Bipolar 2 From Inside and Out

Posts tagged ‘anxiety’

COVID News and Mental Health

Many people have been blaming COVID for depression and other mental health problems. They have said that quarantining and uncertainty have raised the level of anxiety in the general population, and quarantining has caused depression. These increased levels may be – probably are – accurately reported, but I don’t think they necessarily indicate an increase in the incidence of mental illness in our society.

The depression and anxiety that people are feeling are, I believe, natural and expected reactions to the pandemic conditions that prevail. I’m not trying to minimize these experiences, but most people have never experienced clinical depression or anxiety and so don’t understand the nature of the actual illnesses. What depression and anxiety the pandemic has caused is likely to clear up when (if) the pandemic does. This is situational depression and anxiety.

This is not to say that people experiencing pandemic-related depression and anxiety don’t need help. Of course they do. “Talk therapy” may do them a lot of good, and there has been an upswing in the number of online and virtual counseling services available. Whether these people need antidepressants and anti-anxiety meds is a question I’m not able to answer. My best guess is that they don’t, at least not long-term courses of drug treatment, as their symptoms are probably not indicative of mental illness. Short-term anti-anxiety meds may do some good.

I do think that the pandemic and the reactions to it have been triggering for many people who do have mental health conditions. People with OCD who are germophobic saw their most extreme fears become reality. People who have Seasonal Affective Disorder may have suffered more from lack of sunlight during the stay-at-home orders and quarantines.

Many people are in extreme denial, believing that the pandemic is a hoax and refusing to take any steps to prevent its spread. Is this a symptom of mental illness? I don’t see how threatening officials and doctors who promote pandemic precautions is a sign of mental health, but are the people who do this delusional or are they merely at one extreme end of the anxiety spectrum?

I understand that people’s perceptions of reality differ, but it annoys me when people deny mine, which currently is made up of snot and phlegm, as well as depression and anxiety. We can have these academic debates, but for my husband and me, at least, the pandemic has pushed us from believing that it is “out there” to realizing that it’s in here, in the most literal and alarming sense.

My husband has tested positive for COVID, and I have a terrible sore throat and cough, so I likely have it too. We’re resting and taking Coricidin until we hear from our doctors what to do. A dear friend has sent us a pulse oximeter, with instructions to get more help if our O-sats fall below 90.

All this is messing with my head. I was entering a depressive phase anyway. Now I’m not sure if it was due to my bipolar disorder or my immune system crapping out. (Just FYI, my husband and I are both triple-vaxxed. He probably got the virus at work and undoubtedly passed it on to me. I can’t imagine I would test negative now.)

I don’t think our illness is life-threatening, though honestly, it could be. You never know with COVID. And now, that’s part of my reality.

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My Happy Holiday Hypomania

This holiday season is likely to be an up and down thing with me. (Imagine that!) I started out with a definite fit of hypomania that has lasted for several weeks, but I fully expect to hit a patch of depression, which is common for me around the holidays.

That manicky feeling was exacerbated by preparations for Thanksgiving, which largely centered on finding a local restaurant that was going to be open and deciding among the choices. We did find a place that was open and merrily over-ate, with drinks and dinners and desserts galore. (There are only the two of us, with no family in town. I cooked ratatouille for Thanksgiving last year, but was too jittery to plan anything of the kind for this year.)

In the past, over-cooking has been one of my slightly manicky reactions to the holidays. Over-baking, really. I remember baking multiple loaves of banana bread and raisin spice cake as Christmas gifts for all our friends one year, even those who lived out of town. (Mailing baked goods is probably best left to the professionals.) Manicky cooking behavior can be seen as normal, or even celebrated, during the holidays. We all know someone who gives out not just leftovers from Thanksgiving dinner, but whole home-baked pies.

The shopping that surrounds Hannukah and Christmas and the partying that goes with Thanksgiving and New Year’s Eve make it easier for one to indulge in hypomanic or manic behavior without sending up as many red flags as they might at any other time of the year. Usually, holiday depression gets all the attention, and there is certainly more than enough of that to go around. But this year my anxieties – which is how my hypomania usually manifests – have tipped over into a spending spree.

