Meandering Musings

Everything not fit to publish

VA Disability Primer

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VA disability is one of the most well-known benefits but it is also one of the least understood due to its complexity and the subjectivity involved.

Contrary to popular belief the VA does have a duty to assist the veteran in his claim. This includes many things but it essentially requires the VA to help you obtain evidence to prove your claim including providing examinations at no charge. It does not include agreeing with your position or spending time or manpower on frivolous claims. This duty exists through all claims and appeals except in two conditions discussed later. Outside of those two cases, it is not an adversarial process although it can often feel like it. To get so far into the process where the duty to assist vanishes can take years, the best way to avoid a long claim process is to do your best to document everything from the beginning.

Your first step should be to see a Veteran’s Service Officer (VSO) to discuss concerns and go over your records. Your service and medical evidence and any relevant lay evidence are going to win or lose your case. The more relevant evidence that you submit from the beginning the higher your odds of getting a favorable decision and the lower your odds of having an extremely protracted fight at the various appeal levels. Spending a month or two getting your ducks in a row might just save you years of aggravation.

Disability Claims

There are basically two types of disability claims: a new claim and a claim for an increase in an existing disability. A new claim can be your first claim or if you feel you now qualify for disability benefits of a different issue. The steps involved are about the same except for a new claim the VA has to first determine if it is service connected or not.

Before we begin, it should be noted that a vet cannot have a dishonorable discharge, although a less than honorable discharge may be okay depending on the circumstances. Honorable discharges are good of course, unless said disability was caused by misconduct.

The first step is to determine that a disability exists. It has to be chronic and disabling and on the list of recognized disabilities. If it isn’t explicitly listed you still could get it rated if it is closely related to a recognized disability. It also has to be connected to your service. This is by far the most difficult part of the claims process and the most critical. No service connection, no benefits for it.

There are three methods of connecting a disability to your service. The first is the primary connection and is fairly straightforward. It is an injury or illness that occurred during service and is an ongoing disability. Probably the best way to establish this is through a medical review board that leads to medical retirement or discharge but that is not required. Military treatment records work also. With an exception in the paragraph below, no treatment records mean that your odds are long but not necessarily impossible. You will also need what is called a nexus, that is a link to an in-service event to your current issues. A doctor will need to be able to say that it is at least likely as not (50% or greater probability) that said disability is related to your service. The very best nexus is continuing treatment records from military doctors to civilian (VA or private). The next method is the secondary connection. That is a separate issue caused by a service connected disability or its treatment.

The other method of connection is what is called presumptive disabilities (38 CFR 3.307 – 3.309). These cover several things and may have time limits. The first is a list of disabilities that if they manifest within one year of separation from active duty are presumed to be service connected. There are others like Agent Orange exposure or if you were at Camp Lejeune at one time or another over a period of several decades and have an illness that has been recognized as likely caused by whatever you were exposed to. You need proof that you were in the affected area during the timeframe authorized and that you have one of the disabilities listed. With a presumptive claim, you do not need to establish that your conditions are at least 50% or greater likelihood that your service caused or aggravated your issues. If you have a disability not listed and you were there, you will have to find another route to service connection.

National Guard and Reserve service do not confer 24/7 on duty presumption so only disabling issues incurred while on drill or deployed will likely count for VA purposes.

Disability Ratings

Once service-connected, the method used to connect is irrelevant to the rating. It will be rated by the schedule of ratings in the regulations. The schedule of ratings also lists which disabilities are ratable. If you don’t fit perfectly in a rating code the VA can choose what most closely resembles your disability. The bad part is that the ratings are often subjective. One rater might rate you 50% for a single disability and another rater could say 70% and it is possible that neither gets dinged for being wrong because both could be valid depending on how the evidence is interpreted. This is important to understand when it comes time to appeal. The rater is graded on how many claims are worked and completed and its accuracy and can lose their job with low production points and quality ratings.

Ratings are generally between 0% and 100% with 10% increases but most specific ratings will have different gradients and many have a maximum rating at less than 100%. Migraine headaches have a max rating of 50% despite the fact that they can often be 100% disabling. Ratings are often grouped together and treated as a single disability. The most obvious one is mental health disorders. Whether you have generalized anxiety disorder or PTSD the rating is all about symptoms and how it affects your daily life. You can also only be rated with a single mental health diagnosis but symptoms of all can be rolled into the rating. Typically issues that a person are considered to be born with (such as personality disorders) are not ratable. Below is the schedule of ratings for mental health, as an example.

General Rating Formula for Mental Disorders:

  100% - Total occupational and social impairment, due to such symptoms as:
        gross impairment in thought processes or communication;
        persistent delusions or hallucinations; grossly inappropriate
        behavior; persistent danger of hurting self or others; intermittent
        inability to perform activities of daily living (including maintenance
        of minimal personal hygiene); disorientation to time or place; memory
        loss for names of close relatives, own occupation, or own name

 70% -  Occupational and social impairment, with deficiencies in most areas,
        such as work, school, family relations, judgment, thinking, or mood,
        due to such symptoms as: suicidal ideation; obsessional rituals
        which interfere with routine activities; speech intermittently illogical,
        obscure, or irrelevant; near-continuous panic or depression affecting
        the ability to function independently, appropriately and effectively;
        impaired impulse control (such as unprovoked irritability with periods
        of violence); spatial disorientation; neglect of personal appearance and
        hygiene; difficulty in adapting to stressful circumstances (including
        work or a worklike setting); inability to establish and maintain
        effective relationships

