Bipolar 2 From Inside and Out

When My Carer Needs Care

By Farknot Architect / adobestock.com

My husband is the mainstay of my support system and, in large part, my caregiver. I cannot count the things he has done for me and does for me every day. We’ve been married for over 35 years and during that time he has helped me through daily life, major depression, anxiety attacks, loneliness, irrational thoughts, school, therapy. He makes sure I practice self-care and cares for me as needed.

Recently, though, he needed my help and care. The other day he experienced distressing eye-related symptoms – a large “floater” (dark spot) in his vision and unexpected flashes of light. What could I do about it? First, I answered his request to get a flashlight and look in his eye, but I saw nothing.

Next I arranged an appointment for him at our eye doctor. Dan used to be terrible at admitting when he needed medical treatment, but since a heart scare he’s been much more amenable to seeing a doctor. That particular evening, he was scared and cranky, and made up excuses. He left his phone in the car. That’s okay. I had mine right there. He didn’t know the number. That’s okay. I have it programmed into my phone. I waited on hold. “Forget it,” he said. “Never mind,” I replied. “I’ve got nothing else to do.” He said he didn’t see the floater any more. I pointed out that his eyes were closed. I got through to the doctor and made him an appointment for the next day.

Naturally, I drove him to the appointment, as they would have to dilate his eyes. Then, afterward, I drove him on several other errands (including an appointment with a different doctor) and made sure he ate lunch. I canceled one of the errands and put off others when I saw how tired and nervous he was getting. I took him home and tucked him in bed. (The floater turned out to be nothing truly alarming, just an effect of his aging eyes. He named it “Freddie the Free-Floater.”)

Dan has done almost exactly the same for me, many times. I could usually make my own appointments, but he encouraged me to do so. He has driven me to appointments countless times. He makes sure I eat. When I run out of spoons, he cancels or postpones errands, or even runs them for me. He reminds me when I need to have a lie-down or to sleep or to shower.

It was unusual for me to be the caregiver in this situation, and at times difficult, but I didn’t begrudge it. How could I possibly?

Of course, later in the day, I had a crisis and a mini-meltdown of my own, and there was Dan, ready to be with me, talk me through it, and make sure I didn’t skip a meal.

I know this is what marriage is supposed to be – partners helping each other through their individual and mutual times of difficulty. I also know that mental illness can put a terrible strain on a relationship. I admit that I am very needy at times, and was even more so at other times in my life.

But this time I got to be the strong one and take care of his needs before my own. And I was pleased and proud to be able to do that. Often there’s little enough that I can do for him, except offer him encouragement and remind him that I love him and appreciate him and all he does for me. If he asks for something he needs, I try to make sure he gets it (except for the $900 woodchipper, I mean). And I do what I can that benefits both of us – working to bring in money, paying the bills, doing computer research, handling phone calls, reminding him of appointments when I can – mostly stuff that involves computers and phones and recordkeeping and occasionally knowing where missing stuff is. And reassuring him when he gets trapped in the depression that he also suffers from that I love him and that he is strong and good and that he needs to take care of himself, and that if he can’t, I will try and do my best.

My Hypothetical Baby

By pololia / adobestock.com

Having bipolar disorder was one of the reasons I decided not to have children. Really, it was having major depression, which was what I was diagnosed with at the time.

I wasn’t so much concerned with passing my condition on to any potential offspring, since, at the time when I was contemplating motherhood, the genetic links were not yet that firmly established. Now that I know more about it, I think that might have been another deterrent. My parents had no idea what to do with me when bipolar symptoms started happening, and there’s no guarantee that I would have done any better. I’d like to think I would, but there’s no telling, really.

No, what I feared was having to go off my medication while pregnant (and breastfeeding, should it come to that). I was terrified of being unmedicated and I knew that psychotropic drugs were not good for pregnant women or their developing babies. Once I had discovered the benefits of Prozac and other mood-regulating meds, I knew I never wanted to be without them again. I never wanted to again fall into the pit that I had clawed my way out of. (In truth, that pit was waiting for me anyway, when I experienced a major depressive episode many years later.) 

Postpartum depression scared me too. I had heard the horror stories of women killing their children and/or themselves while suffering from the illness. I knew how out of control I could get with just plain ol’ garden-variety depression and anxiety. Adding postpartum hormones to the mix could be a really bad thing.

