Bipolar 2 From Inside and Out

Side Effects: TD and Stevens-Johnson

04 21 24

We all hate side effects. They go from bad to worse to horrible. (A popular meme says that people wish they had side effects like multiple orgasms. Alas, no one’s invented a drug with that side effect yet.)

In my journey through the process of settling on reasonably effective medications, I’ve experienced a number of side effects, including violent nightmares, paranoia, and feeling numb all over. I switched to other meds, but really, those weren’t so bad.

Two of the worst side effects are Tardive Dyskinesia (TD) and Stevens-Johnson Syndrome.

TD, according to Penn Medicine, is “stereotypical involuntary movements of the tongue, neck, and facial muscles, truncal musculature, and limbs.” These movements “can range from slight tremor to uncontrollable movement of the entire body,” explains NIH. Basically, these movements often consist of facial movements like grimacing, sucking, sticking out the tongue, rapid blinking, and chewing motions. The bodily movements can include ones of the arms, legs, and pelvis, from tapping your feet or fingers to rocking the pelvis, swaying, and uncontrolled movements while walking.” (One description of it was “waddling.”)

The medications that can bring on TD include antipsychotics such as Haldol, Risperdal, Abilify, and Seroquel; antidepressants including (but not limited to) Sinequan, Elavil, and Prozac; antiseizure medications such as Lamictal and Dilantin; and, of course, lithium, particularly if taken along with other medications. (I’m currently taking meds in three of these categories and have in the past taken others, though never lithium. I’ve never experienced TD.)

You may have seen commercials on TV with information on treatments for TD. Although they’re designed to prevent a particularly troubling side-effect, they have side effects of their own. A list of these includes depression, suicidal thoughts, mood symptoms, heart abnormalities, allergic reactions, dizziness, weight gain, loss of balance or falls, stomach pains, frequent urination, and constipation. Oh, and there’s one more—uncontrollable body movements that may become permanent. That’s right. The anti-TD meds can cause exactly the symptom they’re supposed to alleviate. Sounds like a good deal to me. Admittedly, the incidence of these side effects is likely less than the incidence of TD from lithium, but would you be willing to roll the dice? Maybe you would, if there’s a chance it could protect you from TD. It’s up to the individual. Me? I’m not sure.

Another undesirable side effect is Stevens-Johnson Syndrome. It’s a condition that at first causes a skin rash that isn’t really itchy and often first appears around the nose and mouth or other mucous membranes. Unless you get immediate treatment, the rash can spread and turn into blisters and painful sores. It can develop into toxic epidermal necrolysis (TEN), a condition in which skin all over the body peels off. It’s potentially fatal. In 80% of cases, a psychotropic medication is the cause. (My psychiatrist prescribed me an antipsychotic particularly associated with the disorder and told me, “Don’t look it up on the internet. It’s gross.” Of course, I did look it up, and he was right. It is gross.)

I’ve had my bouts with side effects over the years. In every case, my doctor listened to me, weaned me off the drug that was causing the problem and titrated me up on a different one until we finally found a regimen that works. I’m fortunate that none of the side effects have been TD, Stevens-Johnson, or TEN. And I’m profoundly thankful.

The only advice I can give is to be mindful of the potential side effects of the drugs you take. On TV commercials, they run through them so rapidly and print them in such small type that they’re difficult to notice. But they matter. It’s your physical health as well as your mental health that’s at stake. If that means you need to do research on the internet, do it. I know there’s a danger that you’ll expect the side effects you read about but, in my opinion, it’s a trade-off worth making, especially with all the new drugs on the market and the potential severity of the side effects you’re facing.

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You May Be Bipolar

04 14 24

If you take three different meds at night and two more in the morning…you may be bipolar.

If your therapist is on your speed dial…you may be bipolar.

If you know the difference between rapid cycling and ultra-rapid cycling…you may be bipolar.

If you have depression clothes and mania clothes…you may be bipolar.

If you’ve stayed in bed for three days and not gone to bed for three days…you may be bipolar.

If your significant other is also your emotional support animal…you may be bipolar.