 50% -    Occupational and social impairment with reduced reliability and
        productivity due to such symptoms as: flattened affect; circumstantial,
        circumlocutory, or stereotyped speech; panic attacks more than once
        a week; difficulty in understanding complex commands; impairment
        of short- and long-term memory (e.g., retention of only highly learned
        material, forgetting to complete tasks); impaired judgment; impaired
        abstract thinking; disturbances of motivation and mood; difficulty in
        establishing and maintaining effective work and social relationships

 30% -    Occupational and social impairment with occasional decrease in work
        efficiency and intermittent periods of inability to perform occupational
        tasks (although generally functioning satisfactorily, with routine
        behavior, self-care, and conversation normal), due to such symptoms
        as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or
        less often), chronic sleep impairment, mild memory loss (such as
        forgetting names, directions, recent events)

 10% -    Occupational and social impairment due to mild or transient symptoms
        which decrease work efficiency and ability to perform occupational
        tasks only during periods of significant stress, or; symptoms controlled
        by continuous medication

 0% -    A mental condition has been formally diagnosed, but symptoms are not
        severe enough either to interfere with occupational and social
        functioning or to require continuous medication

You might be thinking that a person could fit multiple ratings and you would be right. This is where the subjectivity is involved. I have a 100% mental health rating and have 3 100% items, 3 70%, 3 50% and 2 30% listed in my award letter. I am not completely sure but I think what put me at 100% was that I applied for the unemployability rating (discussed later) and mental health is the only other rating where the ability to work comes into play. My examiner opined that I have reduced occupational and social impairment which is the 50% criteria. It is much easier to give someone a 100% rating than unemployment because they have to monitor the latter. I would love to find out the actual reason for my 100% MH rating but that could open me up to review and my curiosity isn’t worth the risk of getting a reduction.

Once rated, you are given a combined rating. This determines your disability compensation, medical and many other benefits. If you only have 1 disability rated it is very simple, you are rated what that disability is rated at. If you have one or more 100% ratings, you have a combined 100%. If you have two or more and no 100% it gets a little more complicated. It is often called ‘VA Math’ but it is a system used around the world. It is really called the ‘whole man system’. It starts out saying you are 100% abled and combine ratings from there. I will use my old ratings as an example. I had 50% mental health, 50% migraines and 20% seizure disorder and a few 0% ratings which aren’t a factor here. Take the highest first and work down. I am now considered 50% abled and 50% disabled after the first 50%. Every rating after this takes a proportional piece of the abled pie. The next 50% is taken out of the 50% abled for a value of 25%. This leaves me 75% disabled. If that were all my ratings, it would be rounded to the nearest 10th value, which would be 80%. I still have 20% left, so 20% of 25% is 5% which brings me to 80%.

In my case, the 20% was worthless for compensation which is the bad part of the whole man system. Each subsequent disability is worth less even if it is significantly impacting you. If you were at 85% you would need a single additional disability at 70%(or multiple disabilities that combine to near 70%) or higher to get to 100%. If you had a 90%, you need another 50% so you can qualify for the far more beneficial 100%. Four 50% ratings will get you to 94% rounded down to 90%, but an additional 10% rating will get you to 95%. The easiest way to figure this out is to use the VA’s table.

To further complicate matters there are bilateral factors. These are disabilities on paired limbs or muscles. This adds another 10%. The bilateral disabilities are combined first from highest to lowest, then 10% is combined and then the rest of your disabilities are combined as described.

A 0% rating may be disheartening since there is no compensation attached to a single 0% rating but there are lots of benefits, including free care for those ratings and a 10 point hiring preference for most federal jobs. The biggest is that it means your disability was service connected which is the most difficult part of the disability claim. You can appeal the 0% or later on put in for an increase if your condition worsens and you don’t have the service connection hurdle in your way. If you have two or more 0% ratings and no other compensable ratings, and those ratings affect your ability to work you can get a 10% combined rating.

Any incorrect or misleading information is unintentional. Please comment with corrections, any important omissions and good citation for it.

The VA System

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The U.S. Department of Veteran Affairs (VA) is a much maligned (both fairly and unfairly) but critical organization. It is the second largest federal agency. The Department of Defense is the largest, so this shouldn’t be a surprise. It employs a little under 350,000 people to serve 5,124,168 enrolled veterans as of 2014.

There are essentially three parts of VA and they have very little interaction: VHA(health services), VBA(benefits) and National Cemetery Administration. To get benefits you need to contact one or more of them depending on what you are trying to get. Signing up with one agency will not get you signed up with the others. Annoyingly, you need to contact both VHA and VBA if you move so you don’t miss important correspondence. All benefits and eligibility for them are authorized by various laws and VA is bound to them. All eligibility decisions can be formally appealed. Everything is based on what can be proven through military records along with civilian medical records if they exist. It is a maze of bureaucracy. The very best way to deal with it is to start with a Veteran Service Officer (VSO).

A VSO is a person hired by veteran’s organizations such as VFW. You do not need to be a member of the organization nor do they ever charge for their services. There are links to several organizations that provide VSO’s on the right side of the page, but it is not a complete list. Shop around and find one that seems to really understand the system. What you need to get started is your DD-214 (only if you are already separated, they can help start the process while still on active duty) and if applicable giving the VSO access to your medical records so they can decide how to proceed on any disability claims. Whether or not you can qualify for disability, which opens eligibility to a lot of services that the VA can provide, as well as financial compensation, depends solely on what is in your records and medical evidence as to your current condition and how it affects your life. To get the most help you will need to sign a limited power of attorney so they can work on your behalf on issues related to the VA. Otherwise, you will be left to fill out forms and submit them on your own; you will also not be able to get information as quickly as a VSO can.

