What's a Mental Hospital Like??

I’m sure it’s a question that you might have wondered after reading my blog which mentions numerous stays in the psychiatric hospital.  So, because it is actually very interesting, I thought I’d describe what happens when you get admitted.  First, to get admitted isn’t easy – I read a quote saying it’s easier to get into Harvard than into a psych ward.  To start the process, you have to go to the ER at a hospital.  I always go to the one closest to Mesa Vista (one of the psychiatric hospitals in San Diego that my insurance accepts, and the nicest, so I’ve heard).  At the ER, they ask you the usual “why are you here” type questions which in my case has always been that I am an immediate danger to myself because of my symptoms.  Read the other posts for details on that.  They take you to a room, ask more questions, take blood, then set you up in an actual room with a bed and a little tv and a curtain for privacy (which I never close because I want to see the happenings), and they make you wear a hospital gown.  It’s very interesting to be in the mix of the ER bustle.  Last time I was there, my neighbor was moaning very loudly and persistently because she was having trouble pooping (or that’s what we gathered at least).  Every time someone passes by it’s a game of “what are they here for??” 

After a while, hopefully not too long, but sometimes hours, a member of the behavioral health team comes in to assess you.  They ask a LOT of detailed questions to determine if hospitalization is necessary.  “I don’t usually admit people that want to be admitted” revealed Ben (the PET team member who was assessing me) after I exclaimed that I didn’t want to be admitted.  So, after a lengthy interview I was admitted.  Then you have to wait for them to take you there, because in this case Mesa Vista is a separate building from the main hospital.  They take you by ambulance, which is ridiculous because it’s literally around the corner.  You could walk in a few minutes.  But hey, that’s protocol. 

When you get there, be prepared to answer a barrage of questions and have tests done (more blood, urine, etc).  There’s a lot of paperwork to sign, and then they need to go through all your belongings to make sure everything you have is safe and allowed (there are a LOT of rules that keep changing every time I am admitted).  This time, I was transferred around 2am, so was very tired when being put through the admissions process and just wanted to snuggle up in my penguin blanket with my stuffed bears that I had brought.  But nope, no stuffies allowed.  No blanket allowed.  I had a meltdown by the nurse’s station.  It was too late for this and I just wanted a simple comfort from home.  “People bring in contraband inside stuffed animals” I was told.  I had to pull myself together and remind myself that I am a grown 34 year old woman and can survive a few days without her blanket and stuffies.  Needless to say, I don’t think I slept at all that night.  It’s loud, it’s bright (there are windows on the bedroom doors) and people are constantly coming into the room to do checks.  Every 15 minutes.  24 hours a day.  They have a clipboard and write a little number corresponding to your location. 

The weirdest things to get used to are the total lack of privacy (even the bathroom doors don’t go all the way to the ceiling), not having access to your cell phone or electronic devices, and the rules about what is allowed in your room, what you can have access to in storage, and what is not allowed at all.  Anything metal, sharp, or otherwise deemed “dangerous” is not allowed (belts, shoelaces, or any type or string on clothing is a big no no).  For some reason, makeup is allowed in storage, but not in your room.  I finally talked one of the nurses into letting me keep my stick of mascara in my room, but that was after a few days and had been initially told no.  Tweezers?  Forget about it.  Jenga?  Storage only.  You can shave your legs only under staff supervision.  Needless to say, there’s a lot of hairy legs on the unit haha.  In the rooms, there are almost no flat surfaces or things that people could tie things to.  I don’t really know what trouble people can get into with flat surfaces, but I guess people get creative when they are trying to hurt themselves or others.  The shower head is this little nub that comes out of the wall and sprays a pathetic stream of water at you, and you need to splash yourself and squeeze up against the wall to adequately wash yourself.  The beds are lined with plastic because they need to keep them sanitary, so they are squeaky and not that comfortable.  The pillows are the same – those flat plastic lined things that don’t offer much support or comfort.  The blankets are thin and scratchy (and so are the towels).  But that’s just a minor inconvenience. 

Meals are excellent – they feed you well and often.  I swear, I always come out of there 5 pounds heavier.  The last few times I had been in, the highlight of my day was filling out the meal card.  You got to pick what you wanted for breakfast/lunch/dinner the next day from a little menu card.  This time, our meals were served in more of a buffet style system.  I liked that better because I could control my portions better without wasting food. 

