Shocking news about Electroshock therapy. Then again, maybe it’s not so shocking afterall… Regardless, I’m rather fascinated so I thought I would share. Enjoy!

Hyperactive Nerve Cells May Contribute to Depression
Identification of cellular mechanism could lead to novel and effective treatments
Scientists at BNL, Cold Spring Harbor Laboratory, and the University of California, San Diego (USCD) School of Mediciine, have identified hyperactive cells in a tiny brain structure that may play an important role in depression. The study, conducted in rats and appearing in the February 24, 2011 issue of Nature, is helping to reveal a cellular mechanism for depressive disorders that could lead to new, effective treatments.
The research provides evidence that inhibition of this particular brain region – the lateral havenula – using implanted electrodes can reverse certain behaviors associated with depression, and also provides a mechanism to explain this effect. These findings lend support to the use of deep brain stimulation as a clinical treatment for people with long-standing, treatment-resistant depression.
This research was supported through Laboratory Directed Research and Development at BNL, and by the Simons Foundation, the Dana Foundation, the National Institute of Mental Health, and a Shiley-Marcos endowment at UCSD.
“This research identifies a new anatomical circuit in the brain that mediates depression, and shows how it interacts with the brain’s reward system to trigger a  constant disappointment signal – which certainly would be depressing,” said Fritz Henn, a neurobiologist and psychiatrist at BNL and Cold Spring Harbor laboratories and a co-investigator on the research. “But,” he added, “identifying this circuit and how it works may open new doors to reversing these effects.”
For example, said co-investigator Roberto Malinow, a professor of neurosciences at the USCD School of Medicine, “It’s possible that the genes specifically expressed in these neurons could be targeted genetically or pharmacologically in order to manipulate them and reduce depression.”
Scientists have known that cells in the lateral habenula are activated by negative or unpleasant events, including punishment and disappointment, such as when you don’t get an expected reward. It may seem intuitive that such negative stimuli can lead to depression, but not everyone who experiences disappointment collapses into a state of  helplessness. To explore this connection, the scientists took a closer look at the brain circuits.
Overall, the results showed that these lateral habenula nerve cells were hyperactive in the depressed animals but not in the control subjects. Furthermore, the degree of hyperactivity coincided with the degree of helplessness.
To explore whether electrical stimulation could potentially reverse this reward-dampening effect, the researchers placed a stimulating electrode in the lateral habenula and measured the effects on the brain cells leading to the reward center. They found that electrical stimulation of hyperactive habenula brain cells markedly decreased excitatory activity leading ot the reward center.
“The study provides a cellular mechanism that may explain the hyperactive of the lateral habenula nerve cells observed in depressed  humans and animal models of depression, as well as why ‘silenceing’ these circuits, whether surgically or pharmacologically, can reduce depression-like symptoms in animals,” Henn said.

Be Specific, please.

