Bipolar 2 From Inside and Out

All Mixed Up

Leigh-Prather/Adobestock.com

As I mentioned a few posts ago, my psychiatrist and I are working on a medication change that will, I hope, pull me out of bipolar depression. The medication that we changed was a mood-leveler, which sounds like a productive way to start.

We’re increasing the dose, which means it shouldn’t take the time it would for the old drug to “wash out” of my bloodstream (and/or brain) while we’re waiting for the new one to kick in. I’ve been that route before, and it’s miserable.

While I haven’t noticed my moods becoming exactly stable since the change, I have noticed certain effects. I am able to get through the minimum of what I need to do each day, though nothing more. And I have noticed that I am getting irritable. This does not happen so much when I’m depressed. When I’m depressed, I don’t care enough about anything to be irritable.

In fact, irritability is one of the ways that hypomania manifests for me, before I get to the euphoria/super-productive/reckless spending stage. I get snappy with my husband about all his annoying habits, like never giving me a straight answer to a simple question. (What are you watching? A movie. What did you get at the store? Food.) I think he thinks he’s being funny, but I find it frustrating. Not that I don’t have annoying habits too, especially when I’ve either depressed or irritable.

So, I guess in one way, the irritability is a good sign. It doesn’t mean I have level moods yet, but it seems to mean that I’m not totally stuck in the depression. (I explained to my husband what was happening with me, and he seems to understand more. Though it remains to be seen if he’ll answer simple questions informatively.)

I think what I’m experiencing is a phenomenon know as mixed states. If to be depressed is to care about nothing and mania is to care about everything, a mixed state is some hellish combination of the two. Imagine being immobilized and jumpy all at the same time. That’s what it’s like, paradox that it is.

I haven’t had mixed states too often in my life, though I have had emotions that swerve drastically from happy to depressed in an instant (which is an extreme version, I think, of what’s known as ultra-rapid cycling). This is something different, though.

Now, I use up all my spoons early in the day and nap, or I stay up but go to bed at around 8:00. Ordinarily, if I went to bed that early, I’d read for a couple of hours, but these days half an hour or 45 minutes is it, tops.

Still, I think (or hope) that this mixed state of affairs is a step along the way to level moods that are higher than the numbness and not-caring of depression. It’s not comfortable to go through, but then neither is depression or mania, even hypomania.

It’s been about six weeks since the change in my medication. Within another four to six weeks, it will likely become apparent whether the change, once set in motion, will have an outcome I can live with. Until then, I need to spend my spoons as wisely as I can and try to remember not to snap at my husband, even when he’s being annoying.

Back in the day, all my friends were doing transcendental meditation. They claimed various effects from it, including lower blood pressure (which I believed) and levitation (which I didn’t). At the martial arts dojo, the sensei did lead a guided meditation which left me feeling energized and ready to train, so I think you would call that a success. Nowadays, I can’t get into a lotus position or even sit on the floor tailor-fashion, which is to say I might make it down, but I can’t get back up. Never mind the fancy kicks and rolls we used to do.

Meditation has come a long way since then, though it is rapidly being overtaken by mindfulness. My psychotherapist recently suggested that I try a mindfulness exercise which could be found on my computer. It took the form of a guided meditation, with the leader noted that the mind would wander, but suggested several ways for me to return my attention to my breath and my surroundings. One distinct advantage was that I could perform it sitting safely in my desk chair. I found it interesting, but not something that I would likely try again. My mind is just too restless, especially when I’m manic. (Perhaps if I tried it regularly, it might have a positive effect on that.) 

You may ask, as I have, what the difference between meditation and mindfulness is. 

In Transcendental Meditation, one of the most popular forms, the practitioner concentrates on a word or syllable that occupies the mind and tries to “transcend the process of thought.”  On the other hand, positivePsychology describes mindfulness as “active awareness of the mind as it wanders and repeatedly refocusing the awareness on the present moment.” The aim of mindfulness,  Rogers Behavioral Health says, is not quieting the mind, but aiming to focus “the attention to the present moment, without judgment.”

According to positivePsychology, mindfulness and meditation are “interrelated,” but “not the same.” The article does note that there is a practice called “Mindful Meditation” that combines the two. Mindful, in describing the intersection, says that mindfulness meditation teaches a person “to pay attention to the breath as it goes in and out, and notice when the mind wanders from this task.”

In essence, the goal seems to be disconnecting the mind from thought, though whether the mind is otherwise occupied differs from practice to practice.

Either one is considered suitable as an adjunct to psychotherapy, depending on whether a person’s goals are relaxation or “bringing the mind back to the present moment.” Meditation is thought to be useful in treating PTSD, while mindfulness has been used in treating “obsessive-compulsive disorder, depression,” in addition to post-traumatic stress disorder. Training helps people to become more aware of their thoughts, feelings, and body sensations so that instead of being overwhelmed by them, they’re better able to manage them. The Mental Health Foundation goes even further, claiming that the practice can give one  “more insight into emotions, boost attention and concentration, and improve relationships.”

