Bipolar 2 From Inside and Out

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How I Treat My Bipolar Disorder

There are many treatments for bipolar disorder, from SSRIs to EMDR and more. I must admit that I haven’t tried all of them, but I have encountered a few over the years. Some worked well, others not so much. But I’m doing well now, so I thought I’d share what works for me—my roadmap to stability.

Note that I said, “How I Treat My Bipolar Disorder.” That’s because my treatment is up to me. My psychiatrist or therapist can recommend a certain treatment, but whether I take that drug, undergo that procedure, or engage in therapy is ultimately my choice. I look at my providers as people who recommend treatments and help me implement them. But they don’t make the decisions. I do. Most of the time, I take their suggestions—they know more than I do about medications, for example. But I feel free to make suggestions, too, if the medication isn’t working like it’s supposed to or is having side effects I can’t deal with.

Meds

My med journey started (approximately 30 years ago) with the then-ubiquitous SSRI, Prozac. It worked well for me, relieving my depressive tendencies (I hadn’t been diagnosed with bipolar yet). Until it didn’t. That’s when my doctors started throwing drugs against the wall, hoping they would stick. Over the years, I’ve been on at least three different SSRIs, two NDRIs, two SNRIs, and a sedative-hypnotic. Probably other ones, too, that I don’t remember. (One of the side effects for one of them was memory loss.)

My previous psychiatrist experimented with a variety of meds until we hit on a cocktail that worked: an SSRI, a broad-spectrum anti-seizure drug, an atypical antipsychotic, and a benzo. My current psychiatrist mostly tweaks the dosages up or down when I need it. I’ve quit the sedative-hypnotic altogether and only take the benzo as needed. Recently, when I told him that I thought I was having mixed states, he upped the dosage of the atypical antipsychotic. (I don’t like to give the names of the drugs I’m taking because what works for me doesn’t necessarily work for others.)

I see the psychiatrist four times a year for med checks, though I can call if I have any adverse reactions or increased symptoms.

(When I was looking for illustrations to go with this post, I was astounded at the number of images of mushrooms that I saw. I guess it’s trendy now, but I’ve never tried them. There were also pictures of marijuana plants. There’s a medical dispensary in my area, but I’ve never pursued getting a prescription. I have taken CBD gummies, but the only effect they had was to make me foggy and dizzy, which I didn’t like. They did nothing for my moods. They didn’t even relax me; I was too nervous about my balance and the potential of falling.)

Therapy

Individual talk therapy is my go-to form of therapy, though I recently felt I could stop. (I keep the number handy in case I ever need it again.) I guess you could say I weaned myself off therapy. When I started I was going once a week; later, once every other week. When it got to three or four weeks between appointments, I decided it was time to fly on my own. I don’t know what particular kind of therapy I had—CBT or DBT, for example. She never said and I never asked.

I went to group therapy when I was still undiagnosed, but it wasn’t helpful. Once, when my therapist was out of town, I went to a therapy group she recommended but had an adverse reaction to it. Another group just seemed to have a weird format and a book they used like a “bible,” and I didn’t get anything out of that, either. A few times, my husband and I went to couples therapy, and it seemed to help. Another time, we went to a few sessions with a different therapist and I felt shredded. She seemed to think that I was the “sick one” and my husband was the “normal one.”

Treatments

Most of the modern treatments I haven’t tried because medication and talk therapy work so well for me. I had a close brush with ECT, which frankly frightened me, when I went through multiple drugs for several years and nothing seemed to work. My psychiatrist gave me the information and gave me time to think it over and make my own decision. I was almost ready to try it when, miraculously, a different drug brought my mental function under control. But when it comes to TMS, ketamine, EMDR, et cet., I have no experience with them. I don’t believe in reflexology and won’t try herbal remedies because they might interact badly with my meds. Basically, because what I’m already doing works for me, I see no need to explore alternatives.

Self-Care

It’s hard for me to keep up with self-care. I do stick to a sleep schedule and get 8-9 hours a night, with occasional daytime naps. I don’t exercise. It’s hard enough just to walk with my arthritic knees and bad back.

My husband helps me enormously with self-care. He works at a store with a grocery section, and he makes sure I have a variety of food and beverages on hand—fruits and juices, fizzy water, bread, and cheeses, for example—and fixes meals with protein, starch, and vegetables. Left to myself, I would probably subsist mostly on peanut butter sandwiches and breakfast cereal. Back in the day, he used to drive me to my therapy appointments when I was too nervous or depressed to drive myself. Now he picks up my scripts at the pharmacy department in his store.