Hazy Recall as a Signal Foretelling Depression
OXFORD, England — The task given to participants in an Oxford University depression study sounds straightforward. After investigators read them a cue word, they have 30 seconds to recount a single specific memory, meaning an event that lasted less than one day.
Cues may be positive (“loved”), negative (“heartless”) or neutral (“green”). For “rejected,” one participant answered, “A few weeks ago, I had a meeting with my boss, and my ideas were rejected.” Another said, “My brothers are always talking about going on holiday without me.”
The second answer was wrong — it is not specific, and it refers to something that took place on several occasions. But in studies under way at Oxford and elsewhere, scientists are looking to such failures to gain new insights into the diagnosis and treatment of depression. They are focusing not on what people remember, but how.
The phenomenon is called overgeneral memory, a tendency to recall past events in a broad, vague manner. “It’s an unsung vulnerability factor for unhelpful reactions when things go wrong in life,” said Mark Williams, the clinical psychologist who has been leading the Oxford studies.
Some forgetting is essential for healthy functioning — “If you’re trying to remember where you parked the car at the supermarket, it would be disastrous if all other times you parked the car at the supermarket came to mind,” said Martin Conway, a cognitive psychologist at the University of Leeds in England. But, a chronic tendency to obliterate details has been linked to longer and more intense episodes of depression.
Now researchers at Oxford, Northwestern University in Illinois and other universities are conducting studies with thousands of teenagers to determine whether those with overgeneral memory are more likely to develop depression later on. If so, then a seemingly innocuous quirk of memory could help foretell whether someone will experience mental illness.
There are already some clues in this direction. In lab experiments Dr. Williams has induced an overgeneral style in subjects by coaching them to recall types of events (“when I drive to work”) rather than specific occasions (“when I drove to work last Saturday”). He found they were suddenly less able to solve problems, suggesting that overgeneral memory is capable of producing one symptom of depression.
And an unusual paper suggests that overgeneral memory is a risk factor for post-traumatic stress disorder. Scientists at the University of New South Wales in Sydney, Australia, assessed 46 firefighters during their initial training and again four years later, when all had experienced traumatic events like seeing comrades injured or killed. Those who could not recall the past in specific detail during the first assessment were much likelier to have developed the disorder by the later one.
“People with P.T.S.D. tend to ruminate at a very categorical, general level about how unsafe life is, or how weak I am, or how guilty I am,” said the lead author, Richard Bryant. “If I do that habitually and then I walk into a trauma, probably I’m going to be resorting to that way of thinking and it’s going to set me up for developing P.T.S.D.”
Dr. Williams stumbled across overgeneral memory by chance in the 1980s. He had asked research subjects to write down the memories elicited by certain cues, and when they left the page blank he thought he had given unclear instructions. Soon he began to wonder about the significance of the omissions.
Usually people seeking a particular memory traverse a mental hierarchy, Dr. Williams said. They begin by focusing on a general description (“playing ball with my brother”) and then narrow the search to a specific event (“last Thanksgiving”). Some people stop searching at the level of generality, however and are probably not conscious of having done so.
This is sometimes a helpful response, which is perhaps why overgeneral memory exists in the first place — it can be a useful way to block particular traumatic or painful memories. Researchers at Leuven discovered that students who did poorly on exams and were more specific took longer to recover from the disappointment than those who were more general. The overgeneral students thought less about the details of what happened and so fared better, at least in the short term. “
“But these researchers say problems can arise when overgenerality becomes an inflexible, blanket style.
Without detailed memories to draw upon, dispelling a black mood can seem impossible. Patients may remember once having felt happy, but cannot recall specific things that contributed to their happiness, like visiting friends or a favorite restaurant.
“If you’re unhappy and you want to be happy, it’s helpful to have memories that you can navigate through to come up with specific solutions,” Dr. Williams said. “It’s like a safety net.”
Some experts think such insights could also be helpful in treating depression. For example, Spanish researchers have reported that aging patients showed fewer symptoms of depression and hopelessness after they practiced techniques for retrieving detailed memories.
“When we have a disorder like depression, which is so common and so disabling for so many people, we need to increase the tools in our tool kit,” said Susan Mineka, a clinical psychologist working on a study by Northwestern University and the University of California, Los Angeles, that is testing for depression and anxiety risk factors, including overgeneral memory. “If we could change their overgeneral memory, maybe that would help even more people stay better for longer.”
Dr. Williams has found that specificity can be increased with training in mindfulness, a form of meditation increasingly popular in combating some types of depression. Subjects are taught to focus on moment-to-moment experiences and to accept their negative thoughts rather than trying to avoid them. It may help by making people more tolerant of negative memories and short-circuit the impulse to escape them, which can lead to overgenerality.
Meditation means that for some, the past is no longer such a heavy burden.
“I always tried to forget the past, the very bad past that made me depressed when my husband died,” said Carol Cattley, 76, who attended a mindfulness course here taught by Dr. Williams. “I’m much more interested in it now.”
I found this interesting, and relatable. I cannot recall a single period of being happy because generally what I remember is being depressed. I can remember instances and events when I’ve been happy, but I have to work much harder to draw on these and they don’t span any length of time. My depressed moods are overarching where my happy moods are temporary injections.The negative experiences and emotions I’ve had seem to permeate the expanses of my mind and coat the good instances in cyanide. No sugar coating here. I do notice that I think back to things and stop at a certain, more general, point instead of continuing to the more specific. For instance, I’ll think about spending time at movie night with Friend. In general I remember being withdrawn from the crowd, irritable, and depressed. I have to push myself to think of specific nights or hours or minutes where this was not how I felt. I have had a lot of great times hanging out, laughing, joking and just being goofy with Friend and my other friends that come along, but these aspects of recollection are not what immediately springs to mind.  I experience happiness, but my recollection of it is muted. I have to put in that little added effort to bring up the happy moments. It makes sense that this kind of memory generalization would lead to or contributes to depression. It’s weird. For as much as I focus on how different my BPD brain is from your average persons’, it still strikes me just how different other people experience the world and just how much those little quirks in our biology can morph our entire perception and interaction in the world.

To Write Love On Her Arms

I promise

Week of Reflection. Since I’m feeling inspirational today I wanted to talk about one of my favorite non-profit organizations. I donate to a wide variety of charitable organizations, mostly environmental and wildlife. This is one of the only people centered organizations I give to. Why this one?
To Write Love on Her Arms is a non-profit movement dedicated to presenting hope and finding help for people struggling with depression, addiction, self-injury and suicide.  TWLOHA exists to encourage, inform, inspire and also to invest directly into treatment and recovery.
The vision is that we actually believe these things…
You were created to love and be loved.  You were meant to live life in relationship with other people, to know and be known. You need to know that your story is important and that you’re part of a bigger story.  You need to know that your life matters.
We live in a difficult world, a broken world.  We believe that everyone can relate to pain, that all of us live with questions, and all of us get stuck in moments.  You need to know that you’re not alone in the places you feel stuck. 
We all wake to the human condition.  We wake to mystery and beauty but also to tragedy and loss.   We know that pain is very real.  It is our privilege to suggest that hope is real, and that help is real. 
You need to know that rescue is possible, that freedom is possible. We’re seeing lives change as people get the help they need.  People sitting across from a counselor for the first time.  People stepping into treatment.  In desperate moments, people calling a suicide hotline.  We know that the first step to recovery is the hardest to take.  We want to say here that it’s worth it, that your life is worth fighting for, that it’s possible to change. 
Beyond treatment, we believe that community is essential, that people need other people, that we were never meant to do life alone. 
The vision is that community and hope and help would replace secrets and silence.  
The vision is that we can reduce the suicide rate in America and around the world.
The vision is that we would learn what it means to love our friends, and that we would love ourselves enough to get the help we need.
The vision is better endings.  The vision is people finding life, finding freedom, finding love. The vision is people breaking cycles, making change.  
The vision is the possibility that your best days are ahead.  
The vision is the possibility that we’re more loved than we’ll ever know.  
The vision is hope, and hope is real.
You are not alone, and this is not the end of your story.
That’s straight from their Vision on the site. They have some great Facts about Depression, Addiction, Self-Injury, and Suicide as well.
Every year they have a collection of days where they make a request that everyone actually write Love on their arms. Once, twice, as many times as you want. The point is so that people will see it and ask why you have Love written all over. People send pictures of their expression to the site, post them on their social networks, text them to friends, and spread the word.  I think this ‘event’ has passed, but that doesn’t mean you can’t still do it whenever you want. It’s a good thing to share, a good message to send. I wanted to let you know.  
I never cover my scars with this, but I write it between them, above them, around them, over and under my family tattoo. It’s silly but I love it.
It should be pretty obvious why I relate to this particular organization, having struggled with and continuing to fight, against all of these issues. While a lot of what I write in this blog is about how tumultuous and sad/angry/hurt I often feel. About the facts, statistics, and issues of Borderline Personality Disorder… My goal is to educate. To understand the label of BPD and see past it, to see the person Beyond the Borderline Personality. In knowledge comes understanding. In understanding comes hope. With hope there is the possibility for a better life. A life worth living.