The journal Mindfulness specifically reports on the usefulness of mindfulness in elementary schools and high schools. This study of studies reports that most of the positive aspects of mindfulness training occurred in high school students and that the effectiveness depended largely on whether the exercises were lead by someone from within the school or “an outside facilitator,” though the article abstract was mute on which was more effective.

NIMH, on the other hand, talks about mindfulness techniques in psychological settings. Specifically, it addresses “mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT),” noting that mindfulness training “should be accessible to everyone with a long-term physical health condition and recurrent depression.”

My own experience is that meditation, lead by an expert in the subject matter to concentrate on, rather than a simple syllable, can indeed be helpful in focusing the mind, rather than merely transcending thoughts. Perhaps the version involving transcending thoughts is more beneficial for phenomena such as relieving stress, lowering blood pressure, and calming agitation is a better use for this style of meditation. Mindfulness, on the other hand, I found to be interesting as a way to corral random thoughts, which I often suffer from, and I can see this practice being useful in daily life. 

I fear, however, that the mindfulness trend that appears to be sweeping the world means many different things to different people, and the benefits of it will depend on what benefits one expects to receive. Any more “mindfulness” is a word that has been taken over by the general population and in particular the business community. It can mean simply “mind” as in “Be mindful of your manners” or “be very aware” or “pay close attention to” as in “Be mindful of how much is spent on travel and entertainment.” Perhaps some agreement on what mindfulness is and what the practice consists of will prove to make it more useful in psychiatric and other settings. 

In that regard, both meditation and mindfulness practices are worth exploring further.

 

By Alice / adobestock.com

I will make a confession: I have never used distance therapy, except for when I couldn’t drive to my therapist’s office, my husband wasn’t available to drive me there, or when I had the last-minute I-just-can’t-go-today feelings or I’m having-a-crisis feelings. This was in the days before teleconferencing, texting, and other long-distance forms of therapy, so occasionally my therapist would agree to do a telephone session, which I appreciated greatly. In general, they didn’t last as long as the standard psychotherapy 50-minute hour, but at times they were lifesavers.

Now, when everything seems to be online, and especially during pandemic lockdown, quarantine, or simply fears of going outside, tele-psychotherapy seems to be becoming a thing. Many services are now available via the internet, smartphones, and whatever way you pursue your online life.

I’ve been looking at these services, not because I need one now, but because I want to know what’s available in case I ever should. The APA (American Psychological Association) provides a lot of helpful information on the subject. Their site has provided a list of pluses and minuses regarding telehealth for psychology. They note: “With the current research and with the current technology, mobile apps and text messaging are best used as complementary to in-person psychotherapy…Research does show that some technological tools can help when used in conjunction with in-office therapy,” though “There are cases in which Web-conferencing or therapy via telephone does seem to be a viable option on its own for some people.”

Inc.com provides a helpful list of the pros and cons of online therapy. Some positive aspects are that:

  • People in rural areas or those with transportation difficulties may have easier access.
  • Most online therapy services cost less than face-to-face treatment.
  • Scheduling is more convenient for many people.
  • Individuals with anxiety, especially social anxiety, are more likely to reach out to an online therapist.

among the negatives are:

  • Without being able to interact face-to-face, therapists miss out on body language and other cues that can help them arrive at an appropriate diagnosis.
  • Technological issues can become a barrier. Dropped calls, frozen videos, and trouble accessing chats aren’t conducive to treatment.
  • Some people who advertise themselves as online therapists might not be licensed mental health treatment providers.

Despite the concerns, research consistently shows that online treatment can be very effective for many mental health issues. Here are the results of a few studies:

  • 2014 study published in the Journal of Affective Disorders found that online treatment was just as effective as face-to-face treatment for depression.
  • 2018 study published in the Journal of Psychological Disorders found that online cognitive behavioral therapy is, “effective, acceptable and practical health care.” The study found the online cognitive behavioral therapy was equally as effective as face-to-face treatment for major depression, panic disorder, social anxiety disorder, and generalized anxiety disorder.
  • 2014 study published in Behaviour Research and Therapy found that online cognitive behavioral therapy was effective in treating anxiety disorders. Treatment was cost-effective and the positive improvements were sustained at the one-year follow-up.
  • A recent review of studies published in the journal World Psychiatry compared people who received CBT treatment online with those who received it in person.  The two settings were shown to be equally effective.

One possible pitfall, warns APA, is that “online therapy or web therapy services are often not covered or reimbursable by most insurance providers. If you plan to be reimbursed, check with your insurance company first. Otherwise, prepare to pay for the full cost yourself.” The services I explored charge about $35 to $80 per week for unlimited messaging and one live session per week. MDLive provides a psychiatrist at $284 for the first visit and $108 afterward. (They have lower rates for seeing a therapist rather than a psychiatrist, and do accept insurance.)