If all your Facebook friends have psych diagnoses…you may be bipolar.

If your refrigerator door has 40 affirmations on it…you may be bipolar.

If you know who Gabe Howard is…you may be bipolar.

If you have a semicolon tattoo…you may be bipolar.

If you’ve ever watched a show with a bipolar character and said to yourself, “No, that’s not it”…you may be bipolar.

If Carrie Fisher is one of your heroes and you call her “Space Mom”…you may be bipolar.

If you’ve gone through a dozen medications trying to find one that works…you may be bipolar.

If you’ve ever felt depressed and jazzed at the same time…you may be bipolar.

If taking a shower is a major event…you may be bipolar.

If you keep a box of Cocoa Puffs beside your bed…you may be bipolar.

If you’ve had a yearly raise and spent it in a month…you may be bipolar.

If all these statements apply to you…you’re DEFINITELY bipolar.

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Is It Bipolar or BPD?

04 07 24

When I first started looking at the literature regarding SMI, I became confused by the abbreviation BPD. At first, I thought it was a typo or an alternative for Bipolar Disorder. Of course, I found out that it wasn’t—BPD stood for Borderline Personality Disorder.

Even if you know what the abbreviation means, it’s easy enough to get confused between the two. In fact, bipolar is often misdiagnosed for borderline, or vice versa. There are some similarities between the two disorders as well. Both involve mood swings. Both can cause reckless behavior. Both can be associated with childhood trauma. And both can lead to suicidal ideation or completed suicide. They’re both very serious diagnoses.

Johns Hopkins says that Borderline Personality Disorder “may also be called emotionally unstable personality disorder. People with BPD have unstable moods and can act recklessly. They also have a hard time managing their emotions. If you have BPD, you may have problems with daily tasks, obligations, and life events. You may have trouble keeping jobs and relationships.”

Sounds familiar, doesn’t it? The same could be said of bipolar disorder. So what’s the difference between the two?

VeryWellMind says the difference lies in the fact that “People with bipolar disorder tend to experience mania and depression, while people with BPD experience intense emotional pain and feelings of emptiness, desperation, anger, hopelessness, and loneliness. In BPD, mood changes are often more short-lived. They may last for only a few hours at a time.”

Not to get picky about it, but as a person with bipolar, I’ve experienced intense emotional pain and feelings of emptiness, desperation, hopelessness, and loneliness while in the throes of a major depressive episode. (Not so much anger.) They did, however, last for months rather than a few hours at a time.

People with BPD can also experience dissociation and paranoia, and reckless behavior. They tend to have intense, unstable relationships. Dissociation is sometimes also seen in manic episodes of bipolar disorder and reckless behavior is a symptom of bipolar mania as well. Bipolar disorder can cause difficulty with relationships too. In between mood episodes, the person with bipolar can achieve stability, while that’s less likely for BPD.

So it seems that BPD might be seen as “bipolar on fast-forward.” The short time span of BPD episodes is one of the major differences between the two conditions. (It’s been described as “pervasive instability.”) But since the two sets of symptoms overlap, even clinicians sometimes mistake one for the other. BPD appears to have a strong genetic component; the cause of bipolar is thought to be a combination of brain functions, genetics, and early trauma.

When it comes to treatment, there are more options for bipolar than BPD. With BPD, medication is generally limited to symptomatic relief, such as with antianxiety agents. Dialectic behavioral therapy is the treatment of choice, along with psychotherapy. There are dozens of medications available for bipolar, as we know from TV commercials if nothing else.

It’s important to note that the two diagnoses can coexist. When they both affect a person, which is possible, they can be even more difficult to diagnose and treat. It’s easy to see how that can happen. Mood swings, reckless behavior, and potential dissociation can be effects of either one. Seeing a person only once a week, as many therapists do, can make it difficult to track the symptoms and see the patterns. And if the person sees a therapist or psychiatrist less often than that, the difficulty is compounded. Symptomatic relief may seem sufficient at first, but long-term is no solution.

