finally made it to a store that carries them to buy some. FYI, neither CVS nor Safeway carry them. As I can only remember as far back as Aug 20, that's where they start. The stars were $1.68 for a pack of 715 in 5 colors and the neon dots were $1.88 for a pack of 475 in 4 colors. I couldn't decide what I wanted, so I just bought both. That's over a years worth of stickers for $3.56 +tax

Realistically I don't think they'll motivate me into better compliance then say 85%, but they'll give me a nice picture of things that is nice to have. Everyone is always so concerned about my levels. I'm using 3 colors, pink dots for my mood stabilizer, gold stars for exercising (ok, I'm not gonna lie, they do make me smile!), and green stars for my antidepressent. Note above that there are no green stars :( It's too much of a time sensitive med and I'm just not getting it. This is a very accessible strategy, as it doesn't cost much, and even blind people can feel the stickers different shapes. All I have to do is dig up a paperclip and secure them to the front of my planner.

Like I said though, ask me in a few months if I even have a clue where my sticker packs are. My strategies tend to fizzle. If I don't I'll dig them up and mail the leftovers to you for free.

Depression Strikes Again!

It happened suddenly between Wednesday and today, and this time I know exactly what the trigger was. I spent a few hours on Friday night after I got home from work (yes, I work now) writing a very long post on it, but have decided to delay posting it and instead emailed it to my current psychiatrist and my shrink instead, who is being very inconsiderate and decided to go on vacation RIGHT WHEN THIS HIT ME. You know, she's supposed to be clairvoyant and all and see everything coming and cancel her vacation just for me! And in case you're thinking "OMG you're being so inconsiderate, bothering this poor woman while she's out of town," I view it the same as if I left a message on her office voicemail. She's under no obligation to read it now. She'll read it eventually.

Anyway, tangent over. Today I woke up and spent the entire day in bed. You know, except for when I had to pee, cuz who wants to lay in a pee soaked bed if they can help it. I took a nap in the evening. I barely ate anything. I didn't bother to take any medication until 4:30. I have quite a few blog posts floating around in my head, such as "No, I'm NOT Into S&M," "I Don't Shave My Legs and I've Decided I Don't Care if You Care," "My New Psychiatrist Refuses to Enter the 21st Century and I'm a Hypocrite" and "One of My Most Embarrassing Moments," which revolves around my period, but I can't figure out why anyone would care about any of this. I also have some back posting I want to do, and a late Freedom Flyer that hasn't even been started.

When it was passed 3:00 and I was still completely naked, I texted a friend and asked her if she could do dinner. I had a cute outfit picked out for the day (my favorite color!) but I couldn't get myself to put it on. I forgot she has a standing 6pm Monday shrink appointment, so we scheduled for tomorrow. she's not doing well either :(

However, I woke up from that evening nap well after 7pm and said, "That's it, you're going out now." And I did. I went to the mall for 45mins and bought a milkshake and socks I wouldn't need if I'd just do my laundry, because I decided that if wearing clean socks tomorrow was going to make me feel less depressed, it was worth the $. So if you count a cake batter flavored milkshake as a meal, I ate 2x today, I got dressed in clothes that make me feel good, I was briefly outside during the 1 block roll to the mall each way, and now I'm writing this dribble, because even if no one cares, writing is therapeutic for me. So I did 4 things today even if it took until 8pm to do them. That's more then I used to do, an improvement. Proof that I've learned something from WRAP even if the one I wrote has been lost for like forever and I never wrote a new one. :D Props to me!

What do you do when you're depressed? Because no one really answered me last time...

Need Advice From Female Wheelchair Users: To Switch or Not To Switch?

Back in 2006 I did a 10pg research paper on physical and sexual abuse of women with disabilities. I'll try to post some references tomorrow. While what I read didn't surprise me, it sure did scare me. There were multiple categories I focused on such as spousal/PA abuse, abuse by parents/relatives, and what scared me the most, although I am pretty mobile and this is unlikely to happen to me, is the possibility of abuse by medical professionals. One or two articles I read talked about women who reported being refused access to their mobility aids until after they were taken advantage of.

When I aged out of my pediatrician, I went 5 years without having a physical, which scared me. I've heard of people who caught serious medical conditions before they were symptomatic, just from a routine well check up, and if I'm going to have a serious medical condition, that's how early I want to find it. I wasn't so worried about abuse as I was about some Dr being annoyed by me. I have inconvenient spasticity issues for some exams, if you catch my drift, and I was worried that if things took more time they might not be so receptive to having me as a patient. I didn't want to just pick someone out of my insurance book and go in blind.

Then one day I met 2 married wheelchair users, and some time later in the middle of a conversation I realized hey, I should go to their doctor. At the time her office was less then 2 miles from where I lived, now it's across the street. Being rolling distance, now walking distance, is definitely a perk.

In the little over 2 years since I got that referral I've been over there 3 times. I don't have much use for a primary care doc other then relieving my constant anxiety that I have some kind of cancer and I have no idea. The 1st time she was OK, and it was a big relief that she was, of course NOT phased by my spasticity. It was a very trusted recommendation.

The second time I went I thought maybe I had strep, and that's when I realized she must double or triple book. I waited a ridiculously long time even though I had called ahead, and then saw her for less then 5mins. Turns out it was just a cold.

