Tag Archives: psychiatry

Being Bipolar – Dis-Ordered systemic narrative and an opportunity to regain control.

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The National Disability Insurance Scheme in Australia and mental illness.

 

There really seems to be two trains of thought around medication and Bipolar Disorder. Those who think medication is a certainty, an absolute Medication is crucial for managing bipolar disorder”, “Bipolar disorder is probably the main psychiatric disorder where medication is absolutely essential. I’ve had people ask me if there’s any way to do this without medicine. [My answer is] absolutely not.” 1 and the anti-medication and anti-psychiatry movement (and the points in between where the two movements meld). Head along to any anti-medication page on the web and you will read plenty of points as to why they are opposed to medication, with little focus on how to achieve better outcomes on the whole. The anti-medication movement seems set against medical ‘tools’ (in this instance, medication) that can assist in managing fluctuations and outright swings in moods. I found a handful of useful sites that propose ways in which to manage Dis-Order without medication who also were reasonable enough to recommend the use of medication if required to stabilise.

 

The more medicalised and psychology and psychiatry based sites reveal the opposite. Some suggesting that the Dis-Order in Bipolar is unmanageable without medication (see above quotes). As with most topics the two opposing arguments seemed ‘preachy’ and self-righteous and for myself personally, both were as hard to stomach as the other.

 

Unlike many other illnesses, it appears that when it comes to mental health and mental illness everyone has an opinion. Unlike other illnesses there appears to be a perception that the general populous is somehow entitled to have a point-of-view about our lived experience. “You should be on medication”, “psychiatry is a money-making and corrupt industry and you should be off medication”, “have you tried just controlling your moods better?”

Jars

On occasions I purposefully choose not to disclose my lived experience for want of not changing the dynamics of the conversation at hand. I get to hear both the good and the archaic opinions and perceptions in relation to mental illness. Working in an executive role within the field of mental illness/health I get to hear it all and while I recognise there have been great improvements, we still have some way to go. I sat in a meeting recently with some case managers/workers who were discussing a change coming through Australia at the moment – the National Disability Insurance Scheme2 (NDIS). In a nutshell the NDIS has the power to mobilise and enable people (such as myself) who have a mental illness to make their own choices around the services they receive to assist manage their illness. It’s an interesting time as the power balance between services/carers shifts towards the service user themselves. The rolling out of the NDIS seems to have (at least in my experience) heightened the entitlement to ‘have an opinion’ of those of us with a lived experience.

 

The NDIS means that people with a lived experience who have previously been (with all due respect to carers) disempowered to make their own decisions around their care and now being encouraged (at least by the NDIS) to-do so. This is creating a remarkable amount of Dis-Order within the system and the way in which we (again) talk about those with a mental illness. Here we have people who have been ‘unable’ to make their own care decisions for 10, 20 and 30+ years, who under the NDIS are suddenly able to make choices to achieve the best possible outcome for their health. There are murmurs in the mental health sector that service users are ‘struggling’ to make these choices and are thereby missing out on services they are entitled to (services now only get paid when a service user selects them over another service provider, so you can see how this can seem problematic for the service providers, while being great for people with lived experience in the long run). What service providers are forgetting is that a Dis-Ordered system has been created around us, one which disengages us from autonomy and self-control, a system, which has historically silenced our care choices and made decisions for us and on our behalf. Especially for those with more severe and persistent mental health issues, the new liberating and enabling system under the NDIS is a new narrative for many – What? I get a choice in my health care? Yes we do.

 

The NDIS has bought about the polarising opinions of many, of carers, of guardians and of service providers. Again, like with the medication debate, those WITHOUT the lived experience are expressing their point-of-view, speaking on behalf of people with a mental illness, albeit guised as concern for the individual (concern which may be genuine to an extent) and cloaked in a thin veil of caring. I say this because I am privy to these conversations without people knowing of my experience of Bipolar and when I dig a little deeper under people’s concerns for ‘us’, it becomes apparent that there is apprehension about the shift of power from services and carers to the service user themselves. Undoubtedly if a carer or a service provider were to read this, I’m sure to have caused offence and to be criticised as not understand their actual intentions. Fine.

 

The NDIS brings about a remarkable change and with this there is a throw-back to mental illness being something to have an opinion about, rather than a health issue that is best managed by the person with a lived experience themselves (and supported when need be). One of the largest risks I see in relation to mental health and NDIS narrative at the moment is that while the NDIS rolls out and embeds, the voices of those without a lived experience of mental illness will cause such a din that people with mental illness will be hard to hear. Having said this, the core principles of the NDIS are genuine empowerment – the choice and control of our own health care will sit squarely with us. While the NDIS still has some bumps in the road to navigate, it’s potential is revolutionary and where we have been silenced in the past, once we regain our voice and confidence in decision making, the future is resoundingly ours to take.

