Bipolar 2 From Inside and Out

Emotional Numbers

May 14, 2023

What’s the relationship between mood and emotions? How is the mind involved? Is it even possible to sort them out?

These days, people talk a lot about one’s Emotional Quotient, or EQ, also known as emotional intelligence, or EI. EQ is defined as “the capacity to be aware of, control, and express one’s emotions, and to handle interpersonal relationships judiciously and empathetically.” Emotions are “a natural instinctive state of mind deriving from one’s circumstances, mood, or relationships with others.” Mood is “a temporary state of mind or feeling.” Obviously, the definitions overlap somewhat.

All of these terms are used by the general public. EQ is the currently popular term. You can find any number of “tests” online that claim to determine your EQ. Often these are phrased in terms of your “personality” and may refer to enneagrams or other psychological theories. Other searches revert back to showing you your IQ, even if you were looking for EQ tests. Many of them charge money to show you the results. I’m not interested enough in my EQ to spend the money, though I took one of the tests. I might ask my therapist if she has a handle on what my EQ might be. I’d be happy with a subjective evaluation such as Excellent, Good, Average, Poor, or Terrible. Anything more, like a circular chart with bright-colored segments, I believe I’ll pass.

How do EQ and IQ tests compare? Healthline says, “IQ tests measure your ability to solve problems, use logic, and grasp or communicate complex ideas. EQ tests measure your ability to recognize emotion in yourself and others, and to use that awareness to guide your decisions.” So, completely different things. A person with a high IQ could have a low EQ and vice versa.

So, what else do the experts say about the difference between moods and emotions? “Moods can last for hours while emotions last anywhere from seconds to minutes, at most.”

There I would disagree.

At least, I have an opinion. An emotion is something I feel for a defined amount of time, usually a short one. My husband and I disagree and I feel an emotion of annoyance. But it seldom lasts for mere seconds. It can dissipate within a minute or last for several hours, depending on when we talk it out.

A mood lasts longer than that. Now that I’m relatively stable, my moods may last longer than a week, but less than years. Right now, I’m having a mood of anxiety, which has lasted for nearly a month, which doesn’t show much sign of pulling back, and which I’ve had to discuss with my therapist and my psychiatrist.

Moods certainly can last for more than seconds or minutes – hours, days, weeks, or longer – but emotions can last a long time too. Have you ever held a grudge? It’s not a fleeting emotion. It’s not a mood, but it can last for potentially years – even the rest of your life. What’s left? A state of mind? A personality trait? A decision?

In my research, I did come across a piece about EQ and various disorders. It was on a site that promotes a treatment center for drug abuse, so I don’t know how accurate it is. But it said that empathy, being a major component of EQ, will change in a person with depression. They may feel more empathy for a person who is also suffering, but less for a person who isn’t. This leads to numbness, they say, which may further impair one’s mental health.

In cases of ADHD, the center says, people may have trouble reacting to emotional stimuli and engage in “inappropriate behavior” for a situation. Without treatment and EQ, they may still feel internal restlessness.

Anxiety and EQ, they say, are complicated. Low EQ may mean detachment from things that threaten safety and self-esteem. On the other hand, people with anxiety and high EQ may have a tendency to be so empathetic that they overthink and lack the ability to self-regulate.

The treatment center says it can improve EQ and thereby improve self-awareness, self-regulation, motivation, empathy, and social skills, all in the context of addiction recovery. Whether this is true – whether raising EQ is possible and promotes benefits in understanding and behavior – is, as far as I can see, far from settled. It’s also unclear to me in which order this would happen. Would treating the mental condition raise the EQ, or would raising the EQ help treat the mental condition?

I also encountered a study that said high EQ is positively associated with good general physical health. Yet another investigated the correlation among EQ, a sense of belonging, and mental health among college students. Rejection in particular was associated with poor mental health outcomes.

I’d like to see more on the subject.

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Distract Me!

May 7, 2023

I recently saw a meme that said being happy was different than being distracted from sadness. I couldn’t deny that they are different. But it seemed to me that it was saying that being distracted from sadness was a bad thing. And I don’t believe that, necessarily.