What’s the takeaway here? I’m not telling you that I have the answer for how you should treat your bipolar disorder. I know what’s worked for me, but you have to find a path that’s right for you. I merely offer my experiences for what they are—mine. You can create your own roadmap, too.

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Is It Narcissism or Gaslighting?

We know that narcissism and gaslighting both lend themselves to abusive treatment, but they are actually two different things. They’re both extremely destructive. They both have serious negative effects on the people around them. And people who are victims of narcissistic abuse or gaslighting face similar problems in determining what to do about it. Let’s take a deeper dive.

Narcissism is a psychiatric condition—a personality disorder—that’s included in the DSM and has been recognized for years. The DSM says that NPD involves “a pervasive pattern of grandiosity (in fantasy or behavior), a constant need for admiration, and a lack of empathy, beginning by early adulthood and present in a variety of contexts.” Diagnostic criteria include a need for excessive admiration, a sense of entitlement, interpersonally exploitive behavior, a lack of empathy, a belief that others are envious of them, and arrogant and haughty behaviors or attitudes. Narcissism is a personality trait, while clinically, Narcissistic Personality Disorder is a psychiatric condition.

(I will not now be discussing politics. Diagnosis-at-a-distance is not valid or desirable. Diagnosis can only be made by a mental health professional who has actually spoken to the person in question.)

Gaslighting, on the other hand, is a form of psychological manipulation that narcissistic abusers sometimes use to control another person by making them doubt their own reality and sanity. But people other than narcissists use gaslighting as well. They could simply have narcissistic tendencies but not be diagnosable or diagnosed with NPD.

In other words, narcissism focuses on a sense of grandiosity and superiority, while gaslighting focuses on the way one person manipulates another in an abusive manner.

Gaslighting gets its name from a movie that showed a husband who tried to convince his wife that she was insane, for personal gain. The term has entered the non-psychiatric discourse and is used very loosely to mean any kind of abusive tactics rather than the specific one of causing another person to doubt their own reality.

Gaslighting can be one tactic that people with NPD use when they do abuse others, but there are a number of other toxic behaviors they demonstrate as well. Someone engaging in narcissistic abuse can use a variety of techniques to emotionally manipulate another person. They may belittle and demean their victim, isolate them from friends and family, and use intermittent reinforcement (in which they sometimes praise and show love for the victim, then take any opportunity to insult and blame them).

A gaslighter denies the victim’s perception of reality. They may explain their abusive behavior as “just a joke.” They may deny that their victim’s memory of an incident is true. They create a sense of cognitive dissonance in which the victim’s lived experience is at odds with what the abuser says really happened. There is obviously a great deal of overlap between gaslighting and narcissistic abuse.

The effects of narcissistic abuse or gaslighting can be severe. Victims can feel low self-esteem, internalize the abuse and believe they are to blame for it or brought it on themselves, feel alienation from friends and family, have difficulty trusting others, be unable to make decisions, and not feel able to maintain a sense of self. They frequently stay with the abuser, unable to recognize what is happening. They may feel they can change the abuser. They can’t.

The best way to counteract the harmful effects of narcissistic abuse or gaslighting is to get away from it. Admittedly, this is difficult to do. The victim may have been conditioned to believe that the abuser loves them and not want to give up on the relationship. Even if the victim does leave, it may take a long time and most likely therapy for them to realize what actually happened and define it as abuse.

Setting boundaries can help, though an abuser is not likely to respect them. Seeking support from friends, family, a psychologist, or group therapy may well be necessary. Couples counseling is not likely to help. The abuser may not admit that they need help. Education can be empowering. Once you learn about the dynamics and techniques of abuse or gaslighting, you’re less likely to be susceptible to them.

But the best thing to do is not to get involved with a narcissist or a gaslighter in the first place. It’s a situation that’s a lot easier to get into than to get out of. Watch for red flags, then keep your distance. They may seem attractive at first, but they’re trouble waiting to happen.

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People-Pleasing as Pathology

There are two schools of thought about people-pleasing. One is that it’s a good thing, that we should try to please other people. The other is that it’s a bad thing, a symptom of some psychological difficulty. Both theories have something to support them.

There’s an innate desire in most of us to be pleasant to the people we interact with. It reduces social friction and generally makes the world a more pleasant place. Pleasing people we have a close connection to is a way of expressing friendship and love. From that point of view, it’s hard to see how pleasing people could be a bad thing.

When people-pleasing goes bad, however, is when the desire to please others is not done from harmless or beneficial motives, but from pathology. The motives make a difference. And people who suffer from bipolar disorder often have tendencies that can result in unhealthy people-pleasing.

