Is it possible to be chronically depressed and optimistic at the same time?

Is it possible to be chronically depressed and optimistic at the same time?

A couple of months ago I came across an article in Elite Daily about people who tend to run late and one common feature was that they were optimists. I am one of those people and I tend to run around 5 minutes late for most of my appointments. I can remember being late for school in fifth grade and having to sprint to school most days. A positive byproduct of this was I won a number of awards in track and field. Despite the lack of awards for most of my life this pattern continues and for some reason it is hard to break. read more

 

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Dysthymia, personality disorders and the MBTI

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 I had been diagnosed with Dysthymia (Persistent Depressive Disorder) in the past and was reluctant to accept the diagnosis. Even though I have spent most of my life dealing with depressive like symptoms, for some reason I refused to identify with the label completely. In the past, when a teenager and young adult, I experienced mostly depression and occasionally brief(~4 hr) euthymic/hypomanic periods. As I have stated in my about section, I experienced severe depression in the morning and euthymia/hypomania in the evening with quite a regularity. Many clinicians would describe this as diurnal variation in the context of a mood episode but I am not so sure.

Continue reading “Dysthymia, personality disorders and the MBTI”

The boundaries of mental illness

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Isn’t everyone a little mentally ill? This seems to be the prevailing idea on my FB feed via memes. One of these memes says, ” relax…we’re all crazy, its not a competition”. When I see this I feel annoyed but at the same time I wonder is there a clear boundary between normal and abnormal? As someone who has experienced psychotic depression, OCD and Dysthymia I’m annoyed because that large of a spectrum invalidates my difficulty to a large degree. I think these people mean well because they are trying to include me as normal but on the other hand  saying that I don’t have much to complain about. Continue reading “The boundaries of mental illness”

Mental illness and mass shootings

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Recently a well known psychiatrist, Dr. Gail Saltz, and Obama stated that most mass shooters aren’t mentally ill. I’m a little perplexed about this since the most recent shooter, Chris Harper Mercer, and many others have at least a personality issues if not an actual personality disorder. A personality disorder is considered a mental disorder and according to Wikipedia mental illness and mental disorder are used interchangeably.

Most mass shooters are angry loners, not mentally ill. Mentally ill more likely to be victims

According to Saltz they tend to be loners with anger issues. Seems fairly obvious but I’m guessing there is more. They tend to often have a preoccupation with becoming famous and getting some kind of revenge against an unfair world. This could indicate some issues with narcissism and antisocial behavior. Additionally, there seems to be some depression however not the clinical variety. All of these mass shooters know they will not survive so the act is essentially suicide.

One solution to this problem could be to somehow screen students using psychological tests such as the MMPI when they are matriculated into college. After that ones that showed a tendency towards that behavior could be monitored closely. I’m sure at this point psychologists have a profile of this type of person.Many would claim an invasion of privacy but so is getting shot at. The rights of the individual have to be balanced against the rights of the group. At the moment they are too much in favor of the individual.

According to DSM-IV, a mental disorder is a psychological syndrome or pattern, which occurs in an individual, and causes distress via a painful symptom or disability, or increases the risk of death, pain, or disability; however it excludes normal responses such as grief from loss of a loved one, and also excludes deviant behavior for political, religious, or societal reasons not arising from a dysfunction in the individual.[

It’s interesting, looking at this DSM-V definition of what a mental disorder/ mental illness is, how it has to cause distress to the individual. What about relatives and society? Perhaps if these mass shooters don’t fit any definition the DSM-V needs to add a label just for them.

edit:

Here are a few articles I’ve read since writing this post that discuss the same topic. It appears one could profile these mass shooters but the description could apply to a lot of people. Mental health is part of the picture but not necessarily the most beneficial thing to focus on. A history of violence appears to be a better predictor.