Shopping online made it an easy thing to fall into. Having PayPal and, this year, credit cards, made it even easier. I did try to shop around and limit myself to sale items, but by Black Friday and Cyber Monday, I had packages being delivered nearly every day – sometimes more than one. I like to think that I was able to keep the total down, but it really was excessive compared to my normal purchasing patterns. I primarily bought ebooks and pajamas, which says a lot about my lifestyle. I also ordered two expensive gifts for my husband, one of which is stashed in the back of my closet and the other not scheduled to arrive until January. Today I ordered a small gift ($25) for him and then two tie-dyed t-shirts. I stopped myself before I ordered more underwear for myself. I still might get Dan more underwear.

My husband noticed the packages that have arrived, of course, and mentioned hypomania to me just as I was about to order more pajamas. “You already have a lot of pajamas,” he said. “You asked me to tell you if I thought you were getting carried away.” That’s true. He does help me track my moods when I don’t realize I’m veering one way or the other, and I have asked him to try to help me keep it in check. I didn’t order that last pair of pajamas, though it was a great sale price.

We’re lucky that this year we had an unexpected windfall, so all my holiday purchasing hasn’t pushed us into financial problems. But as I settle in for the winter in my cozy pajamas, reading my books, I know I’ll have to keep in mind that rush I’ve been feeling ordering online and try to recognize that it’s a function of my bipolar disorder and not just normal holiday cheer.

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Down in the Mouth

Tomorrow I’m going under the knife (forceps, pliers, whatever) to get teeth removed. I’ve written before about my severe dental phobia, but this time there is no other solution. My teeth are bad; my gums are bad. Hell, even my breath is bad.

For this procedure, I will have IV sedation, which is a great relief. Nitrous oxide has never had any effect on me. I have had IV sedation for a dental procedure once before, so I know it works for me.

Due to COVID restrictions, my husband (my emotional support animal) is not even allowed to come into the building or the waiting room. For other, less drastic procedures, he has even been allowed in the treatment room with me, to pat my foot and offer me encouragement. This time he has to wait in the car until the nurse brings me out. That means he stays in the car for up to two hours while I am worked on. I’m glad he has an e-reader and that it’s recently been updated and charged, but still I would prefer a pat on the foot to knowing he’s several doors and a parking space away.

Oddly, I was not nearly this fearful when I had two operations (microlaminectomies) on my back a number of years ago. Perhaps that was because the pinched nerve caused me untold physical pain. That was pain I could understand. All I have with my teeth is emotional pain. For now. I’m sure physical pain will come later, after I regain consciousness.

My memories of dentists and former dental procedures are not good. There have been both physical and psychic pain, shaming, guilt, assorted bodily reactions, and a creeping physical numbness that had nothing to do with Novocain. I have been through procedures both with and without IV sedation. I’ve had my wisdom teeth removed, and another tooth removed and replaced with a partial bridge. I had a tooth that broke and I had a tooth bonded in place, designed to get me through a month or two until I could do a reading from my book. Through careful eating, I made it last five years.

Now, though, there is no getting out of it. I was unable to get these expensive procedures in the past because of a lack of money. Now I don’t have that excuse. Money has been set aside and no other emergency has arisen that requires using it for something else. Needless to say, my insurance doesn’t cover this, and especially not the traveling anesthesiologist. Once I had to abandon fixing my teeth because our transportation gave out, but that’s not a problem this time.

Do I want to get out of it? Yes and no. Dentistry is one of my major phobias (which has no doubt contributed to how bad my teeth are). This has been true since I was a child, and has only grown more extreme. It would be understating the matter to say dental procedures are a major trigger for my anxiety and panic attacks.

