(15) You Call it Bipolar-I Call it MSD: She's a Pretty Good Cook

You Call it Bipolar-I Call it MSD

She’s a Pretty Good Cook

Comorbid, as in comorbidity, is an ominous enough sounding word, meaning simply that a person has two different mental issues, existing at the same time.  Annie used this phrase last week when I was writing about sorting out the different contentions with which I deal.  I was speaking of being able to distinguish between anxiety and agitation, for instance, or anxiety and irritability.

Some sufferers of MSD, do not have multiple mental problems, but that is not the norm.  Just as panic attack syndrome was a part of me for 48 years, anxiety remains with me still.  My point in mentioning comorbidity, is that MSD sufferers, on the average, demonstrate characteristics of their illness 54% of the time, which means the other 46% of the time they do not manifest symptoms of their illness.

Unfortunately, there is no manual that tells me which are good days, and which are days that I must watch out for.  I now employ the mood chart, which allows me to see when one or more red flags appear in any given day.  A red flag may mean inadequate sleep, or the presence of lethargy in my legs, or any of the other identifiable components, with which I must contend.  

So, when I spiraled downward on Wednesday, after leaving the psychiatrist’s office, did it mean that I was suffering from mood spectrum disorder, and that the visit was a trigger?  Or did it mean that, “Life is a bitch: deal with it?”  This is what I am trying to sort out, with Annie as my coach.  In yesterday’s piece, I alluded to Interpersonal Social Rhythm Therapy (ISRT), a therapeutic approach which incorporates the belief that MSD patients can control their symptoms just as effectively with management, as they can with medication. 

This last statement represents the essence of my therapeutic goals and objectives.  In choosing management over medication, I accept the fact that I need a good coach, a good mentor (psychiatrist) and a flexible environment, so as to allow for the foibles of day-to-day existence to crop up upon occasion, without serious complications.  By that I mean that being retired allows me to work when I choose, and even if that is every day, it need not be if I am encountering technical difficulties.  When I was working in the school district, I did not have the luxury of deciding when I wanted to work and when I didn’t.

Obviously, it’s very helpful to not have to go to work (even if I enjoyed my job) if I am “under the weather.”  I liken it to having the flu.  No one wants a coworker who is sick to show up at work and share the goodness.  It’s one of those damned if you do (come to work-sick), damned if you don’t (don’t come to work-slacker) situations.  I, however, have made the decision that I will no longer be working on a crew.  I do not feel as though that is going to benefit anyone, partly because I can not guarantee I will be there, and also because I can not be certain that I will be acceptably disposed to getting along with my coworkers, at any given moment in time.

In addition to ISRT as a therapeutic tool in my recovery program, is Cognitive Behavioral Therapy, which according to Dr. Phelps, “has been shown in several large studies to be as effective as antidepressant medications for the treatment of mild to moderate depression.”  He goes on to say that “most people do not know that therapy works as well as antidepressant medications.”

And that represents the foundation upon which I will build my therapeutic recovery program.  I have prattled on sufficiently about my willingness to obtain and record the necessary data on my mood chart, my enthusiasm for regulating sleep, diet and exercise, and my already-proven ability to utilize Cognitive Behavioral Therapy, so that I do not have to justify my decision.  All I need to do is find a psychiatrist/psychologist who is well-versed in IRST and CBT, so we can get together and make alphabet soup.  With Annie as part of the process, and a soup being contemplated, I am guaranteed of success, because Annie is a pretty good cook.

(14) You Call it Bipolar-I Call it MSD: As the Dust Settles

You Call it Bipolar-I Call it MSD

As the Dust Settles

Whew.  Crisis averted.  We are up here in Eureka, after having escaped the mental clutches of the therapeutic arena.  As Lynda Grace observed, one issue she faced was, “having to leave a session feeling more emotional or upset than when I arrived.”  That was certainly the case with Wednesday’s session.  It left me spiraling downward, and it left Annie going off to market without me, and feeling drained.  We don’t need this grief. 

I will pause one moment to emphatically state that this is not about Dr. Garratt being a good guy, and certainly not about him being a bad guy.  It is about seeking a therapeutic program, designed to meet my specific needs, and those of my coach.  The two methods of therapy that are tailor-made for me are Cognitive-Behavioral Therapy (which was so successful for me and Dr. Jill), and Interpersonal Social Rhythm Therapy (IRTS) which I have already been utilizing since the first day I printed off the blank mood chart and started recording data, based on my daily manifestations of mood spectrum disorder.