When I was moving through my medical retirement proceedings, I was sent to a VFW VSO and he let me know everything I would likely qualify for and got the ball rolling before my retirement was completed. He got my application for disability put in as well as enrolling me in the nearest VA hospital in the area I was moving to. He also started me in the vocational rehab program which is a phenomenal program, especially stacked up against the GI Bill as it existed in 1996. It also covers things that the GI Bill does not such as vocational evaluations.

I had always assumed that a service member would need a medical discharge or retirement to qualify for these benefits. That is not true! You also do not need to be a boots-on-the-ground combat vet injured in the line of duty to qualify for benefits. If you are active duty, you are considered to be on duty 24/7. If you are on active duty and develop epilepsy, as in my case, and is a chronic disability you can get rated for it. Even if the condition existed before enlistment and you still passed the initial medical exam (assuming you disclosed it - never lie about medical issues to the military or VA, it can bite you hard) and it got worse you can get compensation for what got worse. In my case, my service did not cause it, at least as far as I can tell, but it happened on active duty so it is service connected. You could be walking off base and get run over by a drunk driver and if there are any disabling conditions it could be considered as service connected. As long as your disability wasn’t caused by misconduct you can likely get it service connected. If your disabilities happened while driving drunk, for example, it will not likely lead to a service-connected disability. It does have to be chronic and disabling. An acute incident that caused no problems once addressed will not qualify. Reservists and National Guard members do not have the 24/7 on duty presumption since they typically spend so little time each month drilling.

Disabilities are rated from 0%-100%, some are capped lower than that, and are combined (not added together) using what is called the “whole-man system”. It is a system that is used around the world in both private and public disability insurance systems. The max combined disability is 100%. I will write more specifically about the system, obtaining disability benefits and pitfalls to avoid in another post.

Other than a dishonorable discharge, less than honorable discharges might qualify you for some services and benefits. A VSO can help here.

VHA has rules mandated to them for health care that can be a little tricky. It is not as simple as “I served one enlistment give me free health care for life”. Again, a VSO can help you know what sorts of services you qualify for. The simplest is if you have any service-connected disability you can always get seen for that and any treatment your VA doctor thinks is appropriate for free. Your dependents(unless your spouse or child is a veteran or otherwise qualifies) do not get medical care from VA but there are some cases where they do qualify for CHAMPVA which is free insurance they can use in the private sector. Retirees and their families qualify for medical care through the DoD but that is outside the scope and control of VA.

There are 8 categories of vets that qualify for VA care called priority groups. Priority groups have nothing to do with scheduling, everyone is scheduled the same from my experience. If you fit into multiple priority groups, which many do, you will be placed in the highest group you are eligible for. Some vets will have co-pays but they are very low and only apply to some eligible vets and are means tested. If you have co-pays and private insurance you can use that to pay for it. I have read reports from vets on VBN that their private insurance assumes that you paid your deductible to the VA. It is a cheap way to meet your deductible.

This was a quick and dirty introduction to the VA system, I will write more in other articles as there is much more to add. The most important thing here is if you are a vet, take your DD214 and see a VSO and see what you might be eligible for.

Getting Off Meds

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Side effects of psych meds can be bad, withdrawal effects are often worse. Psychiatrists often ignore this fact when prescribing. They often dismiss withdrawal concerns because they have no personal experience with it.

Withdrawal effects happen because of dependence. In typical fashion, the drug companies use euphemisms like ‘discontinuation syndrome’ to hide the fact that they can be highly addictive. They change your brain systems and it gets used to it so when the effects of the drug go away, your brain reacts to less serotonin or dopamine or whatever neurotransmitters are being affected by the drug. In most cases, this dependence doesn’t cause craving, unlike other drugs. Once you taper off Prozac, for example, you aren’t likely to relapse. Benzodiazepines are an exception to this rule. They also have some of the worst and longest lasting withdrawal effects, especially benzos. Withdrawal effects can last years.

Like starting meds, your best defense for minimizing the pain is education. Do a search on personal experiences and research on your specific med. There are lots of sites that offer advice, although it is typically general. Like side effects, withdrawal effects and its duration depend on the person, specific drug, dosage and the length of time the med has been taken.

I am currently not on any psych meds, with a small exception, and have been off for almost two months. I still get withdrawal effects like insomnia, ‘fuzzy’ brain, ‘the shakes’ and rebound depression, anxiety, and psychosis. I feel like I am dying most days. For me, the trade-off is worth it. I have been living with depression for so long it doesn’t bother me that much, newer things like psychosis and anxiety are a little harder to deal with but is okay for now. Paranoia is the worst but manageable. Paranoia is the one thing that gives me pause about staying off.

Three months after initially starting the antipsychotic ziprasidone, I felt weak and really tired. I also noticed the loss of muscle mass. My doctor ordered a testosterone test, an irrelevant one that my primary doc had to school him on. It was also the first time ever, after 20 years of shrinks, a shrink tried to find an underlying cause, which puts a fine point on psychiatry being a pseudo-science. After getting the right tests showing extremely low testosterone, he wanted to put me on replacement therapy which has its own risks and severe ones that I would like to avoid. Luckily, despite my shrink being an MD, he isn’t capable of prescribing hormone replacement therapy, so it got kicked over to my primary doc who is thorough and very competent. As an aside, this is one great thing about the VA system; it is easy to coordinate care between your primary doctor and any doctor from any specialty clinic.

