Bipolar 2 From Inside and Out

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

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

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

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

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

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

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

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

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

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When I was a teenager, being hospitalized for mental illness was a big joke. The local facility was located on a street called Wayne Ave. Wayne Ave., despite whatever else was located there (a pizza restaurant, I think), was shorthand for “crazy.” (This was no doubt an annoyance to people who actually lived on Wayne Ave., of which there were many. Now the former mental facility is a Hospice.) I knew by then that I was mentally unbalanced, but it never occurred to me that I would end up in Wayne Ave. It was an address used only to tease other kids, which was uncomfortable enough.

By the time I got to college, I was aware that I was in trouble, mentally. I had turned down the offer to see the school district psychologist in high school, delusionally afraid that it would show up in my permanent record and prevent me from getting into a good (or any) university.

I did, however, get into a very good university. (No idea if they took my lack of mental health treatment into consideration.) But by this time I was really suffering mentally and emotionally. I tried at least one therapy group, but was able to breeze through it without making any notable progress, thanks to my ability to “act normal” for an hour at a time.

Still, I figured it was just a matter of time until my mental disorders manifested themselves sufficiently to be generally noticed. Maybe even noticed enough to be diagnosed. And I was waxing delusional. I felt sure that at some point in my life I would be hospitalized for my illness. I just wanted to make it through college and work at a paying job for at least two years, if I could, in hopes of getting Social Security. (I said I was delusional.)

Along the way, though, I was (sort of) hospitalized for mental illness. I say “sort of,” because I went to the university clinic, a small facility with about a dozen beds, most of them used for students with flu and the like. (There was a sort of witticism going around campus: It’s a short trip from Willard Straight (the student union building) to Willard State (the nearest psychiatric facility). Again, going to a psychiatric facility was considered a joke.)

I was nearing the end of a disastrous relationship, self-injuring, self-medicating, and vaguely suicidal. I checked in to the campus clinic. I don’t remember much of it, my brain obviously not working too well at the time. I had to tell them I wasn’t really suicidal, or else they would have called my parents, which I definitely didn’t want.

I do remember a nurse who would look in on me as I lay in bed crying. I don’t remember what if any treatment they prescribed. In my memory, mostly they just let me cry.

One very peculiar thing happened, though. The man of the disastrous relationship “checked me out” for an evening (much as you would check out a library book) to go to a dinner with someone in editing or publishing that he thought might help me get that coveted job after college. I don’t remember the dinner being a hit, and of course no job ever came from it. Then I was checked back into the clinic for a few more days of crying. I don’t remember how long I stayed or why I was finally released. It was altogether a peculiar experience, and the gaps in my memory have swallowed most of it.

I don’t think it actually helped me at all, other than to confirm to me that I was indeed ill, with some kind of mental disorder, and to reinforce my delusions. It also, I think, hastened the dissolution of that relationship, which proved to be a good thing in the long run. Was it all a ploy by the boyfriend to establish that I was the “sick one” for the purposes of couples counseling, which I had convinced him to try at one point? I’ll never know.

But since that time, I have never been hospitalized for my bipolar disorder. I have been properly diagnosed and treated. I now take psychotropic meds faithfully and see a therapist. I have been working for decades (except during a major depressive episode, when I learned how hard indeed it is to get Social Security for a psychiatric disability).

I suspect my hospitalization was far from typical. After all, it was dozens of years ago and not in a dedicated mental hospital or ward. I can’t say whether it helped me or not. But it’s an experience I never want to repeat – and, at last, something I never expect to endure again.

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There are a number of metaphors that try to express what it’s like to have bipolar disorder, and none of them is accurate. Thanks to television commercials for bipolar medications, we have even more metaphors, none of which express the reality of the disorder. Maybe, at heart, it is futile to try to come up with a metaphor. The map is never the territory. But let’s examine some of the most common and see where they succeed and where they fail.

