Bipolar 2 From Inside and Out

Where Churches and Mental Illness Meet

06 10 18
bible black background book chapter

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Lately, I’ve been thinking – and writing – about the place where faith and mental illness intersect. (See Mental Illness, Faith and Sin – https://wp.me/p4e9Hv-DB; Prayer and Bipolar Disorder – https://wp.me/p4e9Hv-B6.) I’m still thinking about it, so I’m still writing.

Churches, among other groups, have outreach ministries to the homeless mentally ill, providing sandwiches, socks, and hope of salvation. And the stereotype of the soup kitchen is that patrons “pay” by listening to a hymn or a sermon.

But what about the rest of the mentally ill community – those like me who have homes and families and a certain degree of function? What are churches doing about us?

The answer is: They struggle, but at least some of them are doing something.

Of course, some of them are doing the wrong thing. Andrea Jongbloed reported in Relevant magazine:

I sat in the chair in my pastor’s office, listening to him list off strange things I had done recently. My pastor informed me, “the church leadership is not convinced you are mentally stable enough to continue leading your bible study.”

It wasn’t supposed to happen this way. I had come here to talk about the book I was writing, on mental health and spirituality. Instead, I felt bombarded with accusations…. I left feeling judged and misunderstood.

An article in Christianity Today notes, “In many ways, the church, the supposed haven for sufferers, is not a safe place for those who struggle with mental illness.” The author adds:

The more Christians struggle with how to deal with mental illness, the more we fail to create a safe and healthy environment in which to discuss and deal with these issues. As a result, many of our Christian churches, homes, and institutions promulgate an aura of mistrust, guilt, and shame.

Amy Simpson, writing at qideas.org, outlines what is wrong with churches’ relationship with the mentally ill:

In general, the church tends to handle mental illness in one of three ways: ignore it, treat it exclusively as a spiritual problem, or refer people to professionals and wash our hands of their trouble.

Like it or not, the church is the first place many turn in crisis. And fair or not, the church’s silence or rejection feels like rejection from God. We cannot keep turning away from the most vulnerable among us.

According to Lifeway Research, however, 66% of pastors speak to the church about mental illness in sermons or large group messages “once a year, rarely, or never.” And 74% of pastors say that they are “reluctant to get involved with those with acute mental illness because it takes too much time and resources.”

But some churches are taking on the challenges, or at least trying to.

In a PBS interview, Deborah Potter, a correspondent from Religion and Ethics Newsweekly, explores how Holy Comforter Episcopal Church in Atlanta and St. Catherine-St. Lucy Roman Catholic Church in suburban Chicago are providing not just outreach, but community to the mentally ill.

According to Potter,

Holy Comforter responded … when a group home opened nearby and the priest at the time invited the residents to church. Today, almost two-thirds of the congregation is made up of people with mental illness—including bipolar disorder, clinical depression, and schizophrenia—who worship together and pray together.

The video also features Connie Rakitan, who founded the program at St. Catherine-St. Lucy, “helping to design worship that’s welcoming to all.”

Rakitan explains:

Walking into a church with a long service and a long sermon and lots of music and lots of people could just be so overwhelming that it’s just not doable….We would never, ever use a healing passage, because we would not want to set somebody up for an unrealistic disappointment, because the fact is not everybody gets cured.

Rakitan also points out that the church community offers something that the mentally ill may not find elsewhere: “Their families might be alienated from them or estranged or whatever. They might not have work communities. What do they have left but their faith in God?”

Lorrie Lattimore, of the Baptist Press, tells about a weekly “combined Sunday school and worship time” at First Baptist Church, Tuscaloosa, Ala.

It’s not an ordinary class. Some get up and pace during the Bible lesson. Some rock steady in their chairs. Some mumble to themselves. But all love God and know God loves them in spite of being consumers [sic] of a mental illness, those who have schizophrenia, for example, or depression or bi-polar disorder. Jimmy Tilley, the leader of the class, who also suffers from depression, chronic anxiety and obsessive-compulsive disorder, wouldn’t want the group to act any other way.

She adds:

Few Baptist churches offer some kind of outreach for mental illness consumers. Jim Hightower, minister of pastoral care at First Baptist Church…. noted more churches should have education programs and even ministries because “every church has members who have a mental illness.”

The best advice for churches? Amy Jongbloed sums it up nicely:

Be open to learning about mental illness. Have potentially awkward conversations with newcomers who struggle with their mental health. You won’t regret stepping outside your comfort zone. You will be blessed with stories of struggle, resilience and redemption. If you’re lucky, maybe you’ll even become part of someone’s story of recovery and reconciliation with the Church.