My testosterone levels were extremely low but she wasn’t sure replacement therapy was the thing to do. She wanted a series of tests done over time. I read up on natural ways to increase it and came up with a couple of supplements1 to take at night since testosterone is mostly created during sleep. It seemed to help; my second test was twice as high but still very low. My doctor was skeptical that my attempts to increase it was valid but said to keep doing it and we will check in a few months. The third test came back as bad as the first. She said she now feels comfortable with hormone replacement but I still was not. I was having severe health paranoia over this and imaginary issues and demanded to find the cause of it. She said it was likely the ziprasidone (which it was) but ordered a bunch of tests. All the thyroid tests came back good but the pituitary tests did not. My levels of prolactin were three times as high as they should be, which suppresses testosterone. This might be the reason the supplements didn’t help, I am not sure. So I started tapering off the antipsychotic.

Now, I had been discussing getting off all psych meds with my shrink for a few months because I felt like I didn’t need it and I had a feeling that one or more of them was causing my tiredness. This just clinched it, it set off my health paranoia. My psychiatric symptoms are worse but my ability to deal with them is currently pretty good. I know I will crash again sooner or later, but being out from the side effects even if only for a year is worth the trade-off of future suckage.

I started with ziprasidone, which I did way too fast and it hurt but I had a lab scheduled in 45 days and wanted to be clear of it for as much of that time as possible. The labs showed my testosterone was back to normal, which I didn’t need a test to tell me. I felt more energetic and stronger. The prolactin level was still just a bit high. My primary doc said that it will continue to decrease and no more labs are necessary. Antipsychotics are dangerous, to say the least, and there are scarier side effects that are much more common than the ones I experienced. The really scary part is that I never approached what is considered a therapeutic dosage but it still caused all these issues.

I waited a few weeks to make sure all the withdrawal effects were gone before tapering down mirtazapine. This one wasn’t as bad as some other antidepressants. I stepped down from 45mg in 7.5mg steps, which was about the smallest I could do easily. The lowest dose pills are 15mg, cutting them twice is problematic. The worst was the first step down, it was so painful I stayed there for 2 weeks. After that, it was pain-free and stepped down one week at a time.

The worst withdrawal caused by it is insomnia. I have had insomnia since I was 18, it started in the Army. The only positive effect from mirtazapine was that it kept insomnia away. A bad effect was I slept 12 hours. I used to be able to take melatonin and valerian root which worked well, but it didn’t work at all at after stopping mirtazapine. I tried doxylamine which didn’t either. Lately, they work a little better. I guess it is because my brain had changed and is slowly going back to normal. The good thing is that I no longer sleep 12 hours and still feel exhausted. I sleep 4-8 hours and rarely feel tired. The return of psychiatric symptoms minimize any gains by being very distracting and slowing my thought processes. Pick your poison.

The last thing was clonazepam, a benzodiazepine. I was only taking 1mg a day, and not always every day. Despite the reputation of being hard to get off, I tapered off pretty quickly. In about two weeks. That might have been too fast. I still have withdrawal effects, so I am not completely off it. I take 1-2mg a week, when the withdrawals get too bad and if I get a strong seizure aura.

The hardest part is the pushback from my psychiatrist. The psychiatrist I saw when I started was completely against it. I am a stubborn old cuss, so he gave in but he called it a ‘drug holiday’. My old shrink moved to inpatient and my new one thinks that the fact that I really don’t want to go back on meds means I don’t want to improve and I “endorse low mood and hallucinations”. I don’t even want to see her again because it will be a fight every appointment. Seeing a shrink is stressful enough and is a depressing experience, this just adds to it. Yeah, psychiatry sucks.

Do not ever forget to take your psych meds and when stopping one go very slowly. How slowly is a debate that never seems to get solved. My advice is to go as slow as you feel comfortable. There is no such thing as tapering too slowly unless the drug is causing a life-threatening condition. As an example: Venlafaxine. I tapered off in three weeks from 150mg. I took 37.5mg steps, which was way too large. My mind was cloudy and numb; I was dizzy and got what is commonly described as brain shocks which are painful. I was the walking dead for over a month.

Also, do not go cold turkey, ever. If you are not going off meds, make sure you never run out. The consequences can be painful or worse. Do not ever taper off without your doctor knowing. I can’t stress that enough. You will need them to write prescriptions in a way to make it easy to taper down slowly and to help if really bad things happen. Don’t let them dictate the schedule. If you are simply switching to a new med, the good news is that withdrawal effects are often minimized.

  1. Stress B Complex, Fish Oil(later on Hemp Oil), Vitamin D, Magnesium and Fenugreek. I still take all of those for other reasons other than Fenugreek.

Psych Meds Suck

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Disclaimer: I am not a medical professional. This is simply my opinion based on personal experience and the experience of others at Psych Central and various other places. Do not mistake this for advice or medical opinion. It might be useful as a rough guide but is probably closer to an opinionated rant that is way too long.

I am not anti-drug. I think that they provide tremendous help to those that really need them, I probably wouldn’t be here without them. I also think that they are misused by psychiatrists and unethically marketed by the drug companies. It is a mess made by the pharmaceutical companies and doctors blindly throwing darts and it is the patients who pay the price and it can be much worse than the affliction. I will also disclose that I am incredibly sensitive to psych meds which certainly informs my opinion.

People have been accustomed to taking a pill that solves a specific problem and they work well and typically with no noticeable side effects. You get an infection; there is a pill that clears it up. You have a headache, over the counter drugs take care of it. These things typically work well and predictably.

Psych meds are entirely different than many people’s experience with other types of prescription and over the counter meds. The two biggest issues are that people react differently to the same drug at the same dosage and they take a long time to start working, yet side effects can manifest in the first day or two. There are websites that allow patients to solicit others experience on a drug and even review it as if it were a car or hair salon. This is a waste of time and dangerous. The sad fact is, and it pretty much invalidates most of this rant, there is no reliable way to tell if something will work until you try it. That something worked flawlessly for someone or someone else nearly died on it is irrelevant to how well a third person will do.

