The New Business Model in Psychiatry

I checked myself yet again at the hospital. It became my full time job really.

Shame on me, I ain’t strong enough to survive outside more than a few weeks. But is it really my fault?

Not more than 24 hours later, yes you know it, I checked myself out. I wasn’t scared of the environment this time. I liked the room. I even met a couple of people with whom I could have a decent conversation – shout out to K, L, N and N!

My problem was the medical body. My sessions with them were more of open ended questions like in qualitative research. I felt time had no essence to them. Like progress cannot be measured daily.

When I went to London, and I am not being payed to say this – if you only knew how expensive it actually is to get treated there out of pocket – every single word I said was taken seriously. Every little side effect was looked at. I was seen as a person; a real person and not a spoiled brat complaining for no reason.

Secondly, the doctors would not dwell endlessly on what to do. They took calculated risks. Because if they agreed to the status quo then nothing would happen.

I was always reassured and never ever did anyone tell me this drug or this method works for 20% of the patients. I was given hope – in abundance and also had the opportunity to chat with other patients who are now truly healed.

While I was completely fitting the box of patients in the clinic, my individual voice and needs were immediately heard.

That is why I felt I was wasting time at the hospital and that is why I left 24 hours later instead of staying for a whole 10 days.

My business teachers at university always said a good product or service starts by answering a customer pain.

Very well, mental illness is filled with customer pain; be it the patient herself or her family members.

I have been treated and admitted to hospitals both in Paris and Cairo. Although the settings could be strikingly different; there are major similarities.

Patients have little control over the course of their treatment; unless they happen to well read – and still that could be interpreted as a personality disorder.

Here, business people, here is a business model for you to follow. Instead of keeping the one patient coming back for 10 years, you can have thousands of them and most likely very happy ones too. Am no mathematician but get your excel sheets out and do the works. It doesn’t need a genius to tell you where the money is; and coincidentally health too…

TBC

Capitalism and bipolar disorder

My illness relates to many many factors. It is my upbringing and my biology. It is society, it might even be fate.

My illness maybe relates the most to a lifestyle, no; to a mode of being that I am not the only one to have created but surely had to abide to. My illness is so common you would be surprised. My illness is “in” these days. My illness is a mutation, a mistake if you would like. My illness is a blessing as much as it is a curse.

I get to the downs of the deep blue and sometimes I stay afloat. Sometimes I even catch a boat, a sailboat- nothing too fast. I wonder and I ponder about my existence and yours. I shed a few tears and even pop a few pills.

I always end up where I started with mixed feelings about everything. Nothing is my favorite as how should I know? My illness changes my mind as I grow.

Something is constant amidst this storm. I know there is a malfunction, that much is true. Why does it relate to inequality go ahead and ask me. All is a competition, life has become a race. We run around all day seeking a bigger dream. I don’t get there and you don’t either, but why does she? Born in here, studied in there, oh that is her family? Where is my choice in all of this? Where is this leading me? Achieve and fail and fail to achieve. I ask myself why I stopped dreaming. Those images were not mine but yours, so why keep them in the first place? Illusion, delusion, materialistic being. This is not whom I should be. Why wake up and swirl like a mouse? That’s when I decided not to leave the house. I felt immense fear from life; how on earth can I win this race? Exclusion, demotion, gender roles or nationality?

TBC

Part one: On Guidelines for treating mixed episodes and rapid cycling in bipolar disorder – Beacons Of Hope: Thyroid hormone replacement and rTMS treatment.

My problem with my illness is not my illness per se, it has always been how the medical community thus far dealt with me as a series of isolated symptoms; instead of seeing me as a whole person.

Things have been moving on though. Let me tell you my story with this new treatment am on.

But before that, we have to talk diagnosis. We have to talk guidelines. We have to talk knowledge.

Looking back, the past three weeks seem like months.

My beloved husband researched and researched my condition over and over again. He wouldn’t surrender or admit that I won’t get better. He believed that there is a way out and that I could be cured. At least he told me “let’s have the honor of trying”, bless his pure heart.

Less than three weeks ago I was self admitted to another mental health hospital. I left the very same day. Surprise! Though practically no one understood, everyone accepted, believing I had some internal compass that points to truth. In fact, I was too restless for a single room and too “aware” to stay in a ward.

In a parallel world my husband had found a doctor in London at the London Psychiatry Centre who had very convincing arguments saying that he could treat my condition. In fact he already successfully helped hundreds like me. This brilliant man is called Doctor Andy Zamar. His attitude, bedside manners, and ultimate responsiveness to his patients make him deserve my deepest respect regardless of the outcome of my ongoing treatment. He doesn’t believe in the status quo and he bothers to read what

have written before him.