What We Actually Know About the Connections Between mental Illness, Mass Shootings, and Gun Violence

Mass Murders Fit Profile, as Do Many Others who don’t Fit Profile

How to Stop Violence

 

Mood spectrum controversies

An interesting lecture from Nassir Ghaemi on the bipolar spectrum concept. According to him unipolar and bipolar used to both be encapsulated under the phrase “Manic Depression”. “Manic Depression” meant someone who either experienced severe depression or mania. “Bipolar disorder” is defined by an individual having both depression and mania/hypomania. The two phrases differ only by a conjunction….something I hadn’t paid attention to before. Additionally, according to Kraepelin, a well known historic authority on the topic, individuals displaying mixed states were more common than the ones who had more pure states of either depression or mania. This has been noted more recently by other researchers such as Benazzi who published a number of articles about people who experience mixed depression.

Prevalence of mixed depression, a combination of depression and manic or hypomanic symptoms, is high in patients with bipolar disorders. Controlled studies are needed to investigate treatment of mixed depression; antidepressants can worsen manic and hypomanic symptoms, and mood stabilising agents might be necessary

While my depression has been more chronic I have experienced periods of time when it lifted and I felt normal and productive. There has also been a pattern to some of these “remissions”. They often occurred during my menses and when ever I altered my sleep schedule to a minor degree. These remissions weren’t long enough by DSM standards to qualify for hypomania however as Ghaemi states, the threshold for hypomania is to a large degree arbitrary.

I have noticed as well that my depressions didn’t seem pure. They often included good amounts of irritability, insomnia, racing/crowded thoughts, hypersexuality, and a little grandiosity. Somewhat interestingly these symptoms tended to occur in the late evening to the early morning hours. This has been noted by some researchers who study ultra rapid cycling in children. Many clinicians would probably categorize my experience as someone who is experiencing a pronounced diurnal variation but I am reluctant to think that since diurnal variation usually means a slight remission of symptoms throughout the day without hypomanic-like symptoms.

Manic-depressive insanity in the sense here delimited is a very frequent disease. About 10 to 15 per cent, of the admissions in our hospital belong to it. The causes of the. malady we must seek, as it appears, essentially in morbid predisposition.– Kraepelin

Ghaemi’s perspective much like Kraepelin is based on the big picture of evidence and history, not mainly on image. At the moment the DSM-V seems to be ruled by people who are primarily concerned with the public’s image of them. They mainly don’t want to appear like they are over prescribing and over pathologizing normal behavior. The fact that bipolar is no longer grouped with major depression under Mood disorders is one example of their over reaction to anti-psychiatry.

As someone who has experienced chronic depression with a moderate severity, I am tired of hearing how my so called Dysthymia is defined as mild and at one time in the past, a personality issue. Bipolar disorder has been generally viewed as more incapacitating and more endogenous while unipolar depression is more neurotic. Ghaemi and Kraepelin’s theories make sense to me in light of my experience with depression. It has been for the most part, quite incapacitating, miserable and briefly quite pleasant.

Previous mental illness diagnosis and other health problems

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A couple of weeks ago I went to the doctor due to some problems with my sciatic nerve and some other mysterious nerve sensitivity in my hands, face and feet. Googling my symptoms indicated the possibility of nerve damage which gave me some anxiety and I thought possibly there was some treatment for my sciatic problem. The doctor wasn’t my regular one but another one since it was  a walk in clinic. I had initially intended to go to my regular doctor but she insisted that I go immediately to the clinic that day and that she didn’t have any time to see me. My understanding was that my mysterious nerve symptoms overlapped with a description of  someone having a stroke so I indulged her anxiety and went in the clinic that same day.

Once I got there however they treated me like the neurotic one and the doctor insisted in the end that I should go to a psychiatrist despite the fact that I have no insurance coverage for mental disorders. For some reason the male doctor fixated on my irritated hands which were slightly red and dry(possibly due in part to the sun). Judging by his thinking he seemed to think I had OCD and or possibly Lupus. The Lupus could have been due to admission of some joint pain and my previous diagnosis of depression. His impression of my sciatic nerve problem was that it wasn’t enough of a problem for him to treat it at all. I inquired about muscle relaxants (anti-anxiety meds) but he didn’t want to prescribe for some reason. The philosophy of this clinic seems to be that anti-anxiety meds should be prescribed by a psychiatrist.