There are genetic tests that purport to assist in helping a patient figure out what they will metabolize properly and what won’t. I haven’t used it and reports from patients make it seem just like the psych meds themselves. Hit or miss but it may be a solution if you are having trouble finding meds that work without any significant side effects. At least it is an attempt to inject real science into psychiatry.

I have been on so many psych meds over the past 21 years I can’t remember them all. Outside of the anxiolytics, they either didn’t work well (or at all) or caused terrible side effects, or most commonly both.

I was not taking any psych meds from 2002-2010. I was pretty stable during this time. In late 2010, I crashed hard. It wasn’t really the depression, not directly at least. I had severe anxiety, which wasn’t much of a problem before. It was the first time something new appeared since 1995. I thought they were heart attacks. I even walked into the VA ER and told them I was dying because I keep having heart attacks. Heart checked out fine. Early the next year, anxiety started feeding into my depression and that was the big crash. I don’t remember a lot of this time as depression seems to be a memory thief.

I was on some anti-depressant that wasn’t working and it was suggested I augment with risperidone, an antipsychotic with a lot of scary side effects. Augmenting with antipsychotics seems to be more and more common and that is frightening. They are extremely dangerous meds, even newer ones. The so-called atypicals are just as bad as the older antipsychotics. The distinction between typical and atypical is mostly just marketing and tardive dyskinesia being more rare with the atypicals, other than that the side effect profiles are very similar. I wasn’t in any shape to really argue or think critically, another hazard of psychiatry, so I agreed, especially since it was a very low dosage. I lasted all of two days on it. I can’t adequately explain what it did; zombie mode is sort of accurate but doesn’t capture the suck. On day three, I felt if I took it one more time it would kill me. It took two weeks for the side effects to clear out.

I started over again with a drug called venlafaxine, an SNRI antidepressant. It didn’t really work so they kept increasing the dosage until I was at 150mg. It still didn’t work so they augmented it with mirtazapine, a different kind of psych med. Neither really worked, except mirtazapine is great as a sleep aid, maybe too good.

Around this time I started to get tinnitus, my shrink attributed it to venlafaxine, I tapered off it. It has been two and a half years since I have been off it and I still have the tinnitus. Since I was just on mirtazapine for depression and 15mg wasn’t working it got increased to 30mg. Still worked well for sleep but didn’t touch my depression. It did, however; cause me to gain about 20 pounds in a month. I wanted to drop back down to 15mg but he said 45mg might do better because the weight gain side effect is more prominent at 30. So I agreed. The good news is that I dropped the weight as quickly as I gained it. The bad news was that it caused restless legs which greatly interfered with the sleep properties and still did nothing for my depression. So he increased my anxiolytic to help deal with that. Yes, it can be a vicious cycle.

About 18 months ago, I started hearing voices and seeing things and getting paranoid. My doctor’s immediate reaction was to change my major depression diagnosis to major depressive disorder with psychotic features and put me on another antipsychotic, even though none of these things were more than mild distractions, I knew they weren’t real. I was hesitant because of the previous reaction to risperidone. One good thing about my shrink is that he does accept my input and lets me do research, a very rare trait in my experience. He suggested some scary ones that mess with cholesterol, blood sugar and some are known for very common and significant weight gain. All of which are non-starters for me due to having diabetes and heart issues run in my family, as well as weight issues. He finally suggested ziprasidone, which he said is weight-neutral and the other bad side effects are rarer. He put me on a low dosage of 20mg twice a day.

Things started out okay, the psychotic symptoms were greatly reduced and it started my weight loss where I dropped 50 pounds in 9 months without much effort. That was great! I still need to lose 10 more. The problem was that I was wiped out in the afternoon and got a bad case of the shakes and needed to sleep it off. He removed the morning dose which solved that problem. About six months into it, the paranoia and seeing things came back. Predictably, he increased me to 40mg once a day. This caused different issues than the 20mg 2x a day, which is just weird. It is hard to describe but was something like disassociation. Things got bad enough that I dropped back down to 20mg which was painful for about a week because psych med withdrawals are no joke. It turned out that ziprasidone caused high prolactin in me, leading to dangerously low testosterone levels.

I could go on for dozens of pages of all the problems I have had with psych meds but will spare you for today. Like I said earlier, none of this means that you will have problems with these or other drugs or that they won’t be helpful. We metabolize these things differently so different reactions are the rule, not the exception. Many take these drugs without incident. Please do not use this as a reason to stop taking it or not even trying. I do think it is a decent cautionary tale. Be careful, educate yourself and note any negative or positive effects in a diary. If I had been paying closer attention I might have been able to taper much earlier and avoid a lot of problems. Learn about meds, side effect profiles and how much better they performed in trials against placebo and if there are studies that test against multiple meds.

Doctors are seemingly uncaring about the pain of side effects and withdrawals. I have had shrinks question why I want to get off meds, even with evidence that ziprasidone was causing significant harm. They will question why I am taking so long getting off something or prescribe me just enough to taper off on a schedule they think and no more. Maybe they should take Venlafaxine for a year and taper off quickly in med school.

You might be saying “but that is dangerous”, that is exactly my point! Psych meds are dangerous and should be used only when needed and then very cautiously, yet they are handed out freely and without knowing exactly what is causing your problem. Even in cases where it is situational depression which might only last a month or three, you will likely get offered meds. It is pseudo-science and pure greed that is driving psychiatry. There should be better options. As much as I have been critical about shrinks, I would never accept psych meds from a primary doctor, just like I would never accept other non-psychiatric treatments from a shrink.