Depression

The Black Dog

Winston Churchill was notoriously given to episodes of depression, and he referred to them as “The Black Dog.” It would come and go, but when it was with him, he descended into the depths. (Of course, this did not prevent him from becoming Prime Minister of England and making significant policy decisions and speeches during World War II.)

Dementors

J.K. Rowling has said that the soul-sucking monsters that appeared in the Harry Potter books were metaphors for depression, being able to remove not only joy and happiness from a person’s soul, but the memories of those emotions, and the possibility of ever feeling them again. (Incidentally, once out of the Dementors’ grasp, chocolate is said to help the person recover.)

Masks

This one is popular in TV commercials. A woman (almost always a woman) holds a smiley-face mask in front of her face to cover up her sad expression. Then, after she takes psychotropic medication, she puts the mask in her purse or pocket and suddenly reveals her own smiling face. Or a stock photo shows one person with a brown paper bag over his or her head with a sad face drawn on with marker. This bothers me because it implies that medication takes effect almost immediately, but I suppose there’s no way to show the six-week lag in TV ads.

Fog

The underlying metaphor here is being lost and being unable to find your way out. Everything around you is gray (and most likely rainy) and indistinguishable. It’s difficult to impossible to find your way through. This is actually a fairly accurate metaphor for severe depression or a major depressive episode. The sense of futility, of immobilization or being lost, of being unable to see a way out, is common to people with depression.

Anxiety

Skin

One of the most common sensations reported by people with anxiety is being about to jump out of their skin, or feeling itchy or twitchy all over. The itchiness or twitchiness may manifest in actual physical symptoms, in which case they’re a perception, not a metaphor anymore.

Electricity

The feeling of shocks running through the body or the brain is another way we describe anxiety. It can feel like jolts of current that only add to the twitchiness or agitation.

Indecision

Sometimes the paralyzing side of anxiety is represented by having too many choices or being unable to decipher a map. Instead of being agitated, the person is stymied and motionless. Make no mistake, this is a symptom of anxiety as much as it is one of depression.

Mania

House of cards

This metaphor comes to us thanks to a TV commercial. A person suffering from mania confronts a pyramid made of playing cards, climbs it, and keeps climbing until there are only a few cards left, with the idea that they will ultimately tumble. There’s no indication, though, that the person with mania built the pyramid of cards themselves, and the medication kicks in before the stack ever falls.

Soaring

The feeling of flying is often associated with mania. Soaring far above the mundane and the insignificant, the person with mania feels a sense of grandeur and empowerment, the ability to do anything – and to sustain it. Of course, sustaining the feeling never quite happens. Persons flying high with mania never see the inevitable crash that is coming.

Bipolar Disorder

Playground equipment

The seesaw. The teeter-totter. Even the swings. These metaphors certainly catch the up-and-down, back-and-forth motion of bipolar cycles. There are just two things wrong with these metaphors: They portray movements of equal length. And they’re fun. Bipolar moods do not come on a schedule or last a predictable amount of time. And there’s nothing fun about bipolar disorder.

Rollercoaster

A rollercoaster is perhaps the most common metaphor for bipolar disorder. It improves on the playground equipment analogy some. A rollercoaster, like bipolar, can be scary, especially the first time you experience it. It does involve up and down motions of unequal length. But the rollercoaster has the process backward. The climb up is slow, not an exhilarating whoosh. The swift ride to the bottom is the exciting part, which of course it isn’t. And, of course, once you’ve been through the whole route once, you have to get off and pay to get on again.

We use these metaphors because it’s almost impossible to convey what bipolar disorder is like to someone who’s never experienced it. And they can never convey the reality. Among those of us who have experienced the disorder, we use them as shorthand to describe the feelings we share, at least to some degree, with one another and with others, in hopes that they’ll “get it,” even just a bit.

But language has its limits, especially when it comes to describing what’s going on with our brains and emotions. Sometimes metaphors are as close as we can get.

