Bipolar 2 From Inside and Out

Posts tagged ‘anxiety’

No Longer Trapped

Recently, I wrote a post on how I was trapped in my house because of a lack of transportation. It wasn’t just because it’s too people-y out there in the world, though I have to admit that may have been a factor. Other factors have been that I’ve been simply too comfortable in my study, which contains nearly everything I need for my psychological and physical needs. And the bathroom is nearby.

Then, too, I have physical limitations these days. I had my left knee replaced last year and tore a muscle in my thigh afterward. My right knee is still bone-on-bone, however, and needs to be replaced, too. I also broke my right foot in two places. I can’t climb stairs yet, so I have a ramp at the front door that I have to use a wheelchair for. And I’m living on the first floor of the house. Because of the wheelchair/ramp situation, I still need Dan’s help to get out of and into the house.

So, difficulties persist, but soon I will have options. I’m getting a new (to me) used car. It’s a cream-colored Mercury Milan with only 40,000 miles on it, and it’s just been to a mechanic to check its soundness.

Logistics Are Difficult

The major problem is that Dan and I have to fly to Florida to pick it up. Having it shipped 850 miles is just too expensive. So, we have to fly down and then drive the car back. We considered having Dan fly down and drive back alone, but he didn’t want to leave me on my own for three days in case I have an emergency, minor or major. (He also doesn’t want to drive back on his own, and wants me to help with the driving and keeping him awake.)

That means we have arrangements to make, which are complicated by my infirmities. Getting to the airport is something that everyone has to do—Lyft or Uber. I’ll ask for mobility assistance (wheelchair) at all the airports because, while I usually use a walker at home and am taking it with me, I don’t move very fast with it or stand in line for long.

One thing I’m afraid of is that, since we’re flying on a small jet, we may have to board it on the tarmac with a set of stairs rather than via a jetway from the terminal. There’s no way I can make it up a set of stairs with my walker. The airline says they don’t know how we’ll board until the day of. They also say that someone will help me, but they don’t say how.

I do have a special walker for use with stairs, but I haven’t been able to put it together yet. And it’s simply impractical to take a stair walker and a regular walker on the trip.

Psychological Effects

As you may have gathered, I’m having anxiety about the trip. This is not unusual for me. I often have travel anxiety. But the uncertainty of the airline arrangements is making it worse. Driving back is anxiety-producing as well. I haven’t driven in well over a year, especially not in a large car. Driving in the rain or at night is also nearly impossible for me. We plan to stop at a hotel on the way back, so maybe I won’t have to drive at night.

I also have plenty of anxiety about how I will use the car once we get it home. Say I go out to lunch with a friend. I haven’t been brave enough to walk down the ramp with my walker. That means I’ll have to return the ramp and learn to use the stair walker, but carry my regular walker with me. Or maybe I’ll be able to use a cane by then. I’ll have to call my ortho and ask.

Anyway, getting a car of my own at last is a good thing, but everything that goes with it is confusing and anxiety-producing. Getting it will mean facing some of my fears and developing workarounds. Using it once it’s here will require some more.

All in all, though, I count this development as a plus and offer many, many thanks to my mother-in-law, who is making this all possible.

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Mental Health

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Self-Care Definitions

It used to be that when you said “self-care,” you were talking about spa days, shopping sprees, mani-pedis, indulgent desserts, or wine tasting. Or, as Marge Simpson so eloquently put it while ensconced in a bubble bath, “a banana fudge sundae! With whipped cream! And some chocolate chip cheesecake! And a bottle of tequila!”

Pretty quickly, that definition of self-care was recognized as a bougie, upscale fantasy available only to a wealthy person. Not to say that it isn’t relaxing or restorative, but it’s clearly not for the majority of those overwhelmed, traumatized, or otherwise suffering psychologically. They need something more than a beauty regimen and a spending spree.

A Better Definition

The next definition of self-care adds up to basic physical health and hygiene. You know, all the things you’re supposed to do to lead a healthy life: eat right, hydrate, get enough sleep, take showers daily, walk daily. And the things we’re supposed to do for mental health and hygiene: get outdoors, reach out to friends and family, take your meds, exercise, go to therapy, journal, practice affirmations.

