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scriptshrink · 7 years

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What are mixed episodes like?

The Scriptshrink consultants answer!

CW: Suicide, self-harm

Charlie

It's... weird, and absolutely terrifying to be honest?

You get two kind of different presentations, one where you switch between pure mania and depressive symptoms rapidly, and another where the two almost occur together at the same time. I've only ever experienced the latter.

In my case, it presented as being absolutely miserable, but so agitated. In my "pure" depressive states, I'm tired and lethargic and can barely get out of bed. I have suicidal thoughts and I want to self harm, but because I just completely lack any kind of motivation, I can't act on these thoughts.

But when the manic symptoms kick in, it gets really frightening. I still feel as miserable, except now I have so much energy and my thoughts are moving so quickly that I end up thinking of countless ways to kill myself in excruciating detail, and these kinds of racing thoughts are just completely unstoppable. And it's scary, because I can literally see it in my head? All of the ways to hurt and/or kill myself are just playing in my mind like a movie.

I'd also have constant ideas coming into my head, really exciting things like projects I could start, which is a normal symptom of mania. Except because I was also horrifically depressed, I'd talk myself out of them. It was like my mania was suggesting one thing, but the depression would talk me out of it.

"I could go out and party/have lots of impulsive sex" "No you can't, you're ugly and no one wants to be with you"

"I could write a book!" "You have no talent and no one would read what you wrote"

"I could paint!" "You're awful at art and everything else".

And so on.

I also barely get any sleep, another common symptom of mania, but instead of still feeling energetic and not needing to sleep, I still feel exhausted. I usually can't sleep because my thoughts don't stop racing and I can't seem to relax enough to slow it down. And I can't sit still. So I'll eventually get to sleep at 4/5am after trying for hours, usually wake up about 2-3 hours later. If I do manage to get more than 6 hours, it's really restless, I wake up a lot, and I STILL feel like a truck has hit me the next day.

Also this is really outdated but I think it's one of the best, most in depth descriptions I've ever read: https://thesecretlifeofamanicdepressive.wordpress.com/2008/01/29/the-insane-guide-to-living-with-mental-illness-the-mixed-episode/

NaamahDarling

It's pretty atrocious.

It happens to me a couple times a year, and because I am GOOD by now at catching it early and I have safety measures in place, it never lasts long now. It feels like depression, but there's an agitated edge to it. I am more volatile emotionally.

I dissociate? I think? A little. What that looks like for me is having intense emotional reactions to things but having no connection to those reactions. Like, I might be crying wildly, but that's just my body doing it, and my mind is on the outside going "Whoa, damn, dude. That's pretty bad. You gonna be all right there, little buddy?" I can't stop it. I am not even, after a certain point, even feeling any distress, I'm just a passive audience. It sounds like that wouldn't be all that bad -- crying without feeling sad? -- but it's very bad, it's terrifying. I'm always afraid I might do something else while "out of it" like that, and I don't know if I could stop myself, the same way I can't stop from crying. They are very frightening!

That weird dissociation? Also manifests as this dull static in my head, nothing feels like it matters or is real, I can be in discomfort or pain, I can be hungry or have to pee, and I just . . . don't care. I don't care at all. All I want to do is lie in bed and do nothing, feel nothing. I do the bare minimum necessary to sustain myself. Drink, use the bathroom, sleep. I might do repetitive things like playing phone games or coloring in a coloring book (which can ground me) or do a puzzle. I have to seek out grounding things. Being around people helps, but I also hate it at that time because it's intrusive having to deal with someone else.

Mixed states make me feel helpless. I won't know what to do. My ability to make decisions, my executive functioning, goes straight to hell. I won't be able to make myself food. Asking for help is VERY hard, as I always feel like I'm in the way or unwelcome or am being unreasonable. (That's a feature of depression, but when you add the agitation, it's SO UNPLEASANT because there's this insistent feeling that I NEED help, I really NEED it, but I can't ask for it.) I am miserable and desperately want to ask for help, but it's very hard to do so, and I don't always know what I need, which makes it harder.

