Bipolar 2 From Inside and Out

Sorry, Folks

No new post till Monday. Stuck at Dublin airport.

Traveling is often a challenge for people who have bipolar disorder. Some people can’t do it at all or can’t even leave their houses, which I certainly sympathize with. I really do. There have been times in my life when I could travel and times when I could not, because of my mental state.

Right now, I’m able to. I’m taking advantage of this to go with my husband to Ireland for ten days. We started planning this trip last fall, which has, of course, given me plenty of time to overthink everything – but not to reconsider. I think this will be one of the best things we have ever done together, apart from getting married.

If everything (and by everything I mean Facebook) works right, this post will appear while I’m overseas. I didn’t want to just skip a week in my blog, so I’m trying out the feature that lets you schedule posts ahead of time. I worry that it won’t work, which in the greater scheme of things wouldn’t really be so bad. Just more overthinking.

In addition to overthinking, I am over-scheduling and over-packing. I have been bothering our travel agent with questions about driver’s licenses and phone service. I have made reservations for eight different scenic places and interesting events. (I think they require reservations because of COVID, because they don’t want too many people to show up for tours at the same time.) I have a list of things I need to do before we leave. Every time I cross one thing off, I add another at the bottom. I used to be able to pack for a long weekend for both of us with only one tote bag, but those days are long gone. My list of what I will need to have with me threatens to spill over my luggage allowance.

In the past when I’ve traveled, I’ve had some success with giving myself permission to feel the way I feel – to take a day off from activities if I feel low, for example. This time, what with all the pre-booking, I may not be as inclined to do that. We do have days scheduled with less driving around and I have noted times when we can simply explore local pubs and restaurants. We’re even bringing along a card game in case we feel too useless to leave our bed-and-breakfast.

I have no guarantees that my mood swings will abate while I’m gone, of course. Making sure all my meds are refilled and packed is top on my to-do list. That’s much more important than packing a card game. I can see myself getting cranky about getting to the various locations in time for our reservations, but I’ve been fairly stable lately, so I hope I don’t tip over into something worse than grumpiness. At least my husband will be there to help me laugh and decompress.

I think that time to decompress is necessary while traveling. It may have been my hypomania that told me to make reservations for every occasion. And I hope the looming shadow of my bipolar disorder doesn’t sabotage the whole thing. This vacation is very important for us, which probably means I have too much invested in it, and I don’t mean just monetarily. It’s most likely the last time we’ll ever be able to travel abroad, so I want to make the most of it.

I just hope that making the most of it doesn’t send me tipping over the edge into depression or hypomania. I’m never good psychologically with financial affairs or not knowing what’s going to happen. I’ve seen those tendencies in myself increase with time. I hope that this vacation is what I need to shake me loose from some of those feelings. I hope that I will look back on it, after this bit of writing becomes public, and realize that I have proved my relative stability by being able to go through what is intended to be a magical time. But I guess expecting magic is too big an expectation to put on a vacation.

We already know that in war, disenfranchised people suffer the most – dependent women and children, disabled persons, and the mentally ill included. The war in Ukraine is no different.

During World War II, mental patients and disabled persons were among the “subhumans” that Hitler sought to annihilate. He felt they were a drain on society. (In fact, there are still people who feel this way.) Nowadays, the impact on the mentally ill is somewhat less direct. Reuters has reported that “Russian forces have taken control of a psychiatric hospital in the town of Borodyanka in Ukraine’s Kyiv region, with 670 people inside.” They quote a Ukrainian official as saying, “Today we do not understand how to evacuate these people, how to help them….These are people with certain special needs, they need constant help. They are running out of water and medicines.”

Not that mental health care in Ukraine was all that great to begin with. General healthcare in Ukraine developed from the old Soviet system, which emphasized preventive care rather than treatment of existing disease. Psychiatric Times also notes that “In comparison to other countries, Ukraine carries a high burden of mental illness and a particularly high prevalence of depression, alcohol use disorder, and suicide….Major barriers to mental health care in Ukraine include lack of trust in the psychiatry system, stigma, and lack of awareness and understanding.”

