Bipolar 2 From Inside and Out

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Body and Brain: Self-Image

I’m fat. I admit it. I haven’t been fat all my life, so this came as something of a surprise to me, but I’m dealing with it. I don’t know whether it’s my eating habits or my medication or some genetic thing that has caused me to gain weight, but there you have it. It could be any or all of those.

I’m not trying extreme diets or grueling workouts, though I admit that some exercise would be good for my mental condition as well as my body. I’m living with and acknowledging the fact that I am fat.

The thing is, when I think about myself, I don’t think of myself as fat. Perhaps I’m in denial about it. But I do know how much I weigh and that it’s over what I should, according to all the height vs. weight and BMI Index charts. And I don’t think of myself as thin. I just feel as though I’m still in my 30s and weigh what I weighed then, despite my body’s very clear rejection of those notions. I know I’m really in my 60s and have trouble getting up off the floor if I fall, in part because of what I weigh.

I’ve heard that everyone gets stuck in their head at a certain age and always remains that same age in their mind. It’s not quite like having an inner child of four or ten (or in my case, more like 15). I used to think I didn’t have an inner child until I remembered how much I still love chocolate milk, plush animals, and naps. And I do have that inner teen that wants to make up for all the things I missed when I was a depressed teen, like mad crushes and experimenting with fingernail polish and fake nails. But having an inner weight is different somehow. It’s like my brain and my body are clashing in some way.

At least I don’t have Body Dysmorphic Disorder. That’s when you see tiny, imperceptible flaws in yourself and magnify them until you think that’s all people see when they look at you. Technically, it’s not the same as anorexia because, in anorexia, you focus only on your weight even if you are thin. Anorexia is an eating disorder that you have as a reaction to your flawed perception of your body size. Dysmorphic Disorder is more about smaller perceived flaws such as balding or the size of your nose. (The Mayo Clinic does say that Body Dysmorphic Disorder can cause or be associated with eating disorders, low self-esteem, mood disorders, obsessive-compulsive disorder, and substance abuse. The DSM-5 does not classify Body Dysmorphia as an eating disorder. It’s confusing.)

One of the dangers of Body Dysmorphic Disorder is overuse of plastic surgery, which can be somewhat of an addiction in itself. Just watch a few episodes of the TV series Botched and you’ll see what I mean. There are always horror stories like the one in which a young man wanted to look like Michael Jackson and as a result of repeated surgery suffered the same health problems and conditions that the singer did.

If I had Body Dysmorphic Disorder instead of the ones that I do have, I might be undergoing multiple treatments of liposuction, “cool sculpting,” tummy tucks, gastric bypass, extreme fad diets, weight-loss pills, and other procedures. I don’t and won’t. I’m aware that those are only temporary fixes and leave you open to disappointment, infection, scarring, and other bad effects and complications that can be worse than your original condition and stay with you for life.

So, where does that leave me? Besides fat, I mean. I try to be body-positive about people who don’t conform to societal messages about weight, including myself. It’s a difficult thing to get over. The messages are relentless. I have found myself in the past thinking that fat is unappealing and in the present thinking that extreme thinness is dangerous. But that’s only in the abstract. Any number of men I’ve been attracted to have been anywhere from pudgy to fat, including my husband.

I realize that I may get a lot of pushback from people telling me of all the medical reasons I should lose weight. I’m not saying they’re wrong. I’m just saying that if I’m comfortable with being fat, they could at least be okay with my fatness as well. In other words, I already struggle with my mind. I don’t want to struggle with my body too.

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Are Holistic Approaches to Mental Health Useful?

Well, first of all, the answer to that question depends on what you mean by “holistic.” If you mean treatment that considers the mind, body, and soul, I certainly have to say yes. All three are inextricably intertwined and healing one tends to heal the others as well.

Certainly, the mind is involved – that’s implicit in the word “mental.” To many, this means the brain as the location of the mind. Increasingly, this also means thinking of and referring to mental illnesses as brain illnesses. And the competing theories of what causes depression and bipolar disorder, for example, have had something to do with the brain. Perhaps neurotransmitters in the brain are not behaving the way they are supposed to, or processing traumatic events causes brain illnesses (certainly true in PTSD), or genetics is responsible. whichever it is, the brain is involved.

It’s not controversial to say that the body and the mind are linked in the most profound ways. What affects one affects the other. Mental illness has demonstrable effects on the body, all the way from not being able to care for oneself physically to having a shortened life span. Treatment programs for mental illness often include an exercise component, which causes physical changes in the body and brain. Depression in particular is known to be alleviated by even small amounts of exercise. The exercise partially relieves the depression, which makes it more likely that the depressed person will be able to exercise. It’s a cycle that benefits both the body and the mind.

As far as the soul goes, I don’t feel theologically competent to make any definitive statements. I do know, however, that many people find that spiritual practices such as prayer help them cope with the effects of brain illnesses. It may be subjective, but what works, works. I personally don’t believe that prayer cures mental illness, but even if it just makes the sufferer feel more at peace and more comforted, that’s a component of healing that’s important.

