
By Pixel-Shot / adobestock.com
https://www.ncbi.nlm.nih.gov/books/NBK137739

By Pixel-Shot / adobestock.com

By patpitchaya/adobestock.com
There’s a tendency, once you’ve started to heal from the wounds that mental illness has left you with, to forget how bad it really was at the time. It’s not that time heals all wounds. It’s just that the memories fade as they flow backward into the past. You find yourself asking, was I really that miserable? That irrational? That out of control? Once therapy and medication – or whatever works for you – have gotten you past the crisis stage, it gets harder to remember what it all felt like at the time.
Nor do we want to. Going through an episode of serious mental illness is hard enough when you do it once. Reliving it is devoutly to be avoided, if possible.
Still, the memories get a little fuzzy around the edges. Now that you are mentally healthier, you know that you would never tolerate the kind of treatment you used to, or be so self-destructive, or put yourself down so thoroughly. The times when you did those things, when you felt those ways, seem in some sense unreal.
I think that’s one reason that some people go off their meds. It’s not just that they feel better or think that they’re cured. It’s that on some level they can’t remember how bad it really was back then. So why should they need psychotropics?
Well, I’m here to tell you that, yes, it’s much better now, but yes, it was that bad back then. You may not remember the weeping and wailing and total despair. You may not remember that you were immobilized for months at a time. You may not recollect pushing away people that were trying to help you. But all that happened.
Perhaps you don’t recall what it was that led you to consider self-harm or suicide. You wouldn’t think that way now, of course – you’re so much more stable. Perhaps you think to yourself that an abusive partner wasn’t really all that bad. After all, you got away from him/her/them. It was survivable, so it must have been not that big a deal.
But it was that big a deal. Denying the experiences you’ve had and minimizing their effects on you make it harder to see the long way you’ve come. It’s hard for me to remember now the major bipolar depressive episode that lasted for literally years, when I wasn’t able to work, or write, or read, or be there for my husband or even myself. But it happened, and I can’t deny it. I’d be lying to myself if I tried.
I’m not recommending that you wallow in the memories of the horrible times. I’d rather think about it as keeping little bits of them in a box on a shelf. Every now and then, on a day when you feel particularly strong, you open the lid and peek in. It may be shocking to realize how bad off you were, but a positive relief when you consider how far you’ve come. As the saying goes, the bad times make the good seem so much better.
Bad and good, your experiences have made you what you are today. Denying or minimizing the bad makes it seem like your journey was less long and hard than you know it was. In a way, mental illness is the yardstick by which we can measure mental health. Moving onward and upward are important, but so is being realistic about the past. Yes, it was that bad. And yes, you made it through anyway!

By Farknot Architect / adobestock.com
My husband is the mainstay of my support system and, in large part, my caregiver. I cannot count the things he has done for me and does for me every day. We’ve been married for over 35 years and during that time he has helped me through daily life, major depression, anxiety attacks, loneliness, irrational thoughts, school, therapy. He makes sure I practice self-care and cares for me as needed.
Recently, though, he needed my help and care. The other day he experienced distressing eye-related symptoms – a large “floater” (dark spot) in his vision and unexpected flashes of light. What could I do about it? First, I answered his request to get a flashlight and look in his eye, but I saw nothing.
Next I arranged an appointment for him at our eye doctor. Dan used to be terrible at admitting when he needed medical treatment, but since a heart scare he’s been much more amenable to seeing a doctor. That particular evening, he was scared and cranky, and made up excuses. He left his phone in the car. That’s okay. I had mine right there. He didn’t know the number. That’s okay. I have it programmed into my phone. I waited on hold. “Forget it,” he said. “Never mind,” I replied. “I’ve got nothing else to do.” He said he didn’t see the floater any more. I pointed out that his eyes were closed. I got through to the doctor and made him an appointment for the next day.
Naturally, I drove him to the appointment, as they would have to dilate his eyes. Then, afterward, I drove him on several other errands (including an appointment with a different doctor) and made sure he ate lunch. I canceled one of the errands and put off others when I saw how tired and nervous he was getting. I took him home and tucked him in bed. (The floater turned out to be nothing truly alarming, just an effect of his aging eyes. He named it “Freddie the Free-Floater.”)
Dan has done almost exactly the same for me, many times. I could usually make my own appointments, but he encouraged me to do so. He has driven me to appointments countless times. He makes sure I eat. When I run out of spoons, he cancels or postpones errands, or even runs them for me. He reminds me when I need to have a lie-down or to sleep or to shower.