I’m also unnerved by how the procedures will resonate through my life for an unknown time. That dental bridge was a significant factor in my self-esteem. If I forgot it, I had to turn around and go home. More tooth extractions will no doubt feed into my isolation. And then there’s the indignity of eating applesauce, soft-boiled eggs, and chicken broth until my poor, abused gums heal. As little as I leave my house now, I will be even less willing to do so for quite some time.

So, wish me luck. Both my husband and I are taking a few days off work, on the theory that the sedation and analgesics may leave me woozy. At least I will be able to keep up with my blogging, since that doesn’t require going outside.

I’ll get through this. But I’m afraid it will leave my emotions as disordered as my mouth.

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What Is Bipolar Disorder Like?

There are a number of metaphors that try to express what it’s like to have bipolar disorder, and none of them is accurate. Thanks to television commercials for bipolar medications, we have even more metaphors, none of which express the reality of the disorder. Maybe, at heart, it is futile to try to come up with a metaphor. The map is never the territory. But let’s examine some of the most common and see where they succeed and where they fail.

Depression

The Black Dog

Winston Churchill was notoriously given to episodes of depression, and he referred to them as “The Black Dog.” It would come and go, but when it was with him, he descended into the depths. (Of course, this did not prevent him from becoming Prime Minister of England and making significant policy decisions and speeches during World War II.)

Dementors

J.K. Rowling has said that the soul-sucking monsters that appeared in the Harry Potter books were metaphors for depression, being able to remove not only joy and happiness from a person’s soul, but the memories of those emotions, and the possibility of ever feeling them again. (Incidentally, once out of the Dementors’ grasp, chocolate is said to help the person recover.)

Masks

This one is popular in TV commercials. A woman (almost always a woman) holds a smiley-face mask in front of her face to cover up her sad expression. Then, after she takes psychotropic medication, she puts the mask in her purse or pocket and suddenly reveals her own smiling face. Or a stock photo shows one person with a brown paper bag over his or her head with a sad face drawn on with marker. This bothers me because it implies that medication takes effect almost immediately, but I suppose there’s no way to show the six-week lag in TV ads.

Fog

The underlying metaphor here is being lost and being unable to find your way out. Everything around you is gray (and most likely rainy) and indistinguishable. It’s difficult to impossible to find your way through. This is actually a fairly accurate metaphor for severe depression or a major depressive episode. The sense of futility, of immobilization or being lost, of being unable to see a way out, is common to people with depression.

Anxiety

Skin

One of the most common sensations reported by people with anxiety is being about to jump out of their skin, or feeling itchy or twitchy all over. The itchiness or twitchiness may manifest in actual physical symptoms, in which case they’re a perception, not a metaphor anymore.

Electricity

The feeling of shocks running through the body or the brain is another way we describe anxiety. It can feel like jolts of current that only add to the twitchiness or agitation.

Indecision

Sometimes the paralyzing side of anxiety is represented by having too many choices or being unable to decipher a map. Instead of being agitated, the person is stymied and motionless. Make no mistake, this is a symptom of anxiety as much as it is one of depression.

Mania

House of cards

This metaphor comes to us thanks to a TV commercial. A person suffering from mania confronts a pyramid made of playing cards, climbs it, and keeps climbing until there are only a few cards left, with the idea that they will ultimately tumble. There’s no indication, though, that the person with mania built the pyramid of cards themselves, and the medication kicks in before the stack ever falls.

Soaring

The feeling of flying is often associated with mania. Soaring far above the mundane and the insignificant, the person with mania feels a sense of grandeur and empowerment, the ability to do anything – and to sustain it. Of course, sustaining the feeling never quite happens. Persons flying high with mania never see the inevitable crash that is coming.

Bipolar Disorder

Playground equipment

The seesaw. The teeter-totter. Even the swings. These metaphors certainly catch the up-and-down, back-and-forth motion of bipolar cycles. There are just two things wrong with these metaphors: They portray movements of equal length. And they’re fun. Bipolar moods do not come on a schedule or last a predictable amount of time. And there’s nothing fun about bipolar disorder.

