Bipolar 2 From Inside and Out

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What Should Medical Students Learn About Mental Illness?

I recently saw a news story reporting that a single medical school, Des Moines (IA) University, has made it mandatory for medical students to learn how to care for patients with mental illness.

Funny. I would have thought that was already happening in medical schools across the country. Apparently not. Although medical schools teach prospective doctors to diagnose mental illness, the article notes, they do not require students to learn how to care for the mentally ill. When the class started in 2018, it was an elective, but it later became a requirement.

The curriculum includes having people in recovery from mental illness, loved ones of patients, and healthcare providers speak to the class. It is hoped that this will combat the stigma that arises from student doctors only seeing mental patients on locked wards when they are in severe crisis.

Of course, confinement on a locked ward is not typical for people with SMI. Many people with bipolar disorder and even schizophrenia, for example, require inpatient treatment only occasionally, spending the majority of their lives receiving treatment, medication, and therapy as outpatients. One wonders if the stigma surrounding mental patients extends to them as well. Do some GPs tend to ignore physical disorders while focusing on the mental ones? It’s fairly well known that doctors sometimes focus on a person’s weight as being the cause of all their symptoms instead of looking for (or testing for) other conditions. Might there be a similar narrowing of focus regarding mental patients?

Looking at the course, the answer may be yes. Interestingly, the main concern in developing the course seems to be that because doctors were so uncomfortable treating psychiatric patients that they focused on the SMI and never diagnosed and treated conditions such as heart disease, hypertension, and other medical problems. Professor Dr. Lisa Streyfeller cites what she calls “really horrifying statistics that folks with severe mental illnesses die on average 15 to 30 years earlier than people who don’t have those illnesses.”

As important as it is that people with SMI receive treatment for their psychiatric conditions, physicians need to be aware that such people have physical needs and illnesses as well. And as encouraging as it is that mental patients themselves, and their loved ones and caregivers, are included in the curriculum, the article made no mention of teaching prospective doctors how to interact with mental patients they encounter in their practices. If such courses do not exist in medical schools other than DMU, where are doctors going to learn how to talk with and understand the many, many patients they will have who suffer with anxiety, depression, mania, anorexia, and the dozens of other diagnoses?

In some communities, first responders such as police and EMS workers are beginning to have mental health practitioners go on “ride-alongs” to help educate emergency personnel on how to handle situations involving the mentally distressed. Classes like the one at DMU (if others existed) could benefit from having students “ride along,” doing internships or rotations with established doctors who treat the physical as well as the mental symptoms of their patients. Perhaps psychiatric rotations in medical schools could include student practice in community or campus mental health centers instead of just locked wards. Perhaps medical schools could involve students in role-plays involving speaking with and treating the mentally ill, the way they sometimes do for prospective doctors’ encounters with terminal patients.

With NAMI reporting that 1 in 5 U.S. adults – 20% – experience mental illness each year and that
1 in 25 U.S. adults – 4% – experience serious mental illness each year, the odds are overwhelming that future doctors will need to learn how to treat patients both physically and mentally, as well as simply on a human level.

Here’s hoping that the DMU model class idea spreads – and that medical school education on mental health someday will be covered more thoroughly than a single class and a visit to the locked ward.

 

Reference:

DMU Becomes First Medical School to Require Mental Health Course for Students

A Few Good Things Remain

Sometimes it seems like my life has been one long string of misery, despair, and disappointment. But that’s not true, really. Though I was likely bipolar even as a child and have suffered from depression and anxiety ever since, I still have some good memories of even the most difficult times.

Take childhood, for example. Yes, I was moody and difficult, and I missed out on a lot of opportunities, but good things still happened to me. My parents didn’t understand my condition, but they provided a stable, loving home. We had relatives in the country that we visited often, and I had the opportunity to fish, ride horses, and play in haylofts. My parents encouraged my love of reading and regularly took me to the library to get a “fix.”

Yes, I cried at songs on the radio that weren’t even sad. Yes, I went into complete withdrawal after a humiliating incident at a birthday party. And yes, I walked alone in the rain so no one would see me cry. But I also have memories of camping and hiking and baking cookies, going to concerts and discovering the Lord of the Rings.