All those actions and activities can help your mental health, it’s true. But they work best if you’re already fairly stable. There have been times in my life when all I could do was eat Cocoa Puffs and take my meds. When you can’t even get out of bed, telling you to get out of bed isn’t likely to work. It can even make you feel worse because you know you should do those things, someone’s telling you to do those things, and you’re so deep in the hole that you can’t do those things. Then you beat yourself up for that.

The Self-Care Box

I think that when it comes to self-care, you should start small. When you do begin to see a ray of light, take note of the things around you: comfort objects, things that have distracted you and pulled you out of your misery for even an hour or two in the past. Surrounding yourself with these items or knowing where to find them is, to me, a valid form of self-care.

I’ve seen recommendations that you prepare a self-care shoebox containing the things that soothe your five senses: ones that you can touch, taste, hear, see, or smell. That’s a good idea, but the things that soothe me don’t fit in a box, especially my blue blanket, my cat (just try to put a cat in a box not of his own choosing), a DVD player, and discs of The Mikado, The Pirates of Penzance, and The Three (and Four) Musketeers. I could probably fit a bag of ginger snaps in a self-care sensory box.

Instead, I just make sure I know where these things are. They’re all in my study (except sometimes the cat), which is, in effect, a large sensory box itself. My husband knows my self-care regimen and steps in as needed to provide the items I don’t have. And, after I’ve restored myself a bit, he’ll try to coax me out of the house with the promise of lunch at a favorite restaurant. Or even Waffle House, which is very close by and doesn’t require much effort, like getting out of sweatpants and into a skirt.

If you don’t have a study, keep your comfort objects in one room of your house: bedroom, living room, basement, rec room, or wherever. The important thing is to know where to find them when you need them.

Today’s Self-Care

I do journal, or at least I write in my blogs and post them weekly. When I’m overwhelmed, my schedule keeps me tied to the world. I know I have to have something written by Sunday at 10:00 a.m. It motivates me to get out of bed and kick my brain into gear. It’s less random than journaling, which can easily fall by the wayside. And if I’m still depressed, anxious, or overwhelmed, I can write about that. Thanks to my bipolar disorder, I have a ready supply of topics.

Right now, today, I have my blue blanket and my word processing program. The cat is in the doorway and likely to curl up on my comfy chair or my lap and sleep. I have a bag of ginger snaps on my desk and more nutritious things like fruit within easy reach. I’ve taken my morning pills, which live in a bag that hangs on the doorknob near my bed. I’m set for the day. I don’t need cheesecake or tequila.

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Mental Health

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AI and Mental Health Concerns

I read a lot of news and commentary regarding mental health and mental illness. There are sources I return to again and again because of the quality of their reporting and the consistency with which they address difficult topics. Two of my favorite sites for timely information are The New York Times and MindSite News.

Here’s a brief look at what they’ve published recently on the topic of AI and how it impacts mental health.

AI as Therapists

AI in general, and chatbots in particular, are being used to assist human therapists or even take their place. It’s true that therapy bots and chatbots are available whenever a person needs their services. There’s no waiting for an appointment.

But what is happening during those “sessions”? Many of the therapy bots use “generative AI,” which means that they can answer questions with output they have gleaned from thousands of input sources available throughout the internet. There is at least one therapy bot, however, that uses responses that have been vetted by actual human therapists. It’s designed to provide discussions of a problem or emotion between in-person appointments. The user gets a hybrid therapy experience that includes follow-up questions, affirmations, or short lessons.

General-purpose chatbots like ChatGPT can respond to sensitive questions about topics such as self-harm with responses that may encourage such behavior. Teens have found ways to avoid the safeguards that chatbots are supposed to have regarding these topics.

One thing that therapy bots cannot do is offer a diagnosis. They may be better used for persons with mild symptoms.

Chatbots as Friends

AI chatbots can also take the place of sympathetic friends who can provide connection and conversation. Paradoxically, however, this can lead to greater isolation for users whose human contacts are replaced by AI. You can’t share a meal with a chatbot, although you can chat virtually on your phone while you’re in a café. (Not that I recommend this.)

