Monthly Archives: September 2017

At the Crossroads

I have been living with Bipolar Disorder for about the last 7 years.  Well that’s not really true…I have been living with Bipolar Disorder all my life but I only learned of my condition 7 years ago.  Since then I have been surrounded by a number of professionals: psychiatrists, a family doctor, psychiatric nurses, a CB therapist, and of course the pharmacists.  All of these individuals have played an important role on my road to stability.  I would say that I am much more stable now than I have ever been in my life.  I don’t drink, I don’t take illegal drugs, and I don’t smoke cigarettes so I feel stable…but bored.  The problem is that I am dealing with some very powerful urges to go back to self-medication, the street, to return to the world of addiction.  These feelings even invade my dreams.  So now I find myself at the crossroads.

Copyright 2017 Michael Ligtenberg

Copyright 2017 Michael Ligtenberg

The first prescription drug I took made me fly so high and yeah it was great and I loved it.  I have never had so much fun as I did that summer.  On the downside though, I also completely freaked out on a very good friend a couple of times.  I am lucky she understood and forgave me.  So they took my off the lamotrigine.  And to be honest I miss it.

Now when I go to the pharmacist I pick up 13 bottles of pills, and every day I swallow 23 pills.  So I have no more highs and the lows are manageable.  Instead of flying high I have gained a lot of weight, about 80 pounds in 2 years.  My self-image and self-esteem have gone awry.  I used to run 2 kms a day and now I do nothing.  I also had plantar fasciitis for about a year which was crippling so even walking any distance was extremely painful.  I still managed to do 40 sit ups most every day, but somehow that got lost to.  My healthy routines were shattered.

Now I watch a lot of TV but it is just a way of passing time.  I don’t feel any interest or motivation to do the things that I used to love doing: writing, reading, photography, woodworking, walking.  Even my sex drive has been adversely affected; I just have no libido.  In fact, I just don’t feel much at all.  The only thing that gets me excited for a few moments is online poker and online sports betting.  Fortunately I am not gambling high stakes…I do understand how to win…or at least not to lose too much.  But how long will that last?

Copyright 2017 Michael Ligtenberg

Copyright 2017 Michael Ligtenberg

This isn’t the life I thought I would have.  Lots of people live off my salary…a very respectable one but one that I only see of about 30%.  My present spouse cannot work (bipolar disorder and fibromyalgia), and I have 4 children who have all pursued post-secondary studies (and I’m so proud of them all) so I still have a very high child support payments to make every month and I pay the taxes on that.  It’s depressing because I can’t put away much money for my retirement.  I am 52 and I want to retire when I am 60…I just don’t know if I will be able to afford that.  I have spent 23 years of my life in small rooms filled with 25 teenagers and with only one door out (the escape hatch).  Such is the life of a high school teacher.  Maybe I can get a job as a greeter at Walmart when I retire.

So what is this crossroad?  Well, this is the way I see it:

If I turn left, it leads me back to self-medication.  The urge to drop all of the prescription drugs and go back to self-medication is very strong…wrong but strong.  The consequences would be huge…it would destroy my relationship with the woman I have been living with for more than 4 years.  She would be immensely hurt if I decided to turn left.  It would destroy all the years I have put in to regain my children’s trust.  And to be honest, I don’t know if I could survive that nether world either.  I don’t want to die and I don’t want to go to jail either.  Fortunately the closest big city from my home is about 1600 km (1000 miles) away.

Copyright 2017 Michael Ligtenberg

Copyright 2017 Michael Ligtenberg

If I stay the course and just go straight ahead, I will just have to accept that I am obese and bored, the status quo.  I hardly take showers anymore because that means I will see myself in the mirror and see that old fat ugly guy staring back at me.  I will continue to provide for all the others and continue to countdown the years to go until I can retire, ennui being the flavour of the day.

If I take a right turn, well, it is the most daunting of them all.  It requires motivation.  I will need to improve my diet, exercise more, pick up my camera and go for walks even if it is painful, make a workshop in the basement, read, and take Viagra if need be.

As I read over this blog with my therapist I noticed something, something important.  Subconsciously I think I decided to make the best choice, a right turn…right because perhaps it would be the right decision.  But I am just so tired of fighting with myself.

Do I have the strength?  Should I just grin and bear it?  Or do I go looking for desolation row…

The Importance of Peer Expertise in Counselling

I’ve been away from the blog for a while, and though I haven’t necessary made the best use of my spare time (*cough* Skyrim *cough*), mostly it’s been because I’ve been doing two degrees, one in spiritual care and psychotherpay, and the other in social work. Last week, I finally became a registered social worker, something that I’m very proud of, and I have my own private practice, where I offer both counselling and mediation services, called (somewhat unoriginally) “Bader Services”. I’m a pacifist in my offline life, which is where the mediation is coming from.

