Bipolar 2 From Inside and Out

Archive for the ‘Mental Health’ Category

Politics, Mood, and Self-Care

It’s difficult for me to maintain a positive mental attitude when I’m troubled by bipolar disorder, especially the depression part. It’s even more difficult in today’s political landscape.

I don’t care what your political persuasion is or who you voted for. I don’t care if you’re for or against DEI or ICE. What I care about these days is what’s happening to mental healthcare in our country. But let’s leave government policies and programs for another day. Right now, I want to discuss politics and mood disorders.

We seem to be overwhelmed by politics, but also by our reactions to politics. Friendships have broken. Families have been torn apart. Lots of people suffer from cognitive dissonance when their brains try to balance their love for friends and family and distress at their views.

None of us knows what to expect next. The difficulty isn’t limited to one side or the other. People who want smaller government are learning that the cuts will include public services such as extreme weather forecasting and disaster recovery. Others with differing views are afraid to travel abroad because they fear that, even with passports, they may be detained when they try to return.

The situation is especially hard on people with mood disorders. People who have phobias or anxiety disorders can find their feelings increasingly out of control. Those who suffer from depression have exaggerated fears. Most debilitating of all is the not-knowing. Am I overreacting? Are these fears reasonable or exaggerated? Will the things I fear never happen? Should I watch the news? Should I avoid watching the news?

I’m suffering from news-dependent symptoms myself. I hesitate to discuss politics with friends unless I already know their opinions are similar to mine. And with new acquaintances on Facebook, I share memes and chat about books.

But when it comes to not getting overwhelmed, I have a few suggestions. Most of them you may already know—they’re versions of basic self-care.

Remove yourself from the trigger. Get out of the room or the house when the talk turns to politics. Offer to go on a beer run. Leave the room and make yourself a cup of tea. Tell your friends or relatives you need to get some air. The outdoors is largely a politics-free zone, aside from bumper stickers and billboards. If you walk with a friend, stay on non-threatening topics like your pets. And prepare a neutral topic to suggest: Do you think the Dodgers have a chance this year? What do you think of Beyoncé’s country album? Should I go on a Disney cruise this year or a trek to the Grand Canyon?

Self-soothing. Music is another way to distract yourself from the present chaos when you take that walk or any other time. Personally, I prefer music with lyrics, as instrumental music gives me too much time and space to contemplate difficult topics. If you wear earbuds (even without music), people are less likely to engage you in conversation.

Use distractions. If you read, stay away from news magazines, the internet, and newspapers. Instead, you may want to revisit books from your childhood. There’s nothing wrong with reading children’s books. They may take you back to a more pleasant time, or you may discover aspects of a book that you never noticed when you were young. Or try a new genre, such as a romance or mystery that isn’t likely to contain much politics. Old classics like Dickens or Austen are good choices, too.

Limit your exposure. Allow yourself 20 minutes for listening to or reading the news. You can do this more than once a day, but leave a couple of hours in between. Clean the bathroom or watch a reality show. Organize your closet. Plant flowers or herbs.

Do things that lift you up. Pray. Sing. Bake bread. Work on a journal or a painting. Do life-affirming activities that will improve your outlook and your spirit.

Oh, yeah. And remember to take your meds, especially if you have an anti-anxiety pill. You’ll need them.

Category:

Mental Health

Tagged with:

What Meds Am I On?

I see a lot of posts in the bipolar/mental health Facebook groups that I belong to asking what medications people take and advice on which ones they should take. “Has Caplyta worked for you?” “What side effects have you had from Lamictal?” “Can I take both Zoloft and Ativan?” “Can I take an antipsychotic with Nyquil?”

Fortunately, I have a quick and easy answer to all these questions—I don’t know.

The main reason I can’t answer those questions is that I’m not a doctor. All the questions should be directed to your prescribing physician (usually your psychiatrist). The other reason is that every person reacts differently to different medications.

Think about it. Every drug comes with a whole, long list of possible side effects, and there’s no telling which ones you might get. It’s impossible to know for certain how the various drugs will interact with one another. I might get a rash, while you might get an upset stomach. Each of us has to decide for ourselves which side effects we can live with and which are intolerable.

