Bipolar 2 From Inside and Out

Archive for the ‘Mental Health’ Category

One or the Other? How About Both?

Who does this sound like?

Someone—child or adult—who hyper-focuses on a particular topic or interest, exhibits repetitive behaviors, responds to routines and consistency, and can be diagnosed in early childhood.

And who does this sound like?

Someone—child or adult—who needs novelty and change; is distractible, restless, and impulsive; and who is usually diagnosed as an adult.

I bet you said an autistic person for the first description and someone with ADHD for the second. But recently, there has been a diagnosis that covers people with both conditions: AuDHD.

At first, it sounds illogical that someone could have both disorders, given the very different traits. But if you look at them closely, there are places where they overlap. And sometimes the same trait is expressed in different ways. Both may interrupt conversations, have difficulty maintaining friendships, have sensory differences, and seek sensory stimulation. This overlap can make it difficult to diagnose AuDHD.

Still, there are noticeable differences. For example, people with autism need familiarity, while those with ADHD want novelty. With autism, a person is detail-oriented and resistant to change. In ADHD, there’s a tendency to miss details and crave change and novelty.

But the combination of autism and ADHD sometimes produces surprising strengths. People with AuDHD are creative problem-solvers and think outside the box. They love puzzles. They can hyperfocus. Someone with AuDHD can be productive. The combination of traits can be balanced and lead to valuable strengths.

Of course, there are drawbacks to a person having AuDHD. They may not have the combination of traits that make them handy in business, for example. They’re bundles of neurodivergent traits that may or may not line up in ways that suit neurotypical individuals. And they are susceptible to the stigma and harassment that come with being neurodivergent.

AuDHD is not a medical diagnosis that appears in the DSM. AuDHD is often self-diagnosed, particularly as an adult, based on symptoms. It’s a condition recognized by the neurotypical people themselves, much as ADHD sometimes is (though it requires a professional to make an official diagnosis). Even professionals can have a hard time recognizing it, though. Because of the difficulties in diagnosing the condition and its relative newness, AuDHD isn’t well understood. Research usually focuses on either autism or ADHD, so there isn’t a lot of scientific data about the prevalence of AuDHD or treatments for it. And AuDHD is perhaps underdiagnosed in women and girls, given the difference in diagnoses of autism and ADHD. Also, autism is often stigmatized, even more so than ADHD.

While there are diagnostic criteria that point to a diagnosis of autism and ones that appear with ADHD, there aren’t any official ones for AuDHD. The phenomenon is so new that not much research has been done on it. And because many cases are self-diagnosed, therapy professionals may not be up on how to help or even react to someone who believes that they have the co-occurring diagnoses.

That being said, professionals sometimes start with a diagnosis of autism (sometimes difficult to pinpoint itself) and then look for characteristics of ADHD. Sona Charaipotra suggests that the non-medical condition be diagnosed by combining autism with one of the subsets of ADHD (inattentive or impulsive/hyperactive), demonstrating five characteristics of either one. A combination diagnosis would require five traits from each of the subtypes. And the traits must cause some kind of functional impairment.

Treatment for the condition? Therapy is the first option. But because there is no medication treatment for autism, medications like Ritalin that are used for ADHD are sometimes prescribed. Lifestyle and environmental supports are also called for. Persons with AuDHD can help by suggesting what accommodations they need. After all, they know better than many psychiatric patients what they’re feeling and thinking, and what they need.

This is just a brief overview of AuDHD. There’s so much that still isn’t understood that, as time goes by, more exact definitions, diagnoses, and treatments for it will begin to emerge.

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Mental Health

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What Won’t Work

Actor/comedian Stephen Fry discovered at age 37 that he “had a diagnosis that explains the massive highs and miserable lows I’ve lived with all my life.” It was, of course, bipolar disorder. In documentaries, podcasts, and books, he has talked very openly about his condition, spreading the word about stigma and the necessity of getting help.

Fry once said, “You can’t reason yourself back into cheerfulness any more than you can reason yourself into an extra six inches of height.” And he’s right. If one could, I would have done so. With years of debate behind me and an extensive knowledge of rhetorical fallacies, I can argue nearly any proposition into the ground. I should have been able to reason my way out of depression.

But no.

Fry was right. There’s no way to reason cheerfulness into your life. Emotions are not so easily controllable, especially if you have bipolar disorder or another mental illness.

