Bipolar 2 From Inside and Out

There’s been a lot of media interest lately in Simone Biles. The gymnast described by many as the Greatest of All Time withdrew from the Olympics, citing mental health reasons. Many news outlets and commenters have been understanding, but some have not. A Texas Deputy Attorney General, for example, called Biles a “selfish, childish national embarrassment,” which he apologized for six hours later. A podcaster called her “weak,” and said that her performance showed that “when things get tough, you shatter into a million pieces.” After Biles pulled out, the team won a silver medal, with the Russians getting the gold.

Many have compared Biles with Kerri Strug, who performed the vault in the 1996 Olympics, despite having an injured leg. At the time she was praised for her courage and strength, although it turned out that the American Women’s Gymnastic Team would have won the gold even without Strug’s dramatic vault.

Biles’s situation and its comparison with Kerri Struggs serves to reinforce the idea that only physical injuries are “real” and that talking about and acting on mental health matters is not acceptable. Yes, Olympic swimmer Michael Phelps has talked about his struggle with depression, but only after the Games were over. It was brave of him to talk about it, but he received little to no backlash after deciding to talk openly about depression and suicidal ideation.

As in so many other situations, mental health and mental disorders are considered less “real” than physical disorders. And the pressure put on athletes and Olympic athletes in particular can be a factor in damaging their mental health. Athletes have long been encouraged to “play through the pain,” even when that results in severe physical injury. Few have considered how playing through psychological pain affects athletes.

Added to the stress of competition and the pressures of fans, parents, and coaches to succeed, many athletes have suffered through physical and sexual abuse. Simone Biles has commented that she is part of the #MeToo movement that has brought attention to previously unrecognized instances of sexual harassment and exploitation. In a lengthy tweet, Biles revealed that she was one of the victims of team physician Larry Nasser, who is now in jail following over 100 counts of such behavior. “As I continue to work through the pain,” Biles tweeted, “I kindly ask everyone to respect my privacy. This is a process, and one that I need more time to work through.” She could have tweeted the same thing regarding her recent mental health problems.

Another factor in the language surrounding Biles’s decision to remove herself from the Olympic competition is how many people talk about how she personally denied “us” a gold medal (as if all Americans were in contention for the medal) or ceded the victory to the Russians. Ideological matters ought not to be a point of discussion regarding an athlete’s mental health. But they are. People forget that the Olympic Games are just that – games. Too much patriotic fervor is whipped up based on the outcome and the international goodwill of the Games has been lost.

Along with the fact that an amazing athlete was strong enough not to let the pressures of competition further affect her mental health. Simone should be praised for her decision, not called weak and childish.

Words Matter

“Sticks and stones may break my bones, but words will never hurt me” is one of the worst lies that grownups tell to children. Children threw stones at me when I was a child (though they fortunately never broke my bones). But the many, many words they hurled hurt me deeply internally, rather than externally. I was bleeding inside from them, as much as I bled externally from the rocks.

Plenty of children feel the pain of words. We say, “Children are cruel” and leave it at that, or tell children to simply ignore cruel remarks. We have anti-bullying campaigns that are notably ineffective, especially in the face of cyberbullying. Children who hear demeaning words from their parents, teachers, or other adults are likely the most damaged.

People with mental disorders feel the pain of words, too. There are many ways this happens.

One of the most common taunts, often used in popular media, is “psycho.” One may possibly excuse Robert Bloch, who wrote the book Psycho in 1959, and Alfred Hitchcock, who made the movie in 1960, because they were products of their time, when microaggressions and the concept of nonracial slurs did not exist. American Psycho (2000), has much less of an excuse. In movies such as these, “psycho” is shorthand for “serial killer.”

But now “psycho” is in common usage in phrases such as “psycho bitch from hell” (which is anti-woman as well as offensive to persons with mental illness). Songs such as “Sweet But Psycho,” “I Might Just Go Psycho,” and “Am I Psycho?” are recorded.