The problem is, unless you are ‘lucky’ enough to find an underlying cause like hypothyroidism or you have a significant negative experience in your past, they can only guess what is causing your distress. To be fair there is some research with fMRI’s. So there is some evidence that low serotonin and other neurotransmitters might be the cause of some depression. There are other ways of helping increase these things without the use of meds, like diet and exercise. Going for a short run will have a much more positive effect and more quickly than a pill ever will.

Mental illness is a very personal thing, not everyone with the same diagnosis experiences it in the same ways. For example, some people feel sad while depressed, but I can honestly say that depression has never made me feel sad. I can be having a severe case of depression and still be able to laugh, some cannot. Psych meds are a one size fits all solution to a very personalized problem. Granted, they are more precise than OTC supplements that might not even contain the ingredients the label claims it has.

The worst thing about psychiatry is the pharmaceutical companies. They commonly advertise dangerous psych meds with narrow usage on national TV. This is but one and is the definition of insane, note the list of side effects. Antipsychotics are not an ‘ask your doctor if they are right for you’ kind of drug. Many of these drugs experience high dropout rates during studies due to many factors including horrible side effects, yet they still get approved with suspect studies.

FDA is supposed to be the watchdog of the pharmaceutical industry but more often than not the head of the agency is a former executive of a drug company, or not remotely qualified or have received substantial amounts of money from them. FDA often pushes dangerous drugs with little testing but this is hardly a psych-med only problem.

What is terrible about all this is that psych meds are important and can be very necessary just to function. I know I might have angered some people who need these meds to get through the day. I am not saying to not take them. Stay on them until they are not needed. Yes, sometimes they are needed for a lifetime. I currently am off psych meds, except a very low dosage of clonazepam, but I would not be here without them.

Surviving Psychiatry

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This is not intended to discourage people to seek help. If you need help, please be seen. Psychiatrists are not perfect but are preferable to not going out of fear of psychiatry or stigma or whatever. If you are suicidal or feel you might hurt someone call a hotline, call 911, go to an ER and scream until you are seen if needed. If you have been feeling down or have wide mood swings or hearing voices, don’t let anyone, including psychiatrists, get in your way of getting help.

There are few things more soul-crushing than being hurt by people with good intentions but are oblivious to the damage they cause. Of course, not all psychiatrists are bad but many of the good ones don’t seem to realize that they are causing hurt.

Psychiatry is a pseudo-science. The DSM is a monument to pseudo-science. It is a diagnostic manual that is made up, mostly out of thin air, in a group of committees. Things are added, removed and merged in each new edition. They are arbitrary definitions and mostly cover things that are not measurable or testable. Mental diagnoses magically become other diagnoses or disappear entirely. Many of these diagnoses have no proven cause and no proven treatment. Even a well-known diagnosis like major depression doesn’t really have proven causes so its treatment is not very focused.

The typical approach to treating mental illness is to first place you in one or more defined boxes from the DSM that most closely matches what you are telling them. That is another strike against psychiatry; there is little objectivity in the exams. They actually have an objective portion in each exam note but they are based on what you tell them and what the examiner observes. There is no test to confirm the diagnosis in most cases. If you are seen for a physical issue, the doctor might have an idea of what is wrong and will order tests to confirm it before proceeding. Those tests will determine the treatment protocol, and it is quite effective in most cases. With psychiatry, the best you will get is one or more multiple choice tests, which are self-reporting and “blunt little tools” to quote the eminent Dr. Hannibal Lecter. Next, they come up with a treatment plan using a unique method not see elsewhere in medicine.

I like to call it the ‘throwing crap on the wall and see what sticks and ignore the mess it makes’ method. Each shrink has his or her go-to meds that they try first and they work down an arbitrary list of meds from the set of meds that are either approved for your issue or has some evidence that it works for your issue and is prescribed ‘off label’, until something is found that has an acceptable benefit/drawback ratio for the patient. Heaven help you if a single med doesn’t work, now you have to go through it again with a new drug, while also taking the old one that didn’t work all that well. Polypharmacy is very common in psychiatry; if a drug isn’t working, find another to force the first one to behave itself. Patients with depression and anxiety might end up on 3-6 meds, sometimes more. More often than not side-effects are dealt with by more drugs which can cause more side-effects. It would be comical if the potential damage wasn’t so terrible. This can be a severely painful process, both mentally and physically.

Making matters worse, it is a rare psychiatrist that actually looks for underlying causes. Mental disorders can be caused by a variety of physical issues and those are almost always ignored. I have had a lot of shrinks in the past 21 years and only one actually ran blood work, and that was last year. He kept screwing up the lab order, ordering tests that have no real meaning medically. My primary doctor had to take over to get the correct labs run. Laughably, he thought my low testosterone was the cause of my issues, for 21 years. It was ridiculous and said as much. My primary doctor also thought his hypothesis was groundless.

Psychiatrists may have gone to medical school but it is a joke to call them medical doctors. They don’t even perform therapy because an MS or Ph.D. in Psychology is cheaper than an MD. They hand out meds, track side-effects and not much else.

So how does one who truly needs help minimize the damage a shrink can cause? Simply put, education. Focusing on anything when your mind is not well is sometimes the hardest thing in the world to do, but educating yourself is your best chance at success. Just know that all the education in the world can only aid you, it is not a silver bullet.

Learn about meds, side-effect profiles and how much better they performed in trials against placebo. A shocking amount of psych meds are marginally more effective than placebo. Learn about the various therapy techniques and figure out what you might respond to. Although, the effectiveness of both pills and therapy will be unknown until you give it a go.

