Bipolar 2 From Inside and Out

Brain vs. Brain

Having bipolar disorder is like having cognitive dissonance all the time.

What is cognitive dissonance? When people ask, I usually describe it as when the two halves of your brain slam forcefully into each other and give you a brain-ache. It’s also known as “brain go ‘splodey.”

Take, for instance, the time when I saw excerpts from the musical Cabaret, with the dancers portrayed by women of at least 65. As I reeled out of the theater, my mother saw the dazed look on my face and said, “Don’t you like Cabaret?”

“I love Cabaret!” I replied. Meanwhile, the other side of my brain was saying, ”Oh my God, if they had tried to do the Bob Fosse choreography, someone would have broken a hip for sure!” Slam! Pow! ‘Splodey! Cognitive dissonance.

You can probably see how this relates to bipolar. One half of your brain says, “If you just take a shower, you can go out to lunch.” The other half says, “A shower?!? First I have to find a clean towel and a bar of soap, get undressed without seeing myself in the mirror, fiddle with the water temperature, wash and shampoo, dry off, find clean underwear, and that’s not even thinking about drying my hair and figuring out what I can wear! Oh, my God, I’ve used up all my spoons just thinking about it! I should just eat Cocoa Puffs and go back to bed.”

Instant cognitive dissonance.

Or try this scenario: You see on your newsfeed that the government is considering a new law with a feel-good title regarding mental health issues. “Hooray!” one side of your brain says. “At last! Everyone should support this fabulous bill!” Then you look at the whole article and find that one provision in the bill allows violating the privacy protections of HIPAA, as an example.

“Oh no!” the other half of your brain says. “Any person, even one who’s mentally ill, has the right to medical privacy. What if an abuser gets information about his victim? I’ve got to write a letter protesting this bill. Where are my spoons? Did someone steal my spoons?

There are lots of these situations, hence the near-permanent state of cognitive dissonance.

I want to be around people but I don’t want to talk to anyone.

I want to be left alone but then I’m lonely.

I really want to make love to my partner but I can’t get aroused.

I want to be cured but I hate the idea of being “normal.”

That degree of cognitive dissonance is positively exhausting. No wonder we never want to do anything but lie in bed, not read, not interact, not reach out, not try to do anything but survive another day.

If we think too hard about anything, our brains may go ‘splodey.

Vivek Murthy, the US Surgeon General, just released an advisory on the dangers to teen mental health that social media poses.

CNN reports, “While noting some benefits of the online platforms, the report warns of increasing concern and ‘ample indicators’ that social media can have ‘a profound risk of harm to the mental health and well-being of children and adolescents.’ The 19-page report acknowledges that further research is needed and that online youth well-being is shaped by many complex factors, including screen time, content, and countless strengths and vulnerabilities of individual users.'”

There have been warnings about this crisis for over a decade. According to NPR, psychologist Jean Twenge looked at mental health metrics around 2012 and was shocked: “Rates of depression, anxiety, and loneliness were rising. And [Twenge] had a hypothesis for the cause: smartphones and all the social media that comes along with them. ‘Smartphones were used by the majority of Americans around 2012, and that’s the same time loneliness increases. That’s very suspicious,’ she wrote in The Atlantic in 2017.”

Well, I’m not so sure. Twenge also said that “22% of 10th-grade girls spend seven or more hours a day on social media.” That does sound like an alarming statistic, but it also means that over three-quarters of 10th-grade girls didn’t.

Other stats are similarly suspect. For example, “Teen social media use has skyrocketed in recent years. The rise in tech use coincides with rising rates of anxiety, depression, and loneliness.” This may be true, but it’s a far cry from saying that the rise in social media use causes the rising rates of mental distress. Throughout the years, everything from comic books to rock and roll to video games has been said to cause ills from teen violence to drug use to sexual deviancy. But correlation – the fact that two things happened around the same time – does not equal causation – that the one circumstance causes the other.

Similarly, “A study — considered one of the best to date on the subject — found an uptick in mental health issues after Facebook arrived on college campuses.” Even though it was thought to be one of the best, there were flaws in it (only lasting four weeks, for example), and once again, it suffers from the correlation-causation problem.

Now, I’m not arguing that social media isn’t at all related to adverse psychological outcomes. I’m just saying that the talk about them may not be incontrovertible evidence.