The first hazardous motivation is the desire for outside validation. It’s true that everyone needs validation from someone else at times. When my mother was taking care of my father during his final illness, she knew she was doing a good job. But she needed to hear it from someone else—me. I don’t think that was pathological at all. She was doing something very difficult and emotionally draining. It was just the two of them most days, and my dad, while appreciative, was part of their two-person system. Mom needed to hear someone outside say it.

But when you are empty inside and have no inner validation, you can need external validation all the time. And one of the ways you can get that is to always be accommodating. You provide for someone else’s needs to the exclusion of your own. While you’re filling up someone else’s reservoirs, you’re letting your own go dry. And that’s detrimental to your mental health.

Another motivation for people-pleasing is to avoid conflict and stress. Catering to someone else’s needs to keep things on an even keel is dangerous. A healthy relationship goes both ways, with both people trying to please the other. If you’re afraid that a dire situation will arise if you’re not perpetually accommodating, there’s a good chance that the relationship is abusive. People-pleasing in order to avoid physical or psychological damage to yourself is a big problem.

Low self-esteem can also cause a person to fall into excessive people-pleasing. You think that your only value lies in making other people happy. Of course, low self-esteem is not exclusively a bipolar trait. Depression, adverse childhood experiences, trauma, perfectionism, and cultural or societal expectations can also result in low self-esteem. But trying to build yourself up by being subservient is not the way to go.

Potential rejection can lead to a fear of not fitting in. People-pleasing in these cases is meant to ingratiate oneself with the in-group. The stereotypical new employee can “suck up” to people in higher positions or existing cliques to make others more likely to let them into important business or social circles. Bringing donuts, taking on extra assignments, and picking up the check at lunch are not in and of themselves bad things. But establishing a pattern of this kind of behavior is overkill—excessive people-pleasing in hopes of getting a reward.

One significant danger of people-pleasing is disappearing in a relationship. One person becomes the dominant partner and the other one is in the position of serving that person. Even people outside the relationship may notice the unhealthy dynamic. They may view the people-pleaser as an appendage and the dominant person as the center of the relationship.

Although the stereotype is that women are people-pleasers, either gender can have that role. Intimate relationships of any kind can be plagued with the problem, and other groups of people such as coworkers can contain one or more people-pleasers as well.

What’s the opposite of people-pleasing? People-helping that goes both ways. Reciprocal interactions that benefit both people are to be preferred. They keep a relationship in balance and lessen the possibility of one person, whether bipolar or neurotypical, disappearing.

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Running Out of Meds

Isolated Empty Pill BottlesRunning out of your medications is scary.

I know. It’s happened to me several times.

Sometimes it was a matter of supply. My usual pharmacy ran out of a sleep aid and wasn’t going to get any more until after the weekend. Fortunately, they recommended a mom-and-pop pharmacy (yes, such things do still exist) just down the street and helped me transfer my prescription there.

Another time the problem was the prescription. I ran out of an anti-anxiety med, but when I called in for a refill, I was told that it wasn’t time for one. When I looked at the bottle more closely, I discovered that they had given me 60 pills, as if I were taking two a day, instead of the three a day actually prescribed. (I was changing doctors about that time and there was miscommunication.)

Yet another time, it was money. I ran out of an antipsychotic and was told that even with insurance, it would cost me $800 for a month’s supply because of the out-of-pocket required minimum. I spent a couple of days arguing with the insurance company, researching solutions online, and making sure a local pharmacy would take the coupon I found, which lowered the price to under $200. That was still a hefty chunk of our budget, but we managed to scrape it together until the drug went generic a couple of months later. (I also had to stand in line while the pharmacy called the coupon people and the insurance company to see how to enter it all in their system.)

And of course there are the everyday screw-ups. My husband forgot to pick up my scrips (one time he remembered to pick them up but left the bag in the car and drove 500 miles away), or he forgot which pharmacy they were at, or he didn’t hear me say that I was completely out, or the pharmacy didn’t open until 10:00, or they had my pills in two different bags and only gave us one. There are lots of ways it can happen.

Once I even took my entire supply on a weekend getaway and left them in a drawer at the bed-and-breakfast. I know. Stupid.

Most of the time running out of drugs isn’t a crisis. It just feels like one.

Of course, there are exceptions. It is a crisis if you run out of certain anti-anxiety drugs and you don’t get any for several days. You can have withdrawal – actual, physical as well as psychological withdrawal. I’ve heard that benzo withdrawal can be as bad as opiates. That’s one reason it’s important to replace your meds as soon as possible.

A lot of psychotropic medications build up to a therapeutic level in your bloodstream, so a day or two without them probably won’t even be noticeable. When you start taking them again, your levels will even out.