I can tell one is coming on because I get agitated and irritable. I get restless. I want to DO THINGS but I also get bored more easily. I start having trouble getting to sleep -- I just don't feel tired. The not being able to sleep just makes it worse. They can, in fact, be BROUGHT ON by a lack of sleep, even for just a couple of days. This is why, when people try to get me to do things that require massive schedule upheaval, I get so distressed. It might send me into a tailspin and I could go into a mixed state and I just . . . fucking do not want that at all ever.

When I feel one coming on, I notify my loved ones that I am going to need help with basic things more often, I start enforcing medication/bedtimes, step up the dose of my mood stabilizer, and, ideally, notify my doctor if I have one I trust. (I currently do not.) This is usually enough to bring it down in a few days or a week, and it's not that bad if I catch it early.

Treated, they typically last from a few days up to a couple of weeks before I get them under control. I'm very good at it by now, and my routine works. When I feel stable again, I drop my dose back down and see how I am doing.

NOT treated, they may not end for weeks. Had one a couple years ago that lasted like 3 months because insurance didn't want to pay for my goddamn mood stabilizers, and they are what keep me from having them. I almost hurt myself and I am still very very very angry about it.

Mixed states are just garbage and I HATE them.

Disclaimer

#text #bipolar #bipolar I #bipolar II #manic episode #mixed episode #mixed features #depression #suicide #self harm #consultant #scriptshrink consultants #this is not psychological or medical advice #this is writing advice #personal experiences #Charlie #naamahdarling

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belis86 · 7 years

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Prescription for Psychiatry

I am doing a course at the moment and one of the books on the reading list is the ' Prescription for Psychiatry'. It is centred around Kinderman's vision for mental health services (oulined below) and I wonder if this is likely to become a reality. I have very mixed feelings about it myself.

So… what’s needed? Well… First….

1.Get the message right – drop the ‘disease model’ and adopt a psychosocial model.

2.Stop diagnosing non-existent illnesses – a simple list of people’s problems (properly defined) would be more than sufficient as a basis for individual care planning and for the design and planning of services.

3. Recognise our role lies in supporting well-being, not treating illnesses.

4. Stop pushing the drugs (or at least slow down). They just simply don’t offer an effective and safe solution…. And here I would appeal to the work of medical colleagues such as Dr Joanna Moncrieff and others.

5. Offer psychosocial services that aim for recovery and personal agency on the part of the client. That means working with a wide range of community workers such as social workers, social pedagogues, and psychologists in multidisciplinary teams, and promoting social rather than medical solutions in the first instance.

6. Where individual therapy is needed, recognise that there are many effective, evidence-based, psychological therapies available. When I was first qualified as a clinical psychologist, I was told that to talk to a service user experiencing psychosis was “unethical”, as talking about their problems would make them worse. We now have evidence-based psychological therapies recommended for a wide range of so-called ‘disorders’ and – in my area of speciality, such evidence-based approaches are recommended for all – 100% of people experiencing psychotic phenomena such as hallucinations and delusions. But this again returns to the language and thinking style of medicine – diagnosis, treatment, outcome. We need to accept that a focus on social determinants of well-being means that we are discussing what is effectively a social and psychological phenomenon, with medical aspects, not a medical phenomenon with social correlates

7. In the multidisciplinary teams delivering these services, medical psychiatric colleagues should remain valuable colleagues. An ideal model for interdisciplinary working would see leadership of such teams determined by the personal qualities of the individual members of the team. It would not be assumed that ‘clinical primacy’ would inevitably put our medical colleagues in a position of unquestioned authority – people should regard themselves as consultants TO the team, not leaders OF the team. This does have implications. It could mean a much greater reliance on GPs and other primary care colleagues as opposed to what are not ‘traditional’ psychiatrists. We might see joint working between GPs and community teams, with GPs offering the medical input when needed – as opposed to seeing psychiatrists serving this role. And that might not only be beneficial for the service user, but could see a massive cost saving for the NHS, if this fed through to a commensurate reduction in our dependence on highly expensive psychiatrists. And this principle could apply in residential care, too…

8. When people are in crisis, residential care may be needed, but this should not be seen as a medical issue. Since a ‘disease-model’ is inappropriate, it is inappropriate to care for people in hospital wards; a different model of care is needed. Residential units, again, should be based on social, not medical, models. Residential social workers or nurses may well be the most appropriate people to be in charge of such units. The nature of extreme distress means medical colleagues may well be valuable members of the team but again they should be consultants TO the ward, not having sapiential authority OVER the team.

