Bipolar 2 From Inside and Out

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Weed: Yes Please or No Thanks?

I know that some people swear by the benefits of marijuana for relieving their psychiatric symptoms. They find it calms their anxiety, lifts their depression, and helps them sleep. I know others who avoid it completely. It makes them dizzy and paranoid, which isn’t relaxing at all. Which group is right? Or is either side wholly right? Is marijuana a potential treatment or a potential setback? Or do both these views have their merits?

Let’s start with a look at medical cannabis. In 1850, cannabis was officially recognized as a treatment for a variety of conditions, including gout, snakebite, excessive menstrual bleeding, leprosy, rabies, and insanity, among others. It was inexpensive, widely available, and didn’t require a prescription. But its use declined because it was difficult to control the dosage, opiate-derived medications became popular, and cannabis couldn’t be administered by injection. Recreational use of cannabis was prohibited in all states, thanks in large part to scare campaigns. Fees and regulations made it less likely that doctors would prescribe it. By 1941, it was no longer considered a medical drug. Recreational use, of course, continued. By the 1970s, marijuana was prohibited in all contexts including medical, but investigation of its medical uses increased because it was reported to help cancer and AIDS patients with pain and nausea. It was also beneficial in treating glaucoma patients. State and federal laws differed, however, and in practical terms, marijuana might or might not be available legally.

By the 2000s and 2010s, many states permitted the sale of marijuana or CBD (which is not psychoactive) for medical use, including relieving seizures in children. CBD products are legal in some jurisdictions and not in others, and enforcement varies. Laws in some places are so liberal that there are legal commercial stores on many streets.

The conditions cannabis can be used for differ from state to state, and the restrictions change frequently. It’s hard to keep up with which states allow it for what conditions. PTSD is the psychiatric illness most likely to qualify for medical marijuana use. Some doctors believe that it’s also useful for anxiety, depression, Tourette’s syndrome, and anorexia. CBD and THC (the psychoactive component) are being studied for the treatment of bipolar disorder.

The medical community cautions people with psychiatric disorders about using marijuana. One study cited by the Psychiatric Times found “a strong increased risk of manic symptoms associated with cannabis … an earlier age of onset of bipolar disorder, greater overall illness severity, more rapid cycling, poorer life functioning, and poorer adherence with prescribed treatments.” On the other hand, Medical News Today has reported that users say marijuana use has reduced their anger, depression, and tension, and created higher energy levels.

Other studies have found that marijuana use had negative results on memory, decision-making, coordination, emotions, and reaction time, as well as an increased likelihood of disorientation, anxiety, and paranoia. Some reports suggest that marijuana use makes it more “likely” that psychiatric patients will develop schizophrenia and psychoses.

So, what are the takeaways? First, the results from all these studies are generally self-reported by the marijuana users and therefore subjective. Second, now that medical marijuana is in greater use and easier to get, there may be more thorough studies in the future (much of the cited studies were done 8-10 years ago, though they were still being reported as recently as 2024).

Bipolar patients have been using marijuana to alleviate both manic and depressive symptoms and report that it works better for them than conventional medications and also alleviates the side effects of those drugs. The drug’s calming effects may help with manic symptoms and the euphoric effects may explain the relief of depression reported. But heavy use has been associated with increased symptoms, thoughts of suicide, and the development of social anxiety disorder.

Perhaps the positive effects of marijuana for bipolar disorder are influenced by the expectations of the users: If they expect it to decrease anxiety or lighten their mood, it’s likely to. Still, heavy or daily use should likely be avoided because of possible negative side effects.

My own use of CBD has been confined to legal hemp-based gummies. I have found them to produce unhelpful, uncomfortable sensations, making me unbalanced and prone to falling, which I really don’t need. But that’s me, and it’s anecdotal evidence. Another person I know experiences relaxation and euphoria with no negative side effects.

To answer the question posed in the title, my personal answer is “No thanks,” but I’m not saying that should be the answer for everyone. It looks like a case of “Use at your own risk.”