“Craziness” is also taken lightly in words and phrases such as “cray-cray,” “cuckoo,” “maniac,” “lunatic,” and “cracked,” not to mention “bonkers,” “bananas,” and the more offensive “batshit crazy,” “bug-fuck crazy,” and dozens of other words. There’s even the stereotype of “crazy cat lady.” It may seem cute or silly to call a friend one of these words in a joking manner, but the person who does have a mental illness hears such a word as an insult. Even if it is just overheard, it tells a lot about how the speaker regards the seriousness – or unseriousness – of mental disorders.

There are lots of other examples. “Off their meds” is one. It, along with plain “crazy” or “psycho,” is quite often applied to mass shooters, suicide bombers, and other offenders. While it is true that some of such people have mental disorders, the terms are thrown around long before anyone finds out whether the person is diagnosed with a mental illness or is on psychotropic medication. It is the default explanation. Julie Beck, in an article in the Atlantic, called the easy leap from mass killing to mental illness “a consistent and dangerous narrative.”

Other usages seem innocent enough, but really aren’t. “The weather is bipolar,” meaning it changes quickly, is common. It isn’t accurate, however. Only a person can have bipolar disorder, a serious illness. Applying it to oneself when you change your mind or have a momentary mood swing, is also inaccurate. Likewise, “schizophrenic” is used to describe something or someone that has two sides, or that seems incomprehensible to the viewer. “Multiple personality” (more correctly called Dissociative Identity Disorder, or DID) is shorthand for someone who exhibits different sides of his or her personality on different occasions. People who disagree with you politically are not “insane” or “crazy” either, unless they have been diagnosed with a psychiatric disorder by a professional.

These ways of speaking hurt the persons they are spoken about, but also the mental health community. Fear of being called “psycho” or “crazy” is one reason that some people don’t seek treatment for a disorder or conceal it if they do.

And that’s a sin and a shame.

My next mental health tattoo isn’t going to be about mental health at all – except that it will be.

I have had several ideas for tattoos recently: a yellow rose for my mother (whose maiden name was Rose and whose favorite flower was yellow roses); a compass rose to celebrate my love for travel; or the constellation Orion for my love of astronomy. I also thought of getting a script “My story isn’t over,” which would, of course, be a mental health tattoo.

But what I decided on was a stack of books.

Why is this a mental health tattoo? Because books have saved my life so many times when I was at the bottom of the pit. I find books the best distraction from thinking about my misery. They are the best escape from what is going on around, and inside, me. They take me to places I never imagined I’d go. They have helped me understand my condition.

And I have written two books myself on mental health topics, Bipolar Me and Bipolar Us. They were compilations of these blog posts, including some of my most popular ones, such as “What Is It with Showers, anyway?,” “When You Don’t Want to Live But You Don’t Want to Die,” “The Fire and the Window,” and several on gaslighting and bipolar disorder.

The tattoo will not be about those particular books specifically, as the tattoo will be too small to have titles on the books. Instead, it will represent all the books that have nourished me, supported me, surprised me, touched me, informed me, and delighted me. Books I return to again and again, sometimes every year. Books that I own, or borrowed, or lost in the tornado that destroyed our house.

There was one time in my life when books were not an option for me – during my last major depressive episode. Then I was so deep in despair that no book appealed to me. I couldn’t concentrate enough to read more than a couple of pages. I missed my books (and my music), but I was unable to respond to them as I normally would. I even tried reading one of my favorites, a novel called Memory, but found it upsetting at that time, as I was having trouble retaining or accessing memories because of one of the medications I was on.

When the depressive episode ended, I was once again able to read and enjoy, for which I am infinitely thankful.

These days, I don’t read many books that are about bipolar disorder or other mental conditions, though books like The Noonday Demon have helped me in the past. In my young adulthood, I did read self-help books that I thought would help me with psychological issues, feminist issues, alienation issues, relationship issues, and more. I no longer read those sorts of books, especially workbooks that are supposed to reveal the inner workings of one’s mind and to help discover how various therapies can help get through the bad patches.