9. When the powers of the Mental Health Act are needed, the decisions should be based on the risks posed to self and others, but also on the person’s capacity to make decisions about their own care. This approach is the basis for the law in Scotland, and the law in England and Wales permits the ‘responsible clinician’ to be a psychologist, nurse, or social worker. This should be routine. When we reject a ‘disease-model’ of care and adopt a ‘humancentred’ model, the law relating to mental health could change significantly; with different legal criteria, different ways of assuring that people are offered ‘least restrictive alternatives’, with a psychosocial focus, new roles for new professions, and a greater focus on social justice and judicial oversight. But all this would – in my vision – need one final… or first… step.

10…. Base yourselves in local authority services, alongside other social, community-based, services. That doesn’t mean “design medical teams for psychiatry, manage them out of hospital-based, NHS-based Trusts but put them in a building away from the hospital site”, it means locate the whole service in community services – put the service entirely under local authority control. In the UK, we have the model of public health (transferred to local authority control) to build upon. This should –and could then be – under democratic local governance. I recognise that some local authorities – especially, perhaps, in developing countries, may not yet be robust enough for the task, but this should be the vision and aspiration, rather than aiming for a medical model. Adopting this approach would result in much lower reliance on medical interventions, and a much greater reliance on social and psychological interventions. We would – we may as well be honest – need fewer psychiatrists.

11. As we see a move towards community-based social services, we would look to primary care (General Practice - GP) colleagues for much of the necessary medical consultation and input; linking psychological care to the wider well-being of patients in the community. We would, in contrast, require much greater emphasis on, training in, and staffing of, psychosocial approaches. What I’m proposing would be a very major revolution in psychiatric practice. It would challenge the central tenets of at least some traditionalist, biological, psychiatrists – and the knock-on implications for social psychiatrists (who might otherwise share Pat Bracken’s views and therefore otherwise be sympathetic) could be equally significant as their power and authority is challenged.

#medblr psychiatry psychology antipsychiatry therapy depression psychosis ethics treatment

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laurelkrugerr · 4 years

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I Went to Prison for SBA Loan Fraud: 7 Things to Know When Taking COVID-19 Relief Money

May 12, 2020 7 min read

Opinions expressed by Entrepreneur contributors are their own.

In the months after 9/11, I was frantic.

But my fears had less to do with the tragedy at the Word Trade Center and more to do with the fact that, after 10 years of rampant prescription opioid abuse, my business was failing. I was searching desperately for an out. Meanwhile, the television and radio were blaring with ads for 9/11 FEMA loans administered by the U.S. Small Business Administration.

So, on an especially bad day, I lied.

I said I had an office near ground zero. I received the SBA loan I requested, and immediately paid down the personal credit cards I had run up while waiting for the SBA money. Even so, the loan did little to stop my spiral into drug addiction, mental health issues, marital problems and magical thinking.

In 2002, I resigned my law license and started on the road to recovery. But it all caught up with me about 20 months later, when I was arrested for the misrepresentations on my loan application. I served almost 14 months at a Federal prison for wire fraud and money laundering.

My objective in writing this piece is to offer some insight on what business owners should consider before they take out disaster loans. Certainly, the majority of people requesting these loans are honest and upstanding entrepreneurs who have immense need for the aid, and will use the funds properly. I am very glad there is help for them. That said, history has shown us again and again that when people are in dire need, they’re more prone to make impulsive, ill-advised decisions. My hope is that sharing my experience will help others avoid the consequences I faced. Here are seven takeaways.

