Bipolar 2 From Inside and Out

Do My Friends Really Like Me?

There have been times in my life when I thought I didn’t have a friend in the world, and my disorder was the cause of it. I was just too weird, too odd – unlovable. I didn’t fit in anywhere, with anyone.

Actually, it started in my childhood. I had the idea that my parents only loved me because they had to – because I was their child. Ergo, if I weren’t their child, they would never love me. This was very untrue and unfair, I now realize, but I lived the early part of my life believing it.

I had very little evidence that I could make friends. I just never seemed to get the hang of it. There were kids in the suburban neighborhood where I lived, but we didn’t form what you would call lasting friendships. As I recall, there were two sisters who tried to humiliate me with a cruel prank involving a Ouija board and tape-recorded “messages” from the beyond.

In third grade, children threw stones at me. I had to have three stitches in my forehead. Another kid chased me around the schoolyard with a hypodermic needle that I hope was imaginary. My “best” friend in junior high school literally kicked me in the ass in front of a group of younger kids, which led to the first major meltdown that I can remember.

Though now, looking back, high school was the time when I began to embrace my oddity. I wasn’t diagnosed yet, so I didn’t know that the depressive and manic episodes were responsible, but I was learning that there were people who would accept me regardless. I had a tight little group of three or four friends, most of whom are still my friends to this day. They taught me that lasting friendship was possible. In college, I acquired another tight little circle of friends – and one disastrous train wreck of a relationship that left me with defective coping mechanisms such as self-harm.

Since my diagnosis, I’ve found more friends. Several have not been able to adjust to my mood disorder and have broken off contact. It hurt badly, of course, but I could see their point. When I was at my lowest point, I was not able to be a good friend to them either.

So, how has bipolar disorder been involved in my friendships (or lack thereof)? First, with all the chaos inside my head and my constant need to deal with it, I didn’t have much energy left to find friends. When I did get close to people, I ended up pushing them away with my erratic behavior. Only a few kindred souls stuck with me.

I suffered from imposter syndrome too. I thought that it might look like I had friends, but they would soon realize how damaged I was and leave. Or I believed that I was faking being a friend and really had no idea how to go about it.

I ghosted people without intending to when I went into a depressive episode. If I met them when I was manicky, I might be the proverbial life of the party, entertaining with my peculiar sense of humor. The next time they saw me, though, I might be an uncommunicative, weepy lump.

Still, there are people who have known me through the whole range of my moods and my disorder, and I am confident that they are my true friends. They really like me (shades of Sally Field!) and some even love me. I have Facebook friends that I keep in touch with regularly. They provide me a link to the outside world. I have IRL friends whom I see occasionally (we tend to live in different states). I even have a few friends nearby.

I love my friends. Because of how hard they’ve been to come by, I value them greatly. They have stood by me. They have invited me to dinner, to their parties, and on their vacations. They have comforted me when I was down, distracted me when I was anxious, and enjoyed my company when I’ve been stable. They’ve cried on my shoulder and I have cried on theirs. They’ve bought my books. Some have even lent me money when I really, really needed it. They have become my family of choice.

I treasure every one of my friends – especially my husband, who is my best friend. I wouldn’t be where I am today without them.

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When a lot of people hear the word “routine,” they think “rut.” My opinion, though, is that routine and rut are completely different. A rut is what you get into when you have nothing else in your life but work and chores, while routine is something that provides structure to your day. Of course, a routine can become a rut, if it’s not flexible enough to make room for variety somewhere.

What I think routines are particularly good for is self-care.

Let’s consider how you develop a routine. The business concept of “time-blocking” will help.

Time-blocking is a method of scheduling that relies on dividing your day into blocks of time (duh!) for each of your tasks or activities. A businessperson might have time blocks reserved for “planning meeting,” “business lunch,” and “create spreadsheet.” They estimate how long each will take and adjust the time blocks accordingly. If their time estimates are off, they revise for the next day or week.

One of the principles of time blocking is grouping similar tasks together. For example, one might have a single time block for making phone calls or answering emails. Another one is to leave some blocks empty so they can be used for tasks that you may not have completed or blocks that had to be shifted because of having to put out fires.