Business Insider, in its article on the subject, dealt specifically with a service infelicitously known as Woebot. Unlike the other services, Woebot is a “chatbot” that substitutes artificial intelligence and natural language processing for a real, live therapist. It uses cognitive behavioral therapy. Their website claims that Woebot “is the delivery mechanism for a suite of clinically-validated therapy programs that address many of today’s mental health challenges, from generalized anxiety and depression to specific conditions like postpartum depression, adult and adolescent depression, and substance abuse.” Like a non-directive therapist, it asks probing questions and responds to questions and answers from the user. For now, it is free to users, though they seem to be exploring a paying model.

Other telehealth counseling services include:

Amwell

Betterhelp

Brightside (depression and anxiety, not bipolar or mania)

Online-Therapy.com

ReGain (couples therapy)

Talkspace

teencounseling (will consult with parents)

If you decide to try online therapy, it’s best to compare services and determine what services they offer, at what price, and what the credentials of their therapists are. If you have already tried it, I would be glad to know the results. Feel free to comment.

 

 

The Journey to Proper Meds

By areeya_ann / adobestock.com

This week when I went to my four-times-a-year med check, I told my psychiatrist that I thought I needed a change in medication. The previous time I saw him I had expressed concerns over assorted Life Stuff that was making me extremely anxious. Given what was going on in my life at the time, the anxiety was understandable.

Since then my anxiety has lessened somewhat, now coming out mostly as irritability and difficulty sleeping. And my depression now makes me feel like I have a low-grade fever – logy, listless, exhausted (which is not helped by the sleep problems) – plus the usual depressive numbness, lack of holiday cheer, and all the rest.

My psychiatrist listened to my symptoms, then discussed my meds with me. There were only two, both mood levelers, that he would recommend increasing. I chose the one that had had the most dramatic effect on me when I started taking it. So he increased the dosage from 200 mg. to 300 mg. We’ll see how that works out. I’m to call him before my next med check if I need to.

I’m used to changes in medications. It took a long, trying – even painful – time for my previous psychiatrist and me to work out the cocktail of drugs that would alleviate my seemingly treatment-resistant bipolar disorder. We tried various antidepressants, anti-anxiety agents, anti-seizure meds, antipsychotics, mood levelers, and I-don’t-remember-what-else. At last, when we were about to give up and try ECT, one of the drugs worked. It took some more tinkering before we got the dosages right, but for years now, I’ve been on basically the same “cocktail” of drugs.

Psychiatric Times, in an article on switching antidepressant medications (most of the literature seems to focus on antidepressants), reports that approximately half of all patients fail to achieve an adequate response from their first antidepressant medication trial. High treatment failure rates make it critical for prescribers to know how to safely and effectively switch antidepressants to ensure patient-treatment targets are met.” Other publications put the figure at nine percent, one-third or two-thirds. Whichever is correct, it’s a substantial number.

One method of switching medication is simply called “the switch.” The patient goes off one drug and onto the other. But there are problems with that, including drug interactions between the old medication and the new one.

The technique most recommended is the one that my previous psychiatrist used with me, which is known as “cross-tapering” – tapering down on the first drug and then ramping up on the second. A “wash-out period” when no drug is given allows time for the first med to clear the body before the second is given. This is promoted as the safest method.

I can testify that it is also the slowest and most miserable. Going off one drug, being basically unmedicated while you wait for the second drug to ramp up, and then possibly going through the whole process again when the second drug doesn’t work either (or has side effects you can’t tolerate) is brutal. I went through the process more than once, and it was hell. Basically, it took me back to full-strength depression during the wash-out period and minimal to no effect as the new drug being tried ramped up.

However, eventually, we found a drug that made a huge difference and that, in conjunction with my other medications, allowed me to function almost normally. Close enough for jazz, as they say. The recent adjustment in dosage does not appear to be having much of an effect yet, but I didn’t expect it to. Pretty soon, relatively, I’ll know. And if it doesn’t help – or if it induces side effects – I still have my psychiatrist’s phone number.

References

https://www.psychiatrictimes.com/view/strategies-and-solutions-switching-antidepressant-medications 

https://www.uptodate.com/contents/switching-antidepressant-medications-in-adults

https://www.healthline.com/health/mdd/switching-antidepressants

by Chinnapong / adobestock.com

I missed out on the heyday of the ADA. People didn’t become as conscious of accommodating people with disabilities until much later. And even then, the most common accommodation was wheelchair ramps. But there are some workplace adjustments or accommodations I wish I had available to me, back when I worked in an office.

According to the Americans with Disabilities Act (ADA), persons with disabilities are entitled to accommodations to make it possible for them to work. Most of us think about certain kinds of lighting, closed captions, or specialized chairs. But what about when you have an invisible disability?