Certainly, social media has bad effects on teens – in particular, in cases of cyberstalking and cyberbullying. Cyberbullying has even been blamed in cases of teen suicide, though it seems likely that mental issues of existing depression, isolation, and low self-esteem are involved as well. I’m not going to say there’s anything even remotely questionable there. A lonely, isolated, depressed teen can be preyed upon by a bully, either same-age or older, taking advantage of their insecurities and desire for connection. The fact that this can end in tragedy is no surprise.

The technology of social media makes it easier for bullies to spread their messages further and more quickly than was possible in previous days. The potentially worldwide audience for hate and degradation makes the behavior even more devastating. But, while the technology makes the problem worse, the underlying cause is still bullying. Current efforts at reducing bullying have been largely ineffective. I don’t see how reducing cyberbullying will be any more successful.

Still, most of the objections to social media seem to focus on time spent and “inappropriate content.” And when they say “time spent,” they aren’t talking about the positive aspect of social media on education and homework. We learned during the COVID-19 pandemic about how social media can be used to further education. Zoom meetings for project work, Google searches for research topics, YouTube for instructional videos, and more are appropriate uses of social media.

As to “inappropriate content,” that’s always been available, from magazines to movies. True, there is a greater variety of content with greater disgustingness available. But just as it was never possible to shelter teens from magazines and movies, shutting off inappropriate content is not feasible. Nor can parents reliably monitor their teens’ social media use and the content they interact with. Adults are attached to their own screens, whether for business, shopping, entertainment, or accessing adult content themselves – not to mention all the other tasks they perform. They can’t be looking over teens’ shoulders all the time. Maybe it’s possible to take away a younger child’s smartphone at bedtime, but not teens’.

Some of the objectionable content doesn’t relate to sex, either – or at least not directly. Teen girls are hammered with content that encourages them to be thinner, more compliant with unrealistic adult standards of beauty, and ways of molding themselves into those images. This does promote negative self-images of teen girls’ reality and expectations, leading to lower self-esteem and, potentially, depression. Again, though, short of parents monitoring teen social media use, there’s virtually no way to stop this. Parents have no control over the messages that are coming in and little over how much gets through to teens.

And while the Surgeon General’s report makes some mention of the good aspects of social media, the potential for social media to foster beneficial connections is undeniable – another lesson we should have learned from the pandemic. Teens can keep in touch with friends from around the world, interact with relatives in other states, and attend virtual meetings and events. And if they use that personal connection time to engage in teen talk and trivia with their friends, that’s been true of teens since time immemorial. Think back on how many current adults spent hours talking on their low-tech phones after school with their friends.

So what are the solutions? There aren’t very many, and they aren’t very likely. Some potential (partial) remedies can be tried in schools – more anti-bullying education, and more tech education that focuses on ethics and responsibility. But, of course, those would take time away from the many other educational imperatives that schools have been made responsible for.

The other potential solutions are even less likely. There’s no way to stop content producers from producing objectionable content – not just porn and shady dating sites, but the many messages that teens get about their appearance, dangerous behavior, and other matters of questionable good and benefit.

So, are the warnings justified? Probably, yes. Teens are not just impressionable. Their brains are still pliable and forming. The content they see and hear through the internet does not take that into account. Parents can’t effectively monitor teens’ online behavior, and content producers won’t change what they put out – it’s too profitable.

Alerting parents to the dangers is all well and wonderful, but pointing out a problem with no solutions isn’t all that helpful, really. Here’s one story for parents about what might help:

They say there’s no such thing as a silly question. But I’ve heard a few that come darn close. I understand that some of the people who ask them are genuinely confused about brain illnesses in all their variety. But some of them – I just don’t know. Here’s a look at some of the questions I’ve encountered.

Some people are concerned that various practices can affect mental illness or its treatment. I’ll tackle a few of these.

Can chanting a mantra harm someone who is mentally ill or has schizophrenia?

Can people with mental illness practice mindfulness meditation without hindering their treatment plan or making symptoms worse?

To these questions, I would say that chanting a mantra or practicing mindfulness meditation poses no threat. In fact, these practices are often encouraged as ways to reduce harmful stress.

Does astrology have any cure or remedies for mental illnesses like schizophrenia and bipolar disorder, etc.?

As to astrology, I’d have to say no. It has no place in the treatment of brain illness. It’s not science and has nothing to say about the inner workings of the human mind.