Bordering on crazy at the Con

Sith Twi’lek

This past weekend was my Sci-Fi Convention. I’m a complete and utter geek. This has been established. I am unabashedly geeky.  Saturday was kind of ridiculous. Got to the Con around 10am. Friend and I were doing our Star Wars thing. Dark Lord/Lady of the Sith. He is my Master, I’m his apprentice. Think of it like Darth Sidious and Darth Vader. Sidious is the Master. Vader is the apprentice. Anyways, we have our own personas, not some pre-fabricated existing Star Wars characters. I have no awkwardness about Friend anymore. Well, mostly. I still can’t watch him being cute with the wife. It’s just uncomfortable. But she wasn’t around for our day/night so it wasn’t a problem. My costume came out really, really well. This was supported by the fact that I could not go 5 feet without someone stopping me, or me and Friend, to take pictures. I was approached by at least 5 professional photographers, one of which wanted to do a photo shoot with me in the future. Neat. This was amusing, until it wasn’t. I just wanted to check stuff out and maybe buy some things (which I didn’t b/c the dealers floor sucked this year). Ran into a creepy club guy I knew, I wanted to smack him. Ran into a guy that I can only tolerate for about 5 minutes, but he KEPT talking, wanted to throttle him. By the time late evening rolled around I was starting to panic with the shear amount of people that wouldn’t leave me be. Friend and I hid in an auditorium during panel just to escape the hoard. After this I took off, could no longer deal with the crush of the crowd. Too much fluxuation is exhausting. I even managed to Control my dysmorphia. This I feel, is one of my biggest accomplishments this weekend. All in all though, a very successful experience.
The next day I mellowed out the costuming to something pretty and cute. Did a 50’s style rockabilly swing dress with thigh highs with a back seam. Admittedly I did this to tease Friend. It’s a fetish of his and I intentionally hit his buttons to amusing effect. Especially since he knew I had probably gotten these for him when we were actually messing around. Which I did. Watching him squirm, not be able to touch gave me a little spike of pleasure every time I caught him looking. I’m mean, maybe a little manipulative. Idk. Call it what you will. We actually had a really nice day lounging about and talking with people we knew.
Until the karmic retribution kicked in. I was sitting around the lobby with all my closer friends. By the end of the Con and break down was starting who do I see? Boring-ex. This in itself wasn’t bad. He’s completely forgettable and uninteresting to me. I ignored him. What made me a little mad was, the only reason he would have volunteered to work the Con would be to poke at me. This was the first year I hadn’t volunteered for the Con (I always volunteer because I am friends with everyone that runs it). He never even went, vehemently disliking it, until I dragged him to it last year where he still didn’t have a good time and actively complained about the volunteer director. He was working where I always did. It was obviously to bother me b/c. I fought the urge to lash out and tell him how dick he was. I was more pissed at the lady that let him volunteer, because she knew he was my ex. The stupid thing was, I didn’t really care. I just wanted to flip out. He was being a dick, intentionally poking at me, trying to bother me, which it really didn’t and I still wanted to smash his head into the ground. But hey, maybe he’s had a change of heart and loves the Con and isn’t a wacky boring stalker? What did bother me… was seeing Evil-Ex. I knew he’d probably be here, but miraculously hadn’t seen him. It was only about an hour before I was going to leave so I’d completely relaxed figuring it was safe. Nope. I haven’t seen him in over a year. Not since I moved out of our house. I don’t think it was the seeing him, so much as I was taken completely by surprise and not prepared for it. My stomach jumped into my throat and I needed to get out. (Friend) Good, relaxed, almost happy even (I’m honestly not sure I know what this feels like), (B-ex) annoyed, wrath, amusement, indifference, (E-ex) panic, nauseous, panic, anger, (myself) revulsion, anger at myself for letting him get to me, depressed… all in the span of about 15 minutes. Not together mind  you. I don’t do emotions simultaneously. I cycle, rapidly. One to another. I left, grabbed my wine, and went to Friends to not be alone. Curled up on his couch, depressed, binged at dinner, vomited immediately after, curled back up with my drink until it was time to go home and go to bed. It’s so hopeless sometimes.
What amused me was I had dreams with Boring-ex in them last night: We were at some house together. He was doing work. I was ignoring him. We kept our distance. He kept inching closer though. Doing that thing where you want to make someone aware of your presence to inspire a reaction, but not interact. I noted him there, but went about whatever. Finally I was sitting on the couch drawing and he sat right next to me. Crossed his leg which made him hit my drawing pad. I lost my shit. Screaming, completely enraged. Wrath personified: Which is exactly what I wanted to do earlier that day and repressed the urge. My subConscious said no, you needed to do this. Not just needed to. FUCKING needed to. That’s what I get for repressing my urges. They come out anyways and disrupt me when I’m resting.
Along these lines, I’m actually getting sick of my medication. I know it’s supposed to help me Control myself. In general I haven’t been having such extreme mood swings. Not that I haven’t still been cycling, and exceptionally angry, but not so explosive.  The alcohol and the bulimic crap don’t speak well for my impulsiveness though. I can’t seem to get ahold on those. Meh. I just can’t tell how much the meds help me. When I’m fine, I’m fine and maybe it’s the meds. But when I’m not, I still do the stuff I’m supposed to be fixing. I know there’s no quick fix for this. It’s going to take a long time. A lot of work. It’s hard to see so far down the road when I’m so stuck in the right now.
Edit: Just found out I’m in one of the local papers for my Sith costume! Neat. I am really proud of how it came out. Especially since I made 90% of it by hand.

