Bipolar Me

I’m not saying I’ll never apologize. Indeed, it seems like I’ve spent half my life apologizing, sometimes just for existing. Even apologizing for apologizing, which I now realize must have been incredibly annoying. My self-esteem was hovering near zero, and I felt that anything I did or said was somehow faulty and needed apologizing for.

What I am saying is that it does no good to expect apologies from someone who hurt you in fundamental, serious, and even soul-destroying ways. Abusers. Gaslighters. Narcissists. All manner of people, including friends and family, perhaps even the well-meaning ones.

Those of us with mental disorders such as bipolar, major depression, and anxiety are particularly susceptible to sustaining those kinds of hurts. Years of self-doubt, bullying, and out-of-kilter emotions had left me with no defenses against being hurt. Much as I had tried to put up walls, they were ineffective. I never learned to “just ignore it” when someone did or said something hurtful. And when it inevitably happened, no one – no one – ever apologized.

One reason for that is the essence of apologizing is taking responsibility for something – in these cases, the harm that was done. It happens in everyday life, never mind special situations with abusive people. Here’s how it happens: Someone says something hurtful. You, being hurt, react, visually or verbally. The other person pooh-poohs it: “I didn’t mean it. It was just a joke.” In other words, there’s something wrong with you for feeling hurt.

I’ve tried to explain this to people. When you step on a person’s toe and cause physical pain, you apologize, even if you didn’t “mean to” do it. Ah, but the person replies, when I step on your toe I know I’ve caused you pain. (As if only physical pain is real pain.)

Then there’s the old, “I just made a statement. You chose to react by being hurt.” (As if we could choose our reactions and our feelings.) Next comes a theoretical discussion of whether it is indeed possible to choose our reactions. I don’t know much about neurotypical people, but those of us with glitchy brains use all our mental wherewithal just getting through the day. A hurtful remark can throw us seriously off-balance. It’s like being slapped in the face. You don’t “choose” to be hurt or offended by that. You just are. Maybe – just maybe – you can choose what you do about it, but even that is iffy. The immediate reaction, whether it be crying, anger, or retreat, is just that, immediate. There’s no time to choose it.

Telling a person who’s been emotionally or psychologically hurt to “just brush it off” because the person “didn’t mean anything by it” is like telling a bullied child to “just ignore it.” It can’t be done. The thing, whatever it was, was said or done and caused pain.

Some people even attribute their insensitivity to childhood situations – “My mother made me say I was sorry for walking through the neighbor’s flower bed, and I resented it because I wasn’t sorry.” I say, if you react to hurting someone like a petulant child, the fault is not in the person who is hurt.

However a person avoids taking responsibility for hurting you, the fact is that he feels no need to apologize because, in his mind, he has done nothing wrong, nothing to apologize for. You can wait forever for that apology. It will never come. Even if you need that apology to begin healing the hurt, you may never get it.

Does this lead to lingering resentment? Of course, it does. Does it keep gnawing at you? Yes. Is there anything you can do to make your sister or your lover or whoever apologize? Definitely not. Is forgiveness the only path to healing? Well, that depends.

Sometimes the best you can do is not give the person another chance to hurt you – to break off your relationship with her. Not exposing yourself to that kind of pain is a valid choice. You can put the situation and the person behind you and try to move on. If you can forgive, great. If not, perhaps that’s not a choice you are able to make or to consider. Perhaps it’s part of protecting yourself or rebuilding yourself.

Realize that apology will never come, even if you deserve one. Some people are not capable of realizing the hurt they cause, owning it, and making amends. Getting away from such a person in your life is sometimes the best, or the only, thing you can do.

My brain broke a number of years back. Colloquially, it was what’s known as a “nervous breakdown.” In terms of bipolar disorder, it was a “major depressive episode.” Whatever you call it, it meant that for a couple of years, I was immobilized, irrational, and unresponsive. Unable to work, to take care of myself, to enjoy anything. I had it all – the tears, the fears, the despair, the loneliness. You name a symptom and I had it.

Gradually, with psychotherapy and psychotropics, I got better. In fact, I’ve been so much better that I felt my disorder was in remission. I wrote about that.