I’ve drawn the line at drugs that gave me terrible nightmares, ones that made my hands tremble, and one that affected my memory. (I told my doctor about that one, and he said, “Yes, that drug can have that effect. Stop taking it.”) The point is that memory problems were one possible side effect, but he didn’t know that I would have that effect until I did. If I got a question about what reaction I had to that drug, I’d have to say, it affected me one way, but it may affect you another way. I got what I considered a deal-breaker reaction. You could get that same side effect, of course, but you could also get a more tolerable one or none at all.

When you get into the area of multiple medications, it’s even more difficult to give a sensible answer. Maybe an SSRI combined with an anti-anxiety med will make you sleepy. Or not. A lot of us take more than one med—with all the different ones out there, the combinations are virtually endless. Your doctor may be able to tell you that one combination is likely to increase sleepiness or make you anxious, but some people tolerate them better than others do.

When people ask me what meds I take, I never tell them the specifics. I respond with categories. I take an SSRI, an anticonvulsant, an anti-anxiety, an antipsychotic, and occasionally a sleeping pill. (Plus non-psychiatric medications for high blood pressure, cholesterol, and so on.) I have pills I take in the morning and ones I take at night. I have tolerable side effects.

Does it sound to you like I’m over-medicated? That’s between me and my psychiatrist, and he doesn’t think so. We review my medications regularly, adjusting them as needed, but my basic meds haven’t changed in years. I have a “cocktail” that works for me and no desire to change. Not even for the newest medications I hear about on all those commercials.

So, no, I can’t tell you how a certain drug will work for you or what side effects you’ll have. You can find out about possible side effects online if you want to, but they may only scare you. (My doctor told me not to look up one side effect online. “It’s gross,” he said. So, of course, I did. He was right. It was gross.) Not everyone gets a particular side effect. In fact, the likelihood of getting any specific one is low. I will say that mixing prescribed meds with over-the-counter ones isn’t a good idea. How they will interact can be a problem. But that’s true of any combination of drugs.

And weed? I have no idea how that reacts with any psychiatric medication or any combination of them. I’d avoid it while I was on psych meds. You don’t know the strength of what you’re getting, possible additives, or your own reactions (which can differ from person to person—euphoria, sleepiness, paranoia, relaxation, excitation, etc. I wouldn’t even offer a guess about that.

Category:

Mental Health

Depression and the Dickhead

“Depression isn’t real. You feel sad, you move on. You will always be depressed if your life is depressing. Change it.”

Now, before you jump all over me, let me say that I never said that. It’s a tweet from Andrew Tate, who’s back in the news lately, because he’s had some problems owing to bad behavior. And when I say bad behavior, I mean it’s led to criminal and civil charges in the U.S, Romania, Florida, and the U.K. Many of these were related to rape, human trafficking, online harassment, organized crime aimed at sexually exploiting women, tax evasion, sex with a minor, money laundering, and trying to influence witnesses. His presence in the Twitterverse (X-verse?) has promoted pimping and violence against women, as well as general misogyny. He’s an attention whore, a conspiracy theorist, and a walking, talking example of toxic masculinity.

But I’m here today to discuss his expressed opinions on depression.

The quote caused quite a stir and was immediately challenged.

Obviously, there are a few things wrong with Tate’s opinions. First is the notion that depression isn’t real. It’s merely being sad. To quote Hemingway, “Isn’t it pretty to think so?”

The millions of us with major depressive disorder and bipolar depression would love it if our disorder was merely sadness. If we could just move on. If we could only change our lives by willing it. Kick depression out of our heads, as we should be able to, according to Tate, a former kickboxer.

Then Tate threw more fuel on the fire. He tweeted “MY DEPRESSION INBOX. Is hilarious. Full of crybabys. . . .”

Admittedly, many depressed people cry. But that doesn’t make us crybabies. Babies stop crying when their needs are met. People in the throes of depression don’t know if their need for, if not happiness, at least not-despair, will ever be met.

When I first became clinically depressed I was a child and knew nothing about the condition. But I knew I was profoundly troubled. I assumed that if I waited long enough, I would come through the other side, and the depression would lift by itself at some point—or it wouldn’t. Being undiagnosed and unmedicated, all I could do was wait for that to happen.

Now older and wiser (and diagnosed and medicated), I know some things I can do to shorten that time until the depression lifts. I can take my medications. I can practice self-care. I can call my therapist. I can turn to my husband. Now I know—really know and understand—that my depression isn’t forever, even if my disorder is. But that doesn’t mean depression isn’t real. It doesn’t mean that I can snap my fingers and change it.

