A Baffled Look

The straight dope on mental health

Month: March, 2013

Book Report: “The Road”

I just finished reading Cormac McCarthy’s The Road. The novel portrays a post apocalypse America and a man and his son struggle to survive. Their lives are consumed with finding food and shelter and staying out of danger. I wonder if McCarthy used the plight of the homeless to inform his readers on what it would take to survive in the novel’s setting.

The protagonist and his son even use a shopping cart to move their meager possessions. It’s a symbol of plenty in an age of scarcity. A lot of homeless people use shopping carts. They are constantly searching for their next meal as the characters do in the novel. The people the protagonist and his son run into are dangerous. They have to be constantly vigilant of being robbed or having their provisions stolen. The man and the boy have to hide their shopping cart so they can sleep without losing their stuff. Like the homeless, they risk everything when they sleep. They avoid contact with other people because they can’t trust others. In the novel, the man and the boy avoid houses and towns because they may harbor dangerous people. The homeless people at the drop-in center where I used to work avoid homeless shelters and assisted living facilities because it’s too dangerous. Like the novel, the folks at the drop-in center experience constant obstacles to getting their basic needs met. Like the homeless, the man and boy in the novel have few opportunities to attend to basic hygiene.

In the book, the cities and towns are abandoned because of some kind of apocalypse, but homeless people live that apocalypse every day and their numbers are growing. There are no authorities left anymore in the book and there are none for the homeless today. They can’t trust the cops and most of the folks still lucky enough to have a place to live don’t want them around so the homeless are in effect without protection. Imagine how much worse it is for someone already tormented by their own perceptions to also live in a kind of hell on earth. I sometimes wonder which came first for the clients of the drop-in center, homelessness or mental illness.

The Road won the Pulitzer Prize. It’s gripping and McCarthy’s prose is beautiful. If you want to walk in the shoes of a homeless person this is the book to read.

“So what do you do?”

 

When someone asks me what I do I always say that I’m presently unemployed. People accept that because unemployment is so high these days. I’m not lying when I say it, but feel like I’m hiding something. I don’t say I’m on disability because I’m afraid they’ll ask why. And I feel like I didn’t amount to much. I got a degree, but became too ill to work soon after I graduated. The shame and feelings of failure mentally ill people feel when they qualify for disability or have trouble keeping a job because of their condition is often devastating. There’s a grieving process. It’s especially tough for men. They often tell me that it’s hard to find women who will date them because they don’t work and aren’t seen as good providers. But these days women work as much as men so the word “housewife” has a pejorative meaning now. It’s one thing to stay home because of children, but I don’t have children. It’s hard to find meaning when you can’t work because so many of us have our identities tied up with what we do for a living.

One way I’ve coped is I’ve intensified my involvement with my two favorite hobbies, writing and metalsmithing. Creative outlets can provide distractions from the feelings of loss brought about from loss of employment. Hobbies can also lead to feelings of accomplishment because if you stick to something long enough you get good at it. A hobby encourages goal setting and meeting a goal lessens the feelings of incompetence that occur as a result of loss of livelihood.

Finding a cheap hobby within your budget is another matter. If you like to read, visit a library. Go on outings with people with similar interests. Meetup.com has tons of groups of like-minded people and it often doesn’t cost a lot to join a group. Volunteer at a charity. Helping others helps take your mind off of your own problems. Join a self-help group. Finding others going through something similar as you are will alleviate loneliness. Another reason for pursuing a hobby is that it can lead to fulfilling work that is less stressful than your former job because it’s something you feel passionate about. Having a hobby can help you find hope.

Which of these things is like the other?

Seeing similarities between two seemingly unrelated things is a good thing most of the time. That’s what creative people do. There are many books and articles about the supposed link between creativity and mental illness, but I don’t think many writers and researchers have covered the inability to sort out which ideas are creative and which ones are a sign of trouble. I have Bipolar Disorder and it’s often difficult for me to determine if I’m being productive or if it’s a sign of mania. I wonder things like, “What other loose associations have I had the past two weeks?” Mania is harder for me to notice at first because initially I accomplish a lot. I feel euphoric when I have lots of ideas and euphoria is also a symptom of mania. It sucks to have to worry about a relapse every time I’m having fun.

It’s important for me to know my particular warning signs of relapse. Each mental illness has its own set of symptoms and each person with a psychiatric diagnosis has certain symptoms that usually crop up at the beginning of an episode. I had my husband and my therapist help me determine which particular symptoms usually appear early during an episode so I know when to take measures in order to prevent a full blown episode.

I wish I could say that enlisting my husband and my therapist to help me identify early warning signs frees me from worrying too much about having a relapse, but it doesn’t. Ultimately it’s my responsibility to take care of myself. I spend so much time fretting over how I am feeling that it keeps me from enjoying myself when I’m functioning well. I’ve been seduced by the early signs of mania too many times to not worry. I’ve been told many, many times to “live in the moment” as the cliché goes, but that’s difficult to do when mania has nearly destroyed my life so many times.

