Guest Post #12: The Journey Inspired (Coping with Depression with Severe Fatigue)

Amanda, from the blog Mandibelle16, is a frequent commenter on this blog. Her own blog features her poetry and creative writings as well as articles about mental illness and her walk with depression. Amanda has suffered from Depression with severe fatigue since 2009. The following describes her first episode of severe Depression (which also featured auditory hallucinations) and its aftermath, and her long journey to wellness. But I’ll let her About page speak for itself. She is a talented writer and poet.

Mandibelle16 – About the Author
https://mandibelle16.wordpress.com/about-the-author/

mandibelle16

Amanda is a writer, blogger, and student from Edmonton, Alberta, Canada. She began blogging four-years ago to improve her writing skills and share her thoughts on several topics including, her experiences with mental illness.

Over time, Amanda’s blog has developed into much more than it’s original use. She has taken Editing and Creative Writing courses from Simon Fraser University and the University of Alberta to improve her writing and editing skills, in addition to her Bachelor of Arts Degree in English Literature received in May 2007. Her next step educationally, is developing a portfolio for the University of British Columbia for a Master’s in Fine Arts in Creative Writing. Only twenty-five percent of students make it in this online program and Amanda is hoping to be one of these students in May 2017.

Amanda also has taken blogging, poetry, writing, commenting, and photography courses through WordPress. She looks to improve her writing anywhere she is able. Amanda enjoys poetry and has been learning various forms of poetry from the website Shadow Poetry. Each new type of poetry is fun and challenging. She writes poetry from WordPress The Daily Post, word prompts and her own experiences, as well as participating in National Poetry Writing Month each year in April.

Amanda has been expanding and fine tuning her writing skills in fiction. She has recently been writing short stories and submitting them to literary magazines (etc.) as well as writing Flash Fiction for four different photo and/or word prompts each week. Amanda also participates in other writing prompts or challenges called 3 Line Tales; she also writes a different themed list each week; and participates in a photography prompt called Echoes of My Neighbourhood.

Moreover, Amanda is writing up her first draft of her first novel called How Was Last Night For You. The novel has been in process for a few years but is close to completion of the first draft. After the first draft, she will be working on corrections offered by another already published writer (with great thanks!) to complete a second draft, before hiring an established editor. Whether the book will be self-published or not is yet to be determined.

In addition, Amanda enjoys the Edmonton sports scene. She is a huge Oiler’s fan (NHL) even though the team seems to only be picking-up great draft picks and not making it to the playoffs since 2006. She is also a huge CFL fan of the Edmonton Eskimos who won the Grey Cup this past November 2015. Amanda also enjoys walking and doing yoga. She loves dogs, reading, shopping, and spending time with her wonderful friends and family.

Amanda also has suffered from a Mood Disorder (Depression) since 2009. She has tried countless medications and few have worked for her due to sensitivities and allergies to many medications. Amanda was in hospital when the she initially fell ill in 2009 for three-weeks and this last Summer for three-weeks to do a major medication change. The latest medication change was successful and Amanda is feeling more energy then she has in years.

Amanda suffers from severe fatigue due to her depression as well as insomnia. Her new medication has helped her in both areas. If you would like to talk to her about her mental issues or your own, please feel free; she is always willing to provide what help she can in that area with her experience over the past eight-years.

THE JOURNEY INSPIRED: COPING WITH DEPRESSION WITH SEVERE FATIGUE
By Amanda, Mandibelle16

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My story begins when I was twenty-three-years old. I had my first ‘real’ job after university and I had recently advanced from the role of receptionist to construction administrative assistant at the commercial development company where I worked. I had been in the administrative role in construction three-months before I became ill. It was Christmas time and I felt worn out. I thought I simply needed to take a few days off work to rest. Although I had no idea what was happening to me, I began to experience the onset of a psychotic episode in December 2008.

My episode began with a person from work (for instance) talking to me as they usually would and then afterwards I would hear an echo after they finished speaking. This echo consisted of this person’s voice altering and them saying something to me that was extremely mean. I knew something was not right with what I was hearing, but I had no idea what was happening to me. My current psychiatrist and I still don’t know the reason I had a psychotic episode. I wasn’t unusually stressed, using drugs, and I wasn’t grieving or experiencing emotional loss.

Work became extremely difficult for me to attend. Often, I would end the day crying. I also had difficulties concentrating on my work because my thoughts were going around in my head at such a rate that I couldn’t organize my thoughts properly.

At home I was having difficulty sleeping and I had begun to lose weight because I refused to eat much. I told my parents what was happening to me. My Mom kept track of my symptoms as they occurred. She had some experience with mental illness from an extended family member.