Overthinking. It’s something we all do at times – so many of us that it cannot really be said that it is automatically related to mental illness. But in some cases, it is a symptom.

Let’s start with depression, a subject about which I know a thing or two. When I was in a depressive phase of my (undiagnosed) bipolar disorder, I could, as the saying goes, overthink a ham sandwich (once I actually overthought a BLT). When I was depressed and/or anxious, it seemed as though I had a recorder in my head that would play back for me every stupid thing I had ever done – even such a small thing as handing the wrong person a glass of water. At random moments, the memory would pop up, usually with full color and sound, and I would again castigate myself for being so stupid.

I agonized over decisions. Should I call a friend to tell him or her about a phone call I received that might affect them? One time it was the right thing to do, with positive consequences. Another time it was also the right thing to do, but with negative consequences. Dilemmas like that made it even more difficult to know what to do. Indecision paralyzed me. When I couldn’t figure out the consequences ahead of time, I couldn’t know if my decision was correct. Of course, this is true of most people and many decisions, but the dilemma would derail my thoughts and leave me vacillating.

Intrusive thoughts are quite often symptoms of depression and bipolar disorder, and they can be valid or nonsensical. Are my children getting an appropriate religious education? Where is my passport (when no trip is remotely planned)? They can keep one awake at night.

Psychologically speaking, overthinking and intrusive thoughts are definitely symptoms of OCD. Did I lock the door? Better check three times. Did I leave the stove on? Better check four times. Has the milk in the refrigerator expired? Did my cat get out the door when I wasn’t looking? Better go out and look around. Will I throw up when I ask my boss for a raise? Better not try. Does my aching knee mean I’m getting arthritis? Should I call my doctor about it? Will he think I’m imagining it? My mother only loves me because she’s my mother, not because of who I am. These kinds of thoughts can be disabling, crippling, or at the very least painful. They can cause you to doubt yourself and everything you do.

In mania, overthinking comes later. While you are spending or gambling or having risky sex or driving recklessly you don’t question it. It’s only later, when the episode wears off, that you have intrusive or obsessive thoughts. Oh, my God, why did I do that? How can I ever pay for all that? Are my finances so screwed up now that I can’t pay my rent? Did I binge drink and hurt someone? I’m so ashamed. I feel so guilty.

Cognitive Behavioral Therapy (CBT) may be one way to confront your intrusive thoughts and push them aside in favor of more productive thinking. Talk therapy of the usual sort may help you develop coping mechanisms for when your thoughts run away with you. And psychotropic medication may lessen or eliminate the underlying problem that causes you to have intrusive or obsessive thoughts. In my case, it was the latter two. I still get stymied by some decisions, but I don’t lie awake and think about them. I discuss them with someone else (my husband, my therapist) to get feedback. Then I make a decision and stick with it, or move on to thinking about something else.

What God Gives You

There are two expressions, common in “inspirational” memes, posters, and the like, that rub me the wrong way.

One is “What doesn’t kill me makes me stronger.” I addressed that one in a post (https://bipolarme.blog/2014/11/10/suffering-and-train-wrecks/) roughly seven years ago, and now I’m ready to tackle the other.

“God doesn’t give you more than you can handle.”

Let’s take a look at the premise. It implies that God gives us all our trials and troubles. Already, I have problems with that. Perhaps God is love and the devil gives us trials and troubles. Perhaps neither God nor the devil is involved, and life gives us trials and troubles. Perhaps even we give ourselves trials and troubles. It strikes me that these are equally valid propositions, though many people favor one or another.

At the heart of it, though, is the fact that there are trials and troubles in our lives, whoever or whatever gives them to us, and we must handle them. Wherever they come from, they will not be more than we can handle, the saying states.

The evidence of our eyes, and perhaps our own lives, says that this simply isn’t true. Plenty of people encounter (or have given to them) more than they can handle. Think of the homeless mentally ill. Are they able to handle what they’ve been given? The woman with her third miscarriage? The veteran with catastrophic injuries? Sure, some of them face their conditions bravely, but others don’t, and they’ll never make the news as “inspiration porn,” the uplifting stories of people who can and have overcome their afflictions, which is predominantly what we hear about in the media.