Rollercoaster

A rollercoaster is perhaps the most common metaphor for bipolar disorder. It improves on the playground equipment analogy some. A rollercoaster, like bipolar, can be scary, especially the first time you experience it. It does involve up and down motions of unequal length. But the rollercoaster has the process backward. The climb up is slow, not an exhilarating whoosh. The swift ride to the bottom is the exciting part, which of course it isn’t. And, of course, once you’ve been through the whole route once, you have to get off and pay to get on again.

We use these metaphors because it’s almost impossible to convey what bipolar disorder is like to someone who’s never experienced it. And they can never convey the reality. Among those of us who have experienced the disorder, we use them as shorthand to describe the feelings we share, at least to some degree, with one another and with others, in hopes that they’ll “get it,” even just a bit.

But language has its limits, especially when it comes to describing what’s going on with our brains and emotions. Sometimes metaphors are as close as we can get.

When Your Thoughts Run Away With You

Overthinking. It’s something we all do at times – so many of us that it cannot really be said that it is automatically related to mental illness. But in some cases, it is a symptom.

Let’s start with depression, a subject about which I know a thing or two. When I was in a depressive phase of my (undiagnosed) bipolar disorder, I could, as the saying goes, overthink a ham sandwich (once I actually overthought a BLT). When I was depressed and/or anxious, it seemed as though I had a recorder in my head that would play back for me every stupid thing I had ever done – even such a small thing as handing the wrong person a glass of water. At random moments, the memory would pop up, usually with full color and sound, and I would again castigate myself for being so stupid.

I agonized over decisions. Should I call a friend to tell him or her about a phone call I received that might affect them? One time it was the right thing to do, with positive consequences. Another time it was also the right thing to do, but with negative consequences. Dilemmas like that made it even more difficult to know what to do. Indecision paralyzed me. When I couldn’t figure out the consequences ahead of time, I couldn’t know if my decision was correct. Of course, this is true of most people and many decisions, but the dilemma would derail my thoughts and leave me vacillating.

Intrusive thoughts are quite often symptoms of depression and bipolar disorder, and they can be valid or nonsensical. Are my children getting an appropriate religious education? Where is my passport (when no trip is remotely planned)? They can keep one awake at night.

Psychologically speaking, overthinking and intrusive thoughts are definitely symptoms of OCD. Did I lock the door? Better check three times. Did I leave the stove on? Better check four times. Has the milk in the refrigerator expired? Did my cat get out the door when I wasn’t looking? Better go out and look around. Will I throw up when I ask my boss for a raise? Better not try. Does my aching knee mean I’m getting arthritis? Should I call my doctor about it? Will he think I’m imagining it? My mother only loves me because she’s my mother, not because of who I am. These kinds of thoughts can be disabling, crippling, or at the very least painful. They can cause you to doubt yourself and everything you do.

In mania, overthinking comes later. While you are spending or gambling or having risky sex or driving recklessly you don’t question it. It’s only later, when the episode wears off, that you have intrusive or obsessive thoughts. Oh, my God, why did I do that? How can I ever pay for all that? Are my finances so screwed up now that I can’t pay my rent? Did I binge drink and hurt someone? I’m so ashamed. I feel so guilty.

Cognitive Behavioral Therapy (CBT) may be one way to confront your intrusive thoughts and push them aside in favor of more productive thinking. Talk therapy of the usual sort may help you develop coping mechanisms for when your thoughts run away with you. And psychotropic medication may lessen or eliminate the underlying problem that causes you to have intrusive or obsessive thoughts. In my case, it was the latter two. I still get stymied by some decisions, but I don’t lie awake and think about them. I discuss them with someone else (my husband, my therapist) to get feedback. Then I make a decision and stick with it, or move on to thinking about something else.

Mind and Body, Again

We know that the body affects the mind affects the body in various ways, especially when it comes to mental illness. Many of us who live with anxiety, bipolar disorder, or another condition experience physical symptoms like tremors, nausea, hives, and diarrhea.

The last one is my particular curse, which no one wants to hear about, but there you have it. Or rather, there I have it.

