Bipolar 2 From Inside and Out

I’ve heard that narcissists (and multiple murderers) have too-high self-esteem. I’ve also heard that they have low self-esteem. Which assertion is right? Surely they can’t both be!

Self-esteem became a big topic of conversation in the 1980s. That’s when self-esteem programs for children were beginning to be taught in schools and preschools. There were many questions about them, some of which I asked when assigning a writer to a story about them. (I was an editor for a publication for childcare workers and daycare owners at the time.) Why do children need self-esteem programs? Doesn’t daily living foster self-esteem? What can self-esteem programs do that parents and teachers can’t or don’t? The writer seemed taken aback, but bravely tackled all those questions and wrote a fine article on the subject.

Later, the self-esteem movement came into disrepute and was the subject of much mocking and more authentic criticism. Chief among the things detractors made fun of were “participation trophies” given to every participant in a game or sport, spelling bee, or whatever other sort of competition. Complaints included that this negated the idea of competition altogether, falsely inflated children’s sense of accomplishment, shortchanged children who had truly excelled, and was a touchy-feely practice that had no place in the realm of sports or other competitive areas.

It was also thought that self-esteem programs were teaching the wrong lesson. Instead of learning that effort doesn’t always achieve the desired results, children were learning that everyone was as good as everyone else, which seemed like a mistake to some. Self-esteem programs were also said to lead children to the idea that the world was a kindly place where they would be rewarded just for existing. Instead, they should “toughen up” and learn that the world would deal them harsh blows at times and that they needed to be ready to cope with them. Debate continued about when and where such a lesson should be taught and even if it should be taught at all.

How does this relate to the aforementioned narcissists and toxic people? The two theories about their level of self-esteem seem contradictory and counterintuitive. Do they have low self-esteem? It doesn’t seem like it, the way they take control over others’ lives and manipulate them. Do they have high self-esteem? This sounds a little more plausible.

Reconciling the two theories is problematic. On the one hand, these people’s self-esteem seems to be too great, so they feel they are special and entitled to control other people who aren’t up to the same standard. On the other, their self-esteem might be too low, driving them to overcompensate for their lack by acting powerful and controlling others.

It seems unlikely that both of these mechanisms could apply to a single person. How could they feel genuinely powerful and compensate for being less powerful at the same time?

But, at its heart, true, healthy self-esteem isn’t about power. It’s about loving, accepting, and appreciating yourself for the good qualities that you do have. It’s about recognizing that your place in life is to be neither a doormat nor an idol. It’s about having confidence in yourself that you can face obstacles – though not conquering every obstacle – but knowing your limitations.

Does life teach self-esteem? It can, certainly, if a child is raised in a supportive, encouraging environment; if the child learns that both effort and accomplishment are possible; if the child has role models for self-esteem; and if good lessons about self-worth are taught in the home and at school.

Of course, we know that not all children are raised in such an ideal environment. Probably far too few are. Or children receive mixed messages about self-esteem from parents, schools, religion, and other places where they get training for life events: not to be unrealistically proud but to be proud of achievements; to be humble or to be confident; to be assertive or to obey authority; to share with others or to know what’s theirs and defend it; to cooperate or to take the lead.

Self-esteem is particularly difficult for those of us with brain illnesses or psychological disorders. We may feel broken, unsure of ourselves, and clueless about where we fit into society. In the grip of mania, we can feel ten feet tall and bulletproof. When we are depressed, we can feel worthless. In bipolar disorder, in particular, the two states can be encompassed in a single individual at different times.

But this is not to say that people with psychological challenges are all narcissists. Far from it. I would say that in every person, there are varying degrees of longing to have control and desire to relinquish control. It’s achieving a healthy balance of these two things that’s the real trick.

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When I was a teen to early college age, my main mental health goal was staying out of an inpatient department of a hospital or other mental health facility. I knew, though I wasn’t yet diagnosed, that there was something wrong with me – that I had some kind of mental health problem based on my aberrant behavior and how people reacted to me. That fear has never completely left me, though as I’ve grown and learned more about my diagnosis of bipolar disorder with anxiety, I’ve come to think it is less and less likely. Yet I know that bipolar can sometimes lead to psychosis and necessitate hospitalization. That’s not as likely to happen to me as a person with bipolar 2, but it still crosses my troubled mind.

