Bipolar 2 From Inside and Out

I’m Still Calling My Bipolar a Chemical Imbalance

06 21 20

Romolo Tavani from adobestock.com

There has been a furor lately in the psychiatric community and among psychiatric patients about the causes of depression and other mental disorders, as well as the appropriate treatment and the appropriate name for them. Among the issues are whether neurotransmitters in the brain cause these illnesses and whether biopharmaceuticals will help relieve them.

One of the main arguments against the neurotransmitter theory is that we do not really know whether depressed persons (most of the arguments use depressed persons as the easiest example) really have lower levels of seratonin, norepinephrine, or other brain chemicals than the general population. What is known is that increasing the amount (or decreasing the deficiency) of those chemicals helps many people recover from their condition, at least partly.

No, seratonin et al. are not “magic bullets” for depression. They don’t work for everyone. They can become less effective as time goes on. And no one quite knows how they work. But in many cases, including mine, they were the first – and at the time only – thing that helped. The explanation was sufficient for me, even when my doctors added new drugs to the “cocktail.” Advances in biochemistry, ya know.

Now, however, various scientists, psychiatrists, patients, and reporters talk about “debunking” the biochemical theory. Instead, they say, depression and other disorders are caused by traumatic events and stressors that change the way our brains react to stimuli – that the environment influences the brain in ways that lead to psychiatric illness.

But, it seems to me, we have a chicken-and-egg question going on here. Am I more susceptible to depression (or bipolar) because of the traumas and stresses in my life (especially my youth)? Or has my brain chemistry made me more susceptible to the traumas and stresses?

How, anyway, are we going to prove either theory?

Part of the difficulty seems to me to be the backlash against the pharmaceutical industry, which has surely done some sketchy things of late. Biopharmacy and drug treatment of various illnesses have become less popular as people question whether we really know what’s going on in the brain and whether we really know what those chemicals do.

Psychiatry itself follows the arc of a pendulum. At one time psychotherapy – the “talking cure” – was all that it had to offer. Later, with the advent of Haldol and Thorazine and Prozac and their cousins, it seemed that physical causes were more likely to be responsible for mental illness than unresolved childhood issues. This threatened to put psychotherapists out of business.

(I have always been helped by talk therapy, whether or not I was medicated for bipolar disorder. It has helped me through crises, taught me about healthy coping mechanisms, provided a reality check on my feelings, and so much more. I would never have made it as far as I have without both pharmaceutical help and psychotherapy.)

Now the biochemical theories are questioned and psychotherapy is in the ascendance again. Rather than treating our brains, we are to be treating our memories, uncovering the traumas that are said to have made epigenetic changes in our brains that manifest as depression, anxiety, or whatever. (I don’t think schizophrenia is included. There are just too many factors tying schizophrenia to genetics and the brain.)

It’s true that I had traumas in my young life, though never to the extent that many others experience. Were they brain-changing events? I wouldn’t have thought so. I took biopharmaceuticals and they helped. Was I mistaken about the causation (post hoc ergo propter hoc)?

If all this dissension leads to better ways to help sufferers of mental illness, then good. Plain and simple. But if it causes patients to abandon treatments that are working for them, I am less sanguine. In our pill-shaming, homeopathic culture, it just may be possible that the pendulum has not swung as far as all that.  I’m not giving up my psychiatric drugs based on a theory, when they have helped me so much. And need I point out that the “latest” treatments for depression and bipolar also target the brain and not the traumas they may have endured? Ketamine, ECT, and TMS all affect the brain directly. 

Also, let us consider that part of the objection to the “chemical imbalance” theory is the idea that it more likely promotes stigma to say a person has a “brain illness” than a “psychosocial difficulty.” That’s all well and wonderful, but I would argue that it calls for more education rather than a change in how we treat. “Neurodiversity” may be a less stigma-laden term, but so far it shows little sign of catching on outside the ASD community. (Ask the person-on-the-street what “neurodiversity” means. Then ask what “mental illness” means. Neither answer will be helpful.)

If this remains a debate about what we should call mental illness, then I suppose there is little harm done. But if it affects the way we treat mental illness, that’s another matter entirely.

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Mental Health

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Can Computers Help Diagnose Depression?

