Bipolar 2 From Inside and Out

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

It is devoutly to be hoped.

The Song as Self-Care

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

For a while, I managed to do it. I spent literally years writing a mystery novel. Optimistically, I sent it to over 180 agents. A lot of nothing. At last, one of them was honest enough to tell me what was wrong with the manuscript, instead of just saying, “not right for us” or not answering at all.

And they were absolutely right. Once it was pointed out to me, I could see exactly what they were saying. I had had beta readers vet the first four chapters and gotten positive responses. They didn’t know anything about writing, or possibly even reading with a writer’s perception. But that wasn’t their fault. It was mine, for not selecting my readers more carefully.

Did all this depress me? Hell, yes, it did. I wouldn’t be human if it didn’t.

But I’m also bipolar. Depression for me isn’t just regular depression. Bipolar depression is something different. A darker place. A deeper pit. One that can be almost impossible to claw and climb one’s way up from.

When I was a teenager and undiagnosed and unmedicated, I had several major depressive episodes, and any number of smaller ones. Since at that time I had no idea what was going on or how to get help, I developed a philosophy: Go through it until you come out the other side.

Basically, it meant that I was staying depressed until I magically became un-depressed, whether it was because my brain chemistry backed off enough to let me see a way out, or hypomania kicked in (though I didn’t know what that was at the time). Basically, I suffered through it until I didn’t anymore.

And I thought that was the way it had to be. In one side, wait till I came out the other.

Later in life, I had other major depressive episodes. I tried a lot of things for them, including therapy and medication, but still the best I could manage was to wait it out – even though it took literally years.

Right now I’m in a similar position. All the rejection has put me back in that deep pit, and I don’t see a way out of it. I can’t even think of a new thing to write. Or a way to fix the book that failed. I am even applying for other writing gigs, but so far they have brought only more rejection. I don’t want another major depressive episode, but I can feel myself slipping. It does sound like reactionary depression, a result of the rejections, the realization of bad writing, and other recent blows involving deaths and other traumas. But it feels like endogenous depression, the kind that comes from inside, with wobbly neurotransmitters the major cause.

Of course, I’m a little better off than when I was a teen. I have a proper diagnosis – bipolar type 2 – and proper medication. I still have work that I can do – transcription – which is boring and ill-paying, but keeps me from sitting all day in front of the TV, watching train wreck shows that remind me that other people have more screwed-up lives than I do. I have self-care. I have my husband to be my caregiver.

But basically, I am just waiting to come out the other side.

I am doing the things I ought to do to get me out the other side. I am taking my meds. I have an appointment next week – a telehealth session with the psychologist that I haven’t seen in a year. In the past, she has done phone sessions with me when I wasn’t physically or mentally able to come in, so I know those do me good. And at the end of the month, I see my psychiatrist for a med check (15 minutes). I’m not sure how a session that short will help me in finding the other side to come out of.

I just wonder how far away the other side is.

Why Can’t I Cry?

There’s a lot that’s been happening around me that ought to have made me cry, but I just haven’t. There have been personal losses – the death and funeral of a dear friend. Occasions when I should have cried tears of joy – when an estranged friend wanted to reconnect with me. Professional losses – when I finally had to give up and admit that the novel I had spent years on was just not good enough to be published.

I’ve even thought about the deaths of some beloved animals, to see if that would make me cry. It didn’t.

In the past, I’ve never had trouble crying. As my bipolar disorder is largely bipolar depression, I have cried a lot – teared up, sobbed, wept – on occasions that were appropriate and some that weren’t.

I can’t even cry over the fact that I don’t seem able to cry.

There have been times in my life when I probably should have cried, but didn’t – when I was helping my mother pick out a dress to wear to my father’s funeral, for example. In that case, and in others like it, I postponed crying, or put my emotions in a box and sat on the lid.

Actually, I have had to do that many times throughout my life. Back when I was a teenager, an unmedicated person with bipolar disorder, and full of the volatility, despair, rage, and hormones of that time in life, I suppressed the impulse to cry, in order to look more “normal.”

