Letter to the Psychiatric Times editor: Mania and Hypomania: The Latest Thinking on Duration of Episodes and Other Features

Dear editor,

In response to the October 29, 2019, article by Dr. David Osser, I would like to share insight into diagnostic modeling from the patient perspective.

https://www.psychiatrictimes.com/article/mania-and-hypomania-latest-thinking-duration-episodes-and-other-features

I’ve got bipolar. Both I and II. And schizoaffective disorder. And . . . anything else diagnosed in that 15 minute span of presentation at the ER, which is where I received each of these diagnoses.

For me, an initial diagnosis is a great place to start deciding how to treat my symptoms. After that, the game plan is to treat my specific symptoms and not the diagnosis. Providers sometimes miss this essential progression in treating peers because of adherence to diagnostic criteria.

My significant issue with bickering about manic durations is that showing symptoms for too short a span (it appears 7 days for mania and 4 days for hypomania) serves the primary medical rationale “We might treat it wrong if we don’t have the proper diagnostic definition.”

I’ve been riding this rodeo since 1987, diagnosed in 1999. I’ve had rapid cycling with frequencies every hour and not days. Some providers question the existence of mixed episodes. I’ve had a provider insist I treat psychosis first because of the schizoaffective diagnosis, when the psychosis is consequential of severe depression. Treat the depression, the psychosis goes away.

In all this time messing about with treatment, there is one constant:


All mental health treatment is trial and error.


So, does it really matter about the duration of mania in treatment? I’m showing mania-oid symptoms that happen to last three days. Try me out on some LiCO3. If my mania-oid symptons abate, bam, good job. It’s mania. If not, then . . . let’s trial and error other treatment options.

Being practically cynical, adhering to a minimum episodic duration means peers like me won’t receive the proper treatment of mania because I don’t meet the diagnostic criteria. This is exactly the contrary argument being debated for a revised two day episodic duration . . . even with the proposed revision, my true treatment needs again fall outside the diagnostic capture zone.

Being fully cynical, I often believe the DSM is a billing manual more than a diagnostic treatment manual. This is borne primarily from years of trial and error treatment efficacy frustrations and probably isn’t a reflection of actual purpose.

All said, my sincere recommendation for providers is treat the person and the empirical symptoms and not the diagnosis and diagnostic criteria. This is what works best for me in my recovery journey.

Kindest regards

Steve Bringe
Founder, Stand Up To Stigma

Opinion: Behavioral health services for New Mexico peers FIRST

As an involved mental health peer & who has served advisory and leadership roles
in the New Mexico community for 10 years, I question currently proposed immigration policy and its impact on our peer services.

New Mexico is a “Border State” and a large influx of undocumented immigrants will greatly strain already negligently supported programs in the state. It is reasobable to project this influx will endure funding stretched beyond a social Hooke’s constant and generate longer waiting periods for the limited number of providers in New Mexico.

A typical waiting period for an outpatient behavioral health appointment is three to six months. Our homeless population is underserved with an ever growing population – obviously, housing needs are a HUGE issues for our community. Inpatient stays are revolving doors because inpatient treatment is about immediate stablization and not sustained outpatient success in recovery and wellness.

Why? Funding. Or more specifically, lack of funding. New Mexico doesn’t have a lot of money. Providing every behavioral health service needed for our community takes money. We don’t have enough.

This is an entirely unpopular platform and I’ve been called “heartless”, “racist”, “anti-immigrant”, “white supremicist” (my ancestry makes me one quarter Chinese and one quarter Tahitian – first generation born in America), and a number of other rhetorical barbs designed to shame me for my strong beliefs on social services in New Mexico.

This is an unpopular platform – I openly own this – and I have zero qualms sharing my belief.

With underserved peers and families who are citizens of the United States of America, our citizens’ behavioral health needs must come first. These peers are our priority and our responsibility. When our peers’ behavioral health needs are fully provided, only then should we consider offering services to a significant foreign immigrant population.