Can mental illness be caused by external factors such as mind control or manipulation?

While manipulation exists, mind control doesn’t, unless you’re talking about cult indoctrination. Manipulation in the context of gaslighting can cause stress-related disorders or possibly trauma.

Can too much intellectual curiosity cause mental illness or psychological problems later in life?

Intellectual curiosity is a good thing. Honestly, I don’t see how anyone can have too much. At any rate, it has no relation to mental problems.

Some questions come with relatively simple answers.

How can you find out if a doctor has diagnosed you with a mental disorder?

Your doctor will tell you what the diagnosis is. They won’t keep it a secret.

Can someone with bipolar disorder join Alcoholics Anonymous (AA)?

Sure, they can join. But not all AA groups are comfortable working with people who have psychiatric diagnoses. They concentrate on alcoholism and not mental disorders, so the bipolar disorder likely won’t be addressed in many meetings.

Can covert bullying and gossip harm a person? Would the said person seem mentally unstable or unwell?

Absolutely, bullying and gossip can harm someone. Some people even see bullying as a contributor to teen suicide. The victim is likely to show symptoms of depression and anxiety.

There are questions that ask about specific populations.

What can be done to help teachers that have mental disorders?

The same treatments that work for other people will work for teachers, too. The teacher may need to take a sabbatical to work on their issues without the pressures of their job.

How do the constant pressures of fame and scrutiny affect the mental health and overall well-being of celebrities, and what steps can be taken to better support their mental health and prevent the negative effects of celebrity culture?

While I’m sure there are special pressures on celebrities and they certainly can have mental illnesses, there really isn’t much chance of changing celebrity culture. Supporting their mental health might involve not penalizing celebrities for taking time off from their careers to seek treatment.

What are the most common mental problems among thru-hikers?

I’ll be honest. I had to Google “thru-hikers.” They’re people who hike a long, multi-state trail like the Appalachian Trail from end to end. That said, their most common mental problems are the same as the most common problems of the general population. There’s nothing about being a thru-hiker that poses a special risk.

Then there are questions about family matters.

Does being raised by a single mother cause mental illness or personality disorders?

Just being raised by a single mother doesn’t cause any mental illness. Single mothers are perfectly capable of raising happy, healthy, well-adjusted children. That said, any parent – single, married, mother, father – can have a child with mental problems.

Can tough love from parents prevent mental illness in children?

No. There is no one technique to ensure that children do not develop mental illness. Tough love may not be the best approach for a child who already shows signs of mental difficulties. Tough love can be traumatic, which can make a mental illness worse.

There are the questions that simply perplex me.

What are the effects of watching cute animal videos on mental health?

Aside from saying “Awww” a lot, none that I can see.

What are the effects of reading creepy pastas on mental health?

WTF? Is this about alphabet soup controlled by a Ouija board? A reference to the Flying Spaghetti Monster?

What is the worst diagnosis made by a fictional doctor?

Fictional doctors can’t diagnose fictional characters. They’re fictional.

Did Fred Flintstone ever experience mental illness? If so, what was the reason for it?

See previous answer.

Then there’s the ultimate question.

How can we address the mental health crisis in our society?

A simple blog can’t answer this question. No one person can. It will take the work of thousands of people (or more) to convince the rest of the people to take appropriate action. It won’t be easy and it won’t be quick. We need to convince the general public that, first, there is a problem, and then, that there are things we can indeed do to address it. Even making a dent in the problem is a long-term project. So we’d better get busy. The problems aren’t going away on their own.

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Emotional Numbers

What’s the relationship between mood and emotions? How is the mind involved? Is it even possible to sort them out?

These days, people talk a lot about one’s Emotional Quotient, or EQ, also known as emotional intelligence, or EI. EQ is defined as “the capacity to be aware of, control, and express one’s emotions, and to handle interpersonal relationships judiciously and empathetically.” Emotions are “a natural instinctive state of mind deriving from one’s circumstances, mood, or relationships with others.” Mood is “a temporary state of mind or feeling.” Obviously, the definitions overlap somewhat.