But the main reason that I decided my bipolar disorder made it unwise to have a child was that it would be unfair to the child. How to explain to a toddler that mama couldn’t get out of bed today or that she burst into tears for no apparent reason? How to explain weeks or months like that? How to deal with a child jazzed up on mama’s sudden hypomanic jag, who would then be let down when she crashed? How to soothe a child’s anxieties when mine were making me jump out of my skin? How to take care of a child’s essential needs, when I suck at taking care of my own?

Is that selfish? I know there are people who would say it is. That when the time came, I would suck it up and do the best I could. And I might. But would that “best I could” be good enough? I’ve heard it phrased that I was too involved with giving birth to myself – a relatively stable, reasonably happy, mostly functioning self – to give birth to someone else. And I think there’s some truth in that. It’s been a struggle, filled with despair, misery, hard work, setbacks, immobilization, dangerous thoughts, and living too much in my own head. To do the work of bringing myself to some baseline of functioning while trying to nurture and bring up another person daunts me.

I do understand that there are women with bipolar disorder and even postpartum depression who have children and that those children can be happy, healthy, and as well-adjusted as any modern child ever is. I don’t know how they do it, though. I was fortunate that I had a choice of whether or not to have children. I know that not all women do, and that many are delighted with their choice – whichever way they decide. I know that there are those who desperately want children and are unable to have them. I was fortunate that my husband didn’t push the issue, despite the fact that he would have welcomed a child.

I also had irrational thoughts about that potential child. I imagined that if the child were a boy (which run in my husband’s family), Dan (whose inner child is, shall we say, close to the surface) and the little boy would be natural allies and I the odd one out. He would be the fun dad and I the not-fun mama. And while that’s somewhat irrational, it also might be partly true. It took a long time for me to learn how to relax and have fun and share it with another person.

The one time I was open to having a child was when my father was dying a slow death. I thought that if he was going to see his grandchild, I’d better produce one promptly. Fortunately, it didn’t happen. I later realized that that was a really poor reason to bring a new life into the world.

What I’m saying is that the decision is not – was not – an easy one. Having a mental disorder makes it even more difficult.

 

By Chris / adobestock.com

I went to a very good university. I learned nothing about bipolar disorder from the curriculum. I didn’t take any classes in psychology, though at that time (the 70s), I’m not sure they would have taught that much about the disorder – almost certainly not that there were two versions of it.

I could have taken psychology. There was a requirement that all students had to take two classes outside their major – there were called distribution requirements and were intended to make us more well-rounded individuals. My major was English and I took History of Science and Astronomy (also Beekeeping, but that’s a story for another time).

It had not escaped everyone’s notice that I had psychological problems by that point. My high school had recommended to my parents that I be taken to the school district’s psychologist. They left the choice up to me and I declined, as I thought it would look bad on my permanent record. (It never occurred to me how the behavior leading to that recommendation looked.)

So, I toddled off to college undiagnosed and untreated, but surely in the throes of bipolar disorder. Gradually, I became aware that my mental state was, to say the least, unsteady. I had insomnia – I would spend some nights sitting in the hallway, staring at a poster. I had mental confusion – I changed my major from Linguistics to English based on an irrational assumption about the job possibilities. And I took a year off because I was too depressed to continue. (I went back after a year of working in a restaurant.)

There are certainly things I regret. I regret that I missed so much that was educational, enlightening, or entertaining. I regret that in a fit of hypomania I joined a sorority and tried to fit in while living there. I regret the cutting. And, perhaps most of all, I regret that, once, a fellow depression sufferer asked me to meet her one evening in the student union building to talk – and I didn’t go. I was too involved in my own pain to be open to hers.

As the years went on, I got worse. I had physical problems due to anxiety. I had disastrous relationships. Once or twice, friends became so worried about me that they insisted I go to the school infirmary because they were afraid I might be suicidal. I stayed a couple of days, denied suicidal ideation, and went back to my regular college life.

I did try to get help. At one point I joined a therapy group. One of the exercises that we had to do was to start and maintain a brief conversation with someone else in the group. “I can do that,” I said. I had learned to do that in the sorority, and besides, I was able to fake normal for that length of time. The therapy group never addressed my real problem and so did me no good.