Holistic healing that recognizes the interconnectedness of these three aspects of the person is, in my opinion, more likely to be more effective than any one of them alone.

Then there’s the other thing people often mean when they say “holistic healing.” To many, holistic healing means avenues of treatment beyond the scope of Western medicine. Herbal medicine, meditation, homeopathy, acupuncture, yoga, and crystal healing are among the avenues that have been explored.

There is certainly some validity to herbal medicine. It’s been practiced for thousands of years and the results are well-known, particularly by indigenous peoples who have passed that knowledge on throughout the years. Chamomile, lavender, passionflower, and saffron have been studied for mitigating anxiety or depression in cancer patients, with favorable risk-benefit profiles compared to standard treatments. Ginseng is another popular herb for relieving mental conditions. St. John’s wort has been used as a treatment for depression for hundreds of years, and so has valerian for anxiety. And there are many vitamins and supplements such as B vitamins and zinc that might have beneficial psychological effects.

Unfortunately, there hasn’t been a lot of rigorous scientific study of plant-based medicine. For people who gather herbs and plants from the wild, there’s no telling the potency or amount of the active substance that may be present. Even in herbal products sold at health food stores, there is little standardization, so you don’t always know what you may be getting in terms of dosage.

Meditation and yoga are popular adjuncts to talk therapy and/or medication for psychological problems. In fact, these days, they seem to be promoted as a panacea for mental health. They’re particularly popular recommendations in corporate settings, where they’re seen as a low-cost alternative to more expensive treatments that would affect the company’s health insurance costs.

Nonetheless, meditation and yoga do have beneficial effects on mood disorders such as anxiety and depression, and may be helpful for conditions such as PTSD as well. Any amount of exercise is commonly recommended for people with depression and bipolar disorder. The effects are cyclical. The more one exercises, the more one feels able to get going with exercise. Yoga, being low-impact, is something that can be tried by nearly everyone. I’d still say they are adjuncts to traditional treatments for mental illnesses rather than a first-line approach.

Then there are practitioners of alternative medicine. These therapies range from acupuncture to chi balancing to aromatherapy to biofeedback to reflexology to reiki. Let’s start with one that has some science to back it up.

Acupuncture and its cousin acupressure have solid adherents behind them. Johns Hopkins Medicine says that acupuncture is useful in treating anxiety, depression, insomnia, nervousness, and neurosis, though more studies need to be done. And who am I to argue with Johns Hopkins? If they say it’s effective or even promising, I’m willing to say it falls inside the spectrum of helpful approaches.

Reflexology, not so much. The idea that there are areas on the feet that correspond to body parts and can be helped by foot massage is not scientifically proven for health in any body parts, either anatomically or physiologically. (It hasn’t been disproven either, but you can’t prove a negative.) It’s based on the idea that “energy lines” throughout the body somehow combine in the feet (or hands) to produce a map of the body. It is recommended for anxiety and stress relief.

On the other hand, the massage practice of concentrating on muscles that are tensed is much more well-documented. The Mayo Clinic has said that it can reduce stress and anxiety, and even mentions it as a treatment for depression and seasonal affective disorder (SAD). The thing is, any practice that reduces stress is good for relieving anxiety. Whether or not massage has any effect on serious mental illness (SMI) is doubtful.

Relief from tension is, of course, possible when a person believes that a particular technique can reduce it. So if you believe in aromatherapy, for example, it may help you relax. It’s the placebo effect. I’d rather stick with massage.

Then there are approaches that simply don’t work. Homeopathy is supposed to work on the theory that if a substance is good for the body, introducing a single drop of it into water will be effective in the treatment of a disorder. Never mind the science (though there are rigorous studies that say homeopathy simply doesn’t work), the math doesn’t support this. Diluting a substance to the extent that there are minuscule, millionth amounts per glass of water – or even less – just isn’t sufficient to do anything. If there are larger concentrations of the substance, in which there can be alcohol or heavy metals like iron and lead, there may be drug interactions or serious side effects. In 2017, the FDA alerted consumers that some homeopathic teething tablets contained excessive amounts of the toxic substance belladonna. Belladonna is also said to be a treatment for bipolar disorder and schizophrenia.

Crystals are another way that alternative practitioners attempt to cure assorted diseases and conditions. Jasper and tiger’s eye are recommended for anxiety and lepidolite or citrine for depression. Smoky quartz is even said to relieve suicidal thoughts. I wouldn’t count on it. Again “energy fields” of the body and “vibrations” of the various stones, minerals, and crystals are supposed to combine to affect mental and physical health. I own and wear any number of crystals for their beauty, but have never felt any healing effects. The only benefit I see is if a stone is carried in the pocket as a “worry stone,” which the person can rub to induce a calming effect, an early version of the “fidget spinner,” as far as I can see.

Still, proponents of these alternatives to traditional Western medicine will continue to hope for beneficial effects. The National Center for Complementary and Integrative Health says that Americans spend over $30 billion annually on alternative health care. I say, “Let the buyer beware.”