I didn’t even know that this was a problem related to my mental state for many years. All I knew was that whenever my mother or father was taken to the hospital, I would invariably and eventually find my guts in an uproar – usually when I got home, but sometimes in the waiting room. I thought that my bowels were my “attack organ,” as the saying went, and that I was merely reacting to the stress of the situation.

Of course that was true, but it never occurred to me that this was not just a physical problem, but a mental problem manifesting physically. At the time I was undiagnosed with bipolar disorder and knew little about the condition or how the mind and the body were connected.

The severity of the problem was impressed on me years later, when I was having severe anxiety, just after coming out of a severe and lengthy spell of depression. The more anxious I got, the more episodes I would have, sometimes up to six times a day. I lived with Immodium within easy reach at all times. During the worst of it I didn’t dare to leave the house. When I applied for disability, it was this affliction as much as my bipolar disorder that was the basis of the case.

Naturally, I told my primary care physician about the problem, and he sent me to a gastroenterologist. The specialist thought I might have Irritable Bowel Syndrome, but then again he wasn’t sure and didn’t seem to give it much more thought.

My psychiatrist, though, had a different idea. He suggested that the upset in my guts was caused by upsets in my mind – not that I was imagining it (there was ample evidence that I wasn’t), but that my nerves were overstimulated by anxiety and that caused my gastric symptoms. It was a feedback loop – anxiety caused diarrhea caused anxiety and so on and on.

I don’t know if it was the anti-anxiety med he gave me or if my anxiety just calmed down on its own, but the episodes became fewer and less frequent. I no longer stayed strictly at home, within easy reach of a bathroom, or feared going out. (I did make sure I knew where the bathroom was any place I did go.) I even stopped carrying a change of underwear in my purse. And my disability claim was denied. (I was also making so much money at my at-home freelance work that my lawyer said the judge’s head would explode.)

I still get anxiety-related diarrhea at times, but nothing like the biohazards I used to have. It’s no longer an everyday (or many-times-a-day) occurrence. I still do keep a supply of Immodium in my desk, my purse, and the bathroom, though, just in case.

I hesitated before writing this post, as it’s a difficult and unpleasant topic. But I know that a suffering mind can make the body suffer too, and I thought there might be people out there who have similar problems and needed some reassurance that they weren’t the only one. I don’t know what your “attack organ” may be or what your particular symptoms are, but do keep in mind that the interaction of the mind and the body can produce unwanted results. And that you are not alone in dealing with that.

Anxiety, Fear, Panic, and Phobias

I’ve heard it said that you know when you’re a problem drinker when your drinking causes you problems, whether of the emotional, legal, financial, or several other varieties.

Similarly, I think anxiety, fears, panic, and phobias are problems only when they cause you problems.

Let me unpack that a bit.

Phobias are considered to be a type of anxiety disorder or panic disorder. For example, social anxiety is sometimes defined as social phobia. Everyone has anxieties. Many people have at least one phobia. And most people can avoid these triggers with little or no effect on their daily lives. There are habits they can cultivate to avoid the things that make them anxious or phobic.

For instance, someone with acrophobia, a fear of high places, isn’t usually incapacitated by a stepladder, and can fairly easily avoid standing on cliff edges, rotating top-floor restaurants, and hotel rooms over the first or second floor. (When the anxiety/phobia extends to fear of flying, or aerophobia, the person can limit or eliminate air travel from their lives, usually without much difficulty.)

Crippling phobias, however, are generally classed as mental illnesses. My panic around bees (apiphobia) does not rise to that level; I would call it an anxiety reaction or a panic attack, not a phobia. It usually only manifests as bodily stiffening, tremors, and immobility, and pleas for anyone in the area to shoo away the offending insect. (I once took a beekeeping class to try to get over my phobia. Big mistake. Didn’t work.)

Agoraphobia (fear of unfamiliar environments or ones where you feel out of control), however, can be socially and psychologically crippling. The Mayo Clinic says that agoraphobia “can severely limit your ability to socialize, work, attend important events and even manage the details of daily life, such as running errands.” (Technology has made these constrictions less onerous, what with doorstep delivery and Skype.)

