medication – Life and Lims

Down syndrome PLUS other challenges, like mental health

I’ve already blogged about having an adult daughter with Down syndrome and how that’s so much different from having a younger child with DS. It’s tougher in many ways: the gap between that child and your other non-DS kids, in addition to the gap between that child and most everyone else, is so much wider than it was when they were little. You’re used to the different life, sure, but there are still plenty of times you’re reminded how things would be if that child didn’t have DS. As your other children become adults or older teens, that gap is starker.

What also makes life more … eh, interesting … is when that child has other challenges on top of all that DS does. We as a family have been so blessed that our daughter, unlike about half of people with DS, never had heart problems. She didn’t require surgery. I have always been appreciative of that. For us, however, what’s been tough has been my daughter’s emotional health challenges. I’ve blogged lots about my own mental health, so look at all that for what I’ve experienced personally. Marissa has exhibited a lot of mood swings and meltdowns for probably about five years, and those have gotten so much more frequent and intense the past six months or year. Over a few years, the doctor and I have tried Prozac on her to see if that could help her feel a little less out of control, but it hasn’t helped. Now, however, with her just having such a hard time, I’ve been trying to figure out just what we can do from here.

Here’s the thing: I’ve already written about how difficult it can be to find a good mental health provider, particularly a medical doctor — psychiatrist — who specializes in these things. It’s hard for EVERYONE who finds themselves in need of a psychiatrist. There simply aren’t enough to address the need. That’s particularly the case in smaller communities or other underserved populations. And it’s a tragedy.

Add that to the difficulty of finding someone who has the extra skill to work well with someone with a learning disability, for whom it is much more difficult to understand and express the nuances of things they’re feeling, and the challenge can be overwhelming.

I’ve felt overwhelmed by various emotions: frustration, sadness, some anger, helplessness, inadequacy … the list goes on. I feel bad for my daughter because I know from personal experience (years of it!) how it is to feel so taken over by your emotions. I also know it must be particularly confusing and scary and sad for her. But then when it just goes on and on, day after day, and the things I try to do just don’t seem to help much, I feel frustrated and angry and depleted and just ready for it to STOP. For at least a little while.

I took her back to her regular physician a few weeks ago, in desperation, hoping that he and I might be able to come up with something to help. Just a start. I told him what I’ve struggled with personally and what medications have now helped me for the past two or three years. I told him how few resources there are. I told him, “I know this isn’t really in your wheelhouse, but…” Luckily, he is a good and kind man who is happy to listen and consider ideas and research them, and I trust him to do what he can. He said he’d look into some things and get back to me.

Meanwhile, I had my own check-in with my psychiatrist (well, she’s technically a nurse practitioner who specializes in psychiatry and she is FANTASTIC), who is at a clinic an hour away from here (and that my insurance doesn’t cover, so I pay out of pocket for each visit: $100 each time I have a check-in). I told her about my daughter and asked for some ideas. I felt it was the best option for M to go to this place, since I know they’re good and they specialize in this. But I was thinking they weren’t taking new patients, which wouldn’t help me at all. Luckily, I had taken her there maybe five years ago, when she wasn’t doing too badly, so I was able to get her in again. She has an appointment in two weeks.

Meanwhile, she is having blow-ups and meltdowns multiple times a day, sometimes, and it’s a strain on me and especially on her youngest sister. I’m just holding on until that appointment. And even then, these things take time. It’s going to be more of a challenge to help her than to just be the patient myself (that is tricky enough, believe me).

I am aware often of the multiple challenges people face. Children and adults with DS, like anyone else, have various needs and overlapping issues. It can just make it that much harder to deal with each of those things. I have such sympathy for the individuals with DS who have these needs, and I definitely understand the needs and feelings of their parents and families. Each of us is going through a unique mix of trials and challenges, and many of us go through those without others realizing. My daughter’s DS is obvious to others. What is not obvious is all the other things we are dealing with. My girl is such a sweetie and so loving and outgoing and friendly and happy, and that’s what most people see. They don’t witness the meltdowns and the moods. That’s reserved just for me and mine (yay! ha). Today, I share this to help others see what happens behind our doors some days, and so others in a similar situation as we are can perhaps find something to latch onto and know that I get it. I feel ya.

She’s high and she’s low. Most people see this. I love this face. I love her all the time. But all the complexities and challenges can be exhausting.

Treatment for mental health is hard because diagnosis is even harder

Part of the reason I write this blog is to document my particular struggles with mental health. Having to deal with some kind of challenge that’s within the range of mental health is just as common as dealing with some kind of difficulty with any kind of physical health. In other words, either category is EXTREMELY broad. Physical challenges can range from diabetes or thyroid issues to cancer or gallstones. Any disruption in mental health can lie anywhere in a big range, too. Physical illnesses can sometimes prove tough to pin down, but it seems figuring out a diagnosis of a mental illness can prove consistently more difficult. Even if a diagnosis seems mostly straightforward, finding a treatment that will help the person going through it to get to a fairly “normal” state is far more difficult.

I’m in my mid-40s, and I’ve been diagnosed with depression, bipolar, or atypical bipolar disorder variously over the past 25 years or so. I’ve gone through a number of antidepressants and some medicines that are usually prescribed to treat bipolar disorder. Some have helped for a short time, some haven’t helped at all, some have made me feel worse. Some have helped enough for me to live my life pretty normally. I’ve been seeing a very capable nurse practitioner for the past five or six years, I think, and I’ve been on an antidepressant that’s pretty much kept me mostly in “normal” mode. But I’ve still had bouts (or very, very long, standard stretches) of what I’d just call irritability. And I know that just isn’t ME. I’ve known instinctively that it’s more a quirk in my brain chemistry or something, rather than a defining characteristic of who I am. And my extremely busy life managing a household, taking care of four daughters (now one of whom is married and out of the house, so the dynamics and responsibilities have somewhat changed, but not at all taken her “off the register,” so to say), working from home part-time and volunteering and managing fairly big church responsibilities, just for a short summation, keeps me running at a high level. It’s easy to say it’s “understandable” I’m irritable. But recently I thought it was time to check in with my practitioner and address the irritability again. I’m exhausted from “managing” it. Surely there’s something out there to help me with my underlying mental health so I’m not working so hard to manage and can just live, expending a bit less energy on coping?

