Bipolar 2 From Inside and Out

I thought I had depression and that’s what I was first diagnosed with. Later, I learned that I really had bipolar disorder, type 2, with an anxiety disorder on top of it. Here’s what I learned on my journey to a proper diagnosis.

Understanding. Once I was diagnosed with bipolar disorder, a lot of things from my life started making more sense. I finally realized that some of the inane things I thought and did as a child/teen were attributable to hypomania. Being idiotically happy when I won a goldfish at a carnival, carrying it before me, grinning like a loon. Near-constant mirth when I read a novel parody, laughing long and loudly every time someone used a word or phrase that reminded me of it. Luckily, I didn’t have any money to spend, or I would have done that too, based on my later behavior. Even things I did as an adult before my proper diagnosis made more sense – flight of ideas, pressured speech, and the like.

Second opinion. Going to a different psychiatrist and finally getting the right diagnosis was, in many ways, like getting a second opinion. We don’t often hesitate to get a second opinion on matters concerning our physical health (and insurance companies may require it). Why is it different when it comes to our mental health? I’m not saying that doctor-shopping is a good idea or that a diagnosis of depression did me no good at all. It just took a different psychiatrist to put together all my symptoms in a way that made sense to me as well as to him.

The “Aha Moment.” When I got my bipolar diagnosis, it was like a wake-up call. I instantly understood that my psychiatrist was right. Once I had that insight, I was able to explore my actual disorder in various ways – further sessions with him and with my psychotherapist, reading books and reliable online sources, sharing with other people who have the same diagnosis and listening to their experiences.

Getting the right meds. I had been taking medications for depression for many years. Then I learned that I might – did – need treatment with anti-anxiety medications, mood levelers, and other kinds of drugs that specifically targeted bipolar symptoms. I still needed meds for depression, but I needed a “cocktail” of drugs that addressed all my difficulties, not just one.

Going on maintenance meds. The process of settling on that cocktail of meds took a long and difficult time, but once I had the right diagnosis and the right meds, I was able to cut back to seeing a psychiatrist four times a year to get renewals on my “maintenance” medications. The process that stabilized me also allowed me and my doctor to make “tweaks” to the dosages to correspond with increased or lessened symptoms.

A new revelation. My learning about my disorder didn’t stop with my new diagnosis. Recently I learned that my depression could be what is called “dysthymia,” a type of depression that is roughly equivalent to the difference between mania and hypomania in bipolar 2. I wasn’t sure this applied to me, as my depressive episodes seemed long enough and severe enough to be considered major depression, but after consulting my therapist and other reliable sources, I began to see how a dysthymia diagnosis actually did correspond to my symptoms.

Having hope. The most important thing that the right diagnosis gave me was hope. Properly understanding my disorder and the correct treatments for it allowed me to hope that I could achieve stability and healing from all the years when I didn’t realize I was suffering from hypomania as well as depression. I could at last look forward to a life where my disorder didn’t control me. With help from my psychiatrist and the medications he prescribed, I have been able to live a contented and productive life. Work, stable relationships, and the other benefits of having proper treatment are achievable – and I have largely achieved my goals in life.

And my new diagnosis has been responsible for it.

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In 1887, investigative journalist Nellie Bly pretended to be insane so that she could report on the conditions in a New York asylum. The results of her sojourn there were the subject of her book Ten Days in a Madhouse and became the catalyst of increased funding for mental institutions. (I wrote about her in https://bipolarme.blog/2016/03/20/what-is-sanity/.)

Now there is a book that recounts an even earlier example of a woman who publicized the conditions in an insane asylum. It has a bearing on the rights of mental patients and involuntary commitment.

The legal rights of mental patients have been much discussed of late. Involuntary commitment is a particularly thorny subject. Some people decry it as a violation of civil rights. Others point to its usefulness in cases of extreme danger to self and others, but also in cases of anosognosia that do not quite meet that standard. “Assisted outpatient therapy” is one version of involuntary commitment that has many supporters. (See my post https://bipolarme.blog/2020/03/08/systemic-breakdown-and-involuntary-commitment/.)

Long before this became a matter of debate, and a couple of decades before Nellie Bly’s exposé, a woman crusaded for the rights of mental patients and against the practice of involuntary commitment. Of course, the involuntary commitment she decried was of married women by their husbands, and in 1860s Illinois, husbands were perfectly able to do that. The causes cited could be as varied as novel reading and masturbation (two separate categories). For Elizabeth Packard, the reason her husband gave was that she was insane because she disagreed with his religious opinions and dared to teach her opinions to others.