06 14 20

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I recently spotted a headline that made me stop and read the story. It was from iflscience and the article was “People with Depression Use Language Differently.  Here’s How to Spot It.” Those of you who know of my abiding interest in mental illness, science, and language (I once studied to be a linguist) can imaging how my virtual ears perked up. The article also referenced technology and how it was being used to analyze people’s language.

But before we get to the article, a little background on computers, language, and therapy.

As early as 1950, computer scientist Alan Turing devised a test (now named after him) that challenged computer programmers to create a device that could produce language indistinguishable from actual human communication. This was in the days before computers could speak, so all the interactions were text only. Pairs of computer-and-human partners carried on a conversation, and an observer had to evaluate which of each pair was the machine. If the machine produced language that the evaluator could not distinguish from human speech, the computer was said to have passed the Turing Test. It was an early achievement in machine learning and artificial intelligence. (Only one computer is said to have ever passed the Turing Test, and even that achievement is in doubt.)

In the mid-1960s, another computer program called ELIZA was developed by Joseph Weizenbaum. ELIZA used “scripts” to reply to human communication. One of the most successful scripts was “DOCTOR,” which was based on therapy developed by psychologist Carl Rogers, who was known for repeating non-directional versions of what a client had said back to him or her. (“I’m mad at my mother.” “Why does your mother make you feel mad?”) Surprisingly, many users felt that the program displayed human-like feelings and it was believed that ELIZA could be helpful as an adjunct to psychotherapy – a very early version of a psychological chatbot, in other words.

Now we get to the iflscience article (which was previously published in Clinical Psychological Science and The Conversation). It divided the language that the computers analyzed into content and style. Not surprisingly, the content of the writings of depressed persons contained more words like “lonely,” “sad,” and “miserable.” But the computers noticed that in the realm of style, the depressed subjects were more likely to use first-person pronouns (“I,” “me,” “mine”) than third-person pronouns (“she,” “he,” “him,” “they”). Researchers theorized that people with depression were more focused on themselves than on other people and that pronouns are a more reliable marker of depression than content words.

On mental health forums that were analyzed, “absolutist” words such as “absolutely,” “nothing,” and “completely” were even better markers of depression than content words or pronouns, especially in anxiety and depression forums, and particularly in suicidal ideation forums.

What does this all mean? Researchers are using the knowledge gained from the studies to analyze natural language specimens such as blog posts, with results that sometimes outperform those of therapists. And because of machine learning efforts, the computers are only expected to get better at identifying not just depression and anxiety, but other conditions such as self-esteem problems.

At the moment, computers can analyze only written samples of language produced by those suspected of having psychological problems – blogs, poems, letters. This, of course, might be perfect for use with those chatbots that rely on text-only interactions. And psychologists might be trained to listen for language cues in the conversations they have with clients.

Will the depressive language experiments prove more successful than the Turing Test in mimicking human interaction and more functional than ELIZA in providing helpful feedback to those suffering?

Personally, I hope that the experiments continue, and continue to show promise. Although computers are not likely to take the place of human therapists, they may be able to help identify people who need the most immediate help, or even assist in filling the gap for populations with no easy access to psychological services.

 

Reference

https://www.iflscience.com/health-and-medicine/people-with-depression-use-language-differently-heres-how-to-spot-it/all/

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Mental Health

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Fear of Offending

06 07 20

By Drobot Dean from Adobestock.com

I have to keep a close watch on what I say in public or post online. I am afraid of offending people. Many times I have lost friends because of things I’ve said or done.

Is losing friends because of my bipolar disorder? In a way, yes. Is being afraid of offending others because of my bipolar disorder? In a way, yes.

I was not very well socialized as a child. The house I grew up in was very insular. My parents made few attempts to mix and mingle with neighbors or other school parents, so I didn’t see much of that as a young person and learn the unwritten rules. (My father did mix and mingle with the local gun club, but there were not many persons of my age and gender there.) I never went to preschool because I had a sister, we were very close in age, and my mother figured we could simply play with each other. (This was in the days before formal “playdates.”)

As I got older and my bipolar disorder began to manifest, I was even more out of sync with what the other kids were doing and saying. My mood swings left me laughing uproariously at things no one else thought were funny, or being gloomy and surly as a self-isolating hermit. I never learned the rules at school, either, of how to negotiate the complex patterns of behavior required as a student. I didn’t even know enough not to show off my intelligence, which didn’t win me many friends.