Annie and I have constantly referred to these two therapeutic approaches, and Dr. G. has not so much as asked to see the chart, which I bring with me every visit.  What’s up with that?  Annie had already ingested all of the parameters of psychoeducation, which despite its ominous title, merely means learning about mood spectrum disorder, and all of its ramifications.  Researchers in Spain had long demonstrated that a group-therapeutic approach, in which a series of twenty-one specifically designed lessons were presented over twenty-one weeks, was an effective and efficient method of beginning a long-term therapeutic program, which varies from one individual to the next.

Now, Annie has guided me, independently, through this process, I have been charting the data, and it is time to embrace the Cognitive Behavioral Therapy.  Unfortunately, the psychiatrist I have been seeing places a tremendous amount of emphasis on psychoanalysis, and this is simply not a fit.  In response to the well-intentioned question, “Why don’t you just ask him to switch, and adapt the therapeutic approach that you wish,” I say, “I want to seek out a therapist, whose specialty is in the areas I desire, and not as an afterthought.”  

I must also add, that this is a decision that I do not take lightly, switching doctors in mid-stream, but that I must take into consideration my coach’s input.  Annie has been feeling it in her gut for several sessions now, while she watched the intellectual sparring going on between me, and Dr. Garratt.  She has been feeling as though the emphasis on psychoanalysis does not belong in the picture just yet.  Or even do a certain amount, to cover some basic foundation elements, but enough is enough.

The final component involving making this magnitude of a decision, came from Annie’s therapist, who has been instrumental from the beginning, guiding Annie through the components of psychoeducation, and providing for her, some basic tools for dealing with my escalating illness.  When Annie described the events of Wednesday’s session, her therapist was very supportive of our decision to look for a different therapist.

She said to Annie, when the situation had been outlined, “It’s as simple as this: If you do not feel it is a fit, then it is not a fit.”

I don’t think it gets any more basic than that.  If I go to a shoe store, and select a pair and try them on, I might take a few minutes to accurately test them out.  I might stroll around the store, I might examine the effect in a full-length mirror, but ultimately, if they are too tight around the toes, then it is not a good fit.  Go back to the drawing board, or the yellow pages, whichever applies, and try to find a therapist who is a better fit.  After all, who likes to go around with ill-fitting shoes, when there are plenty of proper-fitting shoes available?  Not me and not Annie either.  

And you know what?  I don’t even think Dr. Garratt would fault our decision.  What exists is a setup for failure, and I do not see failure in the cards.  I may not like the hand I’m dealt, but that doesn’t mean I am throwing it in.  I have a good partner, and there are plenty of dealers, so let’s visit the next casino on the list.  Who knows?  Maybe we’ll hit the jackpot.

The End of the Road

The End of the Road

Norma drove a taxi in San Francisco, and she earned every dime she brought home.  It could be a good job, but mostly it was not.  If she got a run of luck, she could end up ferrying convention-goers from the airport and back, all shift long.  But if the going was rough, and she ended up sitting around waiting, it could drive her nuts.  She’d found cruising the main bars and clubs was totally hit and miss; she missed more than she hit, and she got hit on more than she wished.

What she really liked was the long-distance fare, the one who wanted to go from SFX all the way up to Marin.  Just turn her loose on the freeways, and she could get around like a greased pig on a hot day in the mud.  Just don’t get in her way.  She was on the fast track one Friday, desperate for a good night because she wanted to be able to earn enough money to buy her baby girl something special for her eighth grade graduation, coming up within a week. 

She remembered her own graduation, and the way she had felt so grown up, heading over to the high school, all of two blocks from the middle school.  She liked the fact that she could take certain classes over there as a  middle schooler, like algebra, and band.  It had just made her feel that if she could succeed at the high school, as an eighth grader, she would do fine the rest of her four years.

The night had started off great, whetting Norma’s desire to do well.  She had just taken a guy to the Wharf, and was heading back toward the airport, when she got a call to pick up a fare at a private residence in a swank part of town.  She wanted this call badly, but she needed to head back to the station for a pit stop first.  She hated to take the time, but she also hated to drive around in agony.  