Perhaps I don’t like that kind of workbook because they’re too much like journaling. I once kept a journal, an erratic one that I wrote in irregularly over a year or more. I can’t bear to read it now because it was written when I was undiagnosed, unmedicated, and dealing with a lot of confusion and psychic pain. When, later in life, I tried to return to journaling, it quickly turned into this blog. It contains things I want to say to my old self and my new self, but also things I want to share with others. A blog (and the resulting books) seemed the best way to do that.

Right now I am reading that yearly series of books, plus nonfiction ones (I try to balance my reading between fiction and nonfiction). And when I finish those, I have over a thousand more to choose from, as I keep nearly all my books stored in electronic form on my Nook reader.

So, that’s why I chose books as my next tattoo, and why they represent mental health as well as just plain enjoyment. I have had so little enjoyment in my life when depression has hit me hard. I think it’s time to celebrate the times when books and reading have held me up and helped me through the bad times.

I used to have a couple of suits hanging in my closet. One was oatmeal-colored. One was blue tweed. One was rust-colored. I had a couple of silk blouses and a jacket or two that I could wear over a dress.

I called them my “Respectable Business Lady” disguises.

At the time I was working at a 9-to-5 job where the dress code was pretty casual. Fridays were jeans days, not casual days. But every so often I had to go to meetings or business conventions, and for them, I needed the disguises. I was dressing to “fit in” and to give an impression that I was competent and stable.

I don’t honestly know if the suits worked as a disguise, but I made it through meetings and conventions fairly successfully (I think), if I was allowed to collapse afterward, at home or in a hotel room. I think the disguises were as much to remind me how to behave as they were to convince people that I was indeed respectable and a business lady.

Nevertheless, I can’t really buy into the “fake it till you make it” philosophy that has been so popular in self-help books, including those promoting business and entrepreneurship help. I had no notion of becoming a respectable business lady by wearing those suits. I was always going to be awkward and out of my league. I was only trying to pretend by using protective coloration.

The essence of “fake it till you make it” is practice. As the saying goes, you get good at what you practice. Unfortunately, you can’t practice not having bipolar or another disorder. You can practice assorted coping mechanisms and get better at doing them, but they’re a solution to some of the symptoms, not the disease.

I don’t think that “fake it till you make it” really applies to people with mental health problems. No matter how much or how long you fake it, your mental disorders are not going to disappear, though they may ease up at times. I certainly don’t think the business lady disguises made me go into remission for a week or a weekend. They were merely a coping mechanism and nothing I practiced enough to get really good at.

One danger of trying to fake your way through mental illness is that you can fall into the trap of what’s called “smiling depression.” When this happens, people don’t notice that you’re miserable because your smile makes it seem you are happy. It’s another disguise, but not a permanently successful one.

Once I was teaching a class, and several women gathered around another woman and asked her what was wrong. “I didn’t think it showed,” she said. “No, honey,” I said, “it leaks out around the eyes.” She wasn’t crying or anything like that, but we could all tell something was wrong, despite her smile. We offered her conversation and sympathy until she pulled herself together a bit.

I’ve never been able to school my face into any kind of smiling depression anyway. If some people have “resting bitch face,” I have “resting sad face.” I can’t count the number of times when I didn’t feel particularly sad, but someone asked me what I was sad about. Of course, I was probably suffering from low-grade depression, like a low-grade fever, but at the time I was undiagnosed and had no idea that I had a mental problem that caused me to look that way.

Basically, what I’m saying is that when you have a mental illness like bipolar disorder, you can fake being psychologically together for a while, but you can’t sustain it forever. Certainly not until you “make it.” After I took off my Respectable Business Lady disguise, I would revert to my original self, as far from a respectable business lady as ever. Sometimes it would take me days to recover enough to feel that I was functioning again on any sort of level.

I think it’s better, ultimately, to admit who you are and what you need rather than to try to disguise or fake it. Even if your authentic self is depressed and miserable, getting help for it is still better than trying to cover it up.