The fact remains that some people do receive more troubles than they can handle. There are serious mental illnesses that have no treatment. There are injuries and horrors that leave a person scarred inside and out. There are troubles that are so bad they contribute to death by suicide. In these and other cases, someone or something (or simply life itself) has given certain people more than they can handle.

The premise behind the saying, however, is that God never gives YOU more than YOU can handle. What I’ve said doesn’t mean there is no hope – only that it might come from a source you don’t expect. That might be the same God who ostensibly gave you those trials. It might mean another person, or a group of people, or a society can help you with what you need to make it through.

It’s not necessary to leave it all up to God to solve these problems. And it may be that we cannot rescue ourselves. But perhaps we can be that person, or one of those people, who can help someone whose troubles are more than they can handle by themselves.

I won’t argue whether it is because of the grace of God that other people help. But the original saying, in all its simplicity, is too simplistic. I believe that troubles and trials come to us from somewhere in the world, not from God, and people in the world are ultimately the ones who can help us handle them.

I’m not trying to deny the actions of God in the world. I’m saying that we must do our part to solve these problems too. Donate to a good cause. Volunteer to help. Listen to someone who’s hurting. Even just buy a box of cookies from a Girl Scout. Let’s make that “you” an “us.” God (or life) never gives us more than we can handle – together. (Note: Don’t even get me started on “God helps those who help themselves.” That’s not even in the Bible. Go ahead and look. I’ll wait.)

And why is this post in a blog on mental illness? Because that’s one of the things that some people can handle and others can’t, whether it was God or genetics or brain chemicals or trauma that gave it to them.

Have you heard of Quora? It’s like a crowd-sourced online question and answer center, where anyone can ask questions on practically any topic and request an answer from a specific person, or leave it up to whoever wants to answer.

I’ve used it myself for answers to questions about Ireland and about gardening. But since my Quora “credential” says that I have bipolar disorder and have written two books on the subject, I get questions about bipolar (and other mental health topics), usually several a day. Some I can’t answer. Some have already been answered. But I answer a couple every day. I consider it part of my goal of spreading information about mental health wherever and whenever I can.

Here are some of the types of questions I’ve been asked and how I answered them. Maybe they’ll help some of my readers as well.

What is the best medication to take for bipolar?

This one is the question most commonly asked, and it is easy to answer. I don’t know which medication is right for you. Only you and your psychiatrist can figure that out, basically through trial and error. It may take a while to settle on a med or combination of meds will work for you with the maximum effects and the fewest side effects.

I am thinking of quitting my meds, as I don’t feel I need them anymore or am having bad side effects.

DO NOT DO THIS. There are dangers in going cold turkey, not the least of which is withdrawal symptoms. Work with your psychiatrist. She/he can help you decide whether it’s a good idea to quit a medication. If going off a med is a reasonable idea, your psychiatrist will help you do it safely, most likely tapering off on the med you are on and possibly ramping up on a med that works better or has more tolerable side effects.

Besides, meds for bipolar are supposed to make you feel better – but it’s not a one-time thing. You have to keep taking them to keep feeling “better.” And if you go off a med and then decide to go back on it, it may not work as well.

Would bipolar disorder be eradicated if everyone came from a loving, stable home?

Sadly, no. While bipolar disorder may have a genetic component and may run in families, it can affect any person in any family. I had the most stable, loving family you can imagine, and here I am with bipolar 2.

What causes bipolar disorder?

The jury’s still out on that. Some people will tell you the cause is genetic. Others will say it is caused by deficiencies or overproduction of chemicals and receptors in the brain. Still others will say that trauma, especially childhood trauma, can cause bipolar disorder. Personally, I don’t know for sure, but I suspect it could be any one of them, or any combination of the three.