But even if the med you run out of is one that you can easily tolerate a day or two without, you may have some psychological effects. When I run out of a prescription, even for a short time, I become twitchy and agitated – my hypomania kicks in and comes out as anxiety, the way it usually does for me. I fear crashing back into that deadly unmedicated space where all is misery and despair. Intellectually, I know that likely won’t happen. But it sure feels like it will. This is one way my none-too-stable mind plays tricks on me.

It’s like the opposite of the placebo effect – believing that a sugar pill will help you and experiencing gains until you learn that the pill is fake. In my version, I believe that not taking the pill will cause relapse, even though it actually won’t.

Whatever else you feel or do, DO NOT use missing a couple of pills as an opportunity to go off your meds entirely. This is another lie your brain can tell you: “You’re doing fine without it. Why keep taking it?” It may not in the short term, but you will feel the effects of not taking your meds, and then there you are, back in the Pit of Despair or rocketing to the skies. It won’t be pretty.

For me and a lot of others like me, the key to effective medication is consistency. Once you find the right “cocktail,” stick with it. But if you run out, don’t panic. Keep Calm & Get a Refill.

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Self-Care: We’ve Heard This Before

I’m not denying that it’s good advice. It surely is. But no matter your problem, the recommendations are almost always the same.

I recently saw an article in Psychology Today titled “7 Habits That Could Cut the Risk of Depression in Half.” It recommended “lifestyle medicine,” which the article said could be as effective as medication. Here are their recommendations.

  1. Prioritize sleep.
  2. Cultivate connections (as in go out among people).
  3. Drink less.
  4. Eat well.
  5. Move regularly (as in exercise).
  6. Don’t smoke.
  7. Get up (as in standing up when you’ve been sitting for too long).

The article said, “People who maintained most of these seven healthy habits—five or more—had a 57% lower risk of depression. We all know that a healthy lifestyle is important for our physical health. It’s just as important for our mental health.”

Well, okay. But those recommendations are the same ones said to relieve every condition from heart disease to grief. They’re hardly specific to mental health.

When it comes to recommendations specifically for mental health, “self-care” is what’s recommended. Here’s a typical list of what mental health self-care entails.

  1. Get regular exercise.
  2. Eat healthy, regular meals, and stay hydrated.
  3. Make sleep a priority.
  4. Try a relaxing activity.
  5. Set goals and priorities.
  6. Practice gratitude.
  7. Focus on positivity.
  8. Stay connected.

In other words, they’re about as connected to mental health as the other self-care lists. Again, they’re general suggestions for physical and (maybe) emotional health. They could just as well be recommendations on how to succeed in business. In fact, I looked up self-care for businesspeople, and the only things that really seemed different from the above list were to set boundaries and, ironically, if you’re struggling with stress, see a professional therapist.

Another article about general (not mental-health specific) listed three kinds of self-care: emotional, physical, and spiritual, as well as “enduring” and “temporary.” Here we find recommendations for emotional self-care:

  1. Self-talk.
  2. Weekly bubble baths.
  3. Saying “no” to unnecessary stress.
  4. Giving yourself permission to take a pause.
  5. A weekly coffee date with a friend.

The article adds, “The underlying rule is that it’s something that brings you sustained joy in the long run… And though there are plenty of examples of self-care that seem to tread a fine line between a health-enhancing behavior and self-indulgence, self-care doesn’t have to be about padding your calendar with luxurious experiences or activities that cost money (though it certainly can).”

That’s a good thing. Spa treatments, indulgent desserts, and shopping expeditions do seem to appear on lots of self-care lists. Other self-care recommendations in assorted articles include detoxing from social media, reading a self-help book, going to the symphony or ballet, laughing, getting a hobby, crying, cuddling a pet, flirting, watching sunsets, learning to play guitar, getting out of debt, relaxing, knitting a blanket, cooking out, zoning out with TV or movies, clearing clutter, long brunches, cold or hot showers, drinking tea, doing your own manicure, moisturizing, having a getaway, using essential oils, ordering desserts, doing nothing, and networking.

I’m not saying that those are bad things, necessarily. I just think that a mental health self-care checklist ought to include some things like this:

  1. Take any medications faithfully, as prescribed.
  2. Go to therapy appointments and do the work.
  3. Learn more about your particular condition or disorder.

Too obvious? Maybe. But I think they’re the most important things you can do to care for your mental health. There are lots of other things that may help, including looking after your physical health, keeping a mood journal, trying mindfulness or meditation, and finding ways to relax and renew your spirit. But, to me, these three are the essentials. I think they’re all better examples of mental health self-care than what you find in the popular media. IMHO, of course.

