Speaker 1: 0:00

G'day everybody. My name is Elliot Waters and you're listening to the Dysregulated Podcast. As always, thank you for tuning in and a special welcome to this new series, the In Conversations With so. I'm your host, elliot Waters, and in this feature we will be diving deep into conversations with individuals who have a lived or living experience with mental illness, offering real, raw and genuine insights into what it's like to navigate the complexities of mental ill health. The aim is to bring authentic stories to light, encourage open conversations and create a space where we can ultimately learn from each other. So this episode may include discussions of sensitive topics such as suicide, self-harm, substance use, sexual violence, domestic violence, trauma and other mental health-related issues. These conversations offer genuine insights into mental illness, but they may be distressing for some listeners. If any of these topics are triggering for you, please take care of your wellbeing and reach out for support if needed. Listener discretion is strongly advised. All right, that's on record. Let's hope that this is working, but if not, like I said, we'll just do it again.

Speaker 2: 1:23

Yeah, easy.

Speaker 1: 1:24

So, holly, it's great to be here with you again. Welcome back to the show. Today is a little bit different. This is a new segment. I suppose that really only was thought of. I guess we've had the idea, haven't we? We've spoken before about how we have a lot of good mental health conversations and often we go geez. Wouldn't it have been great if we were recording what we were just talking about? How cool would that be? Well, the idea is, ladies and gentlemen, that that's exactly what we're going to be doing here today, which is just having a general chit-chat about life and all that that means and, yeah, going through some mental health topics and and just sort of vibing out and having a good time. So thank you everybody for joining us. Holly, how are you feeling? How you doing?

Speaker 2: 2:16

yeah, all right, I'm a little bit nervous, as I always get when we start recording things, but I think we have some really good conversations that need some input from the outside world and provide some really good insight into mental health and the system and everything in between.

Speaker 1: 2:31

Oh, the system. Yeah, we'll get on to that in a minute, but yeah, well, thank you for coming on again, I guess broaden the scope of understanding and offer some insights for people that I think hopefully they will find quite useful through our experiences and it's always good to chat with you because we seem to sort of vibe off each other so well, but also because our stories are a little bit different, so we come at the same topics from different angles, albeit we tend to come up with the same conclusions, which is nice. But yeah, so now I'm really pumped, really excited. So I guess, how I grunted before at the New South Wales mental health system or the system more generally, how have you been lately and have you had any experiences with the system? That's worthy.

Speaker 2: 3:32

Yeah. So I've just come out of the public system where I had access to multiple psychiatrists and doctors and mental health nurses and dieticians and psychologists, et cetera. So I've just gone into the private system and it has been difficult navigating the private system. Somehow, whatever I say is very reactive.

Speaker 1: 3:55

Private or public system.

Speaker 2: 3:57

The private. So what I've found the last couple of months like having private psychiatrists. If I say couple of months like having private psychiatrists, if I say I'm feeling pretty low or I'm like really enjoying life and improving, like have, the context is I have bipolar disorder. Either way, the alarm bell seemed to go off in the doctor's heads and I just seem to get shipped into psych wards when I don't really feel I need to be there.

Speaker 1: 4:22

Which is crazy, because I'm begging to go into a psych ward and I would say I definitely need to go, and yet they won't put me in. And yet here you are on the complete other side of the coin. Flip the coin, you're on the other side, but you're getting put in when you don't necessarily believe that you need to go. I find that very interesting, how there's that disparity between ourselves. I don't know. It's interesting to me, yeah.

Speaker 2: 4:49

Yeah, I find it very frustrating because it seems to be that if you get labeled with something like I have, like type one bipolar disorder, that you just everything you say, becomes again reactive, whereas because Elliot's been labeled with things that are apparently as he's told me is more psychosocial problems, that doesn't seem to get addressed as seriously as this whole neurochemical thing that I've apparently got going on. So it just is very frustrating for me because I get over-managed and Elliot's getting under-managed and I just want to give him some of whatever I seem to have that doctors take advantage of.

Speaker 1: 5:30

Yeah, see, you get sort of. I guess a lot of mental health professionals would look at you and look at your diagnosis of bipolar type 1 and that would be all they sort of see, whereas I think for me it's similar, but this time it's in the case of borderline personality disorder that they see me and BPD and that's just about it. And I guess, yeah, there's that tendency to really play it safe with bipolar and keep those manic episodes under control. It's obviously so difficult to ascertain if it's a manic episode or if you're just happy in life. I am sure that would be frustrating.

Speaker 1: 6:13

But with BPD, people with borderline personality are often we get generalised into being attention seekers, which isn't the case at all. But that is the stigma that comes with BPD. So instead the idea is I'm guessing that they don't want to put me in the psych ward because things aren't actually that bad. He's just overreacting to the situation. But that's the whole point of the disorder is that I do overreact to situations and that's the problem. But it's not about attention seeking, but I'm certainly help seeking. So it's very frustrating, you know it's. It's a shame we couldn't swap well, not swap disorders so much or anything like that. But I don't know. Just swap the way in which the system deals with us. Because, yeah, as we know, if you've listened to the show long enough, that I'm crying out for help essentially, whereas, yeah, you are going pretty good and you're being afforded help that you don't really need, which in itself can be detrimental. So it's very frustrating, isn't it? Really annoying?

Speaker 2: 7:25

So just to touch on the BPD again.

Speaker 2: 7:27

You have to correct me if I'm wrong, because I'm definitely not an expert and I don't have the disorder, but your episodes tend to be smaller Small is the wrong word. The duration's not as long, so they're absolutely as intense as a manic episode in bipolar or depression, but they just don't last as long. So therefore, doctors, when you're presenting with an episode, of whatever kind it is, and you're looking to be put into a ward, are they going right, this is only going to last X amount of hours, or maybe a day or two, but then he'll bounce back and be all right. Is that what they're thinking?

Speaker 1: 8:04

I'll answer the first part first, which is it is a bit like bipolar, but compressed, in that the mood swings, instead of happening over weeks and months, are happening day by day, and when I'm really ramping the most like I'm having mood swings every five to 10 minutes, like it's terrible. It's not good, but I think part of the reason that psychiatrists in the public system don't want much, it appears, to do with people with BPD is partly because the gold standard treatment for borderline personality disorder does not involve medications. It's all therapy, because you can't really medicate personality. So dialectical behaviour therapy, dbt, is the gold standard treatment, and you don't get DBT therapy in acute psychiatric wards. It's just not the environment and they can't facilitate it, which is fair enough, and often there is, I think, a bit of that idea that this person's got BPD, they'll calm down. You know, in a little bit they'll calm down, and they should be right to go. I think there is a bit of that way of thinking. But the problem is, though, that even if we do calm down the, the next swing in either direction is is is coming, and it could be coming quite swiftly, and the results can be quite disastrous as well, because BPD is a disorder that is very much marked by impulsivity. So you can imagine if you're having a mood swing into the depressive side of things, coupled with that impulsivity that can drive substance abuse and other reckless behaviours which can then amplify the depressive sort of spiral episode that the person is in. Then all of a sudden we have a big, big problem, which is a problem that an acute care team in a psychiatric ward, for example, I think can come to the rescue a bit and return the individual back to their sort of stable way of proceeding in the world.

Speaker 1: 10:11

But yeah, it's a tough one because that stigma around attention seeking is so detrimental to those of us that have BPD. Because, yeah, quite simply our I guess our what's the word? Our view of the world and how we convey that to the mental health provider it's not taken as seriously as some of the other disorders. Because, yeah, there is that idea that someone with BPD is just craving some attention or, let's say, validation. How dare you Craving some validation? It's not actually that serious, you know. They're sort of putting on an act to get the response that they want, you know. So it's not as serious, but that's not true. The response that we want is so we can push back against the flood of negative emotion that is just charging in. I don't know, I don't know anyone, in all my sort of time of doing this whole mental health thing, which is just about forever for me I've never met anyone with BPD where I would say that they're just attention-seeking like the stigma of attention-seeking just wanting that reaction.

Speaker 1: 11:29

It goes deeper than that. Even if it doesn't appear so on the surface, people with BPD have some real fundamental personality issues at play and views of the self and all that sort of stuff, really deep stuff that can manifest itself a little bit, I guess, superficially maybe on the surface, but it's always coming from a very, very deep, fundamental place. And I think that is forgotten amongst a lot of mental health providers and they just look at BPD and go, oh look, you know he's just bunging it on, you know he or she's just looking for attention. It's not that big of a deal, just get them calmed down and then we can get them out and it's like, well, no, it's actually, there's more to it than that. But you know it's hard to. It's hard to advocate for oneself when you're in those moods, those crisis, acute moments. It's very difficult to convince a mental health provider that's already got a bias against someone with BPD to change their mind and opinion on how you are presenting and the fact that you need help and deserve it. It's very hard to do that when things are stable, let alone when you're in those crisis points. So that's partly why the system, I think, fails those with borderline personality disorder, because there's this wrong perception about the motives, I guess, for someone with BPD going to hospital and then often those with BPD are not given the treatment that they deserve and desperately need.