How do I help a family member with bipolar disorder?

First, you may be able to help them manage their disorder. In the early stages, you can perhaps help them find a psychiatrist, drive them to appointments, pick up their medication, and so forth. Be supportive. Tell the person that you love them and hope they feel better soon. (They may not respond to you at the time, but later they will remember who stood by them and helped them.)

You can also help by helping the person practice self-care. Provide an environment that contains the things that comfort and help ground them – comfort food, soothing objects such as blankets or pillows, favorite scents, or even stuffed animals. Encourage them to bathe or shower and facilitate that: Have clean towels available and clean clothes or pajamas ready to wear. Make sure there is soap and shampoo handy.

For persons in the manic phase of the illness, you can accompany them when they go out, try to help keep them centered on projects at home, try to help them when it comes to overspending or other reckless behavior. Again, remind them that you love them and will be there for them now and when they feel better.

How do I deal with a narcissistic, bipolar boss?

You can’t know that your boss really has a personality disorder or a mood disorder unless you have read their medical files, which is illegal. They may have narcissistic traits or change their mind frequently (which is not the same as having bipolar disorder). You basically have two choices: Put up with it or quit. You will not be able to change your boss’s behavior.

I’m afraid my parents will find out I have bipolar disorder.

If you are underage, you can probably not hide it from them. It’s not a good idea to delay treatment until you are of legal age, though. You can ask your family practice physician to recommend a good psychotherapist or psychiatrist. You can ask your school counselor to help you find help. There are telephone and text hotlines. The best bet may be to talk to your family about it, in a quiet, low-stress environment and explain what bipolar disorder is and why you believe you have it. Their responses may surprise you.

Will I be bipolar for the rest of my life?

Unfortunately, the answer is yes. Bipolar disorder is not a disease like cancer that can in some cases be cured. It’s more like diabetes or asthma, in that you will have to live with it, cope with it, and have treatment for it, most likely for the rest of your life.

But it’s not a thing to be feared. If you have the proper support, such as therapy and sometimes medications, you can live a fulfilling, “normal” life, and accomplish many if not all your goals. I have bipolar disorder and have completed grad school; have a loving, stable marriage; own my own home; and do paid work. You are not tied to a future of despair or fears or bad effects.

Keep trying.

Following My Moods

When I was a teen and undiagnosed with bipolar disorder, I had a weird reaction to people around me – I would pick up their moods and personalities and found myself mimicking them. I suppose it was a way for me to try on other personalities that I might someday integrate into my own, when I was stable enough to do so.

When I was a little older, I began journaling, which quickly turned into blogging. My journals were repetitive and boring, consisting mostly of “Felt depressed. Went to post office.” It didn’t seem helpful to me, though I know journaling is helpful to a lot of people. It helps them express what is happening to them and how they feel about it. In that way, it’s like a diary. Going back over a journal after, say, a year or so of writing (not necessarily every day) can help a person track their moods and their triggers. People can note their physical surroundings and emotional response and note whether seasons or weather, food and drink, interactions with certain persons, or other life circumstances have an effect on their moods and can help identify events that bring on depression or mania.

There are variations of this. One friend of mine used Facebook as his “diary.” He would look back through a year of his posts and conversations to determine when depression had struck him (there were fewer posts during those time periods).

In my own case, my husband and I have noticed that our moods follow each other’s. When I am depressed for a few weeks, he becomes depressed, too. When I am hypomanic, his mood lifts and he finds more joy in his own life. We do things together, like baking or watching our favorite TV shows together or going for day-long or even weekend getaways.

The same is true the other way around. When Dan is depressed or angry or just plain surly, I find it extremely difficult to maintain even a level mood. His mood creeps in and takes over mine. I sometimes try to maintain a level mood when this happens, but it is very difficult. I find myself struggling not to lose whatever peace or joy I have. I find myself frustrated by his depression or annoyance, to the point where I want to tell him to snap out of it. (I try not to do this. It doesn’t help anyway.)