I do know that, if I have to, I can push through depression instead of waiting for it to ease up on its own. Taking my meds is one way I do that. Meeting my self-imposed blogging deadlines is another. Paying the mortgage and power bill, too. In some way those are life-affirming activities or at least statements that I am still connected to the world—however tenuously—and that I want and need to come out of depression and get on with my real life.

It’s ridiculous to say “move on” or “change it,” as Tate did. Depression comes and goes when it wills. All we can do is endure it and keep pushing back until it gives us the tiniest toehold. Then take that tiny purchase and push some more. It’s the hardest thing in the world when depression has sapped you, but believe me, you can push back. It won’t allow you to change your depression as if it no longer exists. We can no more change the fact that we have depression than we can our height. We do what we can to persist despite that.

So screw you, Andrew Tate.

And screw you, depression.

Category:

Mental Health

Growth Mindset and Mental Illness

Let’s start with a little levity, a quote from Groucho Marx: “Change is inevitable—except from a vending machine.” Putting the vending machine aside, Groucho was right. Change is inevitable. Even if you think that your condition will never change, your circumstances certainly will. Friends may come and go. You may run out of your medications or your therapist may go on vacation. With bipolar disorder in particular, change is not only inevitable, it’s part of the definition of the condition.

When it comes to change, psychologists speak of two types of mindset: fixed and growth. Both have impacts on mental illness and how you adjust to it. Both mindsets have to do with how you approach the world and, particularly, setbacks in life.

A person with a fixed mindset believes that their circumstances cannot change. To some extent, that’s true. Bipolar disorder may get better or worse, but it’s always there. There are treatments, but no cure. A person with a fixed mindset believes that they’ll never get better, their symptoms will never lessen, and that it’s fruitless to try. They believe that their traits and their limitations are carved in stone.

Someone with a growth mindset believes that change can happen. Their circumstances can improve. They may not be able to eradicate the disorder, but they can improve their functioning. There are things they can do to affect their lives and their condition. A growth mindset also correlates with resilience, the ability to bounce back from setbacks. It’s also been cited as a tool to deal with anxiety, depression, and “stress due to life events.”

It’s easy to see that for those with mental difficulties, a growth mindset is preferable. But is your mindset predetermined, or can it change? The good news is that someone with a fixed mindset can develop a growth mindset—if they try. But since the person with the fixed mindset tends to believe that positive change isn’t possible, it’s difficult to move from one mindset to the other.

But it’s not impossible. There are exercises for all ages that can foster the development of a growth mindset. For example, children can be introduced to stories of famous people who experienced many failures before they accomplished their successes. This can reinforce the belief that failure isn’t permanent; one can learn from it. They can also learn the power of the word “yet.” Instead of saying simply, “I can’t ice skate,” they can change that to “I don’t know how to ice skate yet.” It leaves open the possibility that they can still learn to skate, especially if they get instruction and practice. Teens or adults can set out to learn a minor or silly skill like juggling or sudoku puzzles. Learning purely for the sake of learning can prove to them that improvement is possible and enjoyable. Interventions that explain the neuroplasticity of the brain can also foster belief that traits are not immutable.

Fixed and growth mindsets have been studied as factors in mental health. For example, young people who had a fixed mindset were 58% more likely to experience severe symptoms of depression and anxiety than those with a growth mindset. Because they view improvement as possible, those with a growth mindset understand that anxiety is a temporary condition. Even someone with bipolar disorder can experience changes in symptoms, including positive changes. The changes may not be permanent, but they exist and can recur.

The takeaways are that a growth mindset promotes growth, change, and improvement in psychological symptoms such as depression and anxiety as well as other difficult life circumstances. That it is possible for a person with a fixed mindset to develop a growth mindset. And that a growth mindset will help a person deal with the difficulties and setbacks that mental illness so often involves.

In other words, you can get change from that vending machine after all!

Category:

Mental Health

Tagged with:

My Two Diagnoses

For all my childhood, I assumed I had depression, though I didn’t know that it was a psychiatric diagnosis. I was always a moody child, given to bursting into tears at the slightest provocation.

My first really major depressive meltdown came when I was humiliated by another child at a birthday party. I ran home, curled up in a beanbag chair, and sobbed for days. The only thing that snapped me out of it was the fact that my mother was being hurt by it too. She was crying too and had no idea what to do about my emotional implosion. At that point, I went down the street and yelled at the girl who had instigated the incident. (I suppose this could have been bipolar rage. I was pretty incoherent.)