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The 988 Hotline: How Is It Working?

The 988 hotline, designed to be like the 911 connections to emergency services, has been in operation now for a couple of months. What have been the reactions to it so far?

Well, the number is shorter than the ten-digit former one for the National Suicide Prevention Lifeline (now known as the 988 Suicide & Crisis Lifeline); is for people experiencing any emotional distress, not solely a suicidal crisis; and can be reached via phone, text, or message app. A trained crisis worker in a center close to the caller will listen and then provide information about support and resources available in the area.

All that sounds – and is – laudable. Even so, the hotline’s existence has not been universally applauded. What are some of the perceived or reported problems?

Back when the hotline was still the National Suicide Prevention Lifeline, there were difficulties with wait times before speaking to a therapist. Many people who were on hold hung up. There is little reason to believe that this problem will go away – in Illinois, it’s been reported that 30% of callers hung up before reaching a counselor. The same company that ran the former hotline, Vibrant Emotional Health, is running the new hotline. And with all the publicity around the new number, there may be an even greater number of calls. (This might be optimistic, though, since a recent survey said over 75% of Americans had not heard of it by the end of June, just before the hotline went live. Federal funding may allow them to hire more of those trained crisis workers, but will that be enough?

That federal funding is another problem. Much is left up to the states, and there are a number that are not cooperating, neither funding nor publicizing the hotline. Only 20 states have done so. And let’s do the math. The federal funding totals $432 million, far more than was formerly spent on the mental health hotline, but it still means only an average of $8.6 million for each state. States can tap additional funding through sources including Medicare and opioid crisis money. But the lack of state involvement will certainly hinder the counselors in finding and recommending resources close to the callers – and callers in rural areas, for example, may not have any resources close by.

Another major concern that has gotten a lot of pushback from the mental health community – especially expressed on social media such as Twitter and Instagram (hundreds of thousands responded with likes) – is who will respond to calls that require serious intervention. Many are afraid that the local police will be notified of a suicidal person or other mental health crisis and respond to it with the aid of a crisis response team.

Specifically, they are upset because of the number of deaths that result when police who do not understand mental illness and its symptoms get involved. The officials that run the hotline say that police or EMTs are called only as a last resort effort for suicide situations. But many potential users are skeptical.

There have been rumors that the hotline can collect geolocation information about callers, but this seems to be limited to general location by phone number and area code, or IP address, which may be helpful in putting callers in touch with local resources, but also means that law enforcement can have this information if the hotline counselors do contact emergency services. Counselors are scheduled to receive training on when to call in law enforcement personnel and the dangers of it.

Of course, not all police involvement results in death. But there are other concerns when police and EMTs are involved. Among these are people being taken to hospital emergency rooms, where they receive slow or inadequate treatment, and involuntary treatment in psychiatric hospitals. (This is a particular concern for people in the LGBTQ+ and POC communities.) When there are so few options to treat the seriously mentally ill, the likelihood of the counselors providing useful advice for sufferers or families is not great.

Nonetheless, we should not let these potential problems overshadow all the good that the new 988 hotline will do. The more coordinated effort with the easily remembered number will help those who know about it in times of crisis. When the bugs are worked out, the states get on board, and the public becomes more aware of the service, it should prove a valuable resource for those not just with suicidal thoughts, but with everyone who suffers from a mental illness and who needs a listening ear, counseling, and resources.

Of course, no new public service endeavor gets off the ground without some rocky start-up time and a few glitches. Let’s keep an eye on the new hotline and see what it can do once it shakes out a bit.

 

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Divisions in the Mental Health Community

It’s sad when communities that ought to work together for the betterment of all are divided by strife. But that’s just what has been happening in the world of mental health.

Even saying “mental health community” is controversial. There are different segments of the population who say that “mental illness” is the more accurate term. Then there are those who advocate for the term “brain illness” while advocating for adequate supports and services.

Indeed, what to advocate for is another discussion. Many people are trying to root out the stigma that goes with having a mental illness. Others say that’s a waste of time – that what is really needed is advocacy for improved treatments and more accessible services. There is, of course, the possibility that one could advocate for both, but the issue seems to be that the stop-the-stigma people are pulling focus away from those who campaign for social and political (and financial) reform. The situation seems complicated by the fact that many “It’s okay to have difficulties” promos actually promote online therapy businesses.

Then there are the different “what causes bipolar disorder?” schools of thought. For years we attributed it to a chemical imbalance – neurotransmitters such as norepinephrine, serotonin, and dopamine not performing their job properly. Now many people think it’s caused, or at least exacerbated, by something else – heredity and genetics, environmental and lifestyle issues, or some combination of them all. Treatment with psychotropic medications, which is the most common for bipolar, tends to lend credence to the neurotransmitter theory, although it’s generally accepted that we don’t have any real idea of how they work.

