Thursday, 24 December 2015

Bug report — context and analytic framework

Severity: Critical

Description: My mood suddenly crashes.

Steps to reproduce: I have absolutely no clue.
Well, that's not entirely true. Through the decades I have been looking for workarounds to this problem some patterns have emerged. It's much more likely to show up if I'm hungry. If I'm tired, or haven't slept well. If I run into frustrations. If I'm picked on, or people poke my insecurities too hard.

So those are (uncomfortable) steps to reproduce I guess?

Actual results: I break down crying, or shout at people, or tense up hard trying not to break stuff around me, or hit inanimate objects until my hand aches, or run away from wherever it is I am right now, or possibly I just go really really quiet and stop interacting with anyone or anything.

Expected results: Not crying over relatively insignificant stimuli. Having a causal path leading up to my emotional reactions. Scale my emotional reactions.

Report log:
2000: Original filing of this behavior as abnormal and requiring support attention. Susanne V
2002: Tagged bipolar mixed state, therapy and lamotrigin stabilized the system, and bug was closed. Spånga youth psychiatric team.
2011: Bug reopened. Problem has existed for many years already, time to do something about it already. Me.
2012: Accepted for work. Edinburgh psychiatry, Scotland.
2012: Dropped due to platform change. Edinburgh psychiatry.
2013: Accepted for work. Liljeholmen psychiatry, Sweden.
2013: Re-tagged mild depression with anxiety. Added SSRI. Liljeholmen psychiatry.
2013: Added Bupropion to fix the additional problems induced by the fix. Liljeholmen psychiatry.
2013: Query about ADHD from me. Response: Irrelevant — you finished school, didn't you? Liljeholmen psychiatry.
2014: Removed Liljeholmen psychiatry from the ticket. Do not assign again. Me.
2014: Accepted for work. Huddinge hospital, Sweden.
2014: Re-tagged bipolar not otherwise specified. Removed SSRI. Huddinge hospital.
2015: Added lamotrigin. Added bupropion. Ran CBT group therapy for bipolar disorder maintenance. Increased lamotrigin. Added SSRI. Removed SSRI. Increased bupropion. Huddinge hospital.
2015: Re-opened ADHD as a possible direction. Me.
2015: Ticket sent to ADHD experts for evaluation. Huddinge hospital.

I find thinking about bug reports instructive when trying to work with my own mental health.
The observed bug is not that difficult to describe: I have less control over my emotions than I should have. I cry over things, I break over things, and it is causing me problems in my daily life.

Far harder is debugging and fixing the problem. Far far harder.
This is no surprise to anyone who has ever worked on software maintenance.
It is harder than in software however — debugging the brain works on hardware nobody understands, software nobody understands, crude debugging tools (whaddayamean inspect current state? good luck with that one!), and crude ways to introduce fixes (let's flood the brain with this signal substance — and see what happens!). The thing you're trying to diagnose changes as you try to diagnose it, and many possible explanations overlap quite a lot in expression, but far less in treatment recommendations.

So for me at least, building a context is a hugely important part of a diagnostic process. Sure, medication, especially if it does Good Things. But if I can understand what the hell is going on in my brain, and re-label my mood swings into something that triggers a bit less personal guilt, that'd probably help me stabilize.

So far, the context I have had is of an affective disorder. It's emotional dysregulation, so let's label it as a disorder of emotional regulation. This means depression, or bipolar, or something similar. I've never fit very well into this box: both mixed state and not otherwise specified are diagnosis-speak for huh, that's weird...
Whacking me with affective medication has worked sometimes, for a bit, or at least changed the flavor of my problems. Sure, I don't suddenly crash out — that ever-present apathy and growing frustration with no longer having any research drive isn't a problem? right?

And if it is bipolar, it means that the way I handle my disorder is by medicating to stabilize, and then doing behavioral adaptations: when I notice my mood going in one direction, pull out concrete actions that pull it in another direction. when I notice my thoughts getting stuck on one thing or one interpretation, seek out alternative interpretations and prepare ways to dislodge myself from when I get stuck on something.
But since I don't fit the box well, these remedies have been somewhat underwhelming so far.

On the other hand, if my problems at their roots are neuropsychiatric: ADHD or autism, then there is a completely different interpretation to my reactions. Maybe I start crying not because I have an anxiety attack (some things fit, not all), not because I am in a depressed episode (a few things fit, most don't), not because I am in a dysphoric hypomania (seldom really seems to fit), but because I have sensory overload? or because I have built up massive guilt complexes from always feeling like I am performing under my full potential? or because I am Just Not Wired for handling frustration?

These last few months I have started reading up on ADHD, and I have started watching my behavior with somewhat different goggles. What are my sensory inputs right around when I crash out? was there a reason I might be exhausted when I take a nose-dive? was there some kind of frustration around? maybe even changes of plans that I wasn't expecting?

One of the big things I am seeking when I am seeking out an ADHD evaluation right now is a new set of possible treatment options.
Another one is to gain tools to push back against my self-loathing. If sensory overload is a thing for me, and inability to handle frustration gracefully, and decreased ability to handle changes in plans, then there are concrete things there I could manage. And maybe tracking my sensory load is not only easier, but going to be more effective than trying to Increase My Sensory Impressions when I am feeling sad and overwhelmed?
And maybe, recognizing that many people with ADHD have their emotional gain turned to 11 means I can stop freaking out when I suddenly get a wash of emotion. Sure, my emotions are stronger than everybody else's — but maybe I can stop at the point of feeling a strong emotion, instead of spiraling down into a panic rat race of despair over having the emotional reaction in the first place.
Maybe, just maybe, I can watch my emotions show up, let them take some place, and then let them go. That seems like an amazing thing other people apparently do.
And if I get more emotional control through tracking my sensory load, and by disengaging from uncontrolled stimuli when I'm starting to feel the tension build, rather than after I go to pieces, that'd go a faaaar way to help me work more satisfactorily.

This change of perspective changes absolutely everything.
The symptoms are the same, but the potential fixes are different.
The symptoms are the same, but if it's sensory overload, not lack of emotional control, then I'm not lazy, I'm just incautious.


  1. Have you heard of Complex PTSD? It can appear like ADHD or bipolar. Affect dis regulation is part of it.

    1. Sounds like something I should take a look at. Thank you!


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