It didn’t always work. For instance, some songs like Simon & Garfunkel’s “I Am a Rock” would almost always turn on the waterworks. But for the most part, I tried to suppress the need to cry.

The thing about it is, when you stuff down the ability to feel sadness or despair, just to survive, you can end up suppressing most of your other emotional reactions as well. Peace, humor, interest, gladness, tenderness all go into that box with the sadness and despair and you sitting on the lid.

That may be what has happened this time. I know I had to suppress my feelings to pick out a funeral outfit and attend the service. I felt despair over the end of my writing attempt, but I didn’t cry. I felt a sense of waiting to see how it would work out when the friend appeared to be reengaging.

I don’t know what else is in the box or how I can get it open again. I am not interested much in the TV shows I used to watch obsessively. I can read only a few pages of books that I would otherwise have devoured. I can’t remember the last time I laughed over something silly my husband said or did. I did not cry over the movie that he finds so very touching that he cries every time he sees it.

I am doing all the right things, though. I am taking my meds regularly and as prescribed. I have called the psychologist that I used to go to and made an appointment for a telehealth session. And I’m trying to figure out how to tell my psychiatrist all this when I go for my med check at the end of the month, if nothing else has worked by then.

Maybe one of those things will open the floodgates, un-stuff the box of stuff, and allow me to cry again, normally, when it’s needful.

But I don’t really know. Writing this post hasn’t done it.

The other day I inadvertently created a firestorm on facebook. Someone posted: Question: What makes schizophrenia a mental illness and autism not a mental illness? Answer: Politics, advocacy, and marketing.

I didn’t understand the thrust of the post, so I asked a question: “Are you saying that autism should be classed as a mental illness or that schizophrenia shouldn’t be?”

Then the floodgates open. There were over 100 responses to the post, of which mine was just one. They ranged from “autism is not a mental illness” to “autism is a form of mental illness” to “autism is a developmental disorder” to “schizophrenia and autism are both neurodivergent conditions.” Few, if any, seemed to address the original question of politics, advocacy, and marketing. (I have no knowledge whether any of the responders were medical or other professionals; persons with one or the other diagnosis; or family members of those with the, let’s call them conditions for now.)

Some people responded that the term “mental illness” should not be used, because it was inaccurate, or stigmatizing, or both. They found the phrase “mental illness” offensive. “Mental disease” was suggested as a better alternative, though for the life of me I can’t see much difference between them. To me, “illness” and “disease” mean basically the same thing. One can go down the rabbit hole here. Is MS a condition or an illness or a disease or a disorder? Is a broken leg a condition? It’s certainly not an illness – unless it gets infected – or a disease. Someone said that mental illness implied a permanent condition, rather than a challenge that can be treated. My bipolar disorder can certainly be treated, and is. But it is also a permanent condition.

Some of the phraseology that was most often used to define autism were neurodivergent, neurological condition, developmental disorder, neurological condition that often presents with mental illness like anxiety. But neurodivergent was also used to described schizophrenia, which was sometimes linked to brain anatomy and genetics. Some classed them both as “disorders of the brain.”

Others pointed out societal or functional differences or other definitions – schizophrenia can be used in court for a “diminished capacity defense”; autism is listed in the DSM-V (Diagnostic and Statistical Manual, considered by many the gold standard for definitions and symptoms of mental illnesses); the age of onset for autism is three, or three to 18, while schizophrenia is usually diagnosed at 18 and over, but not always; autism used to be called childhood schizophrenia; schizophrenia is caused by over-pruning of the neurons, which disrupt the normal growth of the brain; ASD could be a result of disruptions in normal brain growth. Someone pointed out that with both autism and schizophrenia, there are different levels of severity.

Various books and articles were cited. Challenging questions were asked: Do those who insist that autism is not a mental illness think having a mental illness is shameful, whereas having autism is not shameful or perhaps is not an illness at all. Others considered treatments: Medications can help with mental illnesses but are not generally prescribed for autism. People with one or the other condition do not qualify for treatment.