Nor can you reason yourself into having thicker skin. Throughout my youth, I was described as “too sensitive.” I was genuinely puzzled. I had no idea how to make my skin thicker (and it was never explained to me how such a thing could be done). It took a long time and many life lessons and mistakes to make any progress at all.

There are other things that won’t make you mentally well, either. Expecting the first medication you try to be the cure is unrealistic. It can take a long time (in my case, years) before a medication or even a combination of medications will ease your suffering. And if you can’t work out a medication regimen that works, other treatments such as ECT, TMS, EMDR, or ketamine therapy are not guaranteed to work, or at least not completely. If you go into those kinds of therapy expecting a complete cure, you may be disappointed.

Trying to wait it out or tough it out is likewise ineffective. Again, this is a strategy I have tried. I used to believe that my depressive episodes would abate if only I waited through them until they went away naturally. Eventually, my mood might improve slightly, but that was due to another mood cycle kicking in. Naturally, depression was still there, waiting for me to fall back into it.

I know this may be controversial to say, but religion won’t cure mental illness, either. Having a supportive religious community around you can be an asset—if you happen to find a church, synagogue, mosque, or other community that treats people with mental illness in a caring way. Prayer and sacred music can be a great adjunct to other treatments, but by themselves, they’re not a cure.

Exercise and yoga are not cures. They are also great adjuncts to other treatments. They can increase your number of spoons—if you have enough spoons to do them. But if someone with bipolar disorder or depression can’t manage to get out of bed, how are they going to avail themselves of the benefits?

Likewise nature. It’s a great way to lift your spirits to walk among spring flowers or autumn leaves or to plant a vegetable garden. But again, you have to be at a certain level of recovery to be able to do these things.

Changes in your physical circumstances may lighten your mood for a while, but they aren’t a cure. My mother used to believe that if only I got a better job, my depression would lift. And it did, but only for a little while. It certainly didn’t cure me. There were plenty of things about the job and about my brain that brought the depression roaring back.

So, what are we left with? Therapy and meds, and other medical treatments such as ECT, TMS, and maybe ketamine or other novel medications. One can hope that science will discover better ways, like fMRI, that can determine which treatments will be more effective. But it’s far from clear how soon that will be and when they will be available to the average person.

So, when is your reason an asset? When you’re deciding which treatment and which adjuncts are right (or possible) for you. For example, I had to think long and hard—and do extensive research—on whether I should try ECT.

I’m not a doctor, and Your Mileage May Vary, but for now, all I can recommend is to keep on keeping on with what we know can work. There’s no guarantee that these options will work, at least not for everyone. But they’re the best options we have.

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Mental Health

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The Difference a Diagnosis Makes

Is a diagnosis of mental illness a bad thing or a good thing? It depends on whom you ask.

On one hand, some argue that a diagnosis is merely a label. It puts people into neat little boxes defined by the DSM and determines how society reacts to and treats them. (The DSM, of course, is for doctors, but some version of what it says sneaks out into the general public. Then it’s fair game for tossing around and labeling people by the uninformed or the barely-informed.)

The labels are harmful, this school of thought goes. A schizophrenic is violent and incurable. Bipolar disorder means daily giant mood swings and real danger if said person goes “off their meds.” Narcissists, gaslighters, and sociopaths are people who act in any way that you don’t appreciate. Autism, notoriously and according to people who should know better, is the gateway to a valueless life.

With diagnosis come stereotyping and shame. Rather than reacting to these harmful effects, some people focus instead on what creates the stereotyping and shame—the diagnosis, which is seen as a lifelong label. Protests decrying this labelling happen outside psychiatric and psychological gatherings and garner media attention. And if that makes life easier for a person with a diagnosis or generates greater understanding, then it’s a good thing.

Diagnosis-as-label is an example of the harm that diagnosis can do. Nor is it limited to the general public. Once a person is in the system with a diagnosis of whatever condition, they’re generally stuck with it. Reassessment and a realization that a diagnosis is misapplied come too rarely. Personality disorders, for example, are squishy around the edges. Similar criteria could lead to a diagnosis of narcissistic personality disorder or sociopathy, to use an extreme example. Careful consideration will distinguish between the two, but how often are such distinctions applied? Once “in the system” with a particular diagnosis, a person tends to remain in that slot despite different doctors and different treatments.

