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Diagnostic Criteria

by Isyan 3 months ago in coping

A Journey in Mental Health Relapse and Recovery

stock image of a dewy spider web

What is private besides our minds? What space truly belongs to us, beyond the cubic inches of our individual crania? Is that space even private domain at all? Certainly not if our behavior displays substantial deviation from social norms or puts ourselves or others in harms way. Certainly not when one has had a relapse into a volatile state of psychosis after many years of stability and is now mired in a legal battle due the collateral damage of a crisis.

In 2010 when I was first diagnosed with Bipolar I Disorder I would not have imagined that today, over a decade later, I would be begging mental health professionals to yoke me to the diagnosis as they had in the past. At the time I rejected the diagnosis, which had been applied to me after I spoke to a psychiatrist for a total of 10 minutes. I knew I had been acting outside of social norms but I rejected the possibility that I was mentally ill, preferring to believe that I was a visionary and boundary pusher who may have just pushed too far this time.

In 2012 however I found myself in and out of psychiatric wards, fighting both for emotional stability and against the diagnosis and life sentence of prescription medication I had received. I begged my clinicians to consider that I may have had the wrong diagnosis and explained that the medications, which left me lethargic and drooling, were at a dosage well above my therapeutic requirements. No one listened, if anything my protests affirmed the resistance and medication compliance expected of my diagnosis. I was repeatedly met with the resounding cruelty of people who were sworn to do no harm.

I was desperate to escape the pathologization I was experiencing, not only by clinicians, but by friends and family. It seemed that other people's ideas of Bipolar symptoms colored over the reality of my experiences, labeling my every mood or action within a spectrum of diseased behaviors. I was losing access to being the eccentric, creative, highly sensitive person I was - losing my unique identity to the convenience of a diagnosis. There was no distinction between what I considered the innate qualities of my being a "crazy artist" and my being, well, just plain crazy in the eyes of others. There was also no consideration of layers of trauma I was experiencing from a lifetime of emotional and sexual abuse, and my personal struggle to come to terms with my sexuality and gender identity.

Most disturbing to me was that loved ones seemed content, even pleased, with the person I was becoming under the influence of heavy anti-psychotic and anti-seizure medications - demure, quiet, lethargic. It was almost as though they had been longing to see me subdued for some time: taken down a notch from being the vibrant, bold, outspoken, young female bodied person that I had been - the person who lived on farms, walked in the rain, painted the walls, wrestled goats, hitchhiked, shaved their head (and nothing else), didn't ask for permission. I had been behaving outside of social norms for quite some time, especially to the traditional sensibilities of my father's Middle Eastern immigrant family. Given their enthusiastic response to my psychiatric treatment, I could only deduce that they were relieved by the drugged, home bound zombie I had become.

Meanwhile, as the fragile, wild bird of my soul withered in the living prison of my over medicated body, I plotted my own death as a means of escape. Suicidal ideation is considered a symptom of depression. For me it seemed like the only way I could reclaim sovereignty over my body. Nothing belonged to me anymore, my mind belonged to textbook pages. I wanted to take myself back, take myself away from the pain and confusion. I had tried negotiating with my captors, the psychiatric system and its supporters. I had begged and pleaded that my medication dosage be reduced. No one was listening. I was told again and again that I would need to take these medications for the rest of my life, just to achieve a most basic functionality, and for me that was not a life I was willing to accept.

Fortunately, my suicide attempt was not successful, but it did shift something for me, reminding me that I still have agency and I still have a life worth living. In 2013 I worked hard to wean myself off of anti-psychotics, essentially tranquilizers, they do not "correct" brain chemistry, they suppress everything - the good and the bad. I was on the highest dose of ziprasidone, the drug had kept my surface calm and tranquil, while inside I was boiling with deep seated rage. The subsequent return of my emotions, although jarring at first, was as relieving as a sudden rain in an era of drought. I could feel again - I could respond to music and the impulse to dance, I could cry tears of joy and sorrow - it was like being born anew. It was beautiful and volatile, and after a few months I found myself back in a psychiatric in-patient facility, where medication non-compliance was added to the list of my concerning symptoms.