Sure, happiness is better than sadness, and something to aspire to. But it’s not always possible, especially for those of us who struggle with bipolar, depression, and other mood disorders – despite what the positive thinking people say. (I don’t think that “smiling depression” is a good coping mechanism to recommend. It denies reality and doesn’t help someone realize that they should seek out the help they need.)

But when I’m down in the depths, distraction helps. Unless I’m in the total Pit of Despair, it short-circuits my overthinking, relieves (at least for a while) my brooding, and even gives me something I can smile at, if only momentarily.

Where do I find distraction? First, there are other people. There’s my husband. He has the ability to make me laugh at the silliest things. We sometimes toss a soft toy back and forth at each other, exclaiming, “Eeee!” It’s really a stupid game, and not one we play every day, but when you’re not expecting Eeee to fly through the air and bop you, it’s definitely distracting. We giggle like fools.

Another one of my go-to distraction providers is a friend named Tom. He’s a singer-songwriter and improv comedian who has dozens of different songs and jokes I’ve never heard. If I’m too much “in my head” and can’t get out, I can call Tom. Once when I called him, I just flat out said, “I need to be distracted.” “Look at the grouse! Look at the grouse!” he instantly replied. I had no idea it was from a Three Stooges routine, but it was absurd enough to ease me closer to where I needed to be.

That’s an important point, too – the ability to ask for distraction. It’s good to have people around who respond and help. Sometimes a calming voice is all it takes. My Uncle Phil has the most soothing voice, and he has many times centered me by distracting me with stories about anything – using computers for business, tarot cards, religious stories, or whatever. My friend Leslie grounds me by expounding on esoteric subjects – epigenetics, for example – if I ask her to. We’re perpetually told to reach out when we need it. This is just another way to do that. If you don’t want advice or commiseration, reach out for distraction.

Of course, there are other distractions like music, television, movies, and even pursuits like gardening. Doing something you have to concentrate on, like needlepoint, keeps your mind focused, and can be a great distraction if you are able to do it. And there are the cats. They’re so completely unconcerned with whatever’s troubling me that they can’t help but draw my attention away from it too.

I’m not saying that one should distract oneself to the exclusion of working on one’s problems. That way nothing which is necessary gets done. We all know that dealing with our difficulties is the path out of the pit.

And I’m not saying that distractions always work. Dan used to tell me terrible jokes to try to jolly me out of my depressive moods. When that didn’t work, he would tell the same joke again in hopes, I suppose, that I had merely misunderstood it and would think it was funny the second time. At that point in my life and my illness, not even Eeee would have gotten through. I’d have let it bounce off me. Or hidden it so he couldn’t try it again.

I’m hardly going to say that distraction can replace therapy and medication. But as an adjunct, I can’t see the harm in it. If you’re at a point where you’re able to, look at the grouse!

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Does It Matter What We Say?

April 30, 2023

Words matter. I preach that all the time. Language is what gives our thoughts reality and how we make essential connections. Ideas become more concrete when they have words attached to them. It’s hard – perhaps impossible – to convey a thought without language of some kind. And how we use words is dependent on how and what we think.

Words matter. Think about how the terms “rioters” and “protesters” reveal a person’s opinions about the motivations of the people in the “mob” or “crowd.”

Words matter. Our community has been pushing back against words such as “psycho” and “crazy” when it comes to referring to people who need psychiatric help. Many people are gradually realizing that such words are equivalent to slurs and are no longer acceptable. (Except in the aftermath of violence, of course. Then, those terms are tossed around indiscriminately.)

Words matter. But how do we in the community refer to ourselves? What words are advocates using? And how do we want the general public to refer to psychiatric problems?

I’ve written before about the terms “behavioral health” (bad) and “mental illness” (better). But what’s best? Increasingly, the words du jour are “brain illness” and “brain disease.” We’re watching linguistic change in action.