Am I satisfied with my bipolar diagnosis? I’d have to say I am. While I despise the long-lasting mood swings, those are now largely controlled on medication. My destructive relationships haven’t been quick but have still been intense, and now I’ve achieved stability in that too. All things considered, I’ll stick with what I’ve got—not that I have a choice in the matter. If I had been afflicted with BPD, I hope I would have done as well.

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Structure in My Bipolar Days

03 31 24

I used to be a fly-by-the-seat-of-my-pants kind of gal. Work provided the only structure to my days, back when I was able to work in an office. It wasn’t always the same structure, depending on the job, of course. I have worked various shifts over the course of my checkered career—first, second, and third. I adjusted to them fairly well (except when I was working third shift and going to grad school in the mornings).

That all changed when I quit my last office job. I remember feeling so free. I basked in the ability to do freelance work whenever, run errands whenever, go to sleep and wake up whenever. Of course, I was hypomanic at the time, which I should have recognized because of the golden glow that seemed to envelop my days. Naturally, the crash came, along with the absence of freelance work to do. Then, when I fell into a deep depression, anything resembling a schedule fell apart. I didn’t have a specific time for going to bed or waking up, for eating, reading, errands including bill paying, and even showering. Without that structure, I had trouble finding a reason to get out of bed.

Now I’m stable on medication and therapy, and my days have fallen into more of a pattern. I still work at home, but for a company that gives me ghostwriting work. It has a built-in rhythm to it. Most of my assignments are 30,000 words long and due in 21 days. They want us writers to average 1,500 words a day. I divide that up into 750 words in the morning and 750 in the afternoon. I work weekends at this pace, too.

Fortunately, I find 1,500 words a day eminently doable. My daily schedule consists of mornings spent breakfasting, paying bills, keeping track of appointments, or making necessary phone calls (which is my usual role in running the household).

Then, mid-morning, my husband calls on his break from work. Part of the reason is to make sure I’m okay, but most of the time I’m fine and we simply talk, often about what I’ve scheduled for the rest of the week. (I keep track of his appointments and phone calls too. Sometimes I feel like I have a second job as Dan’s secretary.) After we talk, I begin my first stint of writing for the day, my first 750. I’m generally done in time to have lunch around 12:00. Dan calls again in the early afternoon, and I begin my second 750 afterward. When he gets home, we spend time together and have dinner around 7:00.

Those are my daily schedules, which I don’t really need a planner for. When it comes to weekly schedules, I do use a computer app. Our “weekend” is Sunday and Monday because of Dan’s work, but I work on my writing anyway. My calendar is filled with bills to pay by a certain date, appointments we each have to go to (which I remind Dan about), and notes indicating when my 30,000 words are due. I also make note of which weeks are for recycling. (The day before trash day, there’s frantic cleaning.) I have this and another blog that I post in on Sundays. I have a weekly internal schedule for that, too. I start writing them on Tuesdays, have them at least mostly finished on Fridays, tweak and tag them on Saturdays, and publish on Sunday mornings at 10:00.

Having these systems in place keeps me on an even keel which, after all, is my goal as a person with bipolar disorder. My days are predictable, but not boring because I don’t find writing boring, even if it’s on someone else’s topic. Does it seem too regimented? All I know is, it works for me.

This past week, I went on vacation, so for one week, my schedule was largely out the window. I looked forward to staying up late, sleeping late, having meals whenever we felt like it, spending time reading or shopping or sightseeing or watching movies whenever we wanted. Because, as much as I like my structure, I need a break from it at times. Sometimes I take a few days off between book assignments to work on other projects like organizing my jewelry armoire or my desk.

It’s a balancing act, really. Enough structure to keep me focused, but not so much that it becomes a rut. Dan’s phone calls help. Having time in the mornings and evenings before and after I write helps. And my most important routine, of course—taking my meds in the morning and at night. That’s a part of my day’s structure I never want to neglect.

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The Power of Awe

03 24 24

My husband asked me if I wanted to watch this movie, Operation: Arctic Cure. He knows I love stories about people who face hardship. Sometimes they triumph. Sometimes they fail. But they’re always out there trying. Dan also knows that I like stories of Arctic adventure—mountain climbers, exploration ships, races to the pole, and the like. So he figured the movie would be perfect for me. And it was.