As I grew older, I got in the habit of tapping my face – symbolic slaps – whenever I said something that I realized I ought not to have said. (This was both puzzling and annoying to my companions.) It was a reminder to me to keep more of what I thought under wraps.

Of course, at the time I didn’t know that I was bipolar. I thought I was just weird. It never occurred to me that my brain was different, that I reacted in peculiar ways because of something I could not, at the time, control. I tried to be quiet and unobtrusive, but the manic humor kept leaking out, usually when no one else thought whatever it was was funny. I garnered a reputation as an oddball, even among the odd people who befriended me.

Later on, in the world of work, I was even more out of my depth. I still didn’t know how to socialize. I couldn’t manage “team-eating,” the mysterious rituals of the groups of workers who lunched together. I consciously practiced my socializing with the few people who would put up with me. I observed social interactions, but I never really internalized them.

I made statements that were meant to be funny, but they came out sarcastic, and I lost friends. I made statements that were meant to be assertive, but they came out bossy and I lost friends. I became more and more afraid to say anything that might be seen as hurtful, but I still did.

All of this made me afraid to offend people, so I began to shut down. I kept my jokes to a minimum. I didn’t even try to join the ladies who lunch. My social life was practically nonexistent.

Then came the internet and, especially, Facebook. Every time I wanted to post something, I had to run the content through the internal filters I’d built. Was it too racy? Too political? Too self-revealing? Too something? Would it offend someone and lose me more friends?

I developed techniques to soften my replies to other people’s posts. I’d agree with any part of a post I could and then add my real opinion, very softly. (I agree with you that there’s a lot wrong with our economic system, but it’s very complex and I think more regulations will be needed to improve it. I agree that most police are protective and well-regulated, but I think training in dealing with mentally ill persons would benefit everyone.) I became wishy-washy.

How does this reflect my bipolar disorder? Losing friends was one of the big traumas I went through as a child and I never wanted it to happen again. My first physical trauma was at the hands of other children, who threw rocks at me. My first bipolar “break” was a result of being humiliated by my best friend. (“Kids can be mean,” my parents said, but I knew deep inside it was all my fault.) Losing friends became one of my major triggers, something I would try anything to avoid. I just wasn’t very good at avoiding it.

Gradually, I am getting better at socializing and at speaking up without the constant fear that my words and actions will drive away people who care about me. I still try not to be confrontational, but if a meme expresses something I care deeply about, well, I will repost it. I still try not to insult the persons closest to me, but sometimes it takes me a while to figure out how to say something with just the right words in just the right tone of voice.

Bipolar? I think my glitchy brain got sidetracked by the illness when I should have been learning the ways most people behave. Now that my illness is mostly under control, I am trying to make up for lost time.

 

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I Don’t Need a “Pep Talk”

05 29 20

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Here’s the thing. Many people, when you mention a problem, feel obliged to help you fix it or fix it for you. When the problem is related to mental illness, though, that can be counterproductive.

The fact is, most serious mental illness can’t be fixed, at least not by a friend or loved one. To try is to invite frustration on the part of the fixer and worse feelings on the part of the fixee.

Some of the worst help we are offered are pep talks, which are meant to be encouraging. Smile more. Keep trying. Other people have it worse. Everyone goes through this.

No, says my stubbornly glitchy brain. Everyone does not go through a major depressive episode. And when I’m having one is not the time I can concentrate on what constitutes “worse.” I can try all I want, but my bipolar disorder isn’t going to just go away. And smiling when I’m ready to cry is a suggestion that denies my perception of reality and encourages me to lie about my feelings.

You can see much of this kind of advice on Facebook, for example. There are always memes that exhort you to look on the sunny side, have a positive mental attitude, or choose to be happy. But it’s easy enough to scroll by them.

These pep talks hurt more when they’re offered in person by someone you know or even love, especially when that person knows you have a mental disorder. You can’t just scroll by someone you love telling you that, in effect, it’s your own fault that you don’t get better.

I know these sentiments are kindly meant (except for the ones that blame you for your own condition). But the reality is that we can’t cure ourselves of SMI by smiling, or jogging, or thinking happy thoughts, or eating turmeric. We can’t cure ourselves at all.