Speaker 1: 13:07

So whereas in your case, I guess bipolar the system's much more, I guess, not equipped I wouldn't say equipped, but more understanding of the fact that bipolar is very biological in a way. So the gold standard treatment for bipolar disorder is medications as opposed to BPD, that is therapy. So psychiatrists, I think, are more willing to try and intervene for the person with bipolar disorder because I guess they feel like it's more in keeping with what they're able to do. But I don't know, I just look at people as people and if you're in distress, you're in distress. It doesn't really matter In my opinion.

Speaker 1: 13:54

I'm not a mental health professional, but I'm certainly a mental health consumer of these services and I don't know. I think we need to look beyond just the labels and the stigma and the bias that's inherent in those and maybe just look at the individual and the terrible time that they're having and hopefully come up with a way to alleviate that in some way. So anyway, that's my soapbox little point for today. But yeah, I hope that answers that question. But yeah, it is often very different the way that the hospitals treat different conditions.

Speaker 1: 14:31

Obviously, to a certain degree there's a necessity because these conditions are different, but I think there is certain biases at play and unfortunately, those of us with borderline personality disorder would be all too aware of that, and then you as well, holly. I reckon there's bias the other way, which is that you need to have all this extra attention when maybe things aren't quite as bad as what you're being led to believe from the doctor that it could be. So I don't't know. It's a tough one. Don't get me wrong. I rag on the system a lot, but I'm certainly not blaming any individuals and I understand why it is how it is. I just really hope we can come up with a way to improve it a little bit.

Speaker 2: 15:17

Yeah, so touching on that, I guess every time that a mental health professional has intervened, every time that a mental health professional has intervened for me, it's mostly been medication-based. So I have been given an antipsychotic or a benzodiazepine and basically been put on watch for however long to make sure that I'm stable because of the medication. But obviously BPD is a different kettle of fish. So another big question for you if you were coming into the hospital having a BPD episode whether it's high or low or whatever it is how would you want the professionals to handle it? Do you want to sit in a room with a psychologist for four hours and just talk it out? Do you want medication on board? What would be the gold star treatment if you could choose what you needed?

Speaker 1: 16:04

That's a good question. It's hard because when I present to emergency departments which unfortunately I do periodically if you've listened to the episodes, this is to the listener at home. If you've listened to enough episodes of this podcast, you'd know that I've got quite a few different diagnoses. Episodes of this podcast, you'd know that I've got quite a few different diagnoses and usually if I go to the emergency department, if it's a BPD related sort of phenomena that I'm dealing with, I tend to put it instead under the umbrella of depression or anxiety or because those conditions, those disorders, are more easily and readily accepted by the mental health teams than BPD. So I try and downplay the BPD component as much as I can, but I can only do that to a certain extent because it is a key driver of my behavior, rightly or wrong, wrongly. Borderline personality is a big part of me, um, which isn't as big part as it used to be, but it's still very much a driver of a lot of my negative emotions, thoughts and behaviors. Um, but in the hospital setting, I think usually when I present there, things are out of control. So I'm well aware that to fix the condition and move beyond BPD, that requires lots and lots and lots of therapy, of which I've been doing for a while now and we're chipping away. But there's a lot more to do. But if I go to the emergency department it's because I'm really in the hole big time and it scares me. When I go to the emergency department, it's because I'm, you know, really in the hole big time and it scares me. When I go that deep into the hole, that's when I've lost control and I'm at the whim of my crazy crazy is probably not the word maladaptive thoughts and behaviors, but still cognizant enough to know that I need to take myself to the hospital because this is danger zone, this is danger time. So really for me it's all about. It's not about attention seeking, but it is about trying to bring those overt sort of expressions of my disorders under control in that moment. So then I can hopefully be discharged quickly back into the community and then do the things back home that I know I need to do. That will help me moving forward, which is, you know, all the stuff I do go to work, you know, do potty episodes, all that sort of stuff, all the good things.

Speaker 1: 18:40

But in those moments when I'm at the ED, when I rock up to the Mater Hospital, like that's when I'm out of control and I'm scared, like truly scared, petrified of what I'm thinking and the feelings that I'm feeling and the fact that I don't seem to have any way to stop the negative emotion flooding in. It just infiltrates everything. Every thought is negative. It's just, you know, that spiraling has just gone so deep that I don't know which way's up. And what I would like from the hospitals is some help to find the way back up, knowing full well that there's no magic pill that's going to fix my predicament because I've tried them all, my predicament because I've tried them all. So it is all about, I guess, minimizing the potential damage.

Speaker 1: 19:29

But at the same time it's not just medications. You said, would I like to talk to someone and really sort of talk it out? Yeah, probably, usually I would, once I'd relaxed a bit because, you know, because these thoughts, there's plenty of them and often the best way to get them under control is to actually expel them from the mind. And that can be in a few ways journaling or whatever, doing these episodes like I do on the potty, but also talking to a doctor or a mental health professional about these things. So I guess it's a two-pronged sort of attack, but then I think, with most presentations to emergency departments for mental health, that's what you want. You want the medications like a benzodiazepine, for example, like a Valium, to calm down and get some level-headed sort of thinking going, and then you want to be able to talk about what's been going on with somebody, even if it's just to clear your head of it a little bit, and then come up with a bit of a plan upon discharge. That's what I would like.

Speaker 1: 20:40

Part of the problem, though, is that, because, for me, my condition has been going on for so long now like I'm sort of wanting more than just a discharge plan into the community. As we know again, if you've listened I've been begging for some sort of admission somewhere to have a look at all the medications I'm on and how things are traveling on that front. So you know it's not when I'm discharged, so yeah. So basically, go in there first. It'd be nice if there's not too much of a waiting period. But look, you know that's just the way it is. You've got to deal with it.

Speaker 1: 21:19

The first thing would probably be a medication like a benzodiazepine to calm down and get back to some sort of level-headedness, and then I'd like the opportunity to then talk about what's been going on and what has been the triggers for this and then come up with a plan, upon discharge, what the next steps are. And that's where the problem's been for me more recently, which is that the next steps upon discharge have not been very clear, and they're still not very clear as I sit here talking right now. But that's pretty much what I'm looking for usually when I present to the emergency departments, and that doesn't necessarily include being admitted to the actual psychiatric ward where possible. If that can be avoided, that would be great. But sometimes it can't be avoided because you know things are dangerous and it needs to be contained. And although those acute wards are not a fun place to be in, it is still a safer environment than what could potentially happen on the outside. So yeah, I don't know, I don't know a lot of waffling there, but if that makes sense, that's good.

Speaker 2: 22:30

No, that's a brilliant answer. Thank you for answering that question.

Speaker 1: 22:34

What about yourself? What do you look for In a perfect world? Let's say a realistic, but a perfect world? How would you like to be dealt with? I suppose Because, again, we come at the system from different angles, but we're both feeling like we're not getting out of it what we need. So, in a perfect world, what is it that you would like to happen?

Speaker 2: 23:02

Yeah, so I guess I've got some recent experience with this, having just been admitted, probably two weeks ago, for a hypomanic episode that my friend brought me in for. So how I would have liked them to deal with me is that before they go right, we need to medicate. You actually talk to me and see what the level of risk is, and not just listen to my friend. I understand that I don't have all the insight when I'm in an episode, but I like to think this recent one that I had, I at least had some insight into what was going on and I would like to be talked to and then ideally not medicated, because although the medications definitely can bring you out of an episode, it affects me for days afterwards, like I'm groggy, I'm slow, I'm just like a shell, a zombie, I guess you could call it of a person.

Speaker 1: 23:56

So we're talking antipsychotics, aren't we?

Speaker 2: 23:59

Yeah. So the most recent one, I got injected with one called Haldol, not a massive dose, I don't think, but enough that it knocked me for a good two, three, four days, and yeah. So I'd like to avoid that at all costs and try and make a community discharge plan where I can be like in previous episodes where I have absolutely refused to go to hospital. The community team has come to my house a couple of times a day, literally just for five minutes, just to make sure that I'm not a danger to anybody. I'm taking my medication and I'm functioning enough that I don't need to be in hospital. So that would be my ideal situation.

Speaker 2: 24:38

But I know that resources are stretched thin and that's not possible for everybody and that putting someone in a psychiatric ward is a lot easier than community engagement. But I just you get so much trauma out of psychiatric visits. The first one I ever went into I was with people who were three times my age and it was just not a conclusive environment. There's no like you see a doctor every couple of days and they adjust your medications. There's no like you see a doctor every couple of days and they adjust your medications, but there's no engagement, there's no therapy, there's no talking to people, you're just left to your own devices, and I reckon boredom can be just as bad as a weapon, as mania.