But linguistic change happens at a glacial pace. Words that were used in Elizabethan England are still used today. Think about all the words and phrases that Shakespeare invented that are still used today, and with the same meanings – unreal, lonely, and green-eyed (as in jealousy), for example.

Linguistic change, on the other hand, also happens blindingly fast. Slang, tech terms, and jargon in particular appear and disappear in the blink of an eye (as it were). Think about the terms that refer to female beauty. There were times when “phat,” “fresh,” and “fly” were all applied to women. (Yes, I’m dating myself. I don’t even know what the current term is, but I bet it’ll be gone next month. At least I know that “fire” has replaced “awesome,” “boss,” and “da bomb.”)

So, where are we in the (something) community now that we’ve left “behavioral health” behind? “Mental health” was the clear frontrunner for a time. Then it was “mental illness,” then “serious mental illness.” Now the term being put forward is “brain illness” – or even “brain disease.”

I’ve talked about the implications that various words have. What are the connotations of the new terminology? “Mental illness,” as opposed to “mental health,” drives home the point that “mental health” is a euphemism. It’s not health that’s the problem – it’s the opposite of health. “Brain illness,” as opposed to “mental illness” says that the problem is not in the mind, it’s in the brain.

I think that’s a tough concept for the general public to take in. To most, the mind and the brain are synonymous. Whether that’s accurate or not is hard to say. It’s true that the brain is the physical embodiment of thought, emotion, and cognition. These things can’t exist separate from the brain. They are so intertwined that it’s hard to think of one without the other – especially for laypeople.

But “mental illness” implies that the mind – the thinking – is what is disordered. “Brain illness,” on the other hand, says that the problems lie in the functioning – the physical structure – of the brain. In my opinion, it’ll be tough sledding to make the public understand the sometimes subtle difference between the two.

Recently I saw an online post that decried the fact that advocates and professionals aren’t yet using the terms “brain illness” and “brain disease.” And there’s some truth in that. My own therapist doesn’t. But practitioners are engaged in dealing with the general public as well as those in the community. There’s something to be said for addressing those people in language they understand better. There’s the possibility that when hearing “brain disease,” most people will think “brain tumor” rather than what we are really talking about. And there’s the problem with the slowness of linguistic change.

Words matter. But so does the speed of change. Of course, if we want to change the dialogue, we need to use more accurate terms to promote our message. But it’s probably too soon to expect everyone to be on board. I’m not saying that we should give up on the process of fostering change. I am saying that we shouldn’t be beating each other up for not yet having made that progress, even among ourselves. It’s a process, and not everyone progresses at the same rate.

Incremental change is better than none. Indeed, unless you’re talking about a fad, it’s the only way change happens. And we’re not talking about a fad here. We’re talking about a fundamentally new understanding of what it means to have schizophrenia, bipolar disorder, major depressive disorder, and other illnesses.

That’s going to take serious time.

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A Haunting From 40 Years Ago

April 23, 2023

I was chatting with a potential customer the other day. She was interested in having me write a book on gaslighting – a fictionalized account of the experience she had with her soon-to-be ex.

I told her that I sympathized and that I had some experience with the topic, too. I was once in a relationship fraught with emotional abuse and gaslighting. “It was years ago,” I told her, “but the scars are still there.”

Suddenly, I stopped to think. That relationship took place over 40 years ago. For going on 41 years, I’ve been married to a man I met the weekend that everything blew up between Rex and me. But I had been truthful. The scars are still with me.

Oh, they’ve faded since then. I no longer have aversions to the things I associate with him, like cobalt blue glassware and blue spruce trees. I don’t cringe and close up whenever anyone in the room is angry. I don’t put myself down before someone else has the chance to. I allow myself to feel anger when it’s called for. I listen to the kind of music I like, at high volume if I want, and don’t apologize for it. In fact, there’s lots I don’t apologize for anymore.