It was a documentary telling the story of a handful of people cross-country skiing across Baffin Island, Canada, to reach Mount Thor, pictured above. What made this expedition different was that the participants were all people who had been injured in the wars in Afghanistan and Iraq. Most were soldiers, but one was a news correspondent who had been caught in an IED explosion and suffered traumatic brain injury (TBI). The other people on the expedition also had TBI or amputated limbs. And PTSD.

The people who conceived the expedition were hoping that the experience would somehow help them alleviate the PTSD. The teamwork, the effort, the hardships for a cause were all hoped to be therapeutic.

Another inspiration for the trek was Dacher Keltner’s book Awe. In it, the researcher on emotions posited that encounters with the wonders of nature could have beneficial effects on the brain and body. These outcomes would be largely self-reported, of course, but were backed up by scientific data. The participants took their cortisol levels, a measure of stress hormones, before the trip and twice a day during it. They also had sensors that recorded the length and quality of their sleep. And they kept video diaries, with their faces computer-analyzed for symptoms of stress through eye movement and changes in facial expression.

They did indeed encounter hardships. The skiers pulled heavy loads of their gear behind them. There was the numbing cold, vicious winds that held up their travel, and one amputee whose prosthetic caused so much pain that for one day she couldn’t walk. One of the men pulled her along with his own pack so she could stay with the expedition until she was able to adjust her foot the next day. They talked, of course, sharing stories of their war experiences and their families. One participant came to realize that he hadn’t been in touch with people he knew during the war and that he needed to be.

Where did Keltner’s book fit in? It proposed that the experience of awe, perhaps best encountered in nature, had healing properties. The expedition certainly had those awe-some experiences. They were far enough north to see huge displays of the Northern Lights. They conquered milestones such as reaching the Arctic Circle. And they made it to the foot of Mount Thor, a rugged landscape that features the world’s highest vertical cliff.

But those were subjective experiences. Was there science to back up Keltner’s claim and to validate the emotions described by the participants?

The measures of cortisol provided interesting feedback. In normal individuals, cortisol levels start high in the morning and decline through the day, leaving the body ready for peaceful sleep at night. The participants started the journey with cortisol levels significantly lower than average and rapidly declining throughout the day. By the end of the trek, their cortisol levels approached normal. And their sleep quality and length improved as well. One participant had a 40% increase in his sleep stats.

The movie followed the injured warriors during their trek, but not afterward, so it’s unclear whether the gains lasted. But they evidently experienced something profound. They spoke of the clarity from being in nature and the feeling of being a part of the world around them.

Many books and articles on self-care recommend being out in nature. Most of them talk about the benefits of sunlight, motion, and exercise. Keltner’s book and the film suggest a broader effect. The feeling of awe, of being one with the natural world, could increase a person’s peace, happiness, and a deeper connection to other human beings.

It was pointed out that you don’t have to travel to extreme environments to experience this awe. It’s all around us, if only our eyes are opened to it.

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Self-Care and Social Care

03 14 24

We hear a lot about self-care these days. Much of the mainstream media seems to think that it means “shopping therapy,” indulgent desserts, spa days, and mani-pedis. Expensive things. Ones that you need to be able to leave the house to do. (Except for online shopping, of course.)

Businesses are also quick to suggest self-care for their workers who are experiencing stress. What they mean by self-care is to take up yoga or meditation—on your own time and your dime.

Real self-care may include yoga and meditation and even the judicious use of ice cream, but it’s much more than that, of course. Self-care begins with the things that we all know are good for both body and mind—exercise, healthful food, good sleep, and stress reduction. Other good habits often mentioned are a digital detox, mindfulness, journaling, gratitude, affirmations, prayer, fresh air and sunshine, and hobbies.

Those are good things, of course, but they are primarily solo things, or at least were while the pandemic had us cooped up. Now we can get out and about more easily, go jogging or hiking with a friend, invite people over for dinner, and generally add human companionship to our list of self-care techniques.

