The slippery slope

When I was pregnant for the first time, Ian and I attended childbirth education classes. The woman who led the class was natural childbirth proponent and warned us that if you opt for the epidural to relieve the pain, well, one thing leads to another and chances are you end up having an episiotomy and who knows what other horrible thing may befall you. She was perfectly right, of course, but then I was the one who got tired out after a ten month pregnancy followed by twenty-four hours of labor. So, I had the epidural, and of course an episiotomy.

I think I got off rather lucky and was determined the next time to ask for the epidural as soon as I checked in to the hospital. Maybe I could have done it unmedicated, but I never gave it a chance. The third time, I barely had time to climb onto the delivery table when Taylor arrived. No time for an epidural.

Many medical interventions take us by surprise and there is no dress rehearsal. Getting a psychiatric diagnosis is one of those unplanned interventions.

If your relative ends up in the emergency room of the hospital, or taken to a doctor’s office for the first time, what you will be told is that he or she needs to be on medications. If you go that route, here is what they won’t tell you, but this is what it looks like. One thing does lead to another.

1. Your relative will become fat.
2. Being fat makes it difficult to exercise.
3. Dieting doesn’t help.
4. Food and clothing bills will skyrocket.
5. Your relative won’t be able to engage in even occasional social drinking while on medications.
6. Some drugs require laboratory tests on a regular basis to make sure they are not killing the person.
7. Don’t expect to go on the drugs and be back at school or work anytime soon.
8. The drugs don’t work well enough to make you symptom free.
9. Once you are on medications, doctors are very reluctant to take you off them.
10. You, the parent, are no longer in charge. You are now in bed with unrelated people who want to exercise their opinion about the best way forward for your relative. Some may call it interference.
11. You and your spouse may disagree about the medications.

Choosing not to go on medications is not that simple. Finding someone to walk you through your psychosis unmedicated is easier said than done. (See my previous post on finding a therapist.) The family is poorly trained for this role. If you live in a large city, there are organizations that can help and there is greater access to psychiatrists, but very few will do the R.D. Laing thing for you. I recently corresponded with a Soteria type place in the country where I live, to find out if they would take my son should he have another psychotic episode. Yes, as long as he speaks the local language, they said. Well, he doesn’t, so we can cross this option off our list.

Many people assume that if you aren’t on medications, it’s just a matter of time before you become well if you take your vitamins, eat properly and that behavior that is observed on medications will not be there when off them. Not true. You still have the problems that were there in the first place, and they often look physical, not just mental. Chances are your relative will not be able to exercise even when no longer taking drugs. He or she may lose so much weight through not being focused on food that an emergency intervention will be needed. He or she may not be able to do much of anything for several years, even if not on medication.

Taking a holistic approach doesn’t have to mean a no drug at any cost approach. If you sign up anyway for the medications, it is holistically prudent to keep in mind that medication should be temporary, low dose, and singular. Two meds are not better than one. Medications are not a substitute for intensive psychotherapy. Trying to get this message across to the psychiatrist will occupy you for the foreseeable future.

I may be creative, but nobody likes me

There is a lot of blogging right in response to Gianna Kali’s excellent post musing about how teachers say they value creativity, but this is not the classroom behavior they reward. True enough.

Ron Unger in his post suggests that “instead of stigmatizing them or labeling them as forever ill, we might better collaborate with them in helping them figure out where they might have gone wrong while also staying open to the possibility they have a lot to teach us.” Or, as I wrote in an earlier post, teach them to swim.

There is a difference between being dragged down by who you are and having who you are work for you while minimizing the rough edges. It’s called self-awareness. The onus is on you, however, to ask for help and be willing to change. I am thinking of a woman I know, who I am pretty sure would warrant the label bipolar had she ever done time in the bin. To my knowlege, she hasn’t, but maybe some time in there would have made her realize some fundamentals. She is a highly talented person in her field, but she has trouble holding jobs. This is no surprise to anyone who knows her. She simply bulldozes her way over people.

Her daughter I also know. Her daugher is as bright as the mother, but has a habit of getting ejected from every school she has attended. She cannot be in the same room with other people (peers and adults) without insisting that everybody pay attention to the specialness that is her. She is a royal pain in the ass. When you look into the girl’s eyes, the light is never off. She is hard-wired to the “on” position. Her energy is way too intense and it gets her in trouble, lots of trouble. The mother thinks it’s everybody else’s fault, of course. The teachers obviously don’t value her creativity.

Had this woman more insight, she and her daughter could be on top of the world because they would be making their natural talents of leadership work for them, not against them. But she has paid a price, because people avoid her like the plague. Their leadership style needs a trim. Nobody trusts mother or daughter. I am assuming that what I refer to as their leadership is really creativity in both cases because creativity often looks uncontrolled. “Artists” are often ostracized. Mother and daughter’s in your face leadership, is, in a way, art. It’s definitely high drama.

I was put off one day when the mother confided to me that her sister had recently been diagnosed with schizophrenia, knowing that my son had also been bestowed with this distinction. “That explains her,” she said, rather triumphantly. Schizophrenic, she’s a write-off, was the message I got. To me, one could speculate that both sisters are working off the same energy imbalance, but the one who gets the current diagnosis of schizophrenia is the one who couldn’t carry on the charade any more, whereas the woman in question has cut a wide swath through human relationships with her keel still upright, always one storm away from tipping over.

I am relating this cautionary tale, mainly to underscore that unacknowledged and/or untreated schizophrenia/bipolar has social costs, but they also mark personality traits that are valued in society. Rather than feel ashamed of a diagnosis it is much more liberating to think, “right, there is obviously a problem here, which I can work on through a variety of means, but I don’t want to lose sight of the energy and creative flair that has made me who I am.” It may be that you have to crash first before this insight comes.

In the meantime, nobody, except maybe your mother, is going to like you very much.