If you are at risk for diabetes, avoid meds that raise blood sugar. If you have bad cholesterol issues, avoid meds that raise that and triglycerides. Granted, that is removing a lot of meds but it is the sort of things you need to do to minimize the pain. If you have no significant risk of other serious health problems don’t go into treatment with a wide-open attitude. They can still cause serious issues and getting off psych meds can be very painful. These are dangerous drugs that should be approached with caution.

Going to a psychiatrist is a lot like going to the dentist. You aren’t happy to go and most likely won’t be leaving with a smile on your face. Yes, I have dental anxiety. Why do you ask? That in itself sets up a negative impression, even before you get there, which can color the session. This is an issue for the patient and something that shrinks don’t seem to understand. If your shrink acts all superior and is issuing edicts that you are expected to follow without question; the way to combat that is to bring yourself to their level. To do that takes work and the luck of the draw. If they aren’t listening to you and simply dictating, it is simpler to move on. Although, given a specific circumstance being dictated to might be the most useful thing for a patient. Occasionally, we have no insight or perspective. Sometimes, a person might lose control of their reasoning faculties and need firm guidance. If you are lucid enough to do research, you are capable of being in control of your treatment. There is no one-size-fits-all answer in psychiatry but sticking with an unreasonable shrink can cause unbelievable amounts of damage.

That might be the worst thing about this. Your bad doctor is another’s lifesaver. Like meds, you won’t know how a specific provider is for you until you see them. As much as you need to challenge your doctor, your doctor needs to challenge you. I am not advocating for an adversarial process and your doctor will know more about psychiatry than you but you know more about your condition than anyone else in the world. No one seems to experience and deal with mental health problems in exactly the same way. Your shrink can talk about it in general terms that may or may not apply to you until you let them know specifically how your condition and meds affect your life. Open dialog between two people with the same goals is generally the better path.

The thing to remember is that you are in charge. Seeing a psychiatrist doesn’t remove your rights or ability to make decisions. Getting a person declared incompetent to manage their medical decisions is a legal process that has a high bar and is rarely used. At least in the US.

Therapy has another factor to consider: the therapist. You need someone you can respect, trust and have your best interests at heart. This usually means someone who is kind but will push you out of your comfort zone and be willing to confront you in a manner you will be receptive to. That is a tough balancing act and it may take a while to find the perfect fit.

When therapy goes wrong it can be devastating. I have physical and mental scars to attest to that. I had a therapist that was completely against me. I was messed up when I started seeing her and I couldn’t see how toxic she was. Every session was antagonistic and any push-back got labeled as ‘passive-aggressive’. Any attempt at a social life was met with derision. I met one of the best friends I have ever had during this time and she did so much to help me but my therapist said it was an unhealthy relationship, even though we were never more than friends. We got along well, helped each other through some issues and had fun. That was a bad thing apparently. During all this therapy, I not-at-all-surprisingly got worse and worse until I got committed for a week. That was the best week I had had in several years because it got me away from her. Not long after that, I ditched her and I magically improved and did it very quickly. That was 1999 and I haven’t seen a therapist for more than one session since. I probably should go back to one since I am almost completely med-free but nowhere near free of symptoms. I still hear her voice prattling in my head after all these years making it difficult to even think of having a social life.

So this was a lot of whining, but what can be done to improve things? As patients, there is little to do to change an established system that governs itself through non-scientific methods. All we can do is educate ourselves, be assertive and don’t be afraid to fire your psychiatrist or therapist. The field itself simply needs to be more scientific and there is progress on that front. Studies are being done with therapy and fMRI’s to see what therapy is doing or not doing, to the brain, for example. The important thing to remember is that psychiatry is just slightly out of the dark ages.


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Philosophy is perfectly right in saying that life must be understood backward. But then one forgets the other clause—that it must be lived forward. The more one thinks through this clause, the more one concludes that life in temporality never becomes properly understandable, simply because never at any time does one get perfect repose to take a stance—backward. - Søren Kierkegaard

Given the complexities of life, all the roads taken and not taken, it can be impossible to see cause. There are obvious well-marked events that define a life. Meeting your significant other and eventually having children is one such event. How easily could you have not met this person? The effects of that are large and obvious.

How does one begin to find the cause of a life-shattering problem that has no obvious beginning point? Is it even possible? With many things finding the ‘why’ or ‘how’ is the first step in solving the problem. An arson investigator needs to know how a fire was started if there is any hope of getting to the bottom of it. As a programmer, I cannot solve the problem at hand, at least not in a decent manner, if I don’t understand the problem and the background of it.

Everyone feels down from time to time. It is a defining trait of being human. Some get it much worse than others, and it seems random in the sense that it might not be based on anything going on or proportional to the issues. If one has no mental health problems, an acute episode of depression or anxiety can still happen. I had an enjoyable childhood and other than self-esteem and confidence issues, it was unremarkable. My biggest issue as a child was the feeling that I didn’t belong here; I had that as long as I can remember. As an adult, with one or two exceptions, mental health problems came and went (or never left) with no external stressor. I went through lots of stressful times like everyone and even experienced a few downright scary things and none of those events correlated with downturns in my mental health.

Before I started having significant and chronic mental health issues, I was no different. The first time I ever felt so down it seemed that something was ripped out of me was when I was 18 and in the Army. The Army is not a kind environment, at least not in a combat arms unit. I did well and got promoted quickly. I don’t even know why or how it happened. Maybe I was still adjusting to being away from home and being in a radically different environment. It almost ended badly, at the end of a rope on a random Saturday afternoon. Luckily, no one knew and I pushed through it and completed my enlistment without problems of any kind.

After getting out, my life simplified and got really lonely. This was my second bout of suicidal ideation but never got to the planning stages. It was also the first time that it stuck around for more than a few days. This lasted about a month. At least here I can point to a real cause.