My second last day of work, we had a fun office party at a delicious restaurant. Later, we went to a different restaurant at night for drinks. The day had been a better one for me but it ended in tears. I thought I overheard a guy in my work saying something mean about me and I left the second restaurant crying.

I came back to work one last day but I couldn’t control my emotions which were all over the place. A lady at work drove me home and since that time I have not been able to return to work. I’m still embarrassed how I broke down that day. I had no control over myself and despite the fact my episode was eight-years-ago now, I still feel ashamed for how I acted that last day.

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On December 24, 2008 my Dad and I sat waiting to get into a Doctor at a clinic. The Doctor prescribed me Ativan to aid me with sleep and for anxiety. My parents also took me to the University of Alberta free psychiatric clinic. I went there a few times and they diagnosed me with having a psychotic episode with auditory hallucinations.

Eventually, I ended up with help from my Dad and the U of A clinic, admitting myself to the hospital because I was hearing suicidal voices. I didn’t want to kill myself but I was hearing voices whom were telling me to end my life.

Before I went into hospital, I spent three-weeks at home hallucinating and the thoughts in my head kept going round. I would sit down on the couch and for hours become immersed in my thoughts. Then suddenly, it would be lunch time and my Mom would be home from work to check on me and ensure I would eat some lunch and take my medication.

I was under several delusions and one delusion was that food didn’t belong to me so I wouldn’t eat because I thought that was stealing. During my episode I lost about twenty pounds in a month. I also began to feel physical sensations at times moving up my arms.

Additionally, I stopped taking care of myself. It was difficult to force myself to take a bath or shower and often the moment I thought about it, I would forget I needed to accomplish that small task. I didn’t understand why I wasn’t taking care of my appearance and hygiene because I’ve always been finicky about taking care of myself.

I was in hospital three-weeks and when you are hearing voices from people, the hospital is a terrifying place to be. Hearing voices occurs in a person experiencing a psychotic episode because the synapsis in their brain misfires.

If you can recall any thought or idea in your head that you’ve ever learned, seen on TV, or read about, these ideas or thoughts become misdirected in your brain. A person’s worst thoughts come through as voices they hear coming from other people, the TV, Radio, or out of nowhere. For instance, when I was ill I would hear the announcers on a Basketball game on TV and it would sound like they were only talking about me and not the game.

The Doctor I had in hospital took me off the antipsychotic I had been on from the University of Alberta clinic, and slowly put me on a newer antipsychotic drug called Invega. Suddenly, my thoughts were clear and I wasn’t hearing any voices echoing a person talking to me. The thoughts in my brain stopped circling. I have never had a psychotic episode since, and I pray I never do.

When I returned home, I experienced a depressive episode. I lost my energy and began to have severe fatigue. Although, my fatigue levels have changed from awful to manageable, they are something I still deal with today. Fatigue is different than being sleepy. It has a physical and mental aspect and once you run out of energy a person can do nothing but lie down until they have more energy from resting. In this time, I developed a mood disorder that is likely depression.

fatigue
Severe fatigue is a common problem with severe depression.

I also lost some cognitive function which I would later regain. My handwriting for example, was childlike. It took me three-days to fill out my application to my insurance company for disability which was thankfully approved. Reading a simple young adult chapter book such as Twilight or Harry Potter, was extremely challenging at first. It was a couple of years before I could read more than simple adult books and longer still to work back up to being able to read for long periods and read difficult material such as textbooks and literary novels.

I met my present psychiatrist in April 2009 and she took me off of the Invega once we knew I was safely out of the psychotic episode. My psychiatrist switched me to a new antipsychotic because my old one left me with intense muscle pain in my shoulders and neck. For eight-years my Psychiatrist and a Psychiatric Nurse, helped me try tons of medications such as anti-psychotics, antidepressants, stimulants, and sleep medications. I participated in psychiatric testing so we could measure my improvement up to three-years after the episode occurred. We tried an array of medications but the majority had little effect.

Moreover, I had a consultation with a sleep psychiatrist whom I saw every six months. The sleep medications he gave me were a short-term solution to a sleep-disorder that had developed. I had insomnia and had both trouble falling asleep and staying asleep.

The results of trying all this medication was excess weight gain. At first, because I had lost weight in my psychotic episode, I needed to gain a few pounds but now I’m thirty-five pounds over a healthy body weight.

My severe fatigue doesn’t allow me to do cardiovascular activity intense enough to burn fat. I was extremely fit before my episode so being overweight is something that has always upset me because I don’t have much control over it. I eat healthy and in small portions but it doesn’t make much difference. Not to mention, when my mood disorder became worse, it was even harder to exercise.