The alternative was that she stop at a favorite taxi take-out shop, that catered to the drivers, and use their facilities.  She could leave the engine running, because there were so many other drivers around, that she never had to worry that someone would try and drive off in her taxi.  When the dispatcher contacted her a second time, she told him seven minutes and threw caution to the wind.  She was almost on top of her pitstop, and decided to go that route, figuratively speaking.

Upon emerging from the coffee shop, she saw a vague shape slipping away from her taxi, and felt that maybe she had come out just in time.  Hurrying over, she yanked open the driver’s door, and jumped inside, eager to score what might prove to be the most profitable fare of the evening.  Her radio screeched and blared, momentarily startling her, and making her realize that she was on edge.  Before she had time to even begin to figure out what was wrong, she caught a whiff of an unfamiliar scent, and realized that she was not alone in the taxi.

Simultaneously, she felt an icy finger of fear, flitting across the hairs of her neck, and the cold feel of steel against her skin.  She jumped, and a voice, low and cold and menacing, said, “Take it easy lady, and you won’t get hurt.  Just do as I ask, and...”

“Bullshit!” Norma blurted out.  “Total and complete bullshit.  You creeps always start out saying no one is going to get hurt, but you don’t give a fuck about me or my daughter.  All you care about is money.”

“Hey, Sister, pipe down and don’t get your panties in a bunch.  Listen to what I ask you and this will all be over in the time that it takes you to drive from here to The Embarcadero.  That’s all I’m asking.”

“You aren’t asking anything; you have a gun and that isn’t the same thing.”  Norma was doing some quick thinking.  Was this guy really going to let her go at the end of this ride?  Look at his hand shaking, she thought.  He’s a meth-head, and he just needs bucks for his next fix.  This is the shits because these guys are just simply walking time bombs, ones whose teeth are gone and whose finger gets awful itchy on the trigger of a gun.

“But I did ask.  Just do it, Honey, before I get agitated, because if I get agitated, then my hand really starts to shake.  You don’t want me to get nervous with a piece in my hands, do you”  He grinned and revealed firsthand that his front teeth were, indeed, missing in action, and his smile was lopsided and evil.

Norma’s brain was in overdrive; so, coincidentally was her taxi.  She was doing 60, five miles per hour over the speed limit, and she wondered if this idiot had ever taken the time to think about what would actually happen, if he were to shoot her while the taxi was traveling at that speed.  All of the sudden, it was clear what she was going to do.  It was foolhardy, it was downright dangerous, but she had already figured out that she was probably on a one-way trip to nowhere, so it was worth a shot.

Without warning, and raising quite a ruckus from the back seat, Norma took the next exit, and hurtled down the off-ramp at double the posted speed, running the stop light at the bottom, and going right through the empty intersection, at thirty miles per hour.

“Stop!  What the hell are you doing?  This is not the Embarcadero.”

“No, it’s not, but it is the end of the road,” and she turned sharply into a parking lot, squealing her tires, and attracting the immediate notice of a sea of blue.  Slamming on her brakes, she drew up to a stop, right at the rear entrance of the main police station serving the greater San Francisco area.  Jumping out of the taxi, she screamed, “Watch out!  Gun!” and that was all it took.

As they led the assailant away, all Norma could think to say was, “Next time you get into a taxi, remember that you do not need a gun to get to where you’re going.  A simple request will suffice.”

(13) You Call it Bipolar: I Call it MSD: Game-Playing

You Call it Bipolar-I call it MSD

Game-Playing

Yesterday, I foolishly wrote a piece called “Getting Better.”  I say foolishly because it is the same as waving a red flag in front of an already-angry bull, with the result just as predictable.  I had a very rough time at Dr. Garratt’s office yesterday, and that, combined with one or two other factors, plunged me back into a spiraling depression, one which left me incapable of going to yesterday’s initial farmers market.  What you going to do?

What constitutes a rough time at the psychiatrist’s office?  I long since figured out for myself that it was not always going to be warm and fuzzy in that arena, but I figured that since no one was holding me accountable for past actions, it couldn’t be all that bad.  I have not struggled with the fact that there were uncomfortable times this past winter, because it is the nature of the illness, over which I have no control.  And that was part of the problem yesterday at Dr. Garratt’s office.

He had asked me a moment earlier if I felt my father maintained a “patriarchal presence.” 

After asking him to repeat the question, I asked how I was supposed to be able to determine that from the vantage point of a child.  Then I agreed that he did have a patriarchal presence.  In response to his asking if I felt I had the same, I said I felt I was the same as my father in that regard, but that I had refused to adopt the parts of him that I disliked: the black moods, the anger tantrums, or the snide comments at the dinner table.