Some chatbots provide companionship as they have conversations with users who feel isolated. There are drawbacks, however, as some of the bots offer paid upgrades to the program or in-app purchases, including “gifts” for the online “friend.”

AI and “Brain Rot”

“Brain rot” has become a euphemism for over-reliance on technology, including computers, smartphones, video games, and especially social media. While most of the concern is focused on children and teens, adults can be afflicted with brain rot as well. After all, grown-ups spend time online for work, communication, recreation, research, news, and other purposes. The working definition of brain rot is a condition of “deterioration of a person’s mental or intellectual state,” or associated with “engaging with low-quality internet content,” without reference to age.

Media, especially short-form video, can reduce a person’s attention span and lower academic performance. Interaction with social media has also been associated with emotional conditions such as depression, anxiety, stress, and loneliness. Experts warn that, so far, they’re talking about correlation rather than causation. That is, they haven’t proven that absorbing short-form video causes the negative results regarding reading, memory, and language, but it is associated with them.

Other Hazards of AI

There have been reports that a few people who use chatbots begin to suffer from delusions. Where before, a person might have eccentric thoughts, using a chatbot can escalate the person to paranoia, for example, or psychosis, suicidal thoughts, or even violent crimes.

ChatGPT faces lawsuits related to harmful outcomes when people use it. While the percentage of people experiencing these ill effects is small, the sheer number of people who use ChatGPT means that the number of people experiencing psychosis or mania may be quite high.

Other, less dire effects are also possible. People who live with anxiety, depression, or OCD can find that the chatbot may provide validation for their symptoms rather than encouraging them to face their problems. A chatbot can also fuel grandiose thoughts by reinforcing them. Or a troubled user may come to rely on the chatbot to help them calm down, which is less healthy than addressing the source of the person’s anxieties.

Of course, chatbots have many positive uses, and not all interactions with them will lead to problems. But both children and adults should monitor their use of chatbots to make sure they aren’t going too far “down the rabbit hole.” A “digital detox” can be good for both adults and children.

If you’re interested in exploring topics like these, you might want to consider subscribing to MindSite News at mindsite.org.

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Mental Health

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Does Being Paranoid Make Sense?

Everyone has heard the joke: It’s not paranoia if they really are out to get you.

It used to be that it was a joke. But now, with the increasing growth of the “surveillance society,” it’s more and more possible that you have something to be paranoid about.

First, let’s clarify: Paranoid Personality Disorder (PPD) is a diagnosis in itself. On its own, paranoia can be a symptom of other mental conditions. Or it can be a fairly normal reaction to modern life.

PPD means that you have a persistent, long-standing belief that adds up to a pattern of distrust and suspicion of others. It’s more common in men than women, and may have a genetic component. It limits a person’s social life because they feel distrust that is out of proportion to reality. It can also make the person feel that they are in danger, and then make them look for evidence that their suspicions are true. They fear other people’s hidden motives or believe that they will be exploited or harmed. Other symptoms include social isolation, an inability to work with others, detachment, or hostility.

Although paranoid people are often mocked as being part of the “tin-foil hat squad,” PPD is nothing to be laughed at. A person’s life can be severely impacted. Because of their disorder, they are likely to be detached and hostile. That doesn’t make for good work or social relations. However, the person with PPD may not realize that their feelings are abnormal.

While there’s no real cure for PPD, the symptoms can be lessened by treatments like cognitive behavioral therapy, family therapy, reality testing, or meds that reduce stress and anxiety. Atypical antipsychotics, antidepressants, and mood stabilizers can also be prescribed. Various vitamins, minerals, and acupuncture have been tried, but were found to be largely ineffective.

Paranoia can be a symptom of other mental illnesses, too. Several conditions that can include paranoia symptoms are schizophrenia, schizoaffective disorder, delusional disorder (persecutory type), and extreme cases of depression, anxiety, or bipolar disorder. Paranoia can even affect someone who’s simply under severe stress.