The wards themselves (I have stayed in two different ones, each with its own benefits) have community space for hanging out, watching tv and using computers, a room for dining and having groups (psychology or recreation therapy or crafts), a nurses station, bedrooms, a medication room, interview rooms for when you meet with the nurses/doctors, and an outdoor space.  The doors to the ward are kept locked and only accessible with a special fob that the staff all have.  No escaping for us.  Not to mention they’d notice pretty quickly with all the checks they constantly do.  It’s funny, you stop noticing the nurses with the clipboards hovering in the background fairly quickly.   

You meet with your psychiatrist daily to go over your treatment plan, update on medication, and talk about how the symptoms are changing if at all.  It’s usually a pretty quick visit.  This time, because of my non-compliance with medication, it was decided that a slow-release injection of Haldol was a better option for me.  Not only would it ensure that I would get my medication consistently, but it is better for me mentally to not have to be a slave to pills every night.  I agreed to this course of treatment. 

Oh another thing they LOVE to do all day is take your vitals.  Each morning between 6:15am – 6:30am they wake you up, take your blood pressure and temperature, then let you go back to sleep.  They do vitals like TWICE more throughout the day.  First sitting, then standing.  Because I guess there’s a difference.  I’m super good at vitals and always have perfect blood pressure.  I did learn that my heart rate runs naturally high though.  A debate started when my brother visited and he had a fitbit that showed his heart rate under 60bpm.  Mine ran over 110 usually (resting rate).  We had to call a nurse over to settle the score of “who has the normal heart rate”.  Apparently normal is between 60-100bpm, so neither of us won that one.

You can pretty much do what you want all day, except they turn off the tvs when it's group time to encourage you to go.  The remote for the tv is also literally the size of an ipad.  It’s the weirdest thing.  When I saw it for the first time, I was alone and wished someone was around so I could have looked at them and laughed and said “amiright??” You can nap, eat, not eat, hang out with other patients, read, color, go to groups, not go to groups, whatever you want.  There are also snacks in the fridge so if you want pudding or cheese you can have that whenever you want.  Not bad, right?  Then you remember you are locked in. 

The other patients are a whole other story – some are cool, some are weird, some are just plain annoying.  I met a guy once who claimed to be a musical savant and told stories of his life.  He had a gross leg wound and the bandage kept coming off.  Eeew.  Some patients have bipolar, depression, alcoholism, or who knows why they are there.  Some are court ordered.  Some are on involuntarily holds (meaning by law they cannot check themselves out) and others are voluntarily.  I have been mostly there voluntarily, although one time I was on a 51-50 hold.  That’s what they call it and it lasts 72 hours.  Then you are considered voluntary after that if they think you don’t need to be legally held any longer.  If they want to extend it, they have to have a hearing with a judge and stuff.  I’ve never had to do that.

Then, after your symptoms have stabilized and you feel safe to do so, they usually release you.  I’ve been held longer than I wanted to stay many times because I was still experiencing symptoms even thought I didn’t feel like a danger to myself anymore.  So, eventually, if you want to get out, you tell them what they want to hear:  “nope, no more voices!”  And then you are set FREE!!  And you have to do a whole bunch MORE paperwork and discharge stuff.  That’s boring though so I’ll skip that. 

The best feeling in the whole world is driving out of that parking lot back into the world.  Never am I more happy to stop at red lights or get stuck in traffic.  It’s like getting drunk on freedom.  First stop?  Starbucks. 

Hopefully this helps eliminate some of the mystery of the mental ward.  It’s not such a scary place, and certainly necessary for me from time to time.  I always am super reluctant to go in, but leave knowing it was the right decision.  This is also only my experience at one hospital.  I’m sure there are awful places out there, but I’ve always been lucky with Mesa Vista.  If you have any questions about any of this, feel free to ask!

It Continues...