Related: How My Life as an Entrepreneur Shaped My Time in Prison

1. Desperate people do desperate things.

There were thousands of fraud prosecutions after 9/11, Hurricane Katrina, Superstorm Sandy, and so on. Why? Whether because of overwhelming business issues, poor personal judgment, or just plain bad luck, people were wounded, desperate and willing to do anything, anything, to stop the bleeding. But if the wound is too deep, a Band-aid is not sufficient.

Practice point: In any situation, behaving desperately is unlikely to save your business.

2. Beware of the belief that rules are suspended in times of emergency.

The government is advertising that huge amounts of money are available to save our businesses. I recently sat in on a webinar run by a very reputable business consulting group that recommended that attendees get their SBA disaster loan applications in immediately, regardless of the facts or the actual needs of their business — they said we could always modify our applications prior to taking the money. State unemployment websites are actually giving instructions, in writing, on how to mislead and circumvent the system in order to get approved. Don’t take the bait! If you default two years from now, this “good-meaning advice” won’t matter to prosecutors.

Practice point: Be truthful at all times.

3. Beware of magical thinking.

This is a tough one because entrepreneurs are inherently optimistic. We believe that things will always be better tomorrow than they are today. It drives us, makes us successful, informs our risk-taking. But in times of trauma, that voice can be an entrepreneur’s worst enemy. Does this sound familiar? We have learned the hard way that there is no shortcut, and yet we desperately want there to be one right now.

Practice point: Instead of immediately reaching for a bailout or other quick fix, develop a good solid business plan. Maybe a disaster loan will fit into this plan; maybe it won’t.

Related: ‘I Never Thought It Could Happen to Me’ — How to Avoid Business …

4. This paradigm shift will affect all small to mid-size businesses.

We are in the midst of a massive reordering that has already had a huge effect on small and mid-sized businesses. Business owners are being called to closely examine if our business models are still viable, or if we must pivot to new ways of doing things. Example: the Swiss watch industry completely missed the shift to digital watches. Have we waited too long to have a robust online presence? Are our products or services even needed anymore? Have we been holding on by a thread for years, unwilling or unable to look at the hard facts?

Practice point: Get real, now. Don’t borrow money to save a business that can’t be saved.

5. Be cautious when borrowing from the government.

As is the case with any loan, the devil is in the details. The terms and covenants in the loan documents dictate what you can or can’t do with the money once you get it. You can only use the funds for the purposes you stated in your application — that is, to pay operating expenses of the business to keep it afloat until it starts bringing in sufficient revenue again. You (and your spouse) will probably have sign for the loan personally, and will probably have to pledge all available collateral, including a second (or third) mortgage on your house. If you maxed out your personal credit cards while anticipating your disaster relief funding, you can’t use the money to pay off your cards.

Practice point: Read the terms and covenants of the loan closely. Whatever the loan terms say to do, do, and whatever they say don’t do, don’t do. No exceptions.

6. We can’t save our businesses and our lifestyles at the same time.

Here’s the big trap. We have mortgages, car payments, school tuitions, and other personal expenses that have to be paid, and soon. But simply put, SBA loans are meant to save your business, not your lifestyle. Discuss all your options with advisors and friends you trust — ones that will tell you the truth! It’s like going to the doctor. Your diagnosis will only be as accurate as the history you provide. These are trying times, with a triage system designed to be more expeditious than thorough.

Practice point: There is no such thing as a free lunch. Borrowing money comes with responsibility and accountability.

7. Get acquainted with acceptance.

I hope we are all great entrepreneurs who can figure out ways to make our businesses survive and flourish. But let’s face it. Some of our businesses will not make it, even with the infusion of government funds. What should we do? We can pare down, embrace change and do things differently as we start a new chapter. Never forget that there will always be opportunity to start again, and to live a fuller, more abundant life.

Practice point: Sometimes less is way, way more!

Related: The Most Important Career Lessons Are the Ones You Learn From …

Website Design & SEO Delray Beach by DBL07.co

Delray Beach SEO

source http://www.scpie.org/i-went-to-prison-for-sba-loan-fraud-7-things-to-know-when-taking-covid-19-relief-money/ source https://scpie1.blogspot.com/2020/05/i-went-to-prison-for-sba-loan-fraud-7.html

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riichardwilson · 4 years

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I Went to Prison for SBA Loan Fraud: 7 Things to Know When Taking COVID-19 Relief Money

May 12, 2020 7 min read

Opinions expressed by Entrepreneur contributors are their own.