Later in life, it became my goal to find a therapist and a psychiatrist who could help me. I tried various ones, including ones through EAPs, therapy groups, and couples counseling. Some seemed to help, but others were spectacular failures. Some positively shredded me, leaving me worse off than when I came in. Others misdiagnosed me (which I can’t really fault them for, as bipolar 2 was a rare or even nonexistent diagnosis when I started looking for help). Among other things, I learned that group therapy was not for me. And I learned that Prozac did help, at least to some extent.

At that point, my main mental health goal was to find someone who could tell me what was happening to me and to figure out what could help. I no longer remember how I found him, but eventually I came to Dr. R. He was the one who finally gave me the correct diagnosis. Then my mental health goal became finding a medication that would help me with this new diagnosis better than Prozac did.

Dr. R. was patient with his patient. He and I began a journey that lasted for several years, trying one medication after another and then combinations of medications, in hopes of finding a “cocktail” of drugs that worked for me. That became my new mental health goal – along with enduring the years of failures as just the right combination eluded us.

One of my other (it seemed irrational) fears and mental health goals was to avoid being subjected to electro convulsive therapy (ECT). But that became a real possibility when my case proved so resistant to medication that Dr. R. recommended it. I freaked out. It seemed that my fears were about to become reality. I eventually agreed with him that it might be necessary and began to prepare myself for what had seemed to me like an ultimate horror, right up there with being hospitalized.

Fortunately, however, Dr. R. had one more medication in his arsenal and it proved so effective that the ECT was deemed unnecessary. We achieved that effective cocktail of medications that would stabilize me.

Then Dr. R. retired. Immediately, my new mental health goal was to find a new psychiatrist who could prescribe for me and a therapist who could help me with the day-to-day difficulties of living with bipolar 2. It took a while to find a psychiatrist who had an opening – though with a wait of about six months. (My primary care physician continued writing prescriptions for me while I waited.) Eventually, I found Dr. G., who said that, as I was fairly well stabilized on my assorted medications, he needed to see me only four times a year for maintenance and to tweak my meds if I encountered any further difficulties.

It was also time to choose a therapist, and my goal became finding one that I meshed with. (I had learned this was necessary from all the bad experiences that I had had in the past.) I started “interviewing” therapists. I tried to find one that had dealt with mood disorders in the past, wasn’t a Freudian, and could come at things from a feminist perspective. I found Dr. B. I wasn’t exactly typical of her patients. She dealt mostly with college students. (Her practice was in a clinic within the Student Union building at a university that was, fortuitously, right down the road from me.) I have been with her and Dr. G. ever since.

My current mental health goal is to maintain – the medications I’m stabilized on and the sessions with Dr. B. to help me navigate through the difficulties such as anxiety that still pop up from time to time.

It’s a whole lot better than having that goal to stay out of a mental hospital.

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What are boundaries and why is it important to have them?

Boundaries are limits in a relationship that your friends, partners (and relatives) need to observe. They can be simple or complicated. They can address different aspects of a relationship – social, emotional, or physical, for example. And there can be different levels of boundaries that you set.

In the kink community, boundaries are set before a consensual relationship starts. The different levels are “hard no,” “yes,” and “maybe.” It’s easy to understand what hard no and yes mean – that the person simply will not perform certain acts or gives voluntary consent to them. The maybe category is a bit trickier. These are acts that the person is willing to consider or try, but hasn’t definitely either agreed to or ruled out. That’s why partners have “safe words” or other signals that indicate when a maybe isn’t working for them and they need to slow down or stop.

Boundaries are useful in nonsexual relationships too, and again have categories like hard no, maybe, and yes. For example, in romantic relationships I have a hard no against physical abuse, and I communicate that to all my partners. If one of them hits, slaps, or otherwise gets physically violent with me, that’s the end of the relationship. No explanations, no excuses, no second chances. I’m out of there. I’ve made my husband aware of this boundary and he respects it. He’s never crossed that boundary.

Unfortunately, at the time I established that boundary about physical abuse, I didn’t know about the concepts of verbal abuse and emotional abuse. In one significant relationship, I put up with these for quite some time. Verbal abuse and emotional abuse are two of the tactics of gaslighting. I put up with those for far too long before I was able to say, “I’m out of here.”