Speaker 1: 25:17

Especially if you've got ADHD as well, which is very much a disorder of boredom, which is very much a disorder of boredom. That's what I've found as well in these wards that boredom is enemy number one, and it's so true that they're not the most comfortable. You know, make no mistake, these wards are not holidays. In a sense, I guess you're trying to give your mind a bit of a holiday from what it's been going through, but at the same time you're with other people who are also very, very sick and are not the best versions of themselves, and that can be very difficult, especially the first time you're admitted I remember that was it was like a different world. And ever since then I haven't been able to, you know, just ignore the fact that this goes on in our society, in our community, that there's people that are this unwell mentally, whereas I didn't notice before, I was a bit oblivious, I suppose, a bit ignorant perhaps, whereas now, since my experiences in the wards, it's really been an eye-opener of how difficult some people's lives are and there's a lot of us that are facing those sorts of complexities.

Speaker 1: 26:34

I had a really good question. I was going to ask you and typical ADHD brain, I've forgotten, but it was going to be a beauty. But I guess with the antipsychotic, that's one about antipsychotics, but the one that you were on I haven't had before, and you said it knocked you around for a couple of days, and that reminds me of a quote I heard once in relation to antipsychotics, which is you can't be psychotic if you're asleep, and that's often what they do. So how many days did you say you were sort of knocked out? For what was the story?

Speaker 2: 27:08

there, maybe like three or four days, like not totally knocked out, but enough that, like someone would be like, right, it's breakfast time, come and get your breakfast, and I would have to sit there for 30 seconds and go breakfast breakfast. Oh, that means I actually have to get up. It's like the neuropathways in your brain are blocked, because they're obviously blocking dopamine, which is what antipsychotics do. So that must just be some nasty side effect, because it was just, oh, it was horrible. You really are a zombie.

Speaker 1: 27:40

Yeah, yeah, and pretty much all antipsychotics, to varying degrees, have that sort of effect when you were injected with it. I've never had an injection. Well, I've had an injection, but not of a psychoactive drug that I can remember, at least that I can remember at least Whereabouts do they do it and how long did it take for it all to? I'd imagine it would. The effects of the medication would hit pretty quickly.

Speaker 2: 28:13

Yeah, it definitely did. So I've been injected a couple of times on different occasions. So the first time I was on top of a bridge and like completely just erratic and not safe so they needed to inject me. So they inject me in my butt cheek. But this time, at the hospital just recently, because I was willing and I said you know, okay, fine, like you got to do this, do it. Then they just did it in like the top part of your shoulder, like your bicep, tricep, top area there. Does it hurt?

Speaker 1: 28:45

Yeah, it does. Yeah, because I remember I got an injection in the backside of I don't know if it was penicillin or something, some antibiotic Back in the day. I used to get chronic tonsillitis before I got them pulled out and I remember at the GPs they put the needle in and I collapsed because I wasn't really ready and that whole side of my leg and buttock wasn't particularly prepared either, and I pretty much collapsed on the ground because it was, excuse me, it was quite painful. So yeah, and I remember that needle at least looking back now felt like it was huge. But that is a pretty drastic step for them to take. Were you not, I guess, cooperating? Or were you? What was their reasoning for having to go to those sorts of lengths?

Speaker 2: 29:47

Yeah. So for the first time I was obviously on top of a bridge and, refusing to like, they brought me over from the other side and I'm sitting on the road and I just kept trying to get up and get back over the railing and it was just constant for maybe I don't know 15 minutes maybe. And eventually, when the ambulance arrived, the police were like right, this person's clearly mentally ill they have a word for it, I think it's like mentally disordered or something. So they have an act that they legally have a right to inject you if they deem you mentally disordered or mentally ill or whatever it is. So I obviously met that criteria the first time.

Speaker 2: 30:27

But then when I went into the hospital for this hypomatic episode that wasn't very severe in my opinion, they were just like. They were very honest with me. They were like right, we see that you're in some kind of distress. We want to get you out of it. The easiest way to do that is an injection. Would you be okay with that? I said no. They said, if you don't do it, we'll get a court order. And I was like okay, fine, whatever you need to do, just do it. So they didn't even tell me what it was. They just got the needle and were like right, sit still, please, bang. Right, we've got you a bed in the psych ward. Here you go, Chill out. After half an hour I was like completely.

Speaker 1: 31:03

Done and dusted. That was it for the next couple of days. Absolutely yeah, because there's a real loss of autonomy there in that little story. And it's a tough one because if it's a life or death situation or there's danger immediate danger to people in the community, you could justify using it. But do you think you're at that point when they did this? Do you think that justification was there?

Speaker 2: 31:36

Probably the first time. Yes, because I was quite literally trying to absolutely hurt myself in the most deadly way possible and I was combative, like hitting the police officers, Not hard, I was just trying to get away. But I was just so totally out of it that, yeah, I think that was warranted there. But the most recent one I really didn't think I was in that big of an episode, I thought I was just enjoying life. But then again that could be me not having any insight into my situation, which I struggle with, where this is where me and Elliot need to swap disorders or at least half of them so that I can have some insight and he can have some of my ignorance and hopefully get some help.

Speaker 1: 32:18

The insight is killer. I even said that to my psychiatrist the other day and he sort of chuckled and didn't really know how to answer and I was being very serious when I said that. But yeah, it's. Um, yeah, insight's a funny thing. It is a funny thing because it's. It's great to know how everything's operating, why it is, but to actually implement the changes required, that's the hard part and that's the most frustrating part. If you can see plainly what it is that needs to be done but yet know that you're not able to do the things that need to be done, it's not a great feeling. And that's again the contrast between your story and mine and there's quite a few of them, although fundamentally they're very, very similar is that level of insight and what you said just then is so important?

Speaker 1: 33:15

Because a lot of people who don't have bipolar one, bipolar two or any specific, I guess, mental health disorders that results in a level of mania or hypermania, is that during these episodes they are fun and enjoyable and you feel like you're a million bucks and you know. And it can then progress further than that, where people think that they're Jesus or that God's speaking directly to them and they have to carry out. You know there's. You'd be better to answer that sort of and illustrate that point better than me. But at the same time, you know the feedback that you hear from people and I feel the same when I'm in BPD mode and things. At the same time, you know the feedback that you hear from people and I feel the same when I'm in BPD mode and things are all running hot. You know it's. You don't think about the consequences, it just feels awesome. It's like, yes, especially if your baseline of living is not particularly fun. You know like. You know like, but yeah, like, I would say.

Speaker 1: 34:16

For the most part, I'm in a in a level of depression, you know, most days and I'm certainly suffering from anxiety attacks constantly as well. So when there is that bit of relief, like like, it's amazing. And of course, it's amazing because it's like, yeah, this, I think, is closer to how life should be, not as opposed to how life is. For me usually and I'm guessing, correct me if I'm wrong, but that way of thinking is similar in your case as well in that it's like, of course, this is fun because all of a sudden, you know things are all rosy and colourful and you know like what's. Of course, that would be enjoyable and something to try and attain. It's just knowing where the limit is between, like, a healthy level of hey, life is good versus an unhealthy level of I'm the Messiah and everyone should bow down. You know, I don't know. Does that sort of make sense?

Speaker 2: 35:19

Yeah, absolutely. I think I touched on it when I did my like story, the intake interviews, that like I struggle with that now I just my baseline is just boring and it's not fun and it's just I just hate it. So I look for those adrenaline, dopamine, whatever you want to call it in mania. So that's why, during this last episode, I just was not seeing that there was a problem, because I was finally getting the feeling that I've been searching for for months, maybe even a year. It had been since my last episode.

Speaker 1: 35:51

So Do you find so your day-to-day baseline? So you would call that your baselines in the zone of depression. Would that be right?

Speaker 2: 36:05

basically, I probably wouldn't say it's in the zone of depression. It's just boring for me. Adding to it is that like so when I just get up and I'm like nonchalant, don't really mind about anything, like breakfast is good, like whatever happens next is good, like and it's just all. It's all good, but it's just boring because it's not like that high intensity emotion that I just miss from the mania so would it be?

Speaker 1: 36:36

I'm just, I just really want to get a good handle on this and good grasp about your experience here. Um is, would anhedonia come into it at all, the loss of pleasure and activities that you used to find pleasurable? Like everything's just flat and there's just no like spark in anything that you do. It's just all going through the motions and it's just flat. Is that sort of getting closer?

Speaker 2: 37:02

Yeah, definitely, but I try very after doing a lot of psychology work with this I try very hard to get those natural endorphins, dopamine, adrenaline, whatever it is. So I do that at the moment by exercising. So I'll get up in the morning and I'll feel anhedonia and I'll be like life is so boring, like I'm flat, like, but then I'll go for a run or I'll go to the gym and then after that my baseline feels better than anhedonia, but not brilliant, if that makes sense. So there are definitely things that I can do to improve that, which I know some people struggle with. But just because I'm not working at the moment, I can focus all my energy on trying to get those feel-good hormones naturally, because otherwise I will stop taking my meds and I'll happily go manic, because that's what I'm struggling with.