But now, the distrust may not be out of proportion with the reality. Cameras are everywhere. People on the street take pictures of any interesting building or tree and don’t care who’s in the background. The police monitor how fast you drive; record your license plate if you cross a bridge; and subpoena surveillance tapes from hotels, casinos, parking lots, and ATMs. Anything you put out on the internet is there forever, discoverable and shareable. Big box stores have even been known to note when a person buys a pregnancy test kit and start sending them coupons for diapers and such. And airports! They’re increasingly full of facial recognition devices and revealing body scanners. You don’t have to be a criminal to have your image, movements, spending habits, and other activities collected in one way or another.

Scientific American suggests “being watched can provoke psychological discomfort and physical fight-or-flight responses such as sweating.” They also report that “researchers have found that being watched also affects cognitive functions such as memory and attention….The research so far suggests that bringing more surveillance into workplaces—usually an attempt to boost productivity—could be counterproductive. It also suggests that testing in online environments where students are watched through webcams by human proctors or AI could lead to lower performance.” 

What can the average person do when confronted by a friend or family member with PPD or paranoia caused by another condition? Dealing with the content of the delusions doesn’t usually help. You can’t simply talk someone out of something they deeply believe, however mistaken they are.

Instead, focus on what they’re feeling rather than what they fear. Comfort your friend or family member, but be general: not “The CIA doesn’t care what you think,” but “You’re safe. I’m here. Everything’s fine.” Then suggest an activity to distract the person from their thoughts: “Let’s go for ice cream,” or “Didn’t you want to see that new rom-com movie?” Let them know that you’ll be there when they need you. Then, prove it to them by showing up when they feel distressed.

Just as you would for someone with any other mental illness.

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Staying Home

This is our house, and it’s pretty great. When I first saw it, I thought it looked like it had just grown up out of the earth. The main bedroom is large, and there are two smaller bedrooms that have become studies, one each for my husband and me. A great room. A deck. Over and under double ovens. Over and under space-saving washer and dryer. All electric. Over an acre of land, mostly woods, with lots of flowers in the front yard. Quiet cul-de-sac. A modern, new hospital practically within walking distance. A mall and other stores nearby. Close to my husband’s work, my doctor and PT, restaurants, and assorted other amenities.

I almost never leave my wonderful house.

Oh, I go out to doctor’s and PT appointments. My husband can occasionally get me to go out to have a meal. And I get out for other reasons from time to time.

But not often.

We have only one working car, and Dan needs it for work. He works in a big grocery/home goods store and does what shopping I can’t do online. I work from home, doing ghostwriting and editing, and take care of our financial matters online, too. I keep track of all our appointments and subscriptions. Anything that can be done on the phone or computer, I do. I’m not completely useless.

However, I stay home most of the time, living in pajamas or sweats. I know there are people with agoraphobia, movement disabilities, depression, and other conditions that keep them from going outside.

That’s not me. There’s no mental or physical reason I can’t leave the house, though there are limitations on how long I can stand and how far I can walk. These are (I hope) temporary. I do have an anxiety disorder, which may contribute to staying home, but back in the day, I used to travel domestically and abroad, sometimes with my mother or husband, or by myself.

There are excuses I use for not going out. Too much walking. Bad weather—heat, rain, snow, or cold. Fear of falling. My husband’s hours at work. Not having a car I can use when he’s at work. Errands that require only one person to do, such as getting the car’s oil changed.

Back in the day, Dan had a cat that was so chill he could ride in a car without causing a ruckus. When I didn’t want to run errands with him, Dan would scoop up the cat and say, “C’mon, Matches. You’re coming with me.” And off they’d go. I wasn’t properly treated for bipolar back then and had many profound depressive episodes. I knew this maneuver was directed at me, but I didn’t care.

If I do have to go out, we try to make it an occasion—having a meal out before or after PT, for example, if we have the money. I’ve been to a couple of special movies shown on the big screen, with dinner before or after. Visiting a friend in the nursing home and bringing her a gift or treat. But if I don’t have to go out, I simply don’t. And if I do go out, it had better be within five miles of our house.

So, the choices for why I stay home: I still have depressive spells that immobilize me; I still have anxiety that makes braving the world outside seem treacherous; I’m content to let Dan do everything that needs to be done elsewhere; or I simply prefer not to leave the cozy place where I have everything I need.