In the Soviet era, psychiatry was used “as a tool of repression” and “those who opposed the Soviet regime being deemed ‘mentally ill’ and imprisoned in psychiatric hospitals. As a result, Ukrainian older generations are more reluctant to seek mental health care than their youth, remembering the dark history of psychiatry,” reports Not Even Past.

Challenges in the Ukrainian system have included “a large institutionalized psychiatric system associated with human rights violations, alongside public stigma and low awareness of mental health,” says the World Health Organization. They add, “Social services for people with mental disorders are limited or absent in the community. The health information system has mental health data but lacks organization and is not always useful for decision making.”

The COVID pandemic had already taken a toll on mental health in Ukraine, but increasing conflict in the eastern regions caused still more suffering, long before the Russians invaded. In October, 2021, Relief Web reported on the toll-free emotional support hotline that helped more than 3,400 Ukrainians during its first year of operation. The four operators, seven psychologists, and one psychiatrist offered support primarily to women, who made 70% of the calls to the hotline.

Even before the pandemic and the conflict, Ukrainian citizens suffered from a variety of mental health problems. Estimates are that one in three Ukrainians face a mental health challenge at least once during their lives. This is notable, particularly in comparison to countries in Western Europe. Much stigma was also reported, involving problems of “knowledge (ignorance), problems of attitude (prejudice), and problems of behaviour (discrimination).”

Then there are the mental health difficulties directly related to the Russian invasion. Naturally, anxiety and depression are problems in both adults and children. As Relief Web noted, “People fleeing conflict often experience highly distressing situations, loss and trauma, which may impact their mental health and ability to cope. Psychosocial support will be needed in the days, weeks, and months to come.”

ABC News reported on the mental health problems that are arising in Ukrainian children especially. As of March 19, 114 children had reportedly been killed in airstrikes and other acts of war. Children as well as adults no longer have a sense of stability in their lives. Experts recommend supplying structure for the affected children, but this is difficult to impossible in a war zone.

ABC quoted Dr. Jack Shonkoff, director for the Center on the Developing Child at Harvard University, who noted, “Some children in these circumstances tend to be more withdrawn, they’re not crying as much, they’re not demanding much attention.”

He continued, “Sometimes people might look at that and say, ‘This child is managing pretty well.’ Sometimes that’s a sign of the things to worry about the most because these children are withdrawing, they’re internalizing a lot of what’s going on.”

Shonkoff also said that “a good outcome for children in a war zone is … making sure the adults are being taken care of too.” As he put it, “The most important factor that determines how children are going to basically survive and go forward after a war experience is the nature of the adults who are caring for them,” he said. “If the parents and the caregivers are significantly traumatized, they can’t provide that sense of support. The adults’ needs become critically important to protect the children.”

Shonkoff likened it to when adults are advised to put on their own oxygen masks first in case of an airline emergency, before assisting children with theirs. “That’s not a way of saying you’re more important than your child. It’s a way of saying if you pass out, your child won’t be OK,” he said.

What’s the point of all this information? It’s crucial to realize that, in war, not all wounds are physical. We know this from the vast number of veterans who suffer from PTSD. That will no doubt be true of soldiers in Ukraine too. Psychological distress is real – and increasing – and will affect people in Ukraine in both the present and the future. When we talk about sending relief to Ukraine, let’s not forget those with mental health challenges.

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The quotation from Mark Twain goes, “Of all the things I have lost, I miss my mind the most.” It’s a little annoying, at the least, when people repeat it. Those of us with psychiatric diagnoses don’t actually lose our minds, but we do lose a lot of other things along the way.