Once upon a time, when I was diagnosed with unipolar depression, I wished I had bipolar disorder so that at least I could get things done when I was manic. Then I met someone with bipolar disorder and learned how foolish that wish was. Her manic phase led her to begin projects she would never finish, make loud, inappropriate jokes, and have difficulty with social interactions.

I have bipolar 2, and am fairly well controlled on medication, so I don’t get hypomania often, and when I do, it doesn’t usually last very long. Last month, however, I had a manicky time, and the results of it will affect me for several months. In June I also started on a new medication – though one for my physical health, not my mental health. My primary care physician doubled my dose of thyroid supplement. It had an almost immediate effect. After about a week, I became stronger, steadier, in less pain, and – oh yes, – rather manic.

I tend to have the rapid cycling version of my disorder, so when I do get hypomanic, it seldom lasts more than a few days. This time, however, I have had a longer time to experience the hypomania in a way I can’t remember having had before.

Some good things happened and some bad things happened. I got tickets to two live music events that I desperately wanted to see, one in August and one in September. We went out to eat at least twice. I made appointments for tattoos for both myself and my husband, both also in August. I booked us for a weekend getaway vacation in August. I bought myself a pair of earrings to replace ones I had lost.

In other words, I spent a lot of money.

Then July came and I don’t know if we will have enough money to get through it all. I snapped out of the hypomania and reverted to anxiety, which is how my depression often expresses itself. I paid the major bills during the first week. I put us on a strict budget for groceries. I put a little money aside so that I could possibly get a t-shirt at one of the concerts. I determined that the tattoo studio takes credit cards. (I don’t really want to take this option, but if we run out of cash, I may have to.)

Money worries are among my triggers for anxiety and depression, along with thunderstorms, overscheduling, noise, and too many people. When August comes, I will certainly need the bed-and-breakfast getaway, because my nerves will by then be frazzled.

The real question, though, is will I have enough energy to enjoy all the plans I have made for August?

A friend, who goes to DisneyWorld fairly often, learned that he should not do what he calls the “Bataan Fun March,” trying to cram every possible attraction and experience into a single visit. Now he prefers a more leisurely Disney experience, visiting a few of his old favorites and a few new attractions, while leaving time for relaxed dining and time in the pool.

This would probably have been a better approach for me to apply to August. A few events then, a few in September.

It would be convenient if my hypomania returned in August, to allow me to do all the fun things I have committed to. But as we know, bipolar disorder is an unpredictable beast. In the past, I have missed concerts that I had no more spoons for. I have rescheduled appointments that I wasn’t physically or psychologically in any shape to attend. (Most of these were appointments with my therapist, who sometimes agreed to a phone session instead.)

But these commitments are ones that I can’t phone in. All of them require my actual, physical presence. I don’t want to cancel any of them, some I can’t cancel at all, and I can’t phone in any of them. My best hope is that my symptoms will allow me to both attend and enjoy, if that’s possible.

Maybe the new pep I am experiencing from the thyroid meds will help. It does seem to help regulate my moods a bit, as well as affecting my body. Maybe it will allow me to have more spoons for August. Maybe in September I can decompress. Maybe in October, I will be back somewhere near level ground.

Across the Spectra

Most often when “the spectrum” is mentioned, it’s the autism spectrum that springs to mind. There’s good reason for that. Autism affects varying people in varying ways and to various degrees.

But there are other conditions, disorders, and traits that vary across a spectrum as well: right brain/left brain, introvert/extrovert/, depressed/manic, and many others. The one I’m most familiar with, of course is the depressed/manic spectrum (or in my case depressed/hypomanic), but I’ve recently been reading about the other spectra I mentioned.

The first thing to know about spectra is that no one is fully at either end of the spectrum, or at least not all of the time. Think of a spectrum as the weight gauge on an old-fashioned scale at a doctor’s office. Most people’s weight tips the scale at somewhere other than the middle, and if they are all the way to one end or the other, the clinician moves the weight and starts over until the pointer rests in between the two extremes and the heavy weight falls somewhere between either end.