Morals of the Psych ER Saga

I was actually very reluctant to post this experience.
So why am I telling you this? Because this is the ugly side of having a Borderline Personality Disorder. It’s not just the therapy and the research or relatively harmless. It’s explosive and uncontrollable. It’s frantic impulse, threats, self-harm, and actual suicide for some. In that moment I felt crazy. I was in tears, feeling hollow and abandoned, worthless. With nothing to hold onto. My mind screaming, thoughts rattling around until I couldn’t tell the difference between reason and reality. When you can’t see the next minute because your entire world is dissolving in the one you’re in; there is no next minute. Just the one you’re living in.
It is meant to scare you. It is meant to make you think. To help you understand how extreme the emotions can be, and the things they can make us do. How difficult it is to control and not get swept away in the maelstrom that is the borderline mind. This is my reality.
I really didn’t belong there. It’s certainly not something that I’m proud of. I absolutely made a very bad choice. The reason I was there was a death threat even though there was absolutely no way I would have ever done it. I do not believe in suicide as an answer. As long as you’re alive, there’s a chance. A chance that things can change. Change is a powerful thing. As long as there’s change there’s hope for something better. This is my belief.
A belief that my ex knew very well that I held. I later found out that he’d been in my position for this kind of situation too. He made a dumb impulsive decision that he had no intention of acting out and had to take the consequences. There was a little vindictiveness in his refusal to listen. That’s what I get I suppose.
I wanted attention. I certainly got it from this. Not in the way I wanted though. These things never really turn out how you want them to. Everything about it is unhealthy. This type of behavior is part of why Borderline has such a stigma for manipulation. I’ll talk more about this some other day, because I’m really just now beginning to understand what this means in terms of BPD.
I wasn’t afraid of anything that happened to me in there, though maybe I should have been. This was a very dangerous situation to be in. There is no predicting who you will be kept with. No predicting how monitored you will be. No predicting what could happen to you. Most people would not have been so calm in the face of a huge guy about to rampage. Mostly I was annoyed and inconvenienced by the whole thing.

Not to mention I lost an entire evenings worth of sleep. I ended up being awake for almost 40 hours because I couldn’t rest once I got home. No sleep is never good for me. This usually deteriorates my mental state even more. 

I was afraid that this would come back to bite me in the ass though. That it could potentially leak out, and bar me from future employment, make it impossible to get a job. This was my biggest fear.

That and the fact that my landlords were not pleased. I could have lost my apartment, which I had just moved into.
It doesn’t just affect me/you either.  I felt like utter shit once I thought to consider the other people in my life. The people that care about me. I scared my roommate. I terrified my family. I had no right to put them through that. I never stopped to consider that this could affect them too. It’s something I won’t forget again.
The consequences of things like this hit you from all sides.
Like the bill. The whole experience, most of which was just sitting around, cost $2000. No extra zero there. Two thousand dollars. The nurses that have to watch you, the psych that has to be on call, the blood work they had to do, all of it is very, very expensive. This gave me something of a heart attack. Fortunately, I was on unemployment at the time so I could get this waved, but still. Very, very expensive. In money, time, and sanity.
Always, there are consequences to my actions. I reiterate. Actions that I will never indulge again. Mistakes that I have learned from. Having been through it once, believe me, once is enough. I am not altogether unhappy that I had this experience. It has made me consider the impulsive decisions that I am prone to, want to make, and rein them in. I take full responsibility for the mistakes I’ve made, but sometimes you need a swift kick in the ass to make you remember that, had I not been so impulsive in the first place, the whole thing could have been prevented. Prevention is something I work very hard on. It has helped me control my impulses. It has helped me consider my actions. It doesn’t necessarily stop the thoughts, but it has made me work harder to control them, get help for them. I don’t want to be controlled by these kinds of thoughts and behaviors. I’ve never wanted this, but now I have a little more motivation to really work to overcome them. It’s the nature of having a Borderline Personality Disorder to act this way, but we still have a choice in the matter, and the ability to change.
All these things are what I hope people see and understand. If this experience can help someone not make these kinds of poor choices than it was worth putting this story out there. I hope it helps someone. It sure opened my eyes. 

On the inside… the Psych ER Saga Continues

So Where did we leave off? Oh, yes, Rage Guy…

I was in more danger sitting in the friggin’ ward than I would have been wandering the streets!

So finally, after a couple hours, I was called in to see the nurse. She took my pulse, my blood pressure, my blood. I had to roll up my sleeve for her to do this.  My other sleeve, not the arm I was bleeding from, but still one with prominent scarring. This gave me a momentary heart attack because I thought they’d ask to see both arms after seeing the one. She asked me a bunch of questions and walked me back out to the ward where I was informed that a social worker would be with me “soon”.

Back to Rage Guy. Who was even more ragey. He was getting red, veins starting to throb in his forehead. He was onto stories of how he nearly killed a guy the last time he got this mad. Pacing. Back and forth. Much to close for comfort. I was expecting him to start throwing chairs like he was threatening. Take one and throw it right through the nurses’ station window. In the mean time, they’d admitted some grizzly mountain guy that smelled like he’d rolled in week old beer and garbage someone had pissed on, muttering to himself incoherently.

“Soon” apparently meant an hour and a half later. The clock on the wall was the loudest thing in there. The steady tick, tick, tick, was enough to drive anyone mad.