If I knew more about bipolar disorder at that time in my life, I still might not have gotten help for it – there wasn’t that much help available at the time. But I might have understood myself better, done better academically, enjoyed more of the varied experiences that the university and the town had to offer, and been ready to accept help when it finally appeared (in the form of Prozac).

When I finally did get help, it was because I drove past a building with the sign “South Community Mental Health.” I thought, “I don’t know what I’m feeling, but whatever it is, it’s not mentally healthy.” So I began the journey that brought me to where I am today – still bipolar, of course, but diagnosed, treated with medication and therapy, and living a pretty good life. I even went back to college and got a Master’s degree.

I do still think about those years of struggle. I’m glad they’re over, but I still have those regrets. I don’t regret the university experience, though. It did broaden my horizons, introduced me to some people who are still dear friends, and taught me that I needed to keep searching for help with my problems. And that was a valuable thing to learn.

 

By GoodIdeas / adobestock.com

One of the ways I know when I’m slipping into bipolar depression is when I lose my sense of humor. Not even my husband’s awful jokes get a rise out of me. I also lose interest in many things that I ordinarily enjoy – reading, puzzles, and games, to name a few. The joys of life are few and far between.

Lately, I’ve noticed that I seem to be slipping again. I don’t feel overly depressed yet, but the signs are creeping up on me.

I think I first noticed it when it occurred to me that I had not done the New York Times crossword puzzle for at least a week. The Sunday Times puzzle is, or was, something I looked forward to every week. Now, I may not get around to playing it till mid-week or simply wait for next week’s, in hopes that I feel better. Most of my other entertainments have fallen by the wayside as well.

I know part of the problem is lack of spoons. I have been taking on extra work in my transcription job, simply to make extra money, which we do need. But it means I have given up almost all my days off and have had to get up very early to finish assignments. There’s little of me left over to do frivolous things, the things that bring joy.

On top of that, I have a house to furnish from top to bottom. I do not find shopping relaxing or enjoyable. In fact, I loathe it. Yet there I am, once or twice a week, at the vast home improvement store, picking out lighting or flooring or something else the contractor needs right away. It’s exhausting, not rewarding, and it eats into my spoons and my days off even more. It’s almost like having a second job, what with all the research, phone calls, appointments, choices, and decisions. Perhaps I’ll be able to rejoice in our new digs when it’s all done, but right now I can barely picture it.

The lockdown isn’t helping, either. One of the things I used to enjoy was going out to my favorite restaurants or discovering new ones. Now that is right out. I know some people are again indulging, but I’m not willing to risk my life for a cheeseburger and a brew or even tiramisu. My space and my life are constricted to a one-bedroom apartment, with a laundry/utility area substituting for my beloved study.

I do still have some comfort in my life, which is a mercy. When it all gets too much for me, I knock off for a while and watch some cooking shows on TV, which I find soothing, or read a chapter in a book before I fall asleep. At least I haven’t lost my ability to read, which I did once during a major depressive episode. And I’ve been able to maintain my blogs, which gives me satisfaction.

But as to joy, there is none. Life has become a tedious slog through one damn thing after another. One of the questions they always ask you during the depression screener at the doctor’s office is, “Do you no longer enjoy things you used to?” 

I’d say that’s true. Or at least I no longer have the wherewithal to do the things that I used to enjoy. Is it a marker of bipolar depression, or simply a reaction to all the things piling up on me right now? And which one causes the other?

On the surface, my retreat from joy is not excessively alarming. It has not yet reached the point of a major depressive episode. I can still do my work and my work on completing the house. What I can’t do is find a way to take mental time off – and I know that’s not good for my emotional stability.

I guess I’m just afraid that, in my life as it stands right now, there is no room left over for enjoyment. And that feels a lot like psychic numbness and depression. Perhaps when life settles down a little bit – if it ever does – I will get some of the enjoyment back. Perhaps it will become clear to me whether this exhaustion is circumstantial or anhedonia, a symptom.

Nevertheless, I plod onward, hoping for the day when satisfaction, relaxation, engagement – joy – will return. So far, it always has, though sometimes it seems forever before it does. That’s the nature of this illness and of recovery.