I am grateful that I don’t suffer loneliness anymore. I love solitude and making friends seems out of reach. I simply have zero desire for it. I enjoy seeing family, so I am okay with a lack of social life. Over the years I have had many shrinks and therapists and the consensus is that it doesn’t matter and isn’t particularly unhealthy.

About two years after getting out of the Army I got married and had a beautiful daughter. Times were tight and I needed to get a career. I went to a community college and didn’t do as well as I would have liked and was having second thoughts about the program I was in. My mind drifted back to the military as a possibility. I really didn’t want to go back to the Army. An Army base would be a terrible place to raise a family. I knew the Air Force was much more family friendly but I had the impression that promotions came slowly. I became accustomed to quick promotions in the Army so I tossed that out. I eventually settled on the Coast Guard, even though I had to take a demotion. It was completely different than the Army. In some ways, it was nicer and easier and other ways it was much more challenging.

Things were really good. Right after an easy boot camp, I chose to go to a search and rescue station on the coast of Washington State. Family life was good; we had our second daughter about a year and a half into my enlistment. Promotions came as quickly as I was willing to work for them. When I left my first duty station I was an E-5. Smooth sailing until a fateful day. I had a really weird thing happen to me during my time at the search and rescue station. Out of the blue I blacked out, but did not fall, and in came extreme feelings of terror and I could see images of scenes from dreams. It affected me all day, I was in a fog. I had no idea what it was. It was pretty early so I chalked it up to being tired and foolishly didn’t follow up. I was fine the next day so I didn’t think of it again. It happened again, about 8 months later. Luckily, I was home and again it was early in the morning. I just brushed it off.

About 15 months later, I was assigned to a patrol boat in Key West. I had only been on the boat for 4 months and it was a busy and stressful time. We picked up thousands of Cubans from rickety rafts. This was 1994, it was a massive effort from so many CG and Naval ships to keep up with the migration. I think the total count was 30,000 people picked up from the entire task force. When that died down we got diverted to Haiti for Operation Uphold Democracy. Between all of that plus normal fishery and drug interdiction patrols, and I spent a week in training in Yorktown; it was a busy time. On January 3rd, 1995 we were scheduled for a month of dockside maintenance which is hard work but at least we weren’t getting pulled all over the place. The morning of the first day of maintenance I had another one of those weird things and it was significantly stronger than the previous ones. It knocked me on my butt, literally and figuratively, but again I didn’t seek help. I just faked my way through until the end of the day.

At the end of the day, I had another one just as strong during formation. I remember being really wobbly. I lived about a 45-second drive from the base so I made it home easily. I remember walking in and seeing my girls eating and rushing to the couch feeling terrified. I had another blackout, and another, they were coming quickly with very little time between them. Next thing I remember is waking in the ER and hearing two doctors discussing how to fix my shoulder. It turns out I had a grand mal seizure, separated my shoulder and tore my rotator cuff. The shoulder was from the fall off the couch. I tore my rotator cuff because it made me horribly paranoid and was swinging at the paramedics with both arms. This event was a turning point. Everything bad that has happened to me since can be traced here. There is not one injury from that incident that doesn’t still cause me trouble. In fact, it has led to lots of issues, physical and otherwise.

It turns out the weird things I was having before the grand mal was a complex partial seizure, sometimes called an aura. I spent eight days in the hospital, four of which in the ICU because the seizure stopped my heart and I had an irregular beat for a few days. I don’t remember a lot from this time period.

I have learned to be able to tell if a dream will cause a seizure and I avoid thinking about them. Most of them I forget when I wake, but once it causes an aura it is seared into my brain. The auras are a blessing in disguise. I haven’t had another grand mal since because they are warning signals and I have hours to get seen and get it stopped.

This ended my military career, although it took 18 months to get through the medical board. I took advantage of that and all the medical leave and light duty in the Group Key West medical bay to actually enjoy the Keys. I had surgeries and physical therapy to deal with but other than that things were pretty good. During this recovery time, I started getting terrible tension and migraine headaches and still get them to this day. I started feeling down, enough that the corpsman I worked with noticed and I had my first appointment with a shrink and my introduction to the joys of psych meds.

Little did I know that it would not be the seizure that would alter my life the most in negative ways. If anything the epilepsy was responsible for me getting a free education, at least my bachelor degree. Epilepsy was the only basis for the medical discharge, but the VA also service-connected the depression, bad shoulder, and headaches which gave me a high enough rating to qualify for vocational rehab which is a great program that offers free education.

Figuring Things Out

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You can’t change the direction of the wind, you can however, adjust your sails.

Don’t you hate it when things go awry and seemingly have nothing to do with your actions or non-actions? Me too. No memories of taking the wrong path, but here we are regardless.

Is there fault? Most I have talked to say no which seems wrong to me. Does it matter? I don’t know.

So, where to go from here? I don’t like here so I want to move. That is what this journal is about. I am a very private person and doing something like this is out of character and makes me extremely uncomfortable. I am publishing this for two reasons. First, the simple act of writing doesn’t seem to be enough to be helpful. Making it public makes me really think and organize my thoughts in ways I don’t when I write just for me. What I write may seem disorganized at times, but that is one of the things I am working on. Disorganized thoughts are part and parcel of psychiatric issues. Secondly, I have never improved myself while staying in my comfort zone.

This will not just be me simply whining about personal issues although there will be plenty of that. I will try to explore causes to find solutions. This is also an attempt to get me back working and writing code so there will be some of that as well. Just lots of random things, all with the express purpose of self-improvement and get my brain working a little better. If it is helpful to others, that is even better.