I believe my health improving this last year, is due to letting myself be admitted into hospital for a medication overhaul. Sleeping at night had become nearly impossible. My Doctor had me go off my sleeping medications and on a new antipsychotic called Clozapine which makes a person extremely sleepy when they take it. Clozapine has to be monitored closely in patients because it can cause increased heart rate and increase white blood cell count.

I worked my way up slowly to the right dose of Clozapine for my body and it wasn’t easy. The second and third day after going on a new dose of Clozapine, I would feel awful. Then my Doctor would increase the dose and the cycle would repeat until we reached the correct dose for my body.

I spent a miserable weekend at home in a hot house in July on too large a dose of Clozapine. Surprisingly, that’s how we found my perfect dose. Now I only have to go for blood work to check my white blood cell count every so often. But Clozapine allowed me go off of a larger dose of antidepressants and sleeping pills. I can sleep amazingly well at night, even though I sleep to 11:00 am because of the medication.

By November 2015, my energy had increased and I was reading plenty again, writing more, and able to take my last Residential Design class. I could last at night for four or five hours meeting with friends. By January I noticed my concentration had substantially improved. Even though my physical stamina is low, I’m able to do yoga and go for a short walk at times which is a huge step up for my physical health from the last two or three years.

A wonderful aspect of Clozapine is that it is the only antipsychotic that actually heals your brain. I don’t know if I’ll ever be as carefree and able as I was at twenty-three-years-old, but each month I experience improvements to my health. Combined with a supplement program that is helping me to lose weight, I’m doing fantastic for a woman who suffered such a terrible psychotic episode and has lived with mental illness for eight-years.

My goals of late have been entering my writing into writing contests for different magazines to have my writing published. I write fiction, poetry, nonfiction and a bit of everything. I have been blogging for four-years as well. In the beginning, it was to improve my writing skills back to what they were when I finished my English BA.

Now I focus on improving my writing creatively. I’m writing a fictional novel on a curse, a sea witch, and two main characters who fall in love. I’m also participating in National Poetry Writing Month in April. You can check out my blog at: http://www.mandibelle16.wordpress.com.

I have gone back to my roots, to my love of literature and the written word. I adore writing and it makes me whole. It’s what I’m meant to do. I’m looking at applying for an online MFA at UBC in creative writing. I believe my family and friends, creativity, positivity, and faith in God, have lead me through difficult times in my life. They have allowed me to find light when everything seems dark.

Mandibelle16.(2016) All Rights Reserved.

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Is NPD really a dissociative disorder?

dissociative_identity_disorder

I think there’s good reason to think NPD (and to some extent, BPD) is really a dissociative disorder. Think about it. There is a true self and a false self that are split from each other, much the way a person with dissociative identity disorder (DID) has a “waking self” or the “host personality” (the DID’s equivalent of the true self) that has split into different “personalities”, some of which aren’t even aware that others exist. Still, the narrative of the true self runs beneath everything, like an underground river feeds the land above it. In other words, the false self’s behaviors are driven by the need to keep the true self hidden and/or protected.

NPDs (and BPDs) also have episodes of dissociation and feelings of unreality, depersonalization, derealization, or even annihilation when under stress or when injured, and these dissociative episodes can become so bad during a narcissistic crisis that a psychotic break can occur. Narcissists are not unknown to become psychotic during old age due to massive loss of supply.

There are other things too that are dissociative–the magical thinking, the splitting, and the manifestation of the FS itself, which is, in essence, a separate “personality” from the TS.
I’ve read elsewhere that NPD could be a dissociative disorder, and I think it’s a valid argument. Thoughts?

Narcissists in fantasyland.

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We already know narcissists lie. It’s the one thing they’re all good at. I read a conversation today about the way narcissists lie even about things there is no reason to lie about, and that they also begin to believe their own lies.

Narcissists have been telling lies for so long and have gotten so good at it that they really do believe their lies are the truth. Sometimes they even become skilled at using lies to cover up other lies. To a normal person, living a lie and trying so desperately to cover the truth would be an unbearably stressful way to live. Narcissists are stressed out by this as much as anyone else, but they don’t know where their stress comes from. They are deluded and think their lies are the truth. They honestly don’t know any better so they can’t stop lying and they can’t stop the stress that comes from that.

Think of a young child playing pretend. The child may know the fantasy is just a fantasy, but while they’re in it they believe it’s the truth. Tell the child their fantasy is a lie and they will rage and get very upset. But for young children, living outside reality to some extent is normal. When an adult lives outside reality and creates a fantasy world they think is real, we call it crazy.