The drugs used to treat bipolar and other disorders such as schizophrenia are controversial too. Many people credit them with saving their lives. Some others describe them as “neurotoxins.” One typical Facebook post said, “They are powerful, toxic drugs which can cause a chemical lobotomy and terrible adverse effects such as akathisia, dyskinesia, Parkinson’s, dystonia, and many other tortuous, real effects. Many people are left on these drugs for life.” This is one of the milder posts reacting to psychotropic meds. Many also speak of withdrawal symptoms and lives ruined. They also state that Big Pharma is partly to blame: “The sale of psychiatric drugs will continue to increase and force will still be part and parcel of psychiatry….If we have hearts we will not expect psychiatry with all its terrible past of fear, force, and fraud to understand any human being or society!”

Treatment for various disorders, particularly schizophrenia, is widely debated as well. Some people are appalled by involuntary commitment or “forced hospitalization and drugging,” while others see it as a valid procedure for anosognosia (the inability to recognize that one has an illness), as this increases potential harm to self and others. “Assisted Outpatient Treatment” or AOT, a form of supervised drug administration for those who have been released from treatment facilities is gaining adherents. Lynn Nanos’s book Breakdown: A Clinician’s Experience in a Broken System of Emergency Psychiatry makes a strong argument for AOT.

In fact, psychiatry itself is a disputed issue, and not just by Scientologists who feel that all mental illnesses are caused by whatever it is that can supposedly be cured by their practices. (You can probably tell that I don’t give any credence to their beliefs.) But psychiatrist Dr. Thomas Szasz railed against psychiatry in books including Psychiatry: The Science of Lies and The Myth of Mental Illness. Here’s a quote from The Science of Lies:

Because there are no objective methods for detecting the presence or establishing the absence of mental diseases, and because psychiatric diagnoses are stigmatizing labels with the potential for causing far-reaching personal injury to the stigmatized person, the “mental patient’s” inability to prove his “psychiatric innocence” makes psychiatry one of the greatest dangers to liberty and responsibility in the modern world.

With divisions like these, it’s no wonder that mental illness diagnosis, treatment, and priorities are large contributors to the broken system in the United States. Is it a healthy debate? Are they irreconcilable differences? Is there something to be said on both sides? Does science back up any side or does passion prevail? And will any of these debates be resolved in the near future? I believe that until the community gets together on a lot of these issues, not much will get done that will truly help sufferers.

Why Can’t I Sleep? Why Can’t I Wake Up?

Image by fizkes

Often in the past, I went to bed at my usual time but woke up at 4:45 a.m. and couldn’t get back to sleep, no matter what. It was like I had a hamster on a wheel inside my brain.

Other nights I would go to bed early and couldn’t get to sleep for hours. I tried reading, but sometimes I read till 2:00 a.m. with no sleep in sight. (I know you’re not supposed to read when you want to get to sleep because it activates your brain, but it’s been my nighttime habit for decades. When I find that I am reading the same paragraph twice, I know it’s time to knock off and fire up the CPAP machine.)

Then again there are days when I feel the need to nap in the early afternoon. I try to resist, but if I give in, there are no refreshing catnaps for me. I’m down for two and a half hours typically. Then the whole sleep-wake cycle gets off course.

And when I’m in the middle of a depressive episode, I’ve been known to stay awake all night, obsessing and catastrophizing. There are also days I can’t get out of bed in the morning, or all day in some cases, though I don’t usually sleep well after them.

What is it with all the sleep disturbances? Well, I have bipolar 2, so that may have something to do with it. An article published by the National Institutes of Health (NIH) says, “Sleep disturbance is a core symptom of bipolar disorder. The diagnostic criteria indicate that during manic episodes there may be a reduced need for sleep and during episodes of depression, insomnia or hypersomnia can be experienced nearly every day.” They also note that insomnia and hypersomnia are early warning signs, or “prodromes,” of a bipolar episode occurring. In fact, sleep disturbance is the number one prodrome for mania, and is recognized by approximately 80% of those suffering from it as an indication of an impending episode.

Webmd discusses a number of ways that bipolar disorder is associated with poor sleep: either insomnia or hypersomnia (over-sleeping); decreased need for sleep; a circadian rhythm sleep disorder; REM sleep abnormalities which can affect dreaming; and co-ocurring sleep apnea (around a third of people with bipolar also have sleep apnea, which is associated with excessive daytime sleepiness and fatigue). Bipolar meds have also been known to affect sleep-wake patterns, as well as co-occurring substance abuse disorders.

What are the consequences? Sleep deprivation has demonstrated detrimental effects on cognitive functioning, particularly in teens and young adults. This has been observed in performing psychomotor vigilance tasks, working memory tasks, and cognitive processing tasks. No wonder a series of sleepless nights can result in a foggy or fuzzy-headed feeling!

Unfortunately, the advice given for how to counter the effects of sleep disturbance in bipolar disorder is almost indistinguishable from the advice given to the general population, such as incrementally moving bedtime and waking time until the desired period of sleep is reached; and not using electronics such as computers, cellphones, and TVs near bedtime. Some preventives that have worked with bipolar patients have included bright light therapy in the morning and the use at bedtime of supplements containing the naturally occurring hormone melatonin that the body releases in response to darkness.