If we both hit lows at the same time, or experience anger simultaneously, it gets fairly ugly. That’s when we fight, or both retreat to our rooms, or spend time away from each other, indulging in our own pursuits. Admittedly, such contemporaneous moods don’t hit very often, but when they do, it’s hell.

Both of us have learned techniques to respond to these “following” or simultaneous moods. We generally need more space or alone time. We ask each other for what we need and if the other is able to give it (hugs, for example). We offer what we are able to do, if there is indeed anything we realize might help.

Mostly, though, we just wait for the moods to pass and for both of us to return to a level state. I continue taking my meds and writing my blogs.

Interestingly, it was my husband who first noticed these “following” moods. Over the years, he has become pretty perceptive about both our feelings. It may help that he has studied and even worked in psychological settings for a while (no, that’s not where we met), but I think his real education has been living with me for almost 40 years. In all that time, you begin to notice patterns.

At one time my blogs did record my day-to-day (or week-to-week) feelings and actions. Sometimes they still do. But anymore, I find myself exploring other aspects of bipolar disorder and mental illness in general. I don’t believe I’ve said all there is to say about my feelings and symptoms, but this blog has allowed me to stretch out and consider the wider world of mental health.

Apparently, my husband is getting better at it too.

My Unrecognized Mania

I thought I had managed to avoid mania for most of my bipolar life. Brief bouts of hypomania, maybe, but never the real thing. Then I thought back on the last year and a half.

For years I had been trying to write a mystery novel, but a year and a half or almost two years ago, I really kicked it into high gear. I wrote. I rewrote. I tweaked. I outlined. I thought of names for my characters and backstories for them. I mapped out on what day of the week each event happened. I even looked up the weather and sunset time for a certain, pivotal day. I showed the first four chapters to volunteer readers.

Then I decided it was done enough and ready for the world. I started in December, sending out three queries a day to publishers and agents. I was undeterred by the rejections. I knew that many famous authors had been rejected dozens of times before they were published. I sent out 180 queries. It was like my brain was popcorn, exploding with ideas and determination and optimism.

I got the expected rejections, of course. Many, many of them. Most were of the “This is not the right book for me/us. Agents’ opinions differ. You should keep trying” variety, which only egged me on. Surely there was an agent out there for me somewhere.

At last, I got two responses that showed the agents had clearly read the sample chapters. They commented on the substance of my work and told me what needed “improvement.” My eyes were opened. They were exactly right. My book contained serious flaws and was by no means ready to be published.

So, that was about six months or more “wasted” on hypomania. In addition to the obsessive (though futile) attempt to make contact with 180 agents, I had other symptoms of mania or hypomania. I had delusions of grandeur. I thought my book would be published and make a splash. I imagined it might win an award for “Best First Novel” from a noted mystery organization. I even imagined the phone call to tell me that I had won.

No one noticed that I was hypomanic. My husband thought that I was somewhat obsessed, but he felt his duty lay in offering me encouragement, rather than bursting my pretty balloon.

My symptoms backed off.

Then, just a few months ago, Dan and I discovered that we were due to come into a sum of money. We immediately started planning what to do with it, and part of that plan included overseas travel. My hypomania kicked back in. For several months now (though we haven’t gotten the money yet), I fell into a frenzy of planning. And I spent money.

I bought small things, but lots of them. Books of maps and guidebooks. Little pill cases for daytime and nighttime meds. Rain gear. And more – despite the fact that the trip is still at least seven months away.

And I prepped. Oh, how I prepped. I used those guidebooks to plan routes and sights to see, trying to balance the route between things that might please my husband and things I had seen before and wanted to revisit. I googled to find out how distant each b-n-b was from the various attractions, and how far the attractions were from each other. I planned where we would go on each day and how much time it would take to drive, so I would know when we had to check out of our accommodations.