You can do time-blocking on a daily or weekly paper calendar, but business books recommend using scheduling software. I like the idea of using an erasable board that you can put up on your refrigerator or in another convenient place.

How does this relate to self-care? Well, it’s a good idea to make self-care part of your routine, and time-blocking is one way to develop that routine.

The first things to schedule are good habits that help you manage your disorder. For me, these are medication, food, and sleep. I take my meds as soon as I wake up and on my way to bed. I don’t consider that a time block, more like a habit, something to check off on a mental list.

I usually wake around 7:00, unless I have a work assignment that needs to be turned in early in the morning. I usually go to bed around 9:00. I need lots of sleep.

I have a time block for lunch at 12:00 and for dinner at 6:30. I make sure to have food on hand that is easy to prepare for lunch – cheese and crackers, soup, applesauce, and so on. My husband makes dinner because he wants to make sure that I eat at least one complete meal every day.

The other important time block for me to schedule is work. I’m a gig worker, so my assignments can vary. Generally, though, I work until about 11:00 in the morning and till 4:00 or 5:00 in the afternoon. I try to make working a habit, too. It keeps me from falling too far behind if I have a day when I’m simply not able to face getting out of bed and working.

You may have noticed that there are gaps in my schedule of time blocks. These are when I fit in self-care. In the morning, I have time for checking my email and Facebook. Why are these self-care? They’re the ways I keep in touch with friends and acquaintances – the outside world in general.

In the afternoon, between work and dinner, I watch some TV, usually cooking shows, which I find comforting. After dinner, I have time with my husband to see a movie or binge-watch a favorite series. When I take my meds and go to bed, I read for about half an hour. All these are part of my self-care. A person needs to set aside time for relaxation, which is a vital part of self-care.

Sometimes, I have to set aside a time block for something else. If I have to go out somewhere, I usually schedule an hour before I have to leave. It sometimes takes me that long to shower, dress, put my hair up, and make sure I have everything I need in my purse. I know that, so that’s why I leave an hour for it. Then there’s time for whatever errand it is, or maybe lunch out on my husband’s day off.

That’s my daily schedule of time blocks. I also have a weekly set of time blocks. I try to have a first draft of my blogs done on Thursday, finish them and tag them by Friday, proofread on Saturday, and post on Sunday. This is something that’s not quite work, because I don’t get paid for it. It’s something I do for myself and I get satisfaction from it, so I think of it as a self-care activity.

I also use my Google calendar to keep track of things that need to be done monthly – bills, recycling, doctor appointments for me and my husband, deadlines for my gig work, and so on. That’s self-care too, because I suffer an unhealthy amount of stress if our finances get out of control. Reducing stress is part of keeping me on a steady course. I could use the weekly or daily functions, but those are tasks I’m used to after getting into the habit for so long.

I prefer having these times and tasks in a reasonably consistent schedule, with some room for adjustments. Routine helps me get done what I need to do and enables me to schedule self-care too, rather than leaving it to last.

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What Speech Reveals

What you say says a lot about you. How you say it matters too. You can take a simple sentence and change its meaning just by how you pitch your voice and what words you emphasize.

Try it: Say the sentence, “I want you to love me.” Emphasize the “I” and you’re saying, “I, as opposed to anyone else.” Emphasize “want” and you mean “I want it, even if you don’t believe it.” If you come down hard on “love,” you mean “I want love, not friendship.” An emphasis on “me” translates to “I want you to love me, not that other person.” It works for nearly any sentence: “Please close the door.” “You have my attention.” “Why don’t you care about me?” We translate these meanings naturally and internally, without really thinking about them.

Changes in language can certainly be revealing. In fact, there are several different kinds of speech that have a role in mental illness. They can be indicative of a certain kind of mental illness or of the way that a person is feeling. They can be used in diagnosis. They can be a way to better understand what a friend or loved one is going through.

Pressured speech

Pressured speech means that words seem to just tumble out, without much thought as to what is being said. The words come quickly, packed together like little freight trains of meaning that will zoom by if you don’t pay attention. Listening to pressured speech can be both confusing and overwhelming, difficult to understand.

Pressured speech is common in bipolar disorder, especially in manic episodes. People who are experiencing mania feel a compelling, urgent need to share thoughts, ideas, comments, or emotions. They don’t wait for replies, as one would in a normal conversation. They can also speak inappropriately loudly or at inappropriate times, such as in church or during a lecture or concert. Pressured speech can last for an hour at a time or even longer.