We have such a limited amount of funds. I can name a half dozen essential services in Albuquerque who turn away peers because of being underfunded. This is completely wrong.

In an ideal world we could afford to welcome all needful people to benefit from our services. Sadly, doing so would divert services away from our citizens and our peers already underserved. Our peers are our prioirty. This is the reality. Humanitarian support must be offered to our peers at home to ensure all their behavioral health needs are fulfilled.

It’s an unpopular platform and someone has to say it.

Kindly reprinted from Steve’s Thoughtcrimes.

Police kill themselves, too – Insight on police suicide

By Steve Bringe
Founder, Stand Up To Stigma

A very sad and troubling article came across my feed concerning police officer suicides in New York City.

NYPD suicide problem grows as eighth officer takes own life this year

I’d enjoy sharing an insight on the great need for safe, protected mental health services in the law enforcement community. Trust me. This is good stuff. It’s useful information gleaned from a firsthand perspective.

When I was developing CIT (Crisis Intervention Training) for the Albuquerque Police Department, part of what was created was internal mental health services for the officers AND their families. This is an excellent service tbat carries an amount of unrecognized cultural complexity.

Having given numerous CIT presentations for APD and having been tasked with recruiting peer presenters, I’ve had the unique opportunity to speak openly with police officers on the crucial conversation of mental health in a safe, honest, and vulnerable setting. And, having been invited to participate in the full 40 hours of CIT training, I’ve gained direct empathetic understanding of the police perspective in crisis situations. This is because APD officers shared their law enforcement stories with me and our peer presenters.


Observation: Being a cop is a rough and high-stress job and cops aren’t proactive in seeking out mental health treatment.


The issue – as I see it – is there’s a self-stigmatizing critique in the law enforcement culture that to seek mental health services is a weakness and shameful. By making the services internal to APD the hope is more officers will get immediate help with the support of their colleagues.

As a peer who has bipolar and severe PTSD, as well as a history of trying to kill myself, if I didn’t have the excellent services I have now, suicide as a mental health treatment solution would continue to be part of my life. It’s no different for cops who experience horror on the job.

As said, I was also invited to take the full 40 hours of CIT, and not only the two hours I developed. The insight I’ve shared – redacting specific officer stories which were shared on a personal level – speaks from my understanding of the training and ingrained responsibilities officers hold in mental health crisis situations. As their job description requires, cops are placed in environments most folks can’t appreciate as unavoidably emotionally rattling. This happens at crime scenes that aren’t pretty or heart warming. As a layperson, some of the stories officers shared with me are terrifying.

These unimaginable on-the-job life events and the psychologically damaging consequences don’t clock out at the end of the shift. The jolting effects follow the cop home and are there when the cop wakes up the next day and the next day and all the next days to come.


The inherent mental
health-impacting job stress in law enforcement can be crippling and exhausting day after day, and suicide is one natural conclusion to untreated PTSD.


Purposely, I saved the PTSD acronym for the last.

Here’s the insight on the law enforcement culture I want people to realize and understand. My feeling is suicide shouldn’t be exasperated by cultural competency. The law enforcement community is incredibly loyal and tightly insular, and the law enforcement community contends with its own internally propogated stigmatization. Police officers both need and deserve specific and special services for their mental health wellness. And, seeking out these critical services must be accepted, supported, and destigmatized to be effective.


The Albuquerquue Police Department is providing these services. Let’s see what happens with the culturally internal stigma about getting mental health services.


I applaud with both hands and both feet – as well as the hands and feet of the (occasional) make believe people in my head – the forward-thinking and active-solution of the Albuquerque Police Department. I applaud the department’s dedication to the officers’ and the responsibility shown in dispensing the permeating self-sigmatization in law enforcement culture. And, in talking with officers on the street whom I trained, these services are being openly utilized. Score.

As a closing comment, I’ve spoken primarily of the mental health needs of law enforcement officers as being consequential of their employment. It’s equally important to address bipolar, schizophrenia, DID, depression, and any other mental health issue with the same considerations as everyone else on the planet. These mental health needs are also part of APD’s in house services. Just so you know. Score.