The social worker came and got me. She asked me the same questions the nurse did. Then started my psych evaluation. Apparently she’d been on the phone with Boring-Ex who informed her that I was a cutter.  Asshat. So I did what I do best. Lie with the truth. Put on my mask of the little girl, exhausted, a little vulnerable, scared, soft spoken, exceptionally pleasant, and wonderfully rational. I admitted that yes I overreacted but I didn’t quite mean what Boring-Ex thought I meant (I did word my suicide threat well enough that I didn’t outright say I was going to off myself).  There was some misunderstanding in what I said. Yes, I had been a cutter, but it’s not a problem. Admitting things in half truths, admitting where I made ‘mistakes’, giving them the answers they wanted to hear in a manner that made me appear soft but very competent.

After this they lead me back out into the ward. Where I had to take a phone call.
They called my parents. Seriously? I’m 29 years old and they’re calling my parents? Who, by the way, are 500 fucking miles away. What are they going to do besides have a heart attack? So I was sitting on the phone with my mom at 4 in the bleeding morning trying to explain to her that, no, I didn’t try to kill myself, my ex is just a giant douche bag.

An hour later I got to repeat the entire process a THIRD time for the Ward psychiatrist. I’m sure they were trying to see if my story slipped. I’m a fucking genius, and you think I can’t lie, cheat, and manipulate my way out of a psych evaluation? And the Oscar goes to. Medical professionals can be really stupid sometimes.

She decided I was stable enough to go. Plus my blood work came back negative for all drugs and they didn’t have a leg to hold me on. Though they would have had they done a physical examination too.

Back to the ward.

Where Rage Guy was losing his GODDAMN MIND. I couldn’t have given a shit less. On some level I knew I was about 10 seconds away from getting shanked in the collateral damage but it didn’t faze me. I just watched with rapt attention, amused beyond reason. He had started to yell, flex his muscles, hit the walls. The nurses came in, trying to reason with him. Because that was going to work? Finally they informed him that if he didn’t calm down they were going to dose him with a tranquilizer. Three guesses on how he took that. A security guard grabbed my arm and pulled me away. The door to the nurses’ station opened and about a dozen armed security guards swarmed in, circling Rage Guy. He was still threatening ALL of them. He was a cornered animal in fight mode. Ultimatum: Either take the tranquilizer or they were going to beat him down and drag him to lock up. He crumbled. They dosed him.

Not amused.

The guard that grabbed me had pulled me off to the side. Where they locked me in a small room, for my own protection. And forgot about me. About an hour later I tapped on the glass and they said they’d let me out when they found the key. Excuse me?!? I’m in a small, dark room, lit only through the glass from the nurses’ station and they don’t know where the key is?  I was fucking pissed. Why the hell was I the one locked away?

They let me back into the ward. Welcome to the waiting room from hell. Because that’s what I did for the next few hours. Wait. Maybe purgatory would be a better description.

Finally, finally, around 8 in the morning I was handed my discharge papers and given my socks/shoes/phone/wallet and a cab voucher.

What do you say to a cabbie that just picked you up from the Psych ER? It was a lovely spring morning.

And finally it was time to suture my own leg.

Psych ER. Shit hole. Wrapped in cellophane.

Never, ever, again.

And thus ends my adventure in the Psych ER. Please join us next time. Or not. Because I will never, ever go there again. 

Tomorrow, morals of the story and explanation with lessons learned

Spring Sucks… OR… Field trip to the Psych ER

Woohoo. One year anniversary of having been in the Psych ER! Ok, not really a celebratory thing. 

This time of year really bloody sucks.

Hm. Let’s back up. I’m Major Depressive. Yes, I know you know. For whatever reason, ever since I was about 12 years old I’ve had a couple week period of deep depression. Deeper than usual. Always around the end of March, beginning of April. When I was younger, before I understood what was going on with me I noticed it in my grades. I get A’s easily. As my mood deteriorated I wouldn’t even lift an eye to my grades. I got a B in math and my teacher pulled me aside after class and asked me if I had someone to talk to. Every year I had this pattern. {Relatively} Okay, okay, deepest darkest despair, okay. It persists. Everything is always harder for me at the beginning of spring. Darker, spiraling down faster than I can usually brace myself for. For the life of me I don’t know why. If it was winter I’d say I had SAD, except I’m always depressed anyways, and winter isn’t any worse for me than any other time. It’s like a very long cycling badness.

This was my main point for this post, but I figure I’d follow up with an amusing anecdote.

Last year around this time was the final explosion between me and Boring-ex. I’ve mentioned that the only times I really like him is when we’re breaking up, right? I had just moved into my new apartment, finally out of the house I’d shared with Evil-ex and was probably the happiest I’d been in a long, long time. That lasted about two weeks when Boring-ex got his period and abruptly flipped out on me. I hadn’t actually done anything this time, so I was shocked. We ended up screaming in the street, him bitching like a little girl and me not willing to take his shit.

So of course, I went completely crazy. A lot of factors contributed to this though. I only see my family maybe 4 times a year and I was skipping one of those times to spend Easter with Boring-ex, which was that weekend. I was incredibly homesick. I had just started meds for the {first} time a week or two earlier – with a warning that starting new meds could toss my emotional state. This time of year is notoriously detrimental to my mood for deeper depression.  I had just escaped Evil-Ex. We had broken up a while ago, but I had just managed to get out of a very abusive home. The abuse didn’t stop once we broke up. It continued right up until I left and I was still incredibly raw from years of hell. Coupled with this break up being so unexpected I bonked out harder than I have in a while.  Had it just been Boring-Ex and I breaking up, again, I would have been fine. Well. Less traumatized. Well. Not threatening suicide. Which I did. After too much wine and vodka. I was being overly dramatic. I wasn’t really going to do anything. Even then I knew he wasn’t worth even contemplating that. I just wanted him to feel bad. I wanted him to know what a jerk he was and how horribly he was treating me. Bad move on my part b/c he fancies himself a hero of the people and since he wasn’t near enough to me he called the cops. Cops and an ambulance came.  I managed to kick the rescue kids out of my kitchen, but I couldn’t shake the cop out. I was FURIOUS. Apparently Boring-Ex told him I’d overdosed? I was never so specific and of all the ways I could off myself I wouldn’t choose something so passive. I was actually confused when the cop told me this. Anyways, it was either “voluntary” hospitalization or he’d have to process me. Fuck that.