It was unusual for me to be the caregiver in this situation, and at times difficult, but I didn’t begrudge it. How could I possibly?
Of course, later in the day, I had a crisis and a mini-meltdown of my own, and there was Dan, ready to be with me, talk me through it, and make sure I didn’t skip a meal.
I know this is what marriage is supposed to be – partners helping each other through their individual and mutual times of difficulty. I also know that mental illness can put a terrible strain on a relationship. I admit that I am very needy at times, and was even more so at other times in my life.
But this time I got to be the strong one and take care of his needs before my own. And I was pleased and proud to be able to do that. Often there’s little enough that I can do for him, except offer him encouragement and remind him that I love him and appreciate him and all he does for me. If he asks for something he needs, I try to make sure he gets it (except for the $900 woodchipper, I mean). And I do what I can that benefits both of us – working to bring in money, paying the bills, doing computer research, handling phone calls, reminding him of appointments when I can – mostly stuff that involves computers and phones and recordkeeping and occasionally knowing where missing stuff is. And reassuring him when he gets trapped in the depression that he also suffers from that I love him and that he is strong and good and that he needs to take care of himself, and that if he can’t, I will try and do my best.

By pololia / adobestock.com
Having bipolar disorder was one of the reasons I decided not to have children. Really, it was having major depression, which was what I was diagnosed with at the time.
I wasn’t so much concerned with passing my condition on to any potential offspring, since, at the time when I was contemplating motherhood, the genetic links were not yet that firmly established. Now that I know more about it, I think that might have been another deterrent. My parents had no idea what to do with me when bipolar symptoms started happening, and there’s no guarantee that I would have done any better. I’d like to think I would, but there’s no telling, really.
No, what I feared was having to go off my medication while pregnant (and breastfeeding, should it come to that). I was terrified of being unmedicated and I knew that psychotropic drugs were not good for pregnant women or their developing babies. Once I had discovered the benefits of Prozac and other mood-regulating meds, I knew I never wanted to be without them again. I never wanted to again fall into the pit that I had clawed my way out of. (In truth, that pit was waiting for me anyway, when I experienced a major depressive episode many years later.)
Postpartum depression scared me too. I had heard the horror stories of women killing their children and/or themselves while suffering from the illness. I knew how out of control I could get with just plain ol’ garden-variety depression and anxiety. Adding postpartum hormones to the mix could be a really bad thing.
But the main reason that I decided my bipolar disorder made it unwise to have a child was that it would be unfair to the child. How to explain to a toddler that mama couldn’t get out of bed today or that she burst into tears for no apparent reason? How to explain weeks or months like that? How to deal with a child jazzed up on mama’s sudden hypomanic jag, who would then be let down when she crashed? How to soothe a child’s anxieties when mine were making me jump out of my skin? How to take care of a child’s essential needs, when I suck at taking care of my own?
Is that selfish? I know there are people who would say it is. That when the time came, I would suck it up and do the best I could. And I might. But would that “best I could” be good enough? I’ve heard it phrased that I was too involved with giving birth to myself – a relatively stable, reasonably happy, mostly functioning self – to give birth to someone else. And I think there’s some truth in that. It’s been a struggle, filled with despair, misery, hard work, setbacks, immobilization, dangerous thoughts, and living too much in my own head. To do the work of bringing myself to some baseline of functioning while trying to nurture and bring up another person daunts me.
I do understand that there are women with bipolar disorder and even postpartum depression who have children and that those children can be happy, healthy, and as well-adjusted as any modern child ever is. I don’t know how they do it, though. I was fortunate that I had a choice of whether or not to have children. I know that not all women do, and that many are delighted with their choice – whichever way they decide. I know that there are those who desperately want children and are unable to have them. I was fortunate that my husband didn’t push the issue, despite the fact that he would have welcomed a child.
I also had irrational thoughts about that potential child. I imagined that if the child were a boy (which run in my husband’s family), Dan (whose inner child is, shall we say, close to the surface) and the little boy would be natural allies and I the odd one out. He would be the fun dad and I the not-fun mama. And while that’s somewhat irrational, it also might be partly true. It took a long time for me to learn how to relax and have fun and share it with another person.
The one time I was open to having a child was when my father was dying a slow death. I thought that if he was going to see his grandchild, I’d better produce one promptly. Fortunately, it didn’t happen. I later realized that that was a really poor reason to bring a new life into the world.