When I went for my second physical I also waited way over an hour for an appt scheduled in advance, and she definitely rushed that appointment. By the time I finally saw her I was cutting into her lunch hour.

Back in March I thought I had a serious reaction to one of my meds (I didn't) and my psychiatrist never got back to me even though I emailed him pictures and called him to let him know I emailed him pictures (so I ditched him, it wasn't the 1st thing he did, it was the last straw). I was trying to avoid the ER. When I couldn't make the one time I was given, her office staff never got back to me with an alternative. I went to the ER.

I read recently in Urbanite Magazine that a very local community hospital is doing some revamping in preparation for the implementation of the ACA. If you don't want to read the whole article, basically in a few years if practices change certain things in regards to the treatment of MediCARE patients the government will give them a bonus. They're really doing an aggressive campaign and since I've been typing this post I've heard their radio commercial about their brand new satellite primary care offices twice.

I'm by the main hospital once a week. And by by I mean across their parking lot. The only thing that separates their parking lot from the other parking lot is a parking gate. So besides across the street, this is the most convenient you can get. I should also mention that during the warm months I roll over there.

My current primary care doc takes my insurance but I'm pretty sure not mediCAID, and as I recently qualified for the buy-in and it will soon be my secondary, I'm evaluating who I see. It's part of the reason I ditched my psychiatrist. While I'm not planning on a physical for 9 mos, their incessant radio commercials have me thinking. If they don't take mediCAID and they're so closely linked to a hospital, that's pretty shitty. Their primary care/family physician website says that they accept most insurance plans including mediCARE.

I may call/email over their and check, and I also plan to check and see if they have adjustable height exam tables. My current doc does not, and I would switch just for that. It conveys a certain philosophy of inclusiveness. Besides that though, I would be picking someone blind without anybody else's experience to go off of. That anxiety about my spasticity making a doctor uncomfortable is creeping up again. I don't need to deal with someone like that. On the other hand, although I am pretty comfortable having more intimate exams with the doctor I have, I'm not comfortable with the fact that I feel my time is not respected. The article says that the hospital is in the process of switching their physicians to a salary from the current fee for service, so that hopefully won't be an issue.

If you've managed to get this far, what would YOU do? I'm really interested in opinions. And thanks Jay for the picture.

Frustrated, Or, It's My Blog and I Can Rant if I Want to

I forced myself to go to bed early (10pm) last night by taking a melatonin so that I would get up early before work and fold some clean clothes. Yeah right. I've been online for the last 2hrs or so, and I've been in a bad mood. I woke up that way. My new position is an adjustment, but it's not even that. I'll definitely grow a skill set from this job. I should view it as a challenge, but this morning all I can view it as is a drag, and it's not even the job that's dragging me down.

My problem is an all to common problem for those of us who don't drive. My problem is PARATRANSIT

My problem is that I've recently expanded my world greatly beyond the <3mi I usually try to stick to, and while it's GREAT for my depression that I'm out and about and interacting with more people, it's almost not even worth it to me. Notice I said almost

Because I can't drive:

• my 1hr shrink appointments, 15mins away, take at minimum 3hrs, once 3hrs 45min
• My first shift at work last week, a 30min drive, was just 5hrs, but took up 8+hrs of my Friday
• My half hour horseback riding lessons, about 35mins away, take up at minimum 3.5hrs, but in the half dozen times I've taken paratransit out there, they once dropped me off 50mins after the time I said I need to be there (always 30mins early, I'm not stupid), took forever to get me home, and the whole ordeal lasted probably 4.5 or 5hrs. I'm lucky that the guy who dropped me off had his dinner break in between, was actually assigned to take me home, and decided he'd just sit their and wait for me. Otherwise, I can't imagine.
• The only place I can get to in a reasonable amount of time is my new psychiatrist. A 40min roll in the warm months will only take me 60mins with paratransit in the cold months. BTW, her office is about 2.5mi away.

So forget paratransit altogether.

• A trip to the grocery store, a <5min drive, is a 20min roll each way
• A trip to my PT/Massage therapist (2 different people, same location) is a 15min drive, but takes 2 buses and I try to be at the 1st bus stop (directly outside my door, great apartment score!) 60 or 45mins (cuttin it close) early
• That 2.5mi, 40min roll to my psychiatrist mentioned above, I'm sure that doesn't take more than 10mins in a car.

I know I'm not the first, and certainly not the last, but I've still had it up to here! [picture my left hand way above my head]

PS. Unfortunately I don't seem to qualify for state run programs that help cover the cost of PA services (the state does pay for PAs to drive people places) because I'm not at risk of institutional placement if they don't.

Give Your WRAP to Your Shrink

We're in the middle of another 8 week WRAP session. Different volunteer facilitator, different set up, larger group, so I wanted to do it again. We keep getting good ones. Last night she gave us an assignment to come next time with the name of someone we plan to give our WRAP to. I really like that she did that. It's easy to conceptualize that WRAP is something that you do for yourself and yourself alone. But it isn't. WRAP is a working document that is meant to be shared. Especially the crisis / post - crisis plan part. Like mine has the name of the person designated to do my laundry. Generally these people should know these things...

Some people had these blank looks on their faces, so I piped in and said "I have a WRAP I did previously and the first thing I did after I wrote it was make a copy of it and give it to my therapist." I think I saw some wheels turning. Apparently this isn't as obvious of a thing to do as I thought it was.