References

http://www.pbs.org/wnet/religionandethics/2012/06/22/june-22-2012-churches-and-the-mentally-ill/11386/

http://qideas.org/articles/mental-illness-what-is-the-churchs-role/

http://www.villagelife.org/church/archives/baptist_mentalhealth.html

https://www.christianitytoday.com/edstetzer/2016/may/christian-struggle-with-mental-illness.html

https://relevantmagazine.com/god/church/4-misconceptions-about-mental-illness-and-faith

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Mental Health

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How Writing Can Be Therapeutic

06 03 18
black and blue plastic pen non top of black covered notebook

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I write because I have to. It’s what I do. It’s also how I make my living (along with editing and proofreading and now, transcribing). But I also feel that writing is therapeutic for me.

Maybe it can be for you too. Let’s look at some different kinds of writing and how they might help.

Journaling

Journaling is what I actually set out to do when I started this blog. I meant it to be a day-to-day journal of my feelings, my accomplishments, and my difficulties. At the time, however, I was rather depressed and could see only difficulties, not accomplishments.

Journaling works for a lot of people because they can have a record of their mood swings, as well as a place to work out problems and say things they can’t say to anyone else. If they wish, they can share the journal record of moods with a therapist. Journaling is kind of like keeping a diary, but more purposeful.

Blogging

I turned my journaling into a blog. What had started, to be honest, as a lot of whining became a space where I could share stories about what happened to me and others, where I could examine news stories and media statements about bipolar and mental illness, and post opinions about coping and stigma and relationships and medication and all the other fun stuff that goes with mental illness.

Blogging is one way to reach out to others. And there are other people out there who want and need to hear what you say. I have blogging friends who share unique insights that alter how I see my disorder and how I cope with it. Think of blogging as a journal you publish, at least in a limited way.

Unsent Letters

This is a technique that therapists use to help you surface your feelings toward another person and have a safe space to explore those feelings. The fact that you never send the letter means that you can focus on your own feelings and not worry about what the other person might think or say about it.

I’ve used unsent letters to unpack my confusion about IMs from another person. Instant messages are not really the place to hash out the nuances of a relationship or what deeper meaning a particular comment may have had.

Usually, by the time you’ve finished, the letter no longer even needs to be sent, though I advise keeping it around to contemplate later.

Poetry

Poetry is often thought of as a way to express emotions. But really, poetry can be about anything the poet wants to say. Here’s a sonnet I wrote about depression and healing:

The air is still and blankets all my sense.
I’m muffled, muzzled in the sheltering dark
But dare not pray for fire, with bright, intense,
loud flames that rend the silence with a spark.

I breathe, or not? It’s sometimes hard to tell
When swathed in clinging, stifling musty scent
That fills my nostrils and my brain as well
Which cannot will the veil be shredded, rent

to save from suffocation. How shall I
Withstand this cycle till the day appears
And breezes blow the dust away from my
Stopped ears and eyes and lungs, plugged full with fears?

Pull off the cover and let free the soul.
Take broken breath and heal it into whole.

Poetry doesn’t require that much form and structure to be effective or therapeutic. Free verse, or unrhymed, unmetered poetry, is often the place people start. That doesn’t mean it’s easy, though. You have to dig deep to get at what you want to say and how you want to say it, if you’re writing for anyone other than yourself.

Publishing

Speaking of writing for someone other than yourself, there are always fiction and nonfiction (in addition to blogging). If your stories or articles or poems or books are good enough, they could even be published.

You can write either fiction or nonfiction for publication. It’s rare to see fiction on mental health topics, but Sylvia Plath’s semi-autobiographical The Bell Jar and Abigail Padgett’s Bo Bradley mystery series are places to look for inspiration.

Short nonfiction is easier to place, with TheMighty.com being a great site to submit factual personal accounts of invisible illnesses, including mental disorders. You can also share on Medium, where you can tag posts with appropriate descriptors like Mental Health or Psychology.

Getting paid for your published writing is another matter entirely, but it can be done. Writing for publication, however, is fraught with potential pitfalls. It is easy enough to trigger anxiety or imposter syndrome regarding submitting, not to mention waiting for a reply. And the inevitable rejections (everyone gets some) may play hell with your self-esteem.

My advice? Write. And keep writing. Whether you decide to try for publication or write strictly for yourself, it will be a good thing. Why miss another chance to explore your feelings, express your thoughts, and possibly share with others?

 

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Mental Health

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Would You Try Electroshock?

05 27 18

Photo by Mike T

In the course of dealing with my bipolar disorder, I had a near brush with electroshock. I managed to avoid it, but I did give it serious thought.