 

Delphotostock/ from adobestock.com

It often seems that bipolar disorder and especially bipolar depression narrow your life down to the fewest possible choices. Try to take a shower or stay in bed. Eat a handful of cereal or skip eating. Cry or … cry. And that’s all true. These disorders are quite limiting.

However, it’s also true that sometimes we’re faced with too many choices. Right now I am in the process of having our house rebuilt after it was destroyed by a tornado. Every other day it seems the contractor has something new we have to pick out – paint colors, floor coverings, lighting fixtures, ceiling fans – even the color of the grout between the tiles in the kitchen, an aspect of decorating I didn’t know even existed. It’s overwhelming.

The worst was the paint colors. Sherwin Williams has a color palette about 100 pages thick, with seven different shades on every page. My husband and I have a hard time trying to pick a place to go for lunch, much less what color paint we’ll likely have to live with for the rest of our lives.

Needless to say, I dithered for a long time about the colors. The only reason that it didn’t totally immobilize me is that I employed the technique of weeding. Once I had decided on a color for each room (my husband left that largely up to me, except for his study), I began looking at the paint samples and not choosing what I liked, but pitching out what I hated. No beige anywhere. No teal, not even for the bathrooms. And so on. What was left was a much smaller assortment of choices, which hubby and I were able to process. He always liked the lightest version of a color and I the next darker, but we were never far apart.

We got through the process in just a couple of weeks, and with only one real regret (the green we chose was yellower than we really liked, but we’ll mitigate that by covering the walls with photos, posters, and art prints).

Exhaustion is another aid to making choices. I have some mobility issues and can’t walk for very long, especially on the concrete floors in home improvement warehouses. And I’ve always hated shopping, except on the internet. At some point in the process of looking and comparing, I just throw up my hands and say, “What the hell! That’ll do!” and arbitrarily pick one of the two light fixtures that have most attracted my attention. It’s not like my world will fall apart if I don’t get the one, exact light fixture that complements the room. I just need to be able to see. Then I go home, have some iced tea, and put my poor, tired feet up.

One of my therapists once taught me another technique for making decisions – flipping a coin. This sounds obvious, but it’s not. The simple act of coin-flipping can work in one of two ways. Either you can leave the choice in the hands of the coin (as it were), or the result of the flip can focus your mind on what it is you really want. Any number of times Dan and I have played, “Heads, lunch at Frisch’s; tails, Waffle House.” If it comes up tails, we often instantly realize that it was Frisch’s we were wanting all along.

Frankly, I don’t know whether it’s better to have a limited number of choices or a lot. Either way can be mind-numbing, a seemingly insoluble riddle that threatens to stymie you into making no choice at all. (Or, as the therapists tell us, “Not to decide is to decide not to.”) But it is possible to develop techniques that allow you to make those choices and continue with your life.

Of course, I know these are comparatively trivial decisions. I sure couldn’t have figured out “leave or stay” by flipping a coin, especially as seriously unmedicated and out of control as I was at the time. “Get a job or go back to college” was also an important one, but ultimately an easier one to make – I envisioned the situations and asked myself which I’d rather be doing, writing press releases or reading books. The choice was clear at that point. Both were major turning points in my life, but one was excruciating and the other just another choice. I attribute that in large part to the medication and therapy I’d had in between and the coping mechanisms that I had learned and practiced.

 

By gustavofrazao via adobestock.com

Five years ago this month, Greg Abbott, the governor of Texas, vetoed a bipartisan mental health bill because he didn’t believe mental illness existed. He was influenced by Scientologists, a group founded by writer/guru L. Ron Hubbard, that opposes psychiatry, among other things. Abbott is still the governor of Texas.

Aside from Scientologists, what leads people to deny the reality of mental illness, when the signs are all around them? After all, one out of every four people will experience a mental disorder at some time in their lives.

I can think of several reasons. Not good reasons, but reasons.

The first is the “boy who cried wolf” syndrome. People who suffer mental illnesses just keep on suffering them, darn it. It’s not like they have one episode and then it’s gone, like a broken arm. After the second uncompleted suicide attempt or the fourth episode of cutting, the observer concludes that the person with mental problems really has none and the symptoms are just “cries for attention.” In other words, the only thing wrong with the person is that they want to be seen as mentally ill, but really isn’t. They are dismissed as “crazy,” but not mentally ill.