But we can make things better, through therapy and medication, and yes, through some things that are not cures themselves but adjuncts to healing – physical activity, engagement, mindfulness, self-care, and the like. Who knows? Maybe even turmeric.

So, if pep talks don’t work, what can you do instead? What might actually help your friend or loved one? Here are a few suggestions.

Treat the person with mental illness the way you would treat a person with any other illness. I’m not suggesting sympathy cards are appropriate, but a phone call or text message saying you care is usually welcome.

Listen without judgment. Don’t offer advice. If the person opens up to you, respect that. Don’t minimize the problems. If the person doesn’t respond, wait a while and try again.

None of that will “fix” the person, but you know what? Neither will a pep talk. My brain, for one, is simply unable to process them, digs in its metaphoric heels, and says, “Oh, yeah?”

So, what are some things you can say instead of giving a pep talk? Try these.

I’m here for you.

You can always call me.

I’m sorry you’re hurting.

Tell me if you need anything.

Do you need distraction?

Do you need to be alone for a while?

Do you need to talk?

What can I do for you? (The answer may be, “nothing,” but at least you cared enough to ask.)

If you are also suffering from SMI, there is even more you can do. You can say, “I understand how you feel,” and mean it. You can recommend a therapist. You can congratulate the person on any accomplishment, the kind that wouldn’t seem like an accomplishment to anyone else.

In general, stay away from platitudes, feel-good sentiments, and quick fixes – unless you know that the person responds well to that kind of encouragement. They’re too easy to say and too hard to follow through on. Save them for people who are simply having a bad day, not someone who has mental illness.

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The Big Disruption

05 24 20

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I don’t know if I’ll be able to make a blog post next week unless I can write an extra one this week and save it. Next week at this time we’ll be moving from the three-bedroom house we’re currently living in to a one-bedroom apartment, where we expect to stay for three months at the maximum.

The circumstances that led to this situation are complex and the whole process has been feeding into my triggers and issues. No, bipolar disorder won’t stay on hold for even two weeks so we can get this accomplished.

Overthinking. First and perhaps foremost, I hate cleaning, packing, and moving, especially when there’s a time limit on them. I even hate packing for vacations. (I’m okay once the vacation has started. It’s just the lead-up to it that gets me.) When I pack, I always overthink and almost always overpack, as if I’m planning for the Normandy invasion. This is exhausting.

Anxiety. I often have anxiety dreams about packing and moving, usually having to do with moving into or out of a dorm at college. This was indeed a stressor for me, as I lived someplace different every year and went home over the summer. Apparently, it has never quite left my psyche. This set of moves will be unpleasantly like those – a massive, frantic rush at the beginning of summer and another set of the same, though one hopes not as frantic, at the beginning of fall.

Uncertainty. What happened to us is that our house was destroyed by a tornado a year ago. Since that time, we have been living in a house provided for us by the insurance company. Now, however, they’ve put us up here as long as they care to and our former house isn’t completely rebuilt and ready for re-occupancy yet. We’ve had just over a month to make alternative arrangements. Combine that with trying to get a three-month lease, and a one-bedroom was all we could find. (We call it “The Shack.”)

Belonging. I’ve had a hard time bonding with places where I’ve lived – they’ve never truly felt like home to me – and I hope that the rebuilt house, which we are completely furnishing, will have that feel of “mine.” But The Shack will feel the least like home since any I’ve lived in since college. Even my study, where I do my writing, will be a utility room with a table and chair rather than a desk. Nor will we have much in the way of furnishings. A bed, a television, two chairs, boxes for bedside tables, and not much else. The rest is in storage or not to be delivered until permanent move-in.

Immobilization. It is the one-year anniversary of the tornado and we will be swept up in a virtual tornado of packing and moving. I have already noticed tornado dreams and severe storm-related anxiety as the date approaches. I anticipate being virtually immobilized just when I need to be most productive and proactive. It already feels overwhelming.

Isolation. And no, there is no one around who can help us move. It’s just me and my husband, with maybe a little help from U-Haul and Two Men and a Truck. My husband suffers from depression, and between that and my bipolar disorder, we’ve been isolating so much that even with pizza and beer we couldn’t pull together a work gang.

