Master of Irony

In addition to last night's entry, I had a few things to say.  First, for anyone thinking this is something to worry about, first know this is something I am terrified of.  I have good reason, but my fears are also beyond the real risk.  I didn't mean to scare people describing the dementia as so bad.  One reason I am very frightened/aware is that I worked with people who had been bipolar for 60 plus years.  Lithium was the first effective treatment and it's only been around since the 1970s.  So these people had been subjected to bad stuff.  Plus, my patients were always representative of the worst end of the sprectrum, just short of state institutions, and not really all that short of it since it was basically what the state did with these people when they weren't in state facilities anymore.  These were really, really sick people.  Many of them had been left in institutions early on so that they had even more messed up lives.  There were some we had no clue if they had any family or if they ever had.  If I had worked there a few years earlier I would have had lobotomy patients.
 
When I worked there people would ask how I could work in psych without my own feelings about myself being taken over.  I asked that a lot at first too.  Usually it was no big deal because there were such huge differences in the treatment I was getting and what they'd experienced.  This was one of the things I did emotionally focus on too much.  So forevermore be cautioned.
 
Also, I freak out about any changes I see in this area of myself.  I don't know why.  I am not nearly as bothered seeing other things change, but cognitive changes scare me.  Even when I know it will pass I am afraid.  Partly this is because I survive because I have this incredible cognitive control over the whole thing.  Going on disability this time had a lot to do with my knowing I was not going to control things much longer.  Partly it just embarrasses me; I laugh about these things, but it really does upset me to do things like set a paper bowl on a burner because I forgot the pan I am holding just came off that burner.  Instant burning.  So these things then seem exagerattedly awful.
 
There are positives to the whole mess that I need to focus on.  There is evidence that lithium is protective of the brain and I've been on lithium since before diagnosis.  Some of my cognitive changes are from meds and if everything goes beautifully well maybe someday there will be meds that don't overdo the sedation.  Right now I complain about feeling stupid, but the truth is that I'm taking an impressive dose of sedatives, I'm taking 4 or 5 types of sedatives, and my body has been constantly adjusting to this.  That's not good for the thinking. 
 
It also is the one area I feel like my psychiatrist and psychologist both are more unwilling to tell me everything.  I have a very upfront relationship with both, and I need that.  But in this area neither will give me firm answers about what precisely they see.  There's a lot of diversion and redirection when this comes up.  My professional status doesn't help a whole lot there either.  I can't be tested with most standard screens and so they have to make things up.  Sometimes I know what shows and sometimes I don't. 
 
To make that even more complicated I realized just today that I have developed a strong tendency when manic to attempt to hold back when I'm with them.  I have started trying to say as little as possible so that they won't see reality.  Probably this hasn't gone unnoticed, but it also colors how much they actually have seen of the changes I'm complaining about. 
 
Having said all that I do know for sure I've had huge changes.  I attribute a huge amount of that to kindling, which I was very didactic about yesterday, also unintended.  I meant for a tone of "this is where I know my cognition falls apart" and that didn't come out.  Quite simply, this terrifies me.  I worry about it too much and have read about it too much.  I also see typical dementia patients every day I work.  They're one of my specialities and I'm good with them.  Partly though I'm good with them because I know that I am likely to be one eventually and so I treat them with respect. 
 
Anyway, I need to go take all those pills.  Tomorrow is my last day of vacation.  It's been nice, but I cannot wait for my own bed.  Tuesday I'll be home again and normal blogging will return.

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