And some responses were entirely cryptic: B careful what you wish 4.

But back to the original post. I think the poster was trying to say that the autism community did a better job of spreading the word about the condition and thereby defining it, in this case as not-a-mental-illness.

And it’s true that – whatever you think of them as an organization – Autism Speaks has gotten the word out about autism. They excel at awareness (of themselves as well as autism). They organize huge charity walks. They have numerous TV commercials. Their puzzle piece symbol – again, whatever you think of it – is for many the easily identifiable graphic that says, “autism.”

Mental illness, whatever you prefer to call it, does not have that same kind of presence in the public eye. For one thing, there are so many different conditions that it’s hard to choose one to spotlight. Depression seems to be the condition-du-jour. The conversations around it are that anyone can have it and there is help available, which is all well and good. But the vast majority of these messages come from people who are selling or associated with medications or call-a-therapist lines – money-making operations. Nor do the ads always get depression right, many making it seem like no worse than a mild hangover.

SMI (serious mental illnesses such as bipolar disorder and schizophrenia) are only now entering the public discourse, and again, mainly for advertisements of drug treatments. The ones for schizophrenia seldom discuss any symptoms of the disorder – they just show a happy person playing a guitar or some such desired outcome. They don’t convey much about the condition of schizophrenia, its symptoms, how it affects families, or much of anything else.

As for other psychiatric conditions, there is much silence. PTSD is discussed, but only of the “wounded warrior” variety, not the kind that can result from other traumas. Anorexia/bulimia, OCD, social and generalized anxiety, narcissism, and the whole spectrum of personality disorders get little to no screen time.

There is growing discussion about things society – and especially first responders – should know or do about people with psychiatric conditions, but those are largely at the talking stage and a few pilot projects. When the subject hits TV, it is usually triggered (sorry) by an individual incident and is more likely to involve unorganized protests rather than coordinated efforts to address the larger problem. And at times, it seems that no one is listening.

Especially to the people with “forgotten” mental conditions – those that don’t have drug treatments or celebrity proponents or coordinated responses. It’s not that I think autism doesn’t deserve the attention it gets – though clearly there are more discussions to be had around the subject. I just sometimes despair of getting attention for mental illnesses.

But to go back again to the original post, mental illness and autism are two different things that cannot be easily compared. But it is true that autism, at the moment, has an organization with a loud voice behind it. Mental health, not so much.

One thing I’ve noticed about all the political rhetoric about plans to deal with mental illness is that they always lump it in with drug abuse. Like the two were the same thing. Like the solutions are the same. Like the causes are the same. Like the two are somehow related.

It’s true that many people with mental illness have substance abuse issues. And lots of drug abusers also have mental disorders. But people with varicose veins also have acid reflux. That doesn’t mean they’re related.

Of course there are similarities. Drug abuse seems to be controlled by the pleasure or addiction centers of the brain. And mental illness has to do with a malfunctioning brain. But just because the same organ is affected doesn’t mean the causes – or the treatments – are related. The causes and treatments for the lung ailments cystic fibrosis and asthma are not the same.

The various conditions that we call mental illness may be centered in the brain, but we’re a long way from knowing exactly where. Serotonin receptors? Maybe. Other neurotransmitters? Possibly. Drug treatment seems to work by trial and error, at least in my experience. Every time I’ve asked a psychiatrist how a psychotropic medication works, the answer is invariably “We don’t know.”

Treating drug abuse with other drugs is counterintuitive. Besides, it largely doesn’t work. Antabuse merely makes alcoholics so sick when they drink that they prefer to remain sober. Narcan can pull an opioid abuser back from an overdose, but it does nothing to prevent the next one. And methadone has its problems as well, especially since it’s an opioid too.

Many people break the chains of alcohol or drug addiction with the help of 12-step groups. Such groups have no effect on serious mental illness. Even therapy groups have limited results with people who suffer from psychiatric brain disorders. Support groups can help some of them cope with the problems associated with mental illness, such as loneliness, frustration, fear, and, well, lack of support. But healing is a hard thing to come by, and seldom is found in a circle of people with similar severe psychiatric conditions.