All of these terms are used by the general public. EQ is the currently popular term. You can find any number of “tests” online that claim to determine your EQ. Often these are phrased in terms of your “personality” and may refer to enneagrams or other psychological theories. Other searches revert back to showing you your IQ, even if you were looking for EQ tests. Many of them charge money to show you the results. I’m not interested enough in my EQ to spend the money, though I took one of the tests. I might ask my therapist if she has a handle on what my EQ might be. I’d be happy with a subjective evaluation such as Excellent, Good, Average, Poor, or Terrible. Anything more, like a circular chart with bright-colored segments, I believe I’ll pass.

How do EQ and IQ tests compare? Healthline says, “IQ tests measure your ability to solve problems, use logic, and grasp or communicate complex ideas. EQ tests measure your ability to recognize emotion in yourself and others, and to use that awareness to guide your decisions.” So, completely different things. A person with a high IQ could have a low EQ and vice versa.

So, what else do the experts say about the difference between moods and emotions? “Moods can last for hours while emotions last anywhere from seconds to minutes, at most.”

There I would disagree.

At least, I have an opinion. An emotion is something I feel for a defined amount of time, usually a short one. My husband and I disagree and I feel an emotion of annoyance. But it seldom lasts for mere seconds. It can dissipate within a minute or last for several hours, depending on when we talk it out.

A mood lasts longer than that. Now that I’m relatively stable, my moods may last longer than a week, but less than years. Right now, I’m having a mood of anxiety, which has lasted for nearly a month, which doesn’t show much sign of pulling back, and which I’ve had to discuss with my therapist and my psychiatrist.

Moods certainly can last for more than seconds or minutes – hours, days, weeks, or longer – but emotions can last a long time too. Have you ever held a grudge? It’s not a fleeting emotion. It’s not a mood, but it can last for potentially years – even the rest of your life. What’s left? A state of mind? A personality trait? A decision?

In my research, I did come across a piece about EQ and various disorders. It was on a site that promotes a treatment center for drug abuse, so I don’t know how accurate it is. But it said that empathy, being a major component of EQ, will change in a person with depression. They may feel more empathy for a person who is also suffering, but less for a person who isn’t. This leads to numbness, they say, which may further impair one’s mental health.

In cases of ADHD, the center says, people may have trouble reacting to emotional stimuli and engage in “inappropriate behavior” for a situation. Without treatment and EQ, they may still feel internal restlessness.

Anxiety and EQ, they say, are complicated. Low EQ may mean detachment from things that threaten safety and self-esteem. On the other hand, people with anxiety and high EQ may have a tendency to be so empathetic that they overthink and lack the ability to self-regulate.

The treatment center says it can improve EQ and thereby improve self-awareness, self-regulation, motivation, empathy, and social skills, all in the context of addiction recovery. Whether this is true – whether raising EQ is possible and promotes benefits in understanding and behavior – is, as far as I can see, far from settled. It’s also unclear to me in which order this would happen. Would treating the mental condition raise the EQ, or would raising the EQ help treat the mental condition?

I also encountered a study that said high EQ is positively associated with good general physical health. Yet another investigated the correlation among EQ, a sense of belonging, and mental health among college students. Rejection in particular was associated with poor mental health outcomes.

I’d like to see more on the subject.

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Distract Me!

I recently saw a meme that said being happy was different than being distracted from sadness. I couldn’t deny that they are different. But it seemed to me that it was saying that being distracted from sadness was a bad thing. And I don’t believe that, necessarily.

Sure, happiness is better than sadness, and something to aspire to. But it’s not always possible, especially for those of us who struggle with bipolar, depression, and other mood disorders – despite what the positive thinking people say. (I don’t think that “smiling depression” is a good coping mechanism to recommend. It denies reality and doesn’t help someone realize that they should seek out the help they need.)

But when I’m down in the depths, distraction helps. Unless I’m in the total Pit of Despair, it short-circuits my overthinking, relieves (at least for a while) my brooding, and even gives me something I can smile at, if only momentarily.

Where do I find distraction? First, there are other people. There’s my husband. He has the ability to make me laugh at the silliest things. We sometimes toss a soft toy back and forth at each other, exclaiming, “Eeee!” It’s really a stupid game, and not one we play every day, but when you’re not expecting Eeee to fly through the air and bop you, it’s definitely distracting. We giggle like fools.

Another one of my go-to distraction providers is a friend named Tom. He’s a singer-songwriter and improv comedian who has dozens of different songs and jokes I’ve never heard. If I’m too much “in my head” and can’t get out, I can call Tom. Once when I called him, I just flat out said, “I need to be distracted.” “Look at the grouse! Look at the grouse!” he instantly replied. I had no idea it was from a Three Stooges routine, but it was absurd enough to ease me closer to where I needed to be.