But the memories still affect me, all these years later. I still have flashbacks when someone uses one of his pet phrases, like “fish or cut bait.” I dream we’re in the same town and I’m afraid to run into him. I flash on his insistence that it be called “Eighth of January” whenever I hear the tune “Battle of New Orleans.” And now and then, the obscene song he wrote about me – supposedly as a compliment – pops into my head randomly. It’s doing it now as I write about it, of course.

I was at a formative stage in my life when all this – and more – happened. I was exploring newly discovered independence, dealing with the stresses of college, navigating my first serious relationship. I’m sure my lack of experience helped to make the situation particularly searing for me. At the time, no one ever spoke of gaslighting, and physical abuse was the only kind I had ever heard of.

When I was still just coming out of the fog of the relationship, my startle reflex was unnaturally sensitive. I’d react with alarm if my husband dropped a knife in the kitchen. I didn’t even have to see it. The sound was enough to make me flinch and cry out. (I don’t remember any specific incidents from the bad times that seem to be related to this, but there you have it.) For years, I was a jumpy little thing. My husband learned to let me know if he was about to make a loud noise so I could be prepared for it. I have only a little bit of that left – now I jump only when something very sudden or very loud happens.

It’s been suggested that I have some form of PTSD from the experience. I don’t know if that’s true, though I certainly have some of the symptoms. I was told once by a therapist that I do have it, but at the time it seemed wholly incomprehensible. Now that I look back on it, she may have been right, only I wasn’t ready to hear it. And my future therapists moved on to my problems with depression and bipolar disorder. Self-diagnosing is seldom legitimate, so I won’t say that I definitely have PTSD. But this all puts me in great sympathy with those who do.

PTSD or not, I can still see the lingering effects of that relationship even after 40 years. They say time heals all wounds, but in my experience, the wounds don’t heal so much as scar over. The effects are still there and visible, but they no longer bleed like they did.

Of course, defining the trauma is less important than recognizing it and its effects. And healing from it, which I am still doing 40 years later. It’s a work in progress – and so am I.

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How I’ve Experienced Group Therapy

April 16, 2023

I’m not great at group therapy. I’ve tried, but I never managed to get anything from it.

It may be familial. My father had a particularly vicious cancer, multiple myeloma, which he survived for a dozen years, a lot longer than the doctors thought he would back then.

The hospital where he was diagnosed and treated offered support groups for cancer patients. I remember one called “Make Today Count” (which I think implies a certain recognition of mortality that’s not really encouraging – but I’ve never faced it myself).

My father refused to go. Adamantly. Of course, the choice was up to him, but he chose not to get involved and made no apology for it. It wasn’t that he couldn’t accept help. He just relied on family and friends for it – people he knew and had a connection with. I’m sure that support helped him to survive as long as he did, and I can see how a group of strangers, even if they had the same or similar conditions, wouldn’t appeal to his independent streak. It wasn’t that he didn’t have a positive mental attitude, either. No one could have been more determined that he was going to persevere for as long as possible. No one could have been more confident that he would prevail. And no one could have kept doing the things he loved for as long as possible.

I have had experiences with group therapy, but they have not been successful. When I was in college and experiencing a depressive phase, I went to a group offered by the university’s health services. I was skeptical at first. One woman’s problem was that she didn’t know whether she should marry a rich guy or a poor guy who had both proposed to her. (I’m not denying that she was conflicted, but I wondered how much a mental health group could help. Maybe individual therapy could have helped her clarify her thinking, but then again, I just don’t know.)

The other thing I remember was that once the group facilitator issued us a challenge – which of us could role-play meeting another person and holding a conversation with them. My hand went up, and I performed the task easily. I had reached the point where I could fake my way through simple social encounters, so it wasn’t all that difficult. The facilitator looked impressed and slightly disbelieving. It was something I already knew how to do, so it didn’t actually help me with my problems. I don’t know if it helped anyone else either.

Another time, when I was out of college and in private therapy, my therapist was going on vacation and recommended a group I could go to while she was away. They took us through a relatively simple exercise – making a drawing of our life journey. As I recall, we used only symbols, no words.

