Bipolar 2 From Inside and Out

Posts tagged ‘anxiety’

The Year Past, The Year to Come

There are two things associated with the new year – looking backward and looking forward. Looking backward is easier for me, so I’ll start there.

The year 2022 has presented both challenges and joys for me. There was our trip to Ireland, which was a joy but provoked overthinking and anxiety. An over-ambitious schedule and over-packing made the journey less successful than it could have been. Miscalculations on our part meant difficulty with flights and panic over finances when we had to extend our hotel stays and spend more money than we had budgeted. Driving on the “wrong” side of the road made me unable to do any of the driving and panicky whenever we negotiated a corner, encountered a curve, or parallel parked. I spent a lot of the car rides holding on to the “oh, shit” handle and pressing my hand to the roof of the small rental car. I was relieved to have remembered to take my anti-anxiety meds with me, and my husband helped by suggesting when my behavior might necessitate taking some.

Then there was our experience with COVID. My husband was diagnosed. I never was, but I had all the same symptoms, so I assume that I also had it. I remember being concerned, but not unduly anxious. We had (relatively) mild cases, so we sheltered in place and took over-the-counter remedies to combat our symptoms. We had groceries delivered and slept a lot, so I guess I would have to say we coped. When the immediate danger was over, I had COVID anxiety regarding my husband’s job, which includes lots of contact with the public. We both knew it could have been a lot worse and were grateful that it wasn’t.

I kept up with my therapy appointments via WebEx. We both liked the process so well that we have continued meeting that way even though the danger of COVID has lessened. My med appointments were somewhat more problematic. These I had to attend in person, braving the masked world four times during the year. My psychiatrist is less tech-savvy than my therapist, but he did learn how to send my scripts to the pharmacy electronically, so the process was easier for me.

When my typing job slowed way down and was in danger of disappearing, I was able to find a new gig ghostwriting, which added a steady supplement to our income and lessened my perpetual anxiety and preoccupation with financial matters. Now that the typing is almost nil, ghostwriting has proved to be not only a financial boon but a boost to my self-esteem. After a rocky beginning with my first couple of assignments, I’ve had much better success and now feel both competent and confident.

All in all, the past year has been pretty good, I would say. Despite the anxiety I suffered, it never proved crippling. And I didn’t notice any real depression. Relative stability, which is what I felt, is a good thing.

It’s also a harbinger for the coming year, or at least I hope so. I don’t make New Year’s resolutions per se, but my goal for the year is to keep on keepin’ on. I will continue to take all my meds as prescribed. I will continue seeking ghostwriting assignments and doing my best to fulfill them. I will try to rein in my anxiety when we go to Gatlinburg for a few days this spring. I will keep a close eye on our finances but try to avoid major anxiety about them. I will also try to keep a lid on my overspending when I get hypomanic.

I have developed a new sleep-wake cycle in order to be with my husband in the mornings when he gets ready to go to work. I now go to bed at around 8:00 and get up around 6:00, or even 4:30 when Dan has an earlier workday. On those days, we both take a nap in the late afternoon, which sometimes makes our meal times more irregular. Generally speaking, it all works out, for the most part, and I see no reason to change it during the coming year.

Taking my meds faithfully and keeping up with my therapist and psychiatrist appointments are givens. I know that they are the linchpins of my stability. But I will keep on the lookout for depression, anxiety, and hypomania and try to deal with them as soon as I notice the symptoms.

In other words, if I can be said to have plans or goals for the coming year, I intend to continue as I have been and hope that my bipolar disorder doesn’t shake up those plans or goals. As always, it’s a crapshoot.

I see a lot of recommendations that you live not in the past or the future but in the now or in the moment. I have a hard time doing that. I look