My strength, my renewed sense of self, my ability to cope was so strong that not even a tornado shook it. A literal tornado, one that ripped the roof of the house while I was in the second-floor bedroom. I went into taking-care-of-business mode, finding us a place to stay those first few nights, then diving into the morass of insurance, money, salvage, bureaucracy, government agencies, phone trees. Things as complicated as moving into a rental house and as mundane as doing the laundry. There were times when I was exhausted, when I’d had all I could handle for that day or that week, but after a night’s or a weekend’s rest, I pulled myself back together and dug back in.

This week, however, I have broken again. I sustained a psychological blow that threw me so off-balance that I can’t cope. I am back to immobility, depression, floods of tears, despair, misery. It was unexpected.  And it happened during the holiday week, a few days before Christmas.

My publisher closed its doors. And just when my second book was on the point of completion. My first book brought me a sense of pride and fulfillment, though it was hardly a best seller. I signed copies for my friends and family. I did a reading at a bookstore. I had t-shirts printed for me and my husband.

Those t-shirts are now gone, victims of the aforementioned tornado. And I have no copies of the book left, not even the copy I inscribed to my husband. It is like the book never existed. The second may never exist either. I am bereft.

I know it was a mistake to put so much of my pride, my self-esteem, my psychological wellbeing into a thing, something outside myself. But I thought that the book was a part of me that would live on. That it might help other people who struggle with bipolar disorder, and maybe even their friends and families. And the second book would be even better, going more deeply into my experiences and bipolar out in the world – both an inside and outside look at the subject. Bipolar Us, instead of just Bipolar Me.

I don’t how this story ends. At the moment it feels like it has already ended. What do I have left but some electronic files and a half-finished cover? The remembrance that once I wrote a book – two books, in fact. At the moment I am not strong enough to look for another publisher and have no desire to go the self-publishing route. That would feel like another failure, at least for me.

I am crying while I’m writing this. I have been crying a lot over the holidays and staying in bed a lot, too. I made a brief post on Facebook so my friends would know what was happening, but now I have largely retreated. I’ve thrown away at least three blog posts I’ve started. I’m more than a little surprised that I have managed to make it so far with this one. It’s stream-of-consciousness and not likely to get the usual editing before I post it, but I honestly thought I’d have nothing.

I know this is not my failure. I know this is not my fault. That’s how it feels, anyway.

From the ads, you’d think depression was no worse than the flu or a hangover. You can’t concentrate at your job or just don’t want to be there. You live in your sweatpants. You don’t feel like doing the laundry or you can’t remember how to program your high-tech washer. You don’t want to frolic with your husband and kids or go out with your friends. You have resting sad face.

And the cure for all those is a pill! You’ll remember how the washer works. You’ll spend time with friends and family. You won’t wear sweatpants. You’ll have resting happy face.

Well, sorry, that’s not how it works, or at least not how it works for most people.

You see, those commercials don’t show the reality of what depression can be. They acknowledge that depression is not “just being sad,” that it is “a range of symptoms,” but what they show is mostly people just being sad and distracted. And depression – clinical, endogenous, major depression – the kind these powerful medications are intended for – is far worse than sadness and distraction.

Yes, many people get a kind of low-grade depression that is no worse than what the commercials show. But major depression and bipolar depression are serious mental illnesses (SMI). They’re not inconveniences. They’re not something you get over with a single pill.

They can be lifelong. They can be life-altering. And they can be life-threatening.

What the commercials don’t show is anyone suffering, really suffering, from depression. They don’t show the depths of sorrow, fear, and hopelessness, the nights awake and crying, the days unable to get out of bed, the absolute misery.

Of course, those are difficult things to portray in 30 or 60 seconds, even by talented actors and skilled directors. But not even to try is to lie about what depression is and can do.

Depression can immobilize you, make it impossible to hold a job or care for yourself, much less a family. It can make you feel hopeless, as if nothing matters, not even yourself. It can make you feel worthless, unloved, unworthy of love. It can make you question every thought and feeling you have. It can erupt at any moment, day or night, without warning. It can last for weeks, months, even years, relentlessly, without letup. It can tear you apart or leave you feeling like an empty shell.

It can make you believe that life isn’t worth living anymore. It can lead to death.

And what about the medications the commercials are trying to sell? What aren’t they telling you about those?