In the months after 9/11, I was frantic.

So, on an especially bad day, I lied.

Related: How My Life as an Entrepreneur Shaped My Time in Prison

1. Desperate people do desperate things.

Practice point: In any situation, behaving desperately is unlikely to save your business.

2. Beware of the belief that rules are suspended in times of emergency.

Practice point: Be truthful at all times.

3. Beware of magical thinking.

Practice point: Instead of immediately reaching for a bailout or other quick fix, develop a good solid business plan. Maybe a disaster loan will fit into this plan; maybe it won’t.

Related: ‘I Never Thought It Could Happen to Me’ — How to Avoid Business …

4. This paradigm shift will affect all small to mid-size businesses.

Practice point: Get real, now. Don’t borrow money to save a business that can’t be saved.

5. Be cautious when borrowing from the government.

Practice point: Read the terms and covenants of the loan closely. Whatever the loan terms say to do, do, and whatever they say don’t do, don’t do. No exceptions.

6. We can’t save our businesses and our lifestyles at the same time.

Practice point: There is no such thing as a free lunch. Borrowing money comes with responsibility and accountability.

7. Get acquainted with acceptance.

Practice point: Sometimes less is way, way more!

Related: The Most Important Career Lessons Are the Ones You Learn From …

Website Design & SEO Delray Beach by DBL07.co

Delray Beach SEO

source http://www.scpie.org/i-went-to-prison-for-sba-loan-fraud-7-things-to-know-when-taking-covid-19-relief-money/ source https://scpie.tumblr.com/post/617951378740002816

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scpie · 4 years

Text

I Went to Prison for SBA Loan Fraud: 7 Things to Know When Taking COVID-19 Relief Money

May 12, 2020 7 min read

Opinions expressed by Entrepreneur contributors are their own.

In the months after 9/11, I was frantic.

So, on an especially bad day, I lied.

Related: How My Life as an Entrepreneur Shaped My Time in Prison

1. Desperate people do desperate things.

Practice point: In any situation, behaving desperately is unlikely to save your business.

2. Beware of the belief that rules are suspended in times of emergency.

Practice point: Be truthful at all times.

3. Beware of magical thinking.

Practice point: Instead of immediately reaching for a bailout or other quick fix, develop a good solid business plan. Maybe a disaster loan will fit into this plan; maybe it won’t.

Related: ‘I Never Thought It Could Happen to Me’ — How to Avoid Business …

4. This paradigm shift will affect all small to mid-size businesses.

Practice point: Get real, now. Don’t borrow money to save a business that can’t be saved.

5. Be cautious when borrowing from the government.

Practice point: Read the terms and covenants of the loan closely. Whatever the loan terms say to do, do, and whatever they say don’t do, don’t do. No exceptions.

6. We can’t save our businesses and our lifestyles at the same time.

Practice point: There is no such thing as a free lunch. Borrowing money comes with responsibility and accountability.

7. Get acquainted with acceptance.

Practice point: Sometimes less is way, way more!

Related: The Most Important Career Lessons Are the Ones You Learn From …

Website Design & SEO Delray Beach by DBL07.co

Delray Beach SEO

source http://www.scpie.org/i-went-to-prison-for-sba-loan-fraud-7-things-to-know-when-taking-covid-19-relief-money/

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peteramcsherrylaw · 4 years

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How Will Courts Handle Wrongful Dismissal in Light of COVID-19?

Wrongful dismissal claims are based on an implied term that an employer must provide “reasonable notice” to a terminated employee in the absence of just cause. The law uses a fiction of pretending that each party asked themselves the question of “what would be fair if the employer terminated without cause?” upon the commencement of the employment relationship.

Many factors are used by the court to assess what constitutes fair notice. Age, history of employment and the position held on termination are the most frequently referenced considerations. These factors are said to lead to one fundamental issue, which is that the notice period should reflect how long it may take for this person to find comparable employment. Also a factor is the availability of alternate employment. The list of factors does not end here.