So we visited a few weeks ago, and talked for a while. She is fantastic because she’s very thoughtful and discusses the issues with me, asks probing questions, revisits assumptions, etc. We’re partners in my care, and I really feel she’s very knowledgeable, and she’s sensitive as well. That’s a biggie. She said to me that perhaps I’m not really on the bipolar spectrum at all. All she could say was that I’m just my own thing. So there might not be either a diagnosis for whatever I present as yet, or because mental health really is so varied and unique to each of us, maybe there isn’t or won’t be, if that makes sense. All we know is there have to be some kinds of ways to help me with some kind of existing medication so I can function better. So she said she’d try something, a medication that psychiatrists sometimes use to help with that part of mood. It’s a seizure medication used off-label in this way. She tried me on a very small dose, and I actually do feel it’s helping. My life is still CRAZY BUSY!, but I feel a little less like I have to work hard to manage my mood even while I’m managing my life. So I’m feeling hopeful and a little happier, just to have an extra tool in my arsenal, and to know that my practitioner is really awesome at her job.

This just leads me to a few conclusions yet again: we still don’t know a lot about mental health and illness. We’re doing better than 30, 50, 70 years ago, but we have far to go. And we need far, far more practitioners who have the training, experience and skills to deal with this complex issue. So many people are suffering and there simply aren’t enough practitioners around to help them. I’m blessed to have found someone who can do what she does. Even that’s not perfect, but it’s really about the best I think there is. Meanwhile, I just wish, wish, wish we had more incentives for people to go into the profession and stay there, that the specialists were available in every small and underserved area.

I write this because I just want to put my voice out there. I’m mostly a “success story,” and that’s just because I’m not crippled by my lapses in mental health, and pretty well functioning, and I’m a very resilient, determined personality. I have at least enough income and resources that I have been able to find someone to really help, but that’s still taken a great deal of time and work on my part. It’s been a long and tough journey. It shouldn’t be this hard.

As we work to try to improve outreach, availability and quality of care, and genuine help for those of us with mental health challenges (again, not at all just a small portion of our population), let’s continue to just be kind, patient and understanding to those around us who struggle and need our help. It still does mean the world.

One of Robin Williams’ final gifts? Getting us talking about mental health

I love this tribute to Williams by Disney.

Four days after the devastating news of Robin Williams’ suicide, I’m still feeling the loss of someone I never even knew personally. Perhaps it’s because his genius acting work has been a part of my life pretty much ever since I can remember (oh, yes, I was watching when he first hit the airwaves with “Mork and Mindy”). I can mark important times in my life with what movie he was doing at the time; for instance, my husband and I saw “Aladdin” on our first date nearly 22 years ago. Even now, our family quotes from that movie.

But another part of the reason this event has affected me so deeply is that it strikes close to home. I started this blog to write, in part, about mental illness, to just put my own experience out there. And Williams’ death has had me thinking a great deal in relation to how I can understand it and how I want to be able to continue to share my feelings with others. There have been some poignant tributes and some spot-on blog posts and articles about suicide, about depression, about the almighty struggle some experience with their mental health. I don’t think I can do any better, but I can just share my viewpoint.

Just a few weeks ago, I participated in a study focusing on cognitive issues in women who have breast cancer (I was part of the control group). I was happy to do my part for science, even if I had to drive a few hours away to get to Stanford University. Since the study is looking at cognitive effects of cancer or the treatment for it, it included questions and assessments not only about impairment of cognitive processes overall but also about emotional status. Since I had indicated on the questionnaires and intake forms that I take medication for depression, the researcher who worked with me asked me at the end of our time a little bit about my feelings and opinions on it. She said she focuses on psychology and has noticed in her time studying it that there are still not nearly enough treatments available for depression and other mental illnesses. Some people in the blogosphere and media have wondered why Williams, for example, didn’t just “get help.”

Here’s the sad truth: there isn’t nearly enough adequate “help” out there, whether it’s in the form of medications and other medical interventions and treatments or it’s in the form of professionals and non-professionals who really are good at what they do and can give superior guidance.

There is still an epic shortage (in my experience and opinion) in the number of qualified professionals who can treat people from all economic and health-care-coverage situations. This is particularly true in the case of the number of doctors or other practitioners who specialize in and are licensed to provide medications. In my experience, for instance, there are three psychiatrists covered by my health insurance (which might also be the total of all the psychiatrists in my city), and only one is taking new patients. That one I didn’t particularly like, and it’s crucial to have a certain level of rapport with someone who’s treating you for your brain chemistry. So I was lucky enough to hear about another provider who ended up being a better fit for me, but her office is an hour’s drive from my home, and her practice is not covered by my insurance. I am also lucky enough to be able to afford paying out of pocket for her care. But what about those who don’t have insurance at all, who can’t afford out-of-pocket costs, who don’t have access to transportation, etc.? There are a LOT of people not being served.

Then we move on to the issue of actual treatments available, even when one has unlimited access to doctors, therapists, and whatever medical intervention is available. And as the researcher and I discussed a few weeks ago, there are far too few options. I’m on an antidepressant that’s worked well enough for me the past couple of years to get me to where I can cope adequately with life’s challenges without being taken down completely. But there have been times medications weren’t doing enough for me, and it was hard.

There have been at least the number of times I can count on one hand, and possibly up to two hands, moments I’ve been in the blackest and deepest abyss and felt suicidal, even if it was only briefly. And I could go on and on about how if you haven’t been there, you can’t possibly know what it’s like. Logically, in a part of my brain, I knew I didn’t want to hurt my loved ones, didn’t want to deprive them of me. (That’s addressing the “selfish act” observation…) But it was a very distant part of my brain and one that was clouded over by the overwhelming despair and hopelessness of my feelings. As I’ve written before, it’s those times and others that I now feel my brain chemistry betrayed me. And it’s a very weird, unnerving feeling to have your brain working against itself and yourself. Even though I could logically call to mind times I enjoyed life and felt fulfilled and useful and vital and important to others, to the world, I just didn’t FEEL it. And it became impossible to imagine or believe I would feel that way again.

No amount of love and support and encouraging words from others (assuming the best, that one does have that kind of support system — believe me, there are plenty who don’t have that, making things even worse) can make that feeling go away. If your brain chemistry is off, it’s off. And that’s why we absolutely MUST find more options to treat that chemistry. There are far too few options now.

I appreciated this one article on Mashable, for example, that asserted, “Finally, We’re Talking About Mental Illness Like Adults.” People have generally been very thoughtful this week as they’ve discussed Williams. I sincerely and strongly hope that this discussion can continue, that a few important good things may come from this tragedy: 1) Let’s stamp out the stigma for good. Let’s work towards a culture in which people who experience any kind of mental illness can talk openly about it without fear of being judged or misunderstood or mistreated. Let’s make it as easy to talk about as any other illness that’s more “physical.” 2) We need to push for more research into more varied medications. There are a number of drugs out there (but not nearly enough) that are made for the treatment of mental illnesses, but a lot of them are similar to each other and work the same way. Pharmaceutical companies need to branch out and work on far more kinds of medications that attack mental illnesses in different ways, from different directions, etc. 3) We need more doctors. We need more prescribing practitioners available everywhere to everyone. This will not only be the kind thing to do, but one that will contribute to reducing many other existing societal problems: homelessness, joblessness, some violent crimes.

