Bipolar 2 From Inside and Out

Archive for the ‘mental health’ Category

Self-Care and Social Care

We hear a lot about self-care these days. Much of the mainstream media seems to think that it means “shopping therapy,” indulgent desserts, spa days, and mani-pedis. Expensive things. Ones that you need to be able to leave the house to do. (Except for online shopping, of course.)

Businesses are also quick to suggest self-care for their workers who are experiencing stress. What they mean by self-care is to take up yoga or meditation—on your own time and your dime.

Real self-care may include yoga and meditation and even the judicious use of ice cream, but it’s much more than that, of course. Self-care begins with the things that we all know are good for both body and mind—exercise, healthful food, good sleep, and stress reduction. Other good habits often mentioned are a digital detox, mindfulness, journaling, gratitude, affirmations, prayer, fresh air and sunshine, and hobbies.

Those are good things, of course, but they are primarily solo things, or at least were while the pandemic had us cooped up. Now we can get out and about more easily, go jogging or hiking with a friend, invite people over for dinner, and generally add human companionship to our list of self-care techniques.

But maybe what we need is social care (also known as community care). It’s hard to define social care. One source I looked for mentioned advocacy. But that’s pretty much something we have to do for ourselves. There are organizations like NAMI, and they do a great job at advocacy, but there’s only so much they can do. There aren’t brain illness support groups the way there are for alcoholism, narcotics addiction, and other kinds of afflictions that require outside support. There aren’t Meals on Wheels-type services for people who can’t leave their homes because of crippling anxiety. (Of course, grocery stores deliver now, but it gets expensive.)

There are very few group homes for people with SMI who need to transition between the hospital and living alone. There are group homes (sober houses) for those with alcohol or other addictions and even prisoners on parole. Many people with psychological or psychiatric needs rely on family members as long as they are able. I know a woman who lives with her father because of her assorted diagnoses. We’re all worried about what will happen to her when her father, who’s not in good health, dies. Her mother, when she was alive, tried to get her into a group home, with no success.

For those who are able to leave the house on occasion, social networks are recommended as a form of self-care. And even for people who can’t go out, there are social media, email, and video chats, which can fill some of the gaps.

But social services are thin on the ground, at least near me. I live in a suburb near two medium-sized cities. Most of the services available are for the mentally disabled, physically disabled, seniors, and some respite care for caregivers. People with SMI get a list of the crisis numbers. And, of course, psychiatric beds are limited and even psychiatrists have months-long waiting lists.

I know funds are limited and that the other groups need care, too. But social care is needed for those with SMI, too. We’re dependent on tax dollars, which are hard to come by.

It’s worth noting that the National Health Service in the UK has many more programs accessible to those with SMI at little or no cost. Of course, those are functions of socialized medicine, which is not likely to be enacted in the US anytime soon.

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Agency, Autonomy, and Mental Illness

I once suggested to a writer that he should include chemist Clara Immerwahr in his book on notable women. After her education, she had no opportunities to do her own research, as it was the early 1900s. Instead, she helped her husband in his. In 1915, she killed herself because she couldn’t accept the weapons-related research on poison gases her husband was doing. My friend replied that he wanted the women in his book to demonstrate agency.

At the time, I didn’t know what “agency” meant in any context than as an organization or business. Gradually, I learned what else it meant. And I looked it up for an official definition. After giving the definition I expected, I learned that “sense of agency refers to the feeling of control over actions and their consequences.” Clara Immerwahr did not have agency, and she was not included in the book, even though her story was both poignant and important.

While I was at it, I looked up the definition of autonomy. The definition included this: “Autonomy is all about having a choice and a voice. It fulfills an innate need to feel that we are acting of our own volition, allowing us to fully accept the consequences of our actions. It means feeling psychologically free and having the ability to control your life.”