By the by, I aced the CIT exam. 100% is my score. Bonus.

Kindly reprinted from Steve’s Thoughtcrimes.

Dragging Me Kicking and Screaming.

My divorce . . . I wasn’t fond of my divorce. The only difference between my divorce and a bloody, puss-filled, and inflamed hemorrhoidal tissue is nothing. It was icky and messy, it hurt really really really bad, and it was a world-class pain in my arsecrack. So uncomfortable, so ouchy.

After my divorce, I did that most natural of bipolar activities. I isolated. Big time. Calls went unanswered and window shades unopened. The thought of retrieving mail brought on such anxiety-ridden bouts of sleeplessness and self-doubt I questioned my ability or willingness to breathe. My Blanket Fortress was in a perpetual threatened state of being saturated in urine because, in practical terms, it would be easier to change my sheets later than to take on the Himalayan expedition of crawling to the bathroom to use the toilet. I kid you not. This was a serious debate I had each day. My divorce left me in razor-thin mortal existence and my bipolar depressive symptoms were insistent on knocking me off this ragged edge.

I have friends. And, with some of these friends, I was missed. This longing for my presence elicited concern and this longing also elicited an unsolicited visit to my home. I have friends, and I have very good friends who know about my bipolar symptoms and I have very good friends who like me alive. One such friend is Michael.

After a month of completely ignoring the world, Michael and his boyfriend came to my home and kept unrelentedly ringing the doorbell, and despite my bipolar depression sensibilities, I had to answer the door just so I could murder whoever was incessantly leaning on the doorbell button. No, I don’t want another copy of The Watchtower. I appreciate you dropping by. Oh, yes. Stand very still. You have to be murdered.

Drats. It was Michael at the door with Geoffrey. They were smiling, although Geoffrey appeared nauseous over my appearance and aroma. Yes, I was nasty gross from weeks of hygienic neglect. Still, don’t invest too much weight in Geoffrey’s reaction because a used bandaid floating in a public pool triggers Geoffrey’s gag reflex so badly that he dry heaves until his entire body is turned inside-out.

Michael said, “Get ready. You’re going out with us tonight.”

I said, “Michael, leave me alone. I feel like shit.”

Michael said, “No choice, buddy. Get in the shower.”

I said, “Michael, I don’t have the energy for a shower. Just go away.”

Michael said, “Fine. We’ll give you a bath.”

I said, “Michael, I’ve told you a trillion times, I’m not gay and regardless of sexual preference I’m not into threesomes.”

Michael said, “You can’t insult me until I go away. Off to the bath.”

I said, “Fine.”

Geoffrey said, “Uggggg!!! I just threw up a little bit in the back of my throat!”

I said, “You had to wait to say that until my clothes were off? What an excellent ego boost you offer.”

Michael said, “Grow up. And don’t bother deciding on your outfit for the night. We have something special set for you.”

For Michael and Geoffrey, the outfit was more important than hygiene, but only just. What they had planned for me involved many razors and many parts of my body. It involved the makeup aisle at Walmart. It involved a trip to Savers. It involved viewing clothing sized “14” rather than sized “L.”


I was being dolled up in drag and taken on the town.


Shit. I hate my friends.

After the rigorous scrubbing so I didn’t smell like a dumpster fire in the alley behind a curry house, I had so little energy to argue or struggle. I just said, “Shit, Michael. Fine. Whatever. I have only one demand or I’m not going.”

“And what’s that?” inquired Michael, already boasting a smile that wouldn’t fade.


“I’m only going if you promise to keep anyone from hitting on me tonight. I’m severely depressed. I can’t take that kind of attention from anyone.”


With no hesitation, Michael and Geoffrey agreed to my non-negotiable. Perhaps demanding EVERYONE hit on me would have made them go away.