So, to use myself as an example (the one I’m most familiar with), when I am stable (properly medicated), I am close to the middle of the depressed/hypomanic spectrum, with the “weight” perhaps listing just a wee bit toward the depressed side. During depressive or hypomanic episodes, I slide toward one end or the other. No one is either all depressed or all hypomanic, though it feels like it at times, and people don’t stay at one end or the other all the time, except perhaps for the unmedicated person who has never had proper treatment and self-care.

Then consider the right-brain/left-brain scenario. When this theory was first proposed, it associated various traits with one or the other side of the brain. Type-A, energetic, risk-taking, mathematically oriented people were said to be left-brained, while shy, creative, language-loving, and risk-averse types were said to be “right-brained.”

This theory was extrapolated into the real world. Naturally, society at large was judged to be left-brained and that was deemed the better thing to be. These people got things done – businesspeople, politicians, scientists, and the like. Artists, writers, and other creative types were said to be right-brained, and not well adjusted to the left-brained society. There was even a book called Drawing on the Right Side of the Brain, which tried to harness that hemisphere in pursuit of artistic accomplishments and getting left-brained people in touch with their other “side” for a while.

Whenever I’ve taken one of those sided-ness tests, though, I almost always come out somewhere near the middle. What does this mean? I suppose either that my corpus callosum (which connects the two hemispheres) is particularly robust, or that I partake of both natures to some extent, more or less, and at different times. For example, I am mostly a stay-at-home reader and writer, but I am also a closet science geek, and like foreign travel, considered a risk-taking pursuit.

The same with introvert/extrovert (which seems to me to overlap considerably with right/left brainedness, and indeed with depressive/manic). I prefer to stay at home and pursue quiet activities like reading and writing, but I also enjoy going to science fiction conventions, which are known to be rather people-y. I can also tolerate moderate sized gatherings such as parties and book signings, as long as they aren’t filled with loud noise such as screaming children.

What I’m getting at here is that most scales are fairly useless and most people are somewhere in the middle of them, partake of both ends, and slide back and forth to some degree. I suppose there are people who are all one or the other, but I don’t know many and probably wouldn’t find them very interesting if there were.

The mind and the body are inseparable, part of the same organism. You can’t have one without the other. And each affects the way the other works.

Triggers are a good example. You see (or read) or hear or smell or touch something that unlocks an emotion in your brain. You then have a visceral reaction to that feeling – sweating, shaking, nausea, panic flight, or another physical manifestation.

These reactions are most commonly seen in severe PTSD and trauma related to abuse, but they can happen in less severe circumstances as well. Even something as seemingly innocent as tickling can put the brain in command of a bodily sensation. For example, once I was tickled to the point of pain, with the other person refusing to stop when I pleaded for him to. Ever since, my reaction to tickling is both physical and mental. My brain tells my body to shut down the physical sensation of touch. That may seem – and is – comparatively mild, and I don’t want to diminish the experiences of people suffering with PTSD and reactions to trauma. But it shows how my body and brain interact, almost in a feedback loop.

In circumstances like these, the body signals the brain and the brain tells the body how to react. It’s not like a person can choose whether to be traumatized or not by a trigger. The brain takes over.

Lately, I’ve been facing a fairly deep depression and have faced a lot of things that are triggers for me – financial problems, relationship troubles, overwork, etc. I’ve been feeling the bodily lethargy, exhaustion, psychic numbness, and neurasthenia that come with depression. These certainly affect my body, making me twitchy and nervous and unable to sleep (or to sleep too much), or unwilling or unable to face the world outside, some of the more noted hallmarks of depression and anxiety.

But after a recent visit to my primary care physician, I began to wonder if my body was influencing my brain in a rather direct way. Of course, before I got to see the physician, I had to fill out the depression screener, and as usual, I underplayed my symptoms by a bit. After all, I’m already under a psychotherapist’s and a psychiatrist’s care for it. It’s to be expected if I don’t present as all cheery and “normal.”

After chatting with the doctor about my symptoms (most, I thought, related to growing older), he ordered a bunch of tests for me. I’m to have a mammogram, a ColoGuard test, a bone scan to check my bone density, and had a whole bunch of blood tests.