Because they are speaking so fast, people with pressured speech may even have difficulty expressing their own thoughts. There can be a lack of a clear thought process in what the manic person is saying, as they may talk about many things that don’t connect to each other. Their speech may include jokes or rhymes, song lyrics, and such.

It does no good to ask a person with pressured speech to slow down or stop talking. They may feel like they must keep talking, as if they can’t stop.

While pressured speech is most often associated with the mania or hypomania of bipolar disorder, it can also happen with schizoaffective disorder, autism, psychosis, ADHD, or an anxiety disorder.

Flat affect/emotional blunting

Flat affect means that you’re not demonstrating much of an emotional reaction to a situation. Inside, you may feel happy, for example, but it doesn’t show on your face or in your speech. The inside and the outside don’t match.

Emotional blunting is a little different from flat affect, though. With emotional blunting, you don’t feel an emotion internally at all. You might not feel at all interested in a book or a movie that once gave you pleasure or laughter, for example. This results in flat, unemotional, dull speech patterns.

Flat affect and emotional blunting are in some ways the opposite of pressured speech. They may occur when a person is depressed, in shock, or suffering from PTSD or other conditions. It’s a symptom of some illnesses, but not an illness in itself.

Word salad

“Word salad,” also called “schizophasia,” means a confused mixture of seemingly random words and phrases. It happens as a result of a neurological disorder like dementia or a stroke, or a psychiatric condition like schizophrenia. The words can be grammatically correct or not, but they make no sense. One example of word salad would be a person saying, “That clock has a headache.” It’s a real sentence, but it has no meaning that a listener can discern. The person producing word salad may not be aware that they are not speaking coherently.

There are several ways that schizophasia can be expressed. “Graphorrhea” is word salad in writing. “Logorrhea” means excessive talking, but without the attempt at clarity of pressured speech. A “clanging” speech pattern uses rhymes or other sound associations rather than trying to construct meaning in the usual way.

As for me, a person with bipolar disorder, I have experienced emotional blunting often and pressured speech a couple of times. My hypomania tends to have other manifestations such as reckless spending. My husband can tell when I’m nearing or in a depressive episode when I speak mostly in a monotone, with single-syllable responses to most questions. But my lifelong fascination with language has made me aware of the psychological and psychiatric implications of speech. And my lifelong experience with bipolar disorder has made me keenly conscious of the way in which speech interacts with mental illness.

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What Is Mental Wellness?

Seeing that I spend so much time in my blog discussing mental illness, a friend challenged me to say what “mental wellness” looks like. I’ve decided to take a crack at it.

First, I have to say that I’m not sure mental wellness really exists. Everyone (at least everyone I know) seems to have assorted neuroses and minor phobias. These are generally subclinical, though, so they don’t really count as mental illness. Anyone with them, therefore, could be defined as mentally well, I guess.

But really, who is mentally well? A lot of people – maybe most – believe they are mentally well. Not all of them are, given that many people with mental illness can be in denial. Of course, mentally well people can also be in denial about various things. They could be in denial about their own personality traits or those of their friends and loved ones. They may, for example, overlook the fact that they are quick to take offense or that Aunt Nancy is very judgmental. Those may be character traits or even character flaws, but they aren’t mental illnesses.

I have a mood disorder myself, so I’m particularly attuned to how people deal with their moods. Everyone has them. Let’s consider depression. Everyone feels depressed from time to time. (There are people who insist that they are constantly positive or at least aspire to that state, but I do believe that in their heart of hearts they occasionally feel down when no one’s looking.) The hallmark of clinical depression is how long it lasts and to whether it descends at random on a person who has no “reason” to be depressed. But how long is “too long”?

I would guess that people who are mentally well seldom experience more than a few days to a week of depression, unless they are experiencing particularly – well, depressing – circumstances, such as not getting a job or being rejected by a romantic partner.

The time limit criterion breaks down in the case of the death of a loved one. Grief takes as long as it takes, and depression is often a component of grief. My mother-in-law, for example, suffered such grief after her husband of 50+ years died that she was virtually incapacitated for months. And her depression continued for some months after that. Yet I would not say that she was mentally ill. To me, she still fit in the category of mentally well. Reactive depression is different from clinical depression.