If you tell a narcissist to stop lying, they will attack or sometimes, withdraw or even disappear. This happens because: 1. They hate the truth because if they know you can see through their lies, you have blown their flimsy cover and that is terrifying to them; and 2. like a young child, they don’t want to leave their fantasy world–a dream where they are perfect and superior to everyone else. Because in reality they know they aren’t. In fact, narcissists have dismally low self esteem. They hate themselves–but are in love with the false self they created. That’s where their grandiosity and sense of entitlement comes from. They need a constant influx of narcissistic supply from you to keep their false image of themselves alive.

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In “People of the Lie,” M. Scott Peck discusses a malignantly narcissistic patient of his named Charlene. After years of therapy (during which Charlene spent most of her time sadistically playing with Dr. Peck like a toy), in one session she told him about a dream she had of a “marvelous machine.” The machine did everything and was perfect in every way. Charlene proudly told Dr. Peck she had designed and built this marvelous machine herself. When Dr. Peck suggested this machine that did everything was actually an elaborate weapon Charlene had created in her mind to avoid facing the truth about herself, Charlene’s cover was blown and she reacted with unreasonable rage, attacking Dr. Peck for not agreeing with her about the perfection and beauty of the “machine” she was so proud of and what its true purpose was. She could not bear to face the truth and preferred to keep living in her fantasy world of delusions.

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Wizard: “Pay no attention to that man behind the curtain!”

The Wizard in The Wizard of Oz wanted to appear to be a powerful and ruthless tyrant, so even though he was actually a weak and unassuming little man, he hid behind a curtain, amplified his voice, and projected a scary image onto the far wall when Dorothy and her friends entered the Wizard’s castle. What gives the Wizard away as not being a true narcissist (I’d venture to guess he was probably a borderline) was the fact that when exposed, he took responsibility and showed true remorse for behaving the way he did. It’s still a good illustration of the way narcissists deny reality though.

Narcissists hate themselves and only want you to see what they want you to see. While perhaps done unconsciously, they construct a False Self which is a self of lies. This mask isn’t who they are but they sure get good at convincing everyone it is. Their abuse of others stems from the need to protect “the marvelous machine” they created. If they feel this cover may be blown by the truth, they attack, abuse and rage (or leave), because they’re so terrified you may see the emptiness inside or even worse for them, the vulnerable and defenseless True Self hiding in the dark corners of their unconscious.

I’ve seen narcissists talking to themselves, sometimes in public. It’s weird. It’s as if they don’t know they are talking to themselves. I used to point this out to my ex when he was holding conversations with himself, and he’d deny it or get angry. Could narcissism be a psychotic or dissociative disorder? Do they hear voices in their heads? Sometimes I wonder.

By telling themselves so many lies, they are abusing themselves as much as they abuse others. Only they never realize this. And they won’t ever let you tell them. They’d rather wander forever in the confusing labyrinth of their disordered minds where up is down, north is south, dark is light, yes is no, wrong is right, and they are gods. They can’t face reality because it might destroy them. Or so they believe.

#23 – The Borderline-Narcissistic Continuum: A Different Way of Understanding “Diagnosis”

This is more the sort of thing I want to blog more about. Here’s a somewhat scholarly but interesting and thought provoking article about BPD (borderline personality disorder) being on a continuum that ranges from psychosis (being totally out of touch from reality) to normal (neurotic) behavior (the idea being that everyone is neurotic to some degree, which is what makes us human).

Borderline Personality Disorder was originally given that name because mental health experts studying this disorder in the early years believed that borderlines straddled the line between psychotic and neurotic in their thinking and behaving patterns. For a borderline undergoing healing, NPD (actually functional narcissism, which includes developing self esteem) is the first step toward mental health.

According to the experts mentioned in this article and many mental health professionals, BPD is a less functional and more ego-dystonic form of NPD.

BPD Transformation

For the purpose of understanding psychiatric problems in a more nuanced and optimistic way, here is a diagram from Donald Rinsley’s book Treatment of the Severely Disturbed Adolescent:

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Please click on the picture to see it larger. Each row corresponds vertically to the rows above and below in describing degrees of emotional development, and each row describes emotional growth over time from left to right. The majority of the text in brown is Rinsley’s own diagram; the bottom additions in white are mine.

Donald Rinsley was among the most respected authorities on borderline and narcissistic conditions in the second half of the 20th century. He was a psychodynamic therapist who ran a psychiatric hospital for severely troubled adolescents in Topeka, Kansas in the 1960s, 70s, and 80s. He later worked extensively with personality-disordered and psychotic adults in an outpatient psychotherapy practice.

I believe that much can be learned from studying Rinsley’s…

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