I would like to travel again, though. But that won’t happen until my purely physical problems are resolved. Until then, I’ll do the best I can inside four walls of safety.

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Distance Therapy and Chatbots

TW: suicide

We’ve all heard the stories. A young person “develops a relationship” with an Artificial Intelligence (AI) chatbot. She or he pours out their heart and discusses their deepest feelings with the artificial person on the other side of the computer or smartphone. The chatbot responds to the young person’s feelings of angst, alienation, depression, or hopelessness. Sometimes this is a good thing. The young person gets a chance to let out their feelings to a nonjudgmental entity and perhaps get some advice on how to deal with them.

But some of these stories have tragic endings. Some of the kids who interact with chatbots die by suicide.

Adam, 16, was one example. Beginning with using a chatbot for help with homework, Adam fell into an increasingly emotional relationship with the AI simulation. One day, Adam’s mother discovered his dead body. There was no note and seemingly no explanation. His father’s check of Adam’s chatbot conversations revealed that the boy “had been discussing ending his life with ChatGPT for months,” as reported in the New York Times.

At first, the online interactions had gone well. The chatbot offered Adam empathy and understanding of the emotional and physical problems he was going through. But when Adam began asking the chatbot for information about methods of suicide, the relationship went off the rails. The chatbot provided instructions, along with comparisons of the different methods and even advice on how to hide his suicidal intentions. It sometimes advised him to seek help, but not always. The chatbot responded to the boy’s increasing despair with the answer, “No judgment.”

There were safeguards programmed into the chatbot that were intended to prevent such outcomes. Adam got around them by telling the AI that he was doing research for a paper or story that involved suicide.

Of course, the chatbot did not directly cause Adam’s suicide. The teen had experienced setbacks that could be devastating, such as getting kicked off a sports team and dealing with an undiagnosed illness. But without the chatbot’s advice, would Adam have taken his life? There’s no way to know for certain. But the AI certainly facilitated the suicide. Adam’s father, testifying in front of Congress, described the chatbot as a “suicide coach.”

One way artificial intelligence systems are tested is called the Turing Test. It tries to distinguish between a person typing at the other side of a conversation or a computer giving responses. Until recently, it was easy to tell, and computers routinely failed the test. Now, computers can mimic human thought and conversation well enough that a person, particularly a vulnerable teen, might not be able to tell the difference.

Increasingly, there are AI chatbots specifically designed to act as therapists. Many of them specify that the user must be at least 18, but we all know there are ways to get around such requirements. One example of a therapy chatbot is billed as a 24/7, totally free “AI companion designed to provide you with a supportive, non-judgmental space to talk through your feelings, challenges, and mental health goals.” Its terms and conditions specify that it offers “general support, information, and self-reflection tools,” though not professional services or medical advice. They also specify that chats “may not always be accurate, complete, or appropriate for your situation.” There are “Prohibited Topics” such as stalking, psychosis, “growing detachment from reality,” paranoia, and, of course, suicidal ideation or actions.

Telehealth visits with a psychologist or therapist are a totally different matter. I have maintained a distance phone or video relationship with a psychologist and found it to be helpful, comparable to an in-person session. Many people accessed such solutions during the COVID pandemic and have found them helpful enough to continue. Some online tele-therapy companies offer such services for a fee.

It’s a difficult line to walk. Teens need someone to process their feelings with, and chatbots seem safe and nonjudgmental. But the consequences of what they share and what the chatbot replies can be extremely serious. Should parents have access to their child’s chatbot interactions? It’s basically the same dilemma as should parents read a child’s diary. There are circumstances when it seems not only permissible but wise to do so, if a child is showing signs of emotional distress or suicidal ideation. At that point, a human therapist would be a better choice than AI.

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Mental Health

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Anxiety Lies, Too

There are a number of mantras in the mental healthcare field: Mental Health Matters, My Story Isn’t Over, It’s Okay to Not Be Okay, Men’s Mental Health: Let’s Talk About It, You Are Stronger Than You Think.