I don't take notes during WRAP like most people do. I'm more of an auditory learner. Writing would be too distracting. Nor did I work on it in between or have I read any of the now 3 copies of the red book that I have (I may have given 1 to my shrink, can't remember). The way it worked out for me last time was that I was having a bad day, I think it was 6 weeks into the last WRAP session, I can't remember what was going on that day, but I do remember that I wanted to do anything to keep myself from going home and crawling into bed, so I sat outside the library at school (it was a nice day in April or May) and wrote it out in 1 sitting. Then I immediately went in the library and made a few copies, went to the student union and bought a big envelope, took it over to the school post office and mailed 2 copies, 1 for my shrink and 1 for my pdoc. While she would have copied it for free in her office, for whatever reason I wasn't going to see her for a week and a half or something (I wonder how close I did this to the spring action, can't remember) and I thought it was best for her to have read it in advance of our next appt, especially since it was so far away. Then I let both of them know to expect mail, as I unfortunately didn't have the option to scan / email it.

We had a really good session that week, talking about 'when things are breaking down,' 'early warning signs' stuff. Things that I thought she picked up on back when I started seeing her in 2007, but that apparently she missed. Like the fact that when I feel really bad I tend to dress up, put on make up. Because the last thing you want when you feel like crap is for people to ask you if you're OK. If you look good and people give you compliments you have the option of just saying "Thanks," or saying "Thanks. I feel like crap," depending on who it is. If you look like crap and say "I'm fine," they know you're lying. This isn't a conversation we would have had if I hadn't mailed my WRAP, and it was a conversation we needed to have.

Why wouldn't you share your WRAP with your shrink? One of the main components of WRAP is the concept of having 5 supporters. Why wouldn't your shrink be one of your supporters? They're not going to come over and do your laundry, but if your shrink can't help support you with the other stuff, you need a new shrink.

Lawyer Takes on Psychiatric Industry For Over-Prescribing to Foster Children

Speaking of Zyprexa... I have a friend, who took it as an adult, who had a MASSIVE heart attack and has serious diabetes from taking that. Which is why I am seriously cautious about anything that's been out for less then 5 years...

Also, Monday I spent way too much time online and stumbled across some articles on childhood bipolar. When is childhood bipolar no longer childhood bipolar and is just bipolar? Anyone know? Because I really wish I was diagnosed at 15 and not 22 (lot of years in between there), not that it matters what it's called though... *end tangent*

from babble.com Are More Kids Bipolar? That article links to articles from the New York Times and Slate, all good reads.

How to Survive Therapy: Tips 9-16 Cheryl Style

9) If you're in the kind of therapeutic relationship where the therapist generally runs the show, decides what to talk about, and you just go along with it, BUT one week you have something you need to say that you're sure won't be on the agenda...

Call / text / email them, whatever their preferred method, enough in advance that you're SURE they saw it, and simply say "I have something specific I want to talk about this week." They'll be so curious about what it is, and so shocked at your unusual behavior that they'll ask you what it is first thing and you'll have plenty of time to talk.

10) Use students with CAUTION.

They're cheaper (or sometimes free) but the quality you get is iffy. The first student I saw was clueless. The second was GREAT! [Not to say that this hasn't happened to me with licensed professionals also] The other thing you have to consider is that you'll end up having to get a new therapist every year or every other year. Are you OK with explaining your history over and over?

11) If a therapist thinks that antagonizing you / pushing your buttons is good therapeutic motivation, chew that one over.

Maybe it is, but maybe they're reinforcing negative behaviors you'd like to curb.

12) If a therapist utters the words "people like you," or "those people," repeatedly, or even just once, FIND ANOTHER THERAPIST!

Back to the putting people in boxes thing, but HOW ABLEIST!!!! ICK! And PATRONIZING! I'm not a diagnosis, I'M A PERSON! G-d damn it! There is no person like me! Treat me! Help me! NOT my diagnosis! Can you tell I have baggage???

If your reading this blog chances are you have some grasp of the medical, social, charity models of disability. Way to medicalize! Not everyone knows disability theory of course, but some people just innately know NOT to medicalize people. FIND THEM!

13) Take your medication. Or don't. But then try yoga or something...

My point in this is not to be all, bow down to big pharma. The idea of being forcibly medicated sends chills down my spine. My point is that you need something to put you / keep you in balance, be it a mood stabilizer or an acupuncturist. Therapy works best in conjunction with things. Someone I know swears by his chiropractor, another by transcendental meditation, and another swims 10hrs / week. Do it with pills or without. Whatever floats your boat.

Feel like your treatment team is being too forceful, intentionally giving you a one sided picture of things, (especially of DANGEROUS things like ECT), or is even just the tinyist bit vague? Antagonize them. One pdoc suggested maybe I try a medication that, after searching the interwebs, I discovered has a possible side affect of muscle spasm with pain. I thought I was the crazy one. He's crazy for even considering this medication for someone with a diagnosis of spastic CP.

14) JOIN A PEER SUPPORT GROUP!

In addition to the yoga, time with furry creatures (a favorite of mine), or whatnot.