Dan once described boundaries to me using the metaphor of cookies. Suppose someone offers you a cookie and says, “Here’s a delicious chocolate chip cookie I made just for you. Yum, yum. Try it.” Only when you do try it do you discover that the cookie isn’t a chocolate chip cookie at all. Instead, it’s a shit cookie – something you definitely don’t want to eat. You set up a boundary about shit cookies. Just because someone offers you a shit cookie, you don’t have to eat it. And you really don’t have to say, “Yum, yum. This is delicious!”

What kinds of shit cookies are you likely to encounter? They can be insults. You don’t have to believe them. They can be other kinds of distressing – talking about you behind your back, for instance. You don’t have to respond or explain. Or they can be actions such as the aforementioned gaslighting, sandbagging, or saying one thing and then undercutting it with actions. You don’t have to put up with those. Refuse to eat the shit cookies. They are all bad for your mental health.

There are less drastic boundaries that you may have to set as well. If you have a friend who always calls you and vents at length about their problems but never listens to your problems or your advice regarding their problems, you might set a boundary: “You can call me with problems, just not after 9:00 p.m.” or you could set an unspoken limit that you will only listen to the friend for half an hour at a time. After that, you end the conversation and get off the phone. Perhaps you establish a signal that you have reached your limit: “My eyes just glazed over.” Your friend may even pick up on the signal: “Your eyes just glazed over, didn’t they?”

Or you might have a partner that has unreasonable expectations. Such a limit might be that you will be involved in disciplining the children, but you won’t do it all yourself. It could even be a seemingly silly one. I refused to iron my husband’s shirts because I felt resentful when he treated me like a laundress. He came to understand what I meant. And we worked out a solution: wash-and-wear shirts. Those I would gladly purchase. Problem solved.

Sometimes, however, there are people in your life who go beyond simple boundary breaking. They refuse to acknowledge any boundaries that you may have. People who hurt another family member, for instance, or who expect you to solve all their problems – not just asks for help, but insists on it and gets offended when you try to establish that boundary. It’s best to cut toxic people out of your life entirely.

But what if it’s a member of your own family who’s toxic? That makes the situation more difficult. You might cut off contact with the person, but have to see them at family reunions or holiday occasions. The toxic person might go behind your back and tell their side of the story to the rest of the family.

The only thing you can do in those circumstances is not to eat the shit cookies. Establish your boundaries and remain firm with them.

You’ll get a lot of pushback from other family members and even your friends. “But they’re family!” they’ll cry. “Family comes first, before everything else.” But that’s a trap. Family may be very important to you, but at some point you have to establish that ultimate boundary in order to protect yourself and your mental and emotional health.

Toxicity can eat away at your soul. It can destroy whatever good or even tolerable relationship you had with that person. It’s not worth it to try to understand a toxic person or to give them fourth and fifth and fifteenth and fiftieth chances to change. At some point, you have to draw the line and recognize that nothing you say or do will ever change that person. It’s not reasonable to expect you to change your feelings or your actions to accommodate them.

Setting boundaries and sticking to them – sometimes it’s the only way you can live with others or, more importantly, with yourself, at least in terms of your mental health. It takes practice and determination. But in the end, you’ll be mentally healthier. And you won’t experience the lingering taste of shit cookies.

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Nowadays, many workplaces have a toxic culture or at least a dysfunctional one. They demand – not just expect – more from their employees than any human being should have to, or be willing to, give. Sixty-hour weeks. Twelve-hour days. Giving up weekends and holidays. They treat employees as fungible things that can be easily replaced and regularly are, especially if they don’t live up to the brutal “standards” that are supposedly required by the free market.

Toxic workplaces are also full of toxic people. Bullying of employees and coworkers is common. Gaslighting even happens, more regularly than we’d like to admit. Required conformity and enforced corporate “team-building” parties and picnics suck the meaning out of workplace enjoyment. Exhortations that the workplace is a “family” and then behaving in ways that belie this are rampant – false, harmful, and destructive.

Corporate practices aren’t human-friendly, much less family-friendly. Flexible working hours, job-sharing, onsite childcare, remote work, part-time work, and extended sick and other types of leave are largely reserved for only the highest echelons or never even considered for any workers. Health and disability insurance are nonexistent or ultra-expensive for workers because of the monetary costs to the company. Discussions about the stress caused by work end in suggestions to try yoga. Employee Assistance Programs (EAPs), if they exist, provide some therapy, but only with a provider of the company’s choosing and usually only for six weeks or so.