Friends

I’ve certainly lost friends because of my bipolar disorder. I can think of two in particular who were very dear friends, but cut off all contact with me when I was at the depths of my depression and they feared I was suicidal. I reached out to them a few times and even sent them a copy of both my books, but got minimal response. I still miss them, though they now live in another state and it’s unlikely that we’ll ever see each other again, even in social settings we all used to frequent.

Jobs

Twice I lost jobs largely because of my bipolar disorder. The first time, I had been isolating a lot, keeping the door to my office closed and barely interacting with any of the other employees. While an open door wasn’t technically a requirement of the job, I was the only editor who habitually hid behind a closed one, and it wasn’t taken well. I’m afraid I got a reputation as being difficult and uncommunicative. Finally, after several incidents where my emotions ran away with me, I was let go.

The second time was at the job I had directly after that job ended. At first, I did all right in the department where I was assigned. Then my boss left and the department was disbanded. I was transferred to another editing group, and there my difficulties began. The people there misunderstood my attempts at humor. My boss didn’t understand bipolar disorder and when she asked, “What does that mean?” I was caught off-guard and made a brief, unhelpful remark to the effect of “Sometimes I have good days and sometimes I have bad days.” I could see her thinking, “What makes you different than anyone else?”

Finally, I was put on probation, the only time in my entire career when that ever happened to me. I decided to leave before they could fire me. Then I went into a period of hypomania about not having to work there anymore and starting a freelance career, which did not turn out as well as I had hoped.

Intellectual abilities

I know a lot of people worry that when they have a disorder such as bipolar, or even when they take medication for it, they will lose some of their brainpower. I never felt that way, but looking back I can see that the disorder also disordered my thinking. Moods of despair and exhilaration interfered with my cognitive functions. In addition to the general dulling of feelings during depression, I also lost the ability to concentrate enough to read, formerly one of my primary and best-loved activities. Even as I mourned the loss of my reading, I was simply unable to pick up a book and follow its contents. I took to watching mindless TV shows instead – really bad ones.

Enjoyment

Just as I no longer found joy in reading, I no longer found other activities enjoyable or interesting as well. I used to love cooking, especially with my husband, but when depressed, I could barely microwave a cup of mac-n-cheese. I loved good conversation with friends, but I barely talked to anyone and ignored friends’ overtures. I enormously enjoyed traveling, but couldn’t summon the energy even for a day trip.

Confidence

I used to be able to do all kinds of things by myself – attend business conventions (and science fiction conventions) and write articles for publication, for example. When I was suffering the most from bipolar disorder, I could do none of these things. When I went to conventions, I needed a bolt hole and spent as much time as I could in my room. At that point, I couldn’t write about my condition or even send emails to friends. One of my friends said, when I was considering ECT, “Write about it! That’s what you do!” But it wasn’t what I did anymore. Putting pen to paper – or words on a screen – was not even a possibility. I asked someone else if she would write about it instead.

Things I haven’t lost

Of course, most of these things came back to me once I was properly diagnosed and medicated. I now read every night, write my blogs every week, travel here and abroad, and make friends that I keep in touch with. I discovered that some of my friends had stuck by me, even when I was in the depths. I still can’t work in an office, but I have found work I can do from home. I enjoy travel again. And if I’m a little slower to get a joke or find a word, it doesn’t bother me so much. I know my brain is just fine, except for occasional glitches.

Losing all those things made me realize just how good my life is now that I am back to being myself. I have my mind back, if it was ever lost at all.

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This question comes up all the time, about all kinds of public figures and various sorts of disorders. Does Donald Trump have Narcissistic Personality Disorder? Did Freddie Mercury have undiagnosed bipolar disorder? Do the Kardashians have Body Dysmorphic Disorder? Does Joe Biden have dementia? Was Nancy Reagan co-dependent?

Seven years ago, I wrote about Emily Dickinson (https://bipolarme.blog/2015/03/27/diagnosis-and-dickinson/). Then I said that it is impossible to know whether Dickinson or any other historical personage had any psychiatric disorder and, if they did, what it was. Now I have basically the same thing to say about the “diagnoses” of public figures.

