Bipolar 2 From Inside and Out

It’s tough enough for someone with bipolar or depression or anxiety to go outside, where it’s all people-y. It’s another level of achievement when such a person deliberately puts herself or himself out into the public eye.

But that’s just what I did this week. My publisher arranged for me to do a reading and signing of my book at a local branch of a national bookstore. And I agreed to do it. Thursday night was my debut.

Let me go back a few steps. I do have some experience speaking in public, so it wasn’t going to be a completely novel experience. Those occasions were, shall we say, a bit distant in time, mostly before my bipolar disorder reached its heights (or depths). In high school, I did debate and extemporaneous speaking. In grad school, I taught introductory English classes. During my somewhat-less-than-successful business years, I once addressed a power breakfast meeting. I even opened with a joke.

I was prepared to open with a joke (or at least a witticism) this time, too. But my plans soon flew out the window.

I had prepared – or over-prepared, probably – somewhat obsessively. I spent spoons like they were disposable plastic. I picked out an outfit and a back-up outfit, including earrings and back-up earrings. I did my hair. I agonized over which pieces from my book to read, then printed them out in huge type so I wouldn’t have to squint at them. I took an anti-anxiety pill and Immodium, just in case. I was fortunate that Thursday was my day off and also my husband’s, so he could be present as my emotional support animal, wearing one of my book t-shirts.

My expectations, such as they were, took a nose-dive when only two people showed up – both friends of mine, one of whom had already bought my book. It was time to rearrange my plans on the spot, not really one of my strong suits. Why had I knocked myself out making plans if the universe wasn’t going to cooperate with them? I had thought that at least half a dozen people would turn up. I was trying to keep my expectations reasonable, after all.

I’ll admit that when I saw such a small audience, I felt a wave of despair. In actuality, it proved good that they were both friends of mine, because they were a receptive audience who wished me well.

Given the meager audience, though, I abandoned my introduction (though I worked my joke in later). These people already knew me. I gave a brief synopsis of “What is bipolar disorder?” and plunged into my readings.

I had tried out one of my readings previously, when I was on a podcast for indie authors. Of course, I had no eye contact with my audience then and no real idea how my performance went over. On Thursday, I explained Spoon Theory, as it came up in one of the pieces I was to read. I had chosen two of my more light-hearted pieces, though on serious topics (psychotropics and side effects, and cognitive dissonance). Then I finished with a reading of a piece on why I write about bipolar disorder and why I put myself out there to the extent that I do in this blog and my book, and indeed my public appearance.

The big surprise of the evening came when I invited a Q&A session. My husband fed me questions to get things started and my friends also had queries. What I hadn’t been expecting, however, was that a few people in the bookstore cafe where this all occurred got sucked into the discussion and had questions of their own, though they had no idea that the event was scheduled at all. One worked at a local university and had heard his students talking about having bipolar disorder. Another was a woman studying psychology in order to become a counselor. I didn’t always have the answers, and I’m sure I bobbled some of the explanations, but I did my best to come up with reasonable answers about treatments and medications, self-care, and so on.

Then came the signing portion of the evening. I signed a book for one of my friends and the counselor-in-training asked me to sign her notebook with any little inspirational words I might have. (I winged it. I was tired by then and am not usually inclined to be inspirational.)

Then my husband and one of my friends and I went out for milkshakes, which I highly recommend as a way to decompress after such a fraught experience.

All things considered, I’m glad I took the risk and gave it the old college try, as it were. If nothing else, it was good practice for the next time I speak in public, perhaps when my second book comes out.

The reason that I write about bipolar disorder and my experiences with it is that I want to share what I’ve learned and lived. I think I did that Thursday, even if not to the extent that I had hoped. I don’t regret the anxiety and the preparation that went into it and, all things considered, count it as a win. When I think about the melt-downs I could have had – before, during, and after – I feel pride that I kept my depression and anxiety at bay for long enough to share information about bipolar and healing and mental health.

I think it was worth putting myself out there.

 

I have been stable for a few years now and let me tell you, it’s great. But not without its problems.

First, the good stuff. I’m now able to go out of the house more than once or twice a month. In fact, I just went to a weekend-long convention where there were plenty of people and noise, ordinarily two of my triggers. (I still don’t know if I could handle Chuck E. Cheese.) This was a gathering that, although it was attended by hundreds of people, was host to a good many old friends and featured some excellent music.