The other day in therapy, we were asked to think of some things that we used to enjoy doing, but don’t do any more.  I thought about it, and landed on “writing”.  I have always enjoyed writing stories (see my blog for some good ones), and also prefer to communicate important things via written word because I have time to think, organize, and present my feelings in a structured way where I feel more in control.  Face to face conversations, especially about difficult or conflicting things, can be full of uncertainty, and if not prepared, I feel like I never get my point across properly or in the way I mean it to.  For example, I’m not going home for Christmas this year (for a number of reason) but the main one is that many of my friends have new babies that I want to meet and spend time with.  Christmas is not the best time for that, so I’m going to go to Vancouver in March or April when timing is better for everyone.  I tried explaining this to my mom and proceeded to hurt her feelings and give the idea that “I don’t value Christmas traditions” or that “I don’t value my family” and a whole bunch of other negative stuff gets perceived.  I should have just written a well thought out email, and all that could have been avoided.  Anyways, I digress…. I wanted to write this as an extension to my other blog that I posted about a year ago about my experiences with mental illness, because as I said in the last post – it is a story that is never over.

I wanted to write this now because I feel like I need to before the medication kicks back in and takes away my creativity again, including my ability and will to write.   Yes, I was off medication for a few months (bad me), but now I am on a slow release injection so not taking medication isn’t even an option any more.  It’s in me for good, and let’s just say that if I don’t show up for an injection appointment, it will be noticed.   One reason I stopped taking medication was the awful side effects that come along with it, one being for me, a feeling of complete dullness and zombie-like existence.  My spark was gone; all the things that I feel make me who I am are taken away, and what is left is a shell – a person who looks and acts like Lindsay, and even can joke around and have fun and enjoy things – but the essence is gone.  It’s like living in your own shadow, and that was just not for me.  So I stopped.  Cold turkey.  Just like you aren’t supposed to.  This was in June.  I was going on a trip to Vancouver with a friend in a few weeks and I couldn’t stand being tired all the time and feeling dull and cloudy, and I wanted to enjoy this trip.  There was some withdrawal I felt after a few days off medication.  Upset stomach, headache, just generally a sick feeling.  I threw up a few times.  But I knew it would pass (I had tried going off medication one time before for a few weeks and these were the same symptoms that had happened that time, but I felt so awful that I caved and started taking the medication again just to feel better).  After about 2-3 weeks, I felt fully normal again.  Better than I had in a long time actually.  I went on my trip, could stay up to 11pm like a real adult, had energy, and was genuinely feeling like myself again.  I was symptom free too!   This was great.  But it didn’t last.  Of course.  I started having some symptoms come back after about two or three months.  Nothing serious, mostly just intense anxiety at first.  My poor fingernails suffered with that though.  Then the voice of the little kid spirit showed up.  He never says much, but he cries and laughs a lot, and follows me everywhere.  Then came back Ivan, and if you read my older posts, you’ll know who I’m talking about.  He was pleasant enough at first, but then started up with his usual “I want you to die and be a spirit with me” thing, and he would try to get me to hurt myself, which escalated into him trying to get me to kill myself, etc etc.  There was also paranoia that police were after me, and every time I got home from work I was sure they would be there waiting for me.  It didn’t help that the police sometimes park inside the gate at work and so I thought they were after me there too.  I also started feeling like people could read my mind.  Same old same old.  It wasn’t long before people started getting concerned, and I admit it, even I was starting to feel my control slipping away.  I had another near suicide attempt in one of the bad moments – I won’t get into it, but Tiki saved me from a very bad decision.  It was a few days later that I was back in the hospital for the fifth time.

 

I don’t want this post to be incredibly long, even though it already is getting that way, so I’m going to skip over the details about the hospital and all that (I did meet some characters in there, as usual, and we watched the world series as a whole ward so there was an extra sense of camaraderie with all the patients this time.  FYI – I was a one of the minority of people hoping for Houston, and we did it!!).  I can do a whole other post about what it’s like in a psychiatric hospital, the “mental ward” if you will.  It’s interesting, but not for right now.   

What is for right now is the point of why I wanted to write this even though, right now, that is the exact opposite of what I actually feel like doing.  I want to run and hide in Mission Trails behind my house and not talk to anyone ever again, especially if they ask “how do you feel today?”  I don’t want to answer any more questions, I don’t want to tell any more nurses, social workers, psychiatrists, etc about my symptoms, I just want it all to go away.  I went back to read my old posts in this blog, to see what I wrote about because I honestly couldn’t remember, and what I discovered was someone in a good place with their diagnosis and situation.  Someone who had reluctantly accepted their fate and that this was something that needed to be managed on a daily basis through medication and therapy, but things were looking up and it wasn’t so bad. 