Painted up with cheap, vibrant face makeup so I looked like a Teletubby vomited a bag of Skittles on my head, and spruced up in a Prince-purple discoball sequined full length prom dress and electric-shock blonde wig, Michael and Geoffrey shared we were going to dinner at my favorite restaurant at the time (Trombino’s on Academy, still a fave) and then off we’d go to shake the night away at Pulse (admittedly, the best dance club with the best dance music in Q-Town). I barely picked at my thick and rich chicken/pasta plate. I barely had the energy to lift my chin above 24 degrees off my chest. How the hell was I supposed to go dancing to a bass-soaked 350 bpm reimaging of INXS’s “Need You To Night”? Collapse was imminent. I didn’t drive myself, effectively without escape. I was screwed.

“I’m not kidding, Michael. Nobody better hit on me tonight. Get the word around as soon as we get to Pulse.” My mood sucked and I was exhausted from bipolar depression increasing the gravitational constant of the universe for only me. I had nothing left in me to ward off unwanted romantic attention. It’d be easier to melt into a puddle of infected off-green sinus-goo and take residence in a CDC petri dish for all eternity. Michael sighed his reply.


“I heard you and we agreed to protect your chastity. Don’t worry.”


We got to Pulse and I wearily pleaded with Michael and Geoffrey to crack the window and leave me in the car. No go. Michael is slim and Geoffrey is short. How they hauled my 6’3″ nearly-dead weight frame into the club and kept me upright on the dance floor for three hours is Herculean and I learned that night that either bloke could kick my ass if wanted, even when I am at full strength. Very humbling, although it did make me feel very safe and protected. This was important.

The three hours were the worst three hours I’ve ever spent immediately following a meal at Trombino’s while dressed up like a prom date drunk on steroids. It couldn’t end soon enough and it didn’t. The saving grace is Michael and Geoffrey were true to my demand and I wasn’t hit on all night.

Finally, my upright misery could turn into prone misery as Michael and Geoffrey ferried me back to my house and the safety of my Blanket Fortress. It was the first time I was out of the house in over three weeks, and truth told I didn’t hate being out of the house. This is entirely credited to the love and caring Michael and Geoffrey showed me. This sort of adoration is energizing I’ve come to appreciate in my very best friends.

Collapsed in the back seat of their Prius, I forcibly mumbled out, “Hey, guys. Thanks for getting me out of the house. And really thanks for honoring my wish. No one hit on me all night and that means everything. Thank you.”

Michael looked at Geoffrey and Geoffrey looked at Michael as if thumb wrestling to decide who would acknowledge my gratitude. It was Michael who lost.


“Um, Steve. We didn’t have anything to do with that. You just make a really ugly woman.”


After leveling that devastating full-body ego slam, my friends stayed the night to make sure I didn’t kill myself.

It was one of the best nights of my life.

Kindly reprinted from Steve’s Thoughtcrimes.

Thanks to medical billing, everyone can be diagnosed with a mental illness

By Stephie
STS Peer Advocacy Presenter

Regardless of what side of the gun debate you are on, think very, very carefully before advocating for rounding up and vilifying the “mentally ill,” whatever that term even means. Facts: Statistically, people who are mentally ill are far more likely to be victims of violence, not perpetrators. Statistically, most mass shooters are not mentally ill. A few here and there, yes. But most are not.

As most know, a provider of any kind must cough up a diagnosis code in order for anything to be paid by, or re-imbursed by, insurance. If you ever report to your doc or counselor that you are depressed, you will get a diagnosis in the DSM-V. If you are worrying and feeling a lot of anxiety, you will get a DSM-V diagnosis. If your memory isn’t what it used to be and a provider notices, you will get a DSM-V diagnosis. Pretty much the entire experience of being a human being is contained in the DSM-V. If your significant other leaves you, or you get laid off from your career and you are distraught and see a provider, you will get a diagnosis in the DSM-V (“Adjustment disorder.”) If your child dies, or your spouse or mother, and you are experiencing extreme grief and tell a provider, you will get a diagnosis in the DSM-V. If your kid is autistic, they are in the DSM-V. If your teen has had a rough time and has been suicidal or needed therapy (pretty common these days), they have a DSM-V diagnosis.