It occurred to me that people with mental illnesses often either lose their agency and autonomy or never have them in the first place. Of course, many (I hesitate to say most) people these days lack agency or autonomy. They feel trapped, unable to control their own lives. How many people are ultimately psychologically free? How many control their own lives? Limited agency and autonomy are all that we seem to get, and limited autonomy strikes me as being like those ads that say a dental treatment is “virtually painless.” When it comes right down to it, that means “not painless.”

But with a brain illness, it becomes much more difficult to achieve agency or autonomy. The illness takes them away. A feeling of control over actions and their consequences? Tell that to someone who has just maxed their credit card on a manic jag. Minimal control of actions and no control of the consequences. Psychologically free and having the ability to control your life? Tell that to the homeless person with schizophrenia.

IMHO, one of the purposes for the mental health “system” ought to be restoring agency and autonomy to the people they serve and then helping them keep it, whenever possible. But that’s too much to expect, I guess. With the little funding for services and the lack of availability of proper care, there’s not much help for the person with SMI who wants to achieve agency or autonomy. In terms of mental health, just as in senior care, agency and autonomy are difficult to attain and maintain. We don’t have the kind of institutionalized care that would take away agency and autonomy completely, but neither do we have the systems in place for supporting those who have a chance at reaching it. It’s one of those Catch-22 situations.

You can’t give someone autonomy. You can only facilitate it. But we’re not even doing that.

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mental health

What’s My Blood Sugar and Why Does It Matter?

In the past, I’ve had difficulties with my blood sugar. If I went more than four hours or so without eating, I got dizzy and weak. Fortunately, It’s not that difficult to arrange to get food within four or five hours. As long as I kept an eye on it, I wasn’t overly bothered. Although once I didn’t eat for about three days and didn’t just get dizzy, my entire body started shaking.

But a good while back, when I was undiagnosed and unmedicated, I had a different relationship with food. When I was manicky (which in my case manifested as anxiety) I didn’t eat much. I got so skinny that I feared my parents would notice when they came to town for my graduation. So I ate bananas and drank milkshakes in hopes of putting a few pounds on.

But when I was depressed, I ate—poorly, but I ate. I had certain go-to depression foods. Sugared cereals. Carbohydrates like mashed potatoes, fries, and other comfort foods. And a peculiar combination of wavy potato chips and cream cheese topped by an M&M. My husband knew to get worried when I asked him to pick up those ingredients.

But back to blood sugar. The interactions between blood sugar and bipolar disorder are complicated because the interactions between the body and the mind are too. Let’s look at some of those interactions.

First, there are medications. It’s well-known that bipolar and other psychotropic medications can cause weight gain. And in turn, overweight can lead to diabetes. I have indeed gained weight—a lot of it, in fact. (I still prefer fat to misery.) I haven’t acquired diabetes, but I no longer get the low blood sugar weakies.

Then, there’s stress. Bipolar disorder can be affected by stress, of course. Stress can exacerbate the symptoms. The symptoms can cause stress. It can be hard to break the cycle. But stress releases the hormones cortisol and adrenaline into the body, and those substances can cause blood sugar to rise. Poor quality sleep and irregular sleep patterns also affect your body’s chemicals in ways that can affect blood sugar.

Also, as I’ve learned, bipolar can alter your eating habits, causing your blood sugar to behave like a yo-yo. It can also affect your ability to care for yourself in other ways, such as not having the wherewithal to exercise. These lifestyle changes can also make your blood sugar fluctuate.

Also, though this isn’t well understood, there may be genetic factors that are associated with both bipolar disorder and high or low glucose levels. As always, more research is needed.

So, what does this all mean? First, that you should be aware of your blood sugar fluctuations. Maybe track how they correspond to your moods and your lifestyle factors. I’m not saying that you need to get a glucose meter (though if you have one, that’s great). Just know that the two conditions can interact, and the more you know about how they affect you personally, the better off you’ll be. You may be able to make changes in your diet, exercise level, and sleep habits that will make a difference.

Stress reduction is also something that will be beneficial for both conditions. Your therapist may have recommended stress reduction techniques such as meditation or mindfulness (among others), and you may find that these help, too. If, like me, you have high levels of anxiety, your family doctor or psychiatrist may be able to prescribe you an anti-anxiety med that could also help regulate your sleep patterns.

Watching your blood glucose won’t hurt and might help you deal with your bipolar or other disorders. It seems to me that it’s worth a try.

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mental health

Bipolar Poetry

I used to write poetry, since I was in second grade. I continued through high school and college. I stopped because they kept turning into prose. So I wrote prose. I knew I could never make a living writing poetry anyway.

Recently, though, I decided to try poetry again. I thought that instead of the free verse that wanted to turn into prose, I would try my hand at more structured poetry—villanelles and sonnets. And my subject: bipolar disorder, of course. Here’s what I came up with.

Villanelle

We understand there is both loss and gain
and much besides we cannot think to know
In trying to control the cycling brain

as we daily live with depths of pain
and wait to grasp the high amidst the low
We understand there is both loss and gain

and minds that bend and crack beneath the strain
or falter, limping, halting, slow.
In trying to control the cycling brain

we snatch the fleeting highs and yet retain
the memory of how we’ve suffered so.
We understand there is both loss and gain

in swing from scorching sun to drowning rain
and have our deepest feelings put on show
in trying to control the cycling brain.

A search for level ground remains the main
unfinished task that asks for yes or no.
We understand there is both loss and gain
In trying to control the cycling brain.

Sonnets

1.

Where is the light that once so brilliant blazed?
Turned now to dim and gray before the night,
it creeps in shadows hungry for the sight
yet dreads the time when shades are sudden raised.

And I am past the daylight, stunned and dazed
by darkened air that smothers, clinging tight
till breath itself turns faint and pulse is slight,
but when the dawn returns I am amazed.

The rings the sun runs round the endless dark
bring distant hints of what there yet may be
whenever night fades as it must or will,

when color blooms in contrast hot and stark;
my eyes ajar that I may briefly see
the world whirl past my prison’s windowsill.

2.

The air is still and blankets all my sense.
I’m muffled, muzzled in the sheltering dark
but dare not pray for fire, with bright, intense,
loud flames that rend the silence with a spark.

I breathe, or not? It’s sometimes hard to tell
when swathed in clinging, stifling, musty scent
that fills my nostrils and my brain as well;
which cannot will the veil be shredded, rent

to save from suffocation. How shall I
withstand this cycle till the day appears
and breezes blow the dust away from my
stopped ears and eyes and lungs, plugged full with fears?

Pull off the cover and let free the soul.
Take broken breath and heal it into whole.

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Sensory Overload

I know that sensory overload can be a problem for people on the autism spectrum. Too much noise, uncomfortable touch, and assaults on the other senses can affect them negatively.

I discovered this firsthand when my best friend, Robbin, and her ten-year-old daughter, Kelly, visited my house. My husband collects clocks, and the sound of all the ticking bothered the young lady. Then the clocks started to chime. They were not synchronized, and they sounded off one after the other, sometimes overlapping. It was noon. Kelly was visibly distressed by the sound, and they left soon after.

I’ve had some indication that, though I’m not on the spectrum, I’m sensitive to noise as well. When Kelly was six, I brought Robbin a fluffy black-and-white kitten that she had admired. The squealing noises the little girl made cut right through me. I looked over at Robbin, who just shrugged.

It turned out that I’m particularly sensitive to the high-pitched sounds of children laughing and shouting. I learned to avoid Chuck-E-Cheese and Cici’s pizza—basically, any place with a ball pit. High-pitched women’s voices like Judy Holliday’s in Born Innocent bother me. It’s one of my husband’s favorite movies, but I can’t stand to watch it with him. Loud voices are a problem, too. If I’m in a room where people are shouting at each other, I make an excuse to leave until they settle down.

Much more typical is my aversion to two or more sounds. TV and talking, for example. If my husband talks to me while the TV is on, I can’t make out either one, which is particularly difficult when what he’s saying is, “What did that guy say?” And if I’m doing something on the computer, I’m completely lost. I’d be lost at a cocktail party, too, so it’s lucky we’re never invited to them.

WebMD has this to say about sensory overload: “Sensory overload and anxiety are mental health conditions that are deeply related to one another. When a person feels anxious or already overwhelmed, they may be more prone to experiencing sensory overload in certain situations. Likewise, experiencing sensory overload can make you feel a sense of anxiety.” They also say, in addition to autism, that PTSD, ADHD, PTSD, Generalized Anxiety Disorder, and Tourette Syndrome are mental conditions associated with sensory overload. They recommend anti-anxiety or antidepressant meds, self-care, therapy, mindfulness, and meditation as ways to address the problem. Avoiding triggers is another recommendation, and that’s the one I use (see not going to Chuck-E-Cheese, above). That’s the one that seems to have the most beneficial effects.

PsychCentral lists the stimuli that can lead to sensory overload:

  • bright lights, chaotic movement, or a cluttered environment
  • rough, tight, or itchy clothes
  • loud noises, voices, or music
  • scents including chemicals and perfumes
  • foods with strong flavors
  • hot or cold temperatures

And they list the possible effects:

  • overwhelm that makes you want to either shut down or have a meltdown
  • irritation or rage
  • tension in your face, neck, shoulders, or back
  • having either too many thoughts in your mind, or none at all
  • exhaustion
  • dissociation, or being separated from yourself and your surroundings

They add: “It’s possible for sensory overload to cause a panic attack. This could be because much overlap exists between parts of the brain involved with the panic response and those responsible for sensory processing.”

Not being a neuroscientist of any stripe, I can’t speak to the truth of that, but it also seems to me that a panic attack can lead to sensory overload. My other notable experience with sensory overload was having an anxiety attack in the grocery store, where I was overwhelmed by the visual noise of the bright colors on the cereal boxes. As I recall, I took an anti-anxiety pill, went home, and lay down. I don’t remember if I bought the cereal or not.

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What Does Body Temp Tell You?

My husband and I have a dynamic that’s common to many couples. I’m always too cold and he’s always too warm. This becomes apparent at bedtime, when he has the window open and a fan on, and I’m wrapped up like a burrito in assorted quilts. When I ask how the weather is and he says it’s comfortable, I know I need to put on at least a sweater before we go out.

What does this have to do with mental health? Well, the stats on major depressive disorder are alarming, especially among teens and young adults. “This is particularly concerning as the disease course is most likely to be malignant, and the costs of depression in terms of lost opportunities across a lifetime are likely to be highest in youth and young adulthood,” note the authors of a recent study. They also suggest that current pharmacological treatments show “significant limitations in efficacy.” So the quest for better treatments is pressing.

That “TemPredict” study found that body temperature correlates with depression. The study involved more than 20,000 people from around the globe, so from that standpoint, it’s likely to be valid. Over approximately seven months, the participants wore a device that recorded their body temperature (an off-the-shelf Oura ring) once per minute via a smartphone app. They also kept daily subjective records of their body temperature and level of depression, so the data collected included that from the wearable sensors as well as self-reports.

“People with depression have higher body temperatures, suggesting there could be a mental health benefit to lowering the temperatures of those with the disorder, a new UC San Francisco-led study found,” according to UCSF. The study was reported in the journal Scientific Reports.

The results? People with depression have higher body temperatures than those without, particularly at night. This had been suggested by smaller studies, but the new one is much more comprehensive. Of course, the study couldn’t really say whether depression causes higher body temperatures or whether higher body temperatures cause depression. The authors caution that “although no single biological or behavioral abnormality will characterize all individuals with MDD [major depressive disorder], the identification of an abnormality associated with MDD may open the door” to new treatments.

The study’s authors also indicated that “it is uncertain whether the elevated body temperature observed in depression reflects increased metabolic heat production, decreased ability to induce thermoregulatory cooling, or a combination of both.” In other words, “depression [may be] tied to metabolic processes that generate extra heat perhaps, or tied to cooling biological functions that aren’t operating properly. Or there might be a common shared cause, such as mental stress or inflammation that impacts both body temperature and depressive symptoms separately.” So there are still aspects that need to be studied further.

What’s also interesting is that the study suggested that warming people up has a more cooling effect than directly cooling them with ice water, perhaps because of sweat’s cooling effect. At any rate, people who soak in hot tubs have a rebound factor that actually cools them off. (Personally, I wouldn’t mind if someone prescribed me a hot tub.)

The hope is that the results of the study will lead to new treatments for depression.

I don’t doubt the study’s findings. But anecdotally, my spells of depression tend to be deeper and longer than my husband’s, but my body temperature runs lower. Am I an outlier, a data point that falls outside the trend of the study? Oh, probably. I’ve never been much for fitting in with norms.

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Everything in Moderation

Support systems are important for good mental health. There’s just something about sharing difficulties and successes with people who truly understand because they’re in the same place, facing the same issues. You get to say how you’re doing and what has helped you. You get to listen to what has helped others and incorporate their insights into your own journey. You get a chance to bitch and moan if that’s what you need to do. And after you’ve vented to people who share your pain, you feel better.

During the pandemic, we learned the value of connecting without physical presence. In many ways, it was ideal. We didn’t have to get dressed and venture out into the people-y world. We didn’t have to risk getting or spreading illness. Most of our therapy sessions went virtual. Mine did—and stayed that way even after pandemic restrictions were lifted.

Social media has also provided many virtual gathering spaces for people with brain illnesses. For example, there are many Facebook groups that create communities of mental health advocates and sufferers alike. These groups vary in what they offer. Some are chat groups. Others specialize in various diagnoses. Still others provide access to resources so people who need them can find them in one place.

I moderate one of these Facebook groups. It’s called Hope for Troubled Minds, and it addresses people with brain illnesses and their families and caregivers, with an underlying focus on faith. (You can find it at https://www.facebook.com/groups/654965125046006.)

I don’t have an awful lot to moderate, so I curate, instead. Every day, except when I’m out of town, I hunt for articles of interest to our group members. I get them from The Mighty, The New York Times, The Washington Post, CNN Science, blogs, and other Facebook groups. (I subscribed to NYT and WaPo mainly to be able to share articles they print without having members run into a paywall.)

My goal is to post four to six articles or connections a day, and most days I make my quota. The stories I find include first-person articles written by those with psychiatric conditions and their relatives, scientific articles such as those on brain science, and news stories about political and legal aspects of the topic. I also cross-post my own blog posts to the group. I try to keep a balance of different diagnoses so that it doesn’t run too much to bipolar, which is my own disorder and primary interest.

I comment on most of the posts I make to point out interesting quotes or opinions on the issues presented. The group members also make comments and start discussions, though not as many as I would like. Sometimes I post questions that I hope will prompt those discussions.

Recently, I’ve posted links to articles on hospitalization, “high functioning” anxiety, depression and creativity, the difficulty of reaching out, working, eating disorders, ruminating, OCD, DBT, schizophrenia, medication, self-care, co-occurring conditions, suicide, and more.

My goals for the group (and my moderating of it) are to improve member engagement, to seek out some guest bloggers, and to continue to share a diversity of articles.

I’d like to invite you to go with me on that journey. Join our group or tell me what would make it better. Put me in touch with other groups so we can cross-post information. Point me toward blogs I need to be reading and posts I need to be sharing. Volunteer to write for the group and its members.

Help me make Hope for Troubled Minds the best resource it can be.

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How I Treat My Bipolar Disorder

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

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

Meds

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

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

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

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

Therapy

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

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

Treatments

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

Self-Care

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

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

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

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Is It Narcissism or Gaslighting?

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

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

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

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

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

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

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

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

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

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

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

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

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People-Pleasing as Pathology

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

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

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

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

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

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

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

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

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

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

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

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mental health

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