Karen Moore’s book The Woman They Could Not Silence recounts Packard’s story, in detail. Meticulously researched (as was Moore’s previous book, The Radium Girls), the nonfiction work is based on many primary sources, including Packard’s own writings (from when she was in the asylum and hid her papers, in one case inside her hat, as well as the book and pamphlets she published) and newspaper accounts of her crusade and her trial.

Packard’s trial was a result of a law she had promoted requiring a civil jury trial before a married woman could be committed, instead of on her husband’s word and the recommendation of an asylum doctor. Interestingly, immediately before the jury trials were mandated to begin, hundreds of married women were miraculously “cured” and released from the asylum where Packard had been held.

Once released from the asylum, three years after being committed, Packard became a tireless campaigner for the rights of the involuntarily committed and of married women (who at the time were not entitled to their own money or property, or even their own children). Packard also exposed the abuses that mental patients suffered at the hands of asylum staff, including isolation, beatings, and cold water baths (near-drowning) used as punishment. Another policy that she sought to have changed was withholding mail from mental patients. Packard had been prevented from reading supportive letters that her relatives had written.

Women dabbling in politics was not common, or approved of, at the time. Packard was able to influence lawmakers and other officials with a combination of her compelling speaking style, her eloquent presentation of her cause, and her remarkable tenacity. To say that she had an agenda is putting it mildly.

The prologue to The Woman They Could Not Silence begins, “If she screamed, she sealed her fate. She had to keep her rage locked up inside her, her feelings as tightly buttoned as her blouse,” and the book ends, “There was a world out there that needed reforming. And she was determined to do it.”

The Woman They Could Not Silence (subtitled One Woman, Her Incredible Fight for Freedom, and the Men Who Tried to Make Her Disappear) was selected by A Mighty Girl (http://www.amightygirl.com/), which serves as a clearinghouse for books, toys, and other products for adults and children, as one of their “Pick of the Day” recommended books for adults.

I highly recommend it too.

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Many people have been blaming COVID for depression and other mental health problems. They have said that quarantining and uncertainty have raised the level of anxiety in the general population, and quarantining has caused depression. These increased levels may be – probably are – accurately reported, but I don’t think they necessarily indicate an increase in the incidence of mental illness in our society.

The depression and anxiety that people are feeling are, I believe, natural and expected reactions to the pandemic conditions that prevail. I’m not trying to minimize these experiences, but most people have never experienced clinical depression or anxiety and so don’t understand the nature of the actual illnesses. What depression and anxiety the pandemic has caused is likely to clear up when (if) the pandemic does. This is situational depression and anxiety.

This is not to say that people experiencing pandemic-related depression and anxiety don’t need help. Of course they do. “Talk therapy” may do them a lot of good, and there has been an upswing in the number of online and virtual counseling services available. Whether these people need antidepressants and anti-anxiety meds is a question I’m not able to answer. My best guess is that they don’t, at least not long-term courses of drug treatment, as their symptoms are probably not indicative of mental illness. Short-term anti-anxiety meds may do some good.

I do think that the pandemic and the reactions to it have been triggering for many people who do have mental health conditions. People with OCD who are germophobic saw their most extreme fears become reality. People who have Seasonal Affective Disorder may have suffered more from lack of sunlight during the stay-at-home orders and quarantines.

Many people are in extreme denial, believing that the pandemic is a hoax and refusing to take any steps to prevent its spread. Is this a symptom of mental illness? I don’t see how threatening officials and doctors who promote pandemic precautions is a sign of mental health, but are the people who do this delusional or are they merely at one extreme end of the anxiety spectrum?

I understand that people’s perceptions of reality differ, but it annoys me when people deny mine, which currently is made up of snot and phlegm, as well as depression and anxiety. We can have these academic debates, but for my husband and me, at least, the pandemic has pushed us from believing that it is “out there” to realizing that it’s in here, in the most literal and alarming sense.

My husband has tested positive for COVID, and I have a terrible sore throat and cough, so I likely have it too. We’re resting and taking Coricidin until we hear from our doctors what to do. A dear friend has sent us a pulse oximeter, with instructions to get more help if our O-sats fall below 90.