So what is mentally ill? What does this even mean? Most people probably have a stereotyped image of a homeless person talking to themselves. And the vast majority of those folks are not dangerous to anyone but themselves.

As a matter of interest, I just heard this past weekend from a person in the mental health field that racism is in the early stages of being discussed as a mental illness, as it constitutes such disordered thinking.
So just what does mentally ill mean? Think long and hard before you start advocating for a “mentally ill registry.” It is not unlikely that you will be on it.

I’m Human, You’re Human, Let’s Talk

I’m Human, You’re Human, Let’s Talk.

by Amanda Jenson
STS Editor

We’ve experienced another several horrific tragedies lately. As someone who knows what trauma and pain feels like I am sorry. I see you. I hear you—even if I can’t know exactly how you feel. I won’t pretend to.

When these tragedies strike the media focuses on the gunmens’ mental health. I don’t deny that someone who creates such heinous misery has some kind of insanity clouding the mind, but we focus so much on his or her mental health that we forget to focus on the survivors’ mental health and what they are now going through.

My friend with bipolar pointed out that the victims still living will not want to seek care for their health now because the media (including president Trump) immediately bludgeons our feeds with the stigma that having a mental health issue means you are violent.

Proof:

“This is also a mental illness problem,” Trump said of the mass shootings. “These are people that are very, very seriously mentally ill.”

“Trump called for reforming “mental health laws to better identify mentally disturbed individuals who may commit acts of violence and make sure those people, not only get treatment, but when necessary, involuntary confinement.”

“Mental illness and hatred pulls the trigger, not the gun,” Mr. Trump said. Calling mass shooters “mentally ill monsters.”

Unstable gunmen are dangerous, no doubt, and there are no words for the horror I feel at the actions committed by these people, mental illness or no, but comments like these are dangerous for thousands, if not millions of those who suffer with mental illness. We are now “monsters” who don’t belong in public. I’m appalled at the ignorance and stigma portrayed and a little awed at the uncaring and unfeeling behavior they display to those who suffer with mental illness.

Those emotions sound a little like how they describe the gunmen.

Victims may see their symptoms of deteriorating mental health and equate themselves to being dangerous as well, just like their persecutor was.

Who would want to get mental health care if “involuntary confinement” is being used as a means to control those who may want mental illness help? Chills curled their gentle governmentally-controlling fingers down my spine when I read this.

If the media wants to discuss and accuse mental health as the problem for these violent acts then look at the full spectrum of how mental health plays into tragedies, because we now have many people out there ruminating on a bloody scene that they can’t quite believe was real, trembling in the night instead of sleeping. People are flinching and crying in a corner, trying to cover their ears and heads simultaneously, from every little sound they hear. They are wondering if the generally safe world they once knew was a lie. They won’t let their children leave the house now. Their anxiety has overtaken their body and they aren’t eating. They’re vomiting every time they try, their tears rushing too quickly down their face. They aren’t even sure if they are alive anymore. Did they die in the shooting? They think they should’ve died instead. They wouldn’t experience this horror and guilt that they are still living. Those gunshots they keep hearing? Are they inside or outside of their head? They just want those images gone. Some can’t stop picturing their loved ones lying broken on the ground.

And then you have the other spectrum. You have the people laughing, saying they’re fine—the people who perhaps even make crass and sadistic jokes. Why? Are these people sociopaths? They feel numb. They are thinking, “What’s wrong with me?” and instead of seeking help, close themselves off even further for fear of being dangerous and out of guilt of their seemingly callous reaction. Are they like the gunmen? No. A resounding no!

They are dissociated from horrors that can break the human mind. It’s a natural response to disasters and serves a survival purpose. I would know. I have a dissociative disorder borne of extreme violence and horror in my childhood. My disorder is considered a “severe mental illness”. I still function as a kind member of society. (Yet I know what it’s like to sit in that corner shaking and crying due to PTSD. I also know what it’s like to pop out inappropriate jokes.)