Who has the money to go to 6hrs of therapy a week? What therapist wants to see you everyday of the week? Unfortunately, they won't let you stay past an hr. Sometimes you need more then an hour in one sitting. Try searching for a DBSA affiliated group. My group is open 2.5hrs twice a week for unstructured time, followed by a 90min support group both days AND is open a 3rd day for a 2hr WRAP session. It'll get you through hopefully... My therapist might be more grateful then I am...

Don't be nervous to find out that there aren't any licensed professionals present at a peer run support group. "They're" not as crazy as you think, and can share more honest stories then a professional can. Plus, peers don't tend to medicalize.

15) If your therapist can't coordinate with your other treating professionals, DITCH THEM!

I'm not even talking about keeping in touch with my botox doc aka pain doc aka physiatrist (the technical term) because that is so complicated (Um, NOT! See #2). Let's start with the most basic and work up to that one. I once had a therapist and a pdoc who had never heard of each other, nor made any attempt to contact each other. Now if that isn't essential, I don't know what is...

16) Lastly, if you happen to find someone who is email savvy, is actually interested in what you have to say, DOESN'T medicalize or make you want to punch a wall, will willingly coordinate with other treating professionals, AND is open to your ideas for alternative treatments, HOLD ONTO THEM. They're a rare breed...

Wood's Rules: How Do I Get The Most Out of My Therapy?

I don't know how I got to Virginia Wood's blog. I'm a public follower but she'll never be on my blog roll. She doesn't post frequently enough. As you may have guessed, the main reason I take people off my blog roll (after I find a replacement) is failure to post. Anyway, I never read the blogs I follow that are not on my blog roll, I just don't feel like scrolling through my dashboard. So, I don't know what brought me to check out her blog again back in August, but I did and noticed that she links to a very opinionated practice website. I mean, look at it, check out the FAQs-- the one about using insurance to cover therapy. Most people can not afford to keep insurance out of the equation, even if they are using out of network benefits, which in my case are good thank god. Why make people feel uncomfortable about it? At $80-$150 a pop depending on qualifications and geographic location, if you have a serious mental illness, you'll go bankrupt.

Totally going off on a tangent... The point of this post is that I looked around her site (I find it tacky and distasteful that she continually links to her facebook fan page) and found a list of how to benefit most from therapy. "This is really good," I thought. "I should blog about it." And then I forgot. Until last Friday that is, when Therese posted Sue Atkinson's 9 rules for surviving therapy. These lists are completely different and I think it's beneficial to look at them both.

• Talk
• Talk a lot
• Talk some more

I went to a therapist for awhile and sat there and stared at him ALOT. We stared at each other, and then I'd look at him and say "WHAT," if he didn't decide to start opening his mail or walk over to check his email while he waited for me to say something. Sometimes he would tell me the weather report. Often he could tell that I was about to say "WHAT" and would say it first.

I was rather surprised when I started talking to this shrink the 1st appointment, even though I couldn't stand her at the time. It felt WEIRD not to just stare at her, but then again, she isn't an asshole. I guess that was the 1st good sign -- me talking more then she does. That is, after all, the point.

• Keep a journal [or a blog AND every once in awhile go back and look at old stuff, reviewing both the new posts and revelations about old posts with your shrink]

Recently a friend asked me if I write poetry and I said "Not that much, but I did write this, back when I was so messed up I had therapy 2X a week." The catalyst for writing it was something my psychiatrist had asked me earlier the day I wrote it that I hadn't been able to articulate in her office. I just needed another half hour to chew it over, and I was able to give a much more extensive answer then I ever could have done in her office. She was immensely grateful I took the time...

• Write down your dreams

I know everyone dreams every night, but is it weird that I only ever remember my nightmares? That I don't write down. I can remember that I was so freaked out about getting somewhere on time (something that is hard for me) that I woke up in a panic 2hrs early...

• Don't drink or drug 24 hours before or after your session--or better yet, stop using altogether

Why is it that all my treating professionals think it is wrong to use alcohol as an alternative treatment for pain management?

• Attend regularly--especially when you don't want to

That's when I make sure that I go. Even if my apathy makes me late. Not that I think it does me any good... I'm too depressed to get anything out of the actual session. However, having a reason to shower, get dressed, get out of bed, get some fresh air, does me a world of good.

• Pay attention to, and talk about, your feelings about your therapist and your therapy. Or, from the other list, even if after ten agonizing sessions you still think that the therapist hates your guts, it may be worth going on, but tell him or her.

I've never had a shrink that hated my guts, but I have had a few where I hated their guts. I'm batting 1 out of 4 in the bad shrink department (out of 8 total). How do you know if a therapist is truly bad (3 out of the 4) or if you do just have to really stick things out (the 1 out of the 4)? I don't know...

To be continued...

FUCK YOU APA

ECT ruins lives. Where/how do you submit comments? Can anyone figure that out? From baltimoresun.com

Psychiatrists Change Their Recommendation for Depression's Treatment

The American Psychiatric Assn., which labored to bring forth a revision of psychiatry’s “Bible” earlier this year, has just released a more modest opus likely to generate much discussion among mental health professionals.

With the release on Friday of its “Practice Guideline for Treatment of Patients with Major Depressive Disorder,” the nation’s leading psychiatric association makes a number of subtle adjustments to its past treatises on depression and its treatment. The new guideline is the first comprehensive update of the organization's guidelines for depression treatment since 2000.