Then along comes the COVID pandemic. Suddenly, corporations and other, smaller businesses were faced with the difficulties of staffing during lockdowns and quarantines. All of a sudden, workers weren’t so available or so desperate. Owners had to scramble to hire enough workers to keep the wheels turning. Some businesses were forced to raise wages. Others had to rethink corporate travel to cut costs.

And some turned to remote work. Not all could, of course. Some jobs simply can’t be done from home. Construction workers, wait staff, airline attendants, and countless others were simply let go or put on furlough, many of them without even partial pay. But many jobs, particularly office jobs, were the sorts that could be done from home, on the phone or via computer. And that proved beneficial both for the affected companies and for the mental health of their workers. Bosses suddenly realized that work-from-home even improved the bottom line, reducing overhead. It soon became clear that home-workers were able to be as or even more productive when not being constantly interrupted by mandatory meetings and other useless exercises.

How did telecommuting affect workers’ mental health? First, remote workers were spared from many aspects of toxic workplaces. Micromanaging became largely unfeasible.

This certainly helped improve their working conditions and stress. So did getting respectably dressed only from the waist up, especially for those of us with limited spoons. Being able to step away from the computer for a half-hour or more to do something about chores or even hobbies provided a welcome break. Lunches could now be taken whenever you were hungry and last more than 30 minutes. Even spending more time with pets reduced stress and provided emotional support that’s next to impossible in most workplaces.

Many of the stresses that so exacerbate mental health conditions were at least lessened. People were more comfortable in their own homes, with comfort objects and self-care items more readily available. Those with a greater need for alone time suddenly had more of it. If they found that they could work better or more productively part-time at home, it was a benefit for the companies as well.

Of course, not all bosses took to this new way of working. Once they figured out that employees could be more productive when working at home, some of them upped output requirements. They could insist that employees remain logged in during standard working hours, making flex-time less doable. Or they started requiring more output from those telecommuting, or scheduling Skype meetings that cut into employees’ time.

I work at home, remotely, and have for a number of years. I do so because I have been fortunate enough to find jobs that pay (though not a lot), jobs that match my skill set, jobs that aren’t 9-5, and jobs that are conducive to working around my days of depression and hypomania. I’ve considered going back to work in an office from time to time when funds were low, but not enough to actively pursue it. Truth to tell, I don’t think I’ll ever be able to do that again, and not just because I like working in my pajamas. (For those who are curious, I’m doing transcription and ghostwriting at the moment. They provide a supplement to Social Security and allow me time to work on my blogs.)

Did toxic work environments cause mental illness? Probably not, though they have pushed some people closer to the edge and others past the breaking point. It’s hard to work in corporate culture with any kind of mental disorder (except possibly narcissism). For these people, remote working is a blessing. COVID has been devastating, but one of its side effects has been to improve working conditions for millions of people – and especially those living with mental illnesses.

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My friend Martin Baker (https://www.gumonmyshoe.com/) recently posted a series of prompts for mental health bloggers. Number 29 was: Can you ever really understand if you’ve not experienced mental ill health yourself? Here are my thoughts.

In general, I do believe that having a mental illness yourself is the best and perhaps the only way to truly understand the reality of mental illness – the daily struggles, the need for self-care, the loneliness, and the stigma.

I’ve noted before that my mother-in-law didn’t really understand the concept of mental illness. It was like the time when she saw some women on the Phil Donahue show who were talking about their hysterectomies and the pain and suffering they went through. “Those women are such liars,” she said. “I had it done and it wasn’t like that at all.” It’s a matter of assuming your own experience is true for the rest of the world as well, a common logical fallacy. (Later she came around to believing mental illness existed, at least. I attribute this to spending time with me and my husband and reading one of the books I wrote, Bipolar Me.)

Even my husband – who has lived with me for 40 years, sympathized greatly, and helped me unselfishly – didn’t really “get depression” until he got depression. It was a situational depression that deepened into clinical depression. He’s still on medication for it. I remember him saying that he felt miserable and despondent, and had for months. “Try doing it for years,” I said. “I couldn’t,” he replied.