That’s an important point, too – the ability to ask for distraction. It’s good to have people around who respond and help. Sometimes a calming voice is all it takes. My Uncle Phil has the most soothing voice, and he has many times centered me by distracting me with stories about anything – using computers for business, tarot cards, religious stories, or whatever. My friend Leslie grounds me by expounding on esoteric subjects – epigenetics, for example – if I ask her to. We’re perpetually told to reach out when we need it. This is just another way to do that. If you don’t want advice or commiseration, reach out for distraction.

Of course, there are other distractions like music, television, movies, and even pursuits like gardening. Doing something you have to concentrate on, like needlepoint, keeps your mind focused, and can be a great distraction if you are able to do it. And there are the cats. They’re so completely unconcerned with whatever’s troubling me that they can’t help but draw my attention away from it too.

I’m not saying that one should distract oneself to the exclusion of working on one’s problems. That way nothing which is necessary gets done. We all know that dealing with our difficulties is the path out of the pit.

And I’m not saying that distractions always work. Dan used to tell me terrible jokes to try to jolly me out of my depressive moods. When that didn’t work, he would tell the same joke again in hopes, I suppose, that I had merely misunderstood it and would think it was funny the second time. At that point in my life and my illness, not even Eeee would have gotten through. I’d have let it bounce off me. Or hidden it so he couldn’t try it again.

I’m hardly going to say that distraction can replace therapy and medication. But as an adjunct, I can’t see the harm in it. If you’re at a point where you’re able to, look at the grouse!

Words matter. I preach that all the time. Language is what gives our thoughts reality and how we make essential connections. Ideas become more concrete when they have words attached to them. It’s hard – perhaps impossible – to convey a thought without language of some kind. And how we use words is dependent on how and what we think.

Words matter. Think about how the terms “rioters” and “protesters” reveal a person’s opinions about the motivations of the people in the “mob” or “crowd.”

Words matter. Our community has been pushing back against words such as “psycho” and “crazy” when it comes to referring to people who need psychiatric help. Many people are gradually realizing that such words are equivalent to slurs and are no longer acceptable. (Except in the aftermath of violence, of course. Then, those terms are tossed around indiscriminately.)

Words matter. But how do we in the community refer to ourselves? What words are advocates using? And how do we want the general public to refer to psychiatric problems?

I’ve written before about the terms “behavioral health” (bad) and “mental illness” (better). But what’s best? Increasingly, the words du jour are “brain illness” and “brain disease.” We’re watching linguistic change in action.

But linguistic change happens at a glacial pace. Words that were used in Elizabethan England are still used today. Think about all the words and phrases that Shakespeare invented that are still used today, and with the same meanings – unreal, lonely, and green-eyed (as in jealousy), for example.

Linguistic change, on the other hand, also happens blindingly fast. Slang, tech terms, and jargon in particular appear and disappear in the blink of an eye (as it were). Think about the terms that refer to female beauty. There were times when “phat,” “fresh,” and “fly” were all applied to women. (Yes, I’m dating myself. I don’t even know what the current term is, but I bet it’ll be gone next month. At least I know that “fire” has replaced “awesome,” “boss,” and “da bomb.”)

So, where are we in the (something) community now that we’ve left “behavioral health” behind? “Mental health” was the clear frontrunner for a time. Then it was “mental illness,” then “serious mental illness.” Now the term being put forward is “brain illness” – or even “brain disease.”

I’ve talked about the implications that various words have. What are the connotations of the new terminology? “Mental illness,” as opposed to “mental health,” drives home the point that “mental health” is a euphemism. It’s not health that’s the problem – it’s the opposite of health. “Brain illness,” as opposed to “mental illness” says that the problem is not in the mind, it’s in the brain.

I think that’s a tough concept for the general public to take in. To most, the mind and the brain are synonymous. Whether that’s accurate or not is hard to say. It’s true that the brain is the physical embodiment of thought, emotion, and cognition. These things can’t exist separate from the brain. They are so intertwined that it’s hard to think of one without the other – especially for laypeople.