When I finished, I burst out crying uncontrollably and didn’t know why. I don’t remember anyone there helping me process what I was feeling. Maybe I expected too much from a therapy group. Maybe they weren’t equipped to handle a meltdown. But it was a thoroughly upsetting and unhelpful experience, and I didn’t go back.

Another group I attended a few times struck me as a bit peculiar. The participants each related a difficult situation they had been in and the symptoms they experienced, then told how they would have handled it previously and how they handled it now. There were lots of quotes from a book they all carried like a bible. There was no discussion – just the facts and the quotes. (Once I offered someone a piece of gum or a mint and they pointed to me, chuckled, and said, “Dry mouth!”) Again, I didn’t find it really helpful.

At this point, I’ve pretty much given up on therapy groups. Perhaps, like my father, I am simply not a group person. I know there are those who will say that I simply haven’t found the right group. They may be right, but I have stopped looking.

There are lots of mental health groups – not therapy groups, of course – on Facebook and elsewhere on the internet. I’ve become the moderator of one (https://www.facebook.com/groups/HopeforTroubledMinds – come check it out if you want to). What founder Tony Roberts and I try to do is offer a place for people with brain illnesses to learn from and share their experiences, with a faith component. Tony, who is much more in touch with the faith-based communities than I am, provides most of that part of the content. I facilitate by curating articles from around the internet on anxiety, depression, PTSD, bipolar disorder, psychosis, and general mental health. I post memes that relate to mental health or offer encouragement – or sometimes ones designed to bring humor to the subject. And I ask questions intended to spark discussion. I hope it helps.

And I also hope that other people have had better experiences than mine. I’d love to hear about them.

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What Is Resting Sad Face?

April 9, 2023

Resting bitch face is a thing, you’ve probably heard. Some people – usually women, though I suppose some men have it too – look mean when their face is still and their muscles are slack. People who see them assume that they are grumpy at the least or maybe sulky or angry – hence the name resting bitch face.

I have resting sad face. Once when I was working at a restaurant, the manager saw me sitting while on my break and told me that I should smile. I replied that I was paid to smile at the customers, not on my break. Of course, that was a bad response, though I know that women are often told to smile more (men, not so much). I probably would have gotten along better with my coworkers if I had smiled more.

But I was suffering from depression at the time, or at least the depressive phase of bipolar disorder, and was untreated. Smiling was something I had neither the inclination nor the energy to do. Sad was my natural expression.

When I didn’t have resting sad face, I had resting worried face. (A different manager asked me, “What does a girl your age have to worry about except ‘Am I pregnant?'” As it happened, that was the one thing I knew I didn’t have to worry about.) I was also suffering – again, untreated – from an anxiety disorder.

What I haven’t had is the mask of “smiling depression.” Many people with depression pretend to be happy most of the time, at least in public. You can see it dramatized in depression medication commercials when someone holds a happy face symbol in front of their face. (In real life, I’ve noted that the depression or sorrow sometimes leaks out around the eyes, though, even past the mask.)

There are two different kinds of smile – the “Duchenne” smile (named after a 19th-century scientist whose major contributions centered on mapping the muscles that control facial expression) and the “Pan Am” smile. The Duchenne smile is the sincere smile of a truly happy person. It’s easy enough to tell when someone is giving you a Duchenne smile. The muscles at the corner of their eyes crinkle, making little crows’ feet. It happens automatically when you think of a happy memory or greet a person you like a lot.

The Pan Am smile is the one where the smile does not reach the corners of the eyes. (It got its name from airline attendants who were required by their job to smile at all times, whether they were at rest or not, happy or not.) No one has resting Pan Am smile face. It’s impossible. It takes a number of facial muscles to smile and when you’re resting, you don’t use those muscles. No, the Pan Am smile takes intention.

The Pan Am smile, however, is the one a person uses when they do have smiling depression. (I used it once when, at a different job, we were all posing for individual portraits. My results were so fake-looking that the photo was never used. They didn’t even let me see it, much less anyone else.)

I’m kind of hoping that these days, I have at least resting neutral face. That sounds like the right expression for a stable person.