Then there is caring burnout. A person may be sympathetic to a friend or family member with depression or PTSD or whatever, may help them through a number of episodes. But at some point, they get tired. They simply can’t continue expending the considerable effort it can take to deal with a mentally ill person. “If she cancels or doesn’t show up to one more coffee date, that’s it!” they think. I have lost friends for this reason.

Another, more complicated reason is the denial of a person’s reality. I may be suffering internally, but it may not show on the surface. Many of us with mental disorders try to hide the symptoms and sometimes, especially among the high-functioning, it even sort of works for a while. The reality is that the illness continues “behind the scenes,” as it were, and is not apparent to others. This is a double whammy. The disorder exists, but is denied by observers – and maybe even the person who has it.

The truth is that my mental illness is real. It is mine to live with and mine to deal with and mine to experience. What you think about it or whether you believe in it does not affect the reality of it at all.

Well, that’s not quite true. Denial of mental illness does cause pain to the person who has one. Not being believed, being discounted, being blamed for various behaviors can be at the least wearying and at the most, soul-crushing. It feels like gaslighting to have someone say, “You’re not really ill. You’re just making it up/a drama queen/overreacting/going through what everyone goes through. Snap out of it!”

Just imagine what those people in Texas felt when they couldn’t get the help they needed because the governor “didn’t believe” in mental illness. The bill would have given “more resources to medical professionals that help residents dealing with mental health problems. The bill in question was widely popular, supported by many large medical associations in the state and both political parties,” reported the Greenville (TX) Gazette.

Far be it from me to wish a mental disorder on anyone, including Abbott or his family, but sometimes the only way a person can truly understand the reality of mental illness is when it strikes close to home – especially to a family member. One of my own relatives didn’t really believe until she saw up close what I was going through. She now at least believes, though she doesn’t really understand.

Real understanding may be too big a leap for some people to take who have not experienced mental illness for themselves. Belief in its existence ought to be much easier. Apparently, it isn’t.

Resource

http://www.greenvillegazette.com/r/texas-governor-vetoes-mental-health-bill-because-he-doesnt-believe-mental-illness-is-real-103158/

kues1 from adobestock.com

Ha!, you say. That’s an easy one. I know the answer to that. It’s like the difference between walking on pins and needles and walking on eggshells. For me, anxiety is the pins and needles, while mania is produces the eggshells. Pins and needles hurt more, but eggshells are easier to break. Anxiety causes me more pain, but mania has me treading carefully on a fragile edge.

Anxiety and Mania

I know more about anxiety than mania. My diagnosis is actually bipolar 2 with anxiety disorder. As such, I never really experience true mania. Hypomania is about as far as I get. And believe me, that’s enough. 

First, let’s start by admitting that anxiety and mania have a lot in common. At least they do in my life. Both of them make me frantic. Both of them make me obsessed with money. Both disrupt my eating habits. And both of them make me very very twitchy.

Frantic. Both anxiety and hypomania make me feel frantic, like there is something that I need to be doing to alleviate them. I know this isn’t true, that they are out of my control, but it feels that way. I get all revved up inside, a nagging, prickly feeling that jangles my nerves and irritates my brain. I try desperately to think what it might be that would calm the feeling, but there is nothing this side of an anti-anxiety pill, which might or might not help.

Obsessed with money. With anxiety, I obsess about the bills and how I am going to pay them. With mania, I obsess about what money I do have and how I can best spend it. Since this is, after all, hypomania, I tend not to go on wild spending sprees, but I have been known to buy myself or my husband presents, telling myself that the costs are comparatively reasonable and that at least I have limited myself to a non-extravagant amount. (Which may be the anxiety and the hypomania arguing with each other.) With anxiety, I try to anticipate all possible bills and juggle their amounts, due dates, and relative necessity (power cut off or trash removal cut off). I take on extra work, not because I think I have the wherewithal to do it, but because I want the extra money, no matter what it costs me in terms of physical and emotional energy.

Eating habits. Both anxiety and hypomania make me eat too much. With anxiety, no doubt I am trying to fill an existential hole or find something to distract me from my worries. With hypomania, I crave the relatively safe sensations of rum raisin ice cream; cinnamon Danish; or salted, buttery popcorn.