It’s impossible to say whether any given celebrity – or indeed any public or private individual – has a psychiatric disorder unless that person has spoken about it publically. We cannot assume, just from the little we know about another person, that he or she lives with any given condition. This is true not just of psychological disorders, but also physical ones. In the past, it was easier to keep physical difficulties secret. Few knew that John F. Kennedy wore a back brace because of an old injury or that Franklin Roosevelt used a wheelchair because of polio. Only now that their memoirs or the memoirs of their friends have revealed these previously secret afflictions do we know about them.

When it comes to psychiatric diagnoses, the difficulty is not that friends may or may not keep a public person’s secret, but that the public has no real right to know unless the celebrity is open about it. The relationship between a psychiatrist and a patient is confidential. Only the patient can give permission for the doctor to disregard that confidentiality. Lately, it has become common for political figures to endure public examination of their medical records and even psychological records. But this is by no means a requirement for a public office such as president. Really, a president of the US only has to be over 35 years of age, be a natural-born citizen, and get the most votes. And such scrutiny is hardly a requirement – completely irrelevant – for entertainers and athletes.

Speculation about the private lives of public figures has reached the level of a sport. It seems that just because a person has achieved some measure of celebrity, their life is now an open book. Their fans (and detractors, for that matter) want to feel they have a personal connection with the public figure. They want to believe that they know the celebrity better than anyone else. They may feel a kinship with the person because they have the same disorder that the public figure supposedly has. But the most that you can say about a public figure is that he or she shows some behaviors that can be associated with a certain diagnosis – not that the person actually has that condition.

Some celebrated sports figures and actors have been upfront about revealing their own and their families’ stories of psychiatric illnesses. Catherine Zeta-Jones, Glenn Close, Carrie Fisher, and Michael Phelps have let such conditions be known, in hopes of reducing the stigma surrounding mental illness and encouraging others to seek help for their conditions. But these people are the exception. Most people, both celebrities and the general public, suffer in silence.

Basically, the only way to diagnose a person is for them to have an ongoing relationship with a psychiatrist or psychologist. A doctor who has spoken to the individual and spent time with him or her is the only person who can make that diagnosis. Even psychiatrists who testify at trials about the mental state of defendants may not have had any previous, personal contact with them. Yet their opinions help determine the fates of people they don’t really know.

Public figures don’t belong to the public, whatever their fans or detractors may think. Their minds especially are their own. It is reckless, improper, and ultimately futile to speculate on a public or historical figure’s mental state. But people do so and will continue to, as long as there are celebrities and people who feel they have a right to analyze them.

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Bipolar Myths Debunked

Bipolar disorder is misunderstood by many. There are many helpful, reliable sources on the internet that explain it well and many books that provide both psychological expertise and personal stories of living with bipolar. Still, the general public believes many myths about the disorder. Here are a few of them and the real information that can counteract them.

Bipolar is bipolar is bipolar. There are many types of bipolar disorder. The best known are bipolar 1 and bipolar 2. But there are also bipolar 3 and 4 – less well-known but still troubling versions of the disorder. Bipolar 3 is also called cyclothymic disorder. Bipolar 4 is bipolar due to another medical or substance abuse disorder. Each of these types of bipolar has differing symptoms – mania and depression for different lengths of time, for example – but they are not identical.

Hourly mood swings are symptoms of bipolar disorder. It’s common for people to say that their friend’s moods change rapidly, so they must have bipolar disorder. This is a misconception. Bipolar disorder is characterized by alternating periods of mania and depression, but these last longer than hours or days. They can and do last for months or even years. There are types of bipolar disorder that are called rapid-cycling and ultra-rapid cycling, but these forms of the condition still feature episodes of mania and depression that occur up to four times in a year. There is (or may be) ultra-ultra-rapid cycling bipolar, which can manifest over a day or two, but this is extremely rare.