All this is messing with my head. I was entering a depressive phase anyway. Now I’m not sure if it was due to my bipolar disorder or my immune system crapping out. (Just FYI, my husband and I are both triple-vaxxed. He probably got the virus at work and undoubtedly passed it on to me. I can’t imagine I would test negative now.)

I don’t think our illness is life-threatening, though honestly, it could be. You never know with COVID. And now, that’s part of my reality.

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Releasing Old Ghosts

I don’t know what the proper term is (exorcise? banish? reject?), probably because I don’t believe in ghosts. What I do believe in are memories – persons and situations that haunt you, follow you, and inhabit your dreams.

I’ve had my share, especially of the dreams sort.

When I first got out of a truly destructive relationship, I was undiagnosed with bipolar disorder, medicated with valium (prescribed for temporomandibular joint syndrome) and self-medicated with wine. I was not in good shape.

For a long while, anything associated with that harrowing relationship, I shunned. Rex had like blue spruce trees. I avoided them. He had collected cobalt blue glassware. I could barely stand to look at them. He gave me heart-shaped boxes as gifts. I threw away every one I had, even the ones that were actually pretty and useful. He shamed me for my cooking. I gave it up. I gave up things I enjoyed, things that had been part of me. And I didn’t allow myself to explore things that Rex once loved.

He haunted me. I would have dreams in which I was going to meet him, where I was in a place I knew he might show up. I dreamed I was in his house, with cheerful parties going on around me as I panicked. I would have flashbacks to cruel things he had said, such as an obscene song he had written “in my honor.” Times when he said I had “betrayed his honor” for something as simple as cooking the wrong dish for a gathering. Plenty of others.

Now, it seems, the dreams have faded. I have reclaimed parts of my life I used to enjoy. I have banished things that were only his obsessions. The flashbacks are nearly gone.

What has helped me banish these destructive ghosts?

Time, of course, though you’d be surprised how many years it took. And it was gradual. He didn’t vanish from my brain like a puff of smoke. At times I still remembered music in particular – festivals and concerts we had been to together, the obscene song. (As I write this, they come bubbling up again.)

People. A few even from the time that the relationship was going on, who have helped me realize that I should not have been there, that I should not have gone through what I did, that I should have left sooner. I treasure these people. They saw me at my worst, knew me as I was recovering, and are still my friends today.

Other people – friends I had from long before Rex – have steadfastly remained in or reappeared in my life. I may have been bipolar and undiagnosed when I knew them, but these people stood by me, put up with my mood swings and odd behaviors. They have been part of my support system. And new friends, who have no association with those times, but who have had similar feelings and experiences.

Psychiatrists and therapists – also important parts of my support system for all these years. Ones who diagnosed my illness and medicated me properly so that I could deal with the issues that remained. Ones who helped me realize that I had some good memories from those times, that I could rebuild myself by retaining anything that I liked, that I had tools and techniques that I could develop and use to help me do that. I had done bargello needlework for Rex. I switched to cross-stitch. He called the kind of music I liked shit. I delved even further into it, reveled in it. Having developed a love of cats when I lived with him, I’ve never been without one again.

Love. One of the people I met during the next-to-last weekend of my time with Rex is now my husband. He has been with me through the dreams, the flashbacks, and the memories and has been the mainstay of my support system. And there are other people I love, and who have loved me back.

It seems strange that I was with Rex only a little over a year and it has taken me decades to work to this point where the memories have faded, the ghosts no longer haunt me, when it all seems like simply a bad time that has receded into, if not oblivion, at least only a clog that has slowly been removed from my psychological plumbing.

Now I know the right word. It’s time to flush those ghosts that plug up our mental and emotional systems.

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I’m not big on New Year’s resolutions. I can barely plan my day, let alone the whole year. And I’m also not big on making commitments I know I can’t or won’t keep.

Instead, I remind myself of certain behaviors I think I (maybe) can accomplish and refer to the list as often as needed. Here are a few suggestions that may be appropriate reminders for you as well.

You don’t have to drink alcohol at New Year’s Eve parties. Or ever, really. No one should try to pressure you into doing this, but if they do, simply saying, “No thanks,” should be enough. If the person is really pushy, you may have to ask, “Do you have soda or fruit juice?” You are not required to explain why you don’t want to drink alcohol, and you may want to forego attending parties that do not have such non-alcoholic alternatives in the future. You don’t have to attend parties at all, and “No, I can’t make it” is a perfectly reasonable response to an invitation. Or “Maybe next year.”