And I researched the country and foreign travel. Were masks required? What would the weather be like? Where could we change money? How much cash would we need to carry? Would ATMs work with our credit cards? Were they even accepted at most venues? Would our banks charge a foreign transaction fee? Could our cell phones both work abroad and call back to the States? What days and months were some destinations open? Would they acknowledge my handicapped parking pass?

None of this was actually harmful, except maybe the money and time I spent. In fact, much of the obsessing was enjoyable. It’s been my habit in the past to research the places I was traveling, buying guidebooks and other useful things. But this was more than that. I felt internal pressure to make this trip as perfect as it could possibly me. I was planning the Bataan Fun March.

Recently, I snapped out of it and talked it over with my therapist. She affirmed that I was indeed having hypomania, though not a very destructive kind, except maybe the spending. Since then I have barely touched the guidebooks and schedules. I haven’t googled anything.

I must admit, though, that the feeling of accomplishment in both cases was quite enjoyable. I see why people romanticize hypomania or mania and even long for it to happen. It does increase energy and allow one to plan, even if mistakenly. I knew from seeing another manic person in my former workplace that mania seldom accomplished anything of lasting value. I suppose the lesson I must take from these experiences is that I should learn to recognize the signs of mania and try to drag myself back down to earth before I do something I’ll truly regret. That will involve my prescribing physician, my therapist, and my husband (once he realizes that I am getting manicky), all in an effort to get me back to a place of self-control.

But of course, we know that’s not really how bipolar disorder works.

Of all the types of depression that get discussed – major depressive disorder, exogenous depression, endogenous depression, bipolar depression – there’s one type that isn’t talked about very often: dysthymia. The word comes from Greek, where it is made up of dys (bad or ill) and thymia (mind or emotions). But in clinical terms, dysthymia has a more exact meaning than “ill humor” or “bad mood.” I had always assumed that it came along a scale of severity that ranged from major depression through dysthymia to stability to hypomania to mania. It could be that I was mistaken.

Johns Hopkins Medical has this to say: “Dysthymia is a milder, but long-lasting form of depression. It’s also called persistent depressive disorder. People with this condition may also have bouts of major depression at times.” So, it’s milder, but long-lasting, persistent, and may occur in people with major depression. Not very specific, is it?

Johns Hopkins also notes that to diagnose dysthymia, “an adult must have a depressed mood for at least 2 years (or one year in children and adolescents).” The Mayo Clinic also refers to it as “Pervasive Depressive Disorder.”

Dysthymia seems like a “squishy” diagnosis, as the signs and symptoms overlap so greatly with major depressive disorder.

Garden-variety depression or “Major Depressive Disorder,” again according to the Mayo Clinic, “affects how you feel, think and behave and can lead to a variety of emotional and physical problems. You may have trouble doing normal day-to-day activities, and sometimes you may feel as if life isn’t worth living.” The risk factors and symptoms of the two disorders are virtually the same.

However, major depressive disorder, according to multiple sources, must last around two weeks, while dysthymia lasts for two years or more. Personally, I can’t see how this is called “milder.” Alternating between the two conditions is sometimes referred to as “double depression.”

I have thought of dysthymia as milder, and perhaps it is what I have now that my depression is pretty well controlled by medication and therapy. I no longer have extreme symptoms such as the self-harm and suicidal ideation.

Then again, one of my major depressive episodes lasted three years or more, with no visible letup. Was that relatively mild? It sure as hell didn’t feel like it.

Perhaps it doesn’t matter what you call it. The experience of the disorder seems to me more important than the label put on it. I haven’t looked the conditions up in the DSM (I don’t have a copy). But all my life I have been diagnosed with depression or major depression (before my diagnosis was changed to bipolar type 2 with anxiety, and it seems pointless now to call myself dysthymic. Maybe I’ll ask my psychotherapist when I see her next week if she can shed any light on this confusing nomenclature. Maybe she’ll have a handle on which of these I technically have.