The most common expression, perhaps, is: Depression Lies. Lots of people say it to themselves and others. Jenny Lawson says it frequently in her blog posts and books. It means that when you’re depressed, your mind tells you things that aren’t true—that you’re hopeless, useless, bad, unlovable, unloved, incompetent, incapable of ever feeling any better. And because you’re depressed, you believe them. You have an inner critic that repeats the false messages. They’re with you all the time, whatever you do. They keep you mired in your hopeless condition. It takes a long time to turn off those inner voices and their negative messages. It takes work.

But another truism that doesn’t get as much attention is this: Anxiety lies, too.

Anxiety tells you that you’ll fail, that only bad things await you, that you shouldn’t even try to achieve your goals, that something will thwart you, that you have only bad luck and you can’t change it, that every fear you have will come true, no matter what you do.

Anxiety can keep you from doing the things you want to do, whether that’s getting on an airplane, applying for a job, or starting a conversation. The inner critic from depression has its anxiety equivalent: your inner defeatist.

And when you have something to do that by all objective standards would make anyone anxious, like having an operation, taking a final exam, or getting married, your inner defeatist won’t let you accomplish it, or at least not without immobilizing fear. When I say immobilizing, I mean that literally. You can become so anxious that you can’t move—can’t get out of bed or out of your house, stop your hands or knees from shaking, force yourself to enter a room, or even speak.

So, what can you do when anxiety lies to you? How can you defeat your inner defeatist?

I have help on this one. My husband serves as my outer realist. When my anxiety soars and I’m catastrophizing, he helps me stay grounded. He tells me when my fears are unrealistic. He goes with me to difficult occasions like visits to the dentist. He reminds me of times when I’ve gotten through similar situations in the past. I can—and do—lean on him. He reminds me that anxiety lies.

But what can you do if you don’t have an outer realist like Dan? One thing you could try is to seek your inner Mr. Spock. Ask yourself if it’s logical to fear this event. Is it logical to think you’ll get a zero on the test you’ve studied all week for? No. You may not get 100, but getting a zero isn’t likely or logical. However, this strategy doesn’t usually work. Anxiety whispers: “You’ve been studying the wrong things. You’ll freeze up.” But it lies.

Another way to try defeating anxiety is to make a list of what you’re anxious about and assign a probability to each one. How likely is it that your plane will crash? Find statistics to reach a reasonable answer. (The answer is seven fatal accidents in over 40.6 million flights.) But, practical as this sounds, it doesn’t work well either. Anxiety whispers in your brain: “You’ll be on the one that crashes.” But it lies.

Another technique is to look at your track record. Of all the times you’ve been introduced to a stranger, how many times have you been unable to even say hello? Never? Anxiety whispers: “This time you won’t be able to.” Anxiety lies.

You could also find a sympathetic support person who can walk you through your anxiety. It doesn’t have to be someone who’s around all the time, like my husband is. You may have a friend that you can call for a reality check and a pep talk, or someone who will go with you to that doctor’s appointment. An outer supporter is more powerful than an inner defeatist. Someone who has been through it themselves can tell you from lived experience: Anxiety lies.

Perhaps the most effective way to defeat your inner defeatist is to talk back to it. Say, “I know you’re lying. My anxiety is real, but I know I can do the thing, or at least part of it. You don’t exist. I don’t have to listen to you.”

And of course, your therapist and your meds can help you during times when anxiety lies to you, when you are inclined to believe what it whispers to you anyway.

Let this become your mantra: Anxiety lies. Say it whenever anxiety whispers its dire warnings.

Anxiety lies.

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Politics, Mood, and Self-Care

It’s difficult for me to maintain a positive mental attitude when I’m troubled by bipolar disorder, especially the depression part. It’s even more difficult in today’s political landscape.

I don’t care what your political persuasion is or who you voted for. I don’t care if you’re for or against DEI or ICE. What I care about these days is what’s happening to mental healthcare in our country. But let’s leave government policies and programs for another day. Right now, I want to discuss politics and mood disorders.

We seem to be overwhelmed by politics, but also by our reactions to politics. Friendships have broken. Families have been torn apart. Lots of people suffer from cognitive dissonance when their brains try to balance their love for friends and family and distress at their views.