Something happened in this last year because it is not where I am today.  Somewhere along the line, I started to feel extreme anger at the situation.  A hatred for mental illness and for myself.  All these recovery stories just made me mad and bitter, and I hated the girl who so openly wrote about her experiences with the spirits and medications and hospitals.  I wanted to un-post that blog and pretend that no one had read it or knew that about me.  I just wanted to be me, without all that attached.  Me, before anyone knew what I dealt with or became involved.  Me before medication.  Me before therapy.  Me as I was growing up, though sometimes a struggle to do it alone, I want to go back to that.  But I know that’s not possible, and that my condition has continually gotten worse as I have gotten older.  And that there is no more hiding it now.  But I still hate it.  And I feel like there is no way out.   Medication which makes you feel dead, or symptoms which have the capability of making that happen for real.  Either way, there is no good option.  No way out of this.  If only I could have the ability to control my own brain which so horrifically betrayed me, or to will all of this away, but I don’t.  And I don’t know how to deal with it.      

THE END: for now

THE END: for now.  But there is really no end to this story

The biggest things I have had to struggle with (aside from spirits, depression, hospitals, etc) is the fact that 1. The medication causes massive weight gain and I put on about 30 pounds over the year, no matter how healthy I tried to eat. It seems to have leveled off now, but seriously, gaining that much weight has affected my confidence and self image.  And 2. I felt like I lost my creative spark.  I used to write blog posts about art.  I used to draw.  I used to create.  I used to get caught up in my fantasy land of rainbow cows and penguins.  This was all lost since starting on the medications.  These medications limit how much dopamine is in your brain and dopamine is thought to be linked to creativity.  I am trying my best to get it back and slowly, slowly, I think more of me returns every day.  I am happy to say that it has been one year since I have experienced any voices and I am starting to want to draw and create again.  I focus on my successes instead of my set-backs.  You don’t have to let mental illness take over.  You can lead a normal life and have a job and a family and good relationships.  Your diagnosis doesn’t define you.  Stay strong.  You are not alone.    

I am very open to discussing all aspects of my journey so if you have questions please ask them.  I am an open book when it comes to this (finally now after hiding it for so long) and I hope to find others who will open up about their personal struggles with mental illness from anxiety to depression and everything else in between.  I still go to a support group through CARE and there is always the chance that symptoms will return.  I just take it one day at a time.  Thanks to all my friends, family and therapists, who have been so amazing and supportive through all this.  I might not be here if it wasn't for your continued support and love.

Thanks for reading.

MORE HOSPITALS

MORE HOSPITALS

Little by little I started feeling a little better, but almost as soon as that happened, it all came back and the medication didn’t seem to be working.  A spirit had entered my brain and I could feel it inside me, burrowing into my brain.  I became obsessed with the subconscious and I turned against my own brain.  How dare it make assumptions about the world around me (mainly brain teasers and optical illusions made me mad).  The only way to fix this was to cut the bad spirit out.  I sliced open my forehead until blood was dripping down my face.  My friend saw this and immediately drove me to the hospital where I was admitted for a second time. 

This time, I was in the same hospital but in a different ward.  This ward was a little better.  It had a common area with a fridge (always stocked with goodies) games, a tv, and coffee/tea bar.  It also had a great patio.  I met some cool girls this time, and we actually made it a little bit fun.  One of the other patients claimed to be a musical savant, so we would listen to his stories about the old days (he was an older gentleman) and about how he did amazing things in his youth.  The recreational therapists would come most days and we would make beaded bracelets or do some other art project.  I now have a drawer full of beaded bracelets thanks to this!  They are kind of awesome actually.

They messed with my medication a little bit more, adding Haldol to the mix.  Haldol is a powerful antipsychotic but it was added at a low dose to supplement the medication I was already on.  I was taken off lithium because it didn’t seem to be helping at all.  While I was hospitalized, I missed my favourite day of the year – pride parade day! I got a visit from a friend later that afternoon bringing me flowers and some fun gay pride swag.  It was pouring with rain that day so I guess if I had to miss a year, this would not be a bad one.  I was in the hospital this time for about a week.  Long enough.  The voices had quieted and I was feeling ok to go home.  It didn’t last long.