You can “fix” someone with bipolar. No, you can’t. My husband tried to fix me, with no success. Perhaps because he had some experience as an aide in a psychiatric facility or because he had once led a laughter therapy group, he thought he could. He loves me more than anyone ever has, but I was immune to his attempts. When he offered advice, I told him to “quit shrinking at me.” When he told the same joke over and over trying to get a laugh out of me, I just looked at him. Even a psychiatrist and medication can’t “fix” a person with bipolar disorder. They can help to alleviate the condition and even help a person go into remission, but there is just no fixing bipolar.

Bipolar people end up hospitalized. Although some people with bipolar disorder are hospitalized, this is far from the only outcome for them, and many are hospitalized only for short periods. In fact, it can be very difficult to find a hospital or psychiatric facility when one is needed. The closing of many care facilities and the low number of beds available, along with insurance requirements, have contributed to this. Hospitalization is considered in emergency situations, such as when bipolar persons are an immediate threat to themselves or others. Outpatient treatment is preferred for all but the most extreme cases.

Medication, particularly with lithium, is the only treatment for bipolar. Lithium was the first medication to be used with bipolar patients, but it is now far from the only one. Medication (with a wide array of choices) is certainly an important treatment for bipolar disorder, but there are others. “Talk therapy” can help people with bipolar develop coping mechanisms and deal with mood swings. If medication doesn’t work, there are more avenues that can be explored. ECT (electro-convulsive treatment) has come a long way from the bad old days and the horrors depicted in Cuckoo’s Nest. TMS (transcranial magnetic stimulation) is another kind of therapy that has shown progress in treatment-resistant bipolar disorder. Ketamine infusions are also being studied and tried as a treatment. There are people who find nutrition, mindfulness, exercise, and other techniques helpful, and these can be productive adjuncts to other kinds of treatment.

Bipolar people are violent. People with mental illnesses are more often the victims of violence than perpetrators, despite what you may have seen in the movies, television shows, and even news stories. People are quick to say that any violence is due to mental illness or a person who is “off their meds,” but this is quite often a knee-jerk reaction with a questionable basis in fact. The risk of violence is minimal for bipolar persons unless they are also substance abusers.

Bipolar people can’t have romantic relationships, friends, or families. Relationships may be more difficult with bipolar disorder, as they are for many people with mental illnesses, but they are not impossible. Many families care deeply and support their relatives who have bipolar, and many people who have bipolar have loving relationships, marriages, and families of their own. These relationships may be more difficult than those that non-bipolar people have, but they are not impossible. It is true that family members and friends may not understand mental illness and may reject anyone who has them, but there are also many who will stand by you, help you heal, and even advocate for you. Besides, relationships among the general population are not guaranteed to be long-lasting and trouble-free either!

You may share this post with anyone who believes these myths. Perhaps it will lead them to a more realistic view of bipolar disorder and help them better understand friends and family members who are affected by it.

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Image by Richelle, from AdobeStock.com

Not long ago, I noticed that C-SPAN was going to be featuring testimony before Congress on mental health issues and legislation. I thought I’d see what was up. What I heard was a lot of questions about the opioid crisis and what the nation’s response to that ought to be. I tuned out and turned it off. I had been hoping to hear about issues such as insurance parity, access to treatment, assisted outpatient treatment, and more. Instead, what I got was a focus on substance use and abuse.

I also recently saw a map that indicated which states had reimbursement programs for Substance Use Disorders (SUD) and Mental Health initiatives. By far, most of the programs were for SUD. States that covered mental health conditions were in the minority, and most of them provided coverage for both SUD and mental illnesses.

I’m not denying that substance use and abuse are problems in the U.S or that legislative attention needs to be paid to them. I know the opioid crisis is tragically affecting individuals and communities across the country. Nonetheless, I wish as much attention was paid to mental health issues. They affect individuals and communities, too.