At one point I made reference to mood spectrum disorder, and he asked, “Is that the label you prefer?”

I gave him a look.  “I don’t care whether you call it bipolar or mood spectrum disorder, but yes, I prefer MSD.”

“As opposed to a different label?”  He looked blankly at me.

I responded quickly, “I don’t particularly like labels at all, but I accept the fact that I have a mood spectrum disorder.”  I hoped he was not going to question that.

“Do you?  So that you can pin a label to your chest?  So that you can explain/excuse your behavior?  It’s convenient to have a label to fall back on.”  Playing Devil’s advocate, I assumed, and it rubbed me the wrong way.

“I don’t understand this line of questioning.  What are you saying?  Are you saying that you do not think I have a mood spectrum disorder?  I have read everything I can find my hands on, and I agree with everyone who keeps saying that I fit the profile.  I keep the mood chart, and I have come to rely on it for guidance in making plans.”

Dr. G. replied, “I am the one who is qualified here to determine if you have a bipolar disorder.  Who is “everyone” who says you have a bipolar disorder?”

“My family?  Is this a joke?  Why are you questioning the diagnosis?  If there was something wrong with our logic, why wouldn’t you have said something a long time ago?”

He said,  “I am just asking you if you like the feeling of having a label.”  

“If you mean do I care whether my actions are the result of an illness, or whether they are the actions instilled in me by my father, I don’t care, so long as I can take the necessary steps to rid myself of bad habits, and inappropriate behavior.  I hate this line of questioning, and I don’t like playing games.”  

The way Annie and I looked at it, we were paying him the big bucks to make the diagnosis.  On the very first visit, he had prescribed the atypical antipsychotic drug, Seroquel, and then we had settled on Lamictal (Sp?) as a mood-stabilizer, should I determine that is necessary.  It sure sounded to me as though he had decided that I had MSD issues; else, why prescribe medication accordingly?

So if he believed I have a mood disorder, then why is he hammering away at these kind of word games.  I don’t like it, Annie doesn’t like it, and I am beginning to feel as though he is not listening to our joint request that we pursue a holistic cognitive therapy program.  There is too much Freud; there is too much Jung.  And there’s too much of what doesn’t work.  And it’s time to drop back five yards and reassess the situation.

I’ll let you know what my coach and I determine.

(12) You Call it Bipolar-I Call it MSD: In the Spotlight

You Call it Bipolar-I Call it MSD

In the Spotlight

I have a lot going on today, with my appointment over at the coast with Dr. Garratt, and our first farmers market of the season, up here on Bell Springs Road.  Annie and I have to leave the mountain at seven this morning, in order to be in Mendocino, well before our ten o’clock appointment.  If it seems as though three hours is a lot of time to get to the town of Mendocino from here, then I just remind myself of the last time we were on the coast, and we got behind a tourist, who meandered along Highway One, all the way from the Branscomb turnoff to the little coastal village of Mendocino.  Any attempt to pass this vehicle, during the passage through Fort Bragg, where there are two lanes of highway, was rebuffed by this vehicle increasing speed.

I do better with these impediments, than I used to, but they still try my patience to the max.  Then there is the ongoing series of roadwork delays.  A traveler may have no delays whatsoever, or find his path blocked two or three times, in any given trip, by roadwork.  We are on the clock for one hour each time we visit Dr. G, whether we arrive in time or not.  I prefer to leave early, and have time to kill on the other end, than to try and cut it closer, but have to stress every time we get slowed down.

Today also marks the very special opening of this year’s farmers market, up here on the ridge.  There is a long and storied history to this event, going back more than ten years, to the earliest days, when there were only a handful of vendors, and the market was still perched on Bell Springs Road itself, as opposed to being in the quarry, located three and three-fourths miles up Bell Springs Road.

With the market now located off to the side of the road, there is less worry about traffic and dust, as vehicles making their way up or down the thoroughfare can better navigate their way through the area, without having as much concern for pedestrians.  It boggles my little pea brain to remember that as recently as the year before last, I attended only three of these markets, and felt pretty uncomfortable at the ones I did attend.