What I’m saying is that the decision is not – was not – an easy one. Having a mental disorder makes it even more difficult.

By Chris / adobestock.com
I went to a very good university. I learned nothing about bipolar disorder from the curriculum. I didn’t take any classes in psychology, though at that time (the 70s), I’m not sure they would have taught that much about the disorder – almost certainly not that there were two versions of it.
I could have taken psychology. There was a requirement that all students had to take two classes outside their major – there were called distribution requirements and were intended to make us more well-rounded individuals. My major was English and I took History of Science and Astronomy (also Beekeeping, but that’s a story for another time).
It had not escaped everyone’s notice that I had psychological problems by that point. My high school had recommended to my parents that I be taken to the school district’s psychologist. They left the choice up to me and I declined, as I thought it would look bad on my permanent record. (It never occurred to me how the behavior leading to that recommendation looked.)
So, I toddled off to college undiagnosed and untreated, but surely in the throes of bipolar disorder. Gradually, I became aware that my mental state was, to say the least, unsteady. I had insomnia – I would spend some nights sitting in the hallway, staring at a poster. I had mental confusion – I changed my major from Linguistics to English based on an irrational assumption about the job possibilities. And I took a year off because I was too depressed to continue. (I went back after a year of working in a restaurant.)
There are certainly things I regret. I regret that I missed so much that was educational, enlightening, or entertaining. I regret that in a fit of hypomania I joined a sorority and tried to fit in while living there. I regret the cutting. And, perhaps most of all, I regret that, once, a fellow depression sufferer asked me to meet her one evening in the student union building to talk – and I didn’t go. I was too involved in my own pain to be open to hers.
As the years went on, I got worse. I had physical problems due to anxiety. I had disastrous relationships. Once or twice, friends became so worried about me that they insisted I go to the school infirmary because they were afraid I might be suicidal. I stayed a couple of days, denied suicidal ideation, and went back to my regular college life.
I did try to get help. At one point I joined a therapy group. One of the exercises that we had to do was to start and maintain a brief conversation with someone else in the group. “I can do that,” I said. I had learned to do that in the sorority, and besides, I was able to fake normal for that length of time. The therapy group never addressed my real problem and so did me no good.
If I knew more about bipolar disorder at that time in my life, I still might not have gotten help for it – there wasn’t that much help available at the time. But I might have understood myself better, done better academically, enjoyed more of the varied experiences that the university and the town had to offer, and been ready to accept help when it finally appeared (in the form of Prozac).
When I finally did get help, it was because I drove past a building with the sign “South Community Mental Health.” I thought, “I don’t know what I’m feeling, but whatever it is, it’s not mentally healthy.” So I began the journey that brought me to where I am today – still bipolar, of course, but diagnosed, treated with medication and therapy, and living a pretty good life. I even went back to college and got a Master’s degree.
I do still think about those years of struggle. I’m glad they’re over, but I still have those regrets. I don’t regret the university experience, though. It did broaden my horizons, introduced me to some people who are still dear friends, and taught me that I needed to keep searching for help with my problems. And that was a valuable thing to learn.
One of the ways I know when I’m slipping into bipolar depression is when I lose my sense of humor. Not even my husband’s awful jokes get a rise out of me. I also lose interest in many things that I ordinarily enjoy – reading, puzzles, and games, to name a few. The joys of life are few and far between.
Lately, I’ve noticed that I seem to be slipping again. I don’t feel overly depressed yet, but the signs are creeping up on me.
I think I first noticed it when it occurred to me that I had not done the New York Times crossword puzzle for at least a week. The Sunday Times puzzle is, or was, something I looked forward to every week. Now, I may not get around to playing it till mid-week or simply wait for next week’s, in hopes that I feel better. Most of my other entertainments have fallen by the wayside as well.
I know part of the problem is lack of spoons. I have been taking on extra work in my transcription job, simply to make extra money, which we do need. But it means I have given up almost all my days off and have had to get up very early to finish assignments. There’s little of me left over to do frivolous things, the things that bring joy.
On top of that, I have a house to furnish from top to bottom. I do not find shopping relaxing or enjoyable. In fact, I loathe it. Yet there I am, once or twice a week, at the vast home improvement store, picking out lighting or flooring or something else the contractor needs right away. It’s exhausting, not rewarding, and it eats into my spoons and my days off even more. It’s almost like having a second job, what with all the research, phone calls, appointments, choices, and decisions. Perhaps I’ll be able to rejoice in our new digs when it’s all done, but right now I can barely picture it.