I would say that one definition of mental wellness is the ability to cope. With most things. For the most part. Most of the time. I know that sounds wishy-washy, but the fact is that no one, mentally well or not, copes well with everything all of the time. It’s just not in human nature. I think of it this way – just as it’s said that you have a drinking problem when your drinking causes problems (financial, legal, relationship, or whatever sort of problems), you have a mental problem if your lack of coping causes you problems in the same areas. Certainly, mentally well people can get overwhelmed at times by the demands that life places on them. And some people with mental illness can cope relatively well. I like to think that I do, now that I’m reasonably stable on medication and with therapy.

I’m starting to get to the point where I say that someone who is mentally well is simply someone who is not mentally ill. But that’s not really a good answer.

I can say that mental wellness is not a matter of being “shiny, happy people.” Everyone’s life is filled with trials and darkness as well as joy and light. Everyone struggles at some time. But not everyone is mentally ill. So, the question really becomes not what is the definition of mental wellness, but what the definition of mental illness is. We have the DSM, but it’s made up of descriptions rather than true definitions. And you get into some gray areas. Are personality disorders mental illnesses? (I don’t know.) Is autism a mental illness just because it’s listed in the DSM-V? (No. Just no.)

So, to the person who challenged me to say what mental wellness is, I would ask in turn what your definition is. Does anyone else have a better idea of what mental wellness means? I’d love to hear it.

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What’s Really Scary

It’s very nearly Halloween and there are lots of scary things out there, from costumes to movies. But here’s what I find scary.

My number one fear is the return of my bipolar symptoms, especially the depression. I’ve been mostly stable for years now, with only occasional and relatively mild symptoms when I relapse. But I still remember what it was like and I don’t want to go back there. The misery and the hopelessness. The numbness and the pain. The lack of joy, or contentment or, for that matter, even blankness.

Hypomania isn’t as scary, though I know it can and does recur from time to time. I don’t have a history of extreme symptoms and, with my husband’s help, I’m able to navigate the ones that do occur.

I can handle it if I get mild “breakthrough” symptoms when I encounter triggers. I have coping mechanisms in place, including simply waiting for them to pass, because I know they will. That trust in my resiliency – and my medications – has grown over the years.

Still, there’s always the thought in the back of my mind that the efficacy of my meds could wane. I could crash again. There’s no guarantee.

Then there’s the fear that I could develop a batch of new symptoms, triggered by God only knows what. I know that some people with bipolar disorder have hallucinations, hearing or seeing things that aren’t there. One friend of mine has heard voices for years, and another one is visited at times by an imaginary animal. (He doesn’t mind it; he says it’s always been pleasant.) Again, not likely, but then again, my brain has already been proven to be glitchy.

Of course, I do find other things scary. I am terrified of bees, wasps, ticks – anything that impinges on my dermal boundaries. I’ve been stung once and suffered no symptoms beyond the usual, but it did nothing to allay my fears. In fact, I took beekeeping in college, hoping that I would get over the fear. That didn’t work either. I still freeze, shake, scream, cover my head, or run. It’s a phobia, though not a crippling one. It doesn’t bother me enough to try eradicating it via therapy. Besides, if the beekeeping class didn’t help with desensitization, I’m not sure what would.

But there are less personal fears that I have too.

Some are societal problems. Stigma regarding serious mental illness still exists. And although people increasingly seem to be concerned about “mental health,” it turns out what they really mean is usually substance abuse or crime. Initiatives and funding tend to focus on those problems, sometimes to the exclusion of actual brain illnesses – except maybe schizophrenia, and then only as it relates to violence or homelessness. Of course, those are real problems, but there are a lot more people who need to be helped that aren’t getting attention, funding, or treatment.

Speaking of treatment, that’s another subject that’s frightening. It just isn’t available in many locations. I don’t know what the situation is regarding available beds in my geographic area, but I doubt there are many, given national trends and the complete lack of an inpatient ward at the hospital nearest me. If I did experience more extreme symptoms, I’m not altogether sure I could get good, prompt treatment.