I was hospitalized twice more after that, once on a 5150 hold (involuntarily admission to the hospital) with the longest stay being for about two weeks.  All because the spirits wouldn’t leave me alone and cardboard world invaded my mind.  The last time I was in the hospital was in January of 2016 (a WHOLE year ago!).  I spent my birthday there, but thanks to some amazing friends, I felt so loved and happy and they made it a really special day for me.  One friend brought me an entire cake from Extraordinary Desserts called the Moroccan.  It is my favourite of their cakes and they almost never have it available.  It might go down at the best birthday present I have ever gotten.  We had to cut it with a spatula because they don’t allow knives (even plastic ones) in the ward.  #psychhospitalproblems… During the last stay, they also took me off the other medications I was on and just prescribed a higher dose of Haldol.  Along with Lexopro (an antidepressant) I finally felt more stable and functional than I had in over a year.  I started to feel like myself again.  

IOP - Intensive outpatient therapy

IOP-intensive outpatient therapy

After my hospital stay, I was placed on a different medication to see what that would do.  Again it seemed to help at first, but not totally rid me of Alister and the bad things he would say.  I started a new program at CARE called IOP – intensive out patient.  It is a cognitive behavioral therapy based program with time each day for check-ins, therapy exercises, and other activities to help keep people that are having a hard time coping with their conditions.  It ran on Mon/Wed/Fri for 6 hours.I was out of work at this point, using up all my paid vacation and sick time.  My mum came down to stay with me for a little while and was a huge source of strength for me.  This was all pretty hard on her and my family, especially with them being so far away.  So having my mum there was very good for my recovery.  She also finally caved and bought a cell phone so we could communicate wherever and whenever (she now loves her phone, so you are welcome, mum). 

I not only did IOP, but I started going to a support group every week offered through CARE and it was nice because I had started to feel very alone in my experiences.  I benefited a lot from both IOP and the group because I met other people who had conditions like mine and we could share stories.  It was so nice to not feel alone anymore (which is what I hope this blog will do for some people).
  

I had been at IOP for a few months by this point and was doing ok, but I got some of the worst news ever – my insurance wasn’t going to cover my treatment.  Sharp insurance, which is what I had, does not cover UCSD medical group (which is what all my therapy was through).  I had to stop going to IOP and find a new therapist all rather quickly.  It was a huge deal, because I was still very fragile and changing therapists can be a tough thing.  Reluctantly, I started up at a different IOP offered by Sharp.  It was like going to grade two every day.  I could play Wii bowling, color and make collages, do musical therapy (bang on kids instruments) or do aromatherapy where they put drops of oil on your hands that smell so good.  They would give us a snack of cheese and juice each morning and a hot lunch after the program ended for the day around 12:30.  I really felt like I didn’t belong there but it was better than no therapy. The good news is my new one-on-one therapist was amazing and I liked her a lot. I had about a month of that before I had to start coming back to work.  I eased in to it, coming back for just the afternoons after the IOP program ended for the day.  

HOSPITALS: Things got bad

HOSPITALS: Things got bad

One night, I had had enough.  My legs were destroyed from all the cutting (which was hard to hide from my husband – he knew about my struggles, but I still didn’t want him to see the cuts).  Tim was at work and I couldn’t take it anymore.  I found a bottle of old painkillers that had been prescribed for Tim back in Colorado when he had hurt his back.  I was going to eat the entire bottle and then top it off with some alcohol in hopes that I would just drift into an eternal sleep.  I was thinking of nothing or anyone in those moments.  Just relief from bad spirits.  The only thing that saved me from carrying out the plan was my therapist who I had texted right before I started taking pills.  I got in about 6 of them before she called me back.  She told me to throw them away but I couldn’t do it.  She called 911 and an ambulance and police car showed up quickly.  They took the pills away.  They were some of the nicest people I had ever met and were gentle and understanding.  They talked to my therapist on the phone and asked what my diagnosis is – “Schizoaffective Disorder” she told them.  This was the first time that I had heard my diagnosis.  The CARE program is very careful about putting labels on people so since I had never asked, I was never told.  Also, my case was unusual, so I think they had a hard time coming up with a diagnosis. I certainly didn’t fit the stereotypical mold of schizophrenia. 

