Anger Diary, Day 4012
December 28, 2014 12:36 PM   Subscribe

Starting in late August, I have been posting here about my increasingly constant irritability/anger, a lot of which comes up in conjunction with PTSD and/or being bipolar. When I do get through to the mental health center to try to talk about my symptoms, nurses just tell me things like “people don’t die from being angry” and don’t address my horrible quality of life. How do I get my healthcare team to take my symptoms seriously? And is there anything, medical or nonmedical, that might help?

Right now the only meds I’m on are lithium and Depakote, with the Depakote only being about a month old. I’ve tried many suggestions I’ve received here and elsewhere to try to ease back on the anger, and that’s a big part of the reason I started the Depakote. However, the irritability is now worse than ever, especially because I’m still having major sleep problems from being manic and therefore not even getting a break from the anger during sleep. As I addressed in one post, I have no chance of being prescribed benzos again.

I don’t know what to do and I am terrified that I am going to alienate everybody in my life by snapping at them. Even though I often think I truly hate my loved ones, I am holding it in okay though that means I internalize it and take it out on myself more than I would like. Plus, almost every moment of my life sucks. It’s not a funny “OMG I am so cranky” feeling; it is a dark, painful, bottomless thing.

My psychiatrist is still out of town from the holidays and I know there’s not much chance that her supervisor (the on call doc) would make any kind of med change. I don’t know if the Depakote is making things worse or not. I know that many people use atypical antipsychotics for breaking mania and I’ve had ugly experiences with both Seroquel and Risperdal. I had been taking trazodone for sleep, but it wasn’t helping, and we also suspected it was making the mania worse.

On a non-med level, I don’t know what I can do either because really almost everything makes me angry. I get mad at the way fictional characters behave in tv shows, at movies being recorded too quiet or too loud, at writers who are too formulaic, etc. I try to self-soothe and it always seems to backfire: a malfunctioning water heater disrupts plans for a shower; misplaced scissors mean I can’t work on a collage. And that was just yesterday.

I don’t know if there are any people in the world I could stand, but I’d consider going away to something therapeutic (whether it be a mental health thing or meditation thing) if I could make it work financially. I will also add that my body is a wreck between a chronic, relentless cough I’m still trying to diagnose and painful bursitis in one hip. Those things limit what I can do physically.

So I just cry and swear and wait for this to be over, but I have no idea when/if it will be or how to get anybody to take me seriously that this is a problem and it's disrupting every single part of my life.
posted by mermaidcafe to Health & Fitness (18 answers total) 8 users marked this as a favorite
If you are single person dealing with all of this you need a sponsor/mentor/advocate responsible voice on your side.

Stay steady.
posted by Freedomboy at 12:41 PM on December 28, 2014 [2 favorites]

You mention a psychiatrist, but do you have a therapist? Have you talked this out with them? Approaching this 100% with medication may not be the route to go, if that's what you're currently doing.
posted by xingcat at 12:43 PM on December 28, 2014 [4 favorites]

One of the key phrases I've found to help ensure that care providers take mental health concerns seriously is "These symptoms are severe and pervasive, and are affecting my self -care and activities of daily living." In other words, I'm not just irritable, I'm so irritable I can't sleep or engage in meaningful social contact.

On a different note, I'm recovering from hip bursitis myself, and that is a horrible pain that surely does not help any existing mood problems. Memail me if you want to know specific exercises and stretches that brought me relief.
posted by KathrynT at 12:55 PM on December 28, 2014 [29 favorites]

If it were me, I'd keep a daily Anger/Mood Diary (date; rating of 0-10 on anger/irritability, depression, and anxiety for the day; number of hours of sleep) so that I had concrete information for the doctor, and I'd push for in-person appointments with the psychiatrist every two weeks until the medication is stabilized. I would also stop calling them between appointments so that I showed I was giving time for any med adjustments to work and so that they would take me more seriously when I did interact with them; rightly or wrongly, people who work in high-crisis settings tend to dismiss people who are regularly complaining about non-crisis issues (crisis issues being suicidal or homicidal urges, or psychotic behavior severe enough to endanger someone, which would likely require daily check-ins).

I also agree that a therapist would likely also be helpful. Medication can only do so much. For problems affecting large areas of one's life, especially longstanding issues, regular weekly ongoing work with a local therapist will likely be much more effective than any sort of one-time retreat. The larger the problem, the longer it will take to solve it, and ongoing therapy work can help you build the foundations you need to tackle those big problems one step at a time.
posted by jaguar at 1:22 PM on December 28, 2014 [1 favorite]

Is more physical exercise an option? I loved running or hammering away on an eliptacle or really heavy lifting as a focus for my anger.