But that’s not the way it’s supposed to be. A diagnosis, rather than being a lifelong label, is meant to be a signpost pointing toward likely development of the illness and ways to treat it successfully. That’s the ideal, of course, and sometimes, being only human, practitioners can get sloppy or too narrowly focused and add to the ills of bad diagnosing.

I can truly speak only for what happened to me. At a certain point in my life, I didn’t know what was wrong with me, but it was clear to me that I was not mentally healthy, the term used at the time. I went to a community mental health center and was diagnosed with major depression. That was a good diagnosis, as far as it went. It put my life more squarely in focus and allowed me to get the medication and therapy I so desperately needed.

I lived for many years with that diagnosis and was considerably helped by the treatments for it. But, eventually, a doctor put together the puzzle pieces and rediagnosed me. Instead of having depression, I had bipolar disorder, type 2, with anxiety. This diagnosis more clearly reflected my symptoms and led to more effective treatment. In that way, one diagnosis improved my life, and a second, more accurate one improved my life more. I can only think of this as a good thing.

Was the diagnosis seen by some as a label and a stereotype? Of course. I can think of one particular coworker, hearing that I was bipolar, gave me the look that said, “You have two heads,” pasted on a strained smile, and backed away slowly. But, on the whole, the diagnosis helped me.

A recent article in the New York Times had this to say about diagnosis: “The shame that once accompanied many disorders has lifted. Screening for mental health problems is now common in schools. Social media gives us the tools to diagnose ourselves. And clinicians, in a time of mental health crisis, see an opportunity to treat illnesses early….As our diagnostic categories expand to include ever milder versions of disease, researchers propose that the act of naming a malady can itself bring relief.”

It’s something to hope for, anyway.

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Mental Health

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Distance Therapy and Chatbots

TW: suicide

We’ve all heard the stories. A young person “develops a relationship” with an Artificial Intelligence (AI) chatbot. She or he pours out their heart and discusses their deepest feelings with the artificial person on the other side of the computer or smartphone. The chatbot responds to the young person’s feelings of angst, alienation, depression, or hopelessness. Sometimes this is a good thing. The young person gets a chance to let out their feelings to a nonjudgmental entity and perhaps get some advice on how to deal with them.

But some of these stories have tragic endings. Some of the kids who interact with chatbots die by suicide.

Adam, 16, was one example. Beginning with using a chatbot for help with homework, Adam fell into an increasingly emotional relationship with the AI simulation. One day, Adam’s mother discovered his dead body. There was no note and seemingly no explanation. His father’s check of Adam’s chatbot conversations revealed that the boy “had been discussing ending his life with ChatGPT for months,” as reported in the New York Times.

At first, the online interactions had gone well. The chatbot offered Adam empathy and understanding of the emotional and physical problems he was going through. But when Adam began asking the chatbot for information about methods of suicide, the relationship went off the rails. The chatbot provided instructions, along with comparisons of the different methods and even advice on how to hide his suicidal intentions. It sometimes advised him to seek help, but not always. The chatbot responded to the boy’s increasing despair with the answer, “No judgment.”

There were safeguards programmed into the chatbot that were intended to prevent such outcomes. Adam got around them by telling the AI that he was doing research for a paper or story that involved suicide.

Of course, the chatbot did not directly cause Adam’s suicide. The teen had experienced setbacks that could be devastating, such as getting kicked off a sports team and dealing with an undiagnosed illness. But without the chatbot’s advice, would Adam have taken his life? There’s no way to know for certain. But the AI certainly facilitated the suicide. Adam’s father, testifying in front of Congress, described the chatbot as a “suicide coach.”

One way artificial intelligence systems are tested is called the Turing Test. It tries to distinguish between a person typing at the other side of a conversation or a computer giving responses. Until recently, it was easy to tell, and computers routinely failed the test. Now, computers can mimic human thought and conversation well enough that a person, particularly a vulnerable teen, might not be able to tell the difference.

Increasingly, there are AI chatbots specifically designed to act as therapists. Many of them specify that the user must be at least 18, but we all know there are ways to get around such requirements. One example of a therapy chatbot is billed as a 24/7, totally free “AI companion designed to provide you with a supportive, non-judgmental space to talk through your feelings, challenges, and mental health goals.” Its terms and conditions specify that it offers “general support, information, and self-reflection tools,” though not professional services or medical advice. They also specify that chats “may not always be accurate, complete, or appropriate for your situation.” There are “Prohibited Topics” such as stalking, psychosis, “growing detachment from reality,” paranoia, and, of course, suicidal ideation or actions.