The ADA definition of a disability is one that impairs an individual’s ability to – among other “major life activities” – learn, read, concentrate, think, communicate, and work. Certainly, a number of psychological or psychiatric conditions qualify as producing trouble in these areas. In my case, my bipolar disorder made it difficult to do many of those in your standard office work environment.

But would the ADA have made accommodations available to me? The ADA does include some mental illnesses in its list of disabilities. Examples of mental disabilities commonly considered under the ADA are:

  • Major depressive disorder
  • Bipolar disorder
  • Post-traumatic stress disorder
  • Obsessive-compulsive disorder
  • Schizophrenia

Examples of accommodations or work adjustments for those with psychological disabilities include, among others:

  • Flexible Workplace – Telecommuting and/or working from home.
  • Scheduling – Part-time work hours, job sharing, adjustments in the start or end of work hours, compensation time and/or “make up” of missed time.
  • Leave – Sick leave for reasons related to mental health, flexible use of vacation time, additional unpaid or administrative leave for treatment or recovery, leaves of absence and/or use of occasional leave (a few hours at a time) for therapy and other related appointments.
  • Breaks – Breaks according to individual needs rather than a fixed schedule, more frequent breaks and/or greater flexibility in scheduling breaks, provision of backup coverage during breaks, and telephone breaks during work hours to call professionals and others needed for support.

Of course, in order to receive accommodations or adjustments, it’s necessary to reveal to someone – at least your boss or maybe the HR department – that you have a psychological or psychiatric disorder.

My own experience of needing accommodations at work was not great. In the job I held the longest, I only mentioned my depression (as it was then diagnosed), to my immediate supervisor. He was sympathetic, but the work environment was not exactly conducive to my needs.

One of the things that I could have used in dealing with the anxiety that went along with my depression was privacy. At first, that was not even possible, since my entire department was located in a cube farm, where no one had any real privacy. Even the fact that I was an editor and needed to concentrate on my work did not win me a private space.

Later, when we moved to an office that had actual offices, I snagged one with a door. The only problem was that I was not allowed to close the door, or at least looked askance at when I did.

An ideal situation for me (aside from being allowed to close my door) would have been permission to work from home. There was one person at this office who had this privilege, but it was never considered for me. Admittedly, this was very much pre-pandemic, but most of my work was done on a computer, and I had one at home that was compatible with the office computers. It wouldn’t even have been necessary for the company to supply me with one.

Another accommodation that would have helped lots would have been a hotel room to myself at business conventions, which would have allowed me time and space to decompress after a long day of being “on,” meeting and greeting, and being sociable and respectable. Unfortunately, that was a privilege reserved for the men. (As I understood it, the salesmen were booked into double rooms as well, but winked at when they rebooked them into singles.) This may have nominally been due to my sex rather than my mental condition, but not having a solitary retreat from the clamor of a convention definitely had a deleterious effect.

After 17 years at that job, I was let go, most likely because I was considered “unreliable.” At the next office where I landed, I had a boss who understood bipolar disorder (as I was then diagnosed) and who was satisfied with my work.  Never a bad evaluation – until that boss left. “I’m going to miss you,” I said. “I know you will,” she replied.

I realized what she meant when I revealed to my new boss that  I had bipolar disorder. “What does that mean?” she asked. Taken aback, the only reply I could think of was, “Sometimes I have good days and sometimes I have bad days.”  It wasn’t a great description of my condition and set me up for problems. After one year of my mother’s health and my psychiatrist appointments requiring me to miss work, and my missing work in winter owing to living at the bottom of a snowy, icy hill, I received my first bad evaluation. Nothing about my performance had actually changed since my work with the first boss. I could have easily worked from home and occasionally was permitted to, but my work was dubbed sub-par once I did.

(Not that it’s a big thing, but I would also have appreciated being able to take a “brain break” such as doing a crossword puzzle, instead of a cigarette break, since I don’t smoke. And not being asked work questions when I was on the toilet.)

After that, I went freelance, worked at home nearly all the time, and was only required to attend a meeting at an office once or twice a year. I have worked that way since and it suits me. It’s only now that I’ve become my own boss that I’ve been able to get what I really need when it comes to work.

 

References

https://www.eeoc.gov/statutes/americans-disabilities-act-amendments-act-2008#:~:text=The%20Act%20emphasizes%20that%20the,shall%20not%20require%20extensive%20analysis.

https://www.sfglife.com/blog/top-10-causes-disabilities-us-and-why-you-need-disability-insurance/

https://adata.org/factsheet/health

https://www.dol.gov/agencies/odep/program-areas/mental-health/maximizing-productivity-accommodations-for-employees-with-psychiatric-disabilities

https://www.shrm.org/resourcesandtools/tools-and-samples/hr-qa/pages/cms_011495.aspx

https://www.ada.gov/pubs/adastatute08.htm#12102

photo from the author’s collection

 As a child and as a teenager, I was a Girl Scout. We hiked. We camped. We did all sorts of nature-related crafts. We ate wild plants. Well into my 20s, I was an outdoorsy-type person, hiking on the Appalachian Trail, walking to all my classes through the leafy green environs of my college campus, even trudging contentedly through the copious snowfall. One year I lived in a log cabin on a hilltop so far from civilization that you had to go to town to pick up your mail.