Anxieties as a symptom of mental illness are harder to define. While some anxieties have triggers, others simply don’t. “Free-floating” anxiety comes on unexpectedly, like the depressions and manias of bipolar disorder. This doesn’t mean that the anxiety isn’t real. It certainly is. It just means that the anxiety has no identifiable cause such as high places or bees. It is simply (or not so simply) a panic attack, which the Cleveland Clinic says is “sudden, unreasonable feelings of fear and anxiety that cause physical symptoms like a racing heart, fast breathing, and sweating. Some people become so fearful of these attacks that they develop panic disorder, a type of anxiety disorder.” They add, “Every year, up to 11% of Americans experience a panic attack. Approximately 2% to 3% of them go on to develop panic disorder.”

Sometimes I have anxiety that is attributable to triggers, such as financial difficulties, which are relatively easy for other people to understand. Who wouldn’t be anxious when the bank account is dry and a bill is due?

Other times, free-floating anxiety or panic simply descends on me, with nothing that triggers it. It’s an awful feeling, like waiting for the other shoe to drop when there has been no first shoe. Like a cloud hovering around me with the potential for lightning bolts at any time.

The thing is, I don’t know how to get rid of my anxieties, fears, or phobias. There are desensitization procedures that are supposed to work by getting one used to the trigger gradually. (I think that was my idea behind taking the beekeeping class. One of them, anyway.) There are antianxiety medications, including antidepressants and benzos, designed to take the edge off, if not remove the anxiety. (I take antianxiety medications. I’m still afraid of bees. Not that it affects my daily life much, but I’m never likely to visit that island off Croatia that’s covered with lavender.) For phobias, Cognitive Behavioral Therapy (CBT), as well as exposure therapy, has been recommended. This is usually a short-term procedure, according to the Mayo Clinic. But I have an aversion to CBT.

Still, despite my therapy and medications, I have to live with my anxiety and phobias. I’ve probably not reached the point where the anxiety causes me severe problems, like bankruptcy, though I have been known to overdraw my checking account on occasion and run my credit card up too high. These, of course, are signals that I may have a problem or am beginning to have one. It’s something to explore with my therapist, anyway. Maybe she can suggest ways I can deal with my anxieties before they turn into more significant problems.

Coming Down From a Manic Jag

I have been manicky lately, and it has expressed itself, as it does for so many people, with spending money we don’t have. Or at least spending money we’re supposed to be getting but don’t have yet on things which we can’t afford until we get it.

The thing is, we have a nice lump sum of money coming, but we don’t know when it will arrive. And instead of sensibly waiting for it to arrive, I have already begun spending it. A new-old truck for Dan; passport applications for us both; tattoos for us both; concert tickets; clothes and maps and guidebooks and airline tickets for a trip we plan to take next year; a short getaway vacation last week; gardening and home improvement supplies. Just to name a few.

All this leaves us very little for necessities like mortgage, electricity, internet (essential for my work), and even food. We can probably live on our credit card for a while, but I know that’s only a temporary solution, and a bad solution at that, even though the credit company increased my credit limit so we could pay for the airline tickets.

Of course, I am mostly responsible for all this spending. Some of the expenditures wouldn’t wait – the airline tickets, which we had to buy immediately to lock in the current price, and the passports, which I understand can take months to arrive and we shouldn’t wait till the last minute to apply for.

But for other purchases, Dan has been enabling me – “You know you want to go hear Emmylou Harris,” for example. “She’s one of your heroes.” “Might as well get the ticket for Rodney Crowell, too. How likely is it that he’ll be playing in this area again, at least anytime soon?”

Now the proverbial chickens are coming home to roost. Last week I had to deal with a guy at the door who was there to shut off our electricity unless I gave him a check for the past-due balance on the spot. The credit card company may come to regret the limit increase. I’m sure they gave it to me because I regularly paid them more than the amount due, and I can’t do that anymore.