The mammogram and bone scan I’ve scheduled, though they couldn’t work me in until September. (Evidently there is a lot of pent-up demand for hospital-based testing, as the hospitals weren’t doing non-elective stuff during the pandemic.)

Then the results started coming in. White and red blood cells, okay. Liver function, okay. Glucose and triglycerides, okay. Nearly everything within parameters.

I say “nearly” because I got a call from the doctor’s office saying that he wanted to double my thyroid medication. I had been taking a small amount, but now he figured I needed more.

I looked up the symptoms of hypothyroidism on the Mayo Clinic website, which seems trustworthy. They noted that that the condition may be attributed by the patient to growing older. I definitely noticed those: sensitivity to cold, muscle weakness or aches, and joint pain, all of which I feel.

Then there were other symptoms, which I had attributed either to my psychiatric diagnosis (bipolar II) or to the medications I take for it: fatigue, weight gain, thinning hair, impaired memory, and the biggie – depression.

Between the two sets of symptoms, I could see that the doctor had good reason to suspect my thyroid was out of whack and to prescribe an increased dose of the medication. I am now taking the higher dose and waiting to see what happens.

But it struck me: Maybe my symptoms were a combination of bipolar disorder and thyroid hormone deficiency. Maybe my body was trying to tell me something – that not all the symptoms I feel were caused by my glitchy brain. Maybe some of them were caused by my glitchy thyroid.

I have not been taking the new dosage long enough to see any effects, but I have hope. Perhaps, if and when the new dose kicks in, I will feel less of the lethargy, hopelessness, and other attributes of bipolar disorder.

Maybe my brain and my body have conspired to make me feel the way that I do. Maybe there is some relief to be had from treating my body with hormones, rather than just my brain with psychotropics. Maybe I’m not spiraling down into depression as thoroughly as I thought I was. Maybe a little tweak in my medication will help me to feel better.

Maybe if my body problems get worked out, my brain problems will not assert themselves so aggressively.

It is devoutly to be hoped.

The Song as Self-Care

Almost six years ago, I wrote a blog post about music and its power to heal, or at least alleviate, depression. If you’ve been following this blog, you know that I’m currently in the middle of what may turn into a major depressive episode. Again, I return to thoughts of music.

I once gave my therapist a CD of the music I liked best. I had been telling her how I had been stereotyped and even ostracized for the kind of music I like best and was embarrassed to share it with others. (Okay, it was country music, or at least the style now known as Americana – not pop country.) She played snippets from several songs while I watched her not cringe at them.

It’s the music that moves me. I’ve heard a theory that the music we love and respond to when we’re in our late teens and early 20s is what we imprint on. No matter how much or what styles of music we listen to later in life, those are the tunes and songs that will move us, no matter how old we get. These were mine. Later in life I started listening to acoustic blues, light jazz, filk, and 70s oldies, but country/Americana is still what lives in me.

Right now, one of the things I’ve been feeling is emotionally constipated. And maybe it’s time to try allowing music to alleviate that logjam.

Whenever I’m really depressed, I forget how much power music holds. When I’m on an even keel, I semi-regularly throw myself “music parties.” I hole up in my study with my computer and let iTunes blast. I even sing along, though I’m a terrible singer. Sometimes my husband joins me for a while and we have guessing games. (Who’s that singing backup? Emmylou Harris. Who wrote this? No, Shel Silverstein, not Kinky Friedman.) Sometimes I look up music that resonates with Dan and download it for him.

But mostly, it is a solitary pursuit. I wrap myself up in the music and let it soothe me. Or I rock out to the music and let it energize me. Or I let the music reach inside me and pull out feelings I didn’t even know were in there. Sometimes I use the shuffle function and let it surprise me. Other times I thread a path through the songs, letting my brain tell me what to play next. (It’s one of the things I can rely on my brain for.)