When I went to college, my condition was even worse. My moods were even more unstable and I began to self-harm. I went to the college infirmary when I expressed suicidal thoughts and stayed there overnight. Twice. (The only times I’ve been hospitalized, sort of.) I sat awake in the hallway at night, staring at a poster on the wall. I took a year off to try to decide what direction my life would take and returned with nothing changed.

On the other hand, I made some really good friends who stood by me. I had some amazing professors (including Carl Sagan) and developed my writing skills. I finally had my first date, my first kiss, and a few other firsts.

During that time, I also entered into a disastrous relationship that lasted just over a year and did major damage to my self-esteem and my moods. It shredded my ability to cope and led to more self-harm and self-medicating.

But again, there were bright spots. I made some more friends, whom I cherish to this day. I met my husband. I heard some wonderful live music and met many of the performers. I made it through the four years and won my diploma (and it did feel like a real win).

While I was healing from the traumas I’d already experienced, I had a lot of problems with depression and anxiety (which were not yet diagnosed as bipolar 2). But I also held down responsible nine-to-five jobs and began to have my writing published in magazines. I traveled domestically and abroad, both alone and with others.

For a while, it seemed like my disorder was on hold. I thought I had escaped the traumas of the past and made a new life for myself, one that included a few close friends, a lasting love, some new experiences, hobbies, beloved pets, and more music, both live and recorded.

Then I experienced a major crash, one that left me unable to work, to write, or to do much of anything for over a year and a half. It was unrelenting. I enjoyed nothing. I had distressing physical symptoms that left me incapacitated for days. I wouldn’t have gotten through it all without my husband.

Then came my proper diagnosis and medication. Things didn’t change for the better instantly. I still suffered profoundly while my doctor and I tried med after med, seemingly to no avail. At last, we came upon a cocktail of drugs that made it possible for me to live and work again, to enjoy day trips and weekend travel, to write and love and live. Since that time, I have learned to live with the limitations I still have and to treasure the good things that do happen.

My bipolar disorder has been like that, with a series of relapses and relatively stable periods strewn among the bad times. And, though at times my disorder has felt all-pervasive and unrelenting, if I think about it honestly, even the bad times were dotted with little islands of good things.

Bipolar may have been a large part of my life, but it hasn’t been my whole life.

Beautiful at the Broken Places

The Japanese have an art form or maybe a philosophy called kintsugi, which involves embracing the flawed or imperfect. Cracks or breaks in a pottery or ceramic vessel are repaired using gold dust and resin.

According to Wikipedia, “Japanese aesthetics values marks of wear by the use of an object. This can be seen as a rationale for keeping an object around even after it has broken and as a justification of kintsugi itself, highlighting the cracks and repairs as simply an event in the life of an object rather than allowing its service to end at the time of its damage or breakage.”

On December 29, I posted an essay titled “Broken” (https://wp.me/s4e9Hv-broken). In it, I described the despair and depression that finally hit me after a stressful year, one that ended with the news that my second book was not going to be published. It was an awful trigger for me, considering the amount of work and hope and myself I had already invested in the book, and how near it was to completion.

Instead, I have decided to embrace the philosophy of kintsugi. I may have been broken, but nothing says I can’t put myself back together and consider my mending an improvement. In fact, my therapist said something similar after I suffered an earlier breakdown: essentially, that I could choose what parts of myself I would restore and which I could cast aside. Recently I came across an old diary from that time. I have not yet decided whether to read it, keep it unread, or get rid of it. At any rate, I don’t think I’m strong enough to decide that now, given everything else that’s been going on. But there are other things I have decided to keep.

One of my decisions is to keep my first book, Bipolar Me, alive. It was went out of print this month, but I will be self-publishing it on Amazon. I won’t let the second book, Bipolar Us, die either. Right now I am exploring ways to make sure it will be published as a paperback as well as an ebook. It’s better than my first book, I think, and I want it to be available to people that might find help or hope in it.

To celebrate this decision, I have ordered a kintsugi-style bowl. (I can’t afford the real thing.) On the bottom will be written “My Story Isn’t Over,” which is also the motto that informs my semicolon tattoo. I will keep it near my desk, where I can see it often and let it remind me that beauty can come from the broken after all.