The main reason I went in the first place, was to escort my mom, Pauline, so that she could catch up with old friends here on the mountain.  The main reason I did not like to attend, is simply because I did not like to attend any public event.  The nature of my panic attack issues, precluded my attending any public event without a fair amount of stress.  Part of the problem was the claustrophobic sensation of being in the midst of a crowd, though it is not nearly as predominant outside, as it is while indoors.

The other part had to do with what I refer to as the spotlight effect, the notion I used to have that all eyes were on me, as I made my arrival in any public setting.  I find it challenging to explain now, but it involved the impression that when I arrived at any function, at which there were many people, that I drew an inordinate amount of attention, and that everyone was staring at me.  It did not matter that I could point out that I do not stare at others as they arrive, nor do the people around me pay much attention to new arrivals, and yet I could not escape this feeling that I was under some sort of magnifying glass.

I found it so much easier to simply avoid the market than to attend it.  To be honest, that is the way I viewed all public appearances, whether they were intended to be enjoyable, such as a theater, or work, such as having to meet in the multi-purpose room, for a district gathering.  I found ways to delay my arrival until the last moment, and I preferred to stand in the back of the room. 

My very recently acquired ability to distinguish between anxiety, and  mood, serves me well right now.  Anxiety and mood variations coexist within most people, and it is the way one orchestrates these feelings that determines the level of comfort.  Little by little, I am overcoming my anxiety, and learning to enjoy the public venue, as I did last weekend, when I traveled over to the Central Valley for a wedding.  Now I look forward with a keen sense of anticipation to today’s market, and that is a new sensation.  

So if you see me this afternoon, and I do not respond to you, it is not because I am nervous, but more likely because I do not recognize you.  We may talk on FaceBook frequently, but I still haven’t set eyes on you in years.  Take pity on me and introduce yourself, and then watch me relax.  I never fake it when I do not know to whom it is that I am speaking.  I will hold out my hand and say, “Hello, my name is Mark, and you are...?”  

At least I got rid of that confounded spotlight.  

(11) You Call it Bipolar-I Call it MSD: Getting Better

You Call it Bipolar-I Call it MSD

Getting Better

It’s getting better; it’s getting better all the time.  The song says it all, though unless you know where the starting point is, you really do not know a lot.  An ice cube for someone stranded in the middle of the desert would be better than no ice cube, but would not change the situation at all.  From the perspective of someone who has gone from diagnosis, to acceptance, to therapy, I can only say my prognosis has a very positive spin to it.  The proof is in this past weekend, when I was able to attend two different social events, located five hours apart from Bell Springs, and do it with pleasure.

I have gone beyond just surviving, or coping, to actually being able to derive pleasure from being present at special family occasions.  For most people, the first impression would be confusion: Doesn’t everyone derive pleasure from these types of social engagements?  I would respond that any pleasure I have derived in the past, has come with a stiff price tag involving stress and personal discomfort.  Now, with awareness and superb coaching, I am acquiring a new set of skills, complete with tools, manual, and my own personal trainer.

I want to return for a moment to the oft-referred-to mood chart, and the determination with which I have pursued this compilation of data.  I have said that I instinctively felt it was a good tool, an efficient tool, for measuring data over time, which would then allow me to make more accurate predictions, for success of any specific upcoming event.  The mood chart has proven to be everything I had hoped, and more, but for the wrong reason.  There is a pleasing sense of irony here, that tickles my sense of order.  

I had hoped that by getting out my magnifying glass, and examining every facet of the chart, I could then formulate long-range predictions based on the data.  What I did not expect was to be able to use the chart in a far more effective manner, by examining the state of the moment, and being able to use the results to predict the outcome of an immediately occurring event.  In order to be able to accomplish this, reliably, one has to have his finger on the pulse of his moods.  In the past, I had no awareness that this could be done; now I am mastering the art.

I can distinguish between racing thoughts, and agitation.  I can wade through the complexities of irritability, recognizing that which is caused by illness, and that which is caused by circumstances around me.  I can measure the strength of my legs, noting the presence of lethargy, and be able to differentiate between the discomfort caused by arthritis, and that which is caused by depression.

In the past, without an awareness that these threads could be singled out for identification, I could only push and shove my way forward, pretty much at the whim of whatever emotion was calling the shots that day.  Now, by assiduously compiling the data daily, I feel as though I have a reasonably sophisticated barometer of what is happening inside my emotional vat, on any given day.