My own experiences with sleep deprivation and bipolar disorder have been a mixed bag. For many years before I was diagnosed, I was subject to the difficulties caused by shift work, either third or second shift. (When I was on second shift, we sometimes extended our sleepless periods by playing cards or midnight miniature golf after the shift was over.) Third-shift work made me too tired to drive safely, especially if I was also working first shift the next day, which sometimes happened. My husband pitched in and picked me up on those days. My friends knew never to call me before noon.

For a while I took a prescribed sleep aid, but sometime during the last year realized that as my sleep-wake cycle was regulating to a more “normal” pattern, and that the sleep I got without the meds was more refreshing and conducive to clear thought in the morning. So I quit taking it, with the approval of my psychiatrist. Even though I work at home and make my own hours, my work schedule has become predictable as well. Now I wake around 6:00 or 7:00 a.m., check my emails and timeline, have some breakfast and start my work (when I have some). I break for lunch, then resume work in the early afternoon. (And pray I don’t get any more work that day, as sometimes happens.)

As for getting to sleep, it’s usually not a problem (except when it is). Any more, I take my nighttime meds, read for about 30 minutes, and drift off to sleep normally. I usually only need a nap if extra work requires that I stay up late in the evening or get up very early in the morning.

So, does “Sleep, that knits up the ravelled sleave of care,” as Shakespeare described it, exist for people with bipolar disorder? I’d say, not for everyone, but when it does, it’s always welcome. We all have our various sorts of “ravelled sleaves” that need tending to.

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Was My Anger Really Grief?

I had a right to be angry. I had been gaslighted. I had suffered emotional and verbal abuse.

He told me that when I couldn’t answer his accusations, he wanted to kick me. He made up an obscene song as a “tribute” to me and gleefully sang it to his friends. He said that when I wanted to use the bathroom with the door closed, it was a sign that I wasn’t “open enough.” Once he left me to sleep in the car on the streets of Buffalo while he went to a party. He asked me what I would have done if he were not “supporting” me. When I made a mistake with some guests, he said I had “besmirched his honor.” When I told him the singers I listened to were popular, he replied, “Eat shit. Twenty million flies can’t be wrong.” He started an affair with my best friend and invited her into our bed.

When I got him to go to couples counseling, he asked me if I was sure I wanted to, because he and the therapist could have me hospitalized. I retreated into self-harm and self-medication with alcohol.

I lived with this for a year with no way of escape except to a separate room in the house, which I began to pay him rent for. My parents came to town for my college graduation and refused to come into his house.

He never hit me. I always swore I would never stay with a man who hit me, no second chances. But he didn’t, so I stayed. When I finally left, while he was at work, he threatened to call the police on me in case I stole any of his belongings.

When I left, I swore I didn’t feel any anger. Denial and numbness were my reactions at that point. A little later, when my feelings started to return, I had minor, ineffectual revenge fantasies, none of which I ever carried out. I started reading about battered women, learned helplessness, and even brainwashing, trying to get a handle on what had happened and why I had stayed as long as I did.

I was clinically depressed, of course (not yet diagnosed as bipolar). And this was back in the days when the standard definition of depression was “anger turned inward.” So, in effect, the mental health community was blaming me for my own anger and depression. I didn’t know enough to be angry about that, either.

I’ve carried that anger with me ever since, for decades. I’ve gotten past most parts of it, but it still haunts me from time to time. I have dreams and flashbacks, which led one therapist to say that I had PTSD. I didn’t believe it at the time, but now I wonder.

Recently, I’ve done some reading on bipolar anger. Among the ways that it affects you, I learned, are friends avoiding you, family not wanting to have meaningful discussions with you, and receiving reprimands at work. I’ve experienced all of those. The sources say that bipolar anger can manifest as anything from irritability to rage. I’ve experienced those too. My rage came when I finally realized that the abuse never should have happened, and that my abuser would never feel a speck of remorse for what he’d done.

A lot of the anger was kept brewing inside me. I’d like to think that I didn’t let it show, but I know I did. It would come out unexpectedly as sarcastic comments that drove people away, for example, and when I was in one of my longest and deepest depressive episodes, as irrational anger at my husband. I remember one particular time when I yelled at him and called him a racist, which he certainly isn’t.

Most of what I’ve read to do about bipolar anger boils down to anger management: avoid your triggers, take your meds, keep stress in check, and talk with a therapist. I’ve never gone through anger management therapy, but I’m not sure if it would work under my particular circumstances. I’ve taken all those steps just dealing with my bipolar disorder, anyway.

Then recently, I saw a meme on Facebook credited to Minds Journal that said, “I sat with my anger long enough, until she told me her real name was grief.” That started me thinking. What if my anger was really grief? I had lived so long with the anger. Was I unable to recognize its true nature?