Speaker 1: 37:51

That was the next point, because correct me if I'm wrong, but you're on lithium, the mood stabilizer, and olanzapine, the antipsychotic. So both of those medications which I've been lucky enough to have as well, both of those medications are quite well known to have a relationship of some sort with this flat feeling, because they both well, the antipsychotics in particular dampen that dopamine rush and it's the dopamine rush often which is that excited feeling that drives us towards a goal. And the antipsychotics put a lid on that because unfortunately for those with bipolar disorder or schizophrenia, those dopamine levels can go too high. Then all of a sudden we get into psychosis territory. But the trade-off is that, okay, we're not in psychosis territory, which is great, but now we're in gray, dull, flat, depressed sort of zone, and a lot of people or a lot of doctors would look at the I guess the flat effect, as you call it affect A-F-F-E-C-T the flat effect, or emotions, versus the psychosis side of things. Neither of those are great options, but I guess the lesser of two evils is probably the flat effect side of things, because you don't have the energy to carry out any destructive behaviours If you're the person that's going through it. I'm guessing the response would be that both are debilitating and it'd be nice if we could find some sort of middle ground.

Speaker 1: 39:47

And I've found that with me with my medications as well. So, like when I was younger, I've always been a real passionate, excited person. I've spoken about borderline personality already, but one thing about BPD is strong emotions and that can go both ways. So when I was growing up and stuff, I definitely had the negatives but there were some real big positive rushes as well. And now that I'm medicated and and I've done a lot of therapy around controlling emotions and my head space and all that sort of stuff, unfortunately I don't get the rush of excitement like I used to. And it's so depressing because you know like I'm a bit different. You know like there's a lot of disorders at play. Autism is another one that springs to mind as well.

Speaker 1: 40:36

When it comes to this sort of emotional regulation sort of thing, part of my uniqueness, I suppose, was my excitability at different topics and how I would really, you know, get so passionate about things and unfortunately over the years that's sort of been beaten out of me you could say, you know, through medications, and so I struggle a bit too, in the sense that a lot of my meds, I guess, contain me, but they contain me and pin me down at a level that is not Elliot happy, it is Elliot very flat and not really feeling anything, and that, then, is depressing, because I know there are joys in the world, but I feel like sometimes I'd love to know if you feel the same, that in those moments when you do feel nothing but joy for any particular moment, for whatever reason, there's always this caveat I think of, which is hang on, is this healthy?

Speaker 1: 41:33

Healthy, though, should I be feeling this happy, or is this actually a problem? So often I'm not able to be truly happy without being anxious that it's the happiness is actually a negative, if you know what I mean. I don't know. Do you have that similar sort of experience?

Speaker 2: 41:52

yeah, I think so. So when I've talked. So when I was first made stable in inverted commas I talked to psychiatrists about the fact that you know, life is boring, like I feel flat, like nothing interests me anymore, and they're kind of like well, you're not manic and you're not depressed so good, what are you complaining for? Depressed so good, what are you complaining for? So then I did a bit more. So I talked to then a psychologist who was a bit more helpful and he said the best way to combat that is to do things that get you natural endorphins, like go outside, exercise, hang out with friends I've got two dogs, so hang out with them. Like you got to do that sort of thing to try and lift you out of it.

Speaker 2: 42:35

But I think it's so chemical it's not that easy. I can sit here and tell you to go and exercise and see friends and whatever else, but if you're flat and you just don't want to do anything, it's impossible to get yourself up. It is so hard. People who don't have this problem will not understand how hard it is to pull yourself out of this rut that is induced on you by medications that, if you're being real with yourself, you don't want, because you want the mania, or at least that's where I come from.

Speaker 1: 43:10

Yeah, and it's not just the medications doing their thing, it's the disorders first and foremost doing it as well, like a lot of people that haven't been through God love them a mental health sort of journey personally themselves. You know, like with depression, people often, will, you know, stay inside and be a bit reclusive and it'd be hard to get out of bed and it's hard to do the real basics. And unfortunately, I've found that people some people don't understand, some people understand acutely well that there are some times where your brain just will not allow you to do the things that you know you should be doing. And that happens to me so often when I do these big sleeps that I do, which happened the weekend just gone again, another two days spent in bed doing nothing, even though there were things for me to do. But I tried. I tried to get up, I tried to be functional, I tried to be a part of living and engaging in life, but I just couldn't do it because my mind has all these disorders associated with it and they're doing their thing, bringing me down and that's. And so I get a bit frustrated when people look at inaction as being lazy, when it's actually.

Speaker 1: 44:46

Inaction is a direct result of having a mental illness, and that that's really one of those things that frustrates me and that's what I guess I'm trying to do here on the podcast is to get that point across over the course of the show that you know, these disorders, they have their own, I guess, ways of working and it's usually to the detriment of the individual, the self, and it's important that people know that this is how they operate. And although on the surface again, surface level there might be certain indicators or lack of behaviors or lack of engagement that might suggest some degree of laziness, there's actually a lot more going on if you peel back those layers and that's why they're mental illnesses. You know there's no logic to this in most cases, there's no, you know, obvious reason as to why so-and-so should feel so in the dumps today. But unfortunately that's how it is and we've got to deal with that. And yeah, I guess that's a big part of what I'm trying to get across on here, but it's also. But then that's where bipolar is so frustrating, because you get the opposite as well, which, all of a sudden, you feel like you're doing everything and everything's falling into place finally, and you've figured it all out. How amazing is this? But then that could be deemed unhealthy. And then comes that extra complex part which is then knowing what's a healthy happy versus a manic happy. And that's very, very difficult.

Speaker 1: 46:29

And bipolar as well, you know I said before about our BPD is very much therapy-based as far as the gold standard, moving forward and improving one's prognosis. Well, with bipolar it's the opposite. It's medication. And the psychology component also helps with bipolar. But a lot of the times the psychology component is about building the habits to ensure that you have the medication when needed. So it's supplementary to the medication sort of story.

Speaker 1: 47:02

But what that suggests is that, excuse me, that bipolar is very chemically, it appears. You know, there's a lot of neurotransmitters doing their thing and if they're literally not firing as they need to be, firing like that's as physical as it gets, that's not just mental illness, that's a physical problem which is causing then the flow on effect of maybe lack of behaviors or too many behaviors at the same time. So yeah, I don't know. It's all very confusing, that's for sure. But it's very difficult for the people who are going through this.

Speaker 1: 47:41

And there'll be a lot of you listening, you know, sort of nodding, going yep, that's me. I feel that too, you know, we're hypervigilant, not only of those around us especially those with anxiety disorders are hypervigilant of potential threats in our environments, but we're also hypervigilant of what's going on inside our own minds, and that in itself can cause big, big problems because it wears you out, it brings on this anxiety. You can never be sort of calm and happy in the moment because you're just always questioning whether you know this is how it should be, and then yeah, so anyway, I don't really know where that tangent was going, but yeah, it's hard living with mental illness is what I'm trying to say, Something like that. Anyway, sorry, holly, where were we?

Speaker 2: 48:32

That's all right. I just want to talk about another thing that came up during my experience of being stable again in inverted commas, it's capacity. So I got told that my capacity is never going to be the same as it was when I was 17. Like where the point where I was working eight 10 hour days, doing sports training for three or four hours afterwards, going out drinking with friends after that and then going to bed at one o'clock in the morning and waking up again at seven. I'm never going to be able to do that again. It's basically what I got told by a psychiatrist. These medications are going to dull you down. You're going to live a very simple life, but this is how I took it. You're going to live a simple life, but you're going to be stable and that's all we care about. So it took me a long time to come to terms with the fact that my capacity I just can't do everything that everyone else can do.

Speaker 1: 49:22

Well, I speak a lot on the show about my capacity. In particular, I tend to focus on my social capacity, or lack thereof, so that comment there resonates with me in a big way. I don't know, though, if that's is that. I don't know, is that something you should tell somebody?

Speaker 2: 49:43

I don't know. See, this is where I find it really hard to get into a romantic relationship, because how do I explain to someone that you know I can't really be awake past 10.30 pm because my medication puts me to sleep? How can you explain that to someone who is my age, who's 21 and is in their prime? And then, how do you meet people if your social capacity is just zero and you can barely get out of bed some days? That's the thing that I'm finding the hardest, because all my friends are getting into relationships and I'm just here thinking I'm stuck by these medications that I put on to conform to society standards of what they want me to be, whereas I could be happy as manic off in the UK, like I was before, and just and actually meet people and enjoy my. I know there's a swing back to depression and I'd have to deal with that, but part of it, like this, is a battle I have every day. Is it worth it? Is it worth being stable but not living, not thriving?

Speaker 1: 50:47

Yeah, because that's similar to what they're doing with me, which is, you know, it's all about containment. You know, contain the most extremes, or the extremes of my personality and how it manifests itself into the you know the world to our external environment. It's all about containment. Our external environment, it's all about containment. It's not about, I guess, life enrichment and being able to tick off the things that you want to tick off.

Speaker 1: 51:24

There's no secret on this show I've mentioned many times, I'm amazed you were the one that brought up romantic relationships and not me, which is usually, it's always at the forefront of my mind.