I realize this is relatively minor compared to some spending jags that people in the manic phase of bipolar have gone on – gambling debts, for example, and even ones that end in homelessness. But the spending adds up, and we are strained past our limit until that windfall finally arrives.

Naturally, because that’s the way things go, now that I have come to and realized the reckless spending, it has triggered my anxiety. Financial troubles have always been one of my triggers, but it’s appalling to realize that I have dug this hole myself.

And naturally, because that’s the way things go, that anxiety triggers my depression – maybe not a full-blown depressive episode, but enough to affect my life and actions. I isolate. I grow surly with my husband. I have trouble sleeping or sleep too much.

In truth, I am angry with myself and with this damned disorder. When I get manicky, I generally am able to limit my spending to amounts of $25 or less, if sometimes for several such items (or meals). But this time I have overwhelmed myself, and my husband as well. I know we’re not supposed to use bipolar disorder as an excuse for bad behavior, but I can’t help thinking that hypomania is involved at some level. The idea of live music and foreign travel were just so irresistible. I couldn’t make myself wait until a better time.

We’ll get through this, I know. Someday the expected check will come and I can start straightening out some of the mess I’ve created. But until then, anxiety and depression will be my companions. I hope the mania stays fully tamped down until then. At least, I’ll take my meds and hope so. And not skip my therapist appointment in a week and a half. We haven’t had much to discuss lately, but now I’m sure we do.

Good News, Anxiety (and a Little Hypomania)

My husband and I have been waiting for various pieces of good news for several weeks. If they come, and the money associated with them, we could accomplish a few things, both necessary and frivolous, that have been on our minds.

Naturally, the waiting that triggers my anxiety isn’t over yet. One of the good things that we’re hoping to indulge in is a trip abroad, in the early part of next year. Since I learned of this, I’ve been preparing for it like it was the Normandy Invasion.

I got a travel agent (my husband’s nephew) and spent a lot of time with him, going over what we wanted to see (scenic things, not big cities), what we wanted in the way of accommodations (guesthouses and bed-and-breakfasts), airline details, passport details, COVID details, birth certificate details, and more.

Though the trip is over six months away (which should be about right for getting passports), I’ve fallen into a morass of hypomania/anxiety. I’ve been checking what the weather will be like, how much local money we’ll need, any language difficulties, etc. I’ve started ordering things we’ll need, like rain slickers, a road map, power converters (I found ones with USB ports), extra underwear (I have a fear of running out), and so on. I’ve been poring over suggestions that our travel agent sent detailing interesting sights along the route he roughly mapped out for us, given that we’re going on a fly-drive plan. I suppose I’ll settle down at some point and just wait for everything to come together, but then again, maybe not.

Another anxiety-producing (or really, dread-producing) thing that may happen in the near future is getting my teeth fixed. I have a major phobia regarding dentists and have avoided them for far too long. I now have an appointment for a consultation. Even for that, I’ll probably need Ativan. If I make it through the anxiety and phobia, I perhaps will have done something that will bolster my sometimes-quite-low self-esteem. I’ve had problems with my teeth for years, but I am determined (well, sort of determined) that this will be the time that I will conquer them.

Our other new addition is a work truck for my husband, who needs to haul gardening equipment (including dirt and rocks) and timber and large tools around. This is also a piece of good news for me. Because of his work schedule and our one car, I have been unable to go out during the day. Not that I usually need to go out during the day, as I work from home, but it’s nice to have the choice.

Plus, I’ll be able to schedule appointments not just on Mondays, when my husband has off work, but during the rest of the week as well. With only one car, if I have a medical appointment, I’m limited in my choices of appointments and times. I have to drop my husband off at work at 6:00 a.m. to have the car for most of the day. Now I can have much more freedom and don’t have to feel trapped in the house. If I want or need to go somewhere, I can.