Finding a psychiatrist or a therapist can also be difficult, bordering on impossible. When Dr. R., my longtime psychiatrist, retired, I tried to find a new one. I called the doctors he recommended, but none had openings. I turned to my primary care physician, who at least agreed to continue my psychotropics until I could find a psychiatrist. Six months later, I got in to see someone. And that was only for med checks. I had slightly better luck finding a therapist, but it was by no stretch of the imagination a breeze. Fortunately, both have managed to avoid retiring.

Call me a pessimist (okay, I’m a pessimist), but I also fear that things aren’t going to get much better anytime soon.

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On My Own

Earlier this month, my husband went away for 11 days to visit his 96-year-old mother, leaving me at home to fend for myself. I didn’t object to his going (though that hasn’t always been the case on other occasions). But it left us both concerned about how I was going to manage without him for nearly two weeks.

My husband helps me with most of my self-care needs. I guess I shouldn’t even call it self-care because he does so much of it. He makes sure I eat regularly, shops for food, and usually prepares dinner. He recognizes when I’m overwhelmed and gives me a hug. He helps me get ready if I have to go out. He does most of the physical chores. (I do the ones involving a computer, like correspondence, bill-paying, and scheduling appointments.) He calls me twice a day to make sure I haven’t fallen and been unable to get up. If I don’t answer the phone, he rushes home on his break to help me. I really don’t know what I would do without him.

For 11 days, though, I was going to have to. We hadn’t been apart this long for years.

Since one of my major self-care problems is forgetting to eat or not having the energy to make myself something to eat, he stocked up with all the things I like that were easy to fix and eat: juice, cola, ginger ale, yogurt, cans of soup, whole wheat bread, bologna and salami, assorted kinds of cheese, applesauce, and those little frozen meals for useless people like me. There were muffins and frozen waffles for breakfast, peanut butter and mac-n-cheese and spaghetti for lunch and dinner, and even jello and pudding for dessert. Everything that needed heating was microwaveable.

I often eat in my study, where there is a little tray table, so we devised a strategy for getting to and from the refrigerators. The time when I trip and fall most often is when I’m carrying several items and lose my balance. He came up with the idea that I should carry my food items in a plastic grocery bag to and from my room. We have hundreds of those bags. And it worked. I didn’t fall once. I don’t know why we didn’t think of that before.

He still called me every day, though of course there was nothing he could do for me if I fell. In fact, he called me much more often than twice a day, just to talk. We found the thing we miss most when we’re away from each other is simply shared conversation.

I developed a little routine to see me through the days. In the morning, I would have breakfast and watch a cooking show till I was awake and alert enough to start my day. Then I would do my work in the mid-morning until lunch. After lunch, more writing. After dinner, music or TV, or more work, if I had an especially pressing assignment. Go to bed early. Lather, rinse, repeat. Repetitive, certainly, but it seemed to work.

So, what did I learn from this exercise? Well, first of all, I found out that 11 days on my own is a doable thing – if we anticipate difficulties and prep for them. That I am able to continue my daily rhythms and keep up with my work, eating, and sleeping. That I experienced no recurrence of my bipolar symptoms even though my usual environment had changed. (I had been worried about depression or anxiety setting in.) That the loss of my husband’s presence wasn’t crippling. That we managed to retain our important connection despite the physical distance between us.

That photo with this post isn’t entirely accurate, though. I didn’t meet my own needs completely on my own. My continuing self-care still required my husband’s help. But once the systems were in place, I managed. On my own.

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You’ve heard the stories: A homeless man who has been diagnosed as schizophrenic panhandles for change, though few people stop because of his bizarre behavior. He refuses help from a governmental or charitable organization. His family finds him, but he won’t let them do anything to help.

Or this one: A bipolar woman has manic psychosis. She is convinced that her coworkers and people on the street are reading her mind and planting thoughts in her head. She refuses to take her medications because she thinks she doesn’t need them.

Or, perhaps worst of all, this one: A teenager who has been struggling with undiagnosed schizophrenia is convinced his mother is trying to kill him. He threatens her with a knife. The police are called and they shoot the boy.

Extreme stories? Yes. But these tragedies occur nearly every day. Most of them don’t make headlines, but they still cause suffering and even death for countless individuals and families across the US and around the world.