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When You Can’t Tell If Dreams Are Real

When my husband has bad dreams, he has the ability to wake himself up or change the dream. At different times, Dan’s been able to realize that he wasn’t still in high school when he had the dream (the one everyone has) about being late for a test or not knowing anything about the topic. He’s dreamed about getting into a fight with someone, said to himself, “This is stupid,” and left the scenario. And he has had a dream when someone was saying, “I’m going to kill you.” He replied, “No, you’re not. I’m going to wake up now” and did. He’s a lucid dreamer.

Dreams occur during REM, or rapid eye movement, sleep, which happens around an hour and a half after you fall asleep and can last ten minutes or an hour the longer you sleep. Scientists believe that the dreams that come during REM sleep help you interpret memories or work out problems based on your experiences. That happens below the level of consciousness. You don’t usually wake up and think, “Oh! That’s what I should do about my problem!” Gradually, though, the insights gained from dreams can float to the surface and appear as if they’re new ideas.

“Lucid” dreams or dream manipulation occurs when you realize you’re dreaming and can deliberately affect the outcome. It’s not something everyone can do but many people have the ability or can learn. Some wake up immediately when they realize frightening nighttime images are just a dream. Or they may be able to alter the content of their dream or their behavior in the dream. That’s what my husband does.

Some people who dream don’t realize that’s what’s happening. They accept the dream images as reality. They could also feel trapped in the dream, believing that something or someone is threatening them and being unable to affect what happens. Those dreams can be both frightening and repetitive. Instead of being a time to work out problems, dreams become a form of torture. In particular, someone who has PTSD or a phobia can experience terrifying dreams that put them right back into dark places they’ve experienced.

Scientists and therapists are exploring lucid dreaming as a way to help with psychological difficulties that manifest as terrifying dreams. This “lucid dreaming therapy” may act as a kind of exposure therapy in which the dreamer confronts their fears gradually and learns to defeat them. For example, someone with a fear of heights or falling might practice lucid dreaming by incorporating an ability to fly into their dreams.

Journaling or meditation may also help a person develop the ability to dream lucidly since these practices involve recording dreams when you wake up or exploring your mind’s ability to go within. And lucid dreaming can be beneficial. You can experience an elevated mood after having a lucid dream.

There are still unanswered questions about lucid dreaming and how it may affect people with various mental health conditions. One of the basics of lucid dreaming therapy is to learn to tell whether it’s a dream or reality you’re experiencing. Those with schizophrenia, PTSD, bipolar mania, or forms of dissociation may have particular trouble distinguishing between dreams and reality. One technique that may be helpful is to test the reality of the experience, determining whether it’s really a dream. For example, you might try to put a finger through a solid object. If you can do this, it’s a dream; if not, it’s reality. Another technique is to read something that appears in the dream, such as a poster. If the text shifts as you view it, you’re in a dream; if it remains the same, you’re awake. Conduct these reality checks at times throughout the day and you’re more likely to remember to try them when you’re asleep.

Other people recommend a technique to encourage lucid dreaming that involves setting an alarm and then going back to sleep after waking. However, this can lead to disrupted sleep and be harmful rather than helpful, even if lucid dreams do occur because of it. You could also experience vivid, lucid nightmares and need “imagery rehearsal therapy,” a form of journaling in which you write down the dream right after it occurs, then write another scenario that resolves the fear in a more positive way and rehearse this scenario before you go back to sleep.

Should you try lucid dreaming? It can depend on what kind of psychological problems you experience. For example, it’s not clear whether lucid dreaming can relieve nightmares associated with PTSD or make them worse. There are also medications that can be beneficial for repeated nightmares, but it may make sense to try lucid dreaming as a non-drug alternative.

I’m intrigued by the idea that you can learn lucid dreaming but mine are anxiety dreams about missing a plane, and it doesn’t seem called for. I don’t have real nightmares often, which I’m glad of. and they don’t recur. But for people who are plagued by them, I hope they can learn to respond as my husband does.