We’ll get through, I know. And we’ll get through living in The Shack until it’s time to go home at last. I just wish I could see a clear path between now and then.

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Mental Health

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New Diagnosis, New Drug

05 17 20

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While never leaving the category of persons with a serious mental illness, I seem to have also become a person with an autoimmune condition. Here’s what happened.

About two months ago, I noticed a hard lump growing on my forehead and another developing underneath my eye. Then one night, I rolled over in bed to feel a strange sensation in my right forearm – an area of thickened, hardening flesh under the skin about the size and shape of a cuttlefish bone. This seemed sudden and alarming compared to the forehead lump, so off I went to the emergency room. They diagnosed cellulitis and gave me a scrip for antibiotics.

A follow-up visit to my PCP revealed no change in my arm, but again a provisional diagnosis of cellulitis and another course of antibiotics.

When that failed to clear matters up, the doctor decided to biopsy the lump on my forehead and send me for an ultrasound and MRI on the arm. The biopsy revealed the lump to be a sarcoid, which immediately changed the thinking about my arm and cellulitis. It now seemed likely that that was sarcoidosis too.

Sarcoidosis is, according to the Mayo Clinic, “a disease characterized by the growth of tiny collections of inflammatory cells (granulomas) in any part of your body — most commonly the lungs and lymph nodes. But it can also affect the eyes, skin, heart and other organs.” I’m lucky that in my case, only the skin appears to be affected. Having my lungs affected would be pretty scary right about now. (The Mayo Clinic adds, “The cause of sarcoidosis is unknown, but experts think it results from the body’s immune system responding to an unknown substance.”)

Then the real fun began. The treatment my doctor prescribed was steroids (cream for the forehead, pills for the arm), which makes sense, but didn’t play well with my bipolar condition or meds. “Mood changes” appears on the Mayo Clinic’s list of potential side effects, along with agitation, irritability, and a host of other physical and psychological difficulties.

After a few days on the steroids, I began experiencing chills, raging headaches, insomnia, and the dry heaves. A tele-consultation with my doctor later and my dosage was reduced, which seems to have helped (and the steroids seem to be helping reduce my mysterious cuttlefish).

“Steroids are a bipolar sort of medication,” my doctor told me.

“Appropriate,” I said. (My PCP knows about my bipolar disorder. He’s read my books.)

Dr. S. continued, “One time steroids can make you feel terrific and another time they can make you feel miserable.”

“I’m gonna say miserable,” I replied. “I haven’t slept or eaten in three days.”

“Well, they can get you so revved up that you can’t sleep.”

“Actually, it was the dry heaves that kept me up,” I explained.

A mutually agreeable course of action was decided on. I would lay off the steroids for a day, then resume with a lower dose. That’s just what I have done, and my symptoms are better. At least I’m no longer retching.

What does the future hold for me? It’s hard to tell. Potentially steroid injections in my arm, and having the lump on my forehead removed if the steroids don’t resolve them. Potentially mood swings that I won’t know whether to attribute to my bipolar condition or to the steroids.

I hate the thought that this is an autoimmune disorder – that my body is attacking itself. Of course, my brain has been attacking me for so long, I really ought to be used to it by now.

 

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Mental Health

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The Experiment That Changed Psychiatry

05 10 20

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The experiment was famous in the annals of psychiatric history. As I put it in a post in 2016:

A professor at Stanford University devised a simple experiment. He sent eight volunteers, including both women and men, to psychiatric hospitals. Each person complained of hearing a voice saying three words – and no other symptoms.

All – all – were admitted and diagnosed, most of them as schizophrenic. Afterward, the “pseudopatients”  reported to their doctors and nurses that they no longer heard the voices and were sane. They remained in the psychiatric wards for an average of 19 days. They were required to take antipsychotic drugs as a condition of their release.

Rosenhan’s report, “On being sane in insane places,” created quite a stir. Indignant hospital administrators claimed that their staff were actually quite adept at identifying fakes and challenged Rosenhan to repeat the experiment.

This time hospital personnel were on their guard. They identified over 40 people as being “pseudopatients” who were faking mental illness. Rosenhan, however, had sent no volunteer pseudopatients this time. It was a dismal showing for the psychiatric community.