These aren’t easily attainable goals. But we certainly need to work towards them. It will make a world of difference to millions.

Running too fast makes you … tired.

The older I get, the more I realize there are certain lessons I’m just not learning, despite life’s intentions otherwise. One big one is this: I fall victim to one of the classic blunders—the most famous of which is, “Never get involved in a land war in Asia”—

Oh, whoops. I mean, I fall victim to one of my own classic blunders: trying to race through a marathon when I should be walking steadily, turtle-like. A scripture I find quite true but somehow manage to keep ignoring says to serve others, feed the hungry, clothe the naked, visit the sick, etc. But very wisely it goes on to say, “And see that all these things are done in wisdom and order; for it is not requisite that a man should run faster than he has strength.”

Lately, all in the name of doing good for others, I have been running mental and emotional marathons, at the rate of probably 50 miles a day, and stopping only very briefly for breaks. A little water and food here and there, maybe a quick bathroom stop. I’ve almost managed to keep running at this crazy and unwise pace. I’ve powered through walls, I’ve kept going in hopes of second winds, I’ve told myself that I’m “almost there” a hundred times, only to find that the race is far from over. And sure enough, I’ve now managed to spectacularly flame out. I’ve collapsed in the middle of the road, nearly getting trampled by other runners, and I’m just getting myself over to the sidelines, where I can continue to heave and pant and moan.

empty track — The road’s looking a little fuzzy from where I am right now…

Yes, I have four daughters — plus an exchange student — living at home. One is a senior in high school and is in the middle of applying to colleges. The second has Down syndrome and certainly causes some excitement (see my previous post if you don’t know what I mean). The third is a precocious sixth-grader, the fourth a six-year-old who has very definite ideas about how she wants to live her life, which tend to run contrary to how the rest of us see things. My responsibilities toward these growing people are certainly demanding enough, so when you add in my own interests (editing for pay, writing for fun, running a book-review website for the benefit of other like-minded readers, reading, exercising, spending time with my husband of 20 years) PLUS the commitments that I’ve perhaps foolishly made (the past couple of years it’s been a hefty investment of time and energy to the band boosters, to just name one), it’s more than this one woman can carry.

People who don’t know me well (maybe) keep telling me they “don’t know how I do it.” Others who do know me well keep telling me I need to start saying “no.” The answers: I’m not doing it: I’m coming apart at the seams. To those who tell me to say no, I’ve only been able to reply (wail?), “But how???” Because that has been the question of the year. I’ve had no idea how to stop what I’ve already started.

So what’s happened now is I’ve fallen apart and found myself unable to continue. So instead of even walking slowly along the race route, I’m splayed out on the ground. I’m hoping that soon I can regain my wits and strength and start limping again, slowly making some progress.

I’ve had to quit the band boosters mid-year because I simply can’t function anymore; someone else will have to step in. Today, I went to see my therapist a week and a half earlier than I had scheduled because I had to have someone to talk to, to think aloud with, to vent to; to tell about my frustration, my disappointment, my exhaustion. I have an appointment in two days with my psychiatrist, who monitors the medication that keeps me (mostly) “normal” or what I would call on a baseline with others who don’t have the mental-health challenges I have. Perhaps I’ll find some ways to really recuperate and regain my strength so I can once again take up the baton and jog a little down the race course.

I’d like to think I’ll learn something from this latest flame-out. I know I’m trying. Balancing all the responsibilities in life and my desires to do good and make a difference with my own body’s mental and physical needs is a very, very delicate job, and it’s one I’m far from mastering. The problem is when I have some spare energy, I immediately want to use it to do something good for someone else, when perhaps I should be keeping some in reserve. I have to remember the rainy days and save for them in my mental-health bank even when the skies are perfectly clear and blue right now. That’s hard.

I’m likely going to need the rest of my life to learn how to balance, to keep energy in reserve, to really carefully exercise wisdom to gauge when to say yes and when to say no, to keep running or kick in a burst of speed or slow down to a trot or a walk. But I’m going to keep trying.

Glad to read about others’ experiences with mental illness

So I was appreciative this week to receive a book to review called Pros of Prozac: A Faith-Based Memoir of Overcoming the Stigma. Given my experience in book reviewing and my personal interest in mental health issues, this book was a welcome read.

It’s a little slip of a book, just over a hundred pages, which the author says is mostly intentional, so someone interested in the topic can just get a quick overview of her experience. So I read it in one sitting this afternoon. Beca Mark writes about her experience with postpartum depression after the birth of her first child, struggling with mood and depression, and finally deciding to seek professional help and take medication for her depression. It took 15 months to choose to take Prozac, and Mark discovered two things: one, why did she wait so long while suffering so much? and two, she realized that she had actually been struggling with depression her whole life but hadn’t known it until Prozac made her feel really good and really herself.

Mark’s experience is actually what I would call fairly straightforward. She was really struggling, and then struggled with just the concept of taking medication because of the stigma it has in our society (and the real lack of open discussion of the topic in her otherwise close-knit, very large family), and then finally decided to give in and take the medicine. And in fairly short order, she just felt a whole lot better. And she has felt consistently better in the years she’s been taking it, which I’m guessing is probably about five. She makes clear that it hasn’t made her life easy-peasy or super-simple or solved all her problems. It has simply made her more able to think clearly and be motivated and to just be her best self. As I put it, it’s helped her to be able to cope in the way that most “normal” people (i.e. those who don’t have depression or other mental-health struggles) do.

Mark says this is a faith-based memoir, but it’s really not very heavy on the faith angle. I think her beliefs and the culture that surrounds those faith beliefs give a frame to her story, but even those who don’t consider themselves very religious can find a lot of value in her story. All in all, this is really a simple tale, and one that seeks simply to provide some basic information and encouragement to those who may find themselves struggling emotionally but feeling hesitant to accept that there might be a “label” for what they’re experiencing and that medication might help. Our culture at large still places stigma on mental health issues, as well as taking psychiatric medication. And individuals within faith communities may very well sometimes compound that stigma by saying that if a sufferer could just be more self-reliant or more faithful, they wouldn’t suffer.

I heartily support Mark’s goal to contribute to the general discussion and bring this topic “out of the darkness” into the light of day. The more those of us who do struggle with emotional challenges really talk openly about this and show that we’re pretty normal, typical, “good” people, and not weird or weak or something negative, the more others will be better educated, aware, and accepting — and supportive. And, even better, the fewer the number of people who do suffer from mental health issues will feel marginalized or hesitant to seek treatment. Mark really doesn’t want more people to suffer in silence and without treatment. Why should they? It’s pointless to suffer when there is help.