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Mental Health

The Narcissism Trend

Gaslighting was the most recent trend in pop psych. Now it’s narcissism. I even wrote a post called “Is It Narcissism or Gaslighting?” Just recently, I’ve seen posts titled “Why Are Narcissists So Cold Hearted?” “5 Clear Signs You’ve Beaten Your Narcissist,” “Narcissists Hate These 5 Weird Tricks,” “The Narcissist’s Game of Twisted Loyalties,” and “How Narcissists Disconnect from Reality and Logic.”

So, why are gaslighting and narcissism so “popular,” at least for writers and those who have a personal experience they attribute to people with those conditions?

First, let’s acknowledge that the two conditions have certain similarities. Narcissists and gaslighters both tend to have large egos and look down on their victims. Both can be users and abusers. Both use techniques that create learned helplessness, the state in which the victim doesn’t know how to appease their partner. They both rely on intermittent reinforcement, where they go back and forth between solicitous love and breaking down their victim.

Many of the techniques they use are the same. They will isolate their intended victim from friends and family. The abuser will limit their ability to act independently by limiting their finances and outside activities such as work. They will trap their victims in a net that impairs their ability to envision a means of escape.

The difference comes with the ultimate result. The person who is abused by a narcissist gets used to the abuse. They doubt their ability to appease the narcissist—because there is no way to do it. The narcissist escalates the abuse, often from psychological and verbal abuse to physical abuse. The victim is often unable to leave because of fear of further abuse, whether to themselves, their children, or even their pets. They are chained to their abuser by believing that the abuse is evidence of love and that it’s their own fault.

The gaslighter’s specialty is making the victim doubt their own sanity. They will deny things that actually happened. They will say that their victim isn’t remembering things correctly. They will say the gaslit person is upset over nothing. They may even be blatant: “You’re crazy. You need to have your head examined.” One gaslighter I knew agreed to go to couples therapy, then made a big show of presenting his partner as the “sick” one and casting himself as a sympathetic helper.

Another difference is that narcissism is an actual psychiatric diagnosis (Narcissistic Personality Disorder), while gaslighting isn’t. Some therapists work with narcissists and their victims though, as with any personality disorder, improvement is not very likely. Gaslighting is not a “diagnosis” but rather a pattern of behavior. The victim recognizes and diagnoses themself: “I have been gaslit.”

That may be one thing that made the term “gaslighting” so popular. It didn’t require seeing a therapist to identify it, though, of course, you could well need a therapist to untangle the aftereffects.

Narcissists, however, are often “diagnosed” by the layperson. They identify someone who has hurt them in whatever way as a narcissist. Most of them don’t have access to the DSM to compare an abuser’s behavior to the actual criteria for diagnosis. Narcissism is classed in a category of personality disorders that feature “dramatic, emotional, or erratic features.” The Manual lists nine criteria for a diagnosis of Narcissistic Personality Disorder: grandiosity, fantasies, specialness, need for admiration, entitlement, exploitation, lack of empathy, envy, and arrogance, which are relatively stable over time and pervasive. The layperson may see only entitlement, exploitation, and lack of empathy, while not realizing that a narcissist’s traits also include fantasies and envy.

What the layperson identifies as a narcissist is sometimes just a garden-variety abuser or jerk who doesn’t have a personality disorder. Not all abusers are narcissists, and not all narcissists are abusers. Some narcissists do very well in life, becoming successful business leaders and prominent public figures. Their narcissistic tendencies are interpreted as positive attributes like drive or aspiration rather than entitlement or grandiosity.

So, back to the original question: Why is “narcissist” the go-to, trendy label for troublesome partners or bosses? It is possible they truly are narcissists and would be diagnosed as such by a psychiatrist. But it’s more likely that the supposed narcissist merely has the perception that they are better than their partners, whom they see as deserving bad treatment. It’s a common enough problem in society. But attributing a psychiatric diagnosis to them elevates them to a degree that ignores the harm an ordinary person with bad qualities can do.

It’s more dramatic to think that you’re the victim of a person who has NPD than to realize that you are being abused by a regular person who just doesn’t care about you and your feelings.

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How Insurance Handles SMI

Why are so many people with Serious Mental Illness (SMI) underinsured or unable to get insurance at all? As you may guess, a large part of the problem lies not with the providers but with the insurance companies.