I also hope that the rebuild on our house, which was destroyed by a tornado, will make it more beautiful at the broken places. (The only thing that remained was the basement, so it’s really going to be all new.) At last I will have a home that I have had a hand in designing, choosing materials, and decorating. No more mismatched, hand-me-down furniture. No more rental-neutral walls and carpet. I can create my study as a place of comfort as well as work, one where my self-care items are readily available and the colors and decorations reflect a calm, steady mood. Again, it is a chance to rebuild something and make it better.

Most of all, though, I need to keep working on me. There are still cracks and breaks in my psyche that need to be repaired. It will take continued hard work and loving support rather than gold dust and resin, but I hope I can eventually convert my troubled life into a work of reclaimed art.

 

On Stigma Fighting and Political Advocacy

Lately, I’ve noticed a trend in mental health circles. It’s a question of philosophy on some levels. What should we, as people concerned about mental health, mental illness, and society, be doing with our time and energy?

The two choices boil down to fighting stigma and political advocacy. They each have their motivation and their adherents.

The stigma fighters (including the organization Stigma Fighters) maintain that the way to make things better for the mentally ill is to erase the stigma that surrounds mental illness (particularly serious mental illness, or SMI). And there’s no doubt that there is stigma. The mentally ill are feared and blamed for violence in society. They do not get jobs or lose jobs because of their conditions. They hesitate to enter treatment for fear that friends or family will find out.

While mental illness is no longer the “secret family shame” that led to family members being “put away quietly,” kept locked in the attic, and never mentioned, many families do still find that mental illness – in themselves or their loved ones – is something to hide. Something not to discuss in polite company. Something to ignore the existence of.

People who fight stigma usually do so with information and education. Celebrities – even the British royal family – speak openly about conditions such as bipolar disorder, depression, anxiety, eating disorders, OCD, and other of the more common diagnoses. You undoubtedly have heard the PSAs on television that explain that mental health is important and that seeking treatment is not something to be ashamed of.

Are the stigma fighters making a dent in the stigma? It’s hard to say. At least they seem to have opened a conversation about mental health, mental illness, treatments including medications, mental illness among men, suicide, and other problems we face.

Still, the political advocates say, all that stigma fighting has done nothing to increase the number of psychiatric beds available or the number of psychologists caring for rural populations, the homeless, or people with schizophrenia and other psychoses that are foreign to most people’s experience. What we need are people who will bring up these and other issues with legislators and influencers at the local, state, and national levels; who will present proposals that may do some good in increasing access and funding; and who will advocate for improvements such as training for first responders in how to address mental health concerns.

And it’s true. All these things – and more – are needed. We may debate the wisdom of involuntary commitment or compulsory medication, but they are certainly topics that need to be explored if a consensus is ever to be reached. Most people in the mental health community admit that the system is broken and needs to be fixed – or possibly re-thought from the ground up.

Where do I stand on this debate? I feel that one or the other is not enough. It’s not an either/or situation. It seems to me that unless there is some real progress made in fighting stigma, the voting public and the legislators will not understand the realities of mental illness, the need for change, and what needs to be done to fix the system. Unless we engage in spreading information and changing people’s minds about what being mentally ill means, support for policy changes will be thin on the ground. And unless we come up with some solutions that people understand and support, nothing will change.

Myself, I work mostly in the stigma fighting camp. I don’t have the political acumen, contacts, and energy that real activism takes. I know it is vitally important, but it is not something I can do very much or very well.

What I can do, through my blogs and my books, is help with the information and education, spreading the word about mental health and mental illness, and helping alleviate the stigma that accompanies them. I also intend to start looking for opportunities in my writing to comment on the larger societal issues and proposed solutions and help with education about them as well.

To solve the problems surrounding mental illness, we must all do what we can, and what we do best.

Asking for What You Need

I saw a post on a bipolar Facebook page that asked what coping mechanisms people used. There were the usual responses about self-care, which is certainly a fine coping mechanism. But it’s far from the only one.

I’ve learned any number of coping mechanisms over my years in psychotherapy. There’s “looking at how far I’ve come.” There’s “leaving the room when my anxiety gets too bad.” And there’s always one of my favorites: “petting the cat.”

But the answer I put down was “asking for what I need.”