For starters, the APA throws its considerable weight behind the rehabilitation of electro-convulsive therapy (a.k.a. “shock therapy”) as an effective recourse for those who fail to respond to antidepressant treatment. [emphasis mine]

The practice guideline ventures to say that for many patients with chronic or recurrent episodes of depression, “maintenance therapy”—including antidepressant medication and possibly ongoing psychotherapy—may need to continue “indefinitely.”

The guideline reveals a rift between the group drafting the document and the broader “Steering Committee” of psychiatrists on the value of psychodynamic therapy —an often-lengthy series of talk therapy sessions in which patient and therapist probe early-life experiences for the sources of negative thought patterns. While the authors of the guideline would have given psychodynamic therapy an extremely tepid endorsement as an effective depression treatment, the broader board of psychiatrists elected to recommend it “with moderate clinical confidence.” (Both recommended cognitive behavioral therapy without reservations.)

Finally, the association in its latest update bows to the “at least modest” value of physical activity — either aerobic or strength exercises -- in relieving symptoms of mood disturbance, and possibly in preventing depression.

The authors of the practice guideline also engaged in a level of self-disclosure that is new for many psychiatrists. The guideline opens with two pages detailing the extensive ties of those who drafted the document with the pharmaceutical industry. Of the work group’s seven members, all but one declared that he or she received research support, consulting payments, speaking fees or author’s honoraria from several firms developing, manufacturing or marketing psychiatric drugs.

The American Psychiatric Assn. sought to counter any appearance of undue pharmaceutical-industry influence by establishing an “Independent Review Panel,” whose five members were free of any direct financial ties to drug companies, and were charged with “identifying any possible bias.” That panel, the APA reports, “found no evidence of bias.”

--Melissa Healy/Los Angeles Times

Facts About Mental Illness

[Source: Medical Assistant]

Back In Time Post #1

There are things that I have been meaning to post for awhile that I have not. Here are 2 stories from a few months ago:

I was talking with a friend of mine who says "There's this person who lives in my building who looks like she has a powerchair but she doesn't; she uses her hands." After some more discussion I said "Oh, that's So-and-so; she has a power assist. I'm getting one. I actually just went for an eval for one and I'm so excited!"

I then proceed to explain to her how they work. There is a battery pack in the "hub caps" [see right] and when you push with the hand rims the chair goes 3X as far as it would otherwise. When this person was a freshman she had a regular manual chair, and then I saw her with these and my mouth just about dropped open. They are SO MUCH easier to manage, but of course don't go nearly as far on a charge as my jazzy does. BTW they fit on any chair brand.

I told my friend how much they cost (something like 6 or 8 thousand $ JUST FOR THE WHEELS, without the rest of the chair, I think powerchairs are 5-8 thousand $ for the whole thing) and her response was

I like my legs.

WTF??? This is someone who has known me 4.5 years. She then said "I wouldn't want to have to use a wheelchair. They cost too much $."

The other story, I was severely depressed and out at the local diner with some other friends in an attempt to get me to eat when my psychiatrist called. He unfortunately wasn't available to call me back any later, so I had to speak with him while I was sitting in the diner. Now of course those friends knew my business or we wouldn't have been out in the 1st place, but I'd rather not have strangers in a diner overhear my conversation.

My psychiatrist told me to increase one of my medications from 150mg to 225mg but these pills don't have a line in the middle. After complaining to my friends about needing to manage to get myself a pill splitter (in an attempt to get one of them to volunteer to take me, being that I was severely depressed and w/o a drivers license) the woman sitting in the booth behind me turned around and told me that "You can get a pill splitter anywhere," and then listed a few stores. Forget about the fact that I already knew this, why don't you mind your own business lady? Oddly, CVS was out when I went.

And here is something brand new:

So I am newly in charge of the OOO Baltimore website, and decided to put a handy dandy google news ticker on there. Not to sound insensitive, because stories about missing teens are serious, but a story popped up earlier this week about a missing teen "who suffers from depression and bipolar disorder." Redundant much?

A Guest Post on Seclusion & Restraint

My friend wrote this recently and wanted me to share her experiences in order to bring greater awareness about seclusion and restraint. She was pretty much incarcerated in a psych hospital for a year over 2 decades ago. You would hope things were better, wouldn't you? But things like this still go on in developed nations today.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

She couldn’t comprehend the hospital’s rules. She went into her bedroom to escape the racket of people crackling, shoes squeaking, Bob Barker barking from the T.V. set, and the fax shrilly ringing. The noise hurt her ears. The next thing she knew a crowd of men stormed her room. Pinning her limbs behind her back they carried her kicking and screaming to a dirty, barren room. Unceremoniously they dumped her on a gym mat, rushed out and locked the door.

She was bewildered as to why they would play a trick on her. She panicked even more because the walls were closing in on her. Banging on the door she screamed in vain to be freed.

She thought they wanted her to do gymnastics on the gym mat. After several handsprings she found instead the men surged back in. She fought them tooth and nail, but was overpowered. They forced her on a table and tied her in four point restraints. Outnumbered, but not defeated she escaped twice, shouting gleefully she was the great Houdini reincarnate. She thought surely her cleverness would win her release. Each time they tied the leather tighter until she was truly trapped.

She thought that if she peed on herself they would set her free. They just took her gown and underwear away. She laid naked and spread eagle for all to see.

After a time her terror grew so great that she forgot where she was. She forgot she was in restraints.