Except now the wind seems to be shifting. Many psychological experiments from those long-gone days have been called into serious question, some because of reports from participants and others because of unreproducibility. The Rosenhan study, which is widely featured in psychology textbooks, is no exception.

I picked up Susannah Cahalan’s book The Great Pretender: The Undercover Mission That Changed Our Understanding of Madness, expecting to find more details of the experiment – maybe the reports written by the test subjects. Instead, I found a piece of journalistic research that attempted to track down the pseudopatients, and used Rosenhan’s notes for his unpublished, half-finished book extensively.

The author’s conclusion? That the experiment, though published in the prestigious journal Science, was at best dubious and at worse fraudulent. Rosenhan, the author says did not get volunteers from among his grad students, teach them to “cheek” pills so they wouldn’t actually be taking psychotropic meds, and turn them loose on several unsuspecting mental institutions.

Instead, the author says, Rosenhan himself was one of the pseudopatients and so were two friends of his. A sample size of eight or nine is small, but one of three is anecdotal in the extreme. Rosenhan’s write-up of the experiment used an even smaller sample – two, himself and one other. The third was relegated to a footnote as an outlier, one who found his assigned mental hospital to be a kind, helpful, and nurturing place. The sample of two related that the biggest problem on the wards was boredom, barely relieved by the occasional group session, and brief, infrequent drop-ins by a psychiatrist. Nurses remained in “cages” where they could view the floor of the dayroom and hand out meds at the assigned time.

There is doubt, too about how the three pseudopatients got out of their situations. They were all voluntarily committed, so could walk out any time they wanted, but Rosenhan’s notes say that the were released AMA (against medical advice), but with a diagnosis of “schizophrenia, in remission.” (Only one of the alleged pseudopatients had a different diagnosis of bipolar disorder.) Apparently, Rosenhan claimed to have had a lawyer draw up writs of habeus corpus, should the pseudopatients need to be “sprung,” but according to the lawyer involved, this did not happen, but was only briefly discussed.

So, after all this time, what difference does it make whether there were nine pseudopatients or only two or three; whether Science was hoodwinked into publishing a paper the author knew to be deeply flawed (to put it kindly)? We all know that such a situation could not happen today. It takes much more than a self-report of brief auditory hallucinations to get into a psych ward these days. There are extensive interviews, the MMPI test, various screeners to go through. Many of these procedures may have been put in place because of the influence of Rosenhan’s experiment.

But Calahan says that the most far-reaching effect of the experiment was that, not only did it put the entire field of psychiatry in doubt, it was cited again and again in other papers. Those papers – and thus the experiment – were influential in the massive closing of psychiatric hospitals, leading to the current situation of actual people with serious mental illness (SMI) with no place to go, a lack of psychiatric beds in hospitals, sufferers forced to live with untrained relatives, no supervision of medication, and various other breakdowns in the system.

It would be unfair to say that Rosenhan caused all that, but according to Cahalan’s reporting, his paper contributed significantly to exacerbating the problem.

 

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How I Became a Mental Health Blogger

05 03 20

Of course, blogging didn’t exist when I started writing. It was quite a journey ending up where I am today. Even mental health services were a big blank to me when I was young, something that no one I knew experienced or even talked about, except to make jokes about going to “Wayne Avenue,” the location of the nearest insane asylum (as we called it then).

But it’s hard to remember a time when I didn’t write. Childish poems fueled by voracious reading. Hideously depressive poems fueled by burgeoning bipolar disorder. (I still commit poetry from time to time, writing sonnets and villanelles about bipolar disorder.)

But before I returned to poetry with more structure, I indulged in free verse – unrhymed, unmetered verse that relied on the juxtaposition of images rather than formal style. I studied creative writing in high school and college. But the bipolar disorder was undeniably with me, influencing the topics I wrote about: “Two Ways of Looking at the Same Pain” and “Whiskey on the Knife,” a poem about self-harm, are two examples.

As my poetry developed, it started reading more and more like prose, strung out in sentences that relied on line breaks with twists and jarring pauses to create poetic effects. Eventually, I gave up on poetry and simply gave in to prose. I made my living doing prose, and nonfiction at that, writing for magazines about education, technology, child care, and even martial arts.