While at the convention, I experienced one of my more upsetting physical symptoms of stress (the less said, the better). Although it did distress me, I didn’t freak. I dealt with it and went on to enjoy the rest of the convention. I didn’t retreat to my bed and miss the rest of the fun. In earlier times, I would have.

I have more spoons per day. This is a Good Thing, as now I have a job four days a week, two blogs, and assorted other writing to do, including completing my next book. (It should be available later this year.) During the aforementioned convention, I did have to sit and rest on occasion, but I did not have to miss hours at a time owing to a nap attack. I seem to be able to get by on eight or so hours of sleep per night, rather than ten or 12. And I can almost always get to sleep by midnight.

My creativity and emotions are not blunted. My confidence is up. I can push myself a little bit to accomplish things. I can feel satisfied, and content, and happy. And I do, especially today.

Of course, that’s not the whole story. Bipolar disorder is still with me. A part of me. An influence on perhaps every part of my life, not excepting my stability. I am not “cured.” I live with bipolar disorder every day of my life, even if it affects my daily life less than it used to.

To maintain my hard-won stability, I must take medications. Every day. Personally, I don’t mind this, but I know there are those who would disagree with me. Finding the right combination of psychotropics and dosages took literally years to determine and I know enough not to stop taking them simply because I “feel better.” As far as I’m concerned, daily medication is a small price to pay for relative stability. 

I say “relative” stability because I know that at any time, this stability could desert me. I’ve been fooled before by good feelings that disastrously disappeared when the stressors became too great or my brain glitched again, or whatever. That chasm is still out there waiting for me and, to mix my metaphors, I keep having to look over my shoulder at the possibility that it will catch up with me.

I also say “relative” stability because I cannot deny that I’m still a fair distance from functioning “normally” in the “normal” world. In addition to my meds, I still need – indeed, could not do without – the help of my husband, who is my anchor. Alone, I would be much more likely to succumb to the evil influences that beset my brain. I still have symptoms, though I find them manageable and not too intrusive on my life. I tell myself that everyone has problems and limits. Mine may be different, but they are eminently survivable. Even livable.

The fact is, though, that I may say I’m stable, but that comes with a big “for now.” I know the nature of this disorder and the fact that it may come roaring back despite anything I can do to allay or prevent it.

But for now, I am stable, or at least a reasonable facsimile thereof. And that is a victory, even if it’s not a guarantee.

 

 

A Work in Progress

In an earlier post, I discussed how I am rebuilding myself, casting aside pieces of my past and my traumas that no longer fit with who I am becoming (https://wp.me/p4e9Hv-NH).

There are a number of materials that I am using to construct the new me. Some of them are old remnants, things that I had forgotten that give me life and pleasure. Others are ways of working and remembering and loving that make me who I am going to be. What are these materials?

Memories. I have certainly lost friends because of my illness, but I have gained others and kept some of the most important. Though my memories are patchy at best, I do remember good times with good friends – laughter, love, music, meals, adventures. Some of those memories are fleeting. Some come only when someone reminds me of them. I can’t access them when I’m depressed, but those pleasant memories and steadfast friends strengthen me and give me a better idea of who I want to be.

Therapy. It was one of my therapists who gave me the metaphor of rebuilding myself, and she surely helped me do that. I hold tight to some of the things she taught me, or that I discovered with her. I have come a long way. I now have healthy coping mechanisms. I know that if I ever need it again, therapy will be available to me. It builds me up.

Medication. I do love me some psychotropics. I went through a lot of misery combined with trial and error getting to the right cocktail of meds that worked for me. I never want to try life unmedicated again. The stakes are simply too high. If that means that part of my new self will rest on a foundation that includes pills, I’m cool with that.

Creativity. In one way or another, I’ve always been a writer. Bipolar depression stole that from me. At my worst, when I was considering having ECT, a friend suggested that I could write about it. “That’s what you do!” he said. But alas, at that point I couldn’t. And I knew it. Now I can write about the bad things as well as the good and feed my new self with both. Creativity is like hypomania without the crash afterward.

Stubbornness. I’ve always said that the Coburns are a stubborn people. I know I am. And I can use that stubbornness, keep it as a part of the new me. Stubbornness is an antidote to my bipolar. Whether I am down or up, I stubbornly believe that I will someday be back to baseline, even if there is no sign of it at the moment. I will not give up. I will not let bipolar win.