In applying Mark’s story to my experience, I find that mine is a bit more complex. (She does say that mental illnesses are complex in cause, etc.) Because I have bipolar issues, finding medications and treatments to keep me on an even keel can be trickier. Antidepressants help the most, but they tend to “poop out” after a year or two. I’m in that spot right now, I think. I have been on a number of different medications over the years, and it hasn’t been as “simple” (that’s relative, I know) as being able to get on Prozac and stick with it for years. I would like that a lot if it were that comparatively simple.

When it comes to the faith angle, I just wrote that there really isn’t a lot of it in here, so this book is really accessible for everyone. I wouldn’t have minded seeing more, personally. I have written about how my faith informs and is affected by my mental issues, too, and I don’t think Mark really digs into that as much as I have, even.

But bottom line: a good read, particularly for those who are “new” to the idea of having possible emotional struggles, and one that’s simple and straightforward and encouraging. Kudos to Beca Mark for putting her story out there and just being honest. The more of us who do so, the better.

So glad I could help

Few things give me greater satisfaction than having friends (or even just acquaintances) come to me as a resource when faced with questions relating to mental health. Perhaps in part it’s nice to know that, despite my sometimes quirks or slightly “off” behavior, they still consider me a valuable source of information and even wisdom. It’s nice to be valued, to be needed, to be seen as able to dispense tidbits of guidance. It’s even better to feel that maybe, just maybe, everything I’ve gone through can help someone else, that I can maybe help cut short the long journey for them just a little, provide a quicker route that still gets them to a good destination.

I can tell you about my therapists, my psychiatrists (i.e., medicine-dispensers) and medications, the books I’ve read, the ups and downs and ins and outs. I can talk about the wacky ways my mind is able to play tricks on me, despite my hyper-awareness that it can, and a sort of vigilance about trying to think clearly and navigate life from a kind of emotionally handicapped state. I can share the surreal-ness of dealing with others who have been in worse shape than I have ever been, of their living in (and trying to reason from within) realities that just don’t line up with the reality the rest of us know. I can look back on my own experiences and say, “I wish I could have seen the whole picture from the beginning, because I would have gone right to ___.” Man, does it feel good to think that I might be helping someone jump over hurdles with relative ease and speed that I’ve had to walk around, re-jump, and move around countless times.

Again, in this latest discussion, a friend and I agreed that it would make life so much better for everyone if all of us could just open up about our real challenges. Most of us have something, a weakness or an addiction or a habit or an illness, whatever, that we find embarrassing or shameful somehow, that we would really rather NOT talk about. And there are plenty of stigmas left in our culture about lots of problems, including mental illness. It just doesn’t help that there aren’t really clear-cut answers (let alone even questions) about how our minds and emotions, etc., work. The science is much clearer with other health problems. So it makes mental illness still hazy and misunderstood and even a little scary for people who don’t have to face it head-on regularly. If just more of us SPOKE UP! Whatever your shame, your stigma, your weakness, your difficulty, just talk about it. Yeah, unfortunately, you’re probably still going to be judged and misunderstood by some, maybe many. But you could help so many others.

I feel so weak and so isolated sometimes, and then nervous about talking about my experience. Because like most everyone, I just want to be liked, to be understood, to be respected and appreciated. And that stigma can put a big roadblock in the way of that satisfying goal. But I want to help other people. I want to pave the way for less stigma, for more understanding, even for better science (somehow). So, I talk. I write. I blog. I’m open. It can be nerve-wracking and painful. But I’m doing it anyway. Because I’m glad I can help. So call me or write if you have questions or need advice for a family member or friend. Reach out. Sometimes you might need oven mitts, but pretty much I’ll always be happy to talk, if I can help someone else.

Spirituality and mental illness

As a faithful follower of Christ my entire life, my spirituality and connection to the divine have always meant everything to me. My life would not be what it is without my knowledge of and faith in God, my Heavenly Father, and His Only Begotten Son, Jesus Christ. I have always depended on the great gift of the Comforter that Christ left with his disciples, the Holy Ghost or the Holy Spirit. I’ve been taught since I was young how to understand what the Spirit is trying to communicate to me through his still, small voice. It is explained to people in various ways because it can affect and teach each of us a little differently, so each of us must learn exactly how he sounds to us. A scripture in my faith’s canon says that the Holy Ghost will speak to me in my mind and in my heart, and that really rings true in my experience. I can often just feel ideas popping into my head, and I can feel in my heart a good feeling that confirms they are from a trusted source.

But my challenges with my mental health over the years have thrown wrenches into that beautiful process off and on, in various ways. The depression, irritability and anger I’ve felt have blocked that positive flow of messages from a loving God, leaving me to feel adrift and alone and cut off. I’ve sometimes felt that there are just no answers coming to prayers, and I’ve given up asking. I’ve even gotten angry at the heavens then for leaving me in that isolated state, with no communication coming my way. All of it leads to me feeling that I’m alone and undeserving of God’s love, that for some reason he just isn’t paying attention.

Even medication I’ve taken has caused difficulties of its own. As I wrote in my previous post about my long list of medications over the years, when I tried Abilify for a few months about a year and a half ago, I felt absolutely numb. It was unnerving because I’m usually a bubbly person who often sees the bright side of things and, in terms of faith, relies on (even might take for granted) the wonderful peaceful feeling that comes from turning to prayer and scriptures and other messages of a spiritual nature. I know that when I listen to good music that reminds me of God and Christ or when I read a scripture or an inspirational magazine article, I’ll feel uplifted and recharged. I’ll feel the influence of the Holy Ghost, a marvelous gift. So for the few months I took that medication, I didn’t feel anything, including those spiritual feelings. I didn’t feel bad, but I didn’t feel good. I didn’t feel peaceful or Spirit-filled whenever I did all the things that would normally make me feel that influence. It bothered me a great deal. It was a strange feeling to go to church, where I would normally feel happy and inspired, and just feel … nothing. A black hole where there would normally be gardens in bloom with all colors of gorgeous flowers of faith.

What got me through that time was just the knowledge I had still in my mind about all the experiences I could remember. My brain had stored away the memories of knowing that God had answered my prayers at specific times and that I knew that the Holy Spirit had usually been in my heart. I couldn’t feel it then, but I trusted in my head that it had happened before and would come back to me, no matter what wacky tricks this medication was playing with me. And sure enough, when I got off that medicine and got to mostly myself again, I did feel that peace again. The black hole was gone, filled again with light.