No red flags on the immediate surface?  Good to go.  One red flag?  What is the magnitude of the event, and what is the magnitude of the red flag?  I now have a tool in place, which I can use, to find out the probability that I will experience success, in any upcoming social event.  That is better than ingesting Lorazepam, reefer cookies, Vicodin, and booze, in order to try and keep the party inside my head, from bursting out and sharing its mirth with the world around me.  The net result of all that ingesting, was little memory, no enjoyment, and a tendency to avoid all social engagements.

Now, as I said at the top, It’s getting better all the time.  Tell the Lays Potato Chip people, that we don't need can postpone that last truckload of chips, thank-you very much.

(10) You Call it Bipolar-I Call it MSD: Toddler Steps

You Call it Bipolar-I Call it MSD

Toddler Steps

We are heading back from Placerville, going right through the center of Sacratamato, as if we own the joint.  On Friday, on our way to Ione, traffic  heading north on the Five, was at a dead stop.  Not so this morning.  We even took advantage of the carpool lane on the way from Placerville to Sac.

All factors considered, the past five days have been an unqualified success, as far as getting out in the world, engaging in several intense social situations, and learning how to adapt to the uncertainties which comprise my illness.  The success is two-fold, because two of the events took place in the Central Valley, necessitating a ten-hour round trip for each.  The process of getting anywhere must always come under close scrutiny, because the logistics of being trapped inside a car are still very much a part of the big picture for me.

For the second trip over to Sac, yesterday morning, we had brought along an ice-chest, in which we put a nice deli-sandwich that Annie had put together for me; we bought chips, we had bananas, and we had containers of Bell Springs water.  We left at nine in the morning for a five-hour drive, and had enough time to make a quick run past the site of the wedding, so that when the time arrived, it would be no problem.  I took advantage of the time to squeeze in a nap.  I went to sleep immediately, and that would be the end of the story, except that when Annie came to awake me, I was hard to bring to the surface.

That was a result of the Lorazepam.  And here is the lesson that I have learned over the past five days: Mood spectrum disorder is its own beast, providing ample challenges.  Anxiety is another entity, in and of itself.  For me the two have always been inextricably braided together in three strands representing depression, hypomania and anxiety.

However, for some sufferers of mood spectrum disorder, anxiety is not a given.  Sometimes it’s there and sometimes it’s not.  Or sometimes reverberations from mood spectrum disorder create ripples of anxiety.  For me the anxiety came first, in the form of a gradual build-up as a growing child, graduating to panic attack syndrome when I was ten.  After ridding myself of this disorder in 2010, I figured I was good to go.

Now, I must learn to differentiate between anxiety and mood so that I can address the anxiety issue, before I focus on the my mood.  I have found the Lorazepam to be very effective for three reasons: I am already familiar with it, having taken it for five years before getting therapy to get rid of panic attack syndrome; I was incorrectly given the instructions for its proper use, and therefore learned through experience how to better utilize it; finally, this medication allows me to focus, unencumbered by anxiety, on the state of my mood.

Having elaborated greatly on my newfound ability to sift through the various key components of my illness, to see how I am doing at any moment in time, I now find that this ability is further enhanced by being able to further delineate a sense of anxiety from the myriad of other possibilities.  I call it baby steps.  I thought about taking Lorazepam for the graduation on Friday, but in examining the state of my anxiety level, I found it  minimal, so I decided not to.  It was a good decision, and I enjoyed myself immensely, unbothered by anxiety.  

In contrast, I chose to take one two-milligram Lorazepam pill a half-hour before I left the house yesterday morning, and another about eight hours later, prior to leaving for the wedding.  They did the job effectively, in so far as anxiety was concerned, but left me just a fraction over-medicated.  Annie said she saw me doze a couple of times, during one of several periods of general waiting around.  I did well exchanging social pleasantries, although there were only a dozen or so people who I knew. Annie also had a hard time awakening me in the motel, when it was time to leave for the wedding.

Annie said that no one likely would have noticed my slightly sleepy look, and that I had done well in all the categories that counted.  I am pleased with the outcome of this five-day period, including last Wednesday, when we went down to Ukiah to shop, and then came back to Bell Springs, to meet with Kati.  My success is tangible evidence that for the moment, I can manage my illness without either atypical antipsychotic medication, or a mood-stabilizer, which has been my goal from the first day.  

Baby steps, you know, become toddler steps, over time.  Well, I have plenty of time, and I have a good coach.  Thanks Annie.