I had managed to slash up my arms a bit and gashed my ankle worse than I ever have before. I did myself some nerve damage on that one. I only had time to draw a band-aid over it really tightly though because I wasn’t about to tell the cop I’d hurt myself.   I pulled on a huge sweatshirt and eventually let him lead me to the car. I managed to hide this from the Psych people too otherwise they wouldn’t have let me go.

As soon as the taxi dropped me back home in the morning I had to run to the drug store for Steri-strips b/c I had to suture my leg closed. That’s always fun.

Perhaps I’ll do another post concerning my adventures in the Psych ER. Lemme know if you’re interested.

In conclusion, if I seem more down than usual in the next week or so, blame the season. This is an irrationally bad time of the year for me. I’m doing what I can to make it less so. Do they do temporary lobotomies? I could really use one about now. Just for a week or two.

BTW, all those chirpy birds need to shut it.

Bordering on Wakefulness

I have a terrible time sleeping. Not that this should surprise any of you dear readers, as it’s something I complain about a lot. I’ve had sleep problems, probably sleep disorders, since I was very young. Though I was never treated for it (until recently) I self-diagnosed my own insomnia. All through my teenage years, into college, and periodically still, I’ve had it. Sleeping maybe 1-3 hours a night for weeks on end, then finally crashing for 14-16 hours one day only to repeat the cycle over and over. I’ve been much better than this over the last few years, though certainly not great.
When I don’t get enough sleep, I’m a mess. More of a mess than usual. General fatigue aside; I can feel my mind dragging itself down. My moods shifts, swings more than usual. Concentration is nearly impossible and I slip into daydreams trying to replace the night dreaming I don’t get enough of. My mood is very dependent on sleep. The longer the span of sleep deprivation I have the darker my moods and thoughts begin to get.
I can feel the pressure on the back of my eyes, trying to hold themselves open. My vision distorted by the fatigue I feel. Seeing things differently, especially myself, than I know appear in the real.
Time slips by slowly. The clock ticking endlessly as I wait to for my day to terminate.
My ability to distinguish between the rational and the irrational is obvious. At least it is to me. I can’t help it though. I can’t stop it. All I can do is hope that tonight I find some relief from the restlessness induced by the evening before.
My mind starts roaming and racing, creating scenarios and running away with me. Once my brain starts whirring, working itself up, it’s that much harder to ease myself in a calmer state conducive to restful sleep. I may be physically and mentally exhausted when I lay down, but as soon as I start thinking, my mental activity starts running a marathon and there is no slowing it down.
I love to dream. Dreaming is a wonderful escape for me. Wildly vivid, living a life filled with the fantastic. When I’m sleep deprived, the few hours I do manage to sleep, I seem to be more prone to nightmares. Even in these I’m fascinated by what my subconscious creates, but they only contribute to my fatigue. Causing me to waken frequently. Often in a cold sweat. Heart pounding. Which only makes it more difficult for me to fall back to slumber. Then when my alarm finally sounds I can barely pull myself out of bed. Slipping into deeper depression.
I’ve found very little research done on the correlation between sleep deprivation, insomnia and Borderline Personality Disorder. Most of what I’ve found is pretty typical of anyone that is sleep deprived. Regardless, as someone that doesn’t do it well, I can’t stress the importance of getting an adequate nights rest.
“Sleep disruptions can be a common occurrence for those with borderline personality disorder (BPD). It may be caused by everyday stress, medications, or even the hyper vigilance we’re so predispositioned to. Getting a good night sleep may be easier said than done, but recognizing a problem and discussing it with your treatment provider may help you get some needed relief.”
Since Borderline Personality Disorder is a highly affected mood disorder, anything that impacts emotional regulation is going to be a detriment to the moods in someone with BPD.  Sleep helps humans maintain optimal emotional and social functioning while we are awake by giving rest during sleep to the parts of the brain that control emotions and social interactions.The only small study I did find on BPD and sleep dep reported that “the risk of affective and impulsive personality disorder traits were exacerbated by lack of sleep”. I could have told you this with only myself as a test subject. Getting enough sleep is a serious factor with depression in general. Sleep deprivation is one cause of lower levels of serotonin in the brain. Serotonin as we all know, is the bodies natural way to encourage feelings of well being. Hence, having a deficit of sleep deprived seratonin production may contribute to greater levels of stress and depression. Sleep studies indicate that BPD is not {necessarily} related to depression but that serotonin studies do point to links with suicidal, aggressive and impulsive behaviors, stress and burnout.
“In tasks requiring judgment, increasingly risky behaviors emerge as the total sleep duration is limited to 5 hours per night. The high cost of an action is seemingly ignored as the sleep-deprived person focuses on limited benefits. These findings can be explained by the fact that metabolism in the prefrontal and parietal associational areas of the brain decrease in individuals deprived of sleep for 24 hours. These areas of the brain are important for judgment, impulse control, attention, and visual association.”
Only in the past few months (5-ish) was I finally able to get some treatment for my insomnia. This is actually one of the main things that brought me to finding my psychiatrist. I was having such a hard time sleeping. I knew how it affected me, so I went to see a regular doctor to see if he could prescribe me something for sleep. Turns out he couldn’t. That was something for a psychiatrist to do. That coupled with the fact that I was having very self-damaging thoughts he recommended I find a psychiatrist immediately (after he asked why I had come to see him instead of going straight to the psych ER).  As I’ve mentioned before, as a supplement to my current medication, I am also given Trazadone. Even this doesn’t always help. I can stay awake through it, continue to wake in the night, and feel completely exhausted when I need to get up. It does help sometimes though and something is certainly better than nothing. I have friends on Trazadone as well, and they seem to have much better results with it than I do, so I imagine I have other mitigating factors contributing to my sleep problems that most people simply don’t have.
Curling up in my big comfy bed, buried under blankets, surrounded by soft pillows, lying there waiting for unconsciousness to take me. I always look forward to trying.
~Random Quote