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I Love/Hate My Brain

April 2, 2023

My brain is special and magical. It makes me who I am and has often seemed to me to be the best part of who I am. I have always been intelligent and a quick learner. And I thank my brain for that.

On the other hand, my brain is deficient in some ways. It doesn’t have the correct balance of neurotransmitters (or has been adversely affected by trauma as I’ve lived my life or inherited from my parents). When it comes to bipolar disorder, I blame my brain. It’s glitchy, unpredictable, and guilty of making my life miserable at times.

So, I have cause to both love and hate my brain.

The thing is, I have no control over either of those perspectives. I didn’t make my brain smart and adaptable. I can’t take credit for that. I also didn’t make my brain misfire and become my biggest enemy. I can’t take the blame for that.

Much of what I am, my brain is responsible for. I am a moderately successful writer. That can be attributed to my brain as well. I’m creative, too, another quality that resides in my brain. But when I’m depressed, I lose the ability to write, and when I’m hypomanic, I lose the coherence I need to write well. It would be easy enough to say that I love my brain when it’s functioning well and hate it when it’s not. That’s not completely true, though. I’d have to say that my brain is my frenemy.

I am notoriously moody and difficult – hardly surprising since I have bipolar disorder. My intellect doesn’t go away when I’m depressed or hypomanic, but sometimes it goes into hibernation. It makes poorer decisions, it’s true. It’s led me astray many times, even to the edge of death. And I can’t always recognize when it does that. My brain is not the best gatekeeper of my behavior. But my brain does help me clean up the consequences when it does occur.

There is currently a great debate on whether bipolar disorder even comes from the brain. It may not be because of my neurotransmitters, though I still consider them complicit. It may be because of my childhood trauma (at the hands of children my age, not my parents). But again, trauma is said to make physical changes in the brain, so perhaps it is a brain-related reason as well. The other prevailing theory is that bipolar disorder has a genetic component. I don’t know if that means that my genetic heritage affected my brain development, though I suppose it could have. I just don’t know.

I do know that it feels like my brain is at fault. Bipolar is, after all, a mood disorder, and I don’t know where my moods reside, if not in the brain.

So, what can I do with my brain to increase the love and lessen the hate? First, I try to keep my brain fed. I read every day and play jigsaw sudoku to keep it lively and stave off dementia – and to stretch my brain because so much of what I do is word-related, not mathematical. My reading is varied, from novels to nonfiction. I revisit beloved novels from my past, which keeps me grounded in who I am, and explore new books and authors I find, which keeps me excited and open to the new. I try to lessen the opportunities for hate by keeping my brain stable with medication, therapy, and listening to my husband and my friends when they tell me I am loved.

On balance, I love my brain more than I hate it. But I have to keep an eye on it (as it were) to make sure that the hated half doesn’t take over.

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My Emotional Protection Animals

March 26, 2023

I have what I refer to as emotional support animals – principally my husband. He goes with me to places and into situations that upset me, like a dentist appointment or a class reunion. He puts a comforting hand on my shoulder and encourages me.

My cats provide emotional support as well. They ground me when I’m upset and help me calm down. They give me something to focus my attention on instead of the turmoil in my head. They soothe me with their purring and distract me with their antics.

You would think that the animals I identify with most would be cats. I do believe that if I could be any animal, I would choose to be a cat – as long as I could be one of my own cats and not an unwanted, feral stray.

But the animals I identify most with are bunnies and armadillos. Here’s why.

There’s an expression among chefs – when they’re absolutely slammed with work, falling further behind with each passing minute, they describe the situation as being “in the weeds.” I use the phrase a little differently. I was experiencing a mixture of anxiety and depression, totally overwhelmed, though not necessarily with work. Every day brought new challenges that terrified me. Every day I found myself immobilized. And every day I found myself retreating. I felt like a little bunny hiding in the weeds.