We first had a FaceTime consultation during which he made me read some research he had gathered regarding bipolar disorder. Specifically, he wanted me to read in black and white as he said how wrong it is to take antidepressants when one has a mood disorder. He made me read out loud the Maudsley Prescribing Guidelines in Psychiatry for those suffering of rapid cycling. It said loud and clear to “withdraw antidepressants in all patients”.

That my friend is an interesting finding. I have been given antidepressants by the medical community that treated me in the past three years. In 2017 Effexor led me to the emergency room trying to quit it as it was impossibly painful to deal with its withdrawal symptoms. Mind you it was done under medical supervision. But that is another story.

Later on in 2018 I began self medication when I quit lithium by myself – which interestingly I discovered does not work on its own in my particular case as per the guidelines. It has also lots of side effects I could not deal with. So I self medicated and started Prozac 20 mg for 7 months. I did that because I thought it would be a safety net that won’t let me fall into deep depression.

I was wrong, I couldn’t have done myself more harm unknowingly. I did rise into hypomania which inevitably led me to deep depression. When I went to see doctors just before meeting Dr Zamar, they advised and prescribed an increase in Prozac to 40 mg and this is when hell broke loose.

Doctor Zamar diagnosed me then with ultra rapid cycling bipolar disorder otherwise unclassified. I had hypomania turbo charged, as he explained with depressive content. Talk about suicidal thoughts!

Again I read during our call what described my state. Doctor Zamar was not reinventing the wheel. The paper is called Melancholia Agitata and Mixed Depression [Koukopoulos et al. Acta Psychiatr Scand 2007: 116 (Suppl. 433): 50-57. The paper is more that 10 years old!!

So on page 52 here is the “clinical picture of agitated depression” – it was describing me in a nutshell …

Melancholia Agitata and Mixed Depression
Melancholia Agitata and Mixed Depression p.52

So people someone was saying why I was committing suicide in ink…

Check this out

Melancholia Agitata and Mixed Depression
Melancholia Agitata and Mixed Depression p 53.

The last time Doctor Zamar prescribed antidepressants was in 2004. Say what you may. But isn’t it a million percent better to be safe than sorry?

This is a heavy post I know.

My final words are those of hope. Now that we know what not to do, the action he proposed is derived from new research based on thyroid replacement therapy and rTMS.

The treatment combo am doing is that I take on one side Olanzapine known as Zyprexa which is an atypical antipsychotic that is supposed to calm my hypomania.

Secondly I do rTMS or Repetitive Transcranial MagneticStimulation; a treatment that not only has enormous success rates for treating depression but it is virtually side effect free.

Last but not least, Doctor Zamar is using Precision Medecine Nd treating me as a person. We do weekly ECGs and blood tests. He takes my side effects seriously and he doesn’t brush them under the table. He listens. Mind you this post could sound like praise to him, which it is. But listen my friend, it is to everyone of us working with people. Stop being an ear and nose doctor and look at true bloody person you are treating.

At this clinic they do take swabs to send for genetic testing to stop wasting your time. As their website says there is no “one size fits all”. Genetic makeup therefore is very important in deciding treatment, knowing what works and what won’t and also knowing what would be tolerated. In psychiatry this saves light years.

I will be staying explaining in my following post the thyroid replacement therapy.Meanwhile I urge you to read this beautiful hopeful article published on their blog: Bipolar News – Millions could benefit from bipolar breakthrough #worldfirst

TBC

I am committed

I am committed to coming back to this very hospital

I am committed to receive every form of therapy there is under the sun

I am committed to doing whatever it takes to raise our children, see them graduate and organize their weddings

I am committed to loving and honoring my immediate and extended family in every possible way

Meanwhile I am finding my happy middle

It is a mirage

But I need to keep on looking

I will check out tonight if it is the last thing I do

I will come daily as an outpatient

I am committed to heal

I am committed to survive

Worry of hope – rapid cycling

It’s 5 am and I cannot sleep.

I am angry of myself. I am angry of the world. I am angry of hope.

I am supposed to try a new treatment soon. My mood changes more than I can handle. I am up and down at the same time.

I put on my trainers and went down for a walk.

Am writing and waking while listening to music. That is how restless I am.

I am worried it will fail

I am worried I will fail

I am worried I will fail them

I am worried they will fail me

End up my post with the usual

God grant me the serenity to accept the things I cannot change

The courage to change the things I can

And the wisdom to know the difference

TBC

In the world of rapid cycling

Hello everyone. Bla bla bla yes I haven’t written for a while, miss you, etc.