A great epidemic had swept the nation. She was contagious and in isolation, paralyzed and dying, in desperate need of someone to hold her hand and comfort her, to tell her she was not alone. A worried nurse peeked in the window in the door, but didn’t stop. Because of the epidemic the staff shortage was severe. They too were dying.

When she passed her soul entered a soft green space. She watched it shine and ascend toward Heaven. Before entering Heaven’s gate her soul was examined and found wanting. She crashed into the depths of Hell.

Later her doctor came to visit. She stretched her hand as far as she could reach to touch his hand. He stepped back quickly so as not to touch her. She hurt.

Three weeks later she left seclusion. The other patients were afraid of her. Her moans and screams of pain had echoed through the halls at night and sounded animal, not human.

I wish someone would have thought to hold my hand.

Therese & Cheryl ON CREATIVITY & MOOD DISORDERS

Oh how I hate transcribing videos, but since I'm not responding to the whole thing I thought I would.

Starting @ 2:30:

I was so afraid to take medication 20 years ago when I was first diagnosed with depression because I thought that it would take away from my creativity. I thought that I would no longer be able to write. But I agree with so many doctors that have said not only does it make my concentration better, it makes me a better writer. It's just that the subject matter sometimes isn't death and doom and despair. It can sometimes be about children and friendship and all the graces that I experience on a daily basis.

Starting @ 4:10:

... medication isn't the end of creativity. It's not the end of being an artist, a writer, an actress, it's the beginning. It's the beginning of a life--of a better life. Of a treatable mood disorder. So I guess I just wanted to encourage all those artists and creative people out there that treatment isn't our enemy, it's our friend, and it works on the side of life.

I'm shooting myself in the foot writing this. I know this is something that's going to get thrown in my face again and again, every single time I dip into a decent depression and start doing stupid things (or I should say stop doing smart things). But I guess that's sort of the point, isn't it? For someone (as long as it's not my mother) to grab my shoulders and shake me and go

Cheryl you idiot. What do you think you're doing (or not doing)? YOU SAID IT YOURSELF, you like being functional, you hate when your head feels so heavy that your blog's filled with crap. I printed this out and saved it and stapled it to the front of your chart so I could find it in a flash. WTF are. you. doing? Get dressed for starters...

Not that my current therapist would ever speak to me like that (my last one would) you'd laugh hysterically at the thought if you ever meet her, but I am henceforth giving her permission to do so.

I think that a lot of people think that medication dulls who they are. I think that's a common perception, but I wonder how many people that is true for (I'm sure there are some) and how many people experience a "placebo effect." While I wasn't alive back in the day, from what I gather the really old school stuff does dull personality. But as far as Therese and I feel, there is other stuff out there that can balance you out to the point of being appropriately creative and not dull. To borrow from OOO rules, these are our experiences and I am in no way stating that they are yours. My advice is that if your medication does make you feel dull, pressure your psychiatrist until you get it right.

I don't know about you, but my creativity makes me feel alive. My creativity makes me proud of myself. My creativity got me noticed by New Mobility magazine (check out the April issue) and got me a spot on a panel presentation during the upcoming OOO of MD annual conference. My creativity brings focus to successful Cheryl as opposed to utter failure Cheryl. Both sides of me are equally accurate, but which side would you like to focus on when you wake up in the morning?

While of course mania makes me super creative, my experience of bipolar is one of prolonged depression that sucks all of the creativity out of me. My depression doesn't manifest itself in a way where I write about "death and doom and despair," but I feel so disconnected from my writing, from my creativity, from the good parts of me.

So like Therese, I have advice for all you creative bipolar people out there. My advice is to take your medication. My advice to myself is that I take my medication. The point is not for the bottle to sit and look pretty. The point is to strive to be the person that you could be, instead of the person you are. I like that person better.

Chicken or Egg?

There was an article I read awhile ago, Too Much Internet Linked to Depression. Hmmm... I am definitely addicted to the internet. Ask this shrink or the last one. I also have a predisposition to pretty bad depressive episodes. Ask this shrink or the last one. Or this psychiatrist or the last 2. Or my physiatrist. So... which came first? The chicken or the egg? Do I go online because I'm depressed or does being online so much make me depressed?

Kara has 2 posts that talk about how blogging can increase social support. Even CNN says so. But this article isn't talking about blogging, it's talking about porn and gaming. It is possible to be an honest to g-d internet addict and not be into porn or gaming. I'm living breathing proof.

I think though that I am still using the internet just as much as I did when I was depressed all fall. The difference is that when I really have to go somewhere I go. Instead of checking my email making me late to class I now rush to school to check it there before class. The level of panic and urgency surrounding checking my email is still the same as it was, but I've gotten to the point where my brain now sees the panic and urgency surrounding getting to school on time as equally distressing. So I check my email at school instead of in my apt. If I were to get to school too late to do so I would lose it. That is where the addiction comes in.

I think an addiction is an addiction plain and simple, mood disorder or not. My mood disorder keeps me from being able to get up, dressed, and out. My addiction does not. So now instead of just sitting like a bump in front of a screen 24/7, it's when I don't have to be somewhere that I'm online now. I don't have to be at the gym. I don't have to be in bed at 10. I can be in bed at 12. I don't have to do my assignment early, I can finish it 12hrs before it is due. It's still done. I may be online until 2mins before class and then possibly as soon as 2mins after class. This still impacts my life to the point of being disruptive, even though I appear to be pretty functional. It's just that instead of preventing me from being able to get out or even dressed and showered, it's putting me into a sleep deficit. My bipolar didn't cause my addiction, but it does change its manifestation. Not if it impacts my life, but how.