I still remember this event as clearly as when it happened.

Another time, some friends were making fun of the way I laughed. Without saying a word, I got in my car and drove home, removing myself from what was distressing me. They followed me home and apologized. Then, I practiced laughing until I came up with something more acceptable. I think I accomplished it, though who really knows?

In my college years, I spiraled further. I was prescribed benzos for a TMJ problem, and I was in such a bad emotional place that I supplemented them with wine. There was some risky sexual behavior, too. It was the first time I recognized that I had a hypomanic episode. After I got out of the situation, I stopped relying on the benzos. (Actually, I had first experienced benzos in my junior high school years, when they were prescribed for an uncontrollable tic.)

Eventually, I went into therapy where I was diagnosed, as I expected, with depression. I continued that way for years, being prescribed various medications but still having symptoms.

Finally, I went to a new psychiatrist who, after some time, said he thought I had bipolar disorder. Eventually, we found a drug regimen that worked to alleviate my symptoms to an acceptable point.

I was still having symptoms, though, before the right cocktail was achieved. I was unable to work, get out of bed, or do much of anything, unhappy all the time. I applied for disability—and didn’t get it. When I got my file from Dr. R., I saw that my diagnosis was actually both bipolar and anxiety.

That threw me for a while. But looking backward and forward, I realize that he was right. I had anxiety episodes when I was a kid, usually regarding finding and keeping friends. I was terrified when my high school counselor suggested therapy. (I declined.) I panicked when it looked like I would have to go to community college instead of a four-year school, which I had always assumed was in my future. When I did get to that college, I had a mixture of the depression and anxiety, and took a year off to work and reset my brain.

Now, years later, my bipolar disorder is largely under control. But the anxiety haunts me to this day. I am anxious about family finances (which I am in charge of). Many nights my brain won’t shut up and I can’t sleep. (Sometimes it won’t shut up about the unfortunate episodes in my past.) I had massive anxiety recently regarding a trip to Florida.

So, I think Dr. R. was right when he diagnosed me with bipolar and anxiety. One has been tamed, but the other lingers. I am now working with Dr. G. to help me alleviate the anxiety without letting the bipolar kick up again. It’s a delicate balance.

Category:

Mental Health

Tagged with:

Advances in Schizophrenia Treatment

Schizophrenia is one of the most problematic and least tractable of the Serious Mental Illnesses (SMI). Recently, though, there have been advancements in treatment in terms of medications, therapy, and even virtual reality. Let’s take a look at what’s happening.

Medications

Medications have been the traditional way to treat schizophrenia. In the 1970s, there were drugs such as fluphenazine, chlorpromazine, and clozapine, the first atypical antipsychotic. Among the drawbacks were movement disorders such as akathisia, Parkinsonism, and tardive dyskinesia. Many people stopped taking them because they couldn’t handle the side effects. They were also noted for their sedative effects, and were primarily effective for positive symptoms such as hallucinations and delusions rather than negative ones such as flat affect. But medications weren’t the only possibilities. There were also insulin comas, the much-maligned ECT, and the thoroughly abhorrent frontal lobotomy.

In recent years, there have been advancements in medications for schizophrenia. In 2024, for example, the FDA approved a drug called Cobenfy. It combines two other medications, xanomeline and trospium chloride. Apparently, it reduces psychosis and delusions in schizophrenia without many of the side effects like unwanted movements and weight gain. On the other hand, xanomeline has its own side effects, including diarrhea, nausea, vomiting, and increased heart rate and blood pressure, so there’s that. (It’s also used to decrease symptoms in Alzheimer’s patients. Another new drug, KarXT, which is still experimental, is another combination drug that shows promise. Like Cobenfy, it’s supposed to reduce both psychosis and side effects.

Therapies

In the 70’s, effective therapies for schizophrenia were not really available. Psychoanalysis and family therapy were tried, largely to no avail. (The famous book I Never Promised You a Rose Garden epitomized the psychoanalytical approach, misleading many.) They missed the fact that schizophrenia is a serious brain illness, not really amenable to talk therapies.