Twitchy. Both anxiety and hypomania can cause the shakes, tremors in my hands and arms and legs. Alas, not for me the euphoria of true mania, but the inherent sensation that I’m doing something wrong at some level. I can’t even enjoy hypomania without guilt.

There are differences, however.

Anxiety leaves me immobilized, in a way that hypomania just doesn’t. You’d think with all that nervous energy vibrating around my body and brain, I would hyper myself into a frenzy. Instead, all the jitters cancel each other out, leaving me with no place I can go to escape. My fears leave me paralyzed. The money worries leave me unable to decide what bill to pay first. I can’t decide whether it’s better to stay awake and try to read (if I have enough ability to concentrate), or take that anti-anxiety pill and try to rest, if not sleep.

Mania can make me productive, in a way that anxiety can’t. When I’m hypomanic, I can write, or at least put words on the screen. (Whether they’re any good or not is anybody’s guess.) But at least I have the illusion of motion, the impetus to create. That extra energy seems more focused, at least in comparison with anxiety. When I hit a hypomanic jag, I sometimes try to get ahead on my blogs, or at least jot down titles and ideas that I hope I can decipher and develop later.

Neither state of mind is preferable. Anxiety is the more painful and hypomania the more fragile. Anxiety is more familiar to me and hypomania more rare and even exciting. But I can’t choose. I can’t say that I like hypomania more than anxiety, although it does seem to have more benefits. But I know that it can be destructive and futile, promising things that it can’t fulfill.

Given the choice, I’d rather not walk on pins and needles or on eggshells. Level ground is fine with me.

 

Romolo Tavani from adobestock.com

There has been a furor lately in the psychiatric community and among psychiatric patients about the causes of depression and other mental disorders, as well as the appropriate treatment and the appropriate name for them. Among the issues are whether neurotransmitters in the brain cause these illnesses and whether biopharmaceuticals will help relieve them.

One of the main arguments against the neurotransmitter theory is that we do not really know whether depressed persons (most of the arguments use depressed persons as the easiest example) really have lower levels of seratonin, norepinephrine, or other brain chemicals than the general population. What is known is that increasing the amount (or decreasing the deficiency) of those chemicals helps many people recover from their condition, at least partly.

No, seratonin et al. are not “magic bullets” for depression. They don’t work for everyone. They can become less effective as time goes on. And no one quite knows how they work. But in many cases, including mine, they were the first – and at the time only – thing that helped. The explanation was sufficient for me, even when my doctors added new drugs to the “cocktail.” Advances in biochemistry, ya know.

Now, however, various scientists, psychiatrists, patients, and reporters talk about “debunking” the biochemical theory. Instead, they say, depression and other disorders are caused by traumatic events and stressors that change the way our brains react to stimuli – that the environment influences the brain in ways that lead to psychiatric illness.

But, it seems to me, we have a chicken-and-egg question going on here. Am I more susceptible to depression (or bipolar) because of the traumas and stresses in my life (especially my youth)? Or has my brain chemistry made me more susceptible to the traumas and stresses?

How, anyway, are we going to prove either theory?

Part of the difficulty seems to me to be the backlash against the pharmaceutical industry, which has surely done some sketchy things of late. Biopharmacy and drug treatment of various illnesses have become less popular as people question whether we really know what’s going on in the brain and whether we really know what those chemicals do.

Psychiatry itself follows the arc of a pendulum. At one time psychotherapy – the “talking cure” – was all that it had to offer. Later, with the advent of Haldol and Thorazine and Prozac and their cousins, it seemed that physical causes were more likely to be responsible for mental illness than unresolved childhood issues. This threatened to put psychotherapists out of business.

(I have always been helped by talk therapy, whether or not I was medicated for bipolar disorder. It has helped me through crises, taught me about healthy coping mechanisms, provided a reality check on my feelings, and so much more. I would never have made it as far as I have without both pharmaceutical help and psychotherapy.)

Now the biochemical theories are questioned and psychotherapy is in the ascendance again. Rather than treating our brains, we are to be treating our memories, uncovering the traumas that are said to have made epigenetic changes in our brains that manifest as depression, anxiety, or whatever. (I don’t think schizophrenia is included. There are just too many factors tying schizophrenia to genetics and the brain.)