The lockdown isn’t helping, either. One of the things I used to enjoy was going out to my favorite restaurants or discovering new ones. Now that is right out. I know some people are again indulging, but I’m not willing to risk my life for a cheeseburger and a brew or even tiramisu. My space and my life are constricted to a one-bedroom apartment, with a laundry/utility area substituting for my beloved study.
I do still have some comfort in my life, which is a mercy. When it all gets too much for me, I knock off for a while and watch some cooking shows on TV, which I find soothing, or read a chapter in a book before I fall asleep. At least I haven’t lost my ability to read, which I did once during a major depressive episode. And I’ve been able to maintain my blogs, which gives me satisfaction.
But as to joy, there is none. Life has become a tedious slog through one damn thing after another. One of the questions they always ask you during the depression screener at the doctor’s office is, “Do you no longer enjoy things you used to?”
I’d say that’s true. Or at least I no longer have the wherewithal to do the things that I used to enjoy. Is it a marker of bipolar depression, or simply a reaction to all the things piling up on me right now? And which one causes the other?
On the surface, my retreat from joy is not excessively alarming. It has not yet reached the point of a major depressive episode. I can still do my work and my work on completing the house. What I can’t do is find a way to take mental time off – and I know that’s not good for my emotional stability.
I guess I’m just afraid that, in my life as it stands right now, there is no room left over for enjoyment. And that feels a lot like psychic numbness and depression. Perhaps when life settles down a little bit – if it ever does – I will get some of the enjoyment back. Perhaps it will become clear to me whether this exhaustion is circumstantial or anhedonia, a symptom.
Nevertheless, I plod onward, hoping for the day when satisfaction, relaxation, engagement – joy – will return. So far, it always has, though sometimes it seems forever before it does. That’s the nature of this illness and of recovery.

Delphotostock/ from adobestock.com
It often seems that bipolar disorder and especially bipolar depression narrow your life down to the fewest possible choices. Try to take a shower or stay in bed. Eat a handful of cereal or skip eating. Cry or … cry. And that’s all true. These disorders are quite limiting.
However, it’s also true that sometimes we’re faced with too many choices. Right now I am in the process of having our house rebuilt after it was destroyed by a tornado. Every other day it seems the contractor has something new we have to pick out – paint colors, floor coverings, lighting fixtures, ceiling fans – even the color of the grout between the tiles in the kitchen, an aspect of decorating I didn’t know even existed. It’s overwhelming.
The worst was the paint colors. Sherwin Williams has a color palette about 100 pages thick, with seven different shades on every page. My husband and I have a hard time trying to pick a place to go for lunch, much less what color paint we’ll likely have to live with for the rest of our lives.
Needless to say, I dithered for a long time about the colors. The only reason that it didn’t totally immobilize me is that I employed the technique of weeding. Once I had decided on a color for each room (my husband left that largely up to me, except for his study), I began looking at the paint samples and not choosing what I liked, but pitching out what I hated. No beige anywhere. No teal, not even for the bathrooms. And so on. What was left was a much smaller assortment of choices, which hubby and I were able to process. He always liked the lightest version of a color and I the next darker, but we were never far apart.
We got through the process in just a couple of weeks, and with only one real regret (the green we chose was yellower than we really liked, but we’ll mitigate that by covering the walls with photos, posters, and art prints).
Exhaustion is another aid to making choices. I have some mobility issues and can’t walk for very long, especially on the concrete floors in home improvement warehouses. And I’ve always hated shopping, except on the internet. At some point in the process of looking and comparing, I just throw up my hands and say, “What the hell! That’ll do!” and arbitrarily pick one of the two light fixtures that have most attracted my attention. It’s not like my world will fall apart if I don’t get the one, exact light fixture that complements the room. I just need to be able to see. Then I go home, have some iced tea, and put my poor, tired feet up.
One of my therapists once taught me another technique for making decisions – flipping a coin. This sounds obvious, but it’s not. The simple act of coin-flipping can work in one of two ways. Either you can leave the choice in the hands of the coin (as it were), or the result of the flip can focus your mind on what it is you really want. Any number of times Dan and I have played, “Heads, lunch at Frisch’s; tails, Waffle House.” If it comes up tails, we often instantly realize that it was Frisch’s we were wanting all along.