But “mental illness” implies that the mind – the thinking – is what is disordered. “Brain illness,” on the other hand, says that the problems lie in the functioning – the physical structure – of the brain. In my opinion, it’ll be tough sledding to make the public understand the sometimes subtle difference between the two.

Recently I saw an online post that decried the fact that advocates and professionals aren’t yet using the terms “brain illness” and “brain disease.” And there’s some truth in that. My own therapist doesn’t. But practitioners are engaged in dealing with the general public as well as those in the community. There’s something to be said for addressing those people in language they understand better. There’s the possibility that when hearing “brain disease,” most people will think “brain tumor” rather than what we are really talking about. And there’s the problem with the slowness of linguistic change.

Words matter. But so does the speed of change. Of course, if we want to change the dialogue, we need to use more accurate terms to promote our message. But it’s probably too soon to expect everyone to be on board. I’m not saying that we should give up on the process of fostering change. I am saying that we shouldn’t be beating each other up for not yet having made that progress, even among ourselves. It’s a process, and not everyone progresses at the same rate.

Incremental change is better than none. Indeed, unless you’re talking about a fad, it’s the only way change happens. And we’re not talking about a fad here. We’re talking about a fundamentally new understanding of what it means to have schizophrenia, bipolar disorder, major depressive disorder, and other illnesses.

That’s going to take serious time.

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I was chatting with a potential customer the other day. She was interested in having me write a book on gaslighting – a fictionalized account of the experience she had with her soon-to-be ex.

I told her that I sympathized and that I had some experience with the topic, too. I was once in a relationship fraught with emotional abuse and gaslighting. “It was years ago,” I told her, “but the scars are still there.”

Suddenly, I stopped to think. That relationship took place over 40 years ago. For going on 41 years, I’ve been married to a man I met the weekend that everything blew up between Rex and me. But I had been truthful. The scars are still with me.

Oh, they’ve faded since then. I no longer have aversions to the things I associate with him, like cobalt blue glassware and blue spruce trees. I don’t cringe and close up whenever anyone in the room is angry. I don’t put myself down before someone else has the chance to. I allow myself to feel anger when it’s called for. I listen to the kind of music I like, at high volume if I want, and don’t apologize for it. In fact, there’s lots I don’t apologize for anymore.

But the memories still affect me, all these years later. I still have flashbacks when someone uses one of his pet phrases, like “fish or cut bait.” I dream we’re in the same town and I’m afraid to run into him. I flash on his insistence that it be called “Eighth of January” whenever I hear the tune “Battle of New Orleans.” And now and then, the obscene song he wrote about me – supposedly as a compliment – pops into my head randomly. It’s doing it now as I write about it, of course.

I was at a formative stage in my life when all this – and more – happened. I was exploring newly discovered independence, dealing with the stresses of college, navigating my first serious relationship. I’m sure my lack of experience helped to make the situation particularly searing for me. At the time, no one ever spoke of gaslighting, and physical abuse was the only kind I had ever heard of.

When I was still just coming out of the fog of the relationship, my startle reflex was unnaturally sensitive. I’d react with alarm if my husband dropped a knife in the kitchen. I didn’t even have to see it. The sound was enough to make me flinch and cry out. (I don’t remember any specific incidents from the bad times that seem to be related to this, but there you have it.) For years, I was a jumpy little thing. My husband learned to let me know if he was about to make a loud noise so I could be prepared for it. I have only a little bit of that left – now I jump only when something very sudden or very loud happens.

It’s been suggested that I have some form of PTSD from the experience. I don’t know if that’s true, though I certainly have some of the symptoms. I was told once by a therapist that I do have it, but at the time it seemed wholly incomprehensible. Now that I look back on it, she may have been right, only I wasn’t ready to hear it. And my future therapists moved on to my problems with depression and bipolar disorder. Self-diagnosing is seldom legitimate, so I won’t say that I definitely have PTSD. But this all puts me in great sympathy with those who do.

PTSD or not, I can still see the lingering effects of that relationship even after 40 years. They say time heals all wounds, but in my experience, the wounds don’t heal so much as scar over. The effects are still there and visible, but they no longer bleed like they did.

Of course, defining the trauma is less important than recognizing it and its effects. And healing from it, which I am still doing 40 years later. It’s a work in progress – and so am I.

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I’m not great at group therapy. I’ve tried, but I never managed to get anything from it.