I was a little short-sighted as well as impatient, however. The two topics are not mutually exclusive. Mental illness and drug use are often comorbidities (also called co-occurring disorders or dual diagnoses). Still, there are in many places rehab facilities for people who abuse drugs and alcohol, and separate facilities for people with mental illness.

The two conditions share many characteristics. Both can be attributed to brain chemistry. Very Well Mind notes, “[t]he activation of the brain’s reward system is central to problems arising from drug use. The rewarding feeling that people experience as a result of taking drugs may be so profound that they neglect other normal activities in favor of taking the drug.” The effects of brain chemistry on mental illnesses such as depression, bipolar disorder, and schizophrenia are not well understood and are even debated. But though the mechanisms of action on the brain may be different, there is little doubt that the brain is involved in both addiction and mental illness. Medline Plus notes that there are other similarities in causation, including genetics, stress, and trauma.

Various psychiatric disorders are associated with substance use, including psychotic disorder, mood disorders, OCD, sleep disorders, sexual dysfunction, and neurocognitive disorders. Despite this, PubMed has said, “In spite of the high association between substance use and psychiatric disorders, there is a surprising paucity of studies related to treatment and outcome. A few well-designed studies have been recently published and more studies of this nature are required in order to address the challenges posed in the treatment of dual disorders.” One thorough, well-researched article with many sources listed is available from MentalHelp.net.

The latest version of the DSM recognizes the overlapping of substance abuse and mental illness, with substance-related disorders added to the DSM 5. Addiction Policy Forum reports: “The DSM-5 has eleven criteria, or symptoms, for substance use disorders based on decades of research. The DSM-5 has helped change how we think about addictions by not overly focusing on withdrawal.”

The National Alliance on Mental Illness (NAMI) says, “The best treatment for dual diagnosis is integrated intervention, when a person receives care for both their diagnosed mental illness and substance use disorder. The idea that ‘I cannot treat your depression because you are also drinking’ is outdated — current thinking requires both issues be addressed.” They add that the treatment should consist of six elements: inpatient detoxification and inpatient rehabilitation; psychotherapy – especially Cognitive Behavioral Therapy (CBT); medications – including those that assist in detoxification; supportive housing such as group homes; self-help; and support groups, whether faith-based or not.

Of course, the idea that substance use and abuse are diseases has not caught on with many members of the general public. They consider them to be personal failings or the result of having no self-control or hanging around with disreputable friends. Perhaps that is one reason public officials do not listen to those who promote changes in legislation to improve both substance abuse and mental health care. The intersection of addiction and mental health challenges is even more foreign. Advocates who contact their legislators are likely to be brushed off with a “Thank you for contacting my office” letter. Politicians are also disinclined to listen to medical advisors on the subject, especially now that their attention is focused on COVID-19 policy.

Perhaps those who advocate for more enlightened responses to substance use and abuse issues, mental health treatment, and dual diagnoses should start a little lower. Educating legislators is fine, but change is not likely to result until their constituents demand it. For one thing, advocates for reform could attend local city or county meetings in order to counter the pervasive NIMBY (Not In My Back Yard) response to treatment facilities. They could also educate their family members and friends about the realities of drug use, mental illness, and the intersection between them. When more people understand these ideas, they may be more likely to support legislative approaches that encompass them.

Grassroots efforts such as Mothers Against Drunk Drivers (MADD) have worked in the past to contribute to societal change and legislation regarding that problem. It may take a similar effort to achieve change in how addiction and mental illness are understood and treated.

I still think the Congressperson wasn’t talking about dual diagnoses, though.

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My hypomania and my anxiety are fighting each other. Here’s what happened to start the quarrel.

There wasn’t much work for me over the holidays and into February. The transcription company that I freelance for didn’t have many assignments to give out, and, being part-time, I was low on the list to get them. Plus, one of the company’s biggest clients was leaving. And my husband and I got COVID, so it was impossible for him and difficult for me to work.