Frankly, I don’t know whether it’s better to have a limited number of choices or a lot. Either way can be mind-numbing, a seemingly insoluble riddle that threatens to stymie you into making no choice at all. (Or, as the therapists tell us, “Not to decide is to decide not to.”) But it is possible to develop techniques that allow you to make those choices and continue with your life.
Of course, I know these are comparatively trivial decisions. I sure couldn’t have figured out “leave or stay” by flipping a coin, especially as seriously unmedicated and out of control as I was at the time. “Get a job or go back to college” was also an important one, but ultimately an easier one to make – I envisioned the situations and asked myself which I’d rather be doing, writing press releases or reading books. The choice was clear at that point. Both were major turning points in my life, but one was excruciating and the other just another choice. I attribute that in large part to the medication and therapy I’d had in between and the coping mechanisms that I had learned and practiced.

kues1 from adobestock.com
Ha!, you say. That’s an easy one. I know the answer to that. It’s like the difference between walking on pins and needles and walking on eggshells. For me, anxiety is the pins and needles, while mania is produces the eggshells. Pins and needles hurt more, but eggshells are easier to break. Anxiety causes me more pain, but mania has me treading carefully on a fragile edge.
Anxiety and Mania
I know more about anxiety than mania. My diagnosis is actually bipolar 2 with anxiety disorder. As such, I never really experience true mania. Hypomania is about as far as I get. And believe me, that’s enough.
First, let’s start by admitting that anxiety and mania have a lot in common. At least they do in my life. Both of them make me frantic. Both of them make me obsessed with money. Both disrupt my eating habits. And both of them make me very very twitchy.
Frantic. Both anxiety and hypomania make me feel frantic, like there is something that I need to be doing to alleviate them. I know this isn’t true, that they are out of my control, but it feels that way. I get all revved up inside, a nagging, prickly feeling that jangles my nerves and irritates my brain. I try desperately to think what it might be that would calm the feeling, but there is nothing this side of an anti-anxiety pill, which might or might not help.
Obsessed with money. With anxiety, I obsess about the bills and how I am going to pay them. With mania, I obsess about what money I do have and how I can best spend it. Since this is, after all, hypomania, I tend not to go on wild spending sprees, but I have been known to buy myself or my husband presents, telling myself that the costs are comparatively reasonable and that at least I have limited myself to a non-extravagant amount. (Which may be the anxiety and the hypomania arguing with each other.) With anxiety, I try to anticipate all possible bills and juggle their amounts, due dates, and relative necessity (power cut off or trash removal cut off). I take on extra work, not because I think I have the wherewithal to do it, but because I want the extra money, no matter what it costs me in terms of physical and emotional energy.
Eating habits. Both anxiety and hypomania make me eat too much. With anxiety, no doubt I am trying to fill an existential hole or find something to distract me from my worries. With hypomania, I crave the relatively safe sensations of rum raisin ice cream; cinnamon Danish; or salted, buttery popcorn.
Twitchy. Both anxiety and hypomania can cause the shakes, tremors in my hands and arms and legs. Alas, not for me the euphoria of true mania, but the inherent sensation that I’m doing something wrong at some level. I can’t even enjoy hypomania without guilt.
There are differences, however.
Anxiety leaves me immobilized, in a way that hypomania just doesn’t. You’d think with all that nervous energy vibrating around my body and brain, I would hyper myself into a frenzy. Instead, all the jitters cancel each other out, leaving me with no place I can go to escape. My fears leave me paralyzed. The money worries leave me unable to decide what bill to pay first. I can’t decide whether it’s better to stay awake and try to read (if I have enough ability to concentrate), or take that anti-anxiety pill and try to rest, if not sleep.
Mania can make me productive, in a way that anxiety can’t. When I’m hypomanic, I can write, or at least put words on the screen. (Whether they’re any good or not is anybody’s guess.) But at least I have the illusion of motion, the impetus to create. That extra energy seems more focused, at least in comparison with anxiety. When I hit a hypomanic jag, I sometimes try to get ahead on my blogs, or at least jot down titles and ideas that I hope I can decipher and develop later.
Neither state of mind is preferable. Anxiety is the more painful and hypomania the more fragile. Anxiety is more familiar to me and hypomania more rare and even exciting. But I can’t choose. I can’t say that I like hypomania more than anxiety, although it does seem to have more benefits. But I know that it can be destructive and futile, promising things that it can’t fulfill.
Given the choice, I’d rather not walk on pins and needles or on eggshells. Level ground is fine with me.
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