I have had a similar experience before like this. I mentioned some mysterious nervous symptoms and was referred to a psychiatrist. It seems like when a doctor can’t find a suitable diagnosis they immediately try to label the person as unstable…not terribly logical but it apparently saves them from confronting their own ignorance. Admittedly, part of this problem could be due to an error in communication. Here is an excerpt from an article on the topic of mental health stigma.

From a public standpoint, stereotypes depicting people with mental illness as being dangerous, unpredictable, responsible for their illness, or generally incompetent can lead to active discrimination, such as excluding people with these conditions from employment and social or educational opportunities. In medical settings, negative stereotypes can make providers less likely to focus on the patient rather than the disease, endorse recovery as an outcome of care, or refer patients to needed consultations and follow-up services.

At this point, I still have problems with my sciatic nerve and can’t walk for more than 15 minutes or so without resting due to the pain in my lower leg. Additionally, I have unusual sensitivity in my hands and feet which makes typing at the moment somewhat unpleasant. I am quite sure my previous diagnosis of psychotic depression is giving this doctor an excuse to not take my symptoms seriously and I am not sure what to do about it. Stigma due to mental illness is frustrating and it can impact other health problems which aren’t taken seriously.

update: tests don’t confirm Lupus

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Does a bipolar spectrum exist?

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Is there such a thing as a “bipolar spectrum”? I am undecided on this question and welcome any new perspective. Joel Paris, a personality disorder expert, had written a book on the topic in 2012 and tried to make the case that much of what falls in the “bipolar spectrum” is really a problem with “emotional dysregulation”( borderline personality disorder). He also tries to make the case that Bipolar I,Bipolar II and melancholic depression are diseases despite the lack of any physical tests or genetic evidence.

Its crucial to remember that that the bipolar spectrum is an unproven concept. The alchemy that turns depression, impulsive disorders, childhood behavioral disorders, and personality disorders into bipolarity depends on entirely superficial resemblances between observable behavioral symptom patterns. Its not based on any basic understanding of the disease process.

For the most part the book was a logical and interesting critique of the “bipolar spectrum” concept however I had the feeling that, given the fact that Paris was a personality disorder expert, he might be jealous of all the money that goes to fund bipolar spectrum research and would like to divert some of those resources.

I have been diagnosed with Dysthymia and Psychotic depression and might, according to this book, be labeled with Borderline disorder. To label everyone with mood instability as Borderline or another personality disorder seems just as unreasonable as labeling everyone as bipolar given the fact that personality disorders aren’t defined much better than Bipolar disorder. In my case the instability could be explained by PMS and an extreme diurnal mood variation. According to Paris my personality disorder should have abated by middle age however I don’t think my condition has improved much since it began.

Finally, affective instability has a different outcome from bipolar disorder. It gets better with time, but never completely disappears. It remains the chief complaint of patients with personality disorders who are followed into middle age.

Patients with unstable mood experience daily life differently than bipolar patients according to Paris.

They describe their life as on an “emotional roller coaster.” they wake up feeling normal but get rapidly upset by each and every life event . In the course of the day, they feel sad and hopeless, angry to the point of uncontrollable rage, or happy enough to briefly feel slightly “high”. Each mood lasts for a few hours. These emotional reactions are intense, and can take some time to “come down” from them.

He seems to believe that the only true diseases in the DSM are melancholic depression(severe depression) and Bipolar I/II. One could still argue that the previously mentioned categories are still quite arbitrary and vague in comparison to many other diseases. Further more the definition of severe depression varies between different researchers and “severe” depressives only fared slightly better on antidepressants according to some experts(Moncrieff) who have written critiques of antidepressant research.