With a person who doesn’t understand – or even believe in – mental illness, there’s not a lot you can do to change their mind. The images and stories they get from the news, movies, novels, and TV shows tell them that anyone with a mental illness is likely to be a serial killer or a crazed gunman, probably psychotic or at least delusional. Conversely, they can believe that any notorious evildoer must have been mentally ill and probably “off their meds” at the time the atrocity occurred.

We often say that education is the answer. Informing people about the reality of mental illness is supposed to raise their consciousness and help eradicate stigma. That’s all well and good, but getting accurate and informative materials into people’s hands is not that easy. Sure, there are websites, books, and blogs, but the general population simply doesn’t run across these on their own. We who deal with mental illness daily must point them to these resources. Even then, there’s no guarantee that they’ll read or interact with the resources. They have to be interested in and open to the topic.

Public awareness campaigns featuring movie stars and top athletes may help in getting the audience to believe in mental illness in others, and even if they have a mental disorder such as depression themselves. Whether these can counteract the inaccurate and insensitive portrayals of mental illness in the media is still, I think, an open question. Even commercials for various medications for psychiatric illnesses can help people understand a little bit more, though I still believe that many of these ads present a less-than-accurate picture of depression, for example, making it seem no worse than a hangover. And many of the ads promote telemedicine sites for those who have – or suspect they have – some sort of mental disorder. They are less useful for the totally uninformed.

Still, we keep trying to inform and educate. But are we shouting down a rabbit hole or into an echo chamber? Maybe seeing posts from Facebook friends who have mental disorders really does help. I know that some of my Facebook friends have said that my posts and blogs on bipolar disorder have helped them learn.

But in general, I’m pessimistic about people understanding mental illness until or unless they experience it for themselves or in their own families – and maybe not even then. There are those who deny that they have depression, for example, or who may suspect they have a psychiatric disorder but feel that getting help is “for the weak.”

Or maybe I’m just pessimistic today.

Nevertheless, I’ll go on writing this blog in the hope that it will make a difference to someone.

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Anxious in Ireland

So not us.

Over the last couple of months, I’ve written about the anxiety I’ve been having regarding our vacation in Ireland. There’s been the overplanning, overscheduling, overspending, and the trying to make sure that everything went perfectly (like that was going to happen). I had anxiety about whether I would pack too much or too little, whether I could sleep on the plane, whether I could find things to eat comfortably (after recovering from dental surgery). Anxiety about whether I could find help with my mobility challenges in the airports and at my destinations. Anxiety about driving on the left. Et endless cetera.

As my therapist noted when I spoke to her after my return, it was good I took my anti-anxiety meds with me. (I made sure to pack them, even though I haven’t been taking them every day since consulting with my prescribing psychiatrist. I packed all my other psychotropics too, of course. I also carried my sleeping aid, which I’ve also stopped taking regularly, for the plane flights, but didn’t need it.)

Many of the anxieties I encountered in Ireland did indeed have to do with driving. I tried driving the rental car once, but I was too nervous to continue that. My husband ended up doing all the driving and I navigated. After some bad experiences with the GPS unit that the car rental company provided, we switched to using Google Maps on my phone, both of which fortunately worked in Ireland. I was in charge of transmitting the directions to Dan and trying to translate kilometers into miles for him.

One of the first difficulties we had before we defaulted to Google Maps was when we were heading to our first bed-and-breakfast reservation (the accommodations were arranged in advance by the travel company, so I didn’t have to have anxiety about where we were going to sleep each night). The GPS took us on a series of narrow, stony roads that ended up with us running off the one lane and into a ditch. After the initial shock and the realization that we couldn’t simply rock the car out of it, though, I wasn’t really all that anxious, perhaps because it was late at night and I was emotionally as well as physically exhausted.

I had a flashlight in my purse (something I almost always carry). My husband took it and set off on foot to find help, while I waited with the car. In about half an hour he returned with a local couple of lovely, helpful people, who drove us and our luggage to the b-n-b (which was actually quite nearby). They also came back in the morning to pull the car out of the ditch and pulled out a minor dent for us, and they accepted a modest amount of Euros for all their help. All things considered, it could have been much worse. I fell into bed that night and slept soundly.