Now 60 Minutes has come out with a piece called “Is Shock Therapy Making a Comeback?” You can see the segment here: 60 Minutes.

ECT(electroconvulsive therapy, the modern name for the procedure), which is often done on an outpatient basis, works by inducing a brief seizure in a patient. The seizure, which lasts about a minute, releases multiple neurotransmitters in the brain, all at once. The patient is required to have someone to transport them to and from the appointment. Treatments are typically applied one or two times per week for 6-8 weeks.

In a brief article excerpted from the news show segment, Dr. Charlie Welch, of McLean Psychiatric Hospital, explains how ECT differs from how it was performed in the past: “What’s different first of all is that it’s done under general anesthesia with a muscle relaxant. So when the treatment is done, the patient is sound asleep and completely relaxed.” Call it a kinder, gentler shock treatment.

That was the procedure that my psychiatrist offered me after he had spent a number of years trying me on various medications that either didn’t work, or helped only partially.

My immediate reaction was negative. I recall thinking, “Fuck, NO! Keep away from my brain, you Nazi sadist!” After I calmed down a bit, I did some research.

ECT, my sources said, was a long way from the cruel, stigmatizing procedure portrayed in One Flew Over the Cuckoo’s Nest. The Internet was little help, though. The opinions and experiences of people who had undergone electroshock ranged from “It was hideous” to “It was a miracle.”

Truthfully, I was appalled by the notion of electrical jolts surging through my brain. My precious brain, which had both sustained me and betrayed me throughout my life.

Then I thought some more. So ECT sometimes causes memory loss. I already had that, thanks to some of my meds. I would be altering my brain with electricity. But hadn’t I been altering it for years with chemicals – medications that no one seemed to know how they worked?

So I went back to my doctor and said I would at least talk to the doctor who would perform the procedure. And I lined up a journalist friend to write about my experiences if her editor approved. (Note: In the 60 Minutes piece, former Massachusetts First Lady Kitty Dukakis gave permission to have her treatment filmed and broadcast.)

My psychiatrist, however, had one more medication that he wanted me to try before we took that next step. And it worked. So much for electroshock.

Now as to that side effect of memory loss – Dr. Sarah Lisanby of the National Institute of Mental Health in Maryland has developed a new treatment that seems to avoid that particular consequence.

The procedure is called Magnetic Seizure Therapy (MST) and it uses magnets (duh!) to stimulate more precisely focused seizures than ECT does. These focused seizures seem to avoid the parts of the brain associated with memories. As Dr. Lisanby told the 60 Minutes reporters, “For some people, ECT may still be needed. But if Magnetic Seizure Therapy could be effective without the memory loss who wouldn’t want to try that first?”

Would I try MST if I relapsed into treatment-resistant depression? I would certainly consider it, if it were out of the testing stage by then. And I’d do that before I signed up for ECT. While I have memories I’d prefer to forget, with my luck, those would be the ones left unaffected.

The cynical side of me says that these seizure-causing therapies are becoming more popular because insurance companies like the notion of a short course of 6-8 weeks of treatment instead of years of talk-and-medication. (Although Kitty Dukakis said that she has done ECT for years now and expects to continue into the foreseeable future.)

But I could be wrong. It is possible that some kind of treatment could be short in length but longer-lasting in effectiveness. I’m not ruling it out. At this point I’m not ruling out anything that could aid in my progress and my healing.

 

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Mental Health

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Bad Thoughts and Tattoos

05 20 18

Sometimes I have bad thoughts. We all do. I find that mine fall into three groups.

The first kind of bad thoughts are when I want to snap or snipe or snark at my husband, despite the fact that he is indispensable to me. He takes care of me, understands me, helps me, hugs me, feeds me in ways I can’t begin to describe.

When those bad thoughts arise, I have a brief internal chat with myself. (It looks like I’m thinking what to say because that’s exactly what I’m doing.) Then I choose not to say the nasty thing or I think of a less-nasty way of saying it. (I’ve written about the phenomenon before in “Managing My Anger” https://wp.me/p4e9Hv-kw.)

The skills involved are impulse control, the use of “I statements,” and the ability to rephrase. I try to say something that will get my point across without hurting or making things worse. These are techniques I have learned over the years, which makes me think they are things that can be developed with a little practice.

Learning to restrain myself has prevented many a fight. Some people find this style of communication inauthentic or wishy-washy – that I am tiptoeing around my husband instead of saying what I really think. All I can say to that is that it works for me and for our marriage.

The next kind of bad thought is the kind that comes with depression: I’m useless. I’m pathetic. I can’t do anything right. I’m worthless. Jenny Lawson (aka The Bloggess) talks about these thoughts in her book Furiously Happy, and she has one thing to say about them: Depression lies. These are the thoughts of a biochemically influenced brain that makes you miserable and sometimes wants to kill you, or at least kill your possibility of happiness.