But maybe what we need is social care (also known as community care). It’s hard to define social care. One source I looked for mentioned advocacy. But that’s pretty much something we have to do for ourselves. There are organizations like NAMI, and they do a great job at advocacy, but there’s only so much they can do. There aren’t brain illness support groups the way there are for alcoholism, narcotics addiction, and other kinds of afflictions that require outside support. There aren’t Meals on Wheels-type services for people who can’t leave their homes because of crippling anxiety. (Of course, grocery stores deliver now, but it gets expensive.)

There are very few group homes for people with SMI who need to transition between the hospital and living alone. There are group homes (sober houses) for those with alcohol or other addictions and even prisoners on parole. Many people with psychological or psychiatric needs rely on family members as long as they are able. I know a woman who lives with her father because of her assorted diagnoses. We’re all worried about what will happen to her when her father, who’s not in good health, dies. Her mother, when she was alive, tried to get her into a group home, with no success.

For those who are able to leave the house on occasion, social networks are recommended as a form of self-care. And even for people who can’t go out, there are social media, email, and video chats, which can fill some of the gaps.

But social services are thin on the ground, at least near me. I live in a suburb near two medium-sized cities. Most of the services available are for the mentally disabled, physically disabled, seniors, and some respite care for caregivers. People with SMI get a list of the crisis numbers. And, of course, psychiatric beds are limited and even psychiatrists have months-long waiting lists.

I know funds are limited and that the other groups need care, too. But social care is needed for those with SMI, too. We’re dependent on tax dollars, which are hard to come by.

It’s worth noting that the National Health Service in the UK has many more programs accessible to those with SMI at little or no cost. Of course, those are functions of socialized medicine, which is not likely to be enacted in the US anytime soon.

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Agency, Autonomy, and Mental Illness

03 10 24

I once suggested to a writer that he should include chemist Clara Immerwahr in his book on notable women. After her education, she had no opportunities to do her own research, as it was the early 1900s. Instead, she helped her husband in his. In 1915, she killed herself because she couldn’t accept the weapons-related research on poison gases her husband was doing. My friend replied that he wanted the women in his book to demonstrate agency.

At the time, I didn’t know what “agency” meant in any context than as an organization or business. Gradually, I learned what else it meant. And I looked it up for an official definition. After giving the definition I expected, I learned that “sense of agency refers to the feeling of control over actions and their consequences.” Clara Immerwahr did not have agency, and she was not included in the book, even though her story was both poignant and important.

While I was at it, I looked up the definition of autonomy. The definition included this: “Autonomy is all about having a choice and a voice. It fulfills an innate need to feel that we are acting of our own volition, allowing us to fully accept the consequences of our actions. It means feeling psychologically free and having the ability to control your life.”

It occurred to me that people with mental illnesses often either lose their agency and autonomy or never have them in the first place. Of course, many (I hesitate to say most) people these days lack agency or autonomy. They feel trapped, unable to control their own lives. How many people are ultimately psychologically free? How many control their own lives? Limited agency and autonomy are all that we seem to get, and limited autonomy strikes me as being like those ads that say a dental treatment is “virtually painless.” When it comes right down to it, that means “not painless.”

But with a brain illness, it becomes much more difficult to achieve agency or autonomy. The illness takes them away. A feeling of control over actions and their consequences? Tell that to someone who has just maxed their credit card on a manic jag. Minimal control of actions and no control of the consequences. Psychologically free and having the ability to control your life? Tell that to the homeless person with schizophrenia.

IMHO, one of the purposes for the mental health “system” ought to be restoring agency and autonomy to the people they serve and then helping them keep it, whenever possible. But that’s too much to expect, I guess. With the little funding for services and the lack of availability of proper care, there’s not much help for the person with SMI who wants to achieve agency or autonomy. In terms of mental health, just as in senior care, agency and autonomy are difficult to attain and maintain. We don’t have the kind of institutionalized care that would take away agency and autonomy completely, but neither do we have the systems in place for supporting those who have a chance at reaching it. It’s one of those Catch-22 situations.

You can’t give someone autonomy. You can only facilitate it. But we’re not even doing that.