Also useful to me was writing out my problems and expressing myself through drawing - horrible ugly pictures but very therapeutic!
posted by Middlemarch at 1:41 PM on December 28, 2014

I've found that a great way to burn off anger is physically intense exercise like running or hitting/kicking a heavy bag. It does something to your brain chemistry that helps flush the anger out of your system, for a while at least. So once you're feeling a bit better physically, maybe try that?
posted by Jacqueline at 1:47 PM on December 28, 2014

I remember your previous questions, and the complexities of access to care seem to inflect all of them. I'm sorry you're encountering these obstacles. I think you probably know the limits of what's available to you better than anyone, but I wonder if your state NAMI might be able to help with ideas or resources for self-advocacy, just in case there's some untapped corner of the system in your area. (Apologies if this is an imposition, or if you've already been there, bought the T-shirt, but I remember your location from your other questions - link here, county affiliates here.)

This pamphlet describes a range of programs - not sure which are planned and which are fully operative. There is mention (p. 7) of "peer-run respite centers [which] are voluntary, non-medical, crisis alternatives for people in self-defined emotional distress". I am not suggesting you aren't in crisis, but this may be an option (if it is indeed running, and there are available rooms...). Good luck.
posted by cotton dress sock at 2:03 PM on December 28, 2014 [4 favorites]

Exercise and journaling can help, I've been told. I don't have advice, really, just wanted to invite you to message me if you need to vent. Everything feels harder if you are alone or feel alone. But you have people rooting for your good health, myself included. That's not as good as in-person support but holler if you want to talk. Hang in there!
posted by Bella Donna at 2:20 PM on December 28, 2014

Best answer: One of the things you want to say to medical professionals is that your symptoms are interfering with your quality of life. Also, its not anger, it's irritability, which is a known side effect for dang near every medication.

A good script is, "I am experiencing extreme irritability, it's interfering with my quality of life. I need to have my medications evaluated to see if a different combination would be better for me."

If a nurse says, "anger doesn't kill you," you can reply, "it may not seem important to you, but I'm miserable and hurting and your minimizing my discomfort is unkind."

You can advocate for yourself. You don't have to take no for an answer, and speaking to the on-call doc may be the right thing to do in this scenario.
posted by Ruthless Bunny at 2:22 PM on December 28, 2014 [28 favorites]

Years ago, I was an extreeeemely angry young woman. The anger was very justified because terrible things had been done to me. My experience is that the single best antidote to being mad as hell all the time about everything is problem-solving.

I will suggest you take up the offer in this thread to memail some folks and get some practical advice about some of your health issues. I also have health issues and pain and physically misery absolutely make my mood worse.

Second, I will suggest that instead of self-soothing, you engage in more self analyzing. Start a journal and when you are just mad as hell about how a character was written on a TV show, try to figure out why that pisses you off so much. You may find that it speaks to something in your life that is unresolved, like 'That fictional character reminds me of my dismissive doctor' or 'That fictional character reminds me of that jerk relative of mine' or 'That fictional character reminds me of x bad thing that happened to me.' It might turn out to be a good way to process some of your suffering.

But my anger never gets better unless I am working on fixing the underlying problems that cause me to be so pissed off at everything in life. When I physically hurt less, when the finances stop being so dire, etc. then I am less of a grumpy, screechy ball of fury. Self-soothing and that sort of thing is not something I find productive.

Best of luck.
posted by Michele in California at 2:43 PM on December 28, 2014 [4 favorites]

Response by poster: Thanks to all who've commented so far! I appreciate it muchly, both the comments and you taking the time to carefully read my posts.

To answer some questions:

I do have a therapist and she's pretty great. I see her tomorrow. I haven't seen her for a few weeks since I have been so loopy with sleep deprivation and it's kind of a haul to get out there to see her. But I will definitely see her tomorrow and discuss with her. I don't think it would be possible in terms of my healthcare to come more than once a week right now, but I can ask.

Yes, I know exercise is a good suggestion, but I have to hold off on that until I start the physical therapy for the bursitis in a few days and until my breathing is in better shape, though I don't know when that will be. Sorry to be such a naysayer; I just have a lot of limitations right now.
posted by mermaidcafe at 3:36 PM on December 28, 2014 [2 favorites]

A family member in a similar situation has found some relief from a peer support group run for and by people with bipolar disorder. That provides a safe outlet for feelings she does not feel she can share with family members, friends, etc. and knowing there is a place to go once a week and blow off that steam seems to help keep from boiling over the rest of the week. A lot of the way you're describing your frustrations sounds so similar, I wonder if that might be an outlet for you, too.