During the whole trip, I never got really used to the driving situation. Dan noticed that I was making humming noises as we drove and bracing my hand on the dashboard (or the roof) at times. He called this “vibrating” and gently reminded me that I had the anti-anxiety meds with me. Eventually, I got used to taking them every morning before we began our day’s wanderings. My vibration was particularly noticeable when we passed another car or when I thought we were swerving too close to the edges of the road (the ditch situation made this seem all too plausible). Parking in cities – and indeed simply trying to navigate in them – also triggered my anxiety.

Then there were the godawful problems with our flights and our finances. Back in December, the airline had changed our flight out but never notified us about it, so we showed up at the airport four hours after our flight left. I spent several hours on the phone with the airline, our bank, and our credit card company trying to make arrangements for the first flight out the next day and the money to pay for it (since we were considered no-shows). Fortunately, I went into task-oriented mode (which I am sometimes capable of) and shuffled money and flights around before I collapsed. We did miss our scheduled first day in Ireland, though.

Getting a flight back was even worse. There was a problem with our COVID certification (we needed an antigen test, not just a triple-vax card) and later flights were booked solid. In the end, we had to spend two days in a Dublin airport hotel while trying to make arrangements with a dying phone and no charging cable. Dan came through there too when I was at the end of my proverbial rope (or in this case cable) and managed somehow to get a replacement. But by then we were out of money and I had to ask friends and family to PayPal us money for the extra nights in the hotel. It was all quite nerve-fraying and close to panic-inducing.

We’re back home now and I have settled down quite a bit, though I’m still dealing with financial repercussions, which have always been one of my major anxiety triggers. But I’m not taking the anti-anxiety pills daily anymore. And, as always, Dan is helping me.

The good news is that, throughout and despite all this, we managed to have a great time in Ireland. Sure, I had anxiety – and quite a bit of it – but I was still able to enjoy the country, the scenery, the food, the activities, and the wonderful people. We’re already talking about saving to go back.

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Sorry, Folks

No new post till Monday. Stuck at Dublin airport.

Traveling is often a challenge for people who have bipolar disorder. Some people can’t do it at all or can’t even leave their houses, which I certainly sympathize with. I really do. There have been times in my life when I could travel and times when I could not, because of my mental state.

Right now, I’m able to. I’m taking advantage of this to go with my husband to Ireland for ten days. We started planning this trip last fall, which has, of course, given me plenty of time to overthink everything – but not to reconsider. I think this will be one of the best things we have ever done together, apart from getting married.

If everything (and by everything I mean Facebook) works right, this post will appear while I’m overseas. I didn’t want to just skip a week in my blog, so I’m trying out the feature that lets you schedule posts ahead of time. I worry that it won’t work, which in the greater scheme of things wouldn’t really be so bad. Just more overthinking.

In addition to overthinking, I am over-scheduling and over-packing. I have been bothering our travel agent with questions about driver’s licenses and phone service. I have made reservations for eight different scenic places and interesting events. (I think they require reservations because of COVID, because they don’t want too many people to show up for tours at the same time.) I have a list of things I need to do before we leave. Every time I cross one thing off, I add another at the bottom. I used to be able to pack for a long weekend for both of us with only one tote bag, but those days are long gone. My list of what I will need to have with me threatens to spill over my luggage allowance.

In the past when I’ve traveled, I’ve had some success with giving myself permission to feel the way I feel – to take a day off from activities if I feel low, for example. This time, what with all the pre-booking, I may not be as inclined to do that. We do have days scheduled with less driving around and I have noted times when we can simply explore local pubs and restaurants. We’re even bringing along a card game in case we feel too useless to leave our bed-and-breakfast.

I have no guarantees that my mood swings will abate while I’m gone, of course. Making sure all my meds are refilled and packed is top on my to-do list. That’s much more important than packing a card game. I can see myself getting cranky about getting to the various locations in time for our reservations, but I’ve been fairly stable lately, so I hope I don’t tip over into something worse than grumpiness. At least my husband will be there to help me laugh and decompress.

I think that time to decompress is necessary while traveling. It may have been my hypomania that told me to make reservations for every occasion. And I hope the looming shadow of my bipolar disorder doesn’t sabotage the whole thing. This vacation is very important for us, which probably means I have too much invested in it, and I don’t mean just monetarily. It’s most likely the last time we’ll ever be able to travel abroad, so I want to make the most of it.