Do I like who I am becoming? Yes, for the most part. I still have my old flaws, the ones I had before bipolar smacked me down, and maybe some new ones since. I can be lazy and self-centered. I sometimes fail to see the good in others. I find myself being timid and fragile when I need to be brave and sturdy.

But those are things I can work on. I couldn’t do that during all the years that bipolar sapped every bit of energy, creativity, and insight that I had. Now I can do the work and I have the tools.

I am a work in progress. But aren’t we all?

Alike But Different

Having bipolar disorder makes us all alike, but how we have it makes us different.

Those of us who are bipolar share a lot. Obviously, we have mood swings, from depression to mania or hypomania and back again. We are all affected by the stigma that attaches to serious mental illness. And we all want and try to achieve some balance in our lives.

Yet there are differences. Bipolar disorder comes in a variety of versions, the best known being 1 and 2, but now also 3 and 4. (I don’t know enough about 3 and 4 to discuss them here and now, but I’ll try to catch up on it and write about that later.) Those with bipolar 1 know more of mania than I do, but I’m an expert on depression. Others go through different levels and combinations of the two. Some people experience psychosis and may have to be hospitalized. But some of us manage the symptoms and go through life with less extreme manifestations. Some of us are seriously disabled and others decidedly less so.

Even our experiences of mood swings differ. We may go through long spells of depression or mania, or little of one and more of the other. Or we have symptoms that come and go in shorter bursts, or even in “rapid cycling” or “mixed states.”

If we’re lucky enough to get treatment for our bipolar disorder, we can have many different experiences of that, too. There’s talk therapy, including Cognitive Behavioral Therapy. Some people try “natural” treatments involving meditation, diet, supplements, exercise, and other techniques. And there are new treatments being developed, including ketamine, a revised version of ECT, and TMS (transcranial magnetic stimulation).

Of course, for many people, bipolar disorder means medications. The list of possibly helpful meds is long and seems to grow longer every day.  And the doses of those meds vary as well. So do the side effects. What works for one bipolar person may have no effect on another, even if they have the same symptoms. Effective dosages will differ. And side effects can be intolerable to one person, acceptable to another, and not even happen to a third. (That’s one reason I don’t like to give advice about medications. Ask your doctor, or at least your pharmacist.)

But beyond the simple facts of bipolar disorder, there are differences in how we approach it. Affirmations and positivity work for some people but leave others cold. Humor can alleviate the sometimes brutal reality or it can seem insensitive and cruel. Everyone has his or her own tolerance for these approaches and no one can say what’s right or wrong for a given individual.

So, do these differences divide us or do the commonalities bring us together? Personally, I think that sharing our individual experiences of bipolar disorder; our own perceptions of how bipolar affects us; our techniques and methods of getting through the highs and lows; the ways we manage our symptoms and treatments; and our sources of strength – and even moments of weakness – bring us together in spite of an illness that tries its best to separate us from one another and from the rest of the world.

I have my own struggles with bipolar and you have yours. In that sense, each of us is alone, suffering to one degree or another. But we have more in common than separates us. And if, as the saying goes, suffering shared is halved and joy shared is doubled, by sharing we have one more way of fighting this disorder and one more way of finding the good in life despite our illness.

I think too many of us spend time feeling isolated or isolating ourselves from what could be a rich source of companionship and healing. This may in many ways be an individual battle, but in another sense, we’re all in this together.

 

Let me tell you about the time I got stoned in third grade. I was a weird kid – smart, scrawny, emotionally out-of-step, lonely. I dressed funny. I was no good at sports. In short, I was bully-bait. One day I was waiting at the bus stop with some other kids. They decided it would be a fun game to throw rocks – broken pieces of macadam – at my feet. I jumped over them easily, laughing along.

Then one of them threw a rock and hit me in the head. As I was sobbing and bleeding, a passing teacher rescued me and called my mother. The kids ran off, yelling, “We didn’t mean to hurt her!”

I was wounded, nonetheless. Three stitches later, I was, if not as good as new, at least able to carry on. The scar on the outside has since faded to invisibility. The scar on the inside is invisible, too, but very much still with me.