It’s a good coping mechanism because no one can read minds. No one else knows what I need. And, short of them guessing and hoping to hit on the right thing, the only thing I can really do is ask.

I can ask my therapist whether we can work on my anxiety today. I can ask my friend to check in on me daily for a while. I can ask my husband for a hug, or alone time, or some distraction.

Of course, I don’t always know what it is that I need at any given time. At times like that, I can simply ask for things that might help or have helped in the past, like the aforementioned hug or alone time. My husband has been with me for so long and is so familiar with my bipolar disorder that he knows a number of things that are likely to help, and he can suggest them. If all else fails, he suggests I go to bed, or read, or listen to music, all things which can calm or center me. Sometimes he simply puts on my favorite movie, to help draw me out.

Closely tied to the mechanism of asking for what I need is the technique of negotiation. I may know what I want or need, but the other person may not be capable of providing it, or at least not right then. If a friend can’t take my phone call, I can suggest an alternative: Call me after 10:30 or sometime tomorrow. If I need distraction and my husband has to go to work, he can suggest that we go out to lunch the next day.

We’ve developed a shorthand for such situations. When the only thing I can do is say, “help,” he responds with, “help how?” If I can then come up with a suggestion, I do. A lot of the time he is able to provide what I need. But sometimes he just isn’t. Maybe he isn’t able to get me out of the house for lunch. So instead I say, “I need comfort food.” He usually says, “You can get that.” Or he may respond with what it is that he can do: “There’s cheese and crackers here. Will that do?”

Asking for help isn’t easy, and Lord knows negotiating for what you need isn’t either. Both take lots of practice. And there is always the possibility that another person simply cannot supply what you need. That’s where self-care comes in. I know down deep that a nap, or comfort food, or music may help me, and if no one else can provide them, I can usually do it myself.

Receiving help may not be easy, either. Asking for what you need can make you feel, well, needy. And receiving help from someone else may make you feel guilty or unworthy. But the fact is that you – all of us – need help at times and that learning how to ask for and accept help is a valuable skill. And a totally valid coping mechanism.

Dealing With Other People’s Anger

Before I was diagnosed with bipolar 2 and anxiety, I thought I was just a wimp.

Anger – anyone’s anger – frightened me, even if it was not directed at me. I spent a lot of time cringing, until it became an automatic reaction.

This was not because I was raised in an abusive home. I wasn’t. My parents expressed anger appropriately when they were angry, which wasn’t very often, and didn’t take it out on us kids. Once, my father, in a fit of frustration, kicked the locked door to a room my sister and I were squabbling in, and it shocked me. But compared to what some unfortunate kids go through, it was nothing. Once my fifth-grade teacher slapped my hand when I was holding hands with a boy, but again, my main reaction was shock.

But by the time I reached my late teens and early 20s, strong negative emotions overwhelmed me. And not just my own emotions, but other people’s. I was seldom touched by their joy or relief, but their anxiety or anger really got to me. That’s when I started cringing, literally drawing back in fear and trepidation when voices were raised. At its worst, I cringed even when the voices were in another room.

Along with this, my startle reflex was in overdrive. A sudden noise from another room caused me to jump and gasp. The sound of someone dropping a kitchen utensil was enough to set me off.

I believe that these reactions were a result of the anxiety disorder that my psychiatrist eventually diagnosed me with. I always felt that the negative emotions, the anger, and the attacks would be coming at me. I was always on edge, anticipating the raised voice, the accusation, the threatening sound. And it was exhausting. There’s a certain amount of adrenaline that goes with fear and anxiety, and it can leave you shaking.

Oddly enough, I didn’t really start to get over my fear of anger until I began to get in touch with my own anger. For years, I thought that my only feeling was anxiety, but hiding behind the fear was anger. Even in situations that should have made me angry, when I had a legitimate reason to be angry, I never felt that feeling. That part of building a wall against my feelings worked, even if anxiety and depression were walled in, not out.

Gradually, I began to see that there were times when I should have been angry about something that had happened – that I had a right to feel angry. Later, I learned that I also had a right to express my anger. And I learned that neither feeling anger nor expressing it would destroy me. At that point, other people’s anger began to have much less of an effect.