Part of the 12-step approach to addictions is surrender to a Higher Power – not technically the Judeo-Christian God, but the functional equivalent for most. God has not proven to be a reliable cure for mental illness, though of course prayer can help sufferers deal with their suffering and find comfort amid their troubles.

So why do politicians make the assumption that what will be good for one condition will be equally effective for the others? That funding directed at mental health problems and drug abuse can be used for the same types of treatments and treatment centers? Admittedly, politicians are not generally well educated about either mental illness or drug addiction. That’s why they have advisors, who should be able to explain the differences and the nuances to them. And that’s why there are organizations with members who have studied the problems – or who struggle with the conditions themselves – who can inform those who control the pursestrings as well as the general public about what is needed.

It’s convenient to want to deal with mental illness and drug addiction in the same way. Treatment centers, hospital beds, and halfway houses may play a part in dealing with both problems. But hospital beds for detoxing, for example, are different from hospital beds needed for those with serious mental illnesses such as schizophrenia or psychosis, which may necessitate a long, difficult stay.

This is not the place to discuss involuntary commitment or AOT (assisted outpatient treatment, also called “outpatient commitment,” a form of involuntary treatment in the community) for severe mental illness, except to say that involuntary commitment is not an option applied to drug abusers, however much the conditions are conflated. They are complicated issues, and ones that I am not qualified to speak to.

But until we can convince people, and especially those who pull the political strings, that alcoholism, drug abuse, and mental illness are separate subjects that need different kinds of attention and support, we won’t make sufficient progress on either problem.

Jenny’s Back!

Jenny Lawson (aka The Bloggess) is back with a new book to accompany her wildly successful Let’s Pretend This Never Happened and Furiously Happy, plus the coloring book that I can never remember the name of.

Her new book, Broken (in the best possible way), which debuted at #3 in the New York Times, takes Jenny’s weird and out-of-the-ordinary sense of humor and adds more laughs, as well as more serious material.

I haven’t counted how often she talks about vaginas and “lady gardens,” but I bet someone will. And f-bombs abound. (Hardly surprising, since the most requested way for her to sign books is “Knock, knock, motherfucker!”)

Note: If you’re at all a sensitive soul or offended by certain types of language, steer clear of the chapter on “Business Ideas to Pitch on Shark Tank.” It’s raunchy even by Bloggess standards, which means it’s beyond simply raunchy. Of course, if you were a sensitive soul who objected to certain types of language, you probably wouldn’t have picked up this book in the first place.

Jenny’s previous book, Furiously Happy, dealt a lot with struggles against depression and anxiety – Jenny’s own and other people’s. The new book goes into those subjects in more depth, including a personal narrative of using TMS (transcranial magnetic stimulation) to deal with her treatment-resistant depression. There’s even a picture of her using the device.

She also reveals her own “really serious and raw stuff” – experiences with avoidant personality disorder, imposter syndrome, ADD, OCD, tuberculosis, rheumatoid arthritis, anemia, depression, anxiety, and suicidal ideation. So be ready for a bumpy ride.

There are also sweet, sad, funny chapters about her family, and especially how they are dealing with her grandmother’s dementia and Alzheimer’s Disease. And there are chapters that are not sweet, funny, or sad, where she rails against insurance companies and their unhelpful (to say the least) ways. These chapters and passages, I am certain, nearly every reader will identify and agree with.

And, lest you think this is a complete departure from Jenny’s funny stories, rest assured that there is plenty of what Jenny herself calls her “baffling wordsmithery,” including times she lost shoes while wearing them, dog penises and condoms, attic vampires, arguments with her husband Victor, embarrassing moments shared with other people (those who inadvertently say IUD when they really mean IED, for example), roller skating monkeys, dubious beauty treatments, the perils of being an editor, the perils of cooking and cleaning, taxidermy (of course), and high school proms.