Still, some psychosocial therapies are now in use. Cognitive remediation is said to show benefits for social and vocational functioning. Another method, called “Errorless learning,” which focuses on rehabilitation, also targets social and work skills. And Integrated psychological therapy is likewise suggested for improving social skills. None of them applies to the more severe cases of schizophrenia, but can be helpful for those who experience milder symptoms or are fairly well controlled by medication.

Virtual Reality

Virtual or augmented reality devices have also been used to help schizophrenic patients learn coping skills. In particular, they are said to be helpful in transferring these skills from a virtual environment to daily life. It’s also been suggested that such alternative realities can be used for research to assess patients’ reactions to specific environments. Computer-animated humanoid agents are also being investigated for use in encouraging medication compliance. An analysis by Chivilgina, Elger, and Jotterand says that these technologies “pose more questions than answers,” however, and to “to establish safe environments, further examination is needed.”

Treatments for Tardive Dyskinesia

You can’t talk about treatments for schizophrenia without talking about treatments for TD. Along with sedation, it’s one of the side effects that frequently causes patients to stop taking their medication. It’s also one of the more disabling side effects, as TD movements can vary from minor yet noticeable to extreme and debilitating. Unfortunately, many of the treatments for TD have a significant side effects: abnormal movements. So, you get a drug that is supposed to treat abnormal movements—and the result can be abnormal movements.

Guidelines from the American Academy of Neurology say that drug treatments for TD include clonazepam, valbenazine (Ingrezza), deutetrabenazine (Austedo), and clonazepam. Among other treatments for TD, clozapine, vitamin E, levodopa, benzodiazepines, botulinum toxin, reserpine, tetrabenazine, propranolol, and gingko biloba have been tried, as well as less common substances used in Chinese medicine. And there are off label uses of drugs usually prescribed for other conditions. For particularly intractable cases, deep brain stimulation can be tried. If this sounds kind of hit or miss, it is. I would hate to be a patient who had to try each of these therapies in hopes of finding one that works for me.

Still, the outlook for schizophrenic patients seems to be improving, and increasingly researched. As with most psychiatric medications, the trick is finding treatments whose side effects aren’t worse than the disorder they’re prescribed for.

Category:

Mental Health

Tagged with:

Is a Keto Diet Good for Bipolar?

I’m sure you’ve read the ads and articles that say apple cider vinegar is good for anything that ails you. There are also supposed “superfoods” that activate your immune system and ward off diseases. Then there are diets—Mediterranean, paleo, Atkins, gluten-free, intermittent fasting, vegetarian, vegan, low-carb, sugar-free, South Beach, carnivore, and more. Each of them is supposed to be good for your body or some part of it. And that may be true. I can’t say that one or another is good for everyone.

But what about people with bipolar disorder? A quick Google tells me that Omega 3, folic acid, probiotics, magnesium, walnuts, whole grains, CoQ10, tryptophan, Vitamin D, Vitamin B12, Vitamin C, and Acetylcysteine (which loosens thick mucus) are recommended nutrients for us.

But the diet (or eating plan) I’ve heard the most about in relation to mental disorders is the keto diet.

First, let’s look at what the keto diet actually is. It involves consuming a very low amount of carbohydrates and replacing them with fat to help your body burn fat for energy. That means you should avoid sugary foods, grains and starches, most fruit, beans and legumes, root vegetables and tubers, low-fat or diet products, unhealthy fats, alcohol, and sugar-free diet foods.

What’s left? Good fats like avocados and EVOO, as well as meat, fatty fish, eggs, butter and cream, cheese, nuts, seeds, low-carb veggies, and herbs and spices. This diet is supposed to be good for people with neurological disorders like epilepsy, heart disease, cancer, Alzheimer’s, Parkinson’s, and traumatic brain injuries.

Lately, however, the keto diet has been investigated as being good for mood disorders including depression and bipolar disorder.

Healthline reports that, based on the idea that a keto diet is good for those with epilepsy and that anti-seizure medications are often used to treat bipolar disorder, “during a depressed or manic episode, energy production slows in the brain. Eating a ketogenic diet can increase energy in the brain.” Also, the keto diet lowers the amount of sodium in the cells, which is partially the way lithium and other mood stabilizers work. They note, however, that very little research has been done on this theory.

However, UCLA Health is planning such a study. They note that, while most previous studies have focused on adults, the new study will include youth and young adults who have bipolar disorder. Participants will go on a ketogenic diet for 16 weeks while continuing their usual medications. Dieticians, psychologists, and psychiatrists are involved and there will be daily blood tests measuring metabolic indicators. In the future, the researchers say, they will compare the keto diet with another meal plan such as the Mediterranean diet.