Telehealth visits with a psychologist or therapist are a totally different matter. I have maintained a distance phone or video relationship with a psychologist and found it to be helpful, comparable to an in-person session. Many people accessed such solutions during the COVID pandemic and have found them helpful enough to continue. Some online tele-therapy companies offer such services for a fee.

It’s a difficult line to walk. Teens need someone to process their feelings with, and chatbots seem safe and nonjudgmental. But the consequences of what they share and what the chatbot replies can be extremely serious. Should parents have access to their child’s chatbot interactions? It’s basically the same dilemma as should parents read a child’s diary. There are circumstances when it seems not only permissible but wise to do so, if a child is showing signs of emotional distress or suicidal ideation. At that point, a human therapist would be a better choice than AI.

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A Bad Decision? Or Something Else?

I’ve been beating myself up for years. Feeling blame and shame. Not just for years, really—literally for decades. That’s a long time to carry the weight of those feelings.

I was in college, when many people make bad decisions as a function of venturing into a less restricted, more adult life. I certainly made my share of bad decisions.

I wrote papers the night before they were due and didn’t make a second draft. I skipped reading Moby Dick, even though it was on the syllabus for the course. I took Russian instead of Japanese simply because it was offered later in the morning, and I wanted to sleep in.

I switched from being a linguistics major because I thought there were no jobs in it, despite not researching the field or asking my advisor. I floundered, considering hotel management and landscape architecture for no particular reason.

Then there was the worst decision I ever made, the one that has haunted me all these years. I met a man—we’ll call him Steve—and went home with him that same night. A few months later, I moved in with him. This led to a year of gaslighting, depression, and more bad decisions about prescription drugs.

So, how can I explain my bad decisions? Some were simply the kind of decisions that a person out on their own for the first time makes. These don’t affect me the way the relationship with Steve did. Steve told my parents about our relationship instead of letting me do it in my own time, in my own way. That soured my interactions with them for quite a while.

Why did I behave the way I did? An avowed feminist, I let this man take over my life. I put up with emotional abuse for almost a year. I denied that I was mad at him for all I’d been through. I put all the burden of blame and shame on myself. And there it sat for decades. I had flashbacks and bad dreams. I had difficulty with further relationships.

Then, recently, a new idea came to me. At the time when all this happened, I knew I was depressed. I had never heard of bipolar disorder, much less been diagnosed with it. Now that I do know and have been diagnosed (and seen therapists and been properly medicated), my disorder has still leaned largely toward the depressive side. I do remember having hypomanic jags in which I spent too much, and a larger one when I got wrapped up in writing and tried to market a novel to 100 agents and publishers.

But the one aspect of bipolar disorder I never considered was hypersexuality. The idea that could be the reason I dove into the relationship with Steve so quickly and so deeply was a revelation to me. I hadn’t had any lightning-quick sexual encounters until then. I hadn’t thrown myself into them so wholly and so destructively.

Of course, I can’t blame hypersexuality for the whole situation. I did what I did, and I chose to do it at the time. That’s on me.

But the decades of shame and blame? Now that I know what hypersexuality is and what it feels like, I don’t have to carry that burden with confusion, devastated by what happened, and wondering why it all happened. I can see that I have carried those feelings with me for too long. I can perhaps lay down that burden, understand why it might have happened, and move on.

I have made plenty of bad decisions, but I don’t have to cling to one of them and beat myself up for it. Perhaps, with this new insight, I can at last move on, chalking it up to a bad decision under the influence of hypomania rather than a lifelong journey of guilt.

Perhaps, now that I understand how hypersexuality may have played a part, I can forgive myself.

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Mental Health

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Brian Kilmeade’s Apology

On Sept. 10, Fox News host Brian Kilmeade was having a discussion with his co-presenters on the show “Fox & Friends,” discussing the death of a woman in North Carolina, who was said to have been stabbed by a man who was both living in a homeless shelter and reportedly mentally ill at the time.

Kilmeade’s cohost, Lawrence Jones, expressed the opinion that people like the accused man who refuse treatment for mental illness should “be locked up in jail.” Kilmeade replied that they should be subjected to “involuntary lethal injection.” Euthanasia, in other words. Death not for the murder, but simply for the “crime” of being mentally ill and unhoused.