An addiction is like a mood disorder in the "cousin" sense. Very similar but different enough. Just like my mood disorder, my addiction has always been and will always be in my brain. But my addiction is not bipolar. I don't think it was caused by anything in particular, I think it just is. It is not depression or mania; it is compulsion. I don't believe that my addiction and my mood disorder are a matter of 1st and 2nd, cause and effect. They aren't a vertical progression. They're horizontal. Does that make any sense?

I Take Responsibility

Thanks Beth for pointing me to two GREAT articles recently, one of which I will just mention briefly. Debate Over Cognitive, Traditional Mental Health Therapy from the LA Times touches on whether or not therapists should be designing treatment plans within the context of the medical model. But it is the other article, or rather part of it, that is really the focus of this post. The Americanization of Mental Illness from the New York Times also focuses on the medical model, but more extensively.

I'm not going to sum up the entire article as it is super long (totally worth reading the whole thing though) but I am going to pull out two parts. The discussion on the stigma of viewing mental "illness" within the framework of the medical model ("brain-disease"), as "... an illness like any other" (quote from page 3), something purely with a biochemical origin, versus as something originating from situational triggers ("psycho-social") is primarily located on page four. I'm not going to comment on this section anymore except to say GO READ THIS NOW (I'll wait) because I feel like I'd be repeating myself ad nauseam -- especially lately -- as well as because the opinion is substantiated by scientific studies and isn't just my verbal diarrhea.

There is this one quote from page 3 though that really stuck with me and that I will comment on fully.

"Mental illnesses, it was suggested, should be treated like 'brain diseases' over which the patient has little choice or responsibility." emphasis mine

Little choice or responsibility. Wha? Huh? Seriously? I didn't have little choice over whether or not to be bipolar, I had NO choice. It's not like I woke up one day and said "Gee I think I want to have a major mood disorder." I didn't know until high school that my dad is bipolar and this runs rampant in that side of my family. I just drew the short genetic straw so to speak.

[image description: tiles made by elementary school students in CA (found by google images) surround and illustrate the word Responsibility]

However, I DO have full responsibility over what I do with this information.

I AM responsible for the choices I make, although I often do not practice what I preach.

I AM responsible for the decision to take my medication or not, to go to my support group / therapy / medication appointments or not, to go to the gym or not.

I am NOT responsible for the fact that I will have repeated bouts of depression for the rest of my life.

I am NOT responsible for my panic attacks, especially when I have the ones that start in my sleep.

But, I AM responsible for how I decide to handle this, how / when / if I get control over the episode or if I decide to relinquish my power to my states indefinitely.

Little responsibility? How is that little responsibility? That is BIG responsibility.

I Stand with Physicians for a National Health Program

I was flipping channels earlier and landed on CSPAN, paused for a bit, saw they were reairing a press conference on adopting a single payer system from Wednesday. Then I passed because CSPAN is boring. But I don't have cable and nothing was on and I SUPPORT A SINGLE PAYER SYSTEM, so I watched it. And it was interesting and powerful.

I've never thought of viewing the giant 2000 page healthcare bill currently being debated in congress as a health insurance bail out, but that's what it is. Only 1-2% of Americans will be able to access the public option. Did you know that if someone has employer sponsored healthcare they will NOT be allowed to access the public option should they want it? What if it turns out to be better then the policy they have? Too bad. So this bill is NOT lending to increased competition as congress keeps claiming, but locking people into only what their employer wants to offer and not allowing free mobility between plans. How does this help America? It doesn't. And it will still leave 17-22 million people without any coverage. While that is certainly better then 46 million that is NOT GOOD ENOUGH. Private money and government subsidies will be going to pad the pockets of FOR PROFIT insurance company CEOs who on average make $11 million a year.

I've been a fan of a single payer system since I had to prepare arguments for a debate in class 5 years ago. Did you know that, as those stats I looked at stated, the US and South Africa are the only industrialized nations that do not offer every citizen a minimum level of care? The representatives at the press conference, which was sponsored by the activist organization Single Payer Action, stated that it is only the US, so maybe South Africa has gotten its act together over the last 5 years. Shouldn't we follow suit? As an American, I can arguably state that I am a citizen of the most powerful nation in the world, but yet the World Health Organization lists us as 37th in over all health system performance. We should be ashamed of ourselves. We can do better then that.

Dr Carol Paris, a psychiatrist from southern Maryland, activist and representative from Physicians for a National Health Program spoke of a patient who lost her job and insurance and isn't sure how she's going to pay for necessary surgery. She also spoke of another patient whose employer switched plans to one whom she does not participate in, so this patient is now forced to find another psychiatrist. She believes that a single payer system would eliminate competition from for profit companies trying to win your business by allowing you to see any doctor you want and go to any hospital you want, switching to doctors competing for your care. In this system everybody wins, because people are allowed to switch to/keep GOOD DOCTORS instead of being forced into narrow options of their plans. This forces doctors to be better doctors and will result in patients getting better care. This, she says, is competition she supports. I do too.