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Mental Health

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What’s My Blood Sugar and Why Does It Matter?

03 03 24

In the past, I’ve had difficulties with my blood sugar. If I went more than four hours or so without eating, I got dizzy and weak. Fortunately, It’s not that difficult to arrange to get food within four or five hours. As long as I kept an eye on it, I wasn’t overly bothered. Although once I didn’t eat for about three days and didn’t just get dizzy, my entire body started shaking.

But a good while back, when I was undiagnosed and unmedicated, I had a different relationship with food. When I was manicky (which in my case manifested as anxiety) I didn’t eat much. I got so skinny that I feared my parents would notice when they came to town for my graduation. So I ate bananas and drank milkshakes in hopes of putting a few pounds on.

But when I was depressed, I ate—poorly, but I ate. I had certain go-to depression foods. Sugared cereals. Carbohydrates like mashed potatoes, fries, and other comfort foods. And a peculiar combination of wavy potato chips and cream cheese topped by an M&M. My husband knew to get worried when I asked him to pick up those ingredients.

But back to blood sugar. The interactions between blood sugar and bipolar disorder are complicated because the interactions between the body and the mind are too. Let’s look at some of those interactions.

First, there are medications. It’s well-known that bipolar and other psychotropic medications can cause weight gain. And in turn, overweight can lead to diabetes. I have indeed gained weight—a lot of it, in fact. (I still prefer fat to misery.) I haven’t acquired diabetes, but I no longer get the low blood sugar weakies.

Then, there’s stress. Bipolar disorder can be affected by stress, of course. Stress can exacerbate the symptoms. The symptoms can cause stress. It can be hard to break the cycle. But stress releases the hormones cortisol and adrenaline into the body, and those substances can cause blood sugar to rise. Poor quality sleep and irregular sleep patterns also affect your body’s chemicals in ways that can affect blood sugar.

Also, as I’ve learned, bipolar can alter your eating habits, causing your blood sugar to behave like a yo-yo. It can also affect your ability to care for yourself in other ways, such as not having the wherewithal to exercise. These lifestyle changes can also make your blood sugar fluctuate.

Also, though this isn’t well understood, there may be genetic factors that are associated with both bipolar disorder and high or low glucose levels. As always, more research is needed.

So, what does this all mean? First, that you should be aware of your blood sugar fluctuations. Maybe track how they correspond to your moods and your lifestyle factors. I’m not saying that you need to get a glucose meter (though if you have one, that’s great). Just know that the two conditions can interact, and the more you know about how they affect you personally, the better off you’ll be. You may be able to make changes in your diet, exercise level, and sleep habits that will make a difference.

Stress reduction is also something that will be beneficial for both conditions. Your therapist may have recommended stress reduction techniques such as meditation or mindfulness (among others), and you may find that these help, too. If, like me, you have high levels of anxiety, your family doctor or psychiatrist may be able to prescribe you an anti-anxiety med that could also help regulate your sleep patterns.

Watching your blood glucose won’t hurt and might help you deal with your bipolar or other disorders. It seems to me that it’s worth a try.

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Bipolar Poetry

02 25 24

I used to write poetry, since I was in second grade. I continued through high school and college. I stopped because they kept turning into prose. So I wrote prose. I knew I could never make a living writing poetry anyway.

Recently, though, I decided to try poetry again. I thought that instead of the free verse that wanted to turn into prose, I would try my hand at more structured poetry—villanelles and sonnets. And my subject: bipolar disorder, of course. Here’s what I came up with.

Villanelle

We understand there is both loss and gain
and much besides we cannot think to know
In trying to control the cycling brain

as we daily live with depths of pain
and wait to grasp the high amidst the low
We understand there is both loss and gain

and minds that bend and crack beneath the strain
or falter, limping, halting, slow.
In trying to control the cycling brain

we snatch the fleeting highs and yet retain
the memory of how we’ve suffered so.
We understand there is both loss and gain

in swing from scorching sun to drowning rain
and have our deepest feelings put on show
in trying to control the cycling brain.

A search for level ground remains the main
unfinished task that asks for yes or no.
We understand there is both loss and gain
In trying to control the cycling brain.