In 2014, however, on a new medication and with a new psychiatrist, I was able to successfully wean off of all medication under supervision. Despite living on the fringes, I was remarkably stable - anxiety was a daily battle but I did not experience any states of mania or psychosis, nothing that was incompatible with the frenzy of late stage capitalism at least. I wondered if I had really been Bipolar at all, I believed the psychotic states I had experienced were the byproduct of excessive fasting, severe hormonal imbalances, the use of psychoactive drugs and my own predisposition to push the boundaries of my consciousness.

I read Spiritual Emergency, edited by Stanislav Grof and it blew me away. The altered mental states I had experienced, like psychedelic states, were profoundly meaningful to me and I suspected, had value to others as well. I became involved in the "Mad Pride" movement and participated in various groups affiliated with the former Icarus Project, a grassroots organization advocating for peer led, mutual aid based alternatives to conventional mental health support. During my undergraduate degree I became acquainted with "Critical Psychology," a field which examines how psychology and psychiatry replicate the status quo, have been wielded as tools of social control, especially over marginalized groups, and how the field has regularly employed unsound science to establish and promote itself. I was determined to go into psychology or social work myself, in order to be a voice of lived experience in the field, to challenge the existing structures of mental health care and help establish alternatives to this substandard treatment, such as respite centers and peer led interventions. I believed I was on my way to proving to myself and my family, that full recovery from severe mental health symptoms was possible.

That was my plan, until the unprecedented year of 2020 derailed every aspect of my wavering stability. I had not experienced a psychotic break and hospitalization since 2013, not until the summer of 2020, when housing instability, trauma, poverty, fasting, substance use and the collective outrage and protest over the murder of George Floyd helped catapult me first into a creative manic period and then into a fully detached state of psychosis. An unfortunate series of misunderstandings lead to some aberrant actions on my part which incurred felony charges and over a year of dragged out court proceedings (still in progress). There is little chance that I will be able to pursue graduate studies and licensure in psychology now, even with the best possible resolution of my case.

One possible resolution would be California Penal Code 1001.36 - Mental Health Diversion. The penal code stipulates that if a mental health diagnosis factored into criminal conduct, the court may find the defendant better served by undergoing 1 -2 years of outpatient mental health treatment. Successful completion of the program means the state will drop criminal proceedings and the defendant will not have charges on their record. It sounds like the ideal course of action for someone like me, full of remorse, with no prior record, with a mental health diagnosis and with professional and academic goals at stake. Yet, my years of medication-free stability is now undermining the willingness of clinical professionals to apply the diagnosis of Bipolar I Disorder to my symptoms and behaviors.

It is honestly surreal that what seems like only a few short years ago I could not escape the diagnosis I did not want, or the grip of forced psychiatric treatment that came with it, and now I am desperately trying to prove the fact of my mental illness. I worked so hard to fight against the stigma of my diagnosis, to get my life on track, to continue my education, to prove to relatives that I was not that sick, weak person they would need to take care of for the rest of my life. I weaned myself off of disability benefits and medication (not that there is anything wrong with being on either) to prove that I was well, whole, high functioning. I could have been the poster child for the recovery model of mental health treatment!

I have functioned so highly, that I now may not be able to access the very diversion program which is designed to help me. I once begged my mental health providers to lower my medications or reconsider my diagnosis, now I am begging them for medication, diagnosis. I was once shamed for receiving disability benefits, now I am concerned that I should have never gotten off of them. The system perpetuates madness. Prisons and jails are essentially mental health facilities, as the majority of inmates experience mental health diagnoses. My personal life, my mind, my brain is flayed open for the scrutiny of the courts and I do not seem to fit into any tidy diagnostic criteria despite my best efforts.

If I wasn't quite crazy at the start of this ordeal, I assuredly will be by the end of it...

coping

Isyan

lifelong writer and artist emerging from my lair

Read next: She Will Rise: Part 4

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