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Christmas, Bipolar Style

This post will go live on Christmas Eve, and the holiday has been much on my mind of late. My reactions to the holiday aren’t necessarily what you will experience, but as a bipolar person, I wanted to share what depression and hypomania do to me during the holiday season.

Hypomania

I’ve tried the traditional giving of gifts on Christmas Day, but this year our gifts are all either pre- or post-holiday. Last year, I was hypomanic and overspent. I was disappointed, though, when my selections for my husband didn’t garner the response I thought they would. He still hasn’t used the camera I got him last year on the grounds that he didn’t have the time to figure it how to use it. (I’m going to suggest that one of his gifts to me will be to learn its workings.)

This year, I’m slightly less hypomanic. We got a present for both of us, a little early. We got matching heart, lock, and key tattoos. Since the tattoo shop is closed on Christmas and the tattoo artist is much in demand, we booked the appointment early and have already had these done. I’ve bought Dan another item or two on sale—oven mitts and a bathrobe—that I’m telling myself aren’t really presents, just things he needs, so he doesn’t have to get more presents for me. I honestly don’t mind if he doesn’t get me anything else. He gives me little gifts all year long—just things he finds at the store he works at that he thinks I’ll like.

This year I’m working at home, and I plan to work on Christmas Day, at least for a few hours. Realistically, I could take the day off and not risk missing my deadline, but the routine of working helps keep me centered. I have been exploring what local restaurants are open on Christmas Day so we don’t have to cook. For New Year’s Eve and Day, we actually have a tradition—champagne and appetizers on the Eve and Chinese Buffet on the Day. We often ask friends to join us for that.

Depression

I don’t think I’ll be too depressed to go out New Year’s Day, but then again, who knows? Dan has invited friends from work, so there will be people there I don’t know, as well as two that I do. I don’t really feel up to small talk these days, so Dan can handle that with his work friends.

I’ve given up trying to get into the “Christmas spirit” by dressing for the occasion. It never works for me. I’ve had Christmas earrings. One year I had a Grinch t-shirt. I once worked at a place where everyone wore holiday sweaters and sweatshirts. I didn’t have any and felt left out, but I didn’t want to pay the prices for the sweaters. After the holiday, I bought a couple on sale for the next year’s festivities, but I lost the job before I had an opportunity to use them. Oh, well.

My Lack of Advice

I know there are a lot of articles this time of year giving advice on how to deal with the holidays while in a shaky mental state. I’m not going to do that, because you already know all the standard advice—self-care—and I have nothing really insightful to add to it.

Except that it’s okay to have your own traditions or to ignore the holidays altogether if they’re just too much for you. If you’re alone, you could be subject to depression or just feeling numb, but that’s a natural reaction if you’re like me. Scale down your celebrations to suit yourself. If you’re experiencing anxiety, you can skip big celebrations and have your own small—or private—one. If you’re hypomanic, you may be up to some festivities, but you don’t have to be the life of the party at every one. And keep track of your spending. Most people prefer to get only one or two thoughtful presents rather than a flood of random ones.

I don’t wish you Happy Holidays, just survivable ones.

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Saved From My Manicky Self

My usual mania symptom is overspending. This time, it was overextending.

It went down like this.

My side gig is as a ghostwriter. It doesn’t pay a lot, but it supplements my Social Security and, as my friend Robbin and I used to say, keeps me from stealing hubcaps.

Usually, I write self-help books. Ways to declutter your house. How to write in plain English (that one was fun). Advice for older teens nearing adulthood. How to end burnout. Grieving the death of a pet. They’re popular topics, but not very interesting to write about. (Occasionally, I get a more challenging and interesting topic, like pandemic preparedness or flesh-eating diseases.)

But, even though I took the fiction writer’s test and passed, I’ve only written one fiction book. It was pure smut. I have no moral or philosophical objection to pornography (or erotica, or whatever you wish to call it). I did the assignment and the customer was happy with it.

But I’ve been so booked up with self-help that I haven’t had the opportunity or the time to seek out a fiction assignment.

Until recently. I was contacted about writing a plot outline for a piece of fiction with the likelihood of getting to write the book after the customer approved the outline. It would be a 100,000-word paranormal fantasy romance, which sounded like a treat after self-help and smut. I was on the shortlist for the assignment.

And I really wanted it. I heard about the prospect just before the weekend and figured I wouldn’t hear a decision about it until Monday at least. I spent the weekend rolling it over and over in my mind—developing lead character, love interest, and villains; thinking up places in the multiverse where scenes could take place.