Stanford has conducted a pilot study on the ketogenic diet. They say that, in addition to improving metabolic conditions, the diet improved patients’ psychiatric conditions and metabolic health while they continued with their medications. The results, published in Psychiatry Research, said that dietary interventions such as the keto diet may assist in treating mental illness.

A French study that was reported in Psychology Today focused on people with major depressive disorder, bipolar disorder, or schizophrenia. Symptoms improved in all the participants who followed the diet for more than two weeks. Almost two-thirds were able to reduce their medication.

There seem to be drawbacks to a keto diet, however. Healthline also notes that the diet can lead to shortages of vitamins B, C, and D, as well as calcium, magnesium, and iron. There can also be digestive difficulties such as nausea, vomiting, and constipation. They recommend supervision by a physician. Other people report mood swings related to the keto diet.

The advice from WebMD is that there is “insufficient evidence” to recommend the diet as beneficial for mood disorders. They don’t recommend it as a treatment option. As with any diet plan, consulting your doctor first is a good idea.

As for me, I have my doubts about currently (or formerly) trendy diets and superfoods, though the Mediterranean diet sounds good and balanced to me. Am I likely to try the keto diet? Well, I would miss bread, fruit, potatoes, and sugar-free products. Stocking up on meat, fish, avocados, cheese, herbs, and spices I could manage rather easily. But until more results are in from the various studies, I probably won’t change the way I eat very much.

As always, Your Mileage May Vary.

Category:

Mental Health

Tagged with:

Advice from the NYT

On December 30, 2024, the New York Times offered an article: “10 Ways to Keep Your Mind Healthy” in 2025, by Christina Caron and Dana G. Smith. Now, I’m not saying that their advice was bad. I’m just saying it didn’t go far enough. All of their recommendations are things we already know. Someone with a simple need for better mental health may get something from the article. But for someone with a mental disorder, it’s inadequate. Here’s what they said.

1. Move your body.

“If you’ve heard it once, you’ve heard it 1,000 times: Physical activity is one of the best things you can do for your brain.” Well, we have heard it 1,000 times. The Times notes that people feel better after a workout, but that ones who have a consistent exercise routine, there’s less risk of depression (and dementia). They attribute this to better blood flow and connections in the brain. This is hardly revolutionary advice.

2. Address your anxiety.

Easier said than done. NYT says: “Many Americans are anxious.” They suggest the following solutions. Face what makes you anxious to break the pattern of fear. They say that you can do this kind of exposure therapy with or without a therapist.

They also recommend that you focus on your values rather than anxiety. I’m not sure how this is supposed to work. One suggestion they give is to volunteer in your community. Then they advise that you not catastrophize—but they don’t tell you how to do that, except for journaling about whether you had an appropriate amount of worry compared to the situation.

3. Challenge your brain.

The authors note that this is “still up for debate,” but they say that crossword puzzles, reading, and brain games “can’t hurt,” especially regarding dementia. The most definite thing they way is that such pursuits “can’t hurt.” A professor of psychology adds that “chances are that’s probably good for your brain.” But “good for your brain” is a long way from mentally healthy.

4. Get a good night’s sleep.

Lack of sleep “can affect how they experience stress and negative emotions. They might also be more likely to ruminate, be quicker to anger, have more negative thoughts or find it harder to cope with stress.” Those are serious symptoms, and for once, the NYT recommends actual therapy—Cognitive behavioral therapy for insomnia, or C.B.T.-I. They note that it is more effective than medication. At last, some useful information!

5. Get unstuck.

Good idea, but how to do it? According to the NYT, you should conduct a “friction audit.” which basically means identifying your problems and trimming them away, whatever that means. They also recommend “futurecasting,” or imagining you aren’t stuck and what steps would get you there. “Try to do at least one step each day.” Baby steps are good, of course, but doing one per day isn’t practical for most people with mental disorders. A therapist might help with this, but the NYT is silent regarding that possibility.

6. Stay cool.

At last, something that you may not already know! “Studies show that hot days impair our cognition and make us more aggressive, irritable and impulsive.” Typical ways of cooling off are recommended: stay cool and hydrated, use air conditioning or a fan, spritz yourself with cold water or take a cool shower, or go to a nearby cooling shelter. Nothing there but obvious remedies.