The job at the transcription company isn’t great. I make a few hundred dollars a month, which is a good supplement to my Social Security and my husband’s pay. I’m really a crappy typist, though, so it takes me longer to finish assignments than it does for most people. I work only four days a week, but it feels like full-time.

But, with the job likely to go away entirely, my anxiety was triggered. I figured it was time to look for a new part-time gig, maybe one that wouldn’t be as taxing.

I started my job search and eventually found a company that was hiring remote online tutors, which seemed perfect for me. My bipolar disorder makes it difficult for me to work in an office, especially in a 9-to-5 job. I’ve done it in the past, but don’t think I could anymore.

Then good news came – the transcription job wasn’t going away after all. A new client had signed on (though the work hasn’t started to come in yet, so I have no idea what the pattern of assignments will be).

I didn’t want to give up on the tutoring job. (I haven’t started yet, as they are still processing my paperwork.) I figured I might be able to do both, tutoring on the three days per week that I wasn’t transcribing, or in the mornings between assignments. The tutoring gig requires only five hours per week, though you can take on more.

Then I got a lead on a job editing, which is my real love when it comes to work. And I began to wonder whether I could do that in addition to both the tutoring job and the typing job.

Of course, that’s hypomania talking. I don’t get hypomania very often and when I do, I have a hard time recognizing it. My husband sometimes notices it before I do and gently reminds me when he sees me starting to go overboard. “You’d be awfully busy,” he said, looking dubious. It made me stop and think. For one thing, it made me think that it might not have been a good idea to buy the new computer that the tutoring job would require. For another, my time off with him is precious, and I wouldn’t like losing that.

The typing job is supposed to get rolling again, but I like it the least, as it isn’t a good use of my real skill set. But I’ve been doing it for several years now, so I’m kind of used to it. The prospect of having no extra money coming in scares me, though, enough that I am really considering getting that second part-time job. That’s my anxiety talking as well as my hypomania.

Realistically, I ought to just stay with the job I have and hope that the new client works out. Now that that is a possibility, maybe I should give up the idea of more work. But the uncertainty that I’ve recently experienced tells me that I ought to have another way to jump, just in case.

Which will win – my anxiety, my hypomania, or my husband’s common sense? I really want that editing job . . . .

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Going Off (Some) Meds

I regularly tell people not to go off their meds without consulting their psychiatrist. I yell at them, in all caps. It’s not just a bad idea, it can result in withdrawal and even lessening the meds’ effectiveness if you do go back on them. Yet recently, I went off two psych meds without my psychiatrist’s prior approval.

Here’s what happened.

My husband and I recently had COVID – probably the Delta or Omicron Variant, as we have both been triple-vaxxed. That is to say, my husband tested positive for COVID and I have close contact with him, plus I had the same symptoms that he did.

Since we didn’t need expensive and rare treatments or hospital stays and ventilators, we relied on over-the-counter medication to treat the symptoms, which included sore throat, coughing, fever, congestion, and fatigue. We recovered in a couple of weeks to a month and my husband is back to his job, where he regularly interacts with numbers of people. I work at home, so I didn’t have that problem. I just needed to take some time off when I felt truly crappy.

When we read the directions on the OTC symptom-relief pills, however, there was a warning that said not to take anti-anxiety agents or sleep aids with them. My regular routine has been to take a sleeping aid at bedtime and an anti-anxiety pill in the morning and at bedtime, with an extra dose allowed if I have an anxiety attack during the day. I have been taking both of the meds literally for years and have never had any problems with them. (I won’t say what any of the medications are, since everyone has different reactions to different medications, and my reactions, while fairly typical, won’t hold true for everyone.)

Perhaps out of an excess of caution, I decided not to take the anti-anxiety and sleeping meds while on the OTC ones. When I quit taking them, though, I was worried that I might experience some of the ill effects that were possible.