Call it a way to provide myself some self-care without spending any money. Although massages and pedicures and lunches out with friends are often touted as good self-care methods, I can’t do any of those things when I’m depressed. For me, they just add extra stress – showering, getting dressed, going out among people. I love massages, but I love them when I’m feeling good, only just a bit tense. I love lunches out, but they can’t raise me out of depression. I like them better when even chicken and dumplings feels celebratory.

But at my music parties, I don’t have to deal with any of that. I can stay in my pajamas and slippers. I don’t even have to comb my hair. I can exhibit all the common habits that go with depression and not have to use spoons trying to alleviate them.

So, tonight, I believe, it’s music party time. I’ll shut off my phone. I’ll close the blinds in case I want to chair-dance and don’t want nosy neighbors to have a view. I’ll invite my husband if he wants to be there, and not worry if he doesn’t. (What I call a “party” can easily be a party of one, and most often is.) I’ll unplug my headphones from the computer so the music can fill the room, as well as my head and my heart.

And maybe next week, I’ll have something to tell my therapist about – whether it helped or not.

What’s the relationship between bipolar disorder and introversion? My friend and I were discussing this topic. She had noted my aversion to going out and being around people and thought it might be because I was an introvert instead of my having bipolar depression.

She also noted that Spoon Theory sounded a lot like introversion as well – that people who ran low on spoons wouldn’t have enough left to go out and have coffee with a friend, for instance.

She and I still have lots to discuss on the subject, and she is lending me a book on introversion to see if I agreed with her after reading it. I await the arrival of the book, but here are some thoughts I have on the subject. I write them here just to collect my thoughts on the subject.

First, to point out the obvious, introversion is a character trait and bipolar disorder is a mental illness. Character traits do not generally require (or respond to) medication. Bipolar can and often does. Introversion, like many mental disorders, may respond to therapy such as group therapy – unless, of course, the person is too introverted to attend group sessions.

Bipolar depression – or any kind of depression, really – can manifest as an unwillingness to be around other people. The feelings of hopelessness, failure, and unworthiness can make it painful to be in the presence of people, especially ones who don’t know about the disorder or that you have it.

But depression isn’t all there is to bipolar disorder. There’s also mania (or hypomania). Mania can produce the opposite effect, driving the person to desire and enjoy the company of other people, even to the extent of being “the life of the party.” Hypersexuality may come into it, too, which almost certainly requires another person, or even people. Hypomania can produce, if not a full burst of energy, at least a lift that can make being around other people less painful.

I have bipolar disorder, which probably began when I was a child or a teen, though I wasn’t diagnosed until much later. I remember walking through the halls of my school between classes, reading a book the whole way. (Hence the picture, which isn’t me but could have been.) Was I shy? Was I introverted? Was I avoiding attracting the attention of the school bullies, on the theory that I’m invisible when I’m reading? Was I fascinated by the book I was reading and unwilling to put it down?

There’s an argument to be made that reading was my form of escapism and school hallways, notoriously people-y, were a thing I wanted to escape from. But there’s also an argument to be made that I was affected by bipolar depression. I certainly felt that I didn’t fit in, that I was different somehow. Maybe that difference was my disorder. I did have friends, though, and I remember laughing wildly with them at in-jokes in the cafeteria, which was also people-y.

As for spoon theory, I can see what my friend was getting at. Spoon theory generally applies to people who have chronic illnesses, and I maintain that mental illnesses fall into that category. My friend said that she thought perhaps introverts start their days low on spoons and run out of them early in the day, making socializing virtually unachievable.

My take on it is that, as introversion is not a chronic illness or mental disorder, an introvert will likely start the day with the same amount of spoons as non-spoonies – if I’m right, an introvert will start the day with ten or 12 spoons, while the chronically ill may start with only five and have to choose very carefully how to use them. Plus, getting dressed for work might take one spoon for the healthy or neurotypical, while spoonies often spend one whole spoon just taking a shower, let alone choosing clothing, dressing, and getting out the front door.