All the while, I had bipolar disorder, and it was relentless, I experienced the inevitable mood swings, the crashing lows, the tempestuous highs, the confusing mixed states. 

Now, everywhere you turn, there are articles and memes touting how time spent in nature is good for various psychiatric conditions. When you look more closely, though, the studies often refer to simply alleviating bad moods or improving cardiovascular health. Very few of them seem to apply to actual mental illnesses. Perhaps this is to be expected, since improvements in emotions or mental health are largely self-reported or tracked by means of a survey. It’s hard to quantify mental health. But let’s take a look at some of the studies anyway.

Harvard Men’s Health Watch published an article called “Sour Mood Getting You Down? Get Back to Nature.” The subtitle on the piece read, “Research suggests that mood disorders can be lifted by spending more time outdoors.” Then the article went on to suggest that “ecotherapy” shows “a strong connection between time spent in nature and reduced stress, anxiety, and depression.” 

The subtitle suggests that the outdoors has an effect on alleviating mood disorders. The body of the article, though, stresses alleviating unpleasant moods in general, not primarily what psychiatrists would class as mood disorders. The article cited a 2014 study saying that “people who had recently experienced stressful life events like a serious illness, death of a loved one, or unemployment had the greatest mental boost from a group nature outing.” Stressful and sad events, certainly, but not mood disorders such as PTSD, clinical depression, or bipolar disorder.

The article also cites a report published online March 27, 2017, by Scientific Reports, which suggests that “listening to natural sounds caused the listeners’ brain connectivity to reflect an outward-directed focus of attention, a process that occurs during wakeful rest periods like daydreaming. Listening to artificial sounds created an inward-directed focus, which occurs during states of anxiety, post-traumatic stress disorder, and depression.” It does mention psychiatric disorders, but it says only that inward-directed focus occurs during these states, not that inward-directed focus causes them.

Greater Good published an article that claims, among other things, that “scientists are beginning to find evidence that being in nature has a profound impact on our brains and our behavior, helping us to reduce anxiety, brooding, and stress, and increase our attention capacity, creativity, and our ability to connect with other people.” Again, this says nothing about actual psychiatric disorders.

The article also cited a Japanese study: “Results showed that those who walked in forests had significantly lower heart rates and higher heart rate variability (indicating more relaxation and less stress), and reported better moods and less anxiety, than those who walked in urban settings.” The researchers concluded that there’s something about being in nature that had a beneficial effect on stress reduction, above and beyond what exercise alone might have produced.

This, of course, does not apply to those in urban settings who do not have much access to forests or sometimes even parks. And the abstract of the Japanese study says, “Despite increasing attention toward forest therapy as an alternative medicine, very little evidence continues to be available on its therapeutic effects. Therefore, this study was focused on elucidating the health benefits of forest walking on cardiovascular reactivity.” It doesn’t really deliver what the headline offers: “How nature makes you kinder, happier, more creative.” Good heart health is, of course, a good thing, but to extrapolate that to mental health benefits is quite a stretch.

The UK’s Mind.org does offer a link between ecotherapy and mental health in one instance, at least: “Being outside in natural light can … be helpful if you experience seasonal affective disorder (SAD), a type of depression that affects people during particular seasons or times of year.” This article also acknowledges that there are “other options for treatment and support – different things work for different people….You might do an ecotherapy programme on its own, or alongside other treatments such as talking therapies, arts and creative therapies and/or medication. Some ecotherapy sessions follow a set structure, and incorporate types of talking therapy, such as cognitive behavioural therapy (CBT). People in the group may or may not have experience of mental health problems, but the main focus is usually working together on the shared activity.” This at least sounds both more scientific and more likely to produce results.

If a walk in a natural setting does you good and alleviates your symptoms of mental illness, then by all means, make it part of your routine (or do it as often as you can manage). My bipolar depressions, however, are so debilitating that I am unable to plan, much less embark on, a walk in nature, even as far as the mailbox. Bringing nature indoors is, of course, an alternative. But the little plant pictured here, which needs two ounces of water once a month, is all I can really handle.