There are also unwritten policy constraints. For example, take a 60-year-old man or woman in an upper management position who is terminated after 30 years of service. One might expect that the chances of this person finding comparable employment are extremely modest. Keep in mind that Ontario has no mandatory age of retirement.

If one were to apply all these factors, the notice period would be gargantuan. The courts use this unwritten constraint to set the upper end of the notice period, which our Court of Appeal has determined to be two years, absent unusual factors.

Coronavirus and Fair Notice

The obvious question today is what will be the impact of the coronavirus upon the court’s assessment of fair notice? Given the volume of terminations due to loss of business and forced closures across the province, will courts impose the same standards on employers suffering massive financial losses? What about the expected increase in difficulty for employees looking for new jobs?

This is not the first time our courts have considered the impact of a recession on this issue. In the past, generally speaking, there have been adjustments in the employee’s favour to the notice period to reflect that increased difficulty that the employee would have in finding comparable employment.

Keep in mind that the theory of the claim is based on the question of “what would the parties have considered on the commencement of employment, had this issue been addressed?”.

You Say Stop and I Say Go

You can see the competing arguments. The employer will submit that surely it should not have to suffer the brunt of this unexpected issue. How can a judge base a notice assessment on an event which was completely unpredictable and out of the employer’s hands?

The employee will argue that it will be very difficult for them to find comparable employment in this job market and surely this is the fundamental purpose of the notice period. Past cases have always increased the notice period to account for general economic downturns. Why should this be any different?

There may be yet be a third alternative.

At one time the law in Ontario considered a “pause” on the notice period when a plaintiff became ill within the notice period. Take for example an employee who was entitled to 12 months’ notice. They then became ill at month 4 and remained ill for three months. Our Court of Appeal reasoned that this event would simply stop the clock on the notice period for these 3 months and then add on 3 more months at the end of the period.

Might this be used in the current situation? Might a court assess the shutdown period as a “pause” button?

The honest answer is no one really knows. It will likely take a Court of Appeal decision to set the law on this issue, which regrettably takes a trial decision and then an appeal to determine, which could easily take 2 years or more. Typically, no one wants to wait that long and many cases will settle with these competing arguments unresolved.

There is also the unlikely possibility that the Ontario government will legislate this matter. However, it very rarely interferes on this type of issue.

Federal Emergency Grant

There also remains the issue of what the impact of the emergency relief funds of $2,000 a month will have on wrongful dismissal claims. Should this sum reduce the claim? Employment Insurance funds do not offset these claims in normal circumstances, but the employee must generally repay EI benefits from a successful claim. Will this also be the case with the emergency funds? We have the questions but, regrettably, not the answers. At least not yet. Keep in mind that the legislators will likely need to react to these complexities as they arise. The law may still be amended.

Upper End Issues

As mentioned above, Ontario law sets a cap of 2 years on the notice award. Might the current circumstances raise this cap? This would appear, at first blush, to be unlikely, but, again, we are all on shaky ground on this subject. This remains an outside possibility.

Employment Contract

All of the above presumes that there is no contract setting an agreed notice period or severance sum. There is a further issue on this topic based on the concept of frustration of contract. Stay tuned to this page for further review.

Get Advice

The common law is an adaptive process that adjusts to many moving parts of life and economic forces. This issue is one example of such a dynamic force. The vivid changes of law by the Federal and Provincial governments will go hand in hand with the common law. As you can see, the legislators have been quick to act to the current situation, a key and vital factor. We will continue to monitor and update the all news as it develops in this space. If you have questions about your employment or options upon termination, ontact the offices of Guelph employment lawyer Peter McSherry. We can guide you through the issues, help you understand your rights, and defend your position. Contact us online or by phone at 519-821-5465 to schedule a consultation.

The post How Will Courts Handle Wrongful Dismissal in Light of COVID-19? appeared first on Peter A. McSherry.

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#Reasonable notice #Wrongful Dismissal #coronavirus #covid-19 #damages #wrongful dismissal

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