You don’t have to make New Year’s resolutions per se. You can have New Year’s intentions, small goals you don’t have to announce to the world at large and that you don’t have to beat yourself up over if you don’t fulfill them. Instead of resolving to jog every day, intend to get out of doors once a week, even if it’s only to walk to the mailbox and back. Baby steps, after all.

I hate to use the word “should,” but you should keep track of your medications, reorder them if they’re getting low, and see your prescribing physician if the scripts are about to run out. That’s just common sense that’s necessary for your mental health, not a resolution. These days, you may even be able to arrange to have meds delivered.

Try to engage in a hobby once in a while. Say, once a month. It honestly doesn’t matter what the hobby is. Read a book, or even a short story or magazine article. Knit or crochet. Repot a plant. Water a plant. Do a crossword puzzle. Bake your favorite cookies, then eat them all yourself if you want to.

Keep comfort objects nearby. These can be anything that soothes you. A music playlist. A stuffed animal. A scented candle. A cozy blanket or sweater. A favorite warm beverage like cocoa or green tea. Don’t be embarrassed about using them to ground yourself. Most neurotypical people won’t even notice if you’re wearing a favorite sweater or have a scented candle lit.

You can connect with people online. This counts as interacting with people. Say happy birthday. Forward a funny meme. You don’t have to make it specific to your condition, but there are plenty of people on Facebook, for example, who have bipolar disorder or PTSD or an autoimmune disorder. You don’t even have to interact with them. You can join a group, then just sit back and see what others post there.

Avoid triggers, if you can. That judgmental aunt. Your creepy cousin. Your boastful neighbor. Again, you have the right to say no and not explain why. (It’s the not explaining that’s the hardest.) Don’t watch movies that you find upsetting, whether it’s Die Hard or Rudolph the Red-Nosed Reindeer (which many people don’t like because of the implicit bullying).

Write about how you feel, if you want to. It could be a mood journal, a regular journal, a letter that you will never mail, a poem. Don’t feel that you have to show it to anyone. Tear it up afterward, if you want to.

You don’t have to face the new year as a whole. If you must have resolutions, resolve to get through the next week or even the next day.

Make an appointment with your therapist. Many therapists are offering tele-visits these days, so it’s easier than ever just to touch base or to work through a problem, a trigger, or feeling overwhelmed.

In other words, do whatever you can to get you through the next day, week, month, or season. The year will take care of itself, whether you make resolutions or not.

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Sharing About Bipolar

Sometimes I despair. I have realized that part of the meaning in my life is to share with other people the realities of bipolar disorder. At times, I think I have failed. I know I shouldn’t let the fact that others, such as Gabe Howard, Pete Earley, and Laura Pogliano, to name but a few, do it better than I do discourage me. This is not a contest. Everything any of us does to spread the word about bipolar and other mental disorders is a positive thing.

Here are some things I have tried.

Books. I wrote two books based on my blog posts. Neither of them sold very many copies. The first one was published by what I’d call a seat-of-the-pants indie company, and the other one half by them and half by myself, so quasi-self-published. I had a book reading/signing at the local Barnes & Noble. Two people came. We did have an interesting question-and-answer session, even drawing in a couple more people from the cafe where we set up.

I promoted my books, but not very well. There were a couple of podcasts. On one, for first-time authors, it was evident that the host had never read my book, though I sent him one. He asked me questions like, “Are there any other creative people in your family?” My interview on Bipolar Girl went better, but I had no way to gauge the response. I got a write-up in the local paper, but it was clear they wanted me to buy an ad, which I was unable to afford and my publishing company was unwilling to fund. The publishing company did send out form letters to various outlets, but I completely misjudged who should receive them. There were no reviews.

Tattoos. The idea behind the Semicolon Project was that people concerned with suicide awareness and prevention would get tattoos of semicolons. (The idea was that a semicolon is a place in a sentence where a writer could have put a period and stopped, but chose to go on.) When people asked about the peculiar punctuation tattoo, one was supposed to open a dialogue with them about suicide, suicide helplines, and the like. I got the semicolon tattoo and also a bipolar tattoo (a colon, half a parentheses, and another colon to make both a smiley and frowny face). Like this : ) : Gabe Howard has used this symbol on his merchandise, such as t-shirts, mugs, and stickers, and I hope he has achieved a great response. But no one has asked about either of my tattoos, so I have never had to explain them.