That said, I have a lot to be grateful for. Life could be much worse. For the most part self-discipline and a support system have improved my situation considerably. I shouldn’t complain, but I do.

Book Report: “The Marriage Plot”

I’ve been thinking of a novel I just finished reading, The Marriage Plot by Jeffrey Eugenides. In the novel, manic depressive Leonard feels terrible when he’s on Lithium. It’s almost as bad as the illness. When he reduces his dosage of Lithium on his own, he functions much better at first. So there’s no immediate cause and effect that shows him he’ll relapse. The story takes place in 1982-83 so the only thing available then was Lithium. It makes Leonard feel flat and emotionless, makes him gain weight, makes him impotent, makes his hands shake and makes it difficult to think clearly. On Lithium he’s depressed. When he starts to lower the dose (although I wonder how his shrink doesn’t see this in his blood work), his life improves at first. Months later he becomes so manic he has a psychotic break. I think it shows why someone would play with the dosages of their medications because they feel so much better at first. Some people don’t know that they’re ill, but Leonard understands the risk he’s taking, but he’s so afraid of losing his girlfriend Madeline and his livelihood the risk seems worth taking.

I understand completely. Almost everyone I know who takes psych meds has played with the dosages of their medication without asking their doctor first. It’s not lack of insight. They usually don’t stop taking their meds completely. It’s because they have difficulty tolerating side effects and don’t trust their doctors’ to take their complaints seriously.  Like Leonard, they usually don’t tell the people in their life who haven’t been diagnosed with a mental illness what they’re doing. Unlike Leonard, they sometimes admit it to other mentally ill people in their circle of friends. But in the story Leonard doesn’t have mentally ill friends to confide in. Leonard’s bipolar disorder is a secret known only to those closest to him and since they aren’t mentally ill they wouldn’t understand his struggles with the side effects of the Lithium he takes. He feels isolated and there’s no one around him who understands. Like me and many of my mentally ill friends, we experiment on our own different dosages even though in the past it sometimes has led to relapses. This is testament to how debilitating the side effects of some psychotropic medications are. It seems like a chance worth taking.

I’m not advocating that it’s ok for mentally ill people to alter their dosages without telling their psychiatrists, but some people I know have trouble getting their psychiatrist to call them back to discuss their concerns. Some psychiatrists don’t take their patients’ concerns with side effects like weight gain seriously enough. That’s what happens to Leonard. His psychiatrist dismisses his problems with side effects so Leonard lowers his dose of Lithium out of desperation. Psychotropic drugs aren’t magic pills. Like all medications the risks of side effects should be considered with their benefits.

Fat, Starving and Crazy

In last week’s post I mentioned that the antipsychotic Zyprexa made me gain 45 pounds. Many psych meds cause weight gain. A lot of the folks at the drop-in center where I used to work are obese in spite of their lack of money to feed themselves (the drop-in center serves food and provides many amenities such as a place to shower). These days, poor people are more likely to be obese because they lack money to buy fruits, vegetables and unprocessed foods. Junk food in poor areas is cheap and there are few stores that sell fresh fruits and vegetables. These neighborhoods have no grocery stores and even if they did the fresh food is too expensive for them. The people that frequent the drop-in center often run out of food stamps and money to last through the end of the month.

Metabolic syndrome, which causes the inability to process glucose, can be caused by some antipsychotics. Poor diet can also cause metabolic syndrome so the folks at the drop-in center have a double whammy to deal with. Severely mentally ill people live shorter lives partly because they are usually too poor to eat properly and because of the metabolic syndrome caused by their medicines make it very difficult to lose weight.

So the folks at the drop-in center don’t get the nutrients they need from junk food so even though they are fat they’re malnourished. According to the Huffington Post, lack of proper nutrients in junk food harms metabolism and makes your body want to eat more because it’s not getting the nutrients it needs. Wired magazine has an article about obesity and homelessness in Boston. One in three of the homeless population in Boston is obese and malnourished. By malnourished I mean they aren’t getting enough nutrients. Another thing, some psych meds make you hungry all the time. Imagine feeling hungry all the time and not having enough food to eat. It must be torture. Their neighborhoods are too dangerous to go outdoors and walk. The meals at the drop-in center where I worked are fairly nutritious, but they have to buy cheap food in order to stretch out their food budget. I remember those huge, gallon sized cans of vegetables they used. They are also constrained on having enough time to get the food cooked by the time they open at 11 am. So they have to rely on processed food that’s quick to make and will store for weeks.

I read a New York Times article about how food is engineered to entice people to eat more. These foods are made so people crave them. According to the article, this condition is known as “sensory-specific satiety.” It means that there is a tendency for prominent, distinct flavors to overwhelm the brain, which makes you feel like eating less. Sensory-specific satiety became a holy grail for the processed-food industry. They use complex formulas that stimulate the taste buds enough to appeal to a person’s appetite but don’t have a distinct, overwhelming, single flavor that tells the brain to stop eating.

Mentally ill people are already stigmatized enough for their illnesses. They don’t need more isolation from others because they are judged by others even more for being fat.