What these three people – and many others – are suffering from is “anosognosia.” It literally means “lack of insight,” but anosognosia is much more than that. It means that a person has so little insight that they don’t even realize that they are mentally ill. They don’t know that their behavior and thoughts are part of an illness.

Anosognosia is not the same thing as denial. Denial is when someone avoids something that is unpleasant or distressing to them. They do realize that there is something wrong – they just don’t want to deal with it. A person with anosognosia doesn’t even realize that there is anything wrong at all. They don’t realize they are mentally ill. Their brains don’t let them see that their thoughts and perceptions are not in line with reality. They don’t realize that their functioning is impaired. They think that they are perfectly normal. If anything, they think that the people around them are clueless and deluded.

Anosognosia is the number one reason that people with schizophrenia or bipolar disorder do not seek treatment or take their necessary medications. By some estimates, it occurs in up to 98% of people with schizophrenia and 40% of people with bipolar disorder. It’s also common in people with Alzheimer’s or dementia. People with anosognosia don’t get the help they need. Their condition doesn’t improve – in fact, it worsens.

So, what’s to be done? One solution may be a program that California Governor Gavin Newsom recently signed into law. It establishes CARE Courts – Community Assistance, Recovery, and Empowerment courts that make it easier for family members, first responders, outreach workers, and others to institute civil proceedings that make it possible to obtain up to two years of mental health services. The person being judged by the court will have access to a clinical team, lawyer, and “volunteer supporter.” Up to 12,000 of the most vulnerable people in California are expected to be helped by the CARE courts.

The program is controversial, however. Critics have said that the plan amounts essentially to forced treatment. Civil rights and disability groups are not in favor, though the program has been described as “voluntary.” In theory, a person would still be able to refuse treatment. And if the person has anosognosia, that might well be the case. The CARE courts plan is similar to another potential solution recommended by some clinicians – Assisted Outpatient Treatment (AOT). It’s not clear where the state would find people qualified and willing to monitor patients’ treatment and medication compliance. In Santa Clara County, AOT treatment consists of “intensive individual and group clinical services, peer support, intensive case management, housing assistance, 24/7 clinical crisis support, and medical evaluation.”

One of the most frustrating things about trying to get help for someone with anosognosia is the lack of appropriate treatment facilities, mental health workers, and other services. With many of the sickest patients being held in overcrowded emergency rooms or held for only 72 hours in a hospital ward, the situation is extremely complicated and not easy to solve. But if AOT or CARE courts keep mentally ill people out of jails and prisons, which typically provide either inadequate or no psychiatric treatment, that’s a good thing.

Most people with psychiatric disorders may hear about anosognosia and think, “Oh, that could never happen to me.” But the reality is that a person with anosognosia doesn’t realize when it is happening to them. It’s not an easy problem to solve, but educating people about anosognosia and developing plans for dealing with it are vital. It’s the most vulnerable members of society – and their families and friends – who are most affected by it. They need our help, even if they don’t realize it – or particularly when they don’t realize it.

This post first appeared on The Mighty.

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Three Days in the Life

What’s it like to have bipolar type 2? Here’s a look at three typical days.

It’s a day when I’m depressed. I wake up late and try to decide whether to get out of bed. I do so in order to take my meds, since I have to go to the bathroom anyway. If I have anticipated this depression, I will have left a box of Cocoa Puffs by my bedside, and these constitute my breakfast.

If I stay in bed all day, I am bored, because I can’t even focus enough to read. Everything I try to read means nothing to me. If I get up, I spend a large part of the day on the sofa, watching horrible reality shows that remind me that there are other people with crappy lives too. I skip lunch. I forget that I have an iPod with thousands of songs on it. I skip therapy appointments because I’m unable to get up and dressed and drive there. I feel numb and useless and pathetic. My brain reinforces this belief.

In the evening, I cry. I weep. I sob. Snot runs from my nose. I have circling thoughts about every stupid, embarrassing thing I’ve ever done. I try to wait till my husband’s asleep so he won’t hear me crying. I wake in the middle of the night, still crying.

I have anxiety attacks too, particularly when I’m in bed at night. I wake gasping. My husband holds me and strokes my hair until I fall asleep again. It’s really all he can do for me.

My psychiatrist and I keep trying different meds, but none of them does more than take the edge off a little. I still can’t function.