Axis I vs. Axis II: Controversy in BPD- Part 4

Where does Borderline Personality Disorder belong?
I’m referring to the DSM criteria for Axis I and Axis II designation. Let’s start off with, what’s the difference between Axis I and Axis II.
* Axis I: major mental disorders, developmental disorders and learning disabilities. Axis I disorders are predominantly mood disorders.
 * Axis II: underlying pervasive or personality conditions, as well as mental retardation. Axis II disorders are personality disorders.

For or Against?
[For Axis 2] Personality disorders are classified as Axis II disorders.
Personality disorders in general have their own list of general criteria that must be satisfied. They’re a class of personality types and behaviors that the American Psychiatric Association (APA) defines as “an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the culture of the individual who exhibits it”.
“These behavioral patterns in personality disorders are typically associated with severe disturbances in the behavioral tendencies of an individual, usually involving several areas of the personality, and are nearly always associated with considerable personal and social disruption. Additionally, personality disorders are inflexible and pervasive across many situations, due in large part to the fact that such behavior is ego-syntonic (i.e. the patterns are consistent with the ego integrity of the individual) and are, therefore, perceived to be appropriate by that individual. This behavior can result in the client adopting maladaptive coping skills, which may lead to personal problems that induce extreme anxiety, distress and depression in clients.”
The behaviors cause serious interpersonal and social difficulties as well as general functional impairment. I don’t think anyone can argue that BPD fits this criteria, which is a large part of why it is considered Axis II. It also has a sub-designation as Axis II, Cluster B which is characterized by dramatic, emotional or erratic behavior. No argument there either.
[For Axis 1] Both Axis I and Axis II are psychiatric disorders. Only personality disorders and mental retardation are segregated onto Axis II. All other psychiatric disorders are Axis I. Does it really make sense to segregate these if they are essentially the same type of thing?
[For Axis 2] However Axis I disorders are generally treatable with medication. While some presenting symptoms of Axis II disorders may be treatable with medication, it’s not shown that medication can ‘cure’ a personality disorder and correct all presenting symptoms.
 [For Axis 1] Moving BPD to Axis I would have economic benefits. Many insurance companies don’t recognize BPD as a treatable condition and use it as an excuse to withhold payments. I know for a fact that my therapist classifies me as Major Depressive when billing my insurance company. I am pretty certain my psychiatrist does as well. This is certainly true, but not completely accurate.  I’m not going to complain though.
I think the major debate lies here:
[For Axis 2] Axis II BPD is pervasive to a person identity, characterlogical in nature.
[For Axis 1]: But…There’s some debate about whether BPD should be considered a ‘personality disorder’ at all because it has such a high rate of co-morbid symptoms that fall into the Axis I designation.
Axis I disorders are primarily for mood disorders that are reactions to atypical situations which are not part of a person’s character. “Mood disorder is the term designating a group of diagnoses in the DSM IV TR classification system where a disturbance in the person’s mood {not their character} is hypothesized to be the main underlying feature. The classification is known as mood (affective) disorders in ICD 10.”

[For Axis 1] There are many disorders that are just as pervasive as BPD such as bipolar, anxiety, and depression that are not caused by atypical situations, and are classified as Axis I disorders.
Two groups of mood disorders are broadly recognized (though not limited to these two); the division is based on whether the person has ever had a manic or hypomanic episode. Thus, there are depressive disorders, of which the best known and most researched is major depressive disorder (MDD) commonly called clinical depression or major depression, and bipolar disorder (BD), formerly known as manic depression and characterized by intermittent episodes of mania or hypomania, usually interlaced with depressive episodes.”

People with Borderline Personality Disorder almost always have a history of long term, pervasive depression.  I’ve never heard of anyone that didn’t, but I’m not a clinician. Hypomania is not always present. If you have manic phases though, that is the definition of Bipolar and while you can have bipolar disorder and BPD, I think you would then have both Axis I and Axis II designations, not just one or the other. From here it could be argued that the mood regulation disorders are the underlying cause for all the other disorder manifestations.
[For Axis 1] There’s also the stigma that a personality disorder just means that a person has a flawed personality that can’t be changed.  Except there has been plenty of research to support the idea that this is an emotional regulation disorder.  Which means it would technically be a mood disorder and qualify it for Axis I.
I can see how the mood disorder aspects can affect a lot of the behaviors and symptoms of BPD. I’m not sure it can explain all of them though. Things like a tendency towards impulsive behavior, identity disturbance, fear of abandonment, etc… these are not necessarily dependent on mood alone.
I certainly don’t believe that a personality disorder just means you have a flawed personality. Calling it a flaw implies that it’s a minor issue, easily corrected. BPD is not minor, nor is it easily treatable. You might not be able to change everything about who you are (or want to), but if there is an aspect of your life that you do not value; if you are willing to put in the effort; if you have hope of living a better life or just a life different from what you currently experience– it is absolutely possible to make changes in yourself. Without hope for change there can only be resignation to the inevitable. But people do have control over their lives, what choices they make, how they want to live. It may not be easy, maybe everything can’t be ‘fixed’, but it is possible to heal from those things that we are willing to work to change.