If you're a consumer of psychiatric services you know that many physicians / therapists do not accept insurance because of how little they receive. Many, even those with insurance, go without because of this, and I have a feeling that this would change in a climate of a single payer system. More people would get the care they need because more people would be able to afford it.

You may argue that if more people start seeking care and the amount of providers do not increase, this will overload the system, make it impossible for you to get in to see someone when you need. Well I don't know about you, but if waiting a bit longer allows 46 million Americans to get care, keeps between 18-45,000 (depending on the source) people from dying per year due to complete lack of or inadequate coverage, keeps people out of bankruptcy (2/3 of all bankruptcy is caused from uncovered medical costs--an average of $18,000-- and 3/4 of those are middle class insured individuals), allows people to have the luxury (if you want to call it that) of no longer having to choose between buying food or paying for prescriptions, then I'll wait.

There are many more reasons why I support a single payer system, but I want to keep this short. Did you know that there is also a single payer bill that was introduced into congress in January? HR 676. The bill is sponsored by John Conyers (D-MI) and is supported by 88 members of the house. It is only 30 pages instead of 2000 (I haven't read it).

Looking for a Psychiatrist/Therapist

I read a NYTimes article the other day, Where Can the Doctor Who’s Guided All the Others Go for Help?, about psychiatrists who need their own psychiatrists, written by a psychiatrist. Some of the concern I understand, some I do not. If you live in a small area and most around are former students / patients this could be awkward. Not everyone has that problem, not everyone teaches, but here is a problem much more common, not just related to psychiatrists, but to everyone:

There is also the factor of experience ... "I might have some trouble going to younger colleagues. It’s hard to understand the issues that come up in the course of a life cycle unless you’ve lived it yourself.”

Dr. Rachel Seidel, a psychoanalyst and psychiatrist in Cambridge, said that when people feel vulnerable, “we want someone with more insight than we have.”

“It’s a paradox,” she added. “Do I have to have gone through what you’ve gone through in order to be empathic to you? And yet, I’d have a preference for someone who’s been around longer.”

So far in my life I haven't come across this issue myself. I'm only 24 and it should be another year or 2 before my peers are beginning to be credentialed, but I'm not sure it's all that much an issue. Dealing with family dynamics is dealing with family dynamics. Dealing with depression is dealing with depression. Prescribing meds, big deal. The issue of sex (in both senses of the word) is much more of an issue to me.

When I was looking for a therapist I told the person I'd asked for a referral from it didn't matter to me whether it was a male or a female. I'd had both before, my most immediate past therapist is a male, I have high standards and I just cared that they were good. Told her I trusted her. Turns out I was wrong. I realized while I was comfortable discussing my resistance to dating with him I never would have been comfortable discussing my sex life with him. I'm only comfortable having someone who is committed to being a long term therapist as I know they, like botox, are something I will always have a need for, and this is something I will (hopefully) be discussing with this one. He's also old, about 40 years older then me, but that was not the issue. I'd have a problem discussing this with a younger male and would not have a problem discussing this with either a young or seasoned female professional.

The issue of life experience is something that ended up almost being an issue for me, as I ended up trying to find any reason I could not to like her (didn't work). Why I would do that I would rather not discuss, but makes total sense in hindsight. I was scared of going to someone with no experience with disability. While I agree that depression is depression, the route cause of depression can vary, and in my case the route cause of my depression can quite often be intimately tied to my physical disability. Would she really "get it?" Mentioned past therapist was my one and only disabled therapist and while I always skirted the issue, I knew kids stare at him all the time just as they stare at me all the time. He was firm in telling me that this is a non issue and that the only issue is the type of therapy someone uses. He was right.

All therapists should have cultural competence. Should an Asian client not see a white therapist? Should a Jewish client not see a Christian therapist? Why can't a 52 year old client be helped by a 32 year old therapist, although not a cultural issue? Why can't a crip be helped by an AB therapist? That is a cultural issue. What matters I think is openmindness on the part of both the client and the therapist and the treatment methodology / personality of the therapist. Can you handle a therapist with a dark sense of sarcasm, for example? Can you handle a therapist who answers all of your questions with "what do you think", or will you want to strangle them?

Would I be able to help someone with marital counseling at 24? No, but I haven't been through training yet so maybe I could. Could I help someone with parenting issues? I think so. I was a kid, I have parents, I remember my childhood well, and I have a lot of training in child development. Family dynamics are family dynamics. Observe yourself, observe your friends / relatives dynamics too...

What happened with my experience / cultural issue? Well, #1 it turns out that most of what I am dealing with are people issues, not disability issues, related to dynamics and diagnosis. #2 Right about when I started with her is when I began a total paradigm shift in my conceptualization of disability. So I guess I've just taken her on my journey with me. That's the way it should be. I decided at some point that one of my callings in life is to educate people about disability and that I had no problem educating her too. One of the greatest things I can do in life is to make it easier for her to help someone else to get to where I am, to be OK with their disability. My views, I think, aren't so mainstream and she's been as openminded as a person can be. I don't think she's ever had a problem understanding where I'm coming from. In fact, she gets it so easily, sometimes it weirds me out. My psychiatrist, not there. Frustrating, but he doesn't need to be. In today's society a psychiatrist's job is focus on brain chemical levels, not to guide you through paradigm shifts. Just MHO.