Fortunately, my husband has read Jenny Lawson too. When I express these bad self-thoughts – and it’s best if you have a safe person to tell them to – he reminds me. He doesn’t try to deny the thoughts (You know you’re not worthless. You do lots of things right). He tells me, “That’s depression lying to you.” I used to get stuck in these cycles a lot before I was properly medicated and before I had his help and that of my therapist.

Then there are the really bad thoughts, those of self-harm or worse. Most of the time I don’t have these anymore, but when I do, there is one thing I can do. (Actually, there are more things I can do, but this is one that works for me.) I look at my tattoos.

The one on the right wrist is a symbol for bipolar disorder made up of punctuation : ) :  in the form of a smiley face/frowny face. This reminds me that my brain isn’t working right and is sometimes out to get me.

The other is on my left wrist, near my scars from self-harm. It is a semicolon. You may have heard about the Semicolon Project or seen the semicolon symbol on t-shirts or jewelry.

The semicolon is my favorite punctuation mark. It comes at the place in a sentence where a writer could choose to put a period and stop; instead, she continues the sentence. The semicolon says, “My story isn’t over,” something you’ll also see on t-shirts and such. (I’m thinking of making that sentence my third tattoo.)

Recently I had a bout of those really bad thoughts. But I looked at my tattoos and told myself, “My story isn’t over yet. I still have things I need to do.” One of them is to tell my story, in this blog and in a book I’m trying to write.

My tattoos helped me get over the bad thoughts. They have paid for themselves many times over. I never regret getting them. They may have saved my life.

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Mental Health

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Drug Therapy: The Short Form

05 13 18

From what I’ve read in Facebook support groups – and noticed from my own experience – the effects of antidepressants don’t always last as long as we might want.

My first psychotropic medication was, as nearly as I can remember, imipramine (Tofranil). At the time I was only diagnosed with unipolar depression, so it seemed like a good choice. Imipramine is what is called a “tricyclic” antidepressant because of its chemical structure. Many people complained of the side effects.

Tricyclics were about all the medical community had to offer until 1987, when Prozac hit the market, followed by its cousins Zoloft and Paxil. All of these were classified as SSRI drugs, ones that selectively acted on the neurochemical serotonin in the brain, rather than a wide variety of brain chemicals as the tricyclics had.

Since then we have listened to Prozac, talked back to Prozac, and been referred to as a Prozac Nation. Prozac has been hailed as a miracle drug, damned as a gateway to violence or suicide, and prescribed in phenomenal amounts.

And Prozac has helped me. After about six weeks on it, when the drug started to kick in, I was on a sailing trip. One of the crew said I was the passenger most at peace with myself that he knew. It was a revelation to me and a new way of thinking of myself.

Prozac changed my life – possibly saved it. And then, not so much. I moved on to other medications.

“Major Study Finds Antidepressants Work, But May Have Limitations,” by Brigit Katz, published on The Smithsonian.com, validates my perception.

Her article states, “A meta-analysis [or study of studies] of existing trials suggests that the drugs are mostly effective on a short-term basis for patients suffering from acute depression.” Katz’s article also cites articles in the New York Times and The Lancet that report similar findings.

The Lancet study “analyzed 522 double-blind studies that included 116,477 patients and 21 commonly prescribed antidepressants. The results of the study showed that all 21 of the antidepressants were more effective than placebos in reducing depressive symptoms during the first eight weeks of treatment.”

“The new analysis suggests, however, that the efficacy of the drugs may be limited,” Katz reports. “For one thing, the benefits applied in the short term, and only to patients who are suffering from acute major depression.” [emphasis added]

The Smithsonian.com article and the studies conclude that “while the new study suggests that antidepressants are more effective than a placebo, at least in some cases, media reports claiming [as an article in Newsweek did] that the research shows ‘antidepressants do work, and many more people should take them’ are not entirely accurate.”

(This hearkens back to a pet peeve of mine: that headline writers (who are almost never the authors of the articles) do a poor job of summarizing articles in favor of more definitive or appealing descriptions of the text. https://wp.me/p4e9Hv-Br)

At any rate, the meta-analysis bears out my experience. Although I was bipolar 2, my disorder first manifested as major depression. I got relief from Prozac, results that later diminished. Since my proper diagnosis I have found more relief from a combination of an SSRI, an anticonvulsant medication often used for bipolar disorder, and an atypical antipsychotic also useful for bipolar as well as schizophrenia. Even though I do not have seizures or schizophrenia, these medications work for me and have not worn off for several years now.