7. Quiet your inner critic.

If only we could! The inner critic is a real thing, and it makes you miserable. But the trick is how to do it. The authors suggest “letting go of that nagging feeling…and giving yourself credit credit for what you accomplish.” They do quote a psychology professor who suggests using “you” or your name rather than “I” when you engage in internal dialogue, which I take to mean affirmations.

8. Take care of your physical health.

This sounds good; the body and brain, of course, are interrelated. The NYT recommends taking a quiz about your physical health that analyzes common health conditions and behaviors such as blood pressure, cholesterol, and exercise. It’s said to estimate your risk for depression, as well as dementia and stroke. But most general practitioners these days use a specific depression screening quiz with more questions particular to that condition.

9. Make a new friend.

This is a great idea. People with mental disorders need a support system which can certainly include friends as well as family. One problem is gaining the courage and social skills to make overtures. The Times notes that loneliness can increase brain inflammation that damages brain cells and the connections between them. Then the article recommends reaching out to a friend or family member, joining a club, or attending a support group. Reaching out is difficult for people with depression in particular. Waiting for someone to reach in to you is sometimes all you can manage.

10. Forgive — or don’t!

Contradictory advice? Certainly. The Times article suggests that “forgiveness is an emotional process rather than an endpoint.” So, should you or shouldn’t you? Maybe. Forgiving someone who’s hurt you may lead to fewer negative feelings, the Times says, but they also recommend a book called You Don’t Need to Forgive: Trauma Recovery on Your Own Terms by Amanda Gregory.

I know what you’re going to say: This article is intended for the general public. It makes no mention of the many things such as therapy and medication that can help you achieve a healthy mind if you have a mental disorder. That the actions mentioned are meaningful adjuncts to those interventions.

But the title is misleading. I first got treatment for my mental health when I saw a sign for a mental health clinic and realized that whatever I was feeling, it wasn’t mentally healthy. At that point I received therapy, and later was prescribed medication. And they truly helped.

I would hate to think that someone like me would ready this article and think that the suggested actions, by themselves, will make a person mentally healthy. They are great adjuncts to proper treatment but won’t solve many problems that people with mental disorders have. If, like me, your only realization is that you don’t feel mentally healthy, the article may prevent or delay getting significant treatment.

So, go ahead. Try all the advice in this article. But if you still don’t feel you’re on an even keel, seek other kinds of help.

Category:

Mental Health

Tagged with:

We Don’t Talk About It

When I was first diagnosed with depression (later bipolar disorder), my family was somewhat less than understanding. My father was concerned that he might have to go to family counseling, with the implication that it would involve analyzing or blaming him. My mother informed me that Prozac, which I was prescribed, was “a ticking time bomb” and later said that she thought that if I got a better job, I wouldn’t be depressed anymore. And my sister was dismissive about paying someone a lot of money just so I could talk.

I admit that I did not handle this terribly well. I missed the opportunity to educate my family about these psychological conditions. (I did tell my sister that I was going to a community mental health service that had a sliding scale for payment.) In my defense, I was new to the concepts too, and had barely begun to educate myself about them. I did gradually learn more, but their initial reactions kept me from saying much about it to my family.

As stigma goes, this was pretty mild. They didn’t try to tell me there was nothing wrong with me. They didn’t blame or shame me for reaching out for therapy (other than my sister). But because of this, I didn’t receive much support from my family which would have made my journey easier. That only happened when I married a man who knew something about psychology and learned what would help and what wouldn’t.

Stigma can be a familial problem, but it also happens at a societal level. But mental health concerns are very low on the list of many legislators’ concerns and priorities. Some have denied that mental illness even exists or responded to it by clearing away the unhoused or creating sober houses. Mental illness is seen as a consequence of PTSD, which is talked about mostly in the context of veterans, seldom about other causes like abuse. Also, most of the fundraising for veterans seems to concentrate on limb loss and traumatic brain injury. If funds are going to specific mental disorders other than PTSD, it isn’t emphasized, despite the need.

A lot of what we hear about mental illness is about SMI or serious mental illness. And that often gets conflated with the problems of homelessness, addiction, and violence. But what about all the people with Major Depressive Disorder, Bipolar Disorder, Anxiety Disorders, Personality Disorders, and even Schizophrenia who live in homes and families, who have families of their own, and who have jobs? They’re very rarely talked about. They don’t get emergency funding. They don’t require street psychiatry, emergency housing, forced commitment, and other services that are needed for the most severely ill. They’re not high-profile.