That became the shorthand my husband and I used to describe the feelings. He would ask me how I was feeling, and I would reply, “I’m hiding in the weeds.” When I couldn’t express what I was feeling, he would say, “Are you hiding in the weeds?” and I would nod. That’s how I felt – like I had to hide from the flood of feelings and problems that beset me. Like I needed a screen of weeds to offer me what little protection they could. Like I had to be ready to jump at any minute the next time I sensed a threat.

I moved past this phase. After years of therapy and medication, I no longer need the weeds. I have stronger forms of protection that come from inside now. (My husband does calls me “Bunny” as a term of endearment, though.)

Armadillos are another story. Again, though, my fascination with them was in relation to another form of protection, seemingly more solid than weeds.

Armadillos are covered, of course, with bands of scales that protect them from most dangers. They can also roll up in a ball to protect their soft underbellies. I tried to develop hard scales that would prevent trauma from invading my fragile emotional makeup. At times I even rolled up into a ball (or at least a fetal position) when I had a meltdown.

Eventually, I did learn that if you wall off your feelings, it’s hard to get back in touch with them. And the good emotions get blocked off as well as the bad ones. The armadillo armor was not a viable solution for the long term.

I also learned that the armadillo has another defense mechanism. It jumps straight up about two feet into the air, presumably to escape from or startle any predators. Unfortunately for the armadillo, their main predator is the automobile. The little critter’s jump puts it at just the right height to be smashed by the car’s bumper. As a defense mechanism goes, it’s not really what you’d call successful.

That’s when I realized that neither were mine. When I got jumpy – when my anxiety was out of control – I was often smashed by onrushing difficulties, the very ones I was trying to escape.

So, bunnies are out. Armadillos are out. Where can I find an animal to identify with in terms of protection? We’re back to cats, I guess. They at least have claws that they can choose to extend or sheathe. I like the idea of bringing out a defense mechanism only when I really need it.

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When I Need to Feel Normal

March 19, 2023

A lot of the time, I live with sort of a low-grade dread, kind of like coming down with a fever. I’m well-known for overthinking and catastrophizing. The combination is exhausting.

When anything alarming happens, I ratchet up into an agitated state. It could be anything – a relationship problem, a looming financial disaster, a health scare. I respond with racing thoughts, trembling hands, and sleep disturbances. I find myself at 2:00 a.m., wide awake though a little bit foggy, with no real idea what I should do. Most of the time, there isn’t really anything I can do.

This happened a lot when I was in college. My life was complicated then – well, it always has been and still is. I wasn’t particularly worried about my grades or about graduating. No, it was other things that occupied my troubled mind. A difficult relationship was ending in great turmoil. I had lost a lot of weight and didn’t look or feel healthy. I had to pack, move, and find a job. My parents were coming for the graduation ceremony and I didn’t want them to see me in such distress. It was all overwhelming.

I had insomnia that summer. I would find myself lying on the sofa, wide awake, my brain on overdrive, with only a large black cat to keep me company while everyone else in the house slept. That cat kept me anchored in a way. He distracted me with his solidity and his insistent purring. He was a soothing presence that helped me not feel totally alone, without putting any demands on me.

It was that summer when I learned a technique I could use when everything seemed to be spinning out of control. I found that I could ground myself and stop all the whirling thoughts, at least for a while, by doing something small and totally normal. Making myself a cup of tea was my go-to. The familiar actions of finding a mug and a teabag, heating the water, and steeping the tea gave me something physical to do that would get me out of my head and back into my body. No matter how distraught I was, I could always manage to make a cup of tea. It’s not a demanding task. I could do it practically by rote. But it was so familiar – so completely normal – that it was a form of reassurance.

It turns out that the feeling of normalcy can soothe other people too. Once that summer, my uncle Phil was also having a hard time sleeping. Like me, he was afflicted by personal problems and feeling out of touch with his body and tangled up in his head. I busied myself making him a can of soup. It kept me from getting swept up in his turmoil, and it helped him become calmer as he watched me puttering around the kitchen. Again, it was all so normal that it soothed us both.