It’s true that I had traumas in my young life, though never to the extent that many others experience. Were they brain-changing events? I wouldn’t have thought so. I took biopharmaceuticals and they helped. Was I mistaken about the causation (post hoc ergo propter hoc)?

If all this dissension leads to better ways to help sufferers of mental illness, then good. Plain and simple. But if it causes patients to abandon treatments that are working for them, I am less sanguine. In our pill-shaming, homeopathic culture, it just may be possible that the pendulum has not swung as far as all that.  I’m not giving up my psychiatric drugs based on a theory, when they have helped me so much. And need I point out that the “latest” treatments for depression and bipolar also target the brain and not the traumas they may have endured? Ketamine, ECT, and TMS all affect the brain directly. 

Also, let us consider that part of the objection to the “chemical imbalance” theory is the idea that it more likely promotes stigma to say a person has a “brain illness” than a “psychosocial difficulty.” That’s all well and wonderful, but I would argue that it calls for more education rather than a change in how we treat. “Neurodiversity” may be a less stigma-laden term, but so far it shows little sign of catching on outside the ASD community. (Ask the person-on-the-street what “neurodiversity” means. Then ask what “mental illness” means. Neither answer will be helpful.)

If this remains a debate about what we should call mental illness, then I suppose there is little harm done. But if it affects the way we treat mental illness, that’s another matter entirely.

Shinonome Production by Adobestock.com

I recently spotted a headline that made me stop and read the story. It was from iflscience and the article was “People with Depression Use Language Differently.  Here’s How to Spot It.” Those of you who know of my abiding interest in mental illness, science, and language (I once studied to be a linguist) can imaging how my virtual ears perked up. The article also referenced technology and how it was being used to analyze people’s language.

But before we get to the article, a little background on computers, language, and therapy.

As early as 1950, computer scientist Alan Turing devised a test (now named after him) that challenged computer programmers to create a device that could produce language indistinguishable from actual human communication. This was in the days before computers could speak, so all the interactions were text only. Pairs of computer-and-human partners carried on a conversation, and an observer had to evaluate which of each pair was the machine. If the machine produced language that the evaluator could not distinguish from human speech, the computer was said to have passed the Turing Test. It was an early achievement in machine learning and artificial intelligence. (Only one computer is said to have ever passed the Turing Test, and even that achievement is in doubt.)

In the mid-1960s, another computer program called ELIZA was developed by Joseph Weizenbaum. ELIZA used “scripts” to reply to human communication. One of the most successful scripts was “DOCTOR,” which was based on therapy developed by psychologist Carl Rogers, who was known for repeating non-directional versions of what a client had said back to him or her. (“I’m mad at my mother.” “Why does your mother make you feel mad?”) Surprisingly, many users felt that the program displayed human-like feelings and it was believed that ELIZA could be helpful as an adjunct to psychotherapy – a very early version of a psychological chatbot, in other words.

Now we get to the iflscience article (which was previously published in Clinical Psychological Science and The Conversation). It divided the language that the computers analyzed into content and style. Not surprisingly, the content of the writings of depressed persons contained more words like “lonely,” “sad,” and “miserable.” But the computers noticed that in the realm of style, the depressed subjects were more likely to use first-person pronouns (“I,” “me,” “mine”) than third-person pronouns (“she,” “he,” “him,” “they”). Researchers theorized that people with depression were more focused on themselves than on other people and that pronouns are a more reliable marker of depression than content words.

On mental health forums that were analyzed, “absolutist” words such as “absolutely,” “nothing,” and “completely” were even better markers of depression than content words or pronouns, especially in anxiety and depression forums, and particularly in suicidal ideation forums.

What does this all mean? Researchers are using the knowledge gained from the studies to analyze natural language specimens such as blog posts, with results that sometimes outperform those of therapists. And because of machine learning efforts, the computers are only expected to get better at identifying not just depression and anxiety, but other conditions such as self-esteem problems.

At the moment, computers can analyze only written samples of language produced by those suspected of having psychological problems – blogs, poems, letters. This, of course, might be perfect for use with those chatbots that rely on text-only interactions. And psychologists might be trained to listen for language cues in the conversations they have with clients.

Will the depressive language experiments prove more successful than the Turing Test in mimicking human interaction and more functional than ELIZA in providing helpful feedback to those suffering?