Speaker 1: 51:31

But it's true like these, like why the medications, shouldn't the medications and the treatments be being used in a way that does facilitate your ability? And this is just, in general, anyone but like you know, you, the person who's undergoing these treatments to facilitate the individual's ability to get the things that they want out of life, and that could be a life partner. That could be, you know, a nice holiday here and there, and you know, like, is that the life worth building that we're aiming towards, whereas I think often, in psychiatry in particular, it's all about, like I said before, containment. And containment, though, doesn't necessarily equal a happy, fulfilling life and I always thought the end goal should be the happy, fulfilling life. That might take containment in the short, the medium term, containment in the short, the medium term, but surely there's a way to, once that's all sorted out, to then be able to build on that contained, strong, fundamental, to then build on that and get those things that you really want out of life. I don't know.

Speaker 2: 52:43

Yeah, you're hitting the nail right on the head for me, because I have this conversation with doctors in the private system now that I've moved into there and they just don't care, like, as long as I'm stable, they don't care that I'm not thriving, that I'm not living the life that I want to live. They just care that I'm not manic and I'm not depressed.

Speaker 1: 53:01

That's right. Like you know, like I've always wanted, or my goal more recently, has been to go back into the transport industry, because I feel like I've got unfinished business when it comes to transport and logistics, because I used to work in transport when I was younger and I'll do some episodes on that down the track, because it's always nice when I reminisce about it but the thing is, though, I can't go back into the transport industry because of the multitude of though. I can't go back into the transport industry because of the multitude of medications that I'm on, in particular the quetiapine, the antipsychotic. The chlamypramine, the tricyclic antidepressant it has sedative effects to it. My new medication, metazapine it also has sedation as a side effect. These medications, and the whole rest that I'm on, essentially disqualify me from being able to operate, drive a truck, basically, and although my goal to return to the transport industry wasn't just to be a driver, I wanted to go back in operations and be a manager, I wanted to lead a team. But I'm acutely aware as well that you've got to have and this goes for any industry, but transport especially, you've got to have the credentials, and the credentials is not a degree in psychology. The credentials is that I've done night shifts and I've driven trucks and I've unloaded at different places, and I have done that earlier in my career but I wanted to do a little bit more of the work at the coal phase before I transitioned into management and leadership and then be a leader of men and women. That's what I wanted to do, but being on these medications has disqualified me from being able to do that, which is unbelievably, dare I say. It fired me from being able to do that, which is unbelievably, dare I say it, heartbreaking, because the transport industry is one of my loves and it's heartbreaking to think that I may not be able to return like I wanted to.

Speaker 1: 55:01

And then it's like okay, so the medications are containing me. Well, are they? Seriously, you guys listen to this podcast. Are these medications really doing much for me? Really? I reckon I could come up with a pretty strong argument to say that their positive effects are negligible at best. But either way, let's just say that they are containing some of my behaviors. That's all well and good, but they're disqualifying me from the career that I would like to have, which is you.

Speaker 1: 55:30

Career is a huge part of one's life and people gain so much satisfaction and engagement and empowerment from their career, and I've been disqualified before I can even get back to the start line by these medications, which is making me depressed. So it's like, okay, what good are these medications doing? Yeah, maybe they're doing this containment, which is important, but what's the point if then okay, yeah, I'm contained and everything's good, but I can't actually do anything because I'm too lethargic because of the antipsychotics or you know what I mean like and unfortunately, psychiatry, especially in the public system, but the private as well. But the public system, or at least in these wards, there is only a limited amount of time that can be devoted to each patient. So you know the the doctors are, I guess, focusing on the most acute manifestations of these mental illnesses that we have and are trying to get them under control term with a psychiatrist. Unless you've got lots and lots of money and can afford to see a psychiatrist privately every fortnight, which the majority of us can't do, even though that's pretty much what I need, but I can't afford it that's where psychology does a much better job, because psychology, at least in my experience, whether that be through doing my degree or the research that I've done, or being a consumer of psychological services myself is a lot more about. All right now that there's this containment, what behaviors can we incorporate, what ways of thinking can we incorporate to create that life worth living from now on?

Speaker 1: 57:26

But when it comes to psychiatry and the medication stuff, like I'm on now eight medications and at no point has there been a discussion about an exit plan or tapering off the medications.

Speaker 1: 57:39

You know down the track when I get off the meds, you know there's been no discussion about that at all. It's just thrown more at me. And that's why the last trip at all, it's just throwing more at me. And that's why the last trip which you would have heard a few episodes before when I've spoken about it, my more recent trip to James Fletcher to see the psychiatrist there in the public system I went in there with some pretty clear goals, which was to titrate or at least begin the withdrawal of these medications, to sort of start again from baseline, to see first off what my baseline actually is nowadays, because it's so hard to tell, because there's so many different levers being pulled and we don't know which which medications pull and what lever. Um, and then the plan was also my plan to get off the meds so I could go back into the transport industry, which I could then build a life around that fundamental building block, and I walked out of there with a new medication instead.

Speaker 2: 58:36

So that just infuriates me that they just did not listen to anything that you needed.

Speaker 1: 58:44

Yeah, and it sort of infuriates me as well, because then it becomes a question of your autonomy. I think at the start of this episode we mentioned, or I mentioned, about you losing your autonomy when they said you know, we're going to inject you with this pretty much whether you like it or not. It's almost on a similar scale in the sense that the psychiatrist said well, you're going to be taking this medication unless you like it or not, because you don't really have a choice. This is the way it's got to be and that's not. I didn't go in there. I had clear goals going in there of what I wanted to achieve out of that appointment and I achieved nothing. And it's also hard. It highlights another problem, which is how difficult it is to advocate for oneself in these situations, because I don't know about you. You tell me, but sitting with a psychiatrist is quite anxiety provoking for me personally.

Speaker 2: 59:42

I don't know if you feel the same, or it is very much so, and from my experience they have their computer open, they're typing notes. They barely look at you and then they're just you're waiting for them to ask you a question and then they're like bam, have you had a low mood recently? And then you go yes or no, and then they type more and it's just. It's a horrible experience, like I hate it.

Speaker 2: 1:00:04

So my most recent I've been in the private system now for probably four months and so the psychiatrist that I'm seeing I wanted to start an ADHD medication so that I could try and find my thriving not just surviving mentality, and this psychiatrist basically dismissed me and said as soon as I said I'm bipolar type one, he was like nope, not going to happen, didn't listen to me. So then I had to try and self-advocate for the fact that I think I need this, and I did a terrible job. I just ended up saying please, like my life is just a waste of time at the moment, can I please have something to help me get a job and engage in life the way that I want to?

Speaker 1: 1:00:47

Sounds fair to me.

Speaker 2: 1:00:54

So that's, I engage in life the way that I want to Sounds fair to me. I just didn't know what else to do. I basically begged him and he just dismissed me and then I paid $700 and off I went.

Speaker 1: 1:00:58

Yeah, and it is a tricky one because there is a real risk with stimulant medications and bipolar. That can't be denied. There is that risk, and we're speaking about dopamine before, and a lot of mania and those manic episodes and psychosis, even a lot of that is driven by excess amounts of dopamine. So obviously introducing a medication that increases dopamine comes with it. You know some things to be careful of. But at the same time, as far as I'm understanding it although again I'm no doctor, but you know, I've been around the system a fair while now. I have come across people with bipolar who have their moods under control, with mood stabilizers like lithium or lamotrigine, maybe an ant antipsychotic as well, like olanzapine, like you have Holly or quetiapine or I don't know, risperidol, a whole stack of them, and often, well, this is pretty much what happened with me with my first private psychiatrist. The idea was to get my at that point. Bipolar was a pretty you know that diagnosis was pretty solidified with me at the time with how I was presenting. So the idea was, if we get the mood, if we get the bipolar under control first, and then we get the anxiety under control, then we look at the stimulant medication for the ADHD. But that's the hierarchy that needed to be done. Because if the bipolar, or let's just say my mood dysregulation, my emotional dysregulation, if it wasn't under control, the stimulant medication would definitely fuel more of that, and that's just the way it goes and that's fair enough. I agree with that. Fuel more of that and that's just the way it goes and that's fair enough, I agree with that. And then that was the anxiety, was the next component that needed to be sort of looked after, because stimulant medication raises norepinephrine levels, which is the fight or flight or freeze sort of chemical, one of the neurotransmitters that's implicated in that sort of response. Um, so obviously stimulants that raise that as well. If the anxiety is not under control, then that can fuel more anxiety.

Speaker 1: 1:03:19

But once those first initial sort of steps were locked in and everything was running smoothly, then I was introduced the stimulant medication, which at first was dexamphetamine. It was just five milligrams a day, purely and simply to see what it would do if it would rock the boat too much. And in the end we found out that it didn't, which was good. And then, ever since I'm now, I take lots of stimulant medication to try and keep the ADHD under control, and that's where I'm at. I guess the difference there is I was diagnosed bipolar type 2, whereas you're diagnosed type 1, so you've got the potential for psychotic features. You've got the potential for psychotic features, but I'm sure I'm going to look into this in a little bit more depth after this episode and I'll come back with an answer, because I'm sure well I know that there's lots of people that have bipolar disorder that also meet the criteria for ADHD, and so you know there are non-stimulant options for ADHD.