If we were sensible people (we aren’t), we would settle for using the infusion of money to fix my teeth and buy the work truck, then put the rest away for a nest egg. But, damn it, after all we’ve been through in the past few years, frankly, we need a break. I know that many people with bipolar disorder are not able to travel, even outside the town where they live. I know that I am lucky to be able to. I imagine I will still have some anxiety when we get there, such as when trying to adjust to driving on the wrong side of the road. But we’ve built rest and self-care into the plan.

Another time when we traveled, I gave myself permission to be depressed if I felt it coming on. It was a revelation. I didn’t have to force myself to participate in all the activities. I could sleep late if I needed to. I didn’t have to resort to “smiling depression” to seem “normal.”

I hope that on this vacation I can do the same. I hope I won’t get depressed very much, but if I want to skip part of the many activities that our travel agent has found, or sleep late in the b-n-b, I can choose to do that. And that’s part of how I practice self-care when traveling abroad.

Manicky June, Anxious July, Overwhelmed August

Once upon a time, when I was diagnosed with unipolar depression, I wished I had bipolar disorder so that at least I could get things done when I was manic. Then I met someone with bipolar disorder and learned how foolish that wish was. Her manic phase led her to begin projects she would never finish, make loud, inappropriate jokes, and have difficulty with social interactions.

I have bipolar 2, and am fairly well controlled on medication, so I don’t get hypomania often, and when I do, it doesn’t usually last very long. Last month, however, I had a manicky time, and the results of it will affect me for several months. In June I also started on a new medication – though one for my physical health, not my mental health. My primary care physician doubled my dose of thyroid supplement. It had an almost immediate effect. After about a week, I became stronger, steadier, in less pain, and – oh yes, – rather manic.

I tend to have the rapid cycling version of my disorder, so when I do get hypomanic, it seldom lasts more than a few days. This time, however, I have had a longer time to experience the hypomania in a way I can’t remember having had before.

Some good things happened and some bad things happened. I got tickets to two live music events that I desperately wanted to see, one in August and one in September. We went out to eat at least twice. I made appointments for tattoos for both myself and my husband, both also in August. I booked us for a weekend getaway vacation in August. I bought myself a pair of earrings to replace ones I had lost.

In other words, I spent a lot of money.

Then July came and I don’t know if we will have enough money to get through it all. I snapped out of the hypomania and reverted to anxiety, which is how my depression often expresses itself. I paid the major bills during the first week. I put us on a strict budget for groceries. I put a little money aside so that I could possibly get a t-shirt at one of the concerts. I determined that the tattoo studio takes credit cards. (I don’t really want to take this option, but if we run out of cash, I may have to.)

Money worries are among my triggers for anxiety and depression, along with thunderstorms, overscheduling, noise, and too many people. When August comes, I will certainly need the bed-and-breakfast getaway, because my nerves will by then be frazzled.

The real question, though, is will I have enough energy to enjoy all the plans I have made for August?

A friend, who goes to DisneyWorld fairly often, learned that he should not do what he calls the “Bataan Fun March,” trying to cram every possible attraction and experience into a single visit. Now he prefers a more leisurely Disney experience, visiting a few of his old favorites and a few new attractions, while leaving time for relaxed dining and time in the pool.

This would probably have been a better approach for me to apply to August. A few events then, a few in September.

It would be convenient if my hypomania returned in August, to allow me to do all the fun things I have committed to. But as we know, bipolar disorder is an unpredictable beast. In the past, I have missed concerts that I had no more spoons for. I have rescheduled appointments that I wasn’t physically or psychologically in any shape to attend. (Most of these were appointments with my therapist, who sometimes agreed to a phone session instead.)

But these commitments are ones that I can’t phone in. All of them require my actual, physical presence. I don’t want to cancel any of them, some I can’t cancel at all, and I can’t phone in any of them. My best hope is that my symptoms will allow me to both attend and enjoy, if that’s possible.

Maybe the new pep I am experiencing from the thyroid meds will help. It does seem to help regulate my moods a bit, as well as affecting my body. Maybe it will allow me to have more spoons for August. Maybe in September I can decompress. Maybe in October, I will be back somewhere near level ground.

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