So, what’s the takeaway from all this? I think it is that, if your medication for bipolar or depression seems to be “wearing off,” your perception may indeed be valid. But that’s no reason to give up on psychotropics altogether. People and their disorders differ in ways we just don’t know. You can ask your doctor to try a different medication or combination of medications that may work better for you.

The benefits of medication for psychiatric disorders do not simply go away just because the effect of one does.

Read more: https://www.smithsonianmag.com/smart-news/major-study-finds-antidepressants-work-may-have-limitations-180968452/#vjLKOqe2JdKEWOe3.99

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Mental Illness and Gun Violence

05 06 18

photo by Thomas Hawk

There’s been a lot of talk lately that not allowing the mentally ill to own guns would curb the trend of gun violence in the U.S. There are just a few things wrong with that theory.

Are background checks the answer? They aren’t. Such checks at certified gun dealers screen out only the very few who have been hospitalized for mental illness – involuntarily committed, that is, not just referred for a 72-hour hold for observation or self-referred. That’s only a very small portion of those with mental illnesses. Most people with mental disorders are never hospitalized and some never receive any diagnosis or treatment from a psychiatrist, psychologist, or another counselor, which means that background checks would never turn them up. And there are loopholes in many states’ versions of background checks that, for example, allow private sales of guns without them.

To take this to the next level of absurdity, it would be a severe breach of confidentiality if therapists had to report every client to a database somewhere, just in case, and would lead to fewer people being treated for mental health issues, for fear of being put on a registry that might be used for any purpose eventually, even employment. Gun owners don’t want to be on a nebulous registry “somewhere,” and neither do the mentally ill.

Can psychiatrists and other counselors report to the authorities clients they fear may become violent? Again, laws differ from state to state. Usually, the question comes up only when a client makes specific threats against a specific person or a government official. The therapist must make a judgment about whether the client is a danger to self and others, which could result in a 72-hour hold, and may of course be correct or incorrect. A client with generalized anger issues is probably not mandated to be reported.

And to whom and for what purpose would the person be reported? To the police, when no crime has been committed? Is a therapist’s report of a client’s report of feeling angry enough to shoot “someone” sufficient to justify a search warrant of the person’s house for a legally owned firearm?

Are mentally ill people more likely to be violent than other people? No. In fact, mentally ill people are much more likely to be the victims of violence than they are to be perpetrators. But no matter how many times we say that, few listen or believe it. Some mentally ill people turn violence – and guns –against themselves. Some are killed by police officers with no training in handling confrontations with differently abled people, including the mentally disordered.

Not only are mentally ill people more likely to be accused of violence, violent people are more likely to be accused of being mentally ill. That’s practically the first thing anyone says after a mass shooting – “Oh, he must be crazy” (or on psychotropic medications). Of course, with one in four adults being likely to experience some form of mental distress in their lifetimes, it is possible that a shooter is one of those people.

But newscasters and politicians and people on the street are, by and large, not psychiatrists or psychologists. They are no more able to diagnose mental illness than burger-flippers, dairy farmers, lawyers, or business executives. Not that that stops them. Mental diagnoses are flung about indiscriminately nowadays, from people who call themselves OCD because they straighten pictures to psychiatrists who claim to diagnose public figures without having spoken to them once, much less having developed a therapeutic relationship with them.

But can’t potential violence be predicted? No. It can’t. The prison system can’t do it, or there wouldn’t be so many parolees and probationers and those who have served their time who go right back to crime and violence. Mandatory sentencing laws and the political climate have reduced the problem in some areas, but there are still plenty of cases in which the system fails. At trials and parole hearings and sentencing hearings, there is always someone – doctor or lawyer or family member – to say that the offender will not offend again.

But the only known predictor of violence is past violence. That’s why some people think it’s more sensible to restrict the gun ownership rights of domestic abusers rather than someone mentally ill who has no record of violence.

Can’t mentally ill people who’ve proven to be violent be required not to own guns? Theoretically yes, but we know how well it works to tell people on probation who have no record of mental illness that they can’t own guns, drink liquor, or associate with known criminals. The probation system is too understaffed to enforce these requirements already. Who would be willing – or should have the responsibility – to check up on everyone, even the small proportion of the mentally ill who have been involuntarily committed or convicted and then released, and make sure they don’t acquire any guns? If the parole and probation people can’t handle the caseload they already have, why would we think that mental health professionals have any more time, capacity, training, or know-how to do it?

Would banning guns prevent gun violence by the mentally ill? In a word, no. There are already too many guns in circulation in this country for that to be possible, and those guns are too easy to get. And again, there would still be the problems of determining who is mentally ill, by whose definition, and how such a gun ban could be enforced.