It may be familial. My father had a particularly vicious cancer, multiple myeloma, which he survived for a dozen years, a lot longer than the doctors thought he would back then.

The hospital where he was diagnosed and treated offered support groups for cancer patients. I remember one called “Make Today Count” (which I think implies a certain recognition of mortality that’s not really encouraging – but I’ve never faced it myself).

My father refused to go. Adamantly. Of course, the choice was up to him, but he chose not to get involved and made no apology for it. It wasn’t that he couldn’t accept help. He just relied on family and friends for it – people he knew and had a connection with. I’m sure that support helped him to survive as long as he did, and I can see how a group of strangers, even if they had the same or similar conditions, wouldn’t appeal to his independent streak. It wasn’t that he didn’t have a positive mental attitude, either. No one could have been more determined that he was going to persevere for as long as possible. No one could have been more confident that he would prevail. And no one could have kept doing the things he loved for as long as possible.

I have had experiences with group therapy, but they have not been successful. When I was in college and experiencing a depressive phase, I went to a group offered by the university’s health services. I was skeptical at first. One woman’s problem was that she didn’t know whether she should marry a rich guy or a poor guy who had both proposed to her. (I’m not denying that she was conflicted, but I wondered how much a mental health group could help. Maybe individual therapy could have helped her clarify her thinking, but then again, I just don’t know.)

The other thing I remember was that once the group facilitator issued us a challenge – which of us could role-play meeting another person and holding a conversation with them. My hand went up, and I performed the task easily. I had reached the point where I could fake my way through simple social encounters, so it wasn’t all that difficult. The facilitator looked impressed and slightly disbelieving. It was something I already knew how to do, so it didn’t actually help me with my problems. I don’t know if it helped anyone else either.

Another time, when I was out of college and in private therapy, my therapist was going on vacation and recommended a group I could go to while she was away. They took us through a relatively simple exercise – making a drawing of our life journey. As I recall, we used only symbols, no words.

When I finished, I burst out crying uncontrollably and didn’t know why. I don’t remember anyone there helping me process what I was feeling. Maybe I expected too much from a therapy group. Maybe they weren’t equipped to handle a meltdown. But it was a thoroughly upsetting and unhelpful experience, and I didn’t go back.

Another group I attended a few times struck me as a bit peculiar. The participants each related a difficult situation they had been in and the symptoms they experienced, then told how they would have handled it previously and how they handled it now. There were lots of quotes from a book they all carried like a bible. There was no discussion – just the facts and the quotes. (Once I offered someone a piece of gum or a mint and they pointed to me, chuckled, and said, “Dry mouth!”) Again, I didn’t find it really helpful.

At this point, I’ve pretty much given up on therapy groups. Perhaps, like my father, I am simply not a group person. I know there are those who will say that I simply haven’t found the right group. They may be right, but I have stopped looking.

There are lots of mental health groups – not therapy groups, of course – on Facebook and elsewhere on the internet. I’ve become the moderator of one ( – come check it out if you want to). What founder Tony Roberts and I try to do is offer a place for people with brain illnesses to learn from and share their experiences, with a faith component. Tony, who is much more in touch with the faith-based communities than I am, provides most of that part of the content. I facilitate by curating articles from around the internet on anxiety, depression, PTSD, bipolar disorder, psychosis, and general mental health. I post memes that relate to mental health or offer encouragement – or sometimes ones designed to bring humor to the subject. And I ask questions intended to spark discussion. I hope it helps.

And I also hope that other people have had better experiences than mine. I’d love to hear about them.

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Resting bitch face is a thing, you’ve probably heard. Some people – usually women, though I suppose some men have it too – look mean when their face is still and their muscles are slack. People who see them assume that they are grumpy at the least or maybe sulky or angry – hence the name resting bitch face.

I have resting sad face. Once when I was working at a restaurant, the manager saw me sitting while on my break and told me that I should smile. I replied that I was paid to smile at the customers, not on my break. Of course, that was a bad response, though I know that women are often told to smile more (men, not so much). I probably would have gotten along better with my coworkers if I had smiled more.

But I was suffering from depression at the time, or at least the depressive phase of bipolar disorder, and was untreated. Smiling was something I had neither the inclination nor the energy to do. Sad was my natural expression.