The recent murder of an insurance company CEO has focused a spotlight on the role of insurance companies in denying health care in general. There’s been a groundswell of people angry at insurance companies coming between sick people and the doctors who prescribe them care. Ridiculous rulings such as providing anesthesia for only a limited time during surgeries have come to light. Denials of life-saving or pain-alleviating medications have been exposed as common.

One part of the problem is “ghost networks.” These involve the list of in-network providers insurance companies provide to their subscribers. Again and again, these have proved to be faulty. The lists contain doctors who are no longer practicing, ones who aren’t actually in-network, and ones who aren’t accepting new patients. There can also be incorrect phone numbers.

But the plight of people with SMI is even more serious. Insurance companies don’t want subscribers with mental disorders because they don’t make money from them. “One way to get rid of those people or not get them is to not have a great network,” according to someone involved with managing contracts with providers. Patients are pushed out-of-network for more expensive care that’s not covered or covered to a lesser extent by insurance companies. The Affordable Care Act was supposed to guarantee parity for mental health treatment, but that hasn’t always happened, and patients with mental disorders often couldn’t follow up on denials. And Obamacare as it exists now may not last under the new Republican administration.

Then, too, insurers encourage providers to change their treatment plans for clients who have SMI, even if they’re suicidal. Psychiatrists and psychologists find themselves having to tread carefully when writing care plans so that insurers will approve the care that patients need and keep approving longer-term treatment. The insurers can even pressure providers to terminate treatment altogether. Treatment plans that last over six to eight weeks are especially likely to be denied.

Even when insurers do approve treatment plans, another problem is reimbursement to providers. The money they receive is meager and insurers stall in regard to providing it. It can take three or four months to receive any reimbursement at all. This means that providers struggle to keep practicing. Some go out of business and then remain listed on the ghost networks as continuing to provide services.

Some therapists end their relationships with insurance companies because of the frustrations of getting approvals for care. One reported spending eight hours with a client and then having to spend four hours communicating with a difficult insurer while trying to get approvals and payment.

Yet another problem that providers experience is that claims servicing has often been outsourced. Customer service may be handled by representatives in other countries. They may not have access to all the information they need to process claims. Others aren’t familiar with the psychiatric terminology. When providers find it too difficult to follow up on claim denials, they may stop pursuing the matter. The insurance company then doesn’t have to pay for the treatment.

The insurance companies counter that they are following state and federal laws, that their reimbursements represent payments at current market rates, and that their policies are designed to provide access to care for patients with mental illnesses.

And that’s private insurance providers. What about Medicaid?

In four cities, researchers pretended to be Medicaid patients and called clinicians at random regarding their first available appointment. Just over a quarter reported having any available. In LA, only 15% had available appointments and the wait for them could be as much as two months. There were also Medicaid providers on ghost lists like the ones from private insurers.

All these problems certainly contribute to inadequate care for people with SMI. Between finding a provider, receiving a treatment plan, and being at the bottom of insurers’ list of patients to be served, it’s no wonder that so many people who really need care aren’t receiving it.

Will the current level of outrage have any effect on how mental patients receive care? It doesn’t seem likely. Most of the people decrying the brutal treatment by insurance companies are patients experiencing problems other than mental health-related ones. As usual, there are few who speak up for those who need psychiatric treatment, even though egregious obstacles are put in their way. As my father would have put it, mental patients are “sucking hind teat.” And the prospects for that to end look remote. Dealing with the mighty insurance companies is difficult at best and demoralizing at worst. Effective advocacy is needed but unlikely to appear. In the meantime, psychiatric patients are suffering.

Information for this post includes material from Mindsite News, ProPublica, and JAMA.

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Overeating and Bipolar Disorder

When you think about co-occurring disorders associated with bipolar disorder, you generally think of drug or alcohol abuse. But there’s another one you should consider: eating disorders.

For example, binge eating is a problem that many people with bipolar experience. Both conditions typically begin at a fairly young age. Both are experienced in cyclical patterns. And both are associated with changes in energy levels and eating patterns.