However you want to name it or frame it, though, I have – and probably have had since I was a child – some version of the disorder, and have applied the treatments for it (meds and therapy for both), and now experience occasional episodes of the “milder” version, though they certainly don’t last two years.

In a way, I wish the various authorities would make up their minds and quit changing the labels. In another way, I don’t care what the labels are (unless they affect insurance companies and what treatments they allow). I experience this disorder in the way that I experience it. Most of the time I simply call it depression, and I don’t see how it helps to subdivide it. When I hit rock bottom, I call it a major depressive episode. When I’m relatively stable, I call it “in remission.” These may not be the technically correct terms, but they’re what make sense to me.

I don’t know whether other people with bipolar disorder make these fine distinctions, or simply think of their shifting moods as lows and highs, depression and hypomania or mania, or whatever.

But do we really need more labels? Isn’t lived experience good enough? Does the definition affect how our doctors treat us? Are there going to be more subdivisions in the future (a trend which seems particularly rampant right now, as with autism, Asperger’s, high-functioning, low-functioning, and more and more variations)? Does what we call it really help anyone get better?

Maybe I’m wrong here, but I don’t think so.

Mind and Body, Again

We know that the body affects the mind affects the body in various ways, especially when it comes to mental illness. Many of us who live with anxiety, bipolar disorder, or another condition experience physical symptoms like tremors, nausea, hives, and diarrhea.

The last one is my particular curse, which no one wants to hear about, but there you have it. Or rather, there I have it.

I didn’t even know that this was a problem related to my mental state for many years. All I knew was that whenever my mother or father was taken to the hospital, I would invariably and eventually find my guts in an uproar – usually when I got home, but sometimes in the waiting room. I thought that my bowels were my “attack organ,” as the saying went, and that I was merely reacting to the stress of the situation.

Of course that was true, but it never occurred to me that this was not just a physical problem, but a mental problem manifesting physically. At the time I was undiagnosed with bipolar disorder and knew little about the condition or how the mind and the body were connected.

The severity of the problem was impressed on me years later, when I was having severe anxiety, just after coming out of a severe and lengthy spell of depression. The more anxious I got, the more episodes I would have, sometimes up to six times a day. I lived with Immodium within easy reach at all times. During the worst of it I didn’t dare to leave the house. When I applied for disability, it was this affliction as much as my bipolar disorder that was the basis of the case.

Naturally, I told my primary care physician about the problem, and he sent me to a gastroenterologist. The specialist thought I might have Irritable Bowel Syndrome, but then again he wasn’t sure and didn’t seem to give it much more thought.

My psychiatrist, though, had a different idea. He suggested that the upset in my guts was caused by upsets in my mind – not that I was imagining it (there was ample evidence that I wasn’t), but that my nerves were overstimulated by anxiety and that caused my gastric symptoms. It was a feedback loop – anxiety caused diarrhea caused anxiety and so on and on.

I don’t know if it was the anti-anxiety med he gave me or if my anxiety just calmed down on its own, but the episodes became fewer and less frequent. I no longer stayed strictly at home, within easy reach of a bathroom, or feared going out. (I did make sure I knew where the bathroom was any place I did go.) I even stopped carrying a change of underwear in my purse. And my disability claim was denied. (I was also making so much money at my at-home freelance work that my lawyer said the judge’s head would explode.)

I still get anxiety-related diarrhea at times, but nothing like the biohazards I used to have. It’s no longer an everyday (or many-times-a-day) occurrence. I still do keep a supply of Immodium in my desk, my purse, and the bathroom, though, just in case.

I hesitated before writing this post, as it’s a difficult and unpleasant topic. But I know that a suffering mind can make the body suffer too, and I thought there might be people out there who have similar problems and needed some reassurance that they weren’t the only one. I don’t know what your “attack organ” may be or what your particular symptoms are, but do keep in mind that the interaction of the mind and the body can produce unwanted results. And that you are not alone in dealing with that.

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