So, I hear you asking, you’ve told us all the things that won’t work. Is there anything that will?

Not if you think that the problem of gun violence and the problem of treating the mentally ill overlap. Gun violence is one topic and the mental health system is another. There is a lot that can be said about fixing one or the other, but nothing that would solve both at once.

Not that a lot is being done now, unless you count blaming, finger-pointing, and spreading stigma.

 

For more discussion on the topic, see http://www.amhca.org/blogs/joel-miller/2017/10/03/gun-violence-and-mental-illnessmyths-and-evidence-based-facts from the American Mental Health Counselors Association.

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Bipolar Travel Tips

04 29 18

photo by Dan Reily

Last week I blogged about “Running Away From Home” (aka the geographical cure) https://wp.me/p4e9Hv-F9. This week I want to talk about actual travel – for business or pleasure. Travel was one of my greatest joys and one of the things I’ve missed most since bipolar stole so many parts of my life. I am delighted to be able to say that I am beginning to reclaim it.

I know that many people aren’t able to travel at all because of their bipolar disorder, but for those who can, here are some tips to make it easier.

The basic thing to remember while traveling is this: self-care. You may find it hard to do while on the road, but it is essential to keeping yourself functional. Just give yourself permission to do the things you have to do. And find ways to avoid the things that trigger you.

Business Travel

Business travel is the most difficult, and something I’m no longer able to do at all. Oh, I can drive an hour for a half-day training session, but I want to be back in my own house and bed when it’s over with. But the kind I used to do – four to seven days, with coworkers (sometimes in shared hotel rooms), and especially with booth duty – are simply beyond me. There’s no time or space for self-care.

If you must travel on business, however, I recommend bringing along a comfort object (https://wp.me/p4e9wS-k9) such as a small plush animal, a favorite pillow, or toiletries that have a soothing scent like lavender. Fuzzy slippers may have to do as a comfort object if you have to share a room. It’s also a good idea to bring along portable snacks such as nuts or raisins in your purse or briefcase, as regular meal schedules are often thrown off by meetings and other events.

“Me” time is hard to arrange, but do try. One trick that works for me is to find an unused function space and sit there with a pad of notepaper. Zone out. Then if anyone comes looking for you, claim you were just consolidating your notes.

Visiting Relatives

Avoiding arguments is one of the particular challenges of visiting relatives – particularly in-laws.

On one of the first visits I made to my in-laws’ house, I noticed that they shouted a lot. When that happened, I would go into the kitchen and make myself a cup of tea. That’s a strategy I have often used. It’s also a grounding method I can use when things are spinning out of control. When everything around me is chaos, the simple, familiar, soothing action of heating a pan of soup or a teakettle can bring me closer to stability. Whether I really want soup or tea is not the question.

My husband noticed that I kept skipping out to the kitchen and asked why I kept making tea. “Because you’re all shouting at each other,” I replied.

“No, we’re not,” he said.

“Listen to yourselves.”

Just then an argument broke out over where to go to get some sandwiches. “You take the 422 to Souderton, then turn…” “Nah, you follow Cowpath Road then cut over to the 309. That’s shorter.” “But there’s more stoplights!” With each comment, the volume grew. Dan and I went out and got the sandwiches and when we got back, the family members were still arguing about the best way to go. Dan had to admit that I had a point. He just couldn’t hear it until I shifted his perspective.

Another technique you may find helpful when hit with nosy questions from relatives is the “Boring Baroque Response,” described here – https://wp.me/p4e9wS-cY.

Leisure Travel

My friend Robbin says that when you travel, the only things you really need to have in your carry-on are your meds and some clean underwear. Anything else you can buy when you get there if your luggage doesn’t manage to arrive when you do. It’s also good to talk to your pharmacist beforehand and make sure you have enough meds for the scheduled length of the trip. (Do not do what I did and take your entire supply of meds and then leave them at the bed-and-breakfast.)

Once I went to DisneyWorld https://wp.me/p4e9Hv-2K. (Okay, twice, but the first time was epic.) Surviving it was an exercise in self-care. The things I learned there are applicable to almost any travel situation.

It helps if you go with a person or people who understand your disorder and your needs. When you’ve exhausted yourself, it’s good to have someone who can think of options – “Of course, we can go back to the hotel now, if you want, or we could sit in this café and have a cold beverage while you rest your feet for a while.”

The point is, you don’t have to go on what a friend calls the Bataan Fun March – you don’t have to ride every ride, see every scenic overlook, visit every church or castle. Give yourself permission to take a nap or read a book or lounge around the pool, if that’s what you need to do. (If you’re on a guided tour and want to skip an event, let the tour guide know, so the head count doesn’t come out wrong after an event or stop.)