Do I want to go shoot people? Never.
I’m seeking professional and community support for my trauma and pain. I hope those affected by these tragedies will too. I hope they look past the media and governmental stigmas and get the support, love, and understanding they deserve and is naturally needed. There are many of us out here in the community with mental illnesses waiting to hug you, waiting to tell you what services and help you can get, waiting to express how sorry we are and that we know—not exactly, not perfectly, but we know.

I know what it feels like to be cruelly victimized by people. I know what trauma and horror is. It’s stuck in my brain too. Most people with mental illnesses are loving, intelligent people who advocate for others who struggle with mental health issues. Let us hold you now.

Hey White House, Media and those with stigmas still, don’t you think some of these people affected by this will be suicidal? Do you think the horror is over for them just because you played the blame game so effectively? Want to save some more lives? Stop insinuating that all mental illness is dangerous and that those of us with them need to be locked up against our will.

Those affected will be suicidal. Some are now. Save the people left too, stop just focusing on the horrors already committed. And for the love of all humanity (literally), stop telling the world that those of us with mental illnesses are all dangerous. Save the ones who won’t get help now because of your dangerous and scape-goat comments. Stop perpetuating the violence you claim you want to fix.

1. https://www.cnbc.com/2019/08/04/trump-says-hate-has-no-place-in-our-country-after-shootings-in-dayton-and-el-paso.html

2. https://www.thedailybeast.com/trump-calls-for-involuntary-confinement-of-mentally-ill-in-shooting-address

3. https://www.nytimes.com/2019/08/05/us/politics/trump-speech-mass-shootings-dayton-el-paso.html

4. https://www.cnbc.com/2019/08/04/trump-says-hate-has-no-place-in-our-country-after-shootings-in-dayton-and-el-paso.html

My Seasonal Affective Disorder is a Real Drag this Time of Year

Something needs to be done about my Seasonal Affective Disorder and how insufferably cheerful and gratingly pleasant I get during summertime. Not imposing upon my loved ones just because I’m joyful must be leaving a huge void in their heart. There must be a med to drag me into even a mild doldrum, requiring the people in my life the burden of having to be on suicide watch 24/7.

I hardly want to spend any time at all in my bed beneath my Blanket Fortress. And this unforced smile is so easy and uplifting. What a chore this is. For myself, for everone.

I’m so sorry for feeling happy and productive once again. I feel selfish to the core.

Forgive me for this and I’ll forgive you for eating the whole goddam bag of Cheetos. Those were for everyone, you realize.

Reprinted with kind permission of Steve’s Thoughtcrimes.

The Lourdes Mobile Outreach Team: Police, Mental Health Specialists, and . . . Peers?

Here is a promising article about the Lourdes Mobile Outreach Team.

When reading this promising article, I can’t avoid noticing a GLARING omission to this field unit:

WHERE ARE THE PROFESSIONAL PEERS?

Peers are infinitely more qualified connecting with other peers in crisis.

DBSA Albuquerque has a new Tuesday evening peer support group!!!

DBSA Albuquerque a new Tuesday peer support group!!!
Beginning on Tuesday, January 29, DBSA Albuquerque offers a new weekly peer support group for our New Mexico communities.


It’s been a while since we’ve had our evening group centrally located in Albuquerque. By popular demand, we now have a new venue that is friendly, safe, and easily accessible from both I-25 and I-40.

Like our Monday afternoon and Friday evening peer support groups, DBSA Albuquerque offers our Tuesday group free to the community. There is no need to register ahead of time. Just show up and meet other folks who understand what you’re going through in a safe, welcome, and judgment-free space.

Every Tuesday
6:30 pm to 8:30 pm
First Unitarian Church
RE Room 3
3701 Carlisle Blvd. NE
Albuquerque, NM 87110
 
On the SE corner of the
Carlisle & Comanche intersection

Across Comanche from
KOAT 7 News

Dedicated Accessible Parking
First Floor Accessible Entrance.
Parking entrance on Comanche just west of Carlisle