I just hope that making the most of it doesn’t send me tipping over the edge into depression or hypomania. I’m never good psychologically with financial affairs or not knowing what’s going to happen. I’ve seen those tendencies in myself increase with time. I hope that this vacation is what I need to shake me loose from some of those feelings. I hope that I will look back on it, after this bit of writing becomes public, and realize that I have proved my relative stability by being able to go through what is intended to be a magical time. But I guess expecting magic is too big an expectation to put on a vacation.

We already know that in war, disenfranchised people suffer the most – dependent women and children, disabled persons, and the mentally ill included. The war in Ukraine is no different.

During World War II, mental patients and disabled persons were among the “subhumans” that Hitler sought to annihilate. He felt they were a drain on society. (In fact, there are still people who feel this way.) Nowadays, the impact on the mentally ill is somewhat less direct. Reuters has reported that “Russian forces have taken control of a psychiatric hospital in the town of Borodyanka in Ukraine’s Kyiv region, with 670 people inside.” They quote a Ukrainian official as saying, “Today we do not understand how to evacuate these people, how to help them….These are people with certain special needs, they need constant help. They are running out of water and medicines.”

Not that mental health care in Ukraine was all that great to begin with. General healthcare in Ukraine developed from the old Soviet system, which emphasized preventive care rather than treatment of existing disease. Psychiatric Times also notes that “In comparison to other countries, Ukraine carries a high burden of mental illness and a particularly high prevalence of depression, alcohol use disorder, and suicide….Major barriers to mental health care in Ukraine include lack of trust in the psychiatry system, stigma, and lack of awareness and understanding.”

In the Soviet era, psychiatry was used “as a tool of repression” and “those who opposed the Soviet regime being deemed ‘mentally ill’ and imprisoned in psychiatric hospitals. As a result, Ukrainian older generations are more reluctant to seek mental health care than their youth, remembering the dark history of psychiatry,” reports Not Even Past.

Challenges in the Ukrainian system have included “a large institutionalized psychiatric system associated with human rights violations, alongside public stigma and low awareness of mental health,” says the World Health Organization. They add, “Social services for people with mental disorders are limited or absent in the community. The health information system has mental health data but lacks organization and is not always useful for decision making.”

The COVID pandemic had already taken a toll on mental health in Ukraine, but increasing conflict in the eastern regions caused still more suffering, long before the Russians invaded. In October, 2021, Relief Web reported on the toll-free emotional support hotline that helped more than 3,400 Ukrainians during its first year of operation. The four operators, seven psychologists, and one psychiatrist offered support primarily to women, who made 70% of the calls to the hotline.

Even before the pandemic and the conflict, Ukrainian citizens suffered from a variety of mental health problems. Estimates are that one in three Ukrainians face a mental health challenge at least once during their lives. This is notable, particularly in comparison to countries in Western Europe. Much stigma was also reported, involving problems of “knowledge (ignorance), problems of attitude (prejudice), and problems of behaviour (discrimination).”

Then there are the mental health difficulties directly related to the Russian invasion. Naturally, anxiety and depression are problems in both adults and children. As Relief Web noted, “People fleeing conflict often experience highly distressing situations, loss and trauma, which may impact their mental health and ability to cope. Psychosocial support will be needed in the days, weeks, and months to come.”

ABC News reported on the mental health problems that are arising in Ukrainian children especially. As of March 19, 114 children had reportedly been killed in airstrikes and other acts of war. Children as well as adults no longer have a sense of stability in their lives. Experts recommend supplying structure for the affected children, but this is difficult to impossible in a war zone.

ABC quoted Dr. Jack Shonkoff, director for the Center on the Developing Child at Harvard University, who noted, “Some children in these circumstances tend to be more withdrawn, they’re not crying as much, they’re not demanding much attention.”

He continued, “Sometimes people might look at that and say, ‘This child is managing pretty well.’ Sometimes that’s a sign of the things to worry about the most because these children are withdrawing, they’re internalizing a lot of what’s going on.”

Shonkoff also said that “a good outcome for children in a war zone is … making sure the adults are being taken care of too.” As he put it, “The most important factor that determines how children are going to basically survive and go forward after a war experience is the nature of the adults who are caring for them,” he said. “If the parents and the caregivers are significantly traumatized, they can’t provide that sense of support. The adults’ needs become critically important to protect the children.”