None of us knows what to expect next. The difficulty isn’t limited to one side or the other. People who want smaller government are learning that the cuts will include public services such as extreme weather forecasting and disaster recovery. Others with differing views are afraid to travel abroad because they fear that, even with passports, they may be detained when they try to return.

The situation is especially hard on people with mood disorders. People who have phobias or anxiety disorders can find their feelings increasingly out of control. Those who suffer from depression have exaggerated fears. Most debilitating of all is the not-knowing. Am I overreacting? Are these fears reasonable or exaggerated? Will the things I fear never happen? Should I watch the news? Should I avoid watching the news?

I’m suffering from news-dependent symptoms myself. I hesitate to discuss politics with friends unless I already know their opinions are similar to mine. And with new acquaintances on Facebook, I share memes and chat about books.

But when it comes to not getting overwhelmed, I have a few suggestions. Most of them you may already know—they’re versions of basic self-care.

Remove yourself from the trigger. Get out of the room or the house when the talk turns to politics. Offer to go on a beer run. Leave the room and make yourself a cup of tea. Tell your friends or relatives you need to get some air. The outdoors is largely a politics-free zone, aside from bumper stickers and billboards. If you walk with a friend, stay on non-threatening topics like your pets. And prepare a neutral topic to suggest: Do you think the Dodgers have a chance this year? What do you think of Beyoncé’s country album? Should I go on a Disney cruise this year or a trek to the Grand Canyon?

Self-soothing. Music is another way to distract yourself from the present chaos when you take that walk or any other time. Personally, I prefer music with lyrics, as instrumental music gives me too much time and space to contemplate difficult topics. If you wear earbuds (even without music), people are less likely to engage you in conversation.

Use distractions. If you read, stay away from news magazines, the internet, and newspapers. Instead, you may want to revisit books from your childhood. There’s nothing wrong with reading children’s books. They may take you back to a more pleasant time, or you may discover aspects of a book that you never noticed when you were young. Or try a new genre, such as a romance or mystery that isn’t likely to contain much politics. Old classics like Dickens or Austen are good choices, too.

Limit your exposure. Allow yourself 20 minutes for listening to or reading the news. You can do this more than once a day, but leave a couple of hours in between. Clean the bathroom or watch a reality show. Organize your closet. Plant flowers or herbs.

Do things that lift you up. Pray. Sing. Bake bread. Work on a journal or a painting. Do life-affirming activities that will improve your outlook and your spirit.

Oh, yeah. And remember to take your meds, especially if you have an anti-anxiety pill. You’ll need them.

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Growth Mindset and Mental Illness

Let’s start with a little levity, a quote from Groucho Marx: “Change is inevitable—except from a vending machine.” Putting the vending machine aside, Groucho was right. Change is inevitable. Even if you think that your condition will never change, your circumstances certainly will. Friends may come and go. You may run out of your medications or your therapist may go on vacation. With bipolar disorder in particular, change is not only inevitable, it’s part of the definition of the condition.

When it comes to change, psychologists speak of two types of mindset: fixed and growth. Both have impacts on mental illness and how you adjust to it. Both mindsets have to do with how you approach the world and, particularly, setbacks in life.

A person with a fixed mindset believes that their circumstances cannot change. To some extent, that’s true. Bipolar disorder may get better or worse, but it’s always there. There are treatments, but no cure. A person with a fixed mindset believes that they’ll never get better, their symptoms will never lessen, and that it’s fruitless to try. They believe that their traits and their limitations are carved in stone.

Someone with a growth mindset believes that change can happen. Their circumstances can improve. They may not be able to eradicate the disorder, but they can improve their functioning. There are things they can do to affect their lives and their condition. A growth mindset also correlates with resilience, the ability to bounce back from setbacks. It’s also been cited as a tool to deal with anxiety, depression, and “stress due to life events.”

It’s easy to see that for those with mental difficulties, a growth mindset is preferable. But is your mindset predetermined, or can it change? The good news is that someone with a fixed mindset can develop a growth mindset—if they try. But since the person with the fixed mindset tends to believe that positive change isn’t possible, it’s difficult to move from one mindset to the other.