Blog. This blog is the most successful of my methods of reaching out to others to get across my message about bipolar disorder and mental health. It reaches a few dozen readers every week, unlike the thousands of viewers that many sites get. I cross-post my blogs to other sites like The Mighty, Medium, and Thought Catalog, when appropriate. I had somewhat of a better following on Medium, but then their Invisible Illness section decided they wanted posts with more research than I was able to provide, and from writers with higher academic degrees than I have.

The Mighty has been the most consistent in featuring my posts and the most successful in garnering responses. They also sent me a The Mighty t-shirt and hoodie, which, again, no one asks about.

I don’t mean to whine (though I suppose I am), but I sincerely wish I could reach more people. There are many in this world who need to hear the messages about mental health in general and bipolar disorder in particular. Of course, I’m not a celebrity, so I’m not likely to be featured in news stories or TV ads. But, since I am out of other ideas, I will keep on with this blog and any way I can think of to spread the message.

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Think about the devastation that a case of schizophrenia can cause a family. Then multiply that times six.

If you want a book that explores such a situation, look no further than Hidden Valley Road: Inside the Mind of an American Family by Robert Kolker. It’s the true story of a middle-class family with 12 children, six of whom became schizophrenic. The children included ten boys and two girls; neither of the girls developed schizophrenia, so that’s a full 60% of the boys who did.

The story begins in the 1950s, when at least there were hospital beds as well as halfway houses for psychiatric patients. The matriarch, Mimi Glavin, however, preferred to care for her boys at home as much as she could. This was, of course, disruptive to the rest of the family. And the patterns were perhaps obscured by the fact that four of the boys and the two girls never developed the disorder. One of the girls was sent to live with a rich friend, and the other managed to be admitted to a boarding school. These were irregular family arrangements, intended to get the girls out of harm’s way, though they certainly harbored resentment at what they saw as abandonment.

The 50s and 60s were the era of what the mental health community called the “schizophrenigenic” mother. Back then, schizophrenia was thought to be caused by the mother, who was either too cold and distant or too controlling. Take your pick. It was the mother’s fault. It was also the era when Thorazine was the best (or only) treatment that could be given for the disorder.

The boys, many of whom were talented athletically or musically, presented with schizophrenia, as you would expect, during their late teen or early adult years. Chief among the delusions affecting Donald, the oldest son, were religious ones. The younger ones also heard voices. One committed a murder-suicide, and another sexually abused his younger sisters. Violence among the brothers was common. Overlooked in all this was that Don Galvin, the father, had suffered a mysterious hospitalization while on duty in the service, which was classified as depression.

Psychiatrists and other researchers were at that time conducting twin studies to examine whether twins were equally likely to develop schizophrenia or not. The Galvin family was a treasure trove.

Still, the family couldn’t resolve the nature-nurture debate. Were the six boys affected by defective genes? Or was their illness because they had all been raised in the same household? DNA study was in its infancy. Most of the family agreed to interviews and blood studies, though they proved not to be much help.

Of course, the children, when they began to have children themselves, were afraid that the family affliction would be passed down to them. One of the young women put her child in therapy at a young age, hoping to spot incipient signs of psychosis. This choice did possibly more harm than good, as the young boy never developed any symptoms and resented the unnecessary therapy.

The heroines of this story were, of course, Mimi – who cared for all her children as best she could, and her husband after he had a stroke in later life – and Lindsay, the youngest child. The care for her schizophrenic brothers was her purview – monitoring their health, their medications, their hospitalizations, and their money, as well as caring for her mother, who became incapacitated in old age. The mentally healthy brothers and the older sister largely detached from the family and went about living their own lives.

Why read this book? It delves into how schizophrenia can affect not just a person, but a whole (and large) family. It illuminates the struggles the family had to deal with in caring for the brothers who had mental illness. It records how treatments for and research about schizophrenia over the years worked and didn’t. And it’s a well-written book on top of that. I could easily have read it in a couple of days, but I stretched it out over weeks to savor and contemplate.

The book rings with authenticity, as interviews with all of the family and records of their therapy and hospitalizations were made available to the writer. It resonates with pain, frustration, pity, courage, illness, relapses, and desperation. It is truly the best chronicle of schizophrenia I have read. I can’t recommend it highly enough.