A lot of us have invisible wounds and not all of them come with physical scars. There’s a whole category of conditions called “invisible illnesses.” They’re the ones that don’t come with wheelchairs or crutches or seeing-eye dogs. People who look “normal” on the outside but are fighting like hell on the inside. Some of these conditions are autoimmune disorders. Others are caused by developmental difficulties, uncommon viruses, and even hormonal disruptions.

Then there are the ones that live in the brain. In memories. In scars no one can see. In mental illnesses. What was wrong with me was mental and emotional, inside my brain. Maybe the other kids could sense that and that was what made me a target.

There are a lot of the walking wounded among us, along with non-ambulatory people who are also wounded in other ways. People with brain injuries or PTSD. These disorders can strike anyone and you can’t tell who those people are simply by looking at them.

In cases of serious mental illness, in particular, the wounds and scars, while internal, can be deadly. At least once, my own brain has tried to kill me. Bipolar depression, combined with irrational thinking and problems in the world outside my brain, left me with seemingly only one choice. Fortunately, I didn’t act on the pain. I lived through it.

Too many of us have invisible, internal wounds. Too many of us spend enormous amounts of time and energy pretending that we don’t. For some reason, internal wounds seem more shameful, less understandable, than external ones. A broken leg elicits sympathy. A broken brain, not so much.

I know that the rock that hit my head wasn’t what broke my brain. Bipolar disorder is much more subtle than that. Whatever its causes – and the jury seems to be still debating that – a minor physical impact is not considered to be one. The seeds of my bipolar disorder were likely already there, lurking in my differentness, my emotional oddities, my uncooperative but active brain.

But the incident sure didn’t help. It made me more vulnerable to the shocks and disappointments of life as a weird kid. It took a pothole-sized chunk out of what should have been my developing self-esteem. It opened up crevices in my brain where the doubts, fears, insecurities, and excesses of bipolar disorder could lodge.

Wounded people surround us every day. Sometimes the pain leaks out around their eyes. Other sufferers are more adept at hiding it. The important thing to know is that anybody – anybody – you see on the street or meet at work or at church or at the gym could have one of those invisible scars.

Not all the broken look broken. Not all wounds are visible. Not all scars are external.

Be gentle with other people. You never know who’s hurt inside.

Helping Someone Else

My husband used to work in a community correctional facilityessentially a jail. The residents were considered nonviolent offenders technically on parole for mostly drug crimes, but things could still get interesting. Mostly he didn’t talk about his work because he would try to dismiss it from his mind every day as he went by a certain overpass on his way home from work.

One day, though, I was bitching in disbelief about something that had happened at my work – another editor had put his table of contents in random order instead of numerical. I was appalled by the stupidity of that.

There I was ranting about it. Then my husband said, “Boy, that’s tough. All I did today was break up a fight and spot a guy who might have a septic wound. But you – the table of contents out of numerical order? Wow!” That put me in my place.

My husband was someone who helped other people. For years after he left the job, people would come up to him when he was out and about, and reminisce with him. They’d tell him about how well they were doing, how they were clean and sober, how they had jobs, how they had improved their lives. They always said thank you to my husband.

This morning when I woke up and checked my email, I found something I wasn’t expecting. There, nestled in amongst the spam, was a response to a post that I wrote back in January, about passive suicidal ideation (https://wp.me/p4e9Hv-Me).

In the reply, the person told of having thought about suicide but not acting on it. The response ended, “I’ll follow your advice and seek professional help.”

It’s difficult to describe what I felt then. Mostly, it was gratitude that my writing had helped someone, combined with not a little surprise at receiving a response at all. Sometimes writing is like shouting down a well. You never really know if anyone even hears you or if you’ve made a difference. Most of the time when I write this blog, I have no idea how the posts will affect my readers, if at all. But this time I knew – at least if the person followed through – that I had actually helped someone.

When I started Bipolar Me, it was to share my experiences with bipolar disorder and my thoughts on mental illness and mental health. If my writing resonated with someone, good. But I wasn’t writing with the intention of being inspiring, or helping people solve problems, or being a “good example.” I’m not a professional and the kind of advice I give (when I do) is largely commonsense – don’t stop taking your meds, seek professional help, thank your caregivers, and so on.

I’m not going to break my arm patting myself on the back here. There are lots of people who do the work of caring for the desperate and hurting every day. I am privileged to know some of them and to have even been helped by some. There are people like Sarah Fader and Gabe Howard who are advocates and activists for the mentally ill, who go out on a limb to do something to help the whole mental health community.