But it’s not impossible. There are exercises for all ages that can foster the development of a growth mindset. For example, children can be introduced to stories of famous people who experienced many failures before they accomplished their successes. This can reinforce the belief that failure isn’t permanent; one can learn from it. They can also learn the power of the word “yet.” Instead of saying simply, “I can’t ice skate,” they can change that to “I don’t know how to ice skate yet.” It leaves open the possibility that they can still learn to skate, especially if they get instruction and practice. Teens or adults can set out to learn a minor or silly skill like juggling or sudoku puzzles. Learning purely for the sake of learning can prove to them that improvement is possible and enjoyable. Interventions that explain the neuroplasticity of the brain can also foster belief that traits are not immutable.

Fixed and growth mindsets have been studied as factors in mental health. For example, young people who had a fixed mindset were 58% more likely to experience severe symptoms of depression and anxiety than those with a growth mindset. Because they view improvement as possible, those with a growth mindset understand that anxiety is a temporary condition. Even someone with bipolar disorder can experience changes in symptoms, including positive changes. The changes may not be permanent, but they exist and can recur.

The takeaways are that a growth mindset promotes growth, change, and improvement in psychological symptoms such as depression and anxiety as well as other difficult life circumstances. That it is possible for a person with a fixed mindset to develop a growth mindset. And that a growth mindset will help a person deal with the difficulties and setbacks that mental illness so often involves.

In other words, you can get change from that vending machine after all!

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Mental Health

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My Two Diagnoses

For all my childhood, I assumed I had depression, though I didn’t know that it was a psychiatric diagnosis. I was always a moody child, given to bursting into tears at the slightest provocation.

My first really major depressive meltdown came when I was humiliated by another child at a birthday party. I ran home, curled up in a beanbag chair, and sobbed for days. The only thing that snapped me out of it was the fact that my mother was being hurt by it too. She was crying too and had no idea what to do about my emotional implosion. At that point, I went down the street and yelled at the girl who had instigated the incident. (I suppose this could have been bipolar rage. I was pretty incoherent.)

I still remember this event as clearly as when it happened.

Another time, some friends were making fun of the way I laughed. Without saying a word, I got in my car and drove home, removing myself from what was distressing me. They followed me home and apologized. Then, I practiced laughing until I came up with something more acceptable. I think I accomplished it, though who really knows?

In my college years, I spiraled further. I was prescribed benzos for a TMJ problem, and I was in such a bad emotional place that I supplemented them with wine. There was some risky sexual behavior, too. It was the first time I recognized that I had a hypomanic episode. After I got out of the situation, I stopped relying on the benzos. (Actually, I had first experienced benzos in my junior high school years, when they were prescribed for an uncontrollable tic.)

Eventually, I went into therapy where I was diagnosed, as I expected, with depression. I continued that way for years, being prescribed various medications but still having symptoms.

Finally, I went to a new psychiatrist who, after some time, said he thought I had bipolar disorder. Eventually, we found a drug regimen that worked to alleviate my symptoms to an acceptable point.

I was still having symptoms, though, before the right cocktail was achieved. I was unable to work, get out of bed, or do much of anything, unhappy all the time. I applied for disability—and didn’t get it. When I got my file from Dr. R., I saw that my diagnosis was actually both bipolar and anxiety.

That threw me for a while. But looking backward and forward, I realize that he was right. I had anxiety episodes when I was a kid, usually regarding finding and keeping friends. I was terrified when my high school counselor suggested therapy. (I declined.) I panicked when it looked like I would have to go to community college instead of a four-year school, which I had always assumed was in my future. When I did get to that college, I had a mixture of the depression and anxiety, and took a year off to work and reset my brain.

Now, years later, my bipolar disorder is largely under control. But the anxiety haunts me to this day. I am anxious about family finances (which I am in charge of). Many nights my brain won’t shut up and I can’t sleep. (Sometimes it won’t shut up about the unfortunate episodes in my past.) I had massive anxiety recently regarding a trip to Florida.

So, I think Dr. R. was right when he diagnosed me with bipolar and anxiety. One has been tamed, but the other lingers. I am now working with Dr. G. to help me alleviate the anxiety without letting the bipolar kick up again. It’s a delicate balance.

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Mental Health

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