My Happy Holiday Hypomania

This holiday season is likely to be an up and down thing with me. (Imagine that!) I started out with a definite fit of hypomania that has lasted for several weeks, but I fully expect to hit a patch of depression, which is common for me around the holidays.

That manicky feeling was exacerbated by preparations for Thanksgiving, which largely centered on finding a local restaurant that was going to be open and deciding among the choices. We did find a place that was open and merrily over-ate, with drinks and dinners and desserts galore. (There are only the two of us, with no family in town. I cooked ratatouille for Thanksgiving last year, but was too jittery to plan anything of the kind for this year.)

In the past, over-cooking has been one of my slightly manicky reactions to the holidays. Over-baking, really. I remember baking multiple loaves of banana bread and raisin spice cake as Christmas gifts for all our friends one year, even those who lived out of town. (Mailing baked goods is probably best left to the professionals.) Manicky cooking behavior can be seen as normal, or even celebrated, during the holidays. We all know someone who gives out not just leftovers from Thanksgiving dinner, but whole home-baked pies.

The shopping that surrounds Hannukah and Christmas and the partying that goes with Thanksgiving and New Year’s Eve make it easier for one to indulge in hypomanic or manic behavior without sending up as many red flags as they might at any other time of the year. Usually, holiday depression gets all the attention, and there is certainly more than enough of that to go around. But this year my anxieties – which is how my hypomania usually manifests – have tipped over into a spending spree.

Shopping online made it an easy thing to fall into. Having PayPal and, this year, credit cards, made it even easier. I did try to shop around and limit myself to sale items, but by Black Friday and Cyber Monday, I had packages being delivered nearly every day – sometimes more than one. I like to think that I was able to keep the total down, but it really was excessive compared to my normal purchasing patterns. I primarily bought ebooks and pajamas, which says a lot about my lifestyle. I also ordered two expensive gifts for my husband, one of which is stashed in the back of my closet and the other not scheduled to arrive until January. Today I ordered a small gift ($25) for him and then two tie-dyed t-shirts. I stopped myself before I ordered more underwear for myself. I still might get Dan more underwear.

My husband noticed the packages that have arrived, of course, and mentioned hypomania to me just as I was about to order more pajamas. “You already have a lot of pajamas,” he said. “You asked me to tell you if I thought you were getting carried away.” That’s true. He does help me track my moods when I don’t realize I’m veering one way or the other, and I have asked him to try to help me keep it in check. I didn’t order that last pair of pajamas, though it was a great sale price.

We’re lucky that this year we had an unexpected windfall, so all my holiday purchasing hasn’t pushed us into financial problems. But as I settle in for the winter in my cozy pajamas, reading my books, I know I’ll have to keep in mind that rush I’ve been feeling ordering online and try to recognize that it’s a function of my bipolar disorder and not just normal holiday cheer.

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Down in the Mouth

Tomorrow I’m going under the knife (forceps, pliers, whatever) to get teeth removed. I’ve written before about my severe dental phobia, but this time there is no other solution. My teeth are bad; my gums are bad. Hell, even my breath is bad.

For this procedure, I will have IV sedation, which is a great relief. Nitrous oxide has never had any effect on me. I have had IV sedation for a dental procedure once before, so I know it works for me.

Due to COVID restrictions, my husband (my emotional support animal) is not even allowed to come into the building or the waiting room. For other, less drastic procedures, he has even been allowed in the treatment room with me, to pat my foot and offer me encouragement. This time he has to wait in the car until the nurse brings me out. That means he stays in the car for up to two hours while I am worked on. I’m glad he has an e-reader and that it’s recently been updated and charged, but still I would prefer a pat on the foot to knowing he’s several doors and a parking space away.

Oddly, I was not nearly this fearful when I had two operations (microlaminectomies) on my back a number of years ago. Perhaps that was because the pinched nerve caused me untold physical pain. That was pain I could understand. All I have with my teeth is emotional pain. For now. I’m sure physical pain will come later, after I regain consciousness.

My memories of dentists and former dental procedures are not good. There have been both physical and psychic pain, shaming, guilt, assorted bodily reactions, and a creeping physical numbness that had nothing to do with Novocain. I have been through procedures both with and without IV sedation. I’ve had my wisdom teeth removed, and another tooth removed and replaced with a partial bridge. I had a tooth that broke and I had a tooth bonded in place, designed to get me through a month or two until I could do a reading from my book. Through careful eating, I made it last five years.