In other words, I got manicky. Realistically, I should have simply turned down the project. I’m already working on a project that will keep me busy through the end of January, and I write 1,500 words a day on it. If I took on the fantasy book, that expected word count would double. At least until February, I would be writing 3,000 words a day.

Theoretically, that’s not impossible. But I have a writing routine that allows me to get my 1,500 words done every day and leave time for self-care, interaction with my husband, meals, etc. It fits in well with how I work around my bipolar disorder and my strategies for coping with the symptoms.

And if I had made it from the shortlist to the one-list, I would have tried to do it. That was the manicky part of myself talking. It said I could do it, and do it well.

But I didn’t get the assignment. My disappointment was mingled with relief. Realistically, it was doubtful that I could have done it. The chance that I would do poorly on one assignment or the other, or both, was high. The possibility of working myself to frustration or exhaustion was real. It really would have been a bad idea.

So I dodged a proverbial bullet. My manic tendencies were short-circuited, and I was saved from acting on the feeling that I could do it all.

I’ll try to remember that, the next time I’m tempted to overextend myself. I’ll still be on the lookout for fiction assignments, but I won’t take one unless my schedule is clear.

The bad news is that I’m still manicky and back to overspending.

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Grippy Socks and Sour Candy

My husband is a great help when I write my blogs. He keeps an eye out for news stories that deal with mental health in some fashion. So when he saw an article on new words related to the topic, he made sure I saw it. Then he asked me how I felt about it.

The story was about new language that young people were using to describe various mental health concepts.

First and foremost among them was “grippy socks vacay”—a reference to the footwear issued to people who have been committed, voluntarily or otherwise, to psych wards. But “vacay” is short for “vacation.” I can just picture a conversation using it: “Where’s Janet been?” “Oh, she’s been on a grippy socks vacay.” Or “I’m stressed. It’s time I went on a grippy socks vacay.” It seems unlikely that the people who say these things are always referring to an actual stay in a psych ward.

I was more than slightly appalled. It’s true that grippy socks evoke the image of a hospital stay. But grippy socks are a part of any stay in any department of a hospital, not just psych wards. And such a stay is hardly a vacation. It’s likely, I think, that people use this to mean something like “relaxing getaway” or “time to clear my head.” An actual stay in a psych ward, however, is not a relaxing getaway. It’s intense. It’s not supposed to be relaxing. And while it does provide time to clear one’s head, that’s still far from accurate. Medication, group therapy, and individual therapy may eventually clear one’s head or at least change one’s perspective, but it’s hardly just a time away from work and day-to-day stresses.

The article went on to discuss whether the phrase increased or decreased stigma. Some said one, some the other. I think it perpetuates stigma. It implies that someone who is in a psych ward is there to have a good time. “Grippy socks vacay” is demeaning when the hard work that mental patients must accomplish is considered.

If it’s used as a euphemism for an actual psych ward stay, it’s insensitive at the least. If it just means time off from daily cares, it’s still inaccurate and discounts the real experience. Those things can’t be good for reducing stigma.

Now, my friends and I have been known to use irreverent language to refer to our conditions. Robbin and I used to say on occasion that we needed a “check-up from the neck up.” We used it just between the two of us (well, I’ve also used it with my husband) to indicate that we needed to see our therapists. But I don’t see it as being demeaning, especially since we never used it in the context of anything but our own disorders, not a general description of someone the general populace would slangily describe as “crazy.” If we had said of any popular figure that they needed a check-up from the neck up, that would have been something else. But we didn’t.

Of course, you may disagree with this and I’d love to hear from you regarding your opinion.

The other article my husband shared with me was one that indicated that it was a trend on TikTok to use sour candy to ward off anxiety. The article even said that experts backed up the theory.

The idea is that the intense sensation of sourness distracts the brain from the cause of the anxiety. It’s a distraction technique, like snapping a rubber band on your wrist to take your mind away from unwanted thoughts. One expert interviewed for the article said, “Panic ensues when our amygdala triggers the flight or fight response. One way to dampen our amygdala’s response and mitigate panic is by turning our attention to the present moment through our senses: taste, smell, touch, sight, and hearing.” Mindfulness through candy, I guess, would be a way to describe it. The experts also advise grounding yourself with other sensations such as the scent of essential oils.

Other experts noted that sour candy is a kind of crutch and not a long-term solution. One called it “maladaptive.” Sensory distractions, they said, were most effective in conjunction with acceptance rather than avoidance.