My goal, through all of this, has been to bring my own lived experience to treatment of mental illness generally and of bipolar disorder in particular. I facilitated a peer support group for a few years in Toronto and then again in Kitchener, and I’ve run this blog. Over time, I began to realize some of the limitations that come with peer support without professional expertise. After the third or fourth time someone told me they were planning to kill themselves, I realized that I needed more training. I also realized that I was disappointed myself with much of the care that I had received, and wanted to be able to improve “our lot”, so to speak, by becoming a professional.

I’ve learned a lot of things along the way, and I intend to share a number of them on this blog, now that I’m finally finished school (and the depressive episode that inevitably followed it). I thought that I’d write first about my observations of peer expertise and how it can be valuable to counselling.

Peer Expertise and Professional Expertise

When I first heard the term “peer expertise”, I kind of cringed at it. A part of me still does. Don’t get me wrong, I accept the idea that clients are the best experts in their own lives (and in fact based my new career on that), but I also want to avoid the idea of the “patient as superhero”. I think it’s okay to be struggling, to feel like we don’t know what we’re doing, and to need and to ask for help. I’ve always kind of loved that Carrie Fisher was so powerful, despite never quite getting her “life” together. In fact, it was her strength in the face of the clusterf**k that is bipolar disorder, that made her so inspiring. “Expertise” was just the wrong word there.

On the other hand, lived experience does bring with it a kind of expertise, which is not so much about whether or not we know the ins and outs of treatment, but more the ability to test the claims of the so called “experts” with their professional expertise. On the one hand, we can help set the goals for treatment. I once changed physicians because he wouldn’t take me off of a medication that was making it impossible to read, something somewhat necessary to finishing my doctorate. I know that one thing that has always bothered me is the goal of making me more functional (a goal for capitalism), versus making me less miserable (a goal for me). On the other hand, we also as patients can strip the professionals of their pretensions and expose the harm that they often do. We are the experts both in setting goals and in calling out bulls**t, especially when we work together.

Normalization and Empathy

One of my hopes in bringing peer expertise to counselling was to help normalize mental illness for my clients. It’s no longer about turning the patients into an “other”, and “fixing” them so they can be more like “us”. Rather, my hope was that being a consumer/survivor myself, clients would be less likely to see themselves as “different”. So far, this hasn’t panned out quite as much as I would have liked. First of all, there’s the power imbalance in counselling itself that is different than in peer support, and differentiates me from clients in a way that I wouldn’t otherwise like. Second, it often hasn’t…and this will sound strange…come up. Because the counselling is about my client, I’m not there to share my own experiences, and I’d say less than half of my clients even know that I have bipolar disorder. The back-and-forth doesn’t work the way I would have expected.

Where is does come in is through understanding and empathy, something that I’ve discussed before. While I don’t sit down and say, “Well here’s what I do,” because that would come across as patronizing advice, I am able to hear things in a different way because I’ve dealt with many of the same issues. I find that I’m less judgemental, listen more closely, and I am able to make connections more easily. I’m also more readily able to recognize when I don’t know what to do, and to make the sessions more collaborative. Often, a client will bring a problem that I’m actively struggling with and when they ask me what to do I’ll think, “I have no f**king idea,” and start to problem-solve with them, which is better than pretending I have an answer just to look professional.

The Dangers of Identification

"furniture shopping" by woodleywonderworks - CC BY 2.0

“furniture shopping” by woodleywonderworksCC BY 2.0

There are dangers, however, to lived experience in counselling. The most common one that I’ve noted is assuming that someone is going through the same issues that I am going through because we’re living with the same mental illness. People with bipolar disorder are just as different as people without bipolar disorder, as are their experiences of the illness. If I assume that people are going through exactly what I’ve gone through, I’m more likely to miss their actual experiences. I’m not supposed to be projecting myself onto my clients like that. Yes, being bipolar helps, not only working with bipolar disorder but with others living with mental illness, but it’s not because people are more like me, but because we’re different in similar ways from everyone else.

Putting It All Together

Living with mental illness as a counsellor has been really eyeopening for me in a lot of ways, and I’ve come to realize just how valuable it is in practice. It enables me to empathize more with clients and recognize what I don’t know, and it enables me to be more conscious of the kind of harms and stigma that we are living with together. On the other hand, I’ve come to recognize how important it is to keep myself separate from my clients and not project my own experiences onto them. Most of all, I’ve recognized what an adventure the next 30 years or so are going to be!

On a personal note: blogging again is fun! I’m partly trying to remember how WordPress works, and partly realizing just how much I’ve changed over the last four years. When did I start swearing this much? In any event, I’m looking forward to getting back to this blog at a more reasonable rate than before, like once per month. I’ve also realized that there’s a lot more to write! And that alone shows me that the last four years haven’t been in vain.