But today, for just a moment, I felt that I had really touched someone, really helped. It was a good feeling.

So there it is. I started this blog for self-centered reasons, to chronicle my own struggles and occasional victories. If it helped anyone, fine. If not, I still had stories to share. But now I find that having helped someone else has made a difference – in the other person, in me, in the world. Now I believe that my blog and my book could do more of that.

Bipolar Moonshine

Honestly, the things they ask on Quora these days! Quora, for those of you not familiar with it, is a website that allows people to ask questions for “experts” to answer. Somehow, I have become one of the people that others come to with questions about bipolar disorder. (Also the Ivy League, but that’s another story.)

Some of the questions are serious, but others are less so. “If you could stay hypomanic all the time, why wouldn’t you?” “How can I get my bipolar dad to stay on his diabetes meds?” I actually had an answer for that: You can’t. And bipolar has nothing to do with it. 

I’ve answered a few of the questions if I had the time or if a good answer hadn’t already been given. Many of the answers are written by doctors, who can do a much better job than I.

Recently, however, I saw a question that I thought it wouldn’t take a medical degree to answer:

“Is bipolar disorder causally linked to lunar cycles?”

Impressed that the writer knew the difference between “causally” and “casually,” I responded:

“No. The cause, as far as we know, is a glitch in the brain between the synapses. There may also be a genetic or hereditary component. But nothing to do with the moon.”

To my surprise, I received a reply. The writer, while asserting that he or she was also bipolar, said that my response was “no answer at all” and incorrect. Acknowledging the genetic component I mentioned, the author then proceeded to enlighten me with an “unpublished hypothesis.” (He or she also claimed to be “a bipolar scientist,” though not a neurophysiologist.)

The argument was based on several points.

  • Sexual reproduction is always in response to lunar cycles.
  • This is based on gravity, illumination, and diurnal and lunar cycles/high tides.
  • Bipolar disorder is a disruption of sleep.
  • It first manifests at or near puberty, with the onset of hormonal cycles.
  • Something about teenagers having a different sleep cycle than adults, staying up later to reproduce while the parents sleep. (I can’t say I understood this part.)
  • During the full moon, hospitals and police report increases in both people out late at night and odd behaviors and emergencies.
  • Anecdotally, the writer noticed “elevated and depressed moods not necessarily linked to lunar cycles, but not necessarily independent of them either,” noting that “periods of mania occur during full and nearly full/new moon.”

The writer’s hypothesis, if I follow it correctly, is that bipolar disorder involves sleep-hormonal cycles related to the full moon, which evolved in the days before artificial lighting. This apparently gave a reproductive advantage of being awake at night because bipolar disrupts the sleep cycle. This is noted to be “an obvious evolutionary reproductive strategy.” There was more, but that was enough for me. (The writer admitted that statistics to prove any of this did not exist or had to be derived from “Bayesian statistical methods,” which one source I looked at called “a measure of the strength of your belief regarding the true situation.”)

So, where to start? First, if the writer thought he or she already knew the answer, why write in with the question? Obviously, to seek validation or to promote a theory (or to make me look like a fool).

I could answer each point individually. (I’m not a neurophysiologist either, but I do have some experience with rhetoric and logic. And bipolar.) But let’s just take a few.

Not all animals’ reproductive cycles are based on the moon, and neither are humans’. Women have menstrual cycles at all times of the month, and men don’t. (And what about bipolar men?)

Bipolar disorder can certainly cause a disruption of sleep, but is not caused by it. That is too simple an explanation for a complex disorder.

We’ll just skip that one about teenagers reproducing while parents sleep. Its connection with bipolar disorder is slim at best.

That one about the full moon is most likely anecdotal, as reported by police and emergency room workers, but no statistics (other than perhaps Bayesian ones) seem to bear this out. And the moon is full, nearly full, or new for more than half the month. Let’s also disregard the fact that bipolar cycles are seldom exactly a month in length. I had a depressive crisis that lasted several years.

Many causes have been theorized for bipolar disorder, from gut bacteria to early trauma to brain wiring. At the moment, as far as I know, the jury is still debating. Perhaps all of these are components of the cause, though I favor brain wiring as the principal cause. But given the actual science, I’m betting that the moon isn’t the answer.

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