Assisted outpatient treatment (AOT), also known as outpatient commitment (OPC), is a controversial program that you may know by the name “Laura’s Law” in California or “Kendra’s Law” in New York. These programs are designed to facilitate court-ordered outpatient treatment in a very small segment of the mentally ill population. In other words, they force mental health treatment onto certain people. But does forcing people into mental illness treatment actually help anyone? According to the Office of Justice Programs, yes, it does.

For a long time I didn’t wear sandals. No, not because I don’t like them or because my toes have an aversion to open air but because of the scars on my ankles – that’s where I used to cut. My ankles looked like there were pink, wriggly worms embedded in them. And I was scared that everyone would see them and know what happened, know what I did. I figured people would take one look at me (zero in on my ankles for some reason) and then judge me as being a freak and a lunatic and I would be ostracized from normal, human interaction. That was a bit of an overreaction on my part driven by the shame of self-harming in the first place. I’ve gotten over it.

Last week, I wrote a post about stress possibly leading to self-harm. Here, I discuss the fact that really, it's the anxiety that lives between the stress and the self-harm of which you may want to take note.

People self-harm for many different reasons and self-harm in and of itself is not a symptom of bipolar disorder. But like many people with extreme pain in their lives, many people with bipolar disorder do self-harm. I have been one of them. And as sure as I’m sitting here I can tell you, stress precipitated most of the self-harm.

Last week, I wrote a post stating that “Natasha Tracy” is my nom de plume – it is my writing name and not my legal name. Some people showed concern over this and felt it was inconsistent with my convictions regarding stigma and standing up for one’s rights. I would now like to respond to these concerns regarding my own choices, writing and reasons.

Natasha Tracy is not, in fact, my real name. It’s a nom de plume. Writers have a long history of writing under pen names for a whole variety of reasons but one of them has always been judgement. People will judge you, as a person, by what you write. Write erotica, for example, and get yourself a reputation as a slut. And as a mental health writer, I face similar stigma. True, people aren’t likely to make inferences about my sexual nature (although it has happened) but they will make judgements about me as a person and certainly as an employee. Because no matter how much I write about stigma and no matter how open people appear to be, a person with a mental illness is simply always assumed to be unequal to someone without a mental illness. Their point of view is always considered to be tainted by their illness. Their thoughts are never considered to be their own.

I don’t remember most Christmases; they tend to blur together in a sea of turkey, denial and wrapping paper. But the Christmas of 1998 was different. That Christmas was the one just before I began medication. That was the one I spent lying on the couch with bandaged arms. Looking back 1998 should have been a good year for me. I had completed an 8-month work term for my university degree, I had some money for the first time in a long time and I went backpacking across Europe. But unfortunately, 1998 was the year that bipolar decided to attack full-force. I spent the end of 1998 slicing and dicing and sobbing and begging for mercy. From what, exactly, I have never been able to say, but from whatever was causing the pain whatever made it impossible to move from my mother’s couch as the activities of Christmas went on around me. But in spite of this I had no intention of seeing a doctor and I most especially had no intention of seeing a psychiatrist. Those people were nothing but pill-pushers, nothing but drug dealers with letters after their name. And everyone knew that depression wasn’t a real disease and that anyone with real strength of character could overcome mental anguish on their own – not with the crutch of pharmaceuticals.

This was a question recently asked of me, “can people with a mental illness, like bipolar disorder, live alone?” The answer to me was obvious – yes! Absolutely. Of course a person, even with a serious mental illness, can live alone. But then I thought about it for a moment and maybe it’s not that simple. Maybe there are some tools that facilitate living on your own.

I have a friend with bipolar disorder. A nice girl. Fun. Charming. Intelligent. She’s lovely really. We email a lot and sometimes she makes me LOL. But seeing her is very difficult. She has a lot of trouble sticking to any plans we might make. This is because she can never predict her mood. Even if she feels like going out the moment we make the plans, even if it seems like a fun idea then, when the time actually comes she may not feel like leaving the house. I know how she feels. Ideas that seem good on a Wednesday, when they actually arrive on a Friday suddenly seem like the biggest imposition in the world and seem as impossible as lifting a mountain. So how does one make plans if one can never anticipate one’s mood?

I have said it again and again, what goes up, must come down and it usually does so with a resounding thud. A crater. An impact that puts you lower in the ground than before you started. In other words, a depression. And that’s the problem with hypomania. For many people the hypomania itself really isn’t a huge deal (although for some hypomania in and of itself is damaging) but the period afterwards is devastating. It’s the hypomania hangover.