Anyways, that night I was taken by ambulance to the UCSD hospital emergency room in Hillcrest.  The medication I had ingested was expired so I was hooked up to blood pressure monitors, heart monitors, and other pieces of equipment.  I stayed for a few hours until all my tests came back ok. They talked about hospitalizing me that night, but there were no beds available so with an increased dosage of my medication, I was sent home.  I lasted maybe three more days until I was so depressed and in danger of hurting myself, when my therapist asked if I felt like I needed to go to the hospital, I said yes despite being terrified at what that might mean. 

So for the first time that year, I believe it was February of 2015, I was admitted into a locked ward in a psychiatric hospital.  It wasn’t a very pleasant experience – there was nothing to do.  I colored mandalas, watched tv, played games with some of the other patients, took lots of naps.  They fed us a lot and often.  Dinner was at 4:30 though, something I never got used to.  They check your vital signs CONSTANTLY (like even at at 6:30am while you are still trying to sleep).  The worst part is that they don’t let you have your cell phone.  I felt pretty lost without that.  My roommate was a grumpy old lady who would yell at the nurses about how corrupt the medical system was.  She was always friendly towards me at least.  After 5 days, and at my begging, they discharged me.  I felt great on the ride home.  I was loving seeing the trees, the traffic, the people! 5 days of isolation had me feeling like the most grateful person in the world to be alive now that I was free.

THE BEGINNING OF THERAPY AND MEDICATION: It is real now.

THE BEGINNING OF THERAPY AND MEDICATION: It is real now.  No going back.

At the assessment appointment, they asked a lot of questions: do you hear voices? Have you ever believed yourself to have special powers?  Do you feel like your thoughts are being broadcast to the world?  And many many other standard questions.  It lasted about an hour, which is all my nerves could take.  They suggested a mix of therapy and medication.  I reluctantly agreed to both. My first attempts at therapy were not very good.  I didn’t know how to talk about my problems and sat there awkwardly wishing I was anywhere else.  I started emailing my therapist because it was easier for me to communicate through writing.  I had time to think about what I wanted to say, and when my therapy sessions came around, I had something to discuss.  The psychiatrist started me on low doses of medication for anxiety as well as Risperdal, a common antipsychotic drug that would hopefully help with the spirits.  It seemed to lessen the intensity of the voices, but ultimately didn’t stop them.  My case was unusual in that I had remained so functional despite having voices pretty much constantly throughout my life.  I had graduated high school, completed 5 years of University to get my Bachelors of Science, and had held a normal social life, including a boyfriend.  Speaking of the boyfriend, one thing he said really stuck with me.  I told him about the spirits when I was about 19 (one of two people I actually did tell) and he said “it is scary how you talk about them like they are real”.  To me, they were very real and it was one of the first times I had even considered them to be not real.  You sort of assume everyone has experiences like this.  It wasn’t something I ever told my parents about either so when I did finally bring it up with them, they were very shocked and surprised (but very supportive).  I didn’t want to tell them, but because I had started on medication, I thought it would be good to tell a few of the closest people to me.  More about that later though. 

The spirits were still harassing me.  I had about 3 that mainly hung around:  Ivan, who I already mentioned, was the dominant one.  Little Fish was a little boy, maybe around 4 years old, who didn’t talk much but got scared easily and would tag along wherever I went, and Betha.  Betha was a strong force of good.  She would give me confidence and say “you got this!”  and other motivational sentiments.  She wasn’t around all the time like Ivan, but I didn’t mind her when she was there, even though her voice was distracting.  Ivan still was constantly trying to make me die so I would be a spirit like him.  He convinced me one time that I could strangle myself with a belt, and I tried very hard to make that happen, but it didn’t work.  He was lonely.  The spirits that talked to me were unaware of each other, so I guess spirits live a solitary eternal life. 

At one point, a new spirit showed up.  The medication had not been working so well and I found myself feeling very hopeless, confused, and afraid.  I wasn’t finding enjoyment in life, I was struggling to remain as upbeat as possible, but the truth was that I had entered a deep depression.  This new spirit was bad energy.  He would say over again “I want you to bleed.  I want you to die”.  His name was Alister.  He never really said much more than that.  I was in a very weak state of mind when he showed up.  So weak that the spirits were wearing me down and I started to have serious thoughts of self-harm and suicide.  I was desperate for relief from the voices telling me to die.  I had started taking Lithium as well as the antipsychotic and antianxiety in the hopes that it might help (but it is more geared towards Bipolar and mood stabilization).  At this point, we were trying anything.