Examining what happened and my reactions, I have to say that it’s likely. I actually have plenty of reasons for grief – that I was so naive, that my first really significant love relationship was so abusive, that it took me so long to realize it, that it had affected my relationship with my parents, and that the relationship I had been so invested in was based on nothing.

Psychiatrist Elisabeth Kubler-Ross is deservedly famous for her paradigm of the Five Stages of Grief – denial, anger, bargaining, depression, and acceptance. I’ve sat with denial, anger, and depression for a long time. If I’m honest, there was probably some bargaining in there too, which I understand stems from guilt and shame. If only I’d been a better judge of people; if only I’d gotten out sooner; if only I’d never done any of the things I did, from hooking up with him in the first place to letting him control both my feelings and behavior. (And yes, I gave him control. I didn’t stand up for myself. At the time, I didn’t know how, or even that I should.)

So, am I now sitting with my grief? I can’t say that I’ve reached the stage of acceptance. But I’m willing to own my grief and let go of my anger. Maybe in time, I’ll get to acceptance.

This post originally appeared on The Mighty (themighty.com).

John Oliver Takes on the U.S. Mental Health Crisis

You’ve no doubt heard that the mental health care system in the U.S. is broken. You’ve probably experienced that for yourself. But have you heard what John Oliver had to say about it? On August 1, on Oliver’s Last Week Tonight program, the comedian/commentator devoted a full 25 minutes to examining the flaws that plague mental health care.

During the broadcast, Oliver presented appalling statistics (some of which even I had never heard before) and clips of interviews with participants in the mental health system, including people who have been affected by it, practitioners, and insurance executives. With his trademark sardonic humor, exasperated outrage, and comic zingers, Oliver deftly skewered the insurance industry and remote mental health companies, among other targets. It was an enlightening and satisfying performance.

Here are some of the highlights.

Oliver started with a flashback from the 1950s of women entering a beauty parlor (!) to receive makeovers that were supposed to solve their mental problems. “I don’t know what’s more alarming there — nurses being forced to take on the skills of a Sephora brand ambassador or the fact that ‘can make-up cure sad?’” Then he tackled the PSA on mental illness stigma featuring Harrison Ford, which was designed to make discussions of mental health “cool and trendy” and dissed the gallbladder for some reason.

Next, he went through some stats on why such a PSA was necessary – the lack of access to mental health care, particularly since “for every ten clinicians entering work in mental health clinics there, 13 leave. And if we continue at that rate, one day, we’re going to wind up with negative therapists.”

Oliver noted that nearly 85% of all psychologists are white, and ran an interview with an African-American couple. The man said that he “couldn’t find a black man to save my life,” which Oliver said was “something you expect to hear about the crowd on January 6th, or all ten seasons of “Friends.” He also played a video of another man who couldn’t find treatment. His friends said, “Everything will be fine tomorrow. Suck it up, buttercup,” a response that to him meant “a 12-pack of something or a bottle of something.”

Oliver also reported on the fact that hospital ERs are overrun, with one interviewee suffering a stay of 27 days there, and then receiving advice to go from the ER to a doctor. Oliver noted that 27 days in an ER is “not calming” and that seeking help is serious, that “you can’t just put off mental healthcare indefinitely. It’s not a check engine light.”

Some of Oliver’s most biting comments were reserved for AI programs that claim to counsel users on mental health issues. One of the free services was Woebot – “Bot as in robot and ‘woe’ as in ‘Whoa, that’s a dumb name.'” Their mascot is a robot waving a wrench (“He’s going to fix my brain with that!”). And when questioned about anxiety and lack of sleep, which affect 18% of people, the AI responded, “I can’t wait to hop into my jammies later.” Oliver also reported that when Woebot was confronted by the BBC with a test case of a 12-year-old reporting sexual abuse, it replied with the comment that it “shows me how much you care about connection, and that’s really kind of beautiful.”

He did note that teletherapy is valuable and it can fill some the gaps in care. But Oliver also highlighted investigations of sites that were “pill mills,” one of which claimed that 95% percent of their users “should get a scrip.” Noting that it was not 100%, Oliver compared it to the saying, “It’s not arson if you only burn most of a building down.”

Regarding lack of accessibility and insurance parity despite laws requiring it, the program noted that the issue was complicated by finding a provider who will take your insurance. The Labor Department has investigated only 74 claims against insurance companies in the past year (but closed only 12 of the complaints) and has issued fines only 13 times since 2017.

And insurance payments are often based on their own opinions on when a treatment is “medically necessary.” Oliver likened it to an insurance company, saying, “Imagine an insurance company reversing their decision in the middle of any other serious treatment. ‘Hey, we love how this heart surgery is going, just popping in to say, it’s done. Yeah, it’s done now. Hit the showers, everyone, great job. Don’t bother closing anything up, that’s not medically necessary.’” California, Oliver noted, requires insurers to “base medical necessity determinations on current, generally accepted standards of mental health care, instead of just making up the criteria for themselves.”