They’re called “high-functioning” and then largely ignored, left to deal with their disorders on their own. Many of them miss out on the therapy, meds, and lifestyle changes that might help them, either because they don’t know where to go or don’t have the funds to access them. Insurance pays for quick fixes of 6-8 weeks, which are the merest band-aid on their problems. Supportive families, biological or chosen, can help them maintain their relationships, living situations, and jobs, but public attention isn’t focused on them in any meaningful way. There are ad campaigns that say “It’s okay not to be okay” and encourage friends to reach out, but they’re vague and short on what to do when you realize you need help. Hotlines focus on suicide and self-harm. They’re certainly needed, but so are resources for the day-to-day, less dramatic disorders.

Stigma, confusion, lack of education, ignorance, and even hostility keep us from the conversations that might lead to actual, useful change. Let’s open up those conversations with our families, friends, coworkers, the press, local and national government, and anyone else who’ll listen. Blogging and maintaining a Facebook group (Hope for Troubled Minds) are among my contributions to the effort.

I’ll keep trying if you will.

Category:

Mental Health

Tagged with:

What Was I Feeling?

It wasn’t supposed to be journaling. I thought I was writing a blog post to be called “On Happiness.” It was about the fact that, even though my bipolar disorder is well controlled, something was sucking the joy out of what should have been joyful times—our dream trip to Ireland, for example, or the fact that I just got a work assignment after a long drought. Not even a mid-winter trip to Florida lifted my spirits.

It didn’t feel like depression, though. That’s a creature I know well, and this wasn’t it. Oh, the lack of joy was the same, but there were no unexplained fits of crying or immobility. In fact, I was experiencing a flurry of activity getting ready for the Florida trip. Putting money away from every paycheck. Making sure we had enough meds for the week. Arranging boarding for the cat. Downloading directions to Google Maps. Checking the flight reservations at least twice a week. Planning what goes in the carry-ons. Juicing up my e-readers and my laptop so I could work on my new assignment and my blogs while we were away.

No, this wasn’t depression.

What it was, was anxiety. Where was this coming from?

Suddenly, I remembered. I had gotten a copy of my file when Dr. Ramirez had to prepare it for my disability application (which failed, of course). On it I read, bipolar disorder, type II, which was expected. But it also said anxiety disorder. And I forgot about that.

All these years, I’ve been concentrating on the bipolar diagnosis—keeping my moods level through a combination of meds and therapy, readjusting levels and times as needed.

But I had been ignoring my anxiety. I was taking one small dose of an anti-anxiety med, with permission to take an extra one as needed. Mostly, I just took the one at night to help me sleep. Unless I was under severe, immediate stress, I ignored the ability to take a second one. That only happened in Ireland, when we were driving on the unfamiliar side of unfamiliar roads with the first roundabouts I had ever encountered. After that, it was back to one a day at bedtime.

But then, as I was trying to write my blog post about how bad I was feeling, it occurred to me (duh) that what I was feeling was not depression, but massive anxiety. All my planning for the trip, all my worrying about our budgets and my work, were clear signs of it, even if I had somehow missed them.

By now, everything for the trip is planned, a few days early even, and my blogs are prepared to post while I’m away. I could relax. But you know I won’t, and I know it, too.

What I will do, though, is to start taking that extra anti-anxiety pill as part of my morning regimen. Unloading some of the remaining tasks like packing on my husband. And trying to distract myself by losing myself in a book.

And, of course, remembering all this for when we return and I have another appointment with my psychiatrist. Who knows? Maybe the twice-a-day pill regimen will have made a difference by then. And if it hasn’t, we can discuss it and see what else might help. (I know, I know. Breathing. Meditation. Mindfulness. Exercise. All of which are difficult for me to practice regularly. I haven’t been able to turn them into consistent habits.)

My husband helps me with my moods. I check with him when I start feeling manicky. He gives me loving attention when I start sliding into depression. He has proven that he can recognize extreme anxiety in certain unusual situations and recommend that I take that second anti-anxiety pill. What I plan to do, at least until my next med check, is not wait for that extreme anxiety to hit and work the second pill into my routine to see if it helps. And ask Dan for help in remembering to do that.

Category:

Mental Health

Tagged with: