Bipolar 2 From Inside and Out

Self-Care: We’ve Heard This Before

December 31, 2023

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Christmas, Bipolar Style

December 24, 2023

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

Hypomania

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

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

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

Depression

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

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

My Lack of Advice

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

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

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

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Mental Health

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Saved From My Manicky Self

December 17, 2023

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

It went down like this.

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

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

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

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

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

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

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

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

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

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

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

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

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

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Mental Health

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Grippy Socks and Sour Candy

December 10, 2023

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

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

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

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

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

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

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

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

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

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

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

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

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

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Codependency: Fact or Fiction?

December 3, 2023

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Mental Health

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Mental Illness: Poverty and Privilege

November 26, 2023

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

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

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

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

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

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

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

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

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

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

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

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

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

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Mental Health

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Control/No Control

November 19, 2023

When I was a kid, my family used to go to visit relatives in Campton and Beattyville, Kentucky. It was always a good time. There were barns to play in and fishing, berrying, eggs to gather, and so forth. To get there, we took what was then a toll road called the Mountain Parkway. I loved dropping change in the bucket as we passed through the toll stations.

The road wound and twisted up into the mountains. There were steep dropoffs along the sides. I don’t remember railings, though I suppose there were some. We visited there about once a year during summer vacation. My Dad drove.

I have a number of things on my List of Things I’ll Never Be Able to Do Again, and going to Campton is one of them. For one thing, I have no relatives left there anymore—most were quite aged back then and their children have scattered. But the more important reason is that I could not handle the drive.

When I was in Ireland with my husband, we rented a car and drove around the country. The GPS that came with the car was sketchy at best. It took us on one-lane roads that meandered through the hills. On the larger roads, there were many rotaries, which we hadn’t driven before. Eventually, we started relying on my phone and Google Maps, which didn’t get us lost as often or run us off into ditches. We still ended up going on twisty back roads.

But I was terrified the entire time we were driving. Dan had to drive since I couldn’t adjust to driving on the left (I tried once and gave up). My nerves couldn’t handle it. The entire time we were driving, I had my hand braced against the roof of the car. When it was particularly frightening, I made a peculiar humming noise that Dan had to learn to ignore. He’d remind me that I had anti-anxiety meds I could take, too. I did, but they didn’t stop my symptoms.

Fast forward a couple of years. We were in Gatlinburg, Tennessee, driving around looking for where we stayed and where we were going. Again, we used Google Maps on my phone. Again, we were traveling on twisty back roads with sudden hills and no shoulders to speak of. Again I clung to the Oh Shit handle and made the weird humming noise as we navigated the convoluted routes. Again I took anti-anxiety meds.

Then I had a revelation: I could never go to Campton again, even if Dan was driving. The bends in the road and the steep drop-offs would prove too daunting. I don’t want to put myself through that again if I don’t have to. And I don’t want to have to.

I don’t have trouble driving on surface streets or highways, even alone. Those I can handle—even for four- or five-hour drives.

When I’m driving, I feel in control of the vehicle and don’t have the massive anxiety. That is, unless the circumstances involve something that makes me feel out of control, like left-side driving or narrow roads with switchbacks and doglegs. Even if Dan drives and I navigate, I still do the clutching and humming thing. It’s exhausting. If I were driving, I would have to go 20 mph and mightily piss off the cars behind me.

The bottom line? I can drive myself places, but only under certain conditions when I feel in control. If there’s a factor—or more than one—that makes me feel out of control, I can’t do it.

I like to think that I’m not a control freak under other circumstances. There’s just something about a machine that weighs that much going at a speed that feels unsafe in terrain that strikes me as difficult. This still leaves me a lot of places I can go, even without Dan. But not everywhere. And that makes me feel sad and incompetent, two feelings that I don’t like and that there’s no medication for.

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Mental Health

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Pill-Shaming

November 12, 2023

When I first started taking Prozac, when it was just becoming ubiquitous, my mother said, “I hear it’s a ticking time bomb!”

“Oh, dear!” I thought. “Mom’s been listening to Phil Donahue again.” (She had been, but that’s not the point.)

Back in the day, Prozac was hailed as a miracle drug and condemned as a killer drug. On the one hand, it was said to be a “magic bullet” for depression. On the other, it was supposed to result in addiction and suicide.

It’s probably true that it was prescribed too often to too many people who may not really have needed it. And it may have led to suicides—not because Prozac prompted such an action, but either because it was improperly prescribed or because it activated people who were already passively suicidal and pushed them into action.

At any rate, Prozac was not an unmixed blessing.

For me, it was closer to a miracle drug. It was the first medication that had any significant effect on my depression. I noticed no side effects.

But Prozac is no longer the psychiatric drug of choice. Since that time, hundreds—maybe thousands—of psychotropic drugs have been introduced and widely prescribed. Many have proved just as controversial as Prozac. Indeed, the whole concept of psychiatric drugs is now controversial.

I belong to a lot of Facebook groups that encourage discussion on psychological matters and have a lot of Facebook friends with opinions on them, sometimes very strong ones. Some of the people with the strongest opinions are those who condemn certain classes of psychiatric drugs or that category of drugs altogether. They share horror stories of addiction, atrocious side effects, zombie-like behavior, and even death from the use of these drugs.

Benzos are the drugs that are most often condemned. And it’s true that they can be addictive if they’re misused. Whether that’s because a doctor overprescribes them or a patient takes more than prescribed I couldn’t say. But I maintain that benzos aren’t inherently harmful when prescribed appropriately and supervised professionally.

I have personal experience with benzos. They were the first psychiatric drug I ever took, meant to relieve a rather severe nervous tic that affected my neck and head during junior high school. I do remember walking off a short stepstool while shelving books in the library, but I was not injured and the misstep could be attributable to ordinary clumsiness, which was something I was known for (and still am). The benzos were discontinued when I got better. I also took benzos in college because of pain due to temporomandibular joint problems.

Now I have benzos that my psychiatrist prescribed “as needed” for anxiety and sleep disturbances. After all the years I’ve seen him and my history of compliance with prescribed medication, plus the very low doses, he had no hesitation prescribing, and I have no objection to taking them.

But some of the people I see online object to any psychiatric drugs whatsoever. Again, the most common complaints are addiction, side effects, and zombie-like behavior. Of course, I can’t—won’t—deny that they have suffered these effects. Psychotropics are known to affect different people differently. I’ve had side effects from many of the ones I’ve taken that were too unpleasant for me to continue taking the drugs. But after all the different meds I’ve tried during my journey to a combination of drugs that work for me, it would be a surprise if I objected to them altogether.

But I don’t. I’ve had cautious, responsible psychiatrists who’ve prescribed cautiously and monitored rigorously, listening to me when I reported side effects.

So, my personal experiences have been good. I know not everyone’s experiences have been, for a variety of reasons.

What I object to is the drumbeat of “all psychotropic medications are bad and ruin lives.” And the memes that show pictures of forests and puppies that say “These are antidepressants” and pictures of pills with the caption “These are shit.”

I hope those messages don’t steer people who need them away from psychotropic medications. And I hope that people who do need them find prescribers who are conscientious, cautious, and responsible in prescribing them. On balance, I think they’re a good thing.

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Mental Health

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I’m Sorry

November 5, 2023

The other day, my husband was putting together a magnifying lamp that I had bought to help me repair some jewelry. I was trying to adjust the lamp to a height where it would be usable and comfortable. The lamp was a cheap piece of shit and it broke.

Instantly, I apologized. The clamp broke. I apologized again. It turned out that the pin holding the clamp together broke. I apologized again. My husband determined that it was not fixable as it was. Guess what I did? That’s right — said, “I’m sorry.” I said I was sorry for ordering the cheap thing. I said I was sorry for wasting money. I was sorry for wasting my husband’s time. I was sorry for everything.

The week before, I wanted to go to an art house in a nearby town to see the documentary about Joan Baez. The whole way there, I was nervous — about the route we were taking, whether we would find parking near enough to the theater, whether we should eat dinner before or after the movie. And especially whether Dan would like the film. On the way home, I kept asking him, “Was that okay? Did you like it? Is it okay that I chose the movie? Is it okay that I chose that movie?”

On the way home, he reassured me. He liked the movie. He learned things he hadn’t known about Joan Baez. We were lucky to find the parking place so near the theater. It was a nice evening for a drive.

Then he said, “Where’s all this coming from?”

“I chose the movie and the time and bought the tickets and decided which theater to see it at. If anything went wrong, it was all my fault.”

“Ah. Old tapes.”

In these recent cases, things went right. Dan figured out a way to fix the magnifying lamp by cannibalizing another lamp. We got to the movie on time and got good seats. We found a handicapped parking spot open right across from the theater. The movie was great. I felt better after we got home.

Dan was right, though. The excessive apologies started in my past — not with Dan — further back in time than that. If something was my choice, and it didn’t turn out great, it was wrecked. I realize this is all-or-nothing thinking, which is counterproductive.

Even before the old tapes, though, I had a habit of feeling sorry for everything and saying so. I apologized for everything. And I punished myself. If I said something “wrong” or even a tiny bit off-color, I tapped my cheek with an open hand, symbolically slapping myself for doing something bad. (I think it’s important to note that my parents never slapped me as a child, so I don’t know where that came from.)