Resources

https://www.health.harvard.edu/mind-and-mood/sour-mood-getting-you-down-get-back-to-nature

https://greatergood.berkeley.edu/article/item/how_nature_makes_you_kinder_happier_more_creative

https://www.hindawi.com/journals/ecam/2014/834360/

https://www.mind.org.uk/information-support/tips-for-everyday-living/nature-and-mental-health/how-nature-benefits-mental-health/

by sosiukin via adobestock.com

Dear Me:

You’re 13 years old now, and there are a few things you should know.

You have bipolar disorder. No one knows this, not even you. But a lot of people notice that you act “weird” at times. You have decided to embrace your weirdness, which is fine, but what you really need is psychological help. And medication.

Don’t pass up any chance to get that help. Your high school will recommend to your parents that you get counseling. When your parents leave the choice up to you, take it. It will not go on your permanent record, and you will still get into a college. A very good college, in fact.

I know that at times you sit alone and cry. Other times you laugh at things no one else finds funny. This is not just “weirdness.” This is a mood disorder, called bipolar disorder, type 2. Your mood swings will make it difficult for you to make and keep friends. Keep trying. The friends you will find are worth it and will stand by you when you really need them. You will not be alone in dealing with this.

Your choice to go to college out of state will be a good one. There you will have a variety of experiences that will make you grow in unexpected ways. Your mood disorder will go to college with you, though. Leaving Ohio will not mean you will leave bipolar disorder behind. You will still feel the mood swings, and most of them will be depression.

It’s a good idea to take that year off between freshman and sophomore year. I know it will feel scary, but at that point you will be in no shape to carry on with academics. Instead, you will get a job which, while not great, will introduce you to more new people and new ways of life. At least one of those people will stick with you till you are old and gray.

Returning to school will be a good decision. Your parents will support you in that decision. They won’t object to your year off, because they know you will go back. It still won’t be easy, but you will have a core group of friends that accept you, even though you are different from them.

Your bipolar disorder will follow you back to college. It will make you miss some opportunities and choose others that will not be good for your mental health. You will be unhappy most of the time, but you will find that music helps you through it.

Try not to self-harm. I know you will feel numb and want to feel something else, but cutting yourself is a bad decision and will not help. You will carry those scars forever.

When you meet Rex, though, you will be encountering a problem too big for you to handle, and the relationship will leave you scarred as well. It would be best if you were to steer clear of him altogether. But then again, you will find some true friends in his circle, and it would be a shame to miss them. Try your best to hold yourself together, remember what I said about self-harm, and don’t give up on who you are. You are not your disorder, and you will get through this, despite everything.

I know you never gave a thought to marrying, but you will meet a man and in a few years you will marry him. This, I assure you, is a good decision. He will stick by you no matter what and help you find help.

Going into the building that says “South Community Mental Health” will be a good decision. Whatever you will be feeling at this point – most likely misery – it’s not mentally healthy. This will be the place where you will start to climb out of the hole you have found yourself in.

At last, a doctor will tell you that you have bipolar disorder – most often depression, but also anxiety. He will work with you to find a combination of medications that will help you. When that happens, you will become reacquainted with your brain and relearn how to function in the world at large. Your brain will function in a new way, one with fewer out-of-control feelings. You will experience life more fully and be glad of your new outlook.

It won’t be quick, and it won’t be easy, but you will have therapists, and friends, and work, and love, all of which will help see you through. You will have bipolar disorder all your life, but it will not be your life, though it seems that way now.

Reach out for help whenever and wherever you find it. Cherish your friends. Keep trying, even when you want to give up. Better times are on the way.

I promise.

Love, me (older and maybe wiser)

Image by Vadim Gushva via adobestock.com

Once upon a time, I lived with a man who, I later realized, was a gaslighter. (This was in the time before gaslighting became trendy and well-known.) For a while after I left, I had no notion that I had any harsh feelings towards him. It was only later, after I had been away for a while, that I realized what my buried feelings were and what damage he had done. The experience was responsible for parts of who I am today, including my strength and resilience.

For a time, though, right after my deeper feelings began surfacing, I realized that I had been psychologically controlled. I began to read up on the phenomenon. Some of the subjects I devoured were accounts of and theory of domestic physical and psychological abuse, mind control, and cults. They fascinated me – how the human mind and spirit could be so affected by another person or persons that they acted in irrational ways, defended their abusers, changed their personalities, and gave up their lives, either figuratively or literally. I don’t mean to compare my experience to the suffering that the people I read about have gone through, or to the suffering that still exists. All that I knew was that I had been manipulated, and was desperate to find out how, if not why.

I started with the easiest subject to find information about – domestic abuse. I will say that my gaslighter never harmed me physically and only once said something that could be taken as a violent thought towards me. But I learned, particularly, about intermittent reinforcement. This happens when the abuser switches between telling the victim that he loves her and she is wonderful, and that she is stupid or ugly or otherwise worthy of abuse. These mixed signals keep the victim coming back, on the theory that sometimes the person is so nice and loving. “It must be that I make him mad without meaning to,” she thinks.  Thus, she is hooked and less likely to leave.