She has also recently begun to seriously practice CBT and DBT after sort of scoffing at them for years, and has found once she committes to them as a regular daily practice instead of something to be used only in crisis, that has helped prevent some of the escalation to that rage level.

Might be things worth exploring. I'm so sorry you're feeling this way, and I hope you hit upon a good combination of tactics soon.
posted by Stacey at 3:40 PM on December 28, 2014

When I can't exercise, the only thing that comes anywhere close for the physical release of anger is some kinds of music.
posted by salvia at 4:34 PM on December 28, 2014 [2 favorites]

Eat delicious but well balanced food, frequently but without stuffing yourself.

Hard to be irritable on a full stomach.
posted by serena15221 at 6:54 PM on December 28, 2014 [1 favorite]

I found that breastroke swimming did not worsten my bursitis, and in addition to being good exercise and helping in that way, it's quite meditative. You might want to do the modified stroke - without putting your head under water - so that breathing problems aren't aggravated. But obviously, ask your MD because I ain't one, much less yours!
posted by The Noble Goofy Elk at 8:37 PM on December 28, 2014

On the meditation front, some free suggestions: HeadSpace or

Susan Piver. Two totally different feels. HeadSpace is a little more "scientific" feeling and Susan Piver is great for self-compassion.

I am going through withdraw of Lexapro right now (not at all the same thing I know) and the irritability and fear I am pushing away loved ones because of it is a big thing. With my closest, most trustworthy loved ones, I am working up the courage to ask them to have patience with me. Good luck! I am with you spirit (if you'll take that from an internet-stranger).
posted by CMcG at 6:19 AM on December 29, 2014 [1 favorite]

In the first few years after I was diagnosed as Bipolar type I, my anger was almost all-consuming, and would leak out at inopportune times, at the wrong people. It was a clawing thing inside me, and I was its cage. So while I won't presume to know exactly how you're feeling, I have been in a similar place.

What helped me:

- Changing from bog-standard lithium to Eskalith extended release (also infinitely easier on my GI tract as a bonus). But when your psychiatrist comes back, it might be worth asking them if Lamictal and buspirone would be good replacements/adjuncts to the lithium/Depakote regimen. They were life changing for me; YMMV.

- Using therapy to figure out what triggered my anger, and why; then coming up with coping strategies to use in the moments I felt so angry: e.g., saying out loud, 'I'm feeling really angry, and I need to go calm down; I'm going to go walk around the block until I'm calmer;' then going and doing exactly that.

- I bought a body-length heavy punching bag and hung it up. When I was furious, I'd go outside and beat the crap out of that bag, and force myself to keep hitting it until I was physically exhausted and emotionally drained. After a point, you have to decide if you're really angry enough to warrant going outside and hitting the bag until you're exhausted, especially when it's 2 a.m., or raining. Sometimes the answer was yes, but after a point the answer was naaah. If a heavy bag isn't at hand, take a mattress off the bed and prop it up against a wall, and hit that. That shouldn't aggravate your hip too much, since it's mostly upper body.

-When you've seen a doctor for your bursitis, figure out what exercise you can do, and then do it, religiously. For people with this disease, exercise isn't about vanity; it's a major, massive, load-bearing tactic to keep us afloat. I lift weights because I find that lifting heavy things clears my head and forces me to focus on only lifting the weights; there's no room for anything else in my head. And the endorphin release is some damn fine free and fast-acting mood relief.

- Meditation was helpful. Not so much in the immediate term, but over time, it added more emotional distance, so I felt less as if I were an exposed wire with all the insulation stripped off.

- Making little rituals for myself to give the anger a focus; one of my favorites is to write down everything I'm angry about, then light the paper on fire, or rip it up into a million shreds.

-If you have a car, go sit in your car with the windows closed and scream. You'll get some weird looks, but it's a safe place to let some of the anger out.

Ruthless Bunny's phrasing for talking to nurses and doctors is great; I'd use that. Also ask to be referred to anger management classes; it's where I learned most of the above coping methods.

In short, you need better outlets, both physical and emotional, to put all the anger, so that it's got somewhere appropriate to go. Something I've learned after 20+ years of managing this disease, is that there's no single tool that works on its own; you have to have an array of tools in your toolbox, and be willing to deploy them all.
posted by culfinglin at 9:20 AM on December 29, 2014 [3 favorites]

Not much to add except I understand fully how torturous meds can be, and how frustrating it is to repeatedly try new ones till you find that magic bullet.

For anger issues, you really can't beat getting serious about a heavy punching bag. Though, if physical issues limit that, getting two dozen eggs and a tennis racquet/baseball bat/broom handle and hitting some eggs is probably the closest second best I've found. Weird, but satisfying!
posted by Jacen at 12:53 PM on December 30, 2014 [1 favorite]

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