Finances tend to prevent the kind of leisure travel I used to do, but at least now if I can ever afford it, I can also survive it.

 

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Running Away From Home

04 22 18

photo by Karen Cox

When I was a teenager, I lived in Ohio, and all I wanted to do was leave. The suburb I lived in was homogenous and boring. The surrounding area had little to interest me. I was miserable. When it came time to select a college, the first thing I ruled out was anything in the state of Ohio.

It did not occur to me then that the reason I was miserable was not the state of Ohio, but bipolar disorder. And of course I took that with me to college.

When I returned to Ohio and began living in a suburb very near the one I grew up in, my friends were astonished. “I thought you hated Ohio,” they said. “I never expected you’d come back here to live.”

What I had been seeking was a “geographical cure” for a problem I didn’t know I had. I thought could outdistance it, outrun it, make a new life for myself somewhere better.

Believe me, it’s not possible; unless you are trying to leave an abusive relationship, moving somewhere else will do nothing for your underlying problem. Probably not even then.

The next time I had a chance to take the geographical cure – to move to Pennsylvania – I turned it down. I had by that time built up a support system in Ohio of family, friends, and doctors, and I couldn’t bear the thought of leaving them and trying to build a new support system in an unfamiliar place. (Eventually, my husband-to-be moved from Pennsylvania to Ohio, where we’ve lived ever since.)

But there are still times when I think about running away from this life. Often, I wish the Mothership would arrive and take me away to some interesting planet or galaxy.

But sometimes, when life just seems to be too much for me, I think of simplifying my life by starting over somewhere. It would be like being in the Witness Protection Plan, I always imagine. I’d live in a small, unimposing town somewhere. I would have a bookstore (maybe used books). I would live in a small apartment over the shop with one or two cats.

But alas, that wouldn’t work. Aside from the difficulties of moving, which I loathe, I would find myself in another place where I had no support system – no doctor to prescribe meds, no therapist to continue my progress with (I hate breaking in new doctors), no family or friends or husband. (I usually picture myself on my own, except for the cats.)

And life would be just as difficult, if on a smaller scale. I would still have days when I couldn’t get out of bed and open the store; weeks when I couldn’t bring myself to shower, driving away customers; times when the loneliness would become overwhelming. I would still have trouble with finances, health, isolation, shopping, business, et endless cetera. At least I would have a lot of books to read.

I would still have bipolar disorder. I might be able to replace some of what I would have to give up; it wouldn’t be easy or freeing. But sometimes I still like to imagine that it would be.

If my husband dies before I do, I may find myself in some form of such a solitary life and have to adjust to it, though I would most likely remain in my comfortable suburb, where I know a few people and have some great friends, and a psychiatrist and a therapist. I doubt I would again attempt a geographical cure unless forced by circumstances to relocate.

But I wouldn’t enjoy it, just as I wouldn’t really if I ran away from home now. The bipolar would just come with me, hopping into my suitcase before I even packed my underwear.

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Mental Health

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On Pain and/or Suffering

04 15 18

Recently, when I was reading Every Patient Tells a Story: Medical Mysteries and the Art of Diagnosis by Lisa Sanders, I came across this:

Eric Cassell, a physician who writes frequently about the moral dimensions of medicine, argues, in a now classic paper, that pain and suffering are very different. Pain, according to Cassell, is an affliction of the body. Suffering is an affliction of the self. Suffering, writes Cassell, is a specific state of distress that occurs when the intactness or integrity of the person is threatened or disrupted.

Later, when I was reading M Is for Malice, by Sue Grafton, I read this: “Pain was better than anxiety any day of the week and sweat was better than depression.”

The universe seemed to be telling me to focus my attention on pain and/or suffering.

Cassell (as quoted by Sanders), could have been (but probably wasn’t) talking about bipolar disorder when he defined suffering as “a specific state of distress that occurs when the intactness or integrity of the person is threatened or disrupted.” I certainly don’t feel intact or integrated while in the midst of a bipolar episode – either hypomanic or depressive. I suffer. My personhood is certainly threatened and disrupted.

It’s common to hear bipolar described this way: “I suffer from bipolar disorder.” I prefer to say “I live with bipolar disorder,” which I feel is more accurate. It’s always there, but I’m not always suffering. I live with it and it lives with me.