Bipolar disorder took that away from me. After being diagnosed with clinical depression for years, I finally was identified as having bipolar 2. It was treatment-resistant for many years and during that time I was often unable to write.

My mental health blog, which you’re reading now, grew out of a journaling exercise. I began by listing what I did each day – not much, as I was stuck in a major depressive episode and not able to do much. But once again, what started as something else turned into prose. And by that time blogging was a thing.

I started blogging largely as an exercise for myself, to explore bipolar disorder, its symptoms and treatments, and my particular version of it. I set myself the task of posting once a week, a schedule that I still keep. I wrote short essays and longer pieces, whatever I was thinking about at the time. Hardly anyone read the blog. I sometimes wonder if the title “Bipolar Me” was a turn-off, but really that summed up my knowledge about bipolar – my own experiences.

Slowly, I started finding my voice. and finding things to say with it. Things other than what was inside my own head. Oh, I still wrote about my symptoms and my meds and my coping mechanisms, major depression and hypomania, mood swings and roller coasters. But I also started approaching the wider world of bipolar. Bipolar in the news. Bad science reporting about bipolar. TV commercials about bipolar meds. Bipolar disorder and gun violence. All of this was still through the lens of my own experience, as I have no degree in psychology, counseling, or biochemistry, for that matter.

And I started reaching a wider audience. My writing appeared in The Mighty, Invisible Illness, IBPF, Thought Catalog, Medium, and as guest posts on other bloggers’ sites. Eventually, I had enough material to make Bipolar Me into a book of the same name. And then a sequel, Bipolar Us. Both are still available on Amazon and through other outlets.

I know I’m not in the same league with mental health bloggers like Pete Earley and Gabe Howard. They are true activists and influencers, as well as terrific writers. Their work reaches thousands of people with information, analysis, inspiration, and more impact than I will likely ever have.

But I won’t give up blogging just because I’m not the best. I’ll be here every Sunday, posting my bipolar thoughts and opinions, sharing my bipolar experience, and chronicling my bipolar life.

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Mental Health

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Do I Need Advice or Do I Need to Vent?

04 26 20

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Sometimes we need advice. But sometimes we just need to vent. This is true of all people but especially true of people with mental illness.

Venting is the act of getting something off your chest. It may come explosively if it has built up for a while. There may be one final incident, however tiny, that sets you off. All you really want is to feel heard, that someone acknowledges your distress and understands it. All you really need is a sympathetic ear and maybe a pat on the shoulder.

Venting acts as a safety valve. It allows you to “let off steam” that might otherwise build up pressure until it comes out violently, or at least excessively.

Why do I say this is particularly true of people with mental illness? So often we have feelings we can’t articulate, thoughts we don’t understand, or events that trigger us in both large and small ways. It’s natural to want to keep all these things inside. We’re taught to do that – not to “let the crazy show,” to keep all those messy thoughts and feelings to ourselves. Eventually, we get to the point where we think that no one will understand anyway, so there’s no point in giving voice to these feelings.

Then, when we do finally vent, inevitably someone says we’re overreacting. Because, you know, crazy.

If I’m venting, the wrong thing to do is to give me advice. Unless I specifically ask for advice, that is. But even well-meaning advice can easily go wrong. People who do not suffer from psychiatric conditions often offer advice regarding what works for them when they feel a certain way. And yes, a walk in the fresh air and sunshine can certainly be uplifting. But when I’m too depressed to get out of bed, it can be an impossibility. It can even make me feel worse about myself.

To me, suggestions for possible remedies for my disorder are even worse. It’s taken me and my assorted doctors years to assemble the right medications at the right dosages to tame my bipolar disorder down to something livable. When someone tries to tout the latest remedy they heard about – Pilates, elderberries, juice cleanse, probiotics, or whatever – it feels to me like “pill-shaming,” like I’m being blamed because none of my meds will “fix” me thoroughly enough. Add the fact that these suggestions come from questionable sources – laypersons or bogus “studies” – and I’m likely to dig in my heels and feel offended.

At times, though, I do need advice. When I do, I usually get it from my therapist, someone else who shares my disorder, or an old friend who has been there for me on my journey. Sometimes I need a reality check – am I just catastrophizing or is it really true that something bad might be happening? Sometimes I need help dealing with a specific person – what can I say to my sister to help her understand my condition? Sometimes I need a reminder that I really ought to make an appointment with my therapist and get a “check-up from the neck up.”