Shonkoff likened it to when adults are advised to put on their own oxygen masks first in case of an airline emergency, before assisting children with theirs. “That’s not a way of saying you’re more important than your child. It’s a way of saying if you pass out, your child won’t be OK,” he said.

What’s the point of all this information? It’s crucial to realize that, in war, not all wounds are physical. We know this from the vast number of veterans who suffer from PTSD. That will no doubt be true of soldiers in Ukraine too. Psychological distress is real – and increasing – and will affect people in Ukraine in both the present and the future. When we talk about sending relief to Ukraine, let’s not forget those with mental health challenges.

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The quotation from Mark Twain goes, “Of all the things I have lost, I miss my mind the most.” It’s a little annoying, at the least, when people repeat it. Those of us with psychiatric diagnoses don’t actually lose our minds, but we do lose a lot of other things along the way.

Friends

I’ve certainly lost friends because of my bipolar disorder. I can think of two in particular who were very dear friends, but cut off all contact with me when I was at the depths of my depression and they feared I was suicidal. I reached out to them a few times and even sent them a copy of both my books, but got minimal response. I still miss them, though they now live in another state and it’s unlikely that we’ll ever see each other again, even in social settings we all used to frequent.

Jobs

Twice I lost jobs largely because of my bipolar disorder. The first time, I had been isolating a lot, keeping the door to my office closed and barely interacting with any of the other employees. While an open door wasn’t technically a requirement of the job, I was the only editor who habitually hid behind a closed one, and it wasn’t taken well. I’m afraid I got a reputation as being difficult and uncommunicative. Finally, after several incidents where my emotions ran away with me, I was let go.

The second time was at the job I had directly after that job ended. At first, I did all right in the department where I was assigned. Then my boss left and the department was disbanded. I was transferred to another editing group, and there my difficulties began. The people there misunderstood my attempts at humor. My boss didn’t understand bipolar disorder and when she asked, “What does that mean?” I was caught off-guard and made a brief, unhelpful remark to the effect of “Sometimes I have good days and sometimes I have bad days.” I could see her thinking, “What makes you different than anyone else?”

Finally, I was put on probation, the only time in my entire career when that ever happened to me. I decided to leave before they could fire me. Then I went into a period of hypomania about not having to work there anymore and starting a freelance career, which did not turn out as well as I had hoped.

Intellectual abilities

I know a lot of people worry that when they have a disorder such as bipolar, or even when they take medication for it, they will lose some of their brainpower. I never felt that way, but looking back I can see that the disorder also disordered my thinking. Moods of despair and exhilaration interfered with my cognitive functions. In addition to the general dulling of feelings during depression, I also lost the ability to concentrate enough to read, formerly one of my primary and best-loved activities. Even as I mourned the loss of my reading, I was simply unable to pick up a book and follow its contents. I took to watching mindless TV shows instead – really bad ones.

Enjoyment

Just as I no longer found joy in reading, I no longer found other activities enjoyable or interesting as well. I used to love cooking, especially with my husband, but when depressed, I could barely microwave a cup of mac-n-cheese. I loved good conversation with friends, but I barely talked to anyone and ignored friends’ overtures. I enormously enjoyed traveling, but couldn’t summon the energy even for a day trip.

Confidence

I used to be able to do all kinds of things by myself – attend business conventions (and science fiction conventions) and write articles for publication, for example. When I was suffering the most from bipolar disorder, I could do none of these things. When I went to conventions, I needed a bolt hole and spent as much time as I could in my room. At that point, I couldn’t write about my condition or even send emails to friends. One of my friends said, when I was considering ECT, “Write about it! That’s what you do!” But it wasn’t what I did anymore. Putting pen to paper – or words on a screen – was not even a possibility. I asked someone else if she would write about it instead.

Things I haven’t lost

Of course, most of these things came back to me once I was properly diagnosed and medicated. I now read every night, write my blogs every week, travel here and abroad, and make friends that I keep in touch with. I discovered that some of my friends had stuck by me, even when I was in the depths. I still can’t work in an office, but I have found work I can do from home. I enjoy travel again. And if I’m a little slower to get a joke or find a word, it doesn’t bother me so much. I know my brain is just fine, except for occasional glitches.

Losing all those things made me realize just how good my life is now that I am back to being myself. I have my mind back, if it was ever lost at all.

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