So the wrong medication can play tricks on faith. Depression and other mental illnesses can do their own brand of damage. I’ve been through that emptiness before and am kind of feeling it again, and I’m sure I’ll keep experiencing it throughout this mortal existence. It’s not pleasant, and I’d rather not have to go through this. But my feeling is that this is my cross to bear, so I’m doing the best I can to handle it gracefully. Saying I’m doing my best is the truth, but even then it feels silly to say because “my best” can sometimes not be a whole lot. I feel alone inside of myself and that God isn’t sending me answers or the positive feelings I need. But I know in the part of my brain that’s not “messed up” somehow that he’s still there.

I think what I want most to do here is connect with other people who experience these feelings. I think that faith communities are slowly doing better at directly and publicly addressing matters of mental health in the context of religious belief, and that’s wonderful. But depression and other mental illnesses work hard to isolate their sufferers. Those of us who know in our minds and in our hearts that God is aware of us and loves us but sometimes don’t really “feel” it the way we should because of neurochemical vagaries can talk to each other to buoy each other up not just in our specific trials but in our faith. We’ve been given a great gift to have a Savior and the good news of the gospel he has taught. I believe there are still miracles today. Honestly, though, some days, amid the clouds that create a darkness of despair in my heart and head, I don’t feel a conviction that God will work a miracle in my life. And since I know that isn’t true, deep down, I have to work hard to combat the feeling that is false. A dear, dear friend of mine told me a couple of times that she and her mother were able to talk to a well-known Christian writer of our faith after he gave a talk they attended. She wrote me to remind me what he had told them: “He suffers from depression and told my mom and me that being faithful means that you remember the Lord is with you and mindful of you even when the depression doesn’t let you ‘feel’ it. He is still there!” I just cling to that like a little round life saver thrown to me in an ocean of big waves. Eventually the waves die down, and I’m still clinging on for dear life: alive and well yet again. Still.

Medications and me

Having a mental-health concern (that seems most likely now to be a bipolar disorder) for the past 25 years or so has naturally led to my being on various medications to try to improve my quality of life. I’ve already discussed a bit how it’s been a challenge to figure out exactly what I’ve been up against over the years (just some depression? anxiety? postpartum depression or PMS? bipolar disorder? nothing at all?), so I’ll try to go back and address what kinds of medications my doctors and I have tried to use to help me feel a bit more “normal,” or, more accurately, just better able to cope with the usual stresses and strains of life.

The first I ever took some kind of an antidepressant was toward the end of my LDS mission when I was feeling serious stress. The resident older missionary/retired doctor prescribed me a medication that would supposedly help with that. At this point, I honestly don’t remember what it was he gave me. What I do remember is that I was in pretty bad emotional shape and just going about my regular busy schedule just with a new medication didn’t help me feel any better. Besides, it usually takes a few weeks for those kinds of medications to even start making a difference, and in the meantime, I just kept feeling stressed — and guilty or bad about being stressed while I was supposed to be happy and spiritual and serving God and my fellow beings. It just wasn’t a good recipe for success as a missionary or a happy human being. So I ended up having to leave the mission behind and go home to seek help in a different environment (already talked about how that went).

I was next put on lithium when hospital doctors decided I was bipolar. I took that for a bit less than a year, I think. I felt better as time went on, mostly, but I also went back to college, where I felt more at ease and myself and had my friends around me. I am sure that the medicine must have helped though, looking back, because otherwise I probably still would have been seriously depressed/angry/stressed. But the change of environment did contribute, and after a time, I just felt that 1) the diagnosis of bipolar disorder couldn’t really fit me because I didn’t fit the “classic” signs of the “full-fledged” disorder and 2) lithium is a serious drug to be on: it can potentially damage the liver. I was having my blood tested every few months to make sure my liver was fine, but it was still a real concern. So I went off the lithium. During all this I was seeing a counselor at school, so I didn’t do all this just on my own without any professional support, but I don’t know if I had a psychiatrist on my “team” at that time.

After I married and moved to California with my husband, I know I ended up seeing a psychiatrist regularly, but I cannot remember if she had me on any medication. I know I didn’t go back on lithium. She might have put me on some kind of antidepressant, if anything, but I don’t remember for sure, and I have no idea what it was if I did take something. I do know that the first year of my marriage was very rough for me emotionally, and I prefer not to think about the way I acted. It’s too embarrassing. Luckily, my husband stuck it out with me. I also know that I was on hormonal birth control pills for the first two years of our marriage, and I am convinced that fiddling with the sensitive balance of my hormones was not a good thing for me emotionally.

I know that there were months and years I didn’t take any kind of psychiatric medicine, and there were other months and years that I did. It was always some kind of antidepressant. I took Zoloft and Wellbutrin at a few different times off and on after and between pregnancies. I took them together for a year or so, mainly because Zoloft did take away my sexual response. That’s something that’s a warning when you take that and various other medications, such as Prozac, and it’s definitely true for me. It can seem like a small price to pay, but it’s actually a pretty big sacrifice when it comes to a full intimate life with your spouse, so it bothered me greatly. Taking the Wellbutrin with the Zoloft took that side effect away.

After probably my third pregnancy, my gynecologist prescribed me a new medication, Lexapro. He said it worked well and had no significant (definitely not sexual) known side effects. I was eager to sign up. The morning after I first started taking it, I got out of bed in the morning to use the bathroom and then ended up passing out on my way back to bed. I was so scared about the weird feeling I had during that few moments that I told my husband to call 911. The paramedics came out and pronounced me fine. They said I’d most likely rubbed the back of my neck or something and had some kind of vagal episode. OK. Fine. Unfortunately, over the next 5 or 6 days that I took the Lexapro, I still felt weirdly faint and out-of-body-ish, and I figured the only thing that had changed in my life was that new medication. I visited with my general doctor, who told me that was ridiculous. But I decided it was the cause, and I stopped that Lexapro. I instantly felt better, well, fainting-wise. (The lesson here: even if your doctor says you’re being ridiculous, you still should trust your instincts.) So I went back to Zoloft or something similar, I think.

I started going to a psychiatrist again, which I hadn’t done for quite some time, just getting antidepressants from my gynecologists or general physicians, although I had still gone to see counselors for talk therapy more regularly. The psychiatrist I saw at that point, probably in 2007 or so, put me on Effexor eventually, which worked well for me for a while. He did suggest I might be experiencing bipolar disorder and might benefit not from lithium, but Lamictal (lamotrigine). He even gave me a sample pack. Even though I did consider that option, I told him that since I was feeling pretty good taking the Effexor, it seemed silly to stop taking something that was working just to try something else. He thought that was reasonable and kept me on the Effexor.