Now, though, there is no getting out of it. I was unable to get these expensive procedures in the past because of a lack of money. Now I don’t have that excuse. Money has been set aside and no other emergency has arisen that requires using it for something else. Needless to say, my insurance doesn’t cover this, and especially not the traveling anesthesiologist. Once I had to abandon fixing my teeth because our transportation gave out, but that’s not a problem this time.

Do I want to get out of it? Yes and no. Dentistry is one of my major phobias (which has no doubt contributed to how bad my teeth are). This has been true since I was a child, and has only grown more extreme. It would be understating the matter to say dental procedures are a major trigger for my anxiety and panic attacks.

I’m also unnerved by how the procedures will resonate through my life for an unknown time. That dental bridge was a significant factor in my self-esteem. If I forgot it, I had to turn around and go home. More tooth extractions will no doubt feed into my isolation. And then there’s the indignity of eating applesauce, soft-boiled eggs, and chicken broth until my poor, abused gums heal. As little as I leave my house now, I will be even less willing to do so for quite some time.

So, wish me luck. Both my husband and I are taking a few days off work, on the theory that the sedation and analgesics may leave me woozy. At least I will be able to keep up with my blogging, since that doesn’t require going outside.

I’ll get through this. But I’m afraid it will leave my emotions as disordered as my mouth.

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It may look like I’m taking my disorder passively. I stay in bed a lot. I seldom leave my house. It’s true I don’t exercise or go out with friends or hike in the woods or volunteer at a charity or arrange spa days for myself or sleep under a weighted blanket. Those may be good, proactive things that people can do in terms of elevating mood and practicing self-care. But I don’t do any of those.

I do all the “required” things, like visiting my psychiatrist regularly and taking all my meds faithfully. But when it comes to more active practices, I fall far short of the “ideal.”

It may look like I’m passive, but in reality, fighting bipolar disorder is a constant struggle for me. It just mostly happens inside my head.

First, there’s tracking my moods. This takes an active awareness of my behaviors and what they may be telling me about my moods. If I find myself spending more money than usual, I may realize I’m drifting into hypomania. If I can’t laugh at jokes anymore, I may be headed towards depression. If I receive an unexpected bill and start to feel overwhelmed, I may be in line for an anxiety attack.

Even activities that seem ultimately passive or ordinary may require positive activity for me. Answering a phone call may take a lot of effort, even if I know it’s a friend calling. Going to the grocery, as mundane an activity as possible, can take a lot of effort on my part – getting out of bed, getting showered and dressed, going out of the house, choosing from the many options at the grocery, carrying my purchases indoors. These are actions that may not seem related to my mental health, but are. And I must struggle internally with doing them. It takes up psychic energy, not just physical.

And what about seeing my psychiatrist and taking my meds? These, though they may seem minimal, are not passive actions either. As with grocery shopping, I must convince myself – even force myself – to keep track of my appointments and show up at them bathed and clothed. I must monitor how much of my meds I have left and pick up refills. (Or order home delivery for meds and groceries, if possible.)

When even the smallest efforts seem to take too much, well, effort, trying to accomplish them is at heart a mental battle – to think of what needs doing, convince myself I need to do it, plan for it, prepare myself to do it, attempt to do it, and, if I fail, try again later.

Lying in bed may seem the ultimate in passivity, but there can be a constant, very real struggle going on. On one hand, there’s trying to get to sleep and stay asleep. On the other hand is the struggle to get out of bed and do something – anything. Even if my struggles aren’t successful, that doesn’t mean that I am passive. They can be exhausting (though not enough to sleep). They can require tremendous mental effort, which is sometimes more difficult than the active kind for a person with a mental disorder.

So, no, I am not taking bipolar passively. I am fighting to get through it, to conquer it, to keep it at bay, to not let it win. Giving up would be the ultimate passivity, and I’m not going to allow myself to do that. I will continue struggling with my disorder as best I can, determined to do all I can to meet it actively, with intention, and with repeated efforts if necessary. And not beating myself up when I find myself being reactive rather than proactive. It’s important for me to remember that I’m doing the best I can with what I have. And that I dare not be truly passive when it comes to my mental disorder, lest it take over again.

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