There’s scientific evidence that the two conditions are related. For example, research has shown that 30% of people with bipolar disorder also have problems with binge eating, Binge Eating Disorder (BED), or bulimia, and more than 9% of people with BED also have bipolar disorder.

The two disorders are intertwined, affecting each other. Someone experiencing a manic episode may be likely to overeat or binge, probably because of impaired impulse control. Depression, on the other hand, may lead to decreased appetite and low energy that makes it difficult to prepare food.

That’s not always true, though. The revved-up feeling of mania can lead someone to skip meals. Depression can lead a person to eat more “comfort foods,” which are often laden with carbs and sugar, as a coping mechanism, however maladaptive. These foods may increase serotonin and so make the person feel better temporarily. Either way, the over/undereating can cause stress while shopping or preparing food, or result in dissatisfaction with body image.

Medication for bipolar disorder can also have an effect on eating behaviors. We all know that certain drugs cause weight gain as a side effect. Antipsychotics, for instance, may contribute to increased eating because of changes in the brain’s reward system and a decreased ability to tell when you are full. And weight gain may lead to cycles of bingeing and purging.

Research has also shown that people with co-occurring bipolar and an eating disorder also may have PTSD, indicating a possible link between the conditions. It’s thought that people who have experienced trauma may use eating as a control mechanism.

At any rate, the combination of the two disorders is complex, and it’s likely that a person with both conditions may need help from a team or a holistic approach to treatment, both psychological and medical. It’s been suggested that topiramate (Topamax) or lamotrigine (Lamictal) can be considered, as these mood stabilizers don’t appear to result in weight gain.

Personally, I had a combination of the comfort food eating/skipping meals cycle. When I was in college, my weight fluctuated from roughly normal to too thin. Since then, thinness has not been a problem, possibly because of the medication I take. I certainly have a desire for comfort foods like mashed potatoes, pasta, and large amounts of cheese. One of my crazier comfort foods has been ridged potato chips with cream cheese, topped with M&Ms. My husband knows that when I want those particular ingredients, I’m sliding into depression. Lately, I’ve been swinging between comfort foods and skipping meals. On the other hand, I’ve lost 18 pounds since the spring. (My doctor asked me how I did it and I replied, “Eating less” rather than “skipping meals.” He thought I meant portion control, which I do try to do.) My bipolar disorder, while mostly stable, is still a cause of (less extreme) mood swings. My eating habits are likely just that—habits that I need to break. And I need to increase my activity, which should be easier once I get my knees replaced.

At any rate, I’ll try to keep an eye on my consumption and ask my husband to help me when it comes to eating better. Now that the holidays are almost over, it’s time to get back on track. Losing another 18 pounds sure wouldn’t do me any harm.

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Hello, Post-Traumatic Growth

I’ve had my share of trauma in my life. There was trauma in my childhood starting with relentless bullying, including children throwing rocks at me. I still remember crying into my mitten, my tears mixing with the blood. There was trauma in my young adulthood from self-harm to the gaslighting and implosion of my first serious relationship. There’s been trauma of various kinds since I’ve become an adult, when many of my traumas became lumped into the effects of my newly diagnosed bipolar disorder. When my psychiatrist said that I needed ECT, that was traumatic, too.

But I’ve recovered from all those traumas. (At least I think I have.) In fact, I may have experienced what’s called post-traumatic growth (PTG).

Post-traumatic growth is when you come out the other side of a trauma and experience positive changes in five spheres of your life. These are often listed as: appreciation of your life, relationships, personal strength, new possibilities, and spiritual change. PTG is usually discussed in connection with PTSD, sexual violence, and near-death experiences. By those measures, I guess what I experienced was really resilience, the ability to bounce back from hardship. Only one therapist has ever suggested that I had PTSD from the emotional abuse I suffered and, at the time, I dismissed it as unlikely. Now I wonder.

I do appreciate my life more now. My relationships are stronger and more stable. My personal strength is vastly improved. I have responded when new possibilities entered my life. My spirituality has evolved. I feel like a new person, a stronger feminist, a better person, better able to make and develop new relationships.