As for the title, a broken lawn ornament (not Beyoncé the chicken, thank goodness) leads Victor to explain the Japanese concept of kintsugi. According to this practice, philosophy, or art form, broken ceramic items such as vases or teacups are repaired with a fixative mixed with gold powder, which creates something new, stronger, more artistic – and beautiful at the broken places, a theme which runs throughout the book.

What sets Jenny’s books apart from other humor books and from other books on serious illness, especially serious mental illness, is her ability to connect – both readers to herself and readers to each other. Her humorous chapters are over-the-top funny and many evoke a sense of “Yes! Me too! That could/did happen to me!” Jenny even includes instances when people have shared their own stories of faux-pas with her and by extension, with all her readers.

Her serious chapters are educational, descriptive, and occasionally searing. She tackles tough topics with fortitude and forthrightness, educating as well as illuminating. Far from being a textbook on serious mental illness and chronic illnesses, though, her stories bare the truth and present the subjects powerfully. They give hope and understanding as well as connection.

Connection. That’s Jenny Lawson’s superpower.

Grief and Mood Disorders

Grief and mourning are hard for anyone to get through. When you have a mood disorder, it’s even harder.

Depression can linger longer than one might expect. A death, for example, might tip one over into a clinical depressive episode. There are no funeral etiquette books on how to cope with feelings like that. All they will tell you is what to wear to a funeral and what’s an appropriate remembrance to send or what to say at a viewing or funeral service. There are no emotional guides that tell you how long it is appropriate to mourn a loss. The feelings come as they will and stay as long as they stay.

A lot of the emotions associated with depression may visit you, or even move in and stay a while. If you are “lucky,” a period of numbness may get you through the funeral and any other formal observances. But that’s far from guaranteed. Depression may express itself as deep and inconsolable sorrow. Sometimes, there’s no way to turn off that feeling or wait to express it.

There can be anxiety too. Will all my egregious relatives behave themselves or will they do something embarrassing? Are customs from another religion the same as mine or not? It’s easy to get all tangled up and even immobilized. You may be tempted to avoid the whole situation. But if this was a very close friend or loved one, you want to do your best to respect and honor that person, even if you don’t know quite how. It’s even more anxiety if you have to ask yourself how you’re supposed to get through it all.

Grief and mourning are also emotions that may strike you after a death or other loss. You may cry unexpectedly, whenever the emotions hit you. You may wake in the middle of the night and feel the absence of someone all over again.

There aren’t any rules that cover grief and mourning. You feel how you feel for as long as you feel it. Some people try to shame the bereaved into restraining their grief or setting a limit for how long it should go on. The fact is that a loss may leave a hole in your heart for years to come, or forever.

Anger is also an emotion that may come. It’s one of the classic stages of dealing with death, along with denial, bargaining, depression, and acceptance. Anger is harder to understand and harder to control. Some people will not understand that you can feel anger when a friend dies. But my friend just died and I am angry as well as sad that I did not get to see her before she died, even though I know that it was impossible, given the circumstances. People may understand anger a little if the person died by suicide, but it seems inexplicable to many after a natural death.

I can’t tell you how to deal with those feelings. I am dealing with them myself right now. I am trying to hold myself together, to do what is “right” – to keep my grief on hold till I can express it fully. It’s not usually a good idea to stuff your feelings in a box, but sometimes it’s needful, and getting through the ceremonies attendant on a death may well be one of them.

Perhaps the hardest thing to get through is the fact that these emotions and the memories that they bring with them may crop up at unexpected times. Even decades cannot lessen the sorrow of some losses. Good emotions and memories of your loved one – and it need not be a close family member – will help. They may pop out of nowhere, just like the depression does. But these emotions you can hold close to you. If you can remember any of them when the bad times come, that may ease your grief for a while, though it cannot erase it.

Grief, depression, sorrow, anger, and other emotions are appropriate after a death. And don’t let anyone tell you otherwise. They may not understand that such emotions aren’t only for family members and the very closest friends. When someone has touched your life, in whatever manner, your emotions are valid and your grief allows you to express them. Whether you have a mood disorder is irrelevant.

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