Inborn Biogenetic Temperaments: Origins of Borderline Personality Disorder

There is not one thing that leads to the development of BPD. Nature vs. Nurture, Psychological Factors, Social and Cultural Factors, Pathology… these things and more lead to the presentation of a Borderline Personality Disorder. I’m going to start looking into these things, take a more in depth look as some of the influencing considerations.  
In an article called A BPD Brief by John G. Gunderson, M.D. he talks about the Inborn Biogenetic Temperaments that lead to the development of BPD.
The degree to which Borderline Personality Disorder is caused by inborn factors called the “level of heritability” is estimated to be 68%. This is about the same as for bipolar disorder. What is believed to be inherited is not the disorder, per se, but the biogenetic dispositions, temperaments. Specifically, BPD can develop only in those children who are born with one or more of the three underlying temperaments or phynotypes: 

1.) Affect dysregulation
2.) Impulsivity
3.) Disturbed attachments 

Such temperaments represent an individual’s predisposition to emotionality, impulsivity, or relationship problems. For children with these temperaments, environmental factors can then significantly delimit or exacerbate these inborn traits.

Many studies have shown that disorders of emotional regulation or impulsivity are disproportionateloy higher in relatives of BPD patients. The affect/emotion temperament predisposes individuals to being easily upset, angry, depressed, and anxious. The impulsivity temperament predisposes individuals to act without thinking of the consequences, or even to purposefully seek dangerous activities. The disturbed attachment temperament probably starts with extreme sensitivity to separations or rejections. Another theory has proposed that patients with BPD are born with excessive aggression which is genetically based (as opposed to being environmental in origin). A child born with a placid or passive temperament would be unlikely to ever develop BPD.

Normal neurological function is needed for such complex tasts as impulse control, regulation of emotions, and perception of social cues. Studies of BPD patients have identified an increased incidence of neurological dysfunctions, often subtle, that are discernible on close examination. The largest portion of the brain is the cerebrum, the upper section, where information is interpreted coming in from the senses, and from hich conscious thoughts and voluntary movements are thought to emanate. Preliminary studies have found that individuals with BPD have a diminished serotonergic response to stimulation in these areas of the cerebrum and that the lower levels of brain activity may promote impulsive behavior. The limbic system, located at the center of the brain, is sometimes thought of as “the emotional brain”, and consists of the amygdale,  hippocampus, thalamus, hypothalamus, and parts of the brain stem. There is evidence that the volume of the amgydala and hippocampus portions of the brain, so critical for emotional functioning, are smaller in those with BPD. It is not clear whether such neurological irregularities have either genetic or environmental sources.

In summary, research indicates that individuals who have difficulty with impulse control and aggression have reduced levels of activity in t heir brains in a number of key locations. It is theorized that in personas with BPD, mild to moderate impairments in severl systems result in “errors” in the gathering, dissemination, and interpretations of data, and they are consequently more likely to respond with acts of impulsivity or aggression.
Can’t say as I have any arguments against this one. It seems pretty natural that someone with an emotional regulation problem would have the inborn genetics that predispose them to not regulate their emotions well.
I manage to fall into all 3 of the phenotype classes. Some more than others.
Affect dysregulation: Check.  My constant depression and anxiety aside, my temper flares, small things that any normal person would dismiss, bury themselves deep under my skin, set my fury on fire, I can’t let go of the thoughts and actions (intentional or not) that hurt me, and sink me into a murky mental grave. Every. Single. Thing… seems to affect me. Unless I go numb, shut myself off from the world, the people in my world, I can’t escape the barrage of sensations that affect my mood. I won’t say this is all the time,  I do manage to have short periods of times, sometimes a few days at a time, that are stable and okay, where my thoughts and moods don’t run away with me, but in the end, these don’t last.
Impulsivity temperament: Check.  I’m not so much with the not thinking about consequences. I can’t not think about consequences. I think about everything. I analyze things to death. Every path, every permutation, I think about it. Now ask me if that stops me. Not usually. I know the dangers, and I do it anyways. I’m too smart to ignore the consequences, but not smart enough to stop myself from pursuing the dangers, or maybe not smart enough to force myself to care about the consequences. I throw myself into things, the dangerous and the safe, the helpful and the harmful. I take it all in, until it all wears me out.
Disturbed attachment: Check.  Extreme sensitivity to separations and rejections. Some of my earliest childhood memories are of being afraid of rejection, not being able to please my father with my coloring, not being good enough, worrying that my mother wouldn’t come home from the hospital because no one told me she wouldn’t be gone forever.  These things are so small, so innocuous, I can’t imagine my reactions to these were normal. Who fears their father will stop loving them, or be gripped with anger, anxiety, and disappointment because a picture was ‘ruined’?  I had good parents that love me a lot, I don’t think they ever meant me any harm or intentional hurt, yet even in my earliest memories I read so much hurt and anxiety into the things that rocked my little world. I don’t believe it was anything they tried to do to me.
So , do I believe that my BPD is based, at least in part, to inborn traits? Yes, yes I do.
That’s not to say that the events and environments in my life didn’t contribute and exacerbate my problems. There’s no denying that. I can’t help but wonder though, if I wasn’t predisposed to feel, react, the way I do, would all these things ever have affected me the way they did? Still do?
Maybe I’m just hoping that there can be a genetic marker to pin point the brain dysfunction. If there’s a biological indicator, than there’s potential for a medical ‘cure’. Something that can be done to regulate those parts of the brain that don’t function to normal levels. I’m not sure you can actually cure a ‘personality’ {disorder}, but if there’s a genetic factor, than there’s possibly some scientific tinkering to help. I have a lot of faith in science (ß— Irony).