What’s the takeaway from this? Aside from the potential boost in sales for Jolly Ranchers, I mean. I think it’s a good reminder that there are ways to short-circuit anxiety and panic. And for people who only experience occasional, momentary anxiety, it’s probably a good thing. But for someone with an actual anxiety or panic disorder, it’s likely to be only one tool they use — and a minor one, at that.

What have you been reading recently about mental health trends? I’d love for you to share that, too.

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Codependency: Fact or Fiction?

Lately, I’ve been seeing articles with titles that say codependency is a myth or a hoax. They claim that the concept is not just wrong but harmful. Despite its almost 40-year history, codependency now seems invalid to many.

Codependency is defined as a mechanism whereby enablers are enmeshed with their child, spouse, sibling, or significant other to such an extent that they lose the ability to take care of their own emotional needs. The enabling also means that the person suffering from a psychological condition (originally addiction, but later other problems) does not have the motivation to work on themselves or change their behavior. In extreme cases, it means that one partner cannot tell where they end and the other begins.

My husband introduced me to the concept of codependency. He has a background in psychology and was greatly influenced by Melody Beattie’s writing. Her book, Codependent No More (published in 1986 but still selling well), his work with Adult Children of Alcoholics (ACA), and attendance at seminars on the topic have made him a staunch believer. When I told him about the articles, he scoffed. In fact, he seemed offended. It’s a basic tenet that aligns with his experience of psychology.

So, what are the objections to the concept of codependency?

First of all, it’s not a recognized psychological condition in that it’s not an official diagnosis. There are no specific diagnostic criteria, though there is a list of symptoms including fears of rejection or abandonment, avoiding conflict, making decisions for or trying to manage the loved one, keeping others happy to the detriment of self, and generally a “focus on caretaking and caring for others to the point that you begin to define yourself in relation to their needs.” Admittedly, those are largely squishy criteria (there are others), some of which overlap with officially recognized diagnoses.

Another definition states, “The codependent person sacrifices their needs to meet the demands and expectations of the other person. These individuals may also strongly desire to ‘fix’ the other person’s problems. The individual often neglects their self-care and personal growth in the process.” This was developed in the context of addiction studies, and some people object to the concept being broadened to include other circumstances.

More significant is the idea that the concept pathologizes love and support. Interdependence is the natural function of intimate relationships, and depending on each other is the ideal. Codependency theory is said to downplay helping behaviors that are essential to good relationships. In addition, codependency is often viewed as a “women’s problem,” and that reinforces patriarchal stereotypes, such as that women are “needy.” Instead, a person labeled codependent should work on overwriting old scripts of anxious attachment and other negative feedback loops.

Codependence is said to have contributed to the “tough love” movement that involved a hands-off approach to a loved one’s addiction, allowing them to experience the natural consequences of their behaviors. Tough love is discredited these days as a form of verbal abuse and a philosophy that has no basis in psychological practice, as well as reinforcing the idea that an addict must hit “rock bottom” before they are able to accept help. Tough love also promoted a model of intervention as a process involving anger, blame, non-compassionate confrontation, and the use of psychologically damaging “boot camps” for troubled teens.

Then, too, it is said that there is no research validating the concept of codependency, no way to measure it, and no effective treatment for it.

There’s another point of view, though—that codependency is a real, serious problem.

Let’s take that last point first. Research on codependency has revealed specific behaviors associated with it and the tendency to repeat those behaviors in subsequent relationships. Research has also indicated sex differences in codependency, with women being more likely to suffer from it. (It should be noted that women also dominate in diagnoses such as depression. Both genders are affected by depression and codependency, however.) As with codependency, there are statistics to report how many people suffer from depression and other conditions, but none to say how severe their condition is. Also, codependency has its roots in attachment theory, family systems theory, and trauma studies.

Treatment for codependency is quite possible. Education, individual therapy, couples/family therapy, group therapy, CBT, and DBT have all had beneficial effects. Even 12-step programs such as Codependents Anonymous are possible ways to address codependency. And, like some other disorders, codependency responds to techniques such as boundary setting, building on strength and resilience, and self-care. It also has other characteristics common to other conditions—relapses and setbacks, for example.

As for the idea that codependency pathologizes love and support, it is true that these qualities are essential to the human experience and good things in and of themselves. But when those qualities get hijacked by excessive, misdirected, and exaggerated needs, they can become pathological. After all, moderate depression and anxiety are parts of the human experience too, but when they strike with extreme manifestations, they become pathological as well. To say that all expressions of love and support are good is to ignore the harm that they can do when they interfere with those normal experiences of human interaction.

And while the concept of codependence may have started in the field of addiction studies, there’s no indication that that’s the only place where it belongs. Plenty of psychological concepts begin in one area of study and expand into others. The idea of healing the inner child may have started with trauma studies, but it now applies to other areas as well, such as grief therapy and other abandonment issues (including codependency).