Personally, I hope that the experiments continue, and continue to show promise. Although computers are not likely to take the place of human therapists, they may be able to help identify people who need the most immediate help, or even assist in filling the gap for populations with no easy access to psychological services.

 

Reference

https://www.iflscience.com/health-and-medicine/people-with-depression-use-language-differently-heres-how-to-spot-it/all/

Fear of Offending

By Drobot Dean from Adobestock.com

I have to keep a close watch on what I say in public or post online. I am afraid of offending people. Many times I have lost friends because of things I’ve said or done.

Is losing friends because of my bipolar disorder? In a way, yes. Is being afraid of offending others because of my bipolar disorder? In a way, yes.

I was not very well socialized as a child. The house I grew up in was very insular. My parents made few attempts to mix and mingle with neighbors or other school parents, so I didn’t see much of that as a young person and learn the unwritten rules. (My father did mix and mingle with the local gun club, but there were not many persons of my age and gender there.) I never went to preschool because I had a sister, we were very close in age, and my mother figured we could simply play with each other. (This was in the days before formal “playdates.”)

As I got older and my bipolar disorder began to manifest, I was even more out of sync with what the other kids were doing and saying. My mood swings left me laughing uproariously at things no one else thought were funny, or being gloomy and surly as a self-isolating hermit. I never learned the rules at school, either, of how to negotiate the complex patterns of behavior required as a student. I didn’t even know enough not to show off my intelligence, which didn’t win me many friends.

As I grew older, I got in the habit of tapping my face – symbolic slaps – whenever I said something that I realized I ought not to have said. (This was both puzzling and annoying to my companions.) It was a reminder to me to keep more of what I thought under wraps.

Of course, at the time I didn’t know that I was bipolar. I thought I was just weird. It never occurred to me that my brain was different, that I reacted in peculiar ways because of something I could not, at the time, control. I tried to be quiet and unobtrusive, but the manic humor kept leaking out, usually when no one else thought whatever it was was funny. I garnered a reputation as an oddball, even among the odd people who befriended me.

Later on, in the world of work, I was even more out of my depth. I still didn’t know how to socialize. I couldn’t manage “team-eating,” the mysterious rituals of the groups of workers who lunched together. I consciously practiced my socializing with the few people who would put up with me. I observed social interactions, but I never really internalized them.

I made statements that were meant to be funny, but they came out sarcastic, and I lost friends. I made statements that were meant to be assertive, but they came out bossy and I lost friends. I became more and more afraid to say anything that might be seen as hurtful, but I still did.

All of this made me afraid to offend people, so I began to shut down. I kept my jokes to a minimum. I didn’t even try to join the ladies who lunch. My social life was practically nonexistent.

Then came the internet and, especially, Facebook. Every time I wanted to post something, I had to run the content through the internal filters I’d built. Was it too racy? Too political? Too self-revealing? Too something? Would it offend someone and lose me more friends?

I developed techniques to soften my replies to other people’s posts. I’d agree with any part of a post I could and then add my real opinion, very softly. (I agree with you that there’s a lot wrong with our economic system, but it’s very complex and I think more regulations will be needed to improve it. I agree that most police are protective and well-regulated, but I think training in dealing with mentally ill persons would benefit everyone.) I became wishy-washy.

How does this reflect my bipolar disorder? Losing friends was one of the big traumas I went through as a child and I never wanted it to happen again. My first physical trauma was at the hands of other children, who threw rocks at me. My first bipolar “break” was a result of being humiliated by my best friend. (“Kids can be mean,” my parents said, but I knew deep inside it was all my fault.) Losing friends became one of my major triggers, something I would try anything to avoid. I just wasn’t very good at avoiding it.

Gradually, I am getting better at socializing and at speaking up without the constant fear that my words and actions will drive away people who care about me. I still try not to be confrontational, but if a meme expresses something I care deeply about, well, I will repost it. I still try not to insult the persons closest to me, but sometimes it takes me a while to figure out how to say something with just the right words in just the right tone of voice.

Bipolar? I think my glitchy brain got sidetracked by the illness when I should have been learning the ways most people behave. Now that my illness is mostly under control, I am trying to make up for lost time.

 

Tag Cloud

%d bloggers like this: