Honest Choices

Some background:

http://www.slate.com/articles/life/family/2013/11/families_dealing_with_mental_illness_need_support_too.html

I have discussed previously the matter of choice for those suffering their way through the nasty web of substance abuse.  A friend of mine (I truly hope I can consider her such, though I didn't help matters by my own past actions) read the article and said that no one chooses to get cancer, while an addict is making a conscious choice by driving to the store to buy liquor.  She wasn't trying to trivialize the addiction, but there was a clear distinction in her mind and I can appreciate that, along with her candor.  She's right - it's not exactly worthy of neighborly generosity.

Having been in and out of psych wards myself, I believe that most (not all) addictive behavior is linked to various underlying causes and those causes can go untreated or misdiagnosed for years.  Yes, the person suffering the mental health disorder is making a choice to hit the 'packy', but it's not nearly as black and white as outsiders tend to think.  The comorbidity rates between bipolar disorder and substance abuse, for example, are staggering.  And doctors and social workers tend to treat what's obvious - the substance abuse.  They place band-aids over the wounds without treating the actual affliction.  Unfortunately, so do the patients.  When treatment is unsuccessful, they tend to cope by turning toward self-medication, whether to quiet the mental sledgehammers or calm the mania, etc.  I'm not condoning it, though I suppose I am empathizing.

So, it got me thinking about my own recent experiences - what happens to decision making and the old coping strategies when a diagnosis is made and the patient is lucky enough to be treated?  And I don't just mean treated... I mean treated well.  I *think* I may fall, finally, into this category.  I've been fortunate to have been prescribed a medication recently (Clozapine) that is working like a champ.  My moods have been far more balanced, my compulsions are manageable, urges are easily brushed away, sleep is no longer elusive... it's hard to believe.  There are some fairly severe side-effects, which is why it wasn't prescribed to me in the past, but the pros are far outweighing the cons.  This "stubborn" case, as my favorite doctor called me, doesn't have to live miserably anymore.

But again, what happens now?  My excuses are gone.  I've been using self-medication to cope with the bipolar disorder for years, but I don't feel like I'm free falling anymore.  However small it may be, I feel like I have a grip.  It was my Hail Mary pass... 

Now that I'm on it, my friend is 100% correct - if I hit the liquor store, it is my choice.  There's no gray area anymore.  Black and white.  I'm responsible for taking the necessary defensive steps to ensure that I stay on the beaten path.  And I'm not sure what it was about her comments that hit me, but I questioned myself - am I doing everything in my power to ensure that my past behavior wouldn't creep up and bite me in the ass?  The answer was No, specifically again with medication.

I had a medication trifecta in my daily routine, which took care of the majority of cravings and urges that bothered me throughout the day, but there was one additional med that I'd been hesitant to take because of its very powerful side-effects (seems like the best drugs always have the worst consequences, right?).  I don't need to make this part of my routine, but taking this drug, choosing to take this drug, gives me the ultimate quadfecta (wiki says it's a word... I'm not so sure).  There is absolutely no way, NO WAY, I can relapse without incredibly serious risks.  And so... I took it.  And I'll continue to take it until I am absolutely confident that my bipolar disorder is finally under control.  It doesn't mean there won't be difficulties along the way, but this medication cocktail will give me the opportunity to seek help and correct them when they happen.

Why omit this in the past?  Was it due to the side-effects or was it a way to leave the door open to a future relapse?  How very selfish that seems.  If I have the option to go the extra mile, then shouldn't I take it?  It's amazing the lengths that I've traveled to avoid making positive choices.  Hopefully, I can work on reversing that.

Hope Bloats

I certainly have taken a long hiatus, although there's been plenty going on.  I haven't had the willingness to share like I used to.  You can blame the depressive episodes, which far outweighed the mania.  But this meant, on the surface, my "good" behavior exceeded my "bad" behavior (seems like it would be the other way around, doesn't it?).  This is due to the increase in self-harm urges, as we'll call them, happening during the aggravating and pounding hypomanic states, rather than the down-swings.  Unfortunately, it's the bad behavior that people notice.

And that's okay.  For every bad episode, I have the opportunity to learn something about myself or grow.  In the most recent episode, I learned how to assert myself with my insurance company, how to play the game, and how to receive the appropriate care for my particular needs.  I never pictured myself willingly spending as much time as I did working with providers to tweak what needed to be tweaked.

In this case, it was my medication again.  I'm very happy to say that, knock on wood, I have something that *might* work better than anything I've been prescribed in the past (I still say Lithium was the best, setting aside its harsh side effects).  I was given Clozaril, or Clozapine, which is an atypical anti-psychotic usually prescribed for schizophrenia.  Off-label and at low doses, it can be highly effective in the treatment of bipolar disorder.  Woot!  So far, it's been incredible!  I might go so far as to call it a miracle drug. /boggle!

So why not prescribe this last summer when I started my trials with new mood stabilizers?  Again, like Lithium, side effects.  Clozaril packs a punch and can dramatically lower a patient's white blood count and, therefore, immune system.  That means weekly blood draws are required for the first six months of taking the drug, every other week thereafter, and every month after that.  As long as you're on Clozaril, you're getting poked.  Let's face the facts - it's hard enough to get us to take our medication at times, let alone get lab work done on a regular basis.

The rest of the side effects are annoying, but can't outweigh the benefits of taking the drug.  I hypersalivate, believe it or not.  I cough painfully.  And, ugh, I EAT!  See-food diet, just like being on Depakote.  The urge to carbo-load is overwhelming.  I craaaave salt and feel PMSish bloated.  Unless I'm completely preoccupied, I've got food in my hands.  The doctors have put me on a counter-drug, which is nice, but it doesn't completely negate the Clozaril.  Time to get off my ass and exercise, even though winter is approaching.

I actually feel confident with the Clozaril under my belt.  It's working to stabilize my mood, OCD, substance compulsions, sleep... I mean, you just can't beat it.  If it means getting a blood test every week so I can finally make it through the holidays in one piece, then so friggin' be it.

Even Steven.  I love it.  Slowly, I'm gaining a little confidence back.  Let's see how long it lasts.