This is not to denigrate the experiences of anyone who has experienced PTSD, a near-death experience, or sexual violence. I understand that my experiences are nowhere near those traumas. But I’m not here to compare traumas. I’m here to talk about the aftermath.

Some people may experience PTG in the immediate aftermath of a life-altering experience, but I think that’s rare. It can take years or never happen at all. Therapy is likely to be a part of achieving PTG.

There are circumstances where PTG is assumed to be instantaneous, or nearly so. Cancer is a life-changing diagnosis that can take you through the five stages of grief. But, in the case of breast cancer, some people are expected to demonstrate PTG almost immediately. Barbara Ehrenreich has written about her own breast cancer diagnosis. She pointed out the number of people who, quite soon after their diagnosis say that it was the best thing that ever happened to them or that “cancer is a gift.” Ehrenreich noted all the pink ribbons and cheerful positivity that ensued. It was as if people with that diagnosis were not allowed to feel frightened, angry, or bitter.

But for most people, it takes time. The five stages of grief don’t occur according to anyone’s timeline. It’s personal. No one can tell a sufferer what they should feel or when they should feel it. In fact, those diagnosed aren’t even supposed to think of themselves as suffering from cancer. They call themselves survivors rather than victims. Acceptable reactions are strictly limited. How different is that from when people with psychiatric diagnoses are told to simply get over it?

Both resilience and post-traumatic growth are good things. I wonder if they’re related—if people who have resilience are more likely to experience PTG, or if people who demonstrate PTG then become more resilient. And I don’t know if we’ll ever find an answer to that.

But whether either explanation proves to be true, I’m just thankful they both exist. And I feel deeply for those who fight trauma without either one. They need help in any way they can get it, but likely through professional help. I know that whether I am resilient or have PTG, professionals have helped me. And so have non-experts who have supported me on my journey. I thank them all and wish the same for others.

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Our Shadow Selves

You may have heard of the “Shadow Self” or “Shadow Work.” But what does this mean? And is it related to bipolar disorder?

The Shadow Self has been described as the Mr. Hyde to a person’s ordinary Dr. Jekyll. It’s made up of all the parts of ourselves that we want to deny or keep suppressed—our baser impulses, uncivilized or unacceptable emotions, self-talk, beliefs, and antisocial traits that lurk somewhere within our psyches. We all have them. But we hardly ever try to get in touch with our Shadow Self or know what to do about it if we’re aware of those traits and impulses.

According to Carl Jung, the Shadow Self develops from unprocessed childhood events. It also arises when someone internalizes messages they get from family, friends, or society regarding what is acceptable and unacceptable. A person can project their repressed traits onto other people. For example, if you look down on someone because they express rage, there may be rage hidden within your Shadow Self. Or a person may have the belief that being assertive is actually selfish and may be pushed around because of that. They repress a feeling of resentment and feel guilty that they are resentful.

My Shadow Self includes any number of unpleasant aspects. I own that I am obsessive, insecure, and unforgiving. These and other shadow traits result in perfectionism, fear of failure, and self-sabotaging behavior. No doubt there are parts of my Shadow Self that I haven’t recognized yet, or don’t want to.

Of course, some of my shadow traits are almost certainly caused by messages that I haven’t addressed yet. For example, I think my perfectionism was caused by messages I received that making mistakes equaled being bad, something I didn’t want to do. It wasn’t fear of being punished; it was because I didn’t want to be a bad person like some of my relatives who made mistakes involving sex and alcohol.

The Shadow Self isn’t universally bad. It’s a part of everyone. It’s possible to channel the Shadow Self in constructive ways. Million-selling mystery author Sue Grafton referred to hers as “She Who Writes.” Her protagonist was far from a perfect human being, being occasionally given to lying, ignoring rules, and Looking down on others’ faults. Grafton thought she was able to write the character because of her own less-than-noble impulses. It made her detective a flawed human being, but one that readers could sympathize with and, perhaps, see themselves in.