What does all this add up to? I think my husband and the proponents of codependency theory have a point. The fact that it hasn’t been sufficiently studied doesn’t mean that it doesn’t exist, just that it is a comparatively recent idea compared to other conditions and pathologies. It has demonstrable effects on relationships and makes logical sense. If two people become enmeshed, their behaviors are likely to become warped and dysfunctional. In fact, dysfunction is one of the hallmarks of codependency. It explains relationship dysfunction in a way that few other concepts do. It may not be the only relationship hazard, but it checks a lot of the boxes.

Sure, the term codependency has been overused, especially in the type of pop psychology promoted by assorted self-help articles and books. But so have other psychological concepts and societal problems. Just because gender studies has had limited usefulness in analyzing male and female communication styles doesn’t mean that it has nothing to tell us.

So, do I think that the concept of codependency is a myth? No. Do I believe that it’s a “hoax,” as some have claimed? Again, no. Is the concept itself toxic? Does it imply that love and support are invalid? No. Is it overused by people who don’t understand it? Certainly. Does codependency deserve more study and practice before we discard it? Definitely.

I’ve seen codependency working in people’s lives. Anecdotal evidence isn’t sufficient to prove its reality, of course, but it’s a starting point for further exploration by professionals. Just because something doesn’t appear in the DSM, a notoriously changeable document, doesn’t mean it’s not real.

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Mental Illness: Poverty and Privilege

Mental illness is not just an American problem. In fact, it’s a problem around the world, and perhaps much more acute in other nations, especially those plagued by poverty.

There’s no way to know for sure, but many – perhaps most – of the world’s mentally ill are undiagnosed, untreated, ignored. Because what do you do when you live where there’s no psychiatrist? No therapist. No medication. No help.

Your family may support you, shelter you, or shun you, depending on their financial and emotional resources and those of the community. But for many people, there is simply nothing.

Psychiatrist Vikram Patel, one of Time magazine’s 100 Most Influential People for 2015, is working to change that.

As a recent profile in Discover magazine put it, Patel and others like him have set out to prove “that mental illnesses, like bipolar disease, schizophrenia, and depression are medical issues, not character weaknesses. They take a major toll on the world’s health, and addressing them is a necessity, not a luxury.”

In 2003, Patel wrote a handbook, Where There Is No Psychiatrist: A Mental Health Care Manual, to be used by health workers and volunteers in poverty-stricken communities in Africa and Asia. A new edition, co-written with Charlotte Hanlon, is due out at the end of this month.

Patel, in his first job out of med school, in Harare, Zimbabwe, says he learned that there wasn’t even a word for “depression” in the local language, though it afflicted 25% of people at a local primary care clinic. There was little study of diagnosis and treatment in “underserved areas.”

Later epidemiologists learned to their surprise that mental illnesses were among the top ten causes of disability around the world – more than heart disease, cancer, malaria, and lung disease. Their report was not enough to spur investment in worldwide mental health.

Patel developed the model of lay counselors – local people who know the local culture – guiding people with depression, schizophrenia, and other illnesses through interventions including talk therapy and group counseling. By 2016, the World Health Organization (WHO) admitted that every dollar invested in psychological treatment in developing countries paid off fourfold in productivity because of the number of people able to return to work.

One objection voiced about Patel’s model is that the real problem is poverty, not depression or other mental illness. The argument goes that the misery of being poor, not a psychiatric illness, leads to symptoms and that Westerners are exporting their notions of mental health to the rest of the world, backed up by Big Pharma. Patel responds, “Telling people that they’re not depressed, they’re just poor, is saying you can only be depressed if you’re rich … I certainly think there’s been a transformation in the awareness of mental illnesses as genuine causes of human suffering for rich and poor alike.”

Of course the problem of underserved mentally ill people is not exclusive to impoverished nations. There are pockets in American society where the mentally ill live in the midst of privilege, but with the resources of the Third World – the homeless mentally ill, institutionalized elders, the incarcerated, the misdiagnosed, those in rural areas far from mental health resources, the underaged, the people whose families don’t understand, or don’t care, or can’t help, or won’t.

I don’t know whether Patel’s model of community self-help can work for those populations as well as they do internationally. This is not the self-help of the 1970s and 80s, when shelves in bookstores overflowed with volumes promising to cure anything from depression to toxic relationships. It would be shameful if the rich received one standard of care for mental health problems, while the poor had to make do with DIY solutions, or none.

But, really, isn’t that what we’ve got now?

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