Then in 2008, my family and I moved to California from a long stint in Alabama, and life became unbelievably stressful. I’d also been taking the Effexor for probably a year or maybe a little less. At any rate, I’d probably only done well on an antidepressant for a year or so at any time I’d taken one, either because after a while, my life had settled down and I’d gone off a medication and been fine, or the medication had seemed to stop working. In this case, I just kept taking the Effexor, but my new general physician upped my dose. Shortly before another momentous, life-changing event for me, the death of my beloved dad, I started trolling the Internet and found the site I’ve mentioned already by Dr. Jim Phelps, which made me start to seriously consider the possibility that I really did have a bipolar disorder. But this psychiatrist was making the point that there was a wide spectrum of bipolar disorders, not just the “biggie” in which people stay up without sleep for a few days at a time, go on wild shopping sprees and spend tons of money, and do otherwise really foolish things they wouldn’t otherwise do. So I found a psychiatrist in my new town who was on my insurance list and made an appointment. He put me on Lamictal, which my previous physician had suggested a couple of years before. It did seem to slowly make a difference, and I was happy to be off the Effexor, although it did take a solid two or more months to very slowly wean off of that very addictive medication. (If I didn’t get a dose, I’d start feeling kind of headachy and light-headed, in a distinctively Effexor-less way.)

So I think the Lamictal gave me some relief and some hope that I was on the right track, but a couple of months into that, my dad died and sent me spinning. My psychiatrist asked me at the first appointment after Dad’s death (merely two or three weeks afterward, mind you), “So, how are you feeling?” Uh. BAD. My dad died. I’m miserable. Hard to say how the medication is working. I’d feel rotten no matter what. And that’s how it went.

A few months after that, I mentioned to some people in my church congregation that I was struggling with mental illness, and a few recommended I try a different option, a natural formulation called EMPower that was sold by a company called Truehope. The company says that the formulation contains micronutrients that are found to correct the imbalances found in those with bipolar disorder and other mental issues. I have always felt that ideally, it would be nicest to treat the actual cause of a problem rather than just the symptoms, if at all possible. This sounded like a very reasonable option, and Truehope has actually been doing scientific studies showing the benefits of EMPower.

I felt that I needed to at least give this option a shot. If I didn’t, I would never know if it could have helped me or not. So I went in to my psychiatrist, who naturally told me he didn’t agree with my decision and that he couldn’t continue to see me if I went off my prescription and took EMPower instead. I knew he’d say that, and I was ready to say, “OK. I won’t be back.” He said he knew I’d be back in a few months in even worse condition.

I tried the supplement, which is actually pretty expensive (probably about $100 a month, and not covered by insurance, of course), for about six months. I felt at first it really did help, but after a few months, I was just not feeling good enough. I tried a few adjustments and options after some phone calls with the company’s support techs, but I finally had to make the decision to end my own personal “drug trial.” I am sure that the supplement truly does help lots of people, but as with anything, nothing helps everyone. I did struggle, however, with what to do next. I firmly did not want to go back to my previous psychiatrist. He was too abrasive, and I felt I couldn’t work comfortably with him to find the best options to treat me. I finally decided to go see a nurse practitioner working in psychiatry 45 minutes away from my town because my therapist had heard good things about her from several other clients. I felt that it was going to be best for my mental health process to work with a psychiatrist who I felt comfortable with, that we were really a team, that she would be supportive. So I made the appointment. This new person, who I still see almost 2 years later, turned out to be a really good fit personality-wise, which I think makes a big difference in getting the best care possible. The only drawback is that my insurance doesn’t cover her, so I have had to pay entirely out of pocket. Luckily, I have had the spare funds to be able to pay for the visits, and it has been a good choice for me.

I’ll just call my nurse practitioner by her first name for ease of writing. Susan really went into a lot of detail with me, talking to me about the options and what she thought might work to help me, even explaining why she felt that way. I personally have really liked her approach. I like to feel that we’re on the same page, and knowing her reasoning helps me to feel more confident that is happening. We tried probably four or five different medications over the course of probably four to six months, during which time I’d go back every month to see her and check in. We tried Abilify, Prozac, and maybe Celexa. I can’t remember exactly. I did notice Prozac didn’t make me feel any better, and it just made me feel completely dead sexually, which was super-frustrating for me. So that was a no-go. I also know the Abilify didn’t do it on its own, and it actually made me feel, rather than “more normal” or “more like myself,” just kind of numb emotionally. I wasn’t stressed, kind of, but I was just dead. I didn’t feel anything. I felt like a zombie. I absolutely did not like that. She ended up adding in Cymbalta, which felt pretty helpful. Eventually, we took out the Abilify to see if that would help me feel less numb. And it did work. The Cymbalta, at the time, on its own, was a good fit for me. I’ve now been on that for perhaps 18 months.

Unfortunately, I’m afraid that now we’re getting to a point we need to tweak again. I’ve been on just antidepressants before, and I’ve either just gone off them or they’ve stopped working, and I fear this is happening now. I’m just feeling unhinged. The stresses and huge demands on my time are taking a huge toll on me, and I’m not proving up to the challenge of dealing with them in an appropriate manner. I’m coming up in a few weeks on another check-in with Susan, and I think this time we’ll have to address now how to change my dose or try something else. It’s been nice, though, for the past year, feeling pretty good and “myself.” Descending back into my “crash” mode is a scary and upsetting thing, for me and my family, and it’s nerve-wracking for me to ponder how much trial-and-error it’s going to take to get me back to happy. Will it take a couple different medications again and weird feelings of numbness or just not-effectiveness (so I’ll just feel unable to cope for a few more months? Yikes!)? My main fear is looking ahead at a few months of not being myself, far from it, especially with summer months coming on and my kids being out of school and all the stresses that places on me every summer. It scares me.

So that’s where I am, medication-wise. I’ve been a bit of a guinea pig for the past 20 years. It’s difficult because treating any kind of illness can be tricky and require some finesse. The basic stuff is kind of straightforward (infection? take an antibiotic; cold? take some antihistamines and Sudafed and wait it out), but other health issues take some trial and error. Then when it’s mental health, which is still a kind of slippery creature in the early 21st century, and every person’s needs and body chemistry is unique, it’s a science that’s more art than anything else. Being the doctor is probably a challenge, but being the patient is truly difficult. Being that guinea pig, the one on different kinds of medicines, is tricky and frustrating as all get-out. I’ve said for ages I wish there were a control group for me. But there isn’t. Good science requires a control group and an experimental group, and in this case, giving just me a medication and seeing what happens isn’t truly good science. And the onus is still on me as the patient to make the judgment calls, to figure out what’s changed, what to tell my health-care provider, about what might be significant. Do I feel better taking Lamictal even though my dad just died? Can I possibly separate out the effects of that from my normal stress reactions? Can I say I feel better on something even though a bunch of stuff has been happening in my life? If I could put myself in a quiet room without any interference from outside sources, I could judge better. But that’s never possible. (And if I could be by myself in a quiet place — resort, maybe? that would be amazing — I may very well be able to get to feeling better without the medication. Maybe. At least I wouldn’t be bothering anyone else.)