First of all, they present the pills as a rapid cure. Just ask your doctor if X drug is right for you. Well, your doctor may not know if it is the right one. A lot of medicating depression is trial and error. What is right for another person, what alleviates their symptoms and lessens their misery, may do nothing for you. Then it’s time to try another med. And maybe another and another. Maybe a combination of medications. There are lots of different combinations to go through. And lots of side effects, which you may or may not be able to tolerate, some of them much worse than weight gain. All that takes time, and may not get you back to functioning fully and joyously. If you’re lucky enough to find a med or meds that work for you, you could be taking them for the rest of your life.

Then there are the kinds of depression that medication may not solve or resolve at all – treatment-resistant depression. There are different kinds of treatments for those, ones that never get mentioned on television because they don’t come in a convenient, sell-able pill that makes money for a pharmaceutical company. You won’t see ads for electroconvulsive therapy or transcranial magnetic stimulation, even though these therapies can restore some people with depression to better function.

Another thing the drug commercials don’t show is that treatment with psychotropics requires careful monitoring by a doctor. You don’t just get your prescription and go home to your loving family. A psychiatrist will know to look for signs that the drug isn’t working or that it is “activating” a depressed person just enough to allow her or him to act on suicidal thoughts. Will your family doctor know to do that? You might also need time with a therapist or counselor to discuss, for example, what can trigger your depression, coping mechanisms you can try, and ways to repair relationships that have been affected by your symptoms.

If it sounds like I’m angry, I am. These commercials, though they seem to offer hope and healing, really spread false impressions of what depression is, how it affects people, and what treatment for depression is actually like. I’m not denying that the “soft-sell” approach has helped people, especially those with mild or high-functioning depression. But I know too many men and women whose experience is not conveyed in those ads and who desperately need the kind of help that may or may not be available in pill form. Until they can see themselves in the ads and say, “That’s me. That’s what my life is like,” they may not realize that they, too, can be helped and that they desperately need to and deserve to be.

It’s not about the sweatpants. It’s never about the sweatpants.

I had friends who lived so far out in the sticks that the nearest Walmart was a 20-mile drive away and was the only shopping choice other than the feed and grain store.

One of these friends had Dissociative Identity Disorder. To reach a psychiatrist or hospital, he had to drive for an hour to another state.

Not everyone is lucky enough to have psychiatric healthcare that’s even that accessible. A study in the American Journal of Preventive Medicine finds that 65 percent of non-metropolitan counties do not have a psychiatrist and 47 percent of non-metropolitan counties do not have a psychologist.

That mental health services are hard to come by in rural areas is stunning because although “the prevalence of mental illness is similar between rural and urban residents, the services available are very different. Mental healthcare needs are not met in many rural communities across the country because adequate services are not present.”

Western Interstate Commission for Higher Education, in their publication, “Rural Mental Health: Challenges and Opportunities Caring for the Country,” cites accessibility and availability as two difficulties that face people in rural communities who seek treatment for mental illness.

But they also name another one: acceptability. Stigma surrounding seeking mental healthcare is perhaps stronger in rural communities and small towns than in other settings. Even if they could access good mental health care, many sufferers would choose not to go.

Self-reliance is an important facet of rural character. Dealing with their own problems without outside help is deeply ingrained in family farmers and other small-town or rural residents. This may simply be caused by the fact that the rural population, being so distant from resources common in the suburbs and cities, have had to cope with problems without outside help.

Then, too, small-town life means that everyone knows everyone else. The news that a person is seeking help for a mental difficulty could easily get around. There are still fears that such a person might be viewed weak, needy, not committed to Jesus Christ (rates of Christianity tend to be higher outside of large urban areas), or just generally “crazy” in a sector where everyone minds others’ business.

The need for treatment is there, as “the Centers for Disease Control and Prevention found that from 2001 to 2015, Americans in rural counties had higher rates of suicide than those in urban counties.” Isolation and the difficulty of maintaining a small farm or business are among the reasons that depression and anxiety haunt the rural areas. And of course, no one is immune from illnesses that are typically more debilitating, such as bipolar disorder, schizoaffective disorder, and schizophrenia. More than half of people with these illnesses, originating in the physical brain, lack awareness of being ill. Among this subset of the population with mental illness, anosognosia compounds the barriers to people getting the treatment they need in rural areas.