You know it is not me who is inconsiderate or rude: am rapid cycling.

Say what? Say one day am high as a kite (a small kite since am bipolar 2), and the next am digging a tunnel to the the after life (does that even make any sense?)

You get the picture. Am a yo-yo, I am a roller coaster, a bullet train with bad breaks.

I enjoy my ups and do accomplish a lot; especially if you count shopping as an accomplishment. I spend hours without eating (big high five since I tend to feed like a newborn every 2 hours). I even live on 5 hours of sleep and I am Eeyore on any other day.

Woke up at 6 am today (weekend here on my side of the world) and hoped into my trainers and on to the kettle and to my smokes.

Am sociable, am pretty, am smart and talkative. I love it.

I wrote this down to me Nour. Yes to me, for in a few hours I will feel like dirt is better than me. I will feel empty and useless and I will become a burden. I will get back to staring at the ceiling and doing nothing but dealing with suicidal ideation.

Today however I will kiss my kids, a lot and lots more. I will go for a long walk like the book says. I will have lunch with my beautiful loving family and I will dress to impress. I will put on my make up and my new earrings. I will take a selfie or two and hashtag them to mentalhealthawareness.

Meanwhile my rapid cycling friend; I freakin feel you. You are my hero.

Remember, for every down there is an up coming and heck yes we shall ride the wave and rise to the moon.

Bless

TBC

Call for interviews

As part of a bigger life project, I am conducting (anonymous) interviews on how to live/cope with bipolar disorder. Send me a message here or through my Facebook page if you are interested in participating.

Bless

https://m.facebook.com/happilydepressedblog/

You are not the problem; you are the solution

I have been away from writing for a while. It was a period of re-evaluation. I needed time to gather my thoughts before I share them with you.

Today, I want to talk about living in the now. I want to talk about living without fear. I want to talk about hope…

I want to talk about waking up without wanting the day to end. I want to tell you that it’s possible to enjoy life even if circumstances are not ideal.

I want to share with you today my insight about a previously feared decision that I was very hesitant to make.

I was hesitant to live.

My fear blocked me. Doubt was consuming me inside out. I didn’t like the present (my illness) , I regretted the past (my recent diagnosis with depression and bipolar disorder, my genes, my upbringing…), and worried incessantly about the future (relapses, pain, facing myself or even another day).

This topic was my obsession. I thought of nothing but bipolar disorder. I was not sick with the disease, I was the disease itself. I couldn’t put a distance between me and “it”. Bipolar was the boss of me, and I didn’t know any better.

Little by little my dissatisfaction with the situation kept building up. It was sort of an unconscious rebellion surfacing. With hindsight, I understand why I opposed certain hospitalizations and certain drugs or doctors. I refused over and over again to be numbed. Because when I get numb, I forget why I am in this situation in the first place.

I knew something was amiss.

The healing system I surrendered to was treating my symptoms and not my illness.

Traditional psychiatry attempted to take my pain away without telling me that I will also lose myself in the process.

I have been aware for a while that my condition is psychological but to a big big extent also physiological.

I couldn’t accept that my childhood, no matter how sad it was could still affect me some 30 years later. I couldn’t accept that moving from one country to another is enough of a reason to have me sedated by force while I was trying to escape from the ICU after a suicide attempt.

What couldn’t they see? What is being told to me by this suffering? Why is my family witnessing this? Is it all coincidence? Is it all in vain? I was a mental health practitioner at some point, how could I be the patient now? What happened to me???

As my rebellion became my revolution, I weaned myself off drugs. But that was only the beginning. Slowly my cognitive abilities came back. Not all, I still have memory blockage, or loss. I lack concentration sometimes too. But in general I can tell you with confidence that this is my brain. Those are my feelings. This is my reality.

I began to put 2 and 2 together and made some parallels- and those made and still make sense to me. They might not be universal truths; but is there such a thing?

I thought that each hospitalization began with a series of blood tests. Why do they keep on saying that there is no bio marker for mental illness!! A lie. A big fat ugly lie.

I don’t know about you, but I would rather have a half truth than none at all. The medical community has knowledge about biological, pure physiological imbalances that accompany depression, or any illness to that end.

People just take the easy track and stop investigating, or they don’t want to claim responsibility. Tell me why is my sedimentation rate (ESR) abnormal? Why is my vitamin D so low? Why is my thyroid imbalanced? Why did I bleed for weeks with no end between my periods staining every surface I touched before I was diagnosed? Hormones anyone? My ferritin was low, my proteins were in the wrong values. Soon after I started treatment I began to have bad cholesterol. Is my mother the reason for all that? Or is it rainy Paris? Or maybe my then 2 extra kilograms?