This post is incredibly long; perhaps I should have separated it into a few parts. But it’s the best answer to those who would like to know what my experience is with medications. I hope it might be of some use to those of you who struggle with similar problems and need to figure out how to look at your own situations with more clarity. Perhaps it will just make some of you more sympathetic with those in your lives who have challenges similar to mine. Or maybe those who know me but don’t know all these details about me will feel more empathetic with me. Either way, I hope this is of use to someone out there. This is an ongoing story, so I will need to update as the next few months come along and I visit my nurse again.

Dear doctor

Over the years, I’ve come to realize that the doctor-patient relationship is vital to good health. As with any other relationship, it must be built on effective and clear communication, understanding, compassion, and just mutual “liking.”

Unfortunately, it’s hard to find a really satisfying doctor relationship. It’s hard enough to find friends out in the wide world of people, to find someone who just clicks, who is fun and understanding and supportive. When you’re narrowing down the pool of potential medical mates to perhaps 50 people in your town who are qualified and approved by your insurance, then finding that kind of chemistry in that small group is going to be a real challenge. And it’s not as if those 50 potential mates are sitting in one room, giving you an afternoon to interview them and get to know them. They’re holed up in an office somewhere, with crazy schedules, spending 5 minutes with each of their already existing patients, and walled in by receptionists who take messages and aren’t necessarily great conduits for starting relationships or even investigating the possibility.

So I don’t really expect my doctor relationship to be as close and mutually satisfying as a great friendship. But it still must have a few of those qualities for it to be most effective.

Here’s the thing: I know my body best. I’m not a doctor; I don’t have medical training. But I’m not completely ignorant when it comes to medical issues; perhaps that makes me one of those frustrating patients who knows just enough to make me dangerous. Perhaps it’s helpful. At any rate, that’s where I am. I do know that I’ve been in charge of my own medical care for 20-plus years, and I’ve taken all kinds of medications over the years, seen a number of doctors and some specialists, had some tests, and had a LOT of time to ponder on test results or effects of what I’ve taken or tried. I’ve been smack dab in the middle of my own personal lab experiment for all this time. I’ve said for some time now that it’s really unfortunate that I don’t have my own control group. That would make things so much easier. But I’m one person and I’m the control group and the experimental group in one. It doesn’t make for good experimenting. But that’s how it is.

I know these things: over the years, I have come to appreciate that any hormonal changes in my body really reverberate and effect my whole being, emotionally and physically. Female hormone changes can make me irritable or emotional; they can make me tired; they can make me bloated, and they can make all kinds of other waves I don’t even register in my consciousness. I know that I have a mental illness that requires medication, and that is also a very delicate state of being, to get to where medication helps me but doesn’t knock me out or make me feel numb emotionally. I know that if I don’t feel “right,” then I should look into whatever options there are.

Unfortunately, again, since I’m not medically trained, and I don’t have authority to write prescriptions for myself, I need a trained doctor to step in and work with me to find possible problems and possible solutions. We need to be a team. I will respect your training and experience, but I need you to respect that I can feel things in my gut about myself that you can’t. We don’t have a few hours for me to use all the words that it might take to express why I might feel something particular just “in my gut.” I have to figure out how to get it across in about two minutes. And if I can’t do that, then we’re stuck.

I know if I’ve gained weight. You don’t need to point it out. Believe me, I’m all too aware of it. And if you’re a petite woman who runs marathons and doesn’t have a problem with overeating, then I’m going to instantly feel that you won’t understand where I’m coming from, unless you put me at ease otherwise and try not to judge. I eat healthy, mostly, and I exercise every day. I’m doing the best I can. Pointing out I’ve gained 20 pounds and sighing and shaking your head won’t make me feel any more motivated. It will only depress me. Not only that, it will make me dread having to come in and see you. That’s never good. If I dread coming in to your office, then I’ll put it off, and everyone knows that putting off important medical care is bad. Plus, being anxious anticipating what you’re going to say will probably elevate my blood pressure readings while I’m in the office.

If I tell you I’d like to consider some alternate therapies or tests that you don’t usually use, I’d like your support. Sometimes, those require your signatures and authorization. Please don’t refuse because you think these things are a waste of time or money. If I feel that there’s something going on that your regular tests and medicines don’t seem to be addressing, I’d like the opportunity to waste my own time or money. At least I’ll know I’ve tried. I’m not way out there trying really bizarre things. So try to have a little bit of open-mindedness. Yes, I know where you’re coming from. But please understand how frustrating it is to feel “not right” and not have any answers. Rather than making a face and flat-out refusing, you could at least explore more why I’d like to try something else and perhaps find a way within traditional medicine to address that issue. You support my going to an acupuncturist. So let me try a compounding pharmacist, for example. But the second you squeeze up your face into a disapproving look and shake your head and refuse, you’re going to earn my ire (anyone who knows me would know that will just set me off). At least try to make me feel that you’ve heard my concerns and figure out a way to address them your way; at least make me feel that I’m an active partner in my own care. Don’t make me feel judged or condescended to or brushed aside. Work with me so I can feel validated and part of the team.

Listen, I understand that working in health care is tough these days. Doctors especially have huge debts from medical school and have to jump through all kinds of hoops just to get reimbursed halfway reasonable amounts for the work they do. Yeah, it stinks. I appreciate that. My husband works in health care, though he’s not a primary physician. So I’m not completely ignorant. I understand that you need to be true to the science you were taught that was thoroughly researched. But you have to appreciate also that the knowledge we do have is still pretty limited, and that a lot of research that has been done either used men exclusively as the experimental group, or averages have been calculated using the data from a variety of people. We also know that some research ends up being faulty or rushed and has to be reversed later on, with great human costs. Don’t blame me for being just a little bit skeptical sometimes. And simply averaging information gathered from groups of subjects and mathematically deciding that data then should apply exactly to my individual body chemistry and internal workings is not what I’d call the most effective use of scientific inquiry, either.

Most of all, please understand that how I feel is not just physical symptoms, but emotional. It’s all part of one big whole. If I try to take a few minutes to explain or ask for further help or thinking out of the box, please indulge me if you possibly can. If I don’t feel you’re hearing or understanding me, I’ll get more emotional. It’s natural. Don’t blame it on my “being mentally ill” or think immediately that I must need a higher dose of medication for my mental illness. “Normal” people have a wide range of how they express and show emotions, and it’s natural to feel frustrated when we feel we’re not being heard. It’s natural to feel emotional if you don’t feel well physically and there doesn’t seem to be an obvious reason. Please validate my feelings rather than telling me that I don’t have the right to express them in any way. I work hard to be kind and civil and understanding, but I am not devoid of emotion, and I cannot stay completely poker-faced when I feel frustrated. Don’t write me off. But when you say we may not be a good fit, you know what, you’re right about that. But sometimes we patients don’t have the luxury of finding a great fit. I just have to make do with that little group of doctors in town that my insurance will pay for and who are taking new patients. But if you know another doctor who might be a good fit for me, then by all means, please give me a name.