Speaker 1: 1:04:32

I think you said you've tried them, like Stratera before, but didn't really do too much, which is why they're second line interventions, because often they don't do too much. But to go back to your original point, though, you know you need adhd looked at so you can then build on creating that life that you really really want. It's very functional. You know it's gaining that function back, and the medication would have great utility in unlocking your potential and ability to get full-time work, for example, and do all these different things, and I think that's so important To me.

Speaker 1: 1:05:15

I think it's as important looking at the on one hand and this is traditionally how mental health professionals have sort of approached these things, looking at the negatives all the time. You know the deficiency model so so-and-so is deficient in this area and deficient in this area. So we've got to fix the deficiencies so they're back to normal. You know it could be interpersonal stuff, communication, you know, anger control, whatever emotional control, emotional dysregulation. But the other side of the coin is the more strength-based approach where you try and amplify the good and then really work on what the individual is really good at and then leverage that in the world to create that life worth living.

Speaker 1: 1:06:05

But unfortunately in psychiatry they tend to just throw medications at you to try and alleviate the deficiencies but there's next to no focus at all on the other side, which is the things that you've got going for you that are really good, you know, and let's focus on them and make them even better. Psychology was very much like that for a long time. It's starting to turn a little bit now because obviously you've got to look at the deficiencies, because they're the things that are holding you back, but you've got to look at the things that you're good at too, because they're the ones that are going to push you forward. So you sort of need to have a process and this needs to be part of recovery plans and those frameworks that are created by mental health professionals. I think that need to look at both sides of the equation and traditionally, at least in my experience, I think you would agree, holly, from what you're saying, it's very deficiency-based, focused instead.

Speaker 2: 1:07:04

Yeah, absolutely. It is so what I wish. I would have come out with a psychiatrist appointment. So I'd tried two non-stimulants already and I'd been on a stimulant as a teenager when I got diagnosed with ADHD. So I brought all that evidence to him. I was like I'm on an antipsychotic, I'm on a mood stabilizer. I've been stable. This was before I had this episode, the hypomanic episodes but I've been stable for two years, like I really want to try lowest dose possible, like my parents will be around to make sure, like I'll have friends around, I'll have people around to make sure that I don't lose self-awareness and become manic or whatever. But even if he was going to say no which he did I would have liked him to say okay, but here's a really good psychologist who's going to help you work through your symptoms manually and hopefully come up with strategies to do something. But instead he just said no and he didn't even do it nicely, and then he just shoved me out.

Speaker 1: 1:08:02

I don't like that because, like, this is people's lives, you know, like, and I felt a bit like this the other day at my psychiatry appointment, you know, because essentially, the psychiatrist, by writing out the script for the metazepine, the new medication, he essentially was signing off on the waiver that says Elliot cannot be employed in the transport and logistics industry, and that is a huge, huge thing in my world. And there was no discussion around because I did bring it up but it was very briefly sort of touched on and then it was ignored. Moving forward, it's like I need a bit more guidance here than just take this medication. She'll be right Because, yeah, I don't know, I just, yeah, it's hard, it's very hard, and I feel that you shouldn't have to come in with a game plan and obviously you need to be able to talk about what you feel is important to talk about. But you know, like the way you and I are talking here right now, we're essentially saying whether we're saying it outspokenly or not which is, you've got to manipulate your psychiatrist in order to gain the results that you want and need, whereas it shouldn't have to be like that. The psychiatrist should be able to do all these things without us having to lead them.

Speaker 1: 1:09:28

Like the whole idea of the therapeutic relationship, person-centered care, which is made famous by Carl Rogers, a famous psychologist, is that you and your therapist or doctor are supposedly meant to walk side by side. Right? That's the metaphor or the imagery that's used. You know, you don't lead the psychiatrist to say, no, we're going this way, but the psychiatrist doesn't lead you either and say, no, we're going this way. You both walk side by side. Together, you both have input, fair input, and together you come up with the pathway forward and then you both go that way, if that makes sense.

Speaker 1: 1:10:08

A little bit abstract, but that's the general idea. And so often in these situations I've found that, well, I certainly haven't been leading the psychiatrist anywhere. I've been running behind and it's down a path that I'm not particularly happy with, and in my case, most recently, it was essentially that I won't be able to work in the transport industry. So you know, and that's a huge, huge life changing, altering sort of moment, and it was glossed over and like, yeah, it's, yeah, I didn't. I didn't particularly want this episode to be completely about how terrible psychiatrists are.

Speaker 2: 1:10:51

No, I'm so sorry, that's my fault, I just really needed a good rant.

Speaker 1: 1:10:54

No, no. But at the same time I think it needs to be said and it's good that we're saying it. It's just a shame that we both feel as though we need to talk about it, because I think we're very valid in what we're saying. I think so. I don't know by all means everybody. If you're listening and you think maybe we're off the mark, send me a message. You can do that on Instagram or Facebook.

Speaker 1: 1:11:19

But it is a big problem and it's a big problem for a lot of people, and it's especially a problem when you're not able to advocate for yourself as needed. And so often that is the case because you know you can imagine you go in and you're depressed. So you're not really. You know making much eye contact, although if you're autistic like me, that's, that's the norm anyway um, but you know your shoulders are slumped, you're sort of mumbling words a bit, you're not thinking clearly. You're certainly not able to come up with labor intensive, energy intensive. You know arguments to try and get your point across. You just got to do the best that you can, and that's why it's so important that skilled mental health professionals are able to see beyond that and see some.

Speaker 1: 1:12:02

You know some other things that might be going on, that it's that the patient is unable to bring to mind in that moment because of the disorders. But it's so difficult when you're not given the opportunity to begin with to really explain how you feel and where you'd like to end up. So, yeah, it's a tough one and it's good reason that we're talking a lot about it on this episode, because we've both had experiences like this very recently and it's a big problem. It's not a big problem just for you, it's not a big problem just for me, and it's, I dare say, a big problem for a lot of the listeners as well. So, if you are listening and you're finding it very difficult to get your wishes across to your mental health providers, well, unfortunately I don't have the answer to that just yet, although, let me tell you, I'm investigating and as soon as I find out you'll be first to know. But I am definitely in the same boat, and Holly is, unfortunately, as well. Would you agree?

Speaker 2: 1:13:04

Yeah, absolutely.

Speaker 1: 1:13:05

Yeah. So yeah, this is a topic that will be revisited, and it needs to be because, yeah, that whole deficiency model, you know, looking at the negatives and trying to negate the negatives but ignoring the positives you know there's a whole school of thought on positive psychology, which was Martin Seligman was the psychologist who created it. He used to be head of the American Psychology Association. And Martin Seligman was the psychologist who created it. He used to be head of the American Psychology Association. Anyway, positive psychology is this big thing and it's all about making your positives even better, so your skills and competencies, building on them to then create that life worth living.

Speaker 1: 1:13:48

And I think in some ways, psychiatry needs to flow psychology's lead and maybe look at a bit further down the track, even just plan on how long we're going to be on these meds. For as I sit here now, I've seen so many psychiatrists and on so many different medications I have no idea I may be on these meds forever. I don't know. I hope not, because there's some longer term side effects that don't look particularly pretty, but you know it's never really been mentioned to me. There's, you know, there's a timeframe on this and this is the plan and it's just yeah, I don't know. It's very short term thinking and very much focusing on the supposed deficiencies of the individual and not really focusing on the wishes of the individual, which is very disempowering and does rob one of their autonomy, which is not a very good feeling. Anyway, back on my soapbox again, but that's just how I feel.

Speaker 2: 1:14:48

Good to get it out there.

Speaker 1: 1:14:49

Yeah, it is, and it needs to be said because a lot of us are going through it. So it's hard, you know, like because I really want to get back to the transport industry. You know I really do. Although mental health is, I guess, my number one, road transport is sort of my number two, and my dream is always to be able to combine both worlds, and it still is my dream. So what I want to do at the end of it all is I want to do a big research undertaking into the transport and logistics industry from a mental health, psychology point of view and try and improve the horrendous mental health outcomes that there are currently for those men and women who keep Australia moving.

Speaker 1: 1:15:37

It's an industry that is plagued by poor mental health and I'd like to do something about it because I've been in the industry, I've worked night shifts, I've done all the driving, the loading of trucks, done quite a bit, and then obviously I've got the psychology research side of things, my degree, all that sort of stuff. My dream is to put both together, but I really wanted a little bit more time in the saddle, so to speak, before I tried to combine the best of both worlds, but it appears that may not happen, so back to the drawing board. But anyway, that's all right, that's okay, that's something I'm dealing with. So it's yeah, just got to keep on trucking.