There is nothing I can do to change any of this. I can’t cheer up. I can’t even see a time when I won’t feel this way. This goes on every day for months. For years, even. I’d hope for an end to this, but I have given up on hope.

______________________________________________________

It’s a day when I’m hypomanic. I wake up early, not exactly refreshed, but with a more-than-usual alertness. I take my meds, then go downstairs and have a muffin and a container of yogurt for breakfast.

I go to my computer and start writing. I may have an assignment – typing or ghostwriting – or I may just work on new blog posts. The momentum of writing stays with me and presses me to keep going. I write lots, but badly. Maybe I forge ahead and write another blog post or volunteer for more typing. I forget that I need lunch.

I jump around from project to project. I scroll and scroll through Facebook. I check my email every few minutes. I go to clothing websites and order underwear and pajamas and blouses. I look at jewelry, too. I check my bank account at least four times.

I don’t read, because nothing holds my attention. I watch competition shows because of the excitement. I try to listen to music, but I can’t finish one song without flipping to another.

I may notice that I’m hypomanic and try to control it. This goes on for a week or so. I hope it ends soon.

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It’s a day when I’m stable. I wake up after nine hours of sleep and take my meds. I have a bowl of oatmeal and a cup of tea for breakfast. I check my calendar and see what I have scheduled for the next few days, such as an appointment with my therapist or finishing my writing or typing assignment. I have peanut butter and fruit for lunch.

I do my work. I reread what I wrote when I was hypomanic and immediately start revising it – if I haven’t already submitted it. I take on new assignments and try to space them out so they’re not overwhelming. Sometimes I even succeed. I keep a calendar on my computer with dates of appointments for both me and my husband, when assignments are due and when bills need to be paid, and which week is recycling week.

I meet with my therapist once a month via video chat and see my psychiatrist four times a year for medication updates. The only time I miss one of those is when my car is at the mechanic.

I’m very close to “normal.” I hope this goes on forever.

This post first appeared on The Mighty.

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Sometimes when I’m hypomanic, I write. I think that my writing is terrific. This does not always prove to be the case.

I wrote a murder mystery for literally years on and off. I put heart, soul, and sweat into it. I kept revising. I had a bulletin board with index cards of plot points that I moved around, trying to find the best sequence and flow. At last, one day I declared it finished.

I sent a query and a sample to over 100 agents and publishers. I waited. I kept a list of everyone I contacted about my novel, and I marked them off the list when they rejected me. None of them bit except the you-pay-us types that I had accidentally included and scorned. My prospect list was long, so this went on for months.

No doubt I was hypomanic when I decided the novel was done, and when I sent those queries. I wasn’t even deflated when I started getting rejections back. Out of 100 queries, I thought, surely there would be some takers. Maybe there would even be a bidding war for the publishing rights. I started doing research for the sequel and even started writing it.

As I waited, I basked in thoughts of success. I would be a guest at mystery conventions. I would do a book tour. I even imagined that I would receive the Edgar Award (mystery’s Oscar) for Best First Novel. I pictured myself receiving the email telling me that I was nominated and the phone call informing me that I had won.

Of course, I eventually came down when one of the rejections actually told me why my manuscript was being rejected and what was wrong with it. Faced with that reality, I had to admit that I had deluded myself. I had needed to rework the novel a lot more before submitting it. I had needed to workshop it with fellow writers, preferably those who knew something about mysteries. (I had sent the first few chapters to some volunteer beta readers, but they had made comments only on small details, not the structure, pacing, or characters.) I realized at last that I had submitted a manuscript that had a great prologue, but that everything after that needed serious work. Despite the time and effort I had put into it, it just wasn’t good enough. And that was the reality.

That was the longest spell of hypomania I’ve ever had – about a year. Of course, I was doing other things while I wrote and while I waited. I had some depression and some mixed states, but not about my mystery novel. I was exhilarated with that.

What I had were delusions of grandeur. I imagined the success without putting in enough work to achieve it. Despite the evidence of all the rejections, I persisted in believing that I had produced something wonderful and worthy. I anticipated plaudits and acknowledgment of my writing prowess and remarkable achievement. My hypomania was giving me messages that I was great, just as my depression had always given me messages that I was nothing. And I was deluded. I believed the hypomanic messages.