I would very much like to find a doctor who will be on the same wavelength with me, at least in how I communicate with words and body language and a little show of emotion. I’d like one who maybe even has a little sense of humor or likes to banter a little. Maybe with the way our health care system works today, that might be impossible to ask for both of us. If that’s the case, that’s very sad. And on a political note, if that is the case, then just making our health care system bigger won’t solve the problem. It needs an overhaul; it at least needs tweaking and adjusting. Let’s not just make a really ineffective system bigger so more people can be frustrated. Let’s dig into it and see how to truly make it BETTER.

Thanks for your time, former doctor and potential new doctor. I know you have a tough job to do. Thanks for going to medical school and doing the work you do. I just hope that we as a society can figure out how to do better in matching patients to doctors so this process of finding optimal health can be a little easier.

Sincerely, Cathy

A tribute to a one-in-a-million man

Since he turned 45 yesterday, I decided today would be a good day to recognize the superhuman support and love of my husband, Marce. I met him when he was 25, and in a way it doesn’t seem possible we’re in our 40s now, that nearly 20 years have gone by. I’m quite sure when he fell in love with me and decided to propose he had no idea what his married life would have in store for him.

We did have some discussion while we were dating about my mental health. I had returned from my mission, gone through the heartbreak I did with my longtime friend, and been started on lithium after a diagnosis of bipolar disorder. One evening we took a drive to visit my mission president, a man I love a lot and greatly admire, and who was sensitive to my needs. He and his wife sat and chatted with me and Marce; we had only been dating about two weeks at that point, and I didn’t really expect it to get serious. My president asked about how I was doing emotionally, and I told him so far, so good. His dear wife whispered to me, “He is a good young man. Hold on to him!” (She was more right than I could possibly have known that evening.) On the drive back to school, Marce asked me, “What did he mean about taking your medicine?” That gave me the opening to just tell him everything about what I’d experienced and where I was at that point. He listened quietly as he drove, held my hand, and seemed very reassuring and nonjudgmental, which meant a lot to me.

Sometime in the few months after that, I decided to stop taking the lithium because I just didn’t feel I had bipolar (I just didn’t fit the symptoms of the “bipolar I” or the typical disorder, as I think I’ve written about already). The medication could have dangerous side effects, and I needed to have regular blood tests to make sure it wasn’t damaging my liver. I felt since I wasn’t sure about the diagnosis taking a possibly harmful medication didn’t seem like a good idea. Unfortunately, around that same time I got engaged, finished college, and started my new life, and got so busy with a new full-time job and a marriage and new place to live and everything else that I neglected to consider my mental health. If I remember correctly, I didn’t do anything about it immediately (though I know I did find a psychiatrist sometime in that next year). I also started taking birth control medicine, which is chock full of hormones, which I have also learned was probably not a great addition to the cocktail of my personal chemical makeup. Again, unfortunately, I didn’t know any of this at the time.

Marce and Cathy wedding — My sweet love on our wedding day.

What my dear groom experienced in the first year of our marriage was a number of occasions of me flying off the handle at nothing. I remember one trip on a day off to an amusement park, where I went ballistic over something someone near us did and shouted at them. I don’t remember the details, and honestly, just thinking about the idea of it anymore and writing it down mortifies me. But it’s what happened. I was a mess. On that occasion and others, Marce would just quietly try to divert my attention and take me away physically. He rarely made any comments or judgments.

The two of us have very different temperaments and backgrounds. My family was very open and didn’t hold back our opinions. We argued and yelled and were loud. His family was a strict Asian family, and the children did not talk back. There was no argument between children and parents, and yelling wasn’t tolerated. On top of those differences, I had a background in speech and some debate and a need to win. Marce played basketball and never debated. I’m sure it mattered to him if he won basketball games, but he just wasn’t (isn’t) a competitive type. Put that together, and you have no arguments, sure, because it takes two to argue. But I’ve certainly hankered for it over the years. If he had been the arguing type, we’d have had some doozies. As it was, I’ve yelled and screamed and done wacky things, and he’s listened in silence with a nearly emotionless face.

I’m not writing any of this because I’m proud of it. Very much the opposite; I’m embarrassed as all get-out. In many ways, my yelling and anger doesn’t fit with what I consider almost my “real” personality. But it’s happened, and it’s impossible to say that it’s __ percent my hormones/brain chemistry and __ percent my personality/upbringing/etc. I’ve already written about how it’s not possible to separate my “true” personality from what’s been caused by my mental disorder. I just am who I am; what I’ve done and experienced makes me who I am now. I hope that all of my flaws (chemical or not) have at least helped to turn me into a better person over the years, rather than cement me into place as a meanie.

It could be accurate to say that Marce may have needed to be more assertive or actually discuss issues with me more rather than just be silent. But that’s an issue for his blog, if he were ever to write one. What’s important and relevant is that over the course of being together for 19 years, he has never yelled at me; he has never left. He has always loved me and been supportive. I don’t think he’s judged me harshly, despite my giving him good reason to do so. He has done that from the very beginning, up until now, when we can at least put some good labels to what we experience together. Because at this point, it’s not just MY mental health issue; it’s OURS. (Although I have said at times when I’ve had the worst moments that he’s lucky he can at least go to work or somewhere else and get away from me for a while, whereas I can’t get away from myself and what’s happening in my head.) We are in this together; we’re a team. What’s his problems are mine and vice versa; what are his strengths could also be mine, and vice versa. I’ve known from fairly early in our dating days that I just felt comfortable, myself, with him, that I didn’t have to pretend to be something or someone I wasn’t. I was at ease; I felt loved. I’ve also known that we complement each other perfectly. We have truly made a great team.

Many other men may have bolted long ago from what I’ve put my husband through. But he is not other men. Sure, he has weaknesses, but he is an unconditionally loving husband who is dedicated to the institution of marriage and to me, personally. He and I believe that our marriage can last forever, and we’re working on it so we can be happy together for eternity. I now have confidence that is truly possible because I have 18 1/2 years of knowing for sure that my husband is committed to that. I am very blessed. His support has made all the difference in what have been some really challenging times. So, happy birthday, my love. I hope that my strengths and commitment to you have shown you how much I love you and appreciate all you’ve been to me.