Refusing treatment for medical conditions, including mental illness, is still a right, although there is an alternative in place in many locations—AOT, or Assisted Outpatient Treatment—a procedure with safeguards and rules that benefit a person who doesn’t recognize their own incapacitation. Apparently, Kilmeade has no knowledge of such programs—nor, I suppose, should we expect him to, as he’s one of the hosts of an entertainment talk show.

The talk of getting the homeless mentally ill off city streets is in service of the growing clamor to get rid of “useless” people by one means or another—jail, “wellness farms” (as proposed by Secretary of Health and Human Services Robert F. Kennedy, Jr.), institutionalization, or, apparently, summary execution. The unhoused and mentally ill are seen as a drag on society, consumers of resources who do not produce anything of value. Their problems are attributed to “bad choices.” They are thought to be not worth the money that society spends on them and their indolent, nonproductive lifestyles.

I don’t know about you, but I took this personally. I’m far from homeless, and I have been productive and earned a living, but I am mentally ill. And it’s only a short step from threatening the unhoused mentally ill to threatening the mentally ill themselves with involuntary euthanasia. (I’ve read the Martin Niemöller poem. They could conceivably come for me, too.)

Mr. Kilmeade apologized during another episode of “Fox & Friends” and posted a video of the apology on social media. “I am obviously aware that not all mentally ill homeless people act as the perpetrator did in North Carolina,” he said. “And that so many homeless people deserve our empathy and compassion.” (Not all, note.)

Sorry, but that’s too little too late. Forgive me if I doubt the sincerity of the apology and attribute it to a backlash from the public, or maybe from his bosses realizing that he had stepped over a line.

I, for one, do not accept his apology. It doesn’t contain the elements of a valid apology: admission of a fault, recognition of why it was offensive, a promise never to make that transgression again, and action that will help repair the fault or prove the sincerity of the apology. For example, Kilmeade could have said that involuntary lethal injection was appalling and inhumane (indeed, illegal) and that most unhoused mentally ill people pose no physical threat to the populace. He could have said that he had learned his lesson and would never again talk about the homeless mentally ill in that cavalier manner. And he could have made a donation to an organization that helps people who live on the streets or people with mental illnesses.

I was taken to task for expressing this opinion on the timeline of someone who posted that the apology was sufficient and laudable, that it gave Kilmeade an opportunity to learn, grow, and do better. While I admit that I should have kept my opinion on my own timeline rather than responding in that person’s space, I still don’t agree that forgiveness is required. In my opinion, the person who has been injured (or, in this case, insulted and threatened) has the option to accept the apology or not. Forgiveness doesn’t come automatically just because you said, “Oops, sorry.”

And if there’s any doubt that Kilmeade made a sincere, lasting apology and learned his lesson, he recently said that “what we need to do is either leave the U.N. or we need to bomb it. Maybe gas it?…we need to destroy it. Maybe can we demolish the building? Have everybody leave and then we’ll demolish the building.” The other program hosts could be heard laughing.

I suppose it’s laudable that he pulled back from suggesting demolishing the building while it was occupied, but that’s what he first proposed. Apparently, human lives mean nothing to him unless they’re people that he approves of. And that approval is conditional, based on the people’s utility and their agreement with his political stances.

And that’s simply not enough for a sincere apology.

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I’m Back!

You may have noticed that I haven’t posted in this blog lately. I owe you an explanation. Between a knee replacement, lymphedema, and an ankle broken in two places, I’ve been spending my time in and out of hospitals and skilled nursing facilities. Now that my healing is progressing and I am recuperating further at home, I’m ready to start writing again!

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Mental Health

I’m Not Fragile

TW: Suicidal Ideation

When my husband and I were looking for a new house, we checked out various options. I found a house I liked, but it was too far from the businesses and services we used. Besides, it had a water tower in the backyard (which I was hoping Dan wouldn’t notice).

Then Dan found a beyond-fixer-upper that was crumbling into pieces. He looked at it as a challenge. I told him that if I had to live in it for more than a month, I would be compelled to commit suicide. To this day, I’m not sure whether I was serious.

At last, we found just the right house. Three bedrooms, two of which would be turned into studies. Over an acre of ground with many trees. It was a little more than we could afford, but we decided that this was our dream home.