If you try to deny or repress your Shadow Self, it continues to affect you negatively without your knowledge. Identifying it through “Shadow Work” can result in self-acceptance and growth. Therapy is one way to deal with the Shadow Self, though those words may not be used. Trying to do Shadow Work by yourself is also possible, though the help of a therapist may increase your ability to work through difficult emotions like shame and fear. Therapy may include journaling, meditation, artistic expression, and inner dialogue and can help you understand and integrate your shadow traits into your conscious mind. Patience, keeping an open mind, practicing self-compassion, dedicating time to Shadow Work, and reflecting on your progress will help you with the process.

Or help me. I don’t have a therapist at the moment, so if I try to do Shadow Work, I’ll be on my own with it. I don’t know whether I’m brave enough. It’s something I need to consider, though.

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Mania, Overthinking, and Costa Rica

I’ve had a bad spell of overthinking lately. It’s related to a bad hypomanic episode that I had lately. I had it in my head that my husband and I needed to move to Costa Rica. Of that I was sure. (Why Costa Rica? Of that I wasn’t sure.) What I couldn’t decide was whether we needed to go to Costa Rica for a week or two to scope out arrangements before we took the proverbial plunge.

At first, I had been exploring whether there was any real estate for rent at a reasonable price in or near the town of Grecia, which I had somehow fixated on. (Why Grecia? Again, not a clue. That’s about the last thing I’d need to decide and arrange for if we were to move.) I was researching the cost of living, the health care system, and the cuisine. I was practicing in my head the Spanish that remained from my high school days, supplemented by “essential phrases” that were listed online. I looked up what papers were needed and how long you could stay on a temporary visa. I checked on whether we could bring our cat.

It kept me awake at night. After I take my nighttime meds, I usually read for about a half hour before I shut down my brain and try to sleep at night. But I had no such luck. The arrangements, the language, and the travel all occupied my thoughts. I would give up on sleeping, try reading for another half hour. Then the cycle would start all over. For the first time in a long time, I need sleeping pills—the 10 mg. ones. Even then, sleep didn’t come easy.

My husband pointed out that maybe it would be better if we went to Costa Rica for a week or two to see how we liked it before we made the move. Instantly, my mania switched in a different direction. I began working with a travel consultant on what cities or attractions (in addition to Grecia) we might like to see. Anticipating a chunk of money coming in (another manic fantasy), I researched flights, even selecting flight times and layovers as well as costs. I selected dates, then revised them based on seasonal prices. Again, I couldn’t sleep for running over the arrangements in my head.

At last the mania and the planning eased off. The fantasy funding fell through, as I should have realized it would. Along with it, my mania retreated and my overthinking stopped—at least for the time being. My overthinking backed off too, at least on the subject of Costa Rica. Now, what I have to overthink is my writing assignments, which seem to have multiplied while I wasn’t looking. I’ll make money, but not enough to get me to Costa Rica.

At any rate, I’m happy to say that I’m back to where I was before the mania and the overthinking—back to sleeping without sleeping pills, anyway. Now all I have to overthink, besides the writing, is our upcoming trip to Florida, which provides plenty of fodder. I’ve prearranged everything I can think of, but I’m sure there’s something that I’ve forgotten or that is completely out of my control. And I hate that feeling. It leads to other things that are out of control, like thinking and mania.

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Being There

Sometimes there’s just nothing you can do. A friend or family member is in distress—depressed, angry, disappointed, anxious, frustrated, or whatever. They may have experienced major trauma or be in the throes of some emotional upheaval. There’s no way you can solve the problem, and sometimes it’s simply better not to try. Not every problem can be fixed, and not everyone wants you to fix their problem. Sometimes it’s simply futile because there is no solution. Sometimes it’s insulting to even suggest that you might be able to fix it.

What do you do then? You sit with the person as they experience their feelings and say nothing. They don’t need advice. They don’t need conversation. They simply need the presence of another person. They just need you to be there.

Therapists sometimes recommend that when you have a strong feeling, you sit with it for a while. You don’t jump up and try to do something that will make it go away. You don’t ignore it. You don’t try to ignore it. You simply sit with the feeling and feel it. Later, there will be time to talk about it. First, you simply identify the feeling, if you can, and then be there with it.