I was prescribed “vitamins and supplements” yes, but no one ever told me that they would be key in healing me if taken religiously and monitored regularly. I was told not to miss my antipsychotics, my antidepressants, my anxiolytics; those drugs that alienated me further and further from me, from those around me and most importantly from the truth.

I was told I need to play sports and bathe when I was pinned to my bed by drugs. Yes yes, exercise is good for depression. Not once was I told that there is a link between what goes into my body (food yes food!) and my physical or psychological condition.

Not once was meditation mentioned. Not once was yoga mentioned. Not once was even coloring-in mandalas brought up. Just take the drugs and come back for more. I was offered psychotherapy, but I didn’t give it much importance then. I think now it was because I felt to a huge degree that talking about my problems wouldn’t make them disappear.

I realized that no matter the good will around me is, no one would help me but me. I decided to take charge of my life.

At 38, I finally decided to become an adult.

I will listen to the medical community orthodox or not, because yes they do have insight. But most importantly, I will now forward listen to myself. I started to believe in me. I started to believe in my cognitive abilities surfacing and my instinct.

I knew I am no longer Bipolar Disorder. I am Me.

Simply put I began to circle around the idea of inflammation. I knew that illness meant imbalance and imbalance was often caused by inflammation. I also thought that inflammation is not only physical but psychological. I thought I would enforce a way of doing – a way of living – that is anti inflammatory.

When you are ready, the stars align. Without being esoteric, when you buy a red car you start seeing red cars all around you. When you brain focuses on a certain topic, you see it in plenitude.

I began to dig for links and for alternative remedies. I found that others – plenty of others- think the same. I hadn’t given alternative ways a serious thought before. Cancer healed by pure will and some plants? Yeah right!

I think that if you want to go alternative and drive off road, you cannot pick and chose. It has to be integral or better still systematic. Again that is me talking not science.

So it figures that turmeric or curcuma is a miracle drug that treats a wide range of problems relating to inflammation. It figures that I need to treat my candida problem that has been an integral part of my life for the past 10 plus years if I want to heal. Not one, not a single medical authority wanted to establish this link; as if I had several bodies or as if my organs were not related and living in the same ecosystem.

It figures there is a link. And yes, essential oils do work if taken long enough and right enough. It seems that the liver needs a proper cleanse to get rid of all the bad stuff we feed ourselves all the time. Otherwise healing would be in vain.

It figures that sugar and gluten can also be part of the problem, feeding regularly the inflammatory machine. The more you eat it, the more inflamed your body will be, and the more you will crave it. Funny, I consumed jar after jar of jam before my first hospitalization; a food that I truly dislike.

Activities are also inflammatory. Sitting hours in traffic jams is inflammatory. Dealing with negative people and draining meaningless tasks is inflammatory. Going for a walk is anti inflammatory and so is listening to music. Playing with the kids is anti inflammatory; trying to prove that I am right all the time is inflammatory. You get my point.

None of that would work alone. It is a system. A wholistic system that you create and you alone- it has to make sense to you.

The knowledge is there. I am no genius and you don’t have to be one.

We went through hell and back – all of us. Whether you lost a child, a limb, a job, or financial security. You are unhappy because you chose to define yourself as a problem. I Am The One without a Mother. I Am Bipolar Disorder. I am Divorce. I am Unemployment. I am Obesity.

While doing that we forget all the other things that we are, or aren’t! Yes you could be bipolar and it is sad, but you are so much more than that. And you are not so many other bad bad things.

The truth is there is always better; but mind you there is always worse.

So let us take a leap of faith and try to breath it out.

Say it out loud with me

I am not my illness, I am me.

I know this is not an ideal situation, but there is no such a thing.

I know I cannot control tomorrow, but thinking about it constantly won’t change a thing;

When I need help I will ask for it, but I am in charge of my existence;

I live for a reason; and that reason is to understand and free myself from suffering;

I am as happy today as I could ever be….

I beg you please to listen to yourself. Listen to your body. You are not the problem: You are the solution.

Bless

TBC

5 Ways to make your bipolar day pass without biting your nails

Today I am writing about one easy technique to shift your mind from facing racing thoughts, of even black ones. This worked well for me yesterday, and maybe it would work for you too.