Speaker 2: 1:16:19

I think it's okay to be disappointed. Like I know, I definitely when I lost my job late last year, I definitely was trying to make plans to get back into the workforce and then but nothing, none of the support worked of what I wanted to do Really. It just wasn't in my capacity anymore and unfortunately that I feel like that was decided by a psychiatrist.

Speaker 1: 1:16:43

So are you in regular psychology at the moment?

Speaker 2: 1:16:49

Not at the moment. I have an appointment in october with a private psychologist. It was really hard to find one who specialized in bipolar or schizophrenia or psychosis, a lot of. Not that any of this is surface level, but like a lot of the psychologists are like stress, life issues, grief, like I just needed to go to a psychologist who wouldn't freak out if I said the word psychosis, so it just took me a while to find someone. But yeah, the appointment's in October, so I've got another month or so to wait, just raw dog life without a psychologist. Yeah, that's right.

Speaker 1: 1:17:25

But at least you've got a date to sort of focus on and look forward to.

Speaker 2: 1:17:29

Yeah for sure.

Speaker 1: 1:17:32

And it's just such a shame that psychology is so expensive too. Absolutely yeah, Because you said that you've been seeing a private psychiatrist, which obviously there's quite a large fee, I would imagine, involved in that.

Speaker 2: 1:17:46

Yes.

Speaker 1: 1:17:47

Whereas I'm seeing one in the public system. So it's actually free for me. But I'm sort of at the whim of when they've got availability and it's a bit different. You sort of take what you can get a little bit because it's just so expensive. Looking after one's mental health is so expensive.

Speaker 2: 1:18:03

It is yeah. So one of the suggestions that was made to me is that I go through a private psych ward and then try an ADHD medication, a stimulant, and I was like, how am I supposed to afford? I think it's like 30 grand for like a week.

Speaker 1: 1:18:19

It's insane or you go, you've got to be top cover private health insurance.

Speaker 2: 1:18:24

Yeah, which I obviously am not.

Speaker 1: 1:18:26

Yeah, you've got to be gold cover to get psychiatry included. Unfortunately, I know that from the hard way when I was at Maitland Private Hospital I've spoken about that on here before that obviously was a private admission but that did require me to go to top cover private health insurance, which sent me broke, although I did have a great experience up there. But unfortunately I don't have the money at the moment to be able to afford that and that's why I'm doing as much as I can in the public system. Psychology I'm seeing privately. But again, this is another thing that bugs me when it comes to access to psychology, everyone's like in Australia I'm talking this isn't just New South Wales In Australia you can get 10 rebated sessions to see a psychologist, and people who aren't quite aware on how that works seem to assume that that means you get 10 free sessions and you don't get free sessions. You've got to pay the upfront amount first. Then you get your Medicare rebate, which is not the full price of the session. So one of the major major barriers to being able to get the care that you need is the price and the lack of affordability, and you've had that problem a bit in the past, dare I say because we were speaking before about how you haven't been working consistently over, say, 10 years or whatever.

Speaker 1: 1:20:08

Um, it's, it's very hard. It's, it's just so difficult when you've got mental illness, or mental illnesses depending on what they are, it doesn't matter what they are. All of them make the ability to work to your full potential, you know, very, very difficult and often just unattainable. And and yet these services that we're talking about to improve your mental health cost a lot of money. So it's like you've got to be working full time to afford the therapy which will then allow you to keep working full time.

Speaker 1: 1:20:42

And I don't know if you can see the problem in that, but if you're not able to work full time, like me at the moment, for example, I can't afford to go see the psychologist as much as I am required to, because I can't afford it, and then everything starts to slowly disintegrate from there. And that's what I've been trying to overcome the last probably three weeks now. Three weeks now. Have you found the same problem that it's hard to get, I guess, a real solid routine in place to get the help that you need to be able to see the therapist as much as you need and a psychiatrist as much as you need because of those, I guess, socioeconomic factors.

Speaker 2: 1:21:25

Definitely now. Yes, but in the past I was in the public system for almost two years and I could like if something wasn't working or if I was having a bad day or whatever, I could just ring and I could speak to the psychologist within. Sometimes he was available at the time, sometimes it was like 10 minutes an hour and then I could talk to him and if I needed to see a doctor then I could see a psychiatrist within a few days. But since going into the private system and I'm not working at the moment, yes, it's incredibly hard. That's why it's taken so long. I haven't had psychology sessions in four months since getting discharged from the public system and obviously psychiatry is the main priority for me at the moment because obviously my condition isn't, it's neurochemical, it's not really psychology. Obviously I can benefit everyone can benefit from psychology, but it's not the main point of my treatment. So all of my savings have gone into psychiatry.

Speaker 1: 1:22:24

Yeah, I don't understand how and we've spoken about this together often I don't understand how you were afforded the access that you did get in the public system and how I haven't been able to me.

Speaker 2: 1:22:50

So when Elliot first got into the public system and got an appointment with a public psychiatrist, my first reaction is, yes, he's going to get access to a public psychologist and the psychiatrist and all the social workers and dieticians and anything that he needs he's got. He's got what I got, but the difference is Elliot's with the Newcastle team and I was with Lake Macquarie and somehow Lake Macquarie just seems to be so much better and you know what, if Elliot was like a postcode over, he'd be in Lake Macquarie jurisdiction or whatever you want to call it.

Speaker 1: 1:23:19

It's actually even more than that. My street, where I live, is divided. My side of the street is Newcastle City Council or City of Newcastle. Across the road is City of Lake Macquarie.

Speaker 2: 1:23:35

Really I didn't realise it was that close.

Speaker 1: 1:23:37

Yeah, because just down the road from my street is Boundary Road, which is the boundary, so that's how close it is and could have changed so much. But anyway, it is what it is. But yeah, it's, I don't know it's it's. Yeah, I've always like, obviously I'm not, I'm glad that you got that help. That's brilliant, you know, and so you bloody should you know, of course.

Speaker 1: 1:24:05

But I do wonder why sometimes I never was afforded that opportunity and I've always been a bit bemused by that, like where's my social worker? Or you know where's my person that organizes all my appointments and when I need to get my medications, and I don't know. All I can think of is it must come back to my level of insight, because every single mental health I don't even have to be a professional, just anyone that's, I don't know. We've all got experience with mental health. So so many people say, oh, you know, the insight is so great, you know, and I can only assume maybe that it's my level of insight has steered me away from those sorts of services or access to those services. But I don't know, it's an interesting one. But we've spoken about this before, about how our trajectories in the public system has been so different. And yeah, I don't know. I still can't figure out why that is.

Speaker 2: 1:25:05

I don't know yeah like even I had group sessions, so I did two. I did one that was ACT for don't know. Yeah, like even I had group sessions, so I did two. I did one that was ACT for psychosis, which is do you know what it stands for? Acceptance and commitment therapy. Yeah, that one.

Speaker 1: 1:25:18

Yep.

Speaker 2: 1:25:18

And then I did another one on like like mood regulation stuff. So I did, I did two groups. I saw a psychiatrist every week, I saw a psychologist twice a week for a couple of months there when things were bad, and I had a dietician that helped me with the weight gain of olanzapine and I had a social worker making sure that I wasn't going to lose my housing, like I just. I had a job provider who was helping me get things off Centrelink, like the five grand for moving away and shit like that.

Speaker 1: 1:25:48

Jeez, that'd be a hard.

Speaker 2: 1:25:49

Five grand yeah, so I just got all the help that I needed in this one place and they were so good about it once I finally accepted the help, and I just find it so frustrating that either Newcastle isn't the same or they're discriminating against BPD. I don't know.

Speaker 1: 1:26:10

That's what I wonder.

Speaker 2: 1:26:12

Yeah.

Speaker 1: 1:26:12

That's what I wonder. I think it could be partly the BPD stigma that we spoke about at the start of the episode, but also, I think it's still that level of insight, because I've got the insight straight away. It's just like, oh look, he can't be that bad. You know he's still got a grip on reality, you know he's all right, even though I'm not. But yeah, that is something that we've always found a bit interesting, haven't we?

Speaker 2: 1:26:40

Yeah, it's just so infuriating for me because I almost end up feeling guilty that I got such good help for those two years and now I'm stable and I'm not thriving, but I'm not hating life like. I'm kind of in the middle you should definitely, never, ever feel guilty for that.

Speaker 1: 1:26:58

Just I know. I say to you all the time I'm going to say it again there is no need to feel guilty. You got the help that you deserved and was rightfully yours 100%. And they did well by you for the most part, even if the psychiatry component has been a bit limiting, you could say. But holistically, the system actually did quite a good job by you, which is great. It just needs to do such a good job for everybody.

Speaker 2: 1:27:25

Exactly by you, which is great. It just needs to do such a good job for everybody, exactly, and it's like I hate it because they probably I know that they sit in their meetings every morning and they go through all of their people that they've got on for today and they basically have a rant session. I'm sure it's more professional than that, but they talk about all the patients there.

Speaker 1: 1:27:43

Yeah, that Elliot guy. He keeps talking about the Newcastle Knights he just won't shut up about it. Yeah.