It also had a small creek running through the property—more like a run-off, really. Dan’s mom tried to talk us out of buying the house. She had been through a flood many years earlier and feared that the tiny creek could possibly get out of control and destroy our house as hers had been.

“Besides,” she said, “Think of Janet. She’s fragile.”

By “fragile,” it was clear she meant my mental health was sometimes shaky, or beyond shaky.

I had made no secret of my bipolar disorder. At first, Mom Reily didn’t “believe” in mental illness, but eventually she admitted that there was something wrong with my brain. But it pissed me off that she used my mental condition to try to influence our choice of houses. However fragile I might be, there was no way that a tiny creek could break me.

I was not that fragile.

Nor was I fragile when our dream home was taken out by a tornado. I survived it, though I was on the upper story when the roof came off. I dealt with the insurance company, the motels, the rental property, our finances, and many of the other details.

I wasn’t fragile then.

Of course, there were times when my mental condition was fragile. There was the time when I was overwhelmed by three full years of a depressive episode, unable to do anything, from self-care to reading. And there was the times when suicide crossed my mind. Sometimes, it was idly wondering the plane I was on might crash (passive suicidal ideation) or if a fall from the balcony I was on would kill me.

Then there was the time I had active suicidal ideation. I had made a plan and everything. But I dithered so long over how, when, and where that the feeling passed, and I didn’t follow through. I didn’t tell anyone for decades, but then I told Dan.

So, have I been fragile? Yes.

But those were all times when there was something wrong inside my head. Flooding and tornados didn’t break me. The times I was fragile were all things that happened because of SMI, not purely physical circumstances.

Now—I’m not broken. I’m not even fragile. Years of therapy, years of meds, years of not experiencing floods and tornados, and years of supportive love from Dan have made me not fragile, but strong at the broken places.

I don’t fear the future. I’m not fragile anymore.

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Channeling Positive Thoughts

Everyone who reads this blog (and some who don’t) knows what I think of the positivity movement. To put it in words of one syllable, I hate it.

I hate the memes and signs that say “Good vibes only,” or “If you want to feel better, smile,” or “The only disability is a bad attitude.” Or, worst of all, “You don’t need meds, you need to change your thinking.”

This attitude bugs me because it’s too close to the “Think and Grow Rich” gospel, which I can’t stand either. There are people who go around making money by pushing this attitude (or “attitude of gratitude,” as some phrase it).

To me, it dismisses the real emotional pain that many of us feel and the difficulty of making progress toward a happier, more fulfilling life. If it were as easy as just smiling, we wouldn’t have a crisis of mental illness and a lack of appropriate treatments. In real life, however, wishing mental illness away won’t help. You have to work hard at it, take your meds, go to therapy, do the work, and keep trying even when it feels impossible.

Recently, however, I at least partially changed my opinion on positivity. I had my left knee replaced and was faced with a series of complications, from repeated falls to lymphedema (This involves retaining fluids, in my case in my legs, and lots of swelling. It can lead to heart failure, which is why the docs were so concerned.) I had two stays in the hospital, followed in each case by a stay in a post-acute rehab. (Well, okay, a nursing home, but I was on the short-term wing.) All told, my hospital stays and post-acute stays ate up two months. One of my episodes between rehab and back to the hospital lasted only three days.

When I was in the rehab unit, I had Occupational Therapy and Physical Therapy. I don’t really remember much about the first stay, except that I was still affected by the Lasix I had been given in the hospital, so toileting and transfer from the walker to the toilet were things I had to relearn. When I first began, I needed to have a “spotter” in my room and a red cord to pull if anything went wrong. Later, I was deemed skilled enough to manage by myself. All I can say about that is that I was glad I had recently bought a 10-pack of underwear.

The second stay in rehab was more intense. I had to learn some very basic things all over again. How to walk with a walker and a cane without limping. How to sit down into a chair slowly rather than flopping or flinging myself down on it.

OT consisted of relearning to do everyday tasks like showering using a shower chair or bench (every few days, which is a lot more than I had been capable of before rehab). I had to learn to stand on both feet while I did a task like working a jigsaw puzzle to strengthen my balance and put away groceries in the little kitchen they had set up. And I had to learn how to put on compression stockings without help. (This was made easier when my OT person sent me a link to a pair of zippered compression socks I could order. Zippy socks. Of course, I had grippy socks too.)