Being there for another person is a great gift to them. In the face of strong emotion, they may not have the ability to talk about it. Having someone who will simply lend their presence in a time of turmoil gives comfort when it’s needed, unobtrusively.

You don’t have to simply sit when you’re being there for another person. You can touch them, place a hand on their shoulder. You can make them a cup of tea. You don’t ask if they want one. You just do it. The tea will be there if they need a soothing beverage. You will be there if they need a soothing presence.

Our society is so action-oriented these days. When we can’t solve a problem, we feel helpless. And that may be true. We’re helpless to change the situation, helpless to cheer up our friend, helpless to take pain away.

But being there may be the only action that is needed. The power of being there is the promise that, if your friend does need something concrete, something that you can offer, you will be there to provide it. In the meantime, there is nothing that either of you needs to do. Being there is the offering.

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Completing Therapy

In a sense, there’s no such thing as completing therapy, and in another sense, it’s necessary. Right now, I’m trying to balance between the two poles of that spectrum.

I know that, barring any unlikely miracle cures (which I don’t anticipate), my bipolar disorder is something I’ll be dealing with for the rest of my life. On the other hand, I have on occasion achieved periods of stability in which therapy was no longer a necessity.

Sometimes it’s been my therapist who has encouraged me to leave treatment because they didn’t feel that I had symptoms severe enough to require further therapy at that time. I was, if not cured, stable enough to function well without weekly or biweekly boosts of psychological or psychiatric tune-ups. (Once, when I left therapy this way, Dr. L. told me solemnly, “I hope you don’t think I’m rejecting you.” I didn’t, but I thought it was nice of him to bring up the subject.)

Once I quit therapy because it was supremely unhelpful. It was couples therapy, and it wasn’t achieving its goals. The therapist sided with my husband and shredded me. After a few sessions, I refused to go back.

Sometimes, my therapy has quit me. I had a very good relationship with Dr. R., my psychiatrist, who retired and moved across the country. I knew I still needed the services of a psychiatrist as well as a therapist, so I began the long search for another practitioner who could help me, had an opening, and would take my insurance. It’s a process much like interviewing candidates for a job. You need to find a good fit (i.e., one who won’t shred you). At the time I mostly needed someone who could supervise my meds, as I was seeing a therapist for my ongoing psychological issues.

I stayed with that therapist for years. It began to become clear that perhaps I should leave therapy when I needed therapy less often—once every other week instead of every week, then once every three weeks, and eventually every month. Even when we still had sessions, they ran short because I didn’t have immediate issues that needed to be addressed. And her advice consisted of “Look how far you’ve come” and “Keep doing what you’re doing.” When she moved to a new practice, I had one or two more sessions, then ended therapy. I kept her number, though. You never know.

Right now, I am considering leaving therapy with my psychiatrist for purely practical reasons. Dr. G. only sees people on Thursdays and Saturdays till early afternoon. At the moment, my husband works both those days and hours and we have only one working car. I see Dr. G. four times a year for med check, but it’s becoming increasingly problematic for Dan to get time off work to take me to appointments. I suppose I could take a Lyft, but it’s another expense I can’t afford. Perhaps I should look around for another provider closer to me with better hours. If I can find one that doesn’t have a years-long waiting list, I mean. (I’m told that I need to get a referral from my PCP to get one in-network.) Or someone else in Dr. G.’s practice who would be willing to take me on. (I have to go to the office and fill out a form to accomplish that.) Either way, no guarantees.

There have been times in my life when I felt stable enough to go without a therapist or psychiatrist. Right now, though, I’m having issues with anxiety, hypomania, and insomnia, so I need someone at the very least to prescribe or tweak my dosages.

Most of all, though, I hate the process of finding a new psychiatrist—interviewing them to see if we’re a good fit, telling them the Reader’s Digest version of my screwed-up life, getting my records transferred, and the rest of the tap dance involved.

Wish me luck.

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Mental Health

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