I think Cassell was wrong, though, about pain being a purely bodily sensation. I addressed the concept back in the early days of this blog. with a post called “Depression Hurts” (https://wp.me/p4e9Hv-6Z). In it I claimed that bipolar (or depression specifically) caused physical pain as well as emotional pain. I still maintain that one is as valid as the other and that they are virtually inseparable. The mind and the body not being entirely separate, or separable, you see. You get both for the price of one.

Grafton, on the other hand, through her character Kinsey Millhone, was talking about the physical act of running. We all know by now (or should) that exercise is recommended for those who have bipolar disorder or other mental/emotional conditions. But again, there is this idea that physical discomforts (pain and sweat) are better than emotional distress (anxiety and depression). She seems to be saying that pain is the antidote for suffering.

This can be dangerous territory. As someone who used to self-harm, I can easily see how one might think that pain is preferable to anxiety, or numbness, or dissociation – to suffering, that is. But in such cases, pain is really just another aspect of suffering, expressed in bodily terms. Again, the two are inextricably intertwined.

Personally, I would be delighted to avoid all four sensations – pain, anxiety, sweat, and depression. But I don’t think that’s possible, even with avoiding both exercise and self-harm. Sweat is the easiest to dispense with, thanks to modern toiletries, but there have been plenty of times when my anxiety has caused me to sweat. Think about being summoned to a tax audit, for instance, and you’ll see what I mean. Pain is unavoidable; no one goes through life without stepping on a nail or some such. Anxiety and depression occur at least occasionally in the neurotypical as well as the mentally disordered.

The human condition itself involves feeling both pain and suffering. Bipolar disorder involves both pain and suffering. Well, what do you know? We’re only human, after all.

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Mental Health

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Do I Disclose or Don’t I?

04 08 18

As I’ve mentioned before (even on my other blog https://wp.me/p4e9wS-zY), I’m running low on money and clients in my freelancing business. Therefore, I’ve taken up searching job ads online for part-time, work-from-home gigs. (So far, Indeed is the only service that has presented me with reasonable options. I sometimes apply for as many as three a day.)

It’s filling out the applications that has me stumped. Oh, I’ve got a fine resume – one on Indeed and another file I can send to jobs not listed with Indeed. I can write a decent cover letter. If there are editing or writing tests, I can handle them too. I have way more education and experience than I need, but I explain in the cover letter that part-time, contract, or freelance work is what I really want at this time in my life.

Then come the other questions that many ask.

Am I a veteran? No.

Am I a U.S. citizen or do I have the necessary documents to work in the U.S.? Yes.

Is English my first language? Yes.

Am I male or female? Yes.

What race do I identify with? Yes.

(Those aren’t really yes/no questions and are usually marked as optional, but I answer them anyway.)

Then comes the real stumper. Am I disabled? Well, that depends.

Most of the application forms state that they abide by EEOC regulations. Some of them even have a handy list of what are considered disabling conditions – and bipolar is one.

So. Do I take them at their word and believe that they do abide by EEOC regulations, in which case I can reveal my bipolar condition without penalty. In fact, if the company is trying to prove to someone that they are abiding by those regulations, the answer is probably yes, I should.

But we all know that such questions, while well-meaning on the surface, may actually be used to screen out disabled candidates. So perhaps I should answer no.

The deal with the regulations is that employers must offer “reasonable accommodations” to let disabled employees do their jobs, unless the accommodations for that condition are not feasible because of expense or other reasons.

So, as a person with bipolar disorder, what actual accommodations would I need?

The main ones I would need are the ability to work remotely, from home, and to have flex time. Those cost an employer nothing, usually.

And those are precisely the kinds of jobs I am applying for – work-remotely jobs in which you can make your own hours, or at least partially.

So when it comes to “The Question,” I have been answering “yes.” For the purposes of work, I am at least partially disabled by my bipolar condition. I cannot work full time. I have trouble working in a bustling office with lots of people around. I need flex-time to work around my symptoms. (I can still meet deadlines, though.)

Funny, but the forms don’t have spaces or yes/no questions on those subjects.

I have considered the idea that I am doing this all wrong. That I should not disclose my bipolar disorder until I have the job (and for those who don’t ask the question, that’s what I’ll have to do). That after I have the job is when I should discuss accommodations.

But dammit, all evidence to the contrary, I am a cock-eyed optimist. Those EEOC rules are there for a reason and I am that reason. I know that when most employers think “disability,” they think “wheelchair” or “impaired hearing.” But there it is, listed right among the possible disabling conditions – bipolar.

So far I’ve gotten a few form rejection letters and mostly a resounding silence. And in the meantime I’ve been scrambling for other clients and other assignments.

But I hope the day will come when just one of my potential employers means what it says about disabilities.

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Mental Health

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Bipolar Me

Bipolar 2 From Inside and Out

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