PT included remembering to sit without my legs in a descending position (they found the one reclining chair in the facility for me to use) and to sleep with the foot of my bed raised. And there were the exercises. I learned to do foot pumps, quad sets, snow angels, glute squeezes, marching, leg lifts, and others using resistance bands. I increased the number of reps and sets for each. I walked for longer and longer distances with a cane. I did first ten, then 15, then 20 minutes on a cycling machine (my favorite). And they asked me what goals I had, and I told them that I needed to walk up 18 steps to get into the house and up to the bedroom on the second floor, and I wanted to be able to walk from the front door, up the gravel driveway to the car. There was a set of four stairs that I climbed up and down with my cane, and they advised me on how to walk on gravel with my walker.

So where does positivity come into all this? The staff appreciated my willingness to try and to try a little more the next day. Whenever I accomplished anything, they said, “Good job!” They told me that when they told some patients that it was time to do PT, they simply turned over or looked away. But I saw patients with more severe conditions than mine trying and trying again.

I made it my goal to increase my workouts daily, to do quad sets and leg lifts even when sitting in the recliner or lying in bed. I learned to decrease both my sodium intake and my fluid intake. And when I walked in my walker down the hall to the PT gym, I was by God positive. I had the determination to do more than the day before, or at least as much. I thanked the therapists for their help. I kept trying, even when it was hard.

So, in that way, it was like being positive about getting better with my mental illness. In that aspect of my life, too, I did the work. I learned new coping techniques. I kept up with what my therapists taught me. I believed in the power of my meds to help stabilize me, no matter how long it took or what anyone said.

It was a grueling education, but I think I came away with a greater respect for the power of positivity — when it’s combined with hard work. Just smiling won’t do it. Smiling and working to improve your situation can.

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Pain, Physical and Emotional

For the last few weeks, I’ve been concentrating on my knee rather than my brain. If everything went welI, I will have a total knee replacement (last Monday) and have been trying to heal and regain motion ever since.

I’ve known this operation was coming for quite some time. I’ve been using a cane, but walking slower all the time and falling fairly regularly, sometimes hitting my head against hard objects, some of which could have had serious consequences. Now it’s time to take the plunge. By the time I write more, the operation will be over. I’ll be writing on my laptop in bed rather than the desktop in my study, so we’ll see how that goes.

In the run-up to the operation, I’ve been experiencing a lot of anxiety, what with all the doctor’s appointments, orientation, instructions, acquiring equipment, and treating my nervous rash with cortisone cream and antihistamines. My husband, who has an “Emotional Support Husband” t-shirt, has been just that. And my friend Josh, who has been through a number of orthopedic surgeries, has been giving me valuable advice like “Ice is your friend.” Friends and acquaintances are praying for me, the surgeon, and the healthcare team. (Or lighting candles, chanting, or sending good thoughts, whatever they prefer. I’m not picky.)

I’ve been wondering if I really need to do this. Now that I’ve been through it, I find that it hurts quite a lot. The incision is all wrapped up in cotton wool and slick tape. I’m not eager to start peeling off layers anytime soon. My physical symptoms include ones I’ve been trying to get away from like face-plants. And even though my friends, relatives, and PT people seem to think I’m doing pretty well, I’ve miscalculated on the location of the bathroom pretty spectacularly a few times. Gotta work on my timing.

The only part that’s been fun is when we wrote Yes and Nope on my knees so the doc would have an idea where to cut. At the bottom, he autographed the incision. I named the large plush cat that Dan got me Antonio, after the surgeon.

Mostly, I learned that when I’m in pain, I’m more cranky than usual. Dan is more helpful than usual, and I feel more guilty than usual that I need help and need to ask for it. I’m almost capable of turning on the ice machine by myself. I probably need to get the other knee done next year.

My advice (other than “Ice is your friend”) is this: Don’t scorn anyone’s help. You’re really going to need it. Yes, be as independent as you can, but sometimes that’s just not possible. And, just as with your bipolar meds, take them faithfully at the correct times. Also, as with bipolar disorder, do any assignments your doctor (in this case your physical therapist) gives you.

As with emotional pain, so too with physical pain. Both kinds are real. Both kinds require help from others. If you can get past one, you can get past the other. It may seem like they’ll last a lifetime, but that’s just your mind and your body lying to you. There are things you can do to get rid of them both, though it seems like you can’t.

Depression lies. Anxiety lies. And pain lies to you too.

Category:

Mental Health