Sonnets

1.

Where is the light that once so brilliant blazed?
Turned now to dim and gray before the night,
it creeps in shadows hungry for the sight
yet dreads the time when shades are sudden raised.

And I am past the daylight, stunned and dazed
by darkened air that smothers, clinging tight
till breath itself turns faint and pulse is slight,
but when the dawn returns I am amazed.

The rings the sun runs round the endless dark
bring distant hints of what there yet may be
whenever night fades as it must or will,

when color blooms in contrast hot and stark;
my eyes ajar that I may briefly see
the world whirl past my prison’s windowsill.

2.

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.

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Mental Health

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Sensory Overload

02 18 24

I know that sensory overload can be a problem for people on the autism spectrum. Too much noise, uncomfortable touch, and assaults on the other senses can affect them negatively.

I discovered this firsthand when my best friend, Robbin, and her ten-year-old daughter, Kelly, visited my house. My husband collects clocks, and the sound of all the ticking bothered the young lady. Then the clocks started to chime. They were not synchronized, and they sounded off one after the other, sometimes overlapping. It was noon. Kelly was visibly distressed by the sound, and they left soon after.

I’ve had some indication that, though I’m not on the spectrum, I’m sensitive to noise as well. When Kelly was six, I brought Robbin a fluffy black-and-white kitten that she had admired. The squealing noises the little girl made cut right through me. I looked over at Robbin, who just shrugged.

It turned out that I’m particularly sensitive to the high-pitched sounds of children laughing and shouting. I learned to avoid Chuck-E-Cheese and Cici’s pizza—basically, any place with a ball pit. High-pitched women’s voices like Judy Holliday’s in Born Innocent bother me. It’s one of my husband’s favorite movies, but I can’t stand to watch it with him. Loud voices are a problem, too. If I’m in a room where people are shouting at each other, I make an excuse to leave until they settle down.

Much more typical is my aversion to two or more sounds. TV and talking, for example. If my husband talks to me while the TV is on, I can’t make out either one, which is particularly difficult when what he’s saying is, “What did that guy say?” And if I’m doing something on the computer, I’m completely lost. I’d be lost at a cocktail party, too, so it’s lucky we’re never invited to them.

WebMD has this to say about sensory overload: “Sensory overload and anxiety are mental health conditions that are deeply related to one another. When a person feels anxious or already overwhelmed, they may be more prone to experiencing sensory overload in certain situations. Likewise, experiencing sensory overload can make you feel a sense of anxiety.” They also say, in addition to autism, that PTSD, ADHD, PTSD, Generalized Anxiety Disorder, and Tourette Syndrome are mental conditions associated with sensory overload. They recommend anti-anxiety or antidepressant meds, self-care, therapy, mindfulness, and meditation as ways to address the problem. Avoiding triggers is another recommendation, and that’s the one I use (see not going to Chuck-E-Cheese, above). That’s the one that seems to have the most beneficial effects.

PsychCentral lists the stimuli that can lead to sensory overload:

  • bright lights, chaotic movement, or a cluttered environment
  • rough, tight, or itchy clothes
  • loud noises, voices, or music
  • scents including chemicals and perfumes
  • foods with strong flavors
  • hot or cold temperatures

And they list the possible effects:

  • overwhelm that makes you want to either shut down or have a meltdown
  • irritation or rage
  • tension in your face, neck, shoulders, or back
  • having either too many thoughts in your mind, or none at all
  • exhaustion
  • dissociation, or being separated from yourself and your surroundings

They add: “It’s possible for sensory overload to cause a panic attack. This could be because much overlap exists between parts of the brain involved with the panic response and those responsible for sensory processing.”

Not being a neuroscientist of any stripe, I can’t speak to the truth of that, but it also seems to me that a panic attack can lead to sensory overload. My other notable experience with sensory overload was having an anxiety attack in the grocery store, where I was overwhelmed by the visual noise of the bright colors on the cereal boxes. As I recall, I took an anti-anxiety pill, went home, and lay down. I don’t remember if I bought the cereal or not.

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