Now, when I have racing thoughts and distress, I try to find something manageable and entirely normal to do – something I can do automatically, without expending any thought. Putting out fresh food for the cats. Making lists. Watering a plant. Anything that I can do with little expense of energy or thought. In a way, it’s kind of a mindfulness exercise, paying attention to the steps involved and experiencing every movement as I go about accomplishing my normal little task.

This technique doesn’t work for me if I’m having a full-blown panic attack, but maybe it at least helps me stave one off if I catch it creeping up on me. It’s one of my more effective – and non-counterproductive – coping mechanisms.

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What Does PMHNP Mean?

March 12, 2023

What the initials mean is Psychiatric-Mental Health Nurse Practitioner (also known as Psychiatric Nurse Practioner or PNP). What that may mean for mental healthcare is the potential for more treatment and access to therapy. Increasingly, nurse practitioners are taking over some of the duties of psychiatrists and providing services to people who have mental disorders, or even serious mental illness (SMI).

What qualifications do nurse practitioners have? They must have a master’s or doctorate in nursing with a psychiatric nurse practitioner concentration, plus two years of work experience. Unlike psychiatrists, they aren’t MDs.

Psychiatric nurse practitioners perform many of the same functions that psychiatrists do. They work in hospitals, rehab facilities, outpatient mental health centers, and even in private practice in many states. (Other states require that they work under the supervision of a physician.) In addition to providing psychotherapy, PNPs can write prescriptions – including for controlled substances – regulated by state boards of nursing. They work with other professionals and with families to meet patients’ needs and create a holistic care plan that typically includes therapy, counseling, and medication.

There’s a crying need for PNPs. It’s no secret that it’s difficult to find psychiatrists and psychotherapists and that the waiting list is long for a new patient seeking treatment. Last year, 151 million Americans lived in mental health professional shortage areas, according to the U.S. Health Resources and Services Administration (HRSA). They reported that those areas need 7,584 mental health care practitioners to fill the gap.

It’s a good field to go into, too. Salaries are reported as ranging from $81,000 up to $140,000 per year. And in 2021, the unemployment rate was less than 1%. Currently, there are over 10,000 PNPs in the US, of which 80% are women. The U.S. Bureau of Labor Statistics (BLS) projects that the employment of all nurse practitioners will grow by 52% between 2020 and 2030! They anticipate 29,400 new job openings across the U.S. every year between 2020 and 2030. 

Minority Nurse magazine reported in 2020 on why there’s such a strong demand and positive job outlook for PNPs. They cited expanded insurance coverage for mental healthcare under the ACA, increased awareness of the importance of mental health, and the mental healthcare needs of veterans who served in Iraq and Afghanistan. The aging population of Americans may be another factor, as more and more people require services for disorders such as Alzheimer’s and dementia.

How good are PNPs? Psychiatric Times says that “patients report favorable experiences working with nurse practitioners.” Findings from one study determined that patients had “greater satisfaction with their care provided by nurse practitioners when compared with their MD colleagues….Investigators found that patient outcomes from nurse practitioners working independently or with MD collaboration had similar outcomes, when compared with the patients working with MDs alone.”

Although it seems that psychiatrists and PNPs ought to be natural allies, Psychiatric Times also notes that “national initiatives and some agencies have encouraged an us vs. them mentality, pitting psychiatrists against nurse practitioners and other advanced care providers.” That’s unfortunate for so many reasons.

I’ve never used the services of a psychiatric nurse practitioner, though there are several near me. If I had known about them when I was between psychiatrists, I certainly would have investigated the option. There’s something appealing about getting my therapy and my meds all from one person, a situation that hasn’t occurred since my previous psychiatrist retired. (I had to spend six months on a waiting list before I found another.)

For anyone in the same situation, I would suggest looking into it. I am convinced that PNPs have an important role to play in mental healthcare. If their presence reduces the problem of scarcity of mental health professionals, they should be welcomed, and awareness of their availability should be publicized. If more people knew about PMHNPs, it would expand the choices that mentally ill persons have. It would also benefit organizations, inpatient and outpatient facilities, and community-based care.

Is there a downside? I don’t see one.

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