Insurance companies also have “ghost networks” that offer patients providers who aren’t taking new patients or even practitioners who have died. Phone numbers can be wrong too, some of them reaching “jewelry stores and boutiques,” which Oliver admitted that, “to be fair, if you’re a woman in the 1950s, a boutique and a jewelry store is apparently the only mental health care you need.” 

The segment ended with the statement and plea, “It can’t be the case that, when people ask for help, our only option is to tell them to ‘suck it up, buttercup.’”

We can only hope that Last Week Tonight‘s take on the U.S. mental health care system will reach its literally millions of viewers with the news that something needs to be done – and soon. You can see the whole segment at https://www.youtube.com/watch?v=jtIZZs-GAOA or on John Oliver’s official website, https://iamjohnoliver.com/. It’s definitely worth a visit.

This post originally appeared on The Mighty (themighty.com).

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Hearing Voices – Bad and Good

There are many different occasions when you may find yourself hearing voices. Usually, you only hear the voices of people who are physically in the room or on the phone or chat speaking to you. But sometimes the voices aren’t real, and that can be a cause for worry.

One thing that bipolar people fear is developing – or having – psychosis. And one of the major symptoms of psychosis is hearing voices that seem to come from outside you when no one is actually speaking to you. Psychosis is not a disorder, but a symptom. Most often associated with schizophrenia, psychosis involves detachment from reality and delusions of things that are not real. Among the possible delusions is that other voices are speaking to you from another realm.

This can be the television or satellites sending secret messages to you. It can involve demons that are trying to take over your brain and even your body. Often, voices of angels or demons are signs of psychosis. (Sometimes, some people experience a voice that comes from a higher power and ascribe it to a supernatural cause. Is this psychosis? Some people think so, and others perceive it as a different form of reality. If the voice instructs you to do harm to yourself or others, it’s probably psychosis.)

If people with bipolar disorder have the experience of hearing voices, it usually comes during manic episodes, though it can also occur during depressive ones. The initial symptoms of bipolar psychosis are often indistinguishable from other symptoms of the disorder – anxiety, difficulty communicating or concentrating, or flat affect (the blunting of emotional expression). Unwarranted suspicion of others is another sign that something may be amiss. Support groups or “accountability partners” can help a person recognize and cope when they believe they are about to experience psychosis.

Psychosis can be frightening to the person experiencing it and to the people around them, or it can be something that the psychotic person doesn’t even notice (anosognosia). It should be noted that hallucinations and/or delusions can be caused by other problems, such as a brain tumor, dementia, or a bad reaction to medication. My mother experienced the latter when taking a new pain medication, though it was a case of seeing things that weren’t there rather than hearing them.

Psychosis can be treated, but not cured, by a variety of psychotropic medications that reduce the experience of hearing voices. These include mood stabilizers, antidepressants, or anti-psychotic medications. (A person with bipolar disorder may already be taking some of these.) They should be monitored closely by a psychiatrist.

Another example of hearing voices, though, is the inner voice that most of us – especially those with mood disorders – experience regularly. Most of the time it is an “inner critic,” bringing us down with negative self-talk, telling us that we’re worthless or can’t do anything right. This is not a form of psychosis, but can definitely be associated with stress, depression, and anxiety. It might say anything from “You’re fat and you’ll never lose weight” to “You can’t do math” to “The people at work aren’t really your friends. They treat you nicely because they have to.”

These inner voices and negative self-talk can be reinforced by the real voices of other people as well. A family member might say, “You’re really not good at picking boyfriends” or “You’re never on time for anything” or “You just can’t drive in traffic.” If you start to believe these messages and those of your inner critic, they can be self-fulfilling prophecies. If you believe that you don’t deserve respect and friendship, those thoughts will influence your actions, leading to other people perceiving you that way as well.

But if you have an inner critic, you also have – or at least can cultivate – an inner champion. There are ways to empower yourself through positive self-talk. It’s not quick or easy. Daily affirmations can help. You can try them whenever you “hear” your inner critic dissing you. First, say, “Stop!” Derail that negative thought right away. Then replace the thought with a more accurate one – “I’m not worthless. I got out of bed and out of the house today,” if that’s your small triumph.

Daily affirmations are good too. You can try looking in the mirror in the morning and saying something positive about yourself. It’s better if it’s really specific, but it’s okay if it’s just “I am a good person.” Some experts recommend personalizing the positive feedback using the second person – “You made it to work on time yesterday” – or even using your name as you think or say, “Janet, you took a shower today.”

Affirmations that stifle your inner critic and build up your inner champion may not be a cure for psychosis or bipolar disorder, but they can help with the problems of anxiety and depression that so many people with mood disorders face on a daily basis. For that reason alone, it’s worth a try.

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What If My Symptoms Come Back?

It’s inevitable. Once you’ve dealt with a mental illness, you’re afraid it will come roaring back, even if you’ve been stable for a long time. You wonder if your medications will stop working. You dread “breakthrough” episodes that will put you back in the same awful space you thought you had escaped from. You have flashbacks or dreams that take you to places you thought you had left far behind. You imagine you hear someone call your name and wonder if it’s a symptom. Sometimes, something you never thought of as a trigger will catch you by surprise and send you right back to the dark place, the anxious place, the out-of-control place.