Throughout the course of my bout of COVID, I didn’t notice any withdrawal symptoms, excess anxiety, or difficulty sleeping as I feared I might. In fact, I slept better than usual and had fewer attacks of anxiety. So I decided that I would try going off the two meds for a while, even after I felt better. It was about six weeks until my next med check with my psychiatrist.

Of course, when my med check came around, I told my psychiatrist what I had done and why. I thought he might react badly when I said that I did this on my own, without his advice and consent.

Instead, he seemed thrilled.

“Good for you,” he said. “You’ve stopped taking the two addictive ones, too.”

I had known those drugs were potentially addictive, which was why I was watching for withdrawal symptoms. I took the lack of these as signs that, though the drugs were addictive, I was not addicted. (My psychiatrist has to regularly have an analysis done to show whether his patients have a high risk of abusing psych meds or taking more than needed. My score was 0%.)

It felt good to have my psychiatrist validate that I had done a good thing and not a bad one. But even more, it felt good to be taking fewer pills each day. I’ve never minded having to take pills or felt ashamed of taking them, but it was still significant to me that I had lowered my medication schedule to just the ones that had beneficial psychotropic effects, such as antidepressants and mood stabilizers. I was delighted to find that I didn’t need as many pills as I had once thought.

All in all, my experiment was a success, but I was lucky, and my experience is not medical advice. I don’t recommend it to anyone else. Consult your prescribing physician before you cut back on or stop any medication. I MEAN IT!

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When I first went to my therapist, I often described my life and myself as “pathetic.” Slowly, as I made progress, I stopped doing that. It was a revelation that took some time to sink in. Here are some of the things my therapist said and did to help me overcome this harmful description of myself and my bipolar disorder.

Refusing to accept my description. This may seem like an obvious thing, but it had real meaning for me. I had been majorly depressed for approximately three years and bipolar as long as I could remember. I couldn’t do anything – get out of bed, shower, feed myself or the cats, or perform the tasks of daily living. (My husband picked up the slack. Thank God for him.) My therapist never said in so many words, “You’re not pathetic” or “Your thinking is wrong.” She just patiently spent the time with me and gave me tools I could use to get better.

You’d think I would take this as denying my perception of reality, which I ordinarily hate when anyone tries it. But this time, I welcomed it. It was nice at that point to have someone denying my perception because Dr. B.’s perception was so much more appealing than mine. It gave me something to shoot for – a time when I would no longer feel that “pathetic” was an apt description. She also let me cry it out, which I often did when I was feeling particularly pathetic.

Baby steps. (Also known as “Eat the elephant one bite at a time.”) My healing was slow, thousands of baby steps of accomplishing more and more. Because my therapist never gave up, neither did I. Baby steps take you only so far at a time – after all, they’re tiny. But over time, they add up to a measurable distance. As I slowly moved away from my “pathetic” label, I also moved away from feeling pathetic. Eventually, I was able to eat, if not the whole elephant, at least a larger portion of it through slow but steady progress.

Not that I didn’t sometimes backslide. Whenever I hit another depressive episode, my feeling of pathetic-ness came roaring back. It was only as I learned that some other feeling was possible that I was able to catch a glimpse of a time when pathetic might no longer describe me.

Saying, “Look how far you’ve come.” This is something that my therapist kept reminding me. Dr. B. noted that I was becoming able to get out of bed to come to her office. She would bring up the tools that I had acquired or developed to help myself leave the bad old days largely in the past. She would also point out that I not only remembered those tools, I was using them.

Sticking with me. Dr. B. was also there when I backslid. A couple of times I had made so much progress that I thought I was able to go it alone. But, sooner or later, I would need a “booster shot” of work with her to remind me of the things that I really already knew. When I was feeling too low to make it into the office, we would have phone sessions. When COVID hit and in-person visits became even more difficult or impossible to arrange, we began having videoconference sessions. Slowly, I worked up from every week to once every two weeks to once every three weeks – and am now meeting with her only once a month.

And, let me tell you, it feels great not to feel pathetic anymore.


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