In a report called “The Stigma of Mental Illness in Small Towns,” Emily Gurdon reports on the effects of mental illness of the older rural population in particular and their reluctance to seek treatment. “Researchers at Wake Forest School of Medicine wanted to know why,” she says, “so they questioned 478 adults aged sixty and older in rural North Carolina. The most common barrier to treatment, according to their study? The belief that “I should not need help.” Other commonly cited barriers: not knowing where to go, distance, mistrust of counselors or therapists, [and] ‘not wanting to talk with a stranger about private matters.’”

Viable solutions to the problem do not seem to exist. Telemedicine has been suggested as one, though that alone would not overcome the sense that seeking help is shameful or weak. But psychiatric or psychological help via technology is still in its infancy, and many practitioners have no more slots available.

Only that old standby – education about mental illness – seems likely to reduce stigma and increase the use of what services exist. It seems that until attitudes change, availability of and access to services increases, and anosognosia is addressed, barriers to treatment in rural and small-town populations will not go away, and indeed, may only get worse.

This post first appeared on Lynn Nanos’s blog (https://lynnnanos.com/). Lynn is the author of Breakdown: A Clinician’s Experience in a Broken System of Emergency Psychiatry, available on Amazon (https://amzn.to/2scZ2Z2).

Many of you know about Spoon Theory. (If you don’t, here’s the original story – https://butyoudontlooksick.com/articles/written-by-christine/the-spoon-theory/).

Basically, it says that every person with a chronic illness receives a certain number of spoons per day, representing energy that they can spend doing various tasks. The trouble is, you never know how many spoons you will get. Some days, maybe only enough to get out of bed. Other days, enough to get dressed and go out. But when you’ve used up all your spoons, you’re done for the day, whenever that may be. Lots of people us “Spoonie” language simply to indicate that they’re tired. But for those of us with chronic illness – and some people, including me, count mental illness as one (see https://wp.me/p4e9Hv-h6) – use Spoon Theory often. It’s a way of explaining to the neurotypical why we may have the energy one day to do things, but not the next. Out of spoons, and that’s it. My husband now speaks fluent Spoon.

In 2018, a new theory appeared, first on Tumblr and then on Facebook, where it went viral: Fork Theory. You can find the whole story here: http://jenrose.com/fork-theory/.

Fork theory came about as an elaboration of the phrase, “Stick a fork in me; I’m done.” Unlike Spoon Theory, which posits something you have at the beginning of the day that gets taken away, Fork Theory says that everyone is stuck with forks, large and small, all day, and that eventually they reach their limit.

Everyone has a Fork Limit. When that limit is reached, the person either falls apart or retreats from the fray and the day.

The thing is, the forks can be minor annoyances, like misplacing your car keys, or large incidents, such as encountering one of your triggers. This is often confusing to bystanders when they don’t know how many forks you’ve already been stuck by earlier. Your reaction to that tiny final fork may seem out of proportion. But forks are cumulative. It may be the smallest fork of the day that sets you off, if you have had your quota of forks for the day already.

Some days, dealing with forks is like being nibbled to death by mice (or ducks or cats, if you’re a Babylon 5 fan). In fact, most days are like that. Nothing really terrible happens, but you go off on someone anyway when you reach your final fork. And as in Spoon Theory, you never really know what your Fork Limit for any given day will be.

Once I reached my Fork Limit on a day when there was a small hole in our roof, directly over the ceiling fan. Water was flung around the room by the still-functioning fan. It was actually a very small hole and just a sprinkling of water, but I broke down sobbing. It was the Final Fork.

Another day, the Final Fork came when a co-worker at the magazine company I worked for created his table of contents in alphabetical order instead of numerical. I went home ranting and raving. My husband, having no idea about Fork Theory at the time (neither did I) pointed out the much larger fork he’d been stuck with that day and teased me for being upset by such a minor thing. At other times, he’s been able to see the virtual forks sticking out of me and help me to calm down, usually by leaving me alone.

I suppose you can build up an immunity to forks, or perhaps your Fork Limit varies from day to day. I once survived a tornado, but nearly lost it when I couldn’t get a shower to get the gunk out of my hair or a clean pair of underpants.

This week I have managed not to hit my Fork Limit on any given day, though I have come close. But there is a huge fork waiting for me today, plus who knows how many smaller ones. This may indeed be the day when I am done.

My wish for you is for a day filled with all spoons and no forks. Those days have to happen sometimes, don’t they?