Tuesday, 3 August 2010

You lose which ever side the coin flips to

I recently spent almost a fortnight in hospital due to some rather faulty thinking which had me obsessing over ways to end my life.
I suffer from Bipolar Affective Disorder or Manic Depressive Illness (the second being a more accurately descriptive and I feel more apt name for the condition).
So far this has been the third time in just over 8 years since my initial diagnose that I have had to be hospitalised.
Each time it has been the depressive side of the disease that has got me to the point where my doctor has felt it best to "put me away" for a time, until she and a team of other experts, can get me back to some semblance of normality.
I have yet to be hospitalised for mania, although I did swing quite dramatically into a manic phase during my first hospitalisation which is how I came to be diagnosed. That time I had just been hospitalised for depression and work related stress. I went in a sad, overworked but "normal" person, and came out a "certified loon".
I like to make light of my condition. It is a coping mechanism for me.
What used to be a diagnoses that pretty much put paid to people's hopes and dreams has now become a condition which is very treatable.
What is important is that patients comply with the treatment, take their meds, attend the sessions with therapists and contact their psychiatrists as soon as they feel a change in their mood towards either of the two extremes.
And there lies the problem.
No one seeks help when they are feeling fabulous, even if everyone else can see that the fabulousness is too fabulous to be real. The fabulous person remains convinced that they are just too fabulous for those around them and everyone else is just jealous of their fabulousness. Add to this the fact that when one is manic one often feels that taking the medication is not necessary (because one is fabulous so why does one need those pills?) or not wanted because the medication takes the fabulousness that one is so enjoying away, and you have a perfectly set scenario for mania to take a hold.
Then there is the other side of the coin. When one is so depressed that one feels the silt on the bottom of the ocean floor is more lively, exciting, worthwhile and interesting than oneself, it is hard to convince oneself to take one's medication. After all, what is the point? It doesn't help anyway... Or at least that is what one is thinking at the time. Remember I mentioned faulty thought processes?
Both sides of the coin have the same result.... lack of patient compliance. And that leads to the slippery slope of mood instability which ultimately leads to disaster.
Then there is the other aspect of the management of Manic Depressive Illness. In fact this aspect is key in the management of all illness but I will limit myself to Manic Depressive Illness as that is what I know about.
The insurance that one pays a lot for each and every month and is supposed to ensure that one is able to receive the treatment one needs. There are almost always shortfalls and limits and nasty surprises when one goes to pick up one's meds from the pharmacy.
This is bad enough for any type of illness, but when one mixes it with a condition that has a big problem with patient compliance, the patient is even more inclined to not comply with the prescribed treatments.
This can lead to extra time in hospital and or even death if the patient becomes suicidal due to not taking their medication.
In South Africa the government has a list of conditions that medical aids are obliged by law to cover. This list of conditions is called the Prescribed Minimum Benefits (PMB) list and Bipolar (Manic Depressive illness) is on that list. However medical aids still manage to avoid covering the treatment as prescribed by the doctors by creating lists of formularies listing medicines they will cover but refusing to cover others. Strangely many of the medicines on the formularies are not the ones that doctors prescribe, either because their side effects are too severe, or because they have already tried them on their patients and found them to be ineffective.
When someone who doesn't want to be taking their medication gets given the run around by a big business trying to shirk their responsibility of care it makes it very difficult to convince oneself to preserver and do whatever it takes to make sure one gets one's medication and takes it.
Part of what landed me up in hospital recently was the fact that I simply stopped taking some of my medication because the medical aid didn't want to cover it, and I didn't have the cash to pay for it myself. As I told the pharmacist who was dispensing the medicine along with the bad news about how much it will cost me, "The stress involved in having to find the money to pay for this medicine and fight with the medical aid is probably going to do me more harm than any benefits the medication will provide, so don't bother with it thanks."
Clearly I was wrong.