Those fears are not unwarranted. All of those things could happen. For many people, they do. For most, the thoughts pop up at odd moments, even when you’re doing well. They’re unpredictable. That’s part of what makes them so scary – the knowledge that you have no control over these thoughts of recurrence.

It certainly happens to me. I obsess over my own thoughts. I fear dropping back into depression. I wonder if I’m exhibiting hypomanic behavior without realizing it. I overanalyze nearly every feeling I have if it has the slightest hint of a symptom of bipolar about it.

That’s when it’s good to have a strong support system – a person or persons you can talk to and check in with. Someone who recognizes your baseline behavior and when you start to depart from it. Someone who understands your disorder and what the symptoms might be.

I’m fortunate to have a support system in place, though it consists of only two or three people at this point – my therapist, my husband, and to some degree my prescribing psychiatrist. I see my psychiatrist only four times per year for med checks, but I can tell him when I think I’m experiencing symptoms and ask whether he thinks it’s something that warrants a change in meds.

I see my therapist approximately once a month, and she has a better handle on intrusive thoughts and whether they are irrational or not. She provides a “sanity check” for me. Most of the time, she reassures me that they’re normal (or nearly so). Sometimes, she tells me if I should bring them up with my psychiatrist the next time I see him. Mostly, she listens, which is what I think a good therapist does.

The mainstay of my support system, however, is my husband. He understands bipolar disorder from years of living with me and living through my mood swings. He knows my baseline level of behavior and when I begin to depart from it. For example, he can recognize when I am starting to get hypomanic and suggest to me that I might be beginning an episode. Or, if I feel like I might be getting manicky, I can ask him if he sees the symptoms in me or not. If I’m having delusions that other cars are swerving into my lane, he can suggest I take an anti-anxiety med.

Four former members of my support system are no longer there, two because they recognized my symptoms increasing and were not able to deal with them, and two lost to death. Even though my husband and my mental health providers help keep me on an even keel, I do miss the additional input. I need reassurance when I am doing well and help when I begin to veer off course.

This month, however, I am doing better. I just postponed my therapist appointment because I have no pressing issues that need addressing this month. May it stay that way.

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Baby Steps Toward Healing

Once I attended a weekend photography workshop. One of my photos received praise as being innovative and interesting, one based on a technique I had seen a friend use. The rest of my photos missed the mark. I was frustrated by my lack of progress. The instructor reassured me, advising me that I should take (or was taking) “baby steps.” That photo provided a brief glimpse of what I could do if I kept at it.

My therapist has also reminded me of this numerous times. And she’s been right. Almost all the progress I’ve made in dealing with being bipolar has been gradual and incremental.

The baby steps process was long and arduous, lasting for years. The first step was taking Prozac, which helped me for a while, then didn’t. Most of the progress I’ve made with medication has been in tiny, discrete steps. My prescribing psychiatrists have never done anything quickly, which is in one way a blessing and in another a torment. They would try me on one drug, then wait to see the results, then try a different dose or a different drug altogether. Lather, rinse, repeat until progress at last occurred.

Progress in therapy has likewise been gradual over the years. First there were therapists who diagnosed me with depression, which was certainly true, though not the whole picture. And they helped, or at least a number of them did over the years. I learned a lot about depression in general and how it applied to me in particular. I also learned about relationships, and those insights helped my marriage.

Finally, I was given an accurate diagnosis of bipolar disorder 2 with anxiety. That was where the steps toward reaching some resolution regarding my medication really started. That was also when I started working with the therapist who reminded me about baby steps.

Although I had made steps toward healing in the past, I had taken a deep and protracted plunge into depression before I started going to her. Several years of it had left me immobilized, despairing. At my lowest point, I described myself as “pathetic.” There were going to be a lot of baby steps needed to get me out of that miserable place.

So we went to work. I liked the kind of therapy she practiced – non-directional, non-judgmental. (I had had problems with therapists who weren’t like that in the past. Needless to say, I made no progress with them. In fact, I even took steps backward.) There was a long way to go.

Dr. B. frequently reminded me of the importance of baby steps and, eventually, how far those steps had taken me. I learned coping mechanisms. I learned new ways of thinking. I learned to accept myself with the reality of my bipolar disorder, but without the constant misery. And, by the time my proper medications had kicked in, we were making some even bigger steps. But all my progress was built on a foundation of many, many baby steps along the way.

I think all therapy consists of a lot of little steps. I don’t know anyone who has had a great revelation that instantly moved them further along with their healing. I only got glimpses of what my situation could be like if I persisted. And along the way, I regressed at times, needing to re-learn the lessons I had been exposed to and re-taking the steps I had already accomplished. Progress is like that – two steps forward and one step back – especially with a disorder as cyclical as bipolar.

Anyway, I still go to therapy and still take baby steps toward whatever my future holds. I realize it will take a long time – probably the rest of my life – but I’m dedicated to the process.

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