Clusters and hope

Well, it’s halfway through January, and I’m doing okay. I’m not nearly as bad as I’ve been in past years, that’s for sure. I’m definitely walking on eggshells, though, and in some way, I’m terrified of myself.

Last Friday at work we had a training, the second part of training we started in December. It’s about the cluster model, where you group clients not by their diagnosis, but in their overall life experiences with mental illness. I’d post the actual wording of the different cluster types but a) the manual’s in my desk at work, and I’m definitely in my pajamas, in my house, at four am on a Sunday morning, and b) my google-fu isn’t working well at this hour. Okay, off the top of my head, there are five clusters. There’s cluster 1, which is people whose physical health problems have overshadowed their mental health, cluster 2A and 2B, which are people with mental illness and substance abuse, cluster 3A and 3B, which are people with extremely severe mental illness and very little insight into it, cluster 4A and 4B, which are people who have been through a lot of trauma and have trouble moving past it, and cluster 5, which is people who overall are able to manage their illness and function well in the community, and have been from the start.

(I desperately hope I’m a 5, just FYI. I like to think I am, but I get neurotic about things like this.)

This portion of the training was the intermediate course, and we were doing more practicing with actually identifying clusters for people. Examples had been written up and I am so awful about identifying too closely and superimposing myself and my neuroses on people… I have a hard time accepting that people are clustered based on their history, so someone who would be in cluster 3A because they have severe mental illness and spent a great deal of time involuntarily hospitalized, but then received appropriate treatment and have been in constant recovery ever since, have to stay in cluster 3A rather than moving to cluster 5. It just feels… hopeless. After all, the research indicates that on average it takes ten years for someone to get the right diagnosis and medication on board- so does that first ten years of medicine basically dicking around to get something right, mean someone is more or less doomed to remain in a cluster despite their best efforts to the contrary?

I have a hard time accepting that. It was ten horrible years between when I first told my mom that I thought I was depressed, to my hospitalization and being put on the right medications. Sure, I’ve only been hospitalized one time, and it was voluntary (and I pretty much had to beg them to admit me,) but I’ve been pretty damn sick.

I guess the level of insight is what’s important here, but how can someone develop good insight until they are given the right information? It wasn’t until college psychology classes where I discovered that I was on all sorts of wrong medication. Nobody had ever told me “this is your diagnosis, here is the medication that will work, here is why.” I had to do my own research. Most of my clients have been in that same boat and we aren’t educating them. Most of my clients have gone beyond the point where education is really going to help, as the damage from the illness has become too severe and compromised their cognitive abilities. Could these people have been a 5, if only they’d been given good information and the right medication? Could they have been a 5 if their doctor had spent more than six minutes talking to them before handing them a prescription and telling them to come back in three months? Could they have been a 5 if their family had been supportive, if they’d all tried to educate themselves as much as possible right away, rather than trying to pray it away? How many clients have I worked with who could have been a 5 if only circumstances had been different?

It’s easy, sometimes, to let the professional veneer wall off my empathy for my clients. I’m busy, I have too much to do and not enough time or limbs to do it. It’s easy to forget that they’re people with lives and dreams and hopes. It’s easy to forget that at one point, they probably turned to someone and said, “I don’t feel right, something’s wrong,” and chances are good that they were ignored, or not given the right medication, or given the right medication but no education to go with it so they thought it was more like a course of antibiotics than a long-term medication. It’s easy to forget how close I came to not being a 5. It’s easy to dismiss my dad as a crazy alcoholic and try to forget about him as best I can, to move on with my life. Realizing he’s probably a 2A is disheartening, because it’s a road that I could very easily have turned down.

Sometimes the only reason a person is a 5 is because they’re too stubborn to just accept a prescription and no answers. I know that’s why I’m a 5. Am I sick? You betcha. But I’m also informed, and I refuse to accept no as an answer. I refuse to settle for okay, at least not for long. I refuse to end up back in the hospital, or addicted to drugs or alcohol.

The training still threw me for a loop, though, and then I went to a drug lunch afterwards, and was thoroughly depressed by statistics about the rate of metabolic disorders among those with bipolar disorder yet again. I seriously cannot keep up with all the different things I’m somehow supposed to keep up with. Maintaining my sanity is already a full-time job. I take care of myself as best I can, and I’m going to try to get a Y membership if I can afford the cost this year. I have to see where my finances fall here in the next couple weeks, now that my HSA deduction has changed and I now have to pay a premium on my insurance. I want to take belly dancing classes. I want to improve my overall health, I really do, but my mental health is my number one priority. It’s also damn expensive.


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