Does an introvert experience the exhaustion, depletion of energy, and feeling of being totally flattened that a chronically ill or mentally ill spoonie does when the spoons run low or out? Or do they choose to use their remaining spoons in ways other than socializing, such as caring for a pet, pursuing a craft, reading, or shopping online? These are things that, when spoonies crash, they are often unable to do, just as much as they’re unable to go out to dinner with friends. Hell, a lot of the time they don’t have the spoons left to make or even eat dinner. Collapse into a chair or a bed is the most likely choice of activity.

Granted, I haven’t read the book on introversion yet. And I’m not a teacher of psychology like my friend. But I still think that my bipolar disorder is likely the cause of my not wanting to go out among people, rather than introversion. And I absolutely don’t believe that introversion caused my bipolar disorder. I’m of the school that blames that on neurotransmitters being out of whack.

But maybe my friend has a point. I’ll read the book, and we can toss ideas around, maybe via email or phone if I can’t go out where it’s people-y.

(Actually, from my desk chair, but you get the idea.)

This week I tried teletherapy, one of the workarounds that psychiatric patients have turned to in order to promote their own mental health, especially during the pandemic.

I know there are various online companies that specialize in teletherapy, or other health conditions plus psychiatric ones. Among these are Talkspace, Betterhealth, and Brightside, plus meditation and mindfulness apps such as Insight Timer. I wrote about the phenomenon back in January (https://bipolarme.blog/2021/01/10/distance-psychotherapy-is-it-for-you/).

In that post, I said that I hadn’t needed to try teletherapy yet, though I did mention having had telephone sessions with Dr. B., my psychotherapist. These were set up when I was unable to make it to my sessions, whether for transportation or psychological reasons. They helped but were not ideal, of course, because we couldn’t see each other’s faces and body language. Now, of course, with the proliferation of tablets, smartphones, and apps like Zoom, that’s no longer a hindrance,

Lately, I’ve been feeling a need to go back into therapy and by default I had to use teletherapy, as Dr. B. still isn’t seeing clients in person. (I had done Zoom calls for various other purposes, so I knew the drill.) We set up a Webex appointment and I thought about what topics to bring up, since I hadn’t seen her in so long.

I still don’t know all the advantages and disadvantages of commercial teletherapy, but I wasn’t tempted to try it.

First of all, I hate breaking in a new psychiatrist/therapist under any circumstances, as I had to do when my regular psychiatrist retired and moved. At this point, even the Reader’s Digest version of my life – or even just my mental health journey – would take several sessions. And I don’t trust therapy that starts without knowing my diagnosis, my medications (including the ones I’ve tried that didn’t work), what triggers me, at least a summary of my major depressive episodes, what therapy I’ve had so far, what I learned from it, my family and childhood and relationships, and more.

Not to say that a person couldn’t help me at all with my current situation (possible onset of a major depressive episode) without the backstory, but all that history informs what I’m going through now and why. Going through it would take several tele-sessions before we ever got to my current problem.

So, Dr. B. agreed to see me promptly and I appreciated it greatly. I was able to skip all the history and just get to the meat of my problems. She was able to remind me of some of the things that have helped me in the past and suggest some new things as well. And we set up another appointment for next week. One of the things she recommended was that I check with the psychiatrist who prescribes my meds, as I’ve been having some trouble with sleep. (Fortunately, my next appointment with Dr. G. was within the week. I see him only four times a year for maintenance.)

I had my appointment with Dr. G. He refilled all my meds, but had little to suggest about any of my other problems. He heartily agreed with my decision to go back to seeing Dr. B. He told me that one of my meds which I thought I might switch from nighttime to daytime was the kind that built up to a certain level in the bloodstream and it didn’t matter when I took it. And he suggested I make an appointment with my primary care physician regarding a matter that seemed not to be psychiatric in nature. (I agreed, and will do that as soon as the holiday weekend is over.)

So, where does this leave me? In touch with three doctors who know me and know my conditions. Set up with regular appointments to keep an eye – and an ear – on my symptoms. Reassured that my meds are functioning as they should, even if my brain isn’t.

All in all, I don’t feel better, but I feel better about it, if you know what I mean.

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