My gaslighter also used intermittent reinforcement and mixed signals to keep me hooked. I stayed much longer than was good for my mental health.

Learning about mind control – “brainwashing,” kidnapping, and so forth, gave me little insight into my own situation, except that some of the principles were to isolate the person being controlled, to control the environment such as when the person slept or ate, and to be that person’s only source of information or reality. I had been relatively isolated physically, had little control over schedules, and, while TV news was available, it was always filtered through the gaslighter’s sensibilities and opinions. Again, I am not comparing my suffering to that of other people. I don’t believe, really, that suffering can or should be compared.

Learning about cults took me even farther from my own experience, but I was fascinated by it nonetheless. I soaked up information about Jim Jones and Jonestown, Heaven’s Gate, Scientology, and others. Especially interesting to me were stories of people who had escaped from cults. (One of my Facebook friends escaped from a religious cult, which took advantage of her PTSD and bipolar disorder to ensnare her. She supports others who have been victimized by cults and spreads information on cults and the tactics they use.) All I can say is that leaders of cults are usually charismatic, often reject societal sexual norms, and mentally coerce their followers to isolate from family and to finance the cult leader’s lifestyle.

Gaslighting, which I have written about many times (https://wp.me/p4e9Hv-pm, https://wp.me/p4e9Hv-C2, https://wp.me/p4e9Hv-Ir, https://wp.me/p4e9Hv-Cu) most resembles domestic abuse, though usually without the physical violence. It uses the tactics of intermittent reinforcement, isolation, verbal abuse, cults, and mixed signals to convince the victim that her perceptions of reality are invalid – in extreme cases, that she is going insane.

All of these forms of abuse do harm to their victims, in varying degrees. I was lucky to be able to leave my gaslighter when and how I did, and I will forever be grateful to the people who have helped me heal from the experience.

If you are in any of these situations – domestic violence, emotional abuse such as gaslighting, or being victimized by a cult, the best advice is: Get out now. Leave while you still can, before something worse happens. And get help, both from your friends and family, if possible, and from a professional counselor who has experience with these issues. It could save your happiness, your sanity, or even your life.

 

Resources

https://www.goodreads.com/list/show/72664.Nonfiction_resources_on_abuse_and_domestic_violence

National Domestic Abuse Hotline https://www.thehotline.org/

https://nymag.com/strategist/article/best-books-on-cults-reviewed-by-experts.html

https://www.women.com/sophiematthews/lists/books-on-gaslighting-101718

A Sensory Self-Soothing Room

Photo from the author’s collection

Not long ago, I read in the Creativity in Therapy blog (http://creativityintherapy.com/2016/05/create-a-sensory-self-soothing-kit/) an article by Carolyn Mehlomakulu, art therapist, called “Create a Sensory Self-Soothing Kit.” The idea was that a box filled with items that engage your five senses is an excellent tool for being grounded when you need centering or self-care. The recommendations were for any five things that appeal to the senses of touch, sight, hearing, taste, and smell. I tried the exercise and came up with the following:

Touch – plush animal

Sight – amber necklace

Hearing – iPod playlist

Taste – caramel

Smell – Oolong tea

I never actually made myself such a self-comfort box, but I remember the exercise as a way to think about my senses and how nourishing them can nourish me.

Lately, though, I have acquired a room of my own and have been decorating it to suit myself. Recently, I realized that it has all the requisites of a comfort kit toolbox.

Touch – I have quite a collection of stuffed animals stashed around the room. A great many of them were gifts from my husband, who knows my history with stuffed animals (as we used to call them). Every Easter there was a new stuffed rabbit in our Easter baskets, along with the chocolate bunny and the jelly beans.

Perhaps the most important plushie in my room is named “Trauma Bunny.” My husband found her in the store he works at, squashed behind two huge bags of dog food in the pet aisle, rather than in toys where she belonged. Of course, he bought her and brought her home to me. Now she sits on my desk, guarding my headphones and cellphone, close enough for me to reach out and pat her on the head or fondle her ears.

Sight – I have furnished my room with many things I like to look at, from travel souvenirs to prints and paintings that have significance for me. Even the walls are a toasty rusty-brickish color that makes me feel warm just to look at. I also have a television, where I can watch shows that comfort me, such as ones on the Food Network. I have two windows, and the blinds are always up on at least one of them. The view isn’t terrific, but the sunshine is welcome.

Hearing – I do have iTunes on my computer, with more music than I could listen to in a week. Among the tunes are ones recorded by some of my singer/songwriter friends, as well as the well-known artists I like best, ones you don’t hear on the radio anymore. There is also instrumental music, from Vince Guaraldi to Béla Fleck, if I want something less distracting than voices and lyrics.