When I didn’t have resting sad face, I had resting worried face. (A different manager asked me, “What does a girl your age have to worry about except ‘Am I pregnant?'” As it happened, that was the one thing I knew I didn’t have to worry about.) I was also suffering – again, untreated – from an anxiety disorder.

What I haven’t had is the mask of “smiling depression.” Many people with depression pretend to be happy most of the time, at least in public. You can see it dramatized in depression medication commercials when someone holds a happy face symbol in front of their face. (In real life, I’ve noted that the depression or sorrow sometimes leaks out around the eyes, though, even past the mask.)

There are two different kinds of smile – the “Duchenne” smile (named after a 19th-century scientist whose major contributions centered on mapping the muscles that control facial expression) and the “Pan Am” smile. The Duchenne smile is the sincere smile of a truly happy person. It’s easy enough to tell when someone is giving you a Duchenne smile. The muscles at the corner of their eyes crinkle, making little crows’ feet. It happens automatically when you think of a happy memory or greet a person you like a lot.

The Pan Am smile is the one where the smile does not reach the corners of the eyes. (It got its name from airline attendants who were required by their job to smile at all times, whether they were at rest or not, happy or not.) No one has resting Pan Am smile face. It’s impossible. It takes a number of facial muscles to smile and when you’re resting, you don’t use those muscles. No, the Pan Am smile takes intention.

The Pan Am smile, however, is the one a person uses when they do have smiling depression. (I used it once when, at a different job, we were all posing for individual portraits. My results were so fake-looking that the photo was never used. They didn’t even let me see it, much less anyone else.)

I’m kind of hoping that these days, I have at least resting neutral face. That sounds like the right expression for a stable person.

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I Love/Hate My Brain

My brain is special and magical. It makes me who I am and has often seemed to me to be the best part of who I am. I have always been intelligent and a quick learner. And I thank my brain for that.

On the other hand, my brain is deficient in some ways. It doesn’t have the correct balance of neurotransmitters (or has been adversely affected by trauma as I’ve lived my life or inherited from my parents). When it comes to bipolar disorder, I blame my brain. It’s glitchy, unpredictable, and guilty of making my life miserable at times.

So, I have cause to both love and hate my brain.

The thing is, I have no control over either of those perspectives. I didn’t make my brain smart and adaptable. I can’t take credit for that. I also didn’t make my brain misfire and become my biggest enemy. I can’t take the blame for that.

Much of what I am, my brain is responsible for. I am a moderately successful writer. That can be attributed to my brain as well. I’m creative, too, another quality that resides in my brain. But when I’m depressed, I lose the ability to write, and when I’m hypomanic, I lose the coherence I need to write well. It would be easy enough to say that I love my brain when it’s functioning well and hate it when it’s not. That’s not completely true, though. I’d have to say that my brain is my frenemy.

I am notoriously moody and difficult – hardly surprising since I have bipolar disorder. My intellect doesn’t go away when I’m depressed or hypomanic, but sometimes it goes into hibernation. It makes poorer decisions, it’s true. It’s led me astray many times, even to the edge of death. And I can’t always recognize when it does that. My brain is not the best gatekeeper of my behavior. But my brain does help me clean up the consequences when it does occur.

There is currently a great debate on whether bipolar disorder even comes from the brain. It may not be because of my neurotransmitters, though I still consider them complicit. It may be because of my childhood trauma (at the hands of children my age, not my parents). But again, trauma is said to make physical changes in the brain, so perhaps it is a brain-related reason as well. The other prevailing theory is that bipolar disorder has a genetic component. I don’t know if that means that my genetic heritage affected my brain development, though I suppose it could have. I just don’t know.

I do know that it feels like my brain is at fault. Bipolar is, after all, a mood disorder, and I don’t know where my moods reside, if not in the brain.

So, what can I do with my brain to increase the love and lessen the hate? First, I try to keep my brain fed. I read every day and play jigsaw sudoku to keep it lively and stave off dementia – and to stretch my brain because so much of what I do is word-related, not mathematical. My reading is varied, from novels to nonfiction. I revisit beloved novels from my past, which keeps me grounded in who I am, and explore new books and authors I find, which keeps me excited and open to the new. I try to lessen the opportunities for hate by keeping my brain stable with medication, therapy, and listening to my husband and my friends when they tell me I am loved.

On balance, I love my brain more than I hate it. But I have to keep an eye on it (as it were) to make sure that the hated half doesn’t take over.

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