 

  1. http://psychcentral.com/lib/10-small-steps-you-can-take-today-to-improve-bipolar-disorder/00016916
  2. NDIS http://www.ndis.gov.au/funnelback/search?query=mental%20illness

Bipolar disorder is not a character flaw: Finally! (A psychiatrist speaks out)

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So today marks World Bipolar Day and generally speaking, people with Bipolar Disorder continue to experience stigma, discrimination and misunderstanding. Today Professor Phil Mitchell, Head of Psychiatry at the University of New South Wales, spoke in defence of sufferers such as myself, noting that Bipolar should be treated no differently than other illnesses such as diabetes or cancer.  He goes on to note that people with lived experience of Bipolar don’t intend to make life difficult for either themselves or others and that as a mood disorder much of the associated symptoms are like other diseases.

I feel that this article is well timed and for a change, I feel as though I have a psychiatrist batting in my corner, it hasn’t always been like that. When I first visited a psychiatrist (at the recommendation of my psychologist), I was as yet undiagnosed and obviously un-medicated. I spoke to this psychiatrist the same way in which I spoke to most people, you see at the time I identified as a medium and psychic. As we sat down I spoke to him of his dead Aunt, who I believed was standing next to him and giving me messages to relay. Needless to say by the time our session was complete I had a script for anti-psychotics and mood stabilisers. I went back to my psychologist and he recommended I seek another opinion, just to be sure.

I sought out another psychiatrist, this time a female and from a different cultural background. This was important to me, since I felt perhaps her diverse cultural experience may impact on the outcome of my diagnosis, or at least on the medication regime prescribed. I wasn’t disappointed. I still came out with a diagnosis of Bipolar Disorder, although this time it was Type II, not Type I. She also felt we should begin with mood stabilisers only. Her words had a huge impact on me, since both in and out of hospital, my experience with Psychiatrists left a lot to be desired. She mentioned that I was reporting spiritual phenomena and that (in her opinion) there were things that psychiatry couldn’t explain. She challenged the status quo by asking who she was to contest my perceptions that I was indeed a physic and a medium. She shared with me some of the cultural singularities that still takes place in her home country, all of which involved shamanic practices and fortune telling. That was a number of years ago and I have remained relatively well on the mood stabilisers and have had no need for anti-psychotics (although I still hear voices and see things that may not be there).

I manage to raise my children well, hold down a part time job and continue studying at university. I recognise that people see me as eccentric or some such thing and I have had it reported to me that I’m (apparently) quite unusual in my approach to life and to my role as a manager.

The article goes on to talk about the way in which people with Bipolar Disorder need support around them, similar to the other illnesses mentioned, helpful partners, doctors and friends/colleagues all go to make our journey more bearable. This takes me to a time when I was supporting my mother through cancer. She had days where she was so unwell (physically and mentally), so exhausted and so run-down that she couldn’t get out of bed, while other days she was able to go about functioning relatively normally. I resigned from a job to take care of her almost full-time. I would take her to appointments, make her meals, sit with her and keep her company. She came through in the end and is in full remission.

When I ‘came out’ to my parents about my diagnosis of Bipolar the look of horror and confusion said it all. My father explicitly asked whether I was like ‘them’ (meaning the service users I had worked with in my mental health role). Although I left literature around for my parents, my illness remains a taboo topic and one, which they avoid at all costs. I could take up the baton and really ‘get to the bottom of it’ with them, although I feel this is more effort than it is worth. I have enough friends and supports around me to not need to go into battle with them in relation to their own stigma. This is how I feel about my illness, battling ignorance, misinformation and stigma are constants in my life and in order to not become completely worn down, I need to choose my battles carefully.

Currently I work proudly with a mental health organisation that educates the police/services, community, schools and clinicians to raise awareness and reduce stigma around mental illness. I’ve had a great number of conversations with federal and state police and mental health clinicians who are engaged and enthused to address the matter of mental health stigma. Coming across this article today was a reminder that not all are against ‘us’ and that reducing stigma by people both with and without lived experience is the best way to go. When a Psychiatrist can speak so boldly about such matters, I know that, while we have some way to go, things are changing for the better.

http://www.sbs.com.au/news/article/2014/03/30/bipolar-disorder-not-character-flaw-psychiatrist

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