Speaker 2: 1:27:49

Yeah, but they're more likely saying Elliot's so insightful, he's not suicidal, like he's not a risk to anybody, so therefore we can have a 20-minute appointment, shove him out and then we move on to the person who this word I hate is more severe because it's not severe. Person who this word I hate is more severe because it's not severe. Everybody, nobody, has a mental illness that is more severe. They're just different in different ways. Anxiety is absolutely as crippling as schizophrenia, it's just in different ways.

Speaker 1: 1:28:20

It is, and you mentioned about the suicidality. Then there have been times where I have been suicidal, more recently actually, I think I was telling you this yesterday when I was on the phone to you about how I told the psychiatrist that I now had a plan, which I will not be going into details.

Speaker 2: 1:28:43

But when? Elliot?

Speaker 1: 1:28:44

told me this.

Speaker 2: 1:28:45

It just makes me want to fight the system, because how the hell can you tell someone that you have a plan and then they're like on our CEO, like off you go? Why is there no follow-up? Why is there no community team coming to your house making sure you're safe?

Speaker 1: 1:28:59

Yeah, and I've been referred to this acute community team many times before and they just don't ring.

Speaker 1: 1:29:07

So I just, yeah, I don't know. And even more recently, when I said there was a plan, which there was a couple of weeks ago, because I was going through a very, very difficult time, and you know, I fully expect that it's going to swing back around again and I'm going to go through this terrible time, because you know, this is the nature of my, my mental health, which is, um, there's this very short run sort of short-term ups and downs, the bpd sort of stuff, but there is still those longer, those elongated mood disturbances of feelings of things are going okay and then I'll dip down for a couple of weeks and things will be really difficult and there's no reason that I can think of that would suggest that that's not coming again. But even then, when I said that I was almost too insightful because the way I was talking, like I knew the ins and outs and the consequences and all this different stuff, and that played against me. So I don't know, maybe next time I'll just won't talk, maybe I don't know. But anyway, we'll see.

Speaker 1: 1:30:12

We'll see what happens. But the story is I guess you are getting help, but you would like help in some different ways which would enrich your life, which is the difficult part. Would that be fair to say?

Speaker 2: 1:30:27

Yeah.

Speaker 1: 1:30:28

Yeah, I would like some help even though I am getting some help, but I would like some help to also be able to do things that would enrich my life, like get off all these sedating medications and then get back into the career that I would really love to get stuck into. I get back into the career that I would really love to get stuck into. What else has been happening, though, for your mental health? Before we wrap up, how are the doggies going?

Speaker 2: 1:30:54

Yeah, the dogs are really good.

Speaker 1: 1:30:55

I got a puppy in June we haven't met yet, so we need to sort that out once we finish recording.

Speaker 2: 1:31:02

Yeah, so he's beautiful. Because I'm not working, I've been trying to find, find like fucking listening to what the psychiatrist and psychologists have told me like find positive things in life. So I decided I would raise a puppy while I'm not working and then focus very hard on exercise and eating healthy, making sure I get my two fruits, three veg or whatever it is making, make sure I drink three bottles of water, like just real basic stuff, like just making sure I can get everything in a real good routine and habits, and then try and look for work that's not going to. I think a big trigger for my episodes is stress. So if I'm going to work a job that's stressful, I'm way more likely to swing one way or the other in terms.

Speaker 2: 1:31:50

So that's just. It's slightly frustrating because I would love to go back to support work and do what I used to do, but realistically I'm probably going to end up working at Woolies three days a week and just having a non-stressful, very boring life, because if I introduce stress into my life I just spiral in either direction. Yeah.

Speaker 1: 1:32:08

But at the same time, yes, maybe you may need to go to Woolies and do that for a little bit, which isn't your chosen, I guess, career, but at the same time it can definitely be a foundation to build upon. And I guess that's sort of what I'm trying to do too, which is, you know, use my work at the moment and then springboard into another area which isn't going to be the transport industry, it seems. So I'm going full tilt into the mental health world, into being a hopefully a researcher or some sort of keynote speaker advocate. I don't know, maybe this podcast will take off, who knows?

Speaker 1: 1:32:45

Hell yeah, but yeah, it's good that the doggos are going well and my therapy animal, Mabel the cat. She tolerates me, which is pretty good all things considered.

Speaker 2: 1:33:02

I've met your cat. She looks beautiful, but I obviously haven't seen her personality.

Speaker 1: 1:33:07

She's lovely, but I show too much love and I smother her with my love and, I don't know, for some reason she doesn't enjoy it when I get in her personal space without asking. So I don't know. Maybe there's something to remember in that, maybe.

Speaker 2: 1:33:23

My dogs love it. The more I'm close to them, the better yeah.

Speaker 1: 1:33:28

Yeah, so, looking down the track, we'll finish up shortly. So this has been really good because, yeah, just to reiterate to everybody and if you're still listening right now, thank you for listening through, because these episodes are going to be very unstructured, you know, like it's just having a chat about how things have been, essentially talking about all things mental health and everything related, but without any sort of well. There's no real scripts used on this show anyway, because you know, this is the most genuine, honest, vulnerable and fair dinkum podcast on all the internet. So there's no scripts, it just comes from the heart. But at the same time, these conversations the idea is that it's just going to be free, flowing and who knows where we end up. But whatever we cover, we cover it and you come along for the journey too. And, by all means, if you feel as though a lot of this resonates with you, feel free to reach out to me on Instagram, at elliotttwaters, or on Facebook by searching the Dysregulated Podcast. Message me on there and I promise I'll reply as quick as I can. Of course, remembering my social capacity has its problems, so if I do take a little bit to reply, don't take it personally is all I'm saying that is well and truly an Elliot thing, unfortunately.

Speaker 1: 1:34:56

But this is a new segment and I would like to involve as many people as I can, I suppose, because, yeah, there's a lot to be said about this topic and there's a lot more that we could certainly go on, and I dare say this will be the first of a few episodes that Holly and I do together. Of course, holly has been interviewed as part of the Intake interview series previously, so I highly highly recommend listening to that episode. It is a beauty. But if you would like to be interviewed on the show or be a part of the conversation series again, feel free to reach out to me on social media and we can get that happening, because the more people that we get on this show, the broader the scope of understanding around mental illness, and that's a good thing for all of us. And it's a good thing for me too, because I love listening to other people's stories and learning so much. It's a great privilege and an honour. So if you're interested, please let me know. But anyway, holly, any last words before we go.

Speaker 2: 1:36:03

Just if you ever want to reach out to me and have a chat about literally anything under the sun, just let Elliot know and we can connect, because I'd love to connect with some of you all the listeners and hear your stories and your opinions and everything on mental health and anything else that's going on in your life.

Speaker 1: 1:36:19

I would love to connect with you, yeah, yeah because I think sharing the load you know, helping carrying each other's burdens that little bit is so important and it can be as simple as just having an awareness around what the other person's going through. That in itself, you know that common understanding can mean so much and change so many things, and that's simply through talking and communicating Like it's a pretty powerful tool. The old have a conversation. I know it's well, it's probably not cliche, but it is very true that, yeah, having a conversation can change a life, and Holly and I are more than happy to engage in conversations around this sort of stuff. Let me tell you, absolutely it's interesting too. You made a good comment.

Speaker 1: 1:37:10

So this episode has been recorded at the University of Newcastle in the special podcast studio which the university has that I somehow have access to. So let's hope that continues. But Holly made a funny comment as we walked in that, um, it was, it's, it's like a padded room. Um, because it is a padded room in the sense that you know it's. It's got all the sound insulation stuff on the wall and everything like that. But yeah, it is, it did. When I first come in here, it reminded me of a padded room too, so it's quite a fitting little environment, I feel to be talking about this sort of stuff I 100 agree um so, but thankfully this padded room has a door that we can open from the inside, so we can leave whenever we want.

Speaker 2: 1:37:58

So that's good, it's good um, but yeah.

Speaker 1: 1:38:01

so thank you everybody for listening to the new segment, the In Conversations With series. Thank you, holly, for coming on the show again. As always, I appreciate it and we're going to do it again, hopefully sooner rather than later, so thank you.

Speaker 2: 1:38:16

I really enjoyed it. It's really good.

Speaker 1: 1:38:18

Yeah, cool. And, like I said, if you guys have any comments or would like to reach out to me or to Holly, reach out to me via social media. And if you'd like to be a part of the show, whether that be through the intake interviews where we have a look at your story and how things have progressed to today, or whether it's in one of these more laid back episodes where we're just chewing the fat on mental health, you let me know and let's make it happen. So until next time. Thank you for listening. If you're enjoying the show, feel free to like, subscribe, give the show a great rating because it's great for the algorithm, and you can share the show around with your mates. And you can follow me on Instagram at elliotttwaters, and you can also follow the show on facebook by searching the dysregulated podcast.

Speaker 1: 1:39:08

All right, thank you, holly thank you no worries, we'll do it all again soon. Thanks everybody, bye.