I also have a cat tree by the window, where my two cats love to sit or sleep. Both cats purr nicely and loudly. One of them even snores when she sleeps – daintily, but she definitely snores. (Of course, petting the cats also qualifies as touch, and watching them bathe themselves, which I find soothing, counts for sight as well.)

Taste – My husband keeps my room stocked with things he knows I like such as Cocoa Puffs. There’s always diet cola in the bottom drawer on the lefthand side of my desk. Right now there are honey-roasted peanuts in case I need a more proteinaceous snack.

I generally eat only one meal a day, and when I’m really depressed sometimes skip eating altogether. It’s good to know that there’s something here that is easy to access, requires no cooking, and meets some of my basic needs and likes.

Smell – Since I’ve transferred most of my library to an ereader, there are fewer books in my room, but most of the ones I still have are old and retain that almost-indefinable book smell – dust, paper, and some other distinctive aroma that I remember from trips to the used book store as a kid.

I also have a candle that smells like snickerdoodle cookies. I’ve never lit it, but sometimes I just pick it up for a deep sniff. Then there’s my tiny Mr. Coffee, which I use for tea, including oolong, herb tea, and possibly my favorite, the spicy smell of Constant Comment tea.

I practically live here, even though the house is fairly large and there are sensory delights in the other spaces as well. But what I have here, I recently realized, is a comfort box that’s just the size of a room.

Image from foxyburrow/adobestock.com

Recently, I had a chance to sit down with Harvard professor Dr. Michael Rich (M.D.), founder and leader of The Center of Media and Child Health. In addition to his comments on that topic, Dr. Rich had a lot to say about social media and mental health in general.

What are some of the problems you see for patients with psychological problems in their use of social media?

I take care of a fair number of patients and one of the things that’s hardest for them is to come clean to those who want to help and nurture them. I think first of all that for people who are both struggling with psychological or psychiatric issues – and for all of us – the hardest but most important thing to do, particularly with social media, is to be real, be authentic.

I think that the biggest problem with social media is how we are using it. Essentially most of us use social media to market ourselves to the world. We go to it in hopes that it will build community, we’ll make connections with people. What ends up happening is those who are most vulnerable or folks with varieties of anxiety – most prominently social anxiety – feel anxious in an in-person social situation. They go to social media to take baby steps to try to connect with people. But because we are using it as a marketing tool to the world, what they see appears to be that everyone else is happier, more successful, and “better” than they are. They go to it feeling insecure and they come out of it feeling even worse in many cases.

What really builds relationships and connections is us showing each other our vulnerabilities, showing each other the ways in which we need someone else, not the ways in which we are a prize for someone else.

Image courtesy Dr. Michael Rich

You use the term “problematic interactive media use.” Can you tell us what you mean by that?

Part of why we call it problematic interactive media use is it’s not an addiction. It is more akin to binge eating disorder, in the sense that it’s overuse of a necessary resource in the 21st century. The online space, the interactive media space, is necessary to function at school, at work, etc. Problematic interactive media use is continued overuse despite negative outcomes and it is driven by underlying conditions, including anxiety, especially social anxiety, but also depression.

We don’t see the technology as being the problem, so calling it internet addiction or gaming disorder or smartphone disorder or smartphone addiction points to the technology as having done something to us. It is actually our behavior that is the issue – how do we behave with these technologies, not how have these technologies harmed us in some way.

What do you think about the online therapists that have become so popular since the pandemic?

I think that there are many, many ways to use telehealth that can be very effective, but I think that it is much more effective and much more efficient in terms of progress made when it is with someone you have already met face-to-face in real life, as opposed to someone you are meeting for the first time online. First of all, you get a lot more visual and audio cues.

The other thing, quite honestly – I hate to say it, but there are people who exploit that need, who present themselves as doctors. It’s problematic because obviously someone is not only exploiting it for their own advancement, but they are generating false hope in people. I think it is unethical and profoundly unfair to someone who is seeking any sign that there is a way out of the dark space for them.

I think that what’s really important here is to use the same level of vetting of your caregivers as you would someone you’re seeing in real life. Talk to them and see if you can trust this person enough – whether you feel heard, whether you feel connected, whether you feel that they really care, rather than just going through the motions.

Any final thoughts?

I think we lost a lot when “friend” became a verb. We friend people willy-nilly, but they’re not the kind of friends that you can cry to in the middle of the night or who you could reach out to for a shoulder to lay your head on. I think that we, in our quest for and achievement of near-infinite connectivity, have lost our connectedness in a deep and meaningful way. 

I think that, quite honestly, if we can learn from the authentic behavior of folks who are sharing a vulnerability like bipolar disorder or virtually anything – attention deficit hyperactivity disorder, physical disabilities, cognitive disabilities – if we can actually be honest and true and let people know our limitations, that people will step in and complement us. They will complete us. I think that that is what true friendship or true relationships are. 

 

Interview with Dr. Michael Rich, November 5, 2020

 

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