And I apologized endlessly. For everything. My friends noticed. They asked why I did it. They let me know that it was annoying. I tried consciously to stop. And after a while, after having friends who stuck with me, after practice, I did stop. For a while.

Then I got in a relationship with a gaslighter and again felt guilty for everything. He blamed me for things I did and things I didn’t do. Once, he even claimed that when I did something wrong in front of company, I had offended his honor. And of course, if I selected anything — where we went, what we ate, what music we listened to, I was at fault. I was at fault for liking mayo on my sandwiches and for not offering him a bite of my sandwich. I was seriously wrong not to wait for him even though he was past the time for a meet-up with friends. Wrong to hook up with a friend while he was hooking up with one of mine in the next room. Eventually, I shut down, afraid to do anything.

Years later, I got past the apologizing, for the most part. The past two weeks, I’ve been backsliding. I think it may be because money has been extra tight, which makes me extremely nervous, and I’ve had to tell Dan he can’t make some purchases now. That feels treacherous, even though he doesn’t complain or blame or shame me. But it puts me back into the mindset of blaming myself before someone else can. It’s not comfortable for either of us. It’s all I can do not to apologize for feeling this way, for my disorder having this effect.

I’m hoping that writing about it will help me work out how I feel. And maybe make the apologies back off. At least for a while.

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Mental Health

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Am I Neurodivergent?

October 29, 2023

Last week I wrote about language that has been lost from technical meaning to become popular usage. This week I want to explore a term that may or may not apply to me—neurodivergent.

The dictionary definition I looked up said that neurodivergent means “differing in mental or neurological function from what is considered typical or normal.” It added that the term is “frequently used with reference to autistic spectrum disorders.” The alternate definition given is “not neurotypical,” which is no help at all.

I’m not on the autism spectrum, so I don’t “qualify” as neurodivergent that way. And I don’t have any of the other disorders, like ADHD, that typically are associated with neurodiversity. So where does that leave me?

Another definition: “Neurodiversity describes the idea that people experience and interact with the world around them in many different ways; there is no one ‘right’ way of thinking, learning, and behaving, and differences are not viewed as deficits.”

I like that better. It leaves room for a lot of varieties of neurodivergence.

A medical website explained it this way: “Neurodivergent is a nonmedical term that describes people whose brains develop or work differently for some reason. This means the person has different strengths and struggles from people whose brains develop or work more typically. While some people who are neurodivergent have medical conditions, it also happens to people where a medical condition or diagnosis hasn’t been identified.”

Wikipedia also notes, “Some neurodiversity advocates and researchers argue that the neurodiversity paradigm is the middle ground between strong medical model and strong social model.”

It’s true that my bipolar disorder means my brain and my behavior are not typical. I feel neurodivergent, even though I know that’s hardly a criterion. I’ve accepted that my bipolar is somewhere in the middle ground between the medical model and the social model. For a long time, I believed in the medical model absolutely. To me, my bipolar disorder was brought on by bad brain chemistry. I couldn’t see any glaring social problems such as abuse in my family. Mine was very much the traditional social model—working father, stay-at-home mother, one sister. I never suffered domestic violence or sexual abuse.

What I didn’t see was that there are other kinds of traumatic events, some of which I did experience as a child. Some of them were so painful that I remember having meltdowns because of them. Young adulthood brought more trauma. Since then, a combination of medication and therapy has helped. Perhaps the medication helped with the part of my disorder that was caused by my brain, while therapy helped the social trauma part.

Lately, I’ve been thinking about the idea of a spectrum. Although autism is often considered using the convenient concept of a spectrum, I know that “being on the autism spectrum” is not accepted by all. High-functioning or low-functioning, people are at base autistic or non-autistic, not “a little bit autistic,” as the spectrum seems to imply. Other people find the spectrum idea useful.

I’ve also thought about the introvert/extrovert spectrum. It makes sense to me that no one is truly at either end of that spectrum—all introvert or all extrovert. Nor is anyone pure ambivert, evenly poised between the two ends of the spectrum. We’re all various degrees of ambivert, leaning toward one side or the other, but sharing some of the characteristics of each.

My brain has developed differently or works differently for some reason. But according to the spectrum philosophy, no one is totally neurotypical or totally neurodivergent. We’re all jumbled somewhere in the middle. A little to one side and we’re considered one or the other. So, I see myself as on the neurodiversity spectrum—neither one nor the other and not evenly balanced between the two. Somewhere in the relative middle, to one side or the other. Part neurodivergent and part neurotypical.

Whatever I am, I’m not 100% neurotypical or 100% neurodivergent. But I’m at least partly neurodivergent. And I’m comfortable with that.

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Mental Health

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