JR1
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Dual Diagnosed--"First Things Last" Holistic Paradox I have to bow to the holistic foundation for wellness--diet, exercise, discipline, recreation, social interaction, rest, and spiritual maintenance. I believe these principles of wellness contribute heavily to prevention of disease and recovery from disease. Many have suggested that the period of time between a normal, balanced, and functional state (baseline) and the diagnosed state of bipolar disease and/or of addiction has a direct influence on the rate and resilience of recovery from bipolar disease and/or addiction. As a corollary, I have observed that the longer the diseases remain untreated, the more that "normal" and functional baseline seems effectively to vanish, giving way to a modified baseline of chaos, distress, dysfunction, and desperation--a phenomenon of fundamental change which may be referred to as a psychic change. If these statements are valid, then they would help to explain the difficulty in treating one who is chronically ill with bipolar disease or addiction/alcoholism; and they would offer support to the urgent need for early diagnosis. http://www.mcmanweb.com/article-114.htm What do we do when such chronic diseases have destroyed the patient's holistic foundation for wellness, when the chronically ill patient is faced first and foremost with rescue and salvage? May we simply place the patient in a healthy environment and invoke healthy habits and pursuits with any reasonable expectation for effective and durable recovery? The equation seems logical and complete, doesn't it? One final question remains, however: "Does the patient possess a state of mind and reason and a level of willingness sufficient to engage the treatment? My current treatment plan includes prayer, group support, therapy, writing, and service to others. I have used this foundation for my recovery for more than four years, and, yes, I admit that these things did indeed "rescue" me from my hopeless state; and, yes, I need to do more now to strengthen and perpetuate that recovery. There is no question in my mind now that continued ill health in any respect MAY yet trigger my relapse. I received my diagnosis (bipolar disease) in October 2002, with a prescription for Wellbutrin--antidepressant. The medicine MODERATED my depression long enough to review my history and prognosis, for I am also a recovering alcoholic (sobriety date 09/13/02). By January 2003, the medicine apparently had begun to induce rapid cycling of my mood swings, but I was well into my recovery from alcoholism, and that was my salvation. Management of Bipolar disease involves a foundation of medication. On the other hand, management of alcholism/addiction involves a foundation of personal change, employing both holistic tools (spiritual healing, physical healing, step by step ongoing personal assessment, peer counselling, occasional professional support, service to others) and heuristic tools (an ongoing trial and error attempt to adapt flexible principles of recovery to individual needs and lifestyles). http://www.psycom.net/
depression.central.bipolar_abstracts.html http://www.mja.com.au/public/mentalhealth/articles/sacks/
sacks.html http://www.aabangalore.com/medical.html The heuristic part of recovery actually takes full force in the later stages of recovery, and it is in many ways an extension of the holistic principles (self appraisal, spiritual and physical restoration, taking responsiblity, and ultimately interaction with others who are looking to recover). I am referring at all times, of course, to the method of recovery suggested by AA. http://www.aa-louisiana.org/steps.htm The point I wish to make is that the fluke of alcoholism in my profile gave me access to tools which I use also to manage and recover from my mental illness. I now apply these tools, rather than medication, and I find, by contrast to those who take the meds, that my progress has at no point been quick or spectacular. I have found, however, a feeling of peace, security, and solidity in my slow recovery--qualities which my meds-taking friends have found to be elusive in their recovery. In the final stages of recovery from alcoholism (and I am finding this to be true for my recovery from mental illness as well), most of us begin to focus more acutely on other aspects of health, such as diet, exercise, social interaction, recreation, discipline-forming pursuits, and spiritual pursuits. Many question why these fundamental needs do not receive more attention at the BEGINNING of recovery. My only reply to the question is that "the clock is ticking", so to speak, and most of us who have been in the chronic stages of illness are seeking emotional survival, first and formost. As a result, few if any of us in early recovery have the will, the presence of mind, or the resources to engage in a fully balanced regimen of mental and physical management--desperation, you might say, demands an attitude of "first things first." ( You might also say "first things last" in the context of a balanced holistic approach.) That is the main dilemma for successful treatment of late stage chronic mental illness or chronic addiction. And..., that may help to explain the paradox of relapse which can and often does occur even though the patient has engaged all the holistic principles of wellness. I wish I could cite examples of such relapses from public documents, but reports are hard to find, since most efficacy reporting is offered by the purveyors themselves of holistic alternatives. (...nothing negative reported.) I have friends, who, if they would break their anonymity, could verify relapse under fully healthy circumstances. Often they will say something such as, "I just felt too good, resulting in a reckless change in my behavior." http://www.lakesidemilam.com/drmara.htm Most health professionals and most of the afflicted will agree that sometime, early in the illness, balanced care and management would have arrested the diseases. However the irony of the diseases in their early stages is that they present false feelings of wellness which camouflage the diseases themselves so effectively that even trained health professionals frequently fail to identify the symptoms. The preceding paragraph points to the ultimate irony of these diseases and, in my mind, the subtle flaw in pharmaceutical treatment. The meds not only provide the main focus for treatment, but the meds also hide the roots of these diseases by inducing a transient feeling of well-being in the patient. When the meds fail, as they most often will do, the patient relapses to a mind set such that it will not permit him a reasonable assessment of his condition. Rather, the patient (and the prescribing doctor) scramble frantically for a new medication or a different dose or combination of meds. I suggest, when this occurs, that the meds are well past the point of serving their therapeudic objective--that the patient has been tragically induced to rely on the meds well beyond the often "one-time-window" of opportunity for essential psychic change--change of the type I and others have chosen to pursue through peer identification, interaction, and support and through therapy and counselling. Here I can see a parallel possibility in holistic treatment. Where one school of holistics may for instance focus on diet as the treatment, or on any singular component of wellness as a cureall, the patient may receive again that "transient" feeling of well being (as with the meds). Again, when the feeling of wellness fails, the patient becomes frantic for an alternative, placing all reason aside and plunging into a round-robin pursuit of alternative remedies. Again, the patient will have missed a perhaps "one-time window" of opportunity for full assessment and full treatment. So the paradox of "first things last" really applies to the rescue phase of treatment, where it may be necessary to acknowledge my critical needs first--where it may be necessary to set an objective which is more modest than total health. The objective of my rescue has been to seek a level of reason, clarity of mind, and understanding which will facilitate a good choice for the longer term--to present a "window of opportunity" through which I can move from mere relief to optimistic recovery. http://www.morningsiderecovery.com/dual_disorders.php (I do not necessarily endorse the treatment facility, but merely cite the method.) In the long term, the choice of treatment and its objectives is really up to you, isn't it? I have already stated MY treatment of choice. My objective is remission. Thanks, for coming to this forum and for being a part of my recovery! Jim Rist www.cerebral-storm.com/page13.html CAUTION: Please do not instantly adopt as truth everything you read on these topics. Please look for supporting information from other sources; look for authority and experience underlying opinions; look for research; and, most of all, please begin to talk with and listen to others who have gone through what you are going through. Find out what works for them. Become aware. This is not a time to hide your feelings or to ignore your instincts. Post edited by: JR1, at: 10/19/2007 11:48 Post edited by: JR1, at: 03/06/2008 13:59 James A Rist
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