I’m not completely over it. When someone expresses not simple anger, but rage, near me, I again feel the need to rebuild the walls. But I am learning to deal with it. Sometimes I am able to help the person examine their rage and explore what to do with it. Other times I can simply remove myself physically from the situation, so the rage doesn’t come pounding in on me. I learned to do that when I was dealing with simple anger and the anxiety surrounding it. But I’ve found that it works for rage, too. If I don’t have to be around it, I don’t stay within range.

Fortunately, rage is rare in the people I choose to have around me. Anger still happens, both for me and others around me, but I have learned coping mechanisms and built up the strength to withstand it.

I no longer cringe.

 

 

No Apologies

I’m not saying I’ll never apologize. Indeed, it seems like I’ve spent half my life apologizing, sometimes just for existing. Even apologizing for apologizing, which I now realize must have been incredibly annoying. My self-esteem was hovering near zero, and I felt that anything I did or said was somehow faulty and needed apologizing for.

What I am saying is that it does no good to expect apologies from someone who hurt you in fundamental, serious, and even soul-destroying ways. Abusers. Gaslighters. Narcissists. All manner of people, including friends and family, perhaps even the well-meaning ones.

Those of us with mental disorders such as bipolar, major depression, and anxiety are particularly susceptible to sustaining those kinds of hurts. Years of self-doubt, bullying, and out-of-kilter emotions had left me with no defenses against being hurt. Much as I had tried to put up walls, they were ineffective. I never learned to “just ignore it” when someone did or said something hurtful. And when it inevitably happened, no one – no one – ever apologized.

One reason for that is the essence of apologizing is taking responsibility for something – in these cases, the harm that was done. It happens in everyday life, never mind special situations with abusive people. Here’s how it happens: Someone says something hurtful. You, being hurt, react, visually or verbally. The other person pooh-poohs it: “I didn’t mean it. It was just a joke.” In other words, there’s something wrong with you for feeling hurt.

I’ve tried to explain this to people. When you step on a person’s toe and cause physical pain, you apologize, even if you didn’t “mean to” do it. Ah, but the person replies, when I step on your toe I know I’ve caused you pain. (As if only physical pain is real pain.)

Then there’s the old, “I just made a statement. You chose to react by being hurt.” (As if we could choose our reactions and our feelings.) Next comes a theoretical discussion of whether it is indeed possible to choose our reactions. I don’t know much about neurotypical people, but those of us with glitchy brains use all our mental wherewithal just getting through the day. A hurtful remark can throw us seriously off-balance. It’s like being slapped in the face. You don’t “choose” to be hurt or offended by that. You just are. Maybe – just maybe – you can choose what you do about it, but even that is iffy. The immediate reaction, whether it be crying, anger, or retreat, is just that, immediate. There’s no time to choose it.

Telling a person who’s been emotionally or psychologically hurt to “just brush it off” because the person “didn’t mean anything by it” is like telling a bullied child to “just ignore it.” It can’t be done. The thing, whatever it was, was said or done and caused pain.

Some people even attribute their insensitivity to childhood situations – “My mother made me say I was sorry for walking through the neighbor’s flower bed, and I resented it because I wasn’t sorry.” I say, if you react to hurting someone like a petulant child, the fault is not in the person who is hurt.

However a person avoids taking responsibility for hurting you, the fact is that he feels no need to apologize because, in his mind, he has done nothing wrong, nothing to apologize for. You can wait forever for that apology. It will never come. Even if you need that apology to begin healing the hurt, you may never get it.

Does this lead to lingering resentment? Of course, it does. Does it keep gnawing at you? Yes. Is there anything you can do to make your sister or your lover or whoever apologize? Definitely not. Is forgiveness the only path to healing? Well, that depends.

Sometimes the best you can do is not give the person another chance to hurt you – to break off your relationship with her. Not exposing yourself to that kind of pain is a valid choice. You can put the situation and the person behind you and try to move on. If you can forgive, great. If not, perhaps that’s not a choice you are able to make or to consider. Perhaps it’s part of protecting yourself or rebuilding yourself.

Realize that apology will never come, even if you deserve one. Some people are not capable of realizing the hurt they cause, owning it, and making amends. Getting away from such a person in your life is sometimes the best, or the only, thing you can do.

 

 

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