And it should be understood that advice is just that – a suggestion that I am free to take or leave. Even my therapist, who usually gives very good advice when I ask her, sometimes suggests techniques or approaches that just don’t work for me. And even she knows that sometimes I just need to vent, to feel the feelings of sorrow or hurt or rage and let them out in a safe place. To quote Jimmy Buffet, “It cleans me out and then I can go on.”

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Mental Health

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Caution: Wide Mood Swings

04 19 20

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Mood swings are universal. Everybody has them at one time or another.

Bipolar disorder is not just mood swings. Not everyone has moods that can last for months or years at a time or moods that are so extreme that they interfere with one’s daily life. The depths of despair and the rocketing highs are not what most people experience – and they should be glad they don’t. Bipolar disorder is a serious mental illness (SMI). It can be more or less severe, and it can be well or poorly controlled with medication and therapy, but the reality is that bipolar is a mood disorder, an illness, and a curse. 

Of course, the mood swings of bipolar disorder don’t always last for months or years. Sometimes you go spinning out of control every few weeks. This is called “rapid cycling.”

But even rapid cycling doesn’t describe the lightning-quick mood changes that can happen within a day or two. That’s called “ultra-rapid cycling,” and it’s like being whip-sawed by your brain. Those valleys and peaks come so closely together that you don’t even have time to catch your breath between them.

I think that the official criteria miss the mark on this. Many of them define rapid cycling as experiencing four mood swings within a year. Ultra-rapid cycling seems not to have a specific definition, but I and a lot of other people with bipolar disorder experience moods that swing not over the course of months, but over the course of weeks, or even days.

Ultra-rapid cycling blurs the lines into mixed episodes. Those are occasions when high and low moods occur at the same time. For many bipolar sufferers, this means simultaneous exaltation and despair, which is a terrible combination and a bitch to experience. For me, a person with bipolar type 2 whose hypomania expresses most of the time as anxiety, a mixed episode is a frightening blur of defeat and nervousness, a simultaneous feeling that the worst has already come and that it is about to descend to even lower levels. It’s like ricocheting off the insides of your own skull.

What to do at a time like this is a puzzle. Do I try the things that soothe me when anxiety strikes? Do I try self-care for depressed moods? Do the two strategies cancel each other out, leaving me swinging helplessly? Do I try to suppress both moods, knowing that the consequent numbness will make it all the more difficult for me to feel “normal” moods again? Once those walls are built, they are hard to tear down.

Ultra-rapid cycling and mixed episodes may be handy jargon to describe mood swings that don’t fit the common mode of bipolar disorder.  But they’re hell to live through. And since mood levelers, antidepressants, and anti-anxiety meds generally take a while to build up in the bloodstream enough to have an effect, there is little in the way of pharmaceutical help. An anti-anxiety pill may relieve the jitters and racing thoughts, but may also leave you more susceptible to the inevitable lows.

I don’t know if there’s much research going on regarding rapid cycling and mixed episodes. It seems like they’ve barely been named, much less defined or studied. And it’s true that there is a lot about plain old garden-variety bipolar disorder that remains to be understood and treated.

But for those of us who don’t fit the mold of months-long or years-long mood states, rapid cycling can be an uncomfortable way of life. When I was undiagnosed and unmedicated, I experienced those long, interminable lows. They did last months, years, until the depths of hell were all that I could see. The jags of ambition seldom visited me, but the creeping, lingering anxiety could easily take over. Now that I’m no longer subject to those excruciating extremes, I still am subject to the quick-change, rapid-fire series of moods. My mood levelers do work, in the sense that they reduce the peaks and valleys, but they never seem to put me on a totally even keel.

Perhaps that’s too much to expect. I’ll have to admit that I prefer a life of rapid- or ultra-rapid-cycling bipolar to the monotonous despair of long depressive cycles. At least now I have a firm conviction that the moods will end, or at least shift, to something more tolerable, and that that will happen sooner rather than later.

Given the choice between the lingering depths and the more rapid changes, I’ll take the one that doesn’t leave me in misery for years at a time.

 

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Mental Health

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