Basically, I put my nice pjs (the ones that look like a training suit) and my nice coat on and hit the road. I had company, which had was great, but I could have done it alone to. So why is this would be good for you?

1- makes you get out of bed: Yet you do not need to take off your pjs if you planned it well the night before – don’t over do it. Getting out, I think is an essential tool for healing. First of all, you have to think about stupid things like crossing the street. You also despite your illness and foggy mind, start noticing people: a pair of purple shoes, a child with a dinosaur helmet, a woman with a chapka on her head…. (probably me)

Chapka hat, why not?

2- It gets your find an aim: I think a major problem I have is finding goals- no matter how small or useless – to fill up my day. I wake up and if you’d see my expression it is somewhere between a story dog and a toddler learning to walk. Well, I look weird and feel even stranger. I have say at least 12 hours to fill before the blissful sleeping pill is taken. So going out with your phone to find pictures that relate to your “illness” is great! It makes you feel important, like you are some artist on a mission for a new project they are taking on.

Bipolar is everywhere - credit of thought to dear father Ahmed Loutfy

3-It diverts your attention: Not to be confused with the previous point. When you focus on something, usually your brain forgets what it was thinking about the second before. I make this assumption even if your brain is completely coucou like mine. I have a rule of thumb, if it happens once, it can happen again. Guess what, while taking meaningless pictures across Paris with my father, I forgot being bipolar by totally being bipolar. Tricky right? I mean the importance of your state of mind is shifted to what your current state of mind can do. Hope you get it better now.

Nothing is perfect

4-You start taking hold of your destiny: Yes you are still crazy and your mood shifts from one minute to the other – I wonder how you are actually reading me now. Anyway, when you walk, you have to choose which way to go. You can keep going straight, yes true- but it is still a choice. Medication, psychotherapy sessions, visits to your psychiatric, you will do all this but with little to say. Taking this precious iPhone (fine you can take your Samsung either but not sure it would work as well) makes you the captain of the ship. The ship my friend is you.

Do you really want eggs?

5- Might be a useful exit in social situation: If you ever find yourself in a situation where you have to answer the famous “So, what do you do?” Or “What is your passion”? There, in their faces, you got your pictures, you are an artist. It is actually a bit more complex that this. I think taking pictures helps you shape your identity. Now, I would like to find one bipolar pal who doesn’t need this.

Define your identity by trying out things

Waiting for Monday

It is inexplicable what bipolar means. It sounds simple enough; one day up one day down. Yet, this dam type II has most of the time down periods.

I noticed it is mostly Sundays that I don’t tolerate. I think I never liked Sunday. When I went to school, I had Friday and Sunday off, so I always looked forward to Thursday. Till now, it is my favorite day. Sunday reminds me of regressing to routine, of boredom, of loneliness, of responsibility…

I decided to press the panic button today and went to the emergency day center CAC. I couldn’t open my eyes this morning without crying. I cried when I saw the bed empty, when I heard the sound of my husband talking to the kids. I cried to the sound of TV in the background. I cried because my children were beautiful. I got dressed, i even put on make up to look normal for them. I am sick of them seeing their mother crying and shattered in a million pieces.

I fought the feeling and went to make their favorite breakfast. Fuffy eggs. Everyone ate, tears came down even more because they ate. It was going up, the feeling was growing… The void, the meaninglessness of my life, my love to them..

Today my feelings are like a song, With a beat, with percutions in the background and a soft singer whose voice breaks through your heart with its depth, its high notes travelling through your veins.

I do not know what to expect from myself, from CAC, or from today. I am in terrible pain.

I see other people in the clinic, some gazing with their eyeballs made of glass. It scares me, I was like this once and I do not want this to repeat itself. But I like to talk to other patients. Their pains and stories make mine legit.

I feel nauseous, not from the stomach. I feel I want to throw my “guts” out. I wish one could throw up their mind and feel this amazing void afterwards.

The psychiatric nurse and I spoke and we decided I should not be sedated. I have to have feelings, but they hurt. It is like a fresh wound on which you throw alcohol and scream each time – perpetually…

We will see what will happen. At least Sunday will be over soon and Monday will come. It will be grey yes, it will be freezing, but it will be Monday. My roller coaster ride will slow down, and there will will be at the dawn of a new day.

I know it hurts to be here. But I kept my promise and pressed the panic button. I want my family to know that I love them more than anything and despite everything. I just wish they have the patience to wait for me, for this darkness has to cease. They say there is light at the end of the tunnel. If one saw it, I can too.

Not religious, but praying to see this light for more than one day, i saw it for the most for one week…

May you never experience my pain.

See you Monday

TBC