I have abandoned that manuscript and taken up other projects. I have also abandoned my research and writing for a sequel. I still have problems recognizing the actual merits of my writing, or lack thereof. I try to keep my expectations in check. I have some successes and some failures, though none nearly as monumental as the mystery. I live with my limitations instead of flying with my fantasies. Have I lowered my horizons? Well, yes. But I like to think that now, at least most of the time, I view the horizon where it really is.

I did love the exuberant feelings that I experienced. They gave my life a sense of meaning. If I learned anything from the experience, it was that I couldn’t, or at least shouldn’t, pin my sense of personal worth on something that isn’t real.

Of course, when I’m in the grip of hypomania, it’s hard to realize that.

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Body and Brain: Self-Image

I’m fat. I admit it. I haven’t been fat all my life, so this came as something of a surprise to me, but I’m dealing with it. I don’t know whether it’s my eating habits or my medication or some genetic thing that has caused me to gain weight, but there you have it. It could be any or all of those.

I’m not trying extreme diets or grueling workouts, though I admit that some exercise would be good for my mental condition as well as my body. I’m living with and acknowledging the fact that I am fat.

The thing is, when I think about myself, I don’t think of myself as fat. Perhaps I’m in denial about it. But I do know how much I weigh and that it’s over what I should, according to all the height vs. weight and BMI Index charts. And I don’t think of myself as thin. I just feel as though I’m still in my 30s and weigh what I weighed then, despite my body’s very clear rejection of those notions. I know I’m really in my 60s and have trouble getting up off the floor if I fall, in part because of what I weigh.

I’ve heard that everyone gets stuck in their head at a certain age and always remains that same age in their mind. It’s not quite like having an inner child of four or ten (or in my case, more like 15). I used to think I didn’t have an inner child until I remembered how much I still love chocolate milk, plush animals, and naps. And I do have that inner teen that wants to make up for all the things I missed when I was a depressed teen, like mad crushes and experimenting with fingernail polish and fake nails. But having an inner weight is different somehow. It’s like my brain and my body are clashing in some way.

At least I don’t have Body Dysmorphic Disorder. That’s when you see tiny, imperceptible flaws in yourself and magnify them until you think that’s all people see when they look at you. Technically, it’s not the same as anorexia because, in anorexia, you focus only on your weight even if you are thin. Anorexia is an eating disorder that you have as a reaction to your flawed perception of your body size. Dysmorphic Disorder is more about smaller perceived flaws such as balding or the size of your nose. (The Mayo Clinic does say that Body Dysmorphic Disorder can cause or be associated with eating disorders, low self-esteem, mood disorders, obsessive-compulsive disorder, and substance abuse. The DSM-5 does not classify Body Dysmorphia as an eating disorder. It’s confusing.)

One of the dangers of Body Dysmorphic Disorder is overuse of plastic surgery, which can be somewhat of an addiction in itself. Just watch a few episodes of the TV series Botched and you’ll see what I mean. There are always horror stories like the one in which a young man wanted to look like Michael Jackson and as a result of repeated surgery suffered the same health problems and conditions that the singer did.

If I had Body Dysmorphic Disorder instead of the ones that I do have, I might be undergoing multiple treatments of liposuction, “cool sculpting,” tummy tucks, gastric bypass, extreme fad diets, weight-loss pills, and other procedures. I don’t and won’t. I’m aware that those are only temporary fixes and leave you open to disappointment, infection, scarring, and other bad effects and complications that can be worse than your original condition and stay with you for life.

So, where does that leave me? Besides fat, I mean. I try to be body-positive about people who don’t conform to societal messages about weight, including myself. It’s a difficult thing to get over. The messages are relentless. I have found myself in the past thinking that fat is unappealing and in the present thinking that extreme thinness is dangerous. But that’s only in the abstract. Any number of men I’ve been attracted to have been anywhere from pudgy to fat, including my husband.

I realize that I may get a lot of pushback from people telling me of all the medical reasons I should lose weight. I’m not saying they’re wrong. I’m just saying that if I’m comfortable with being fat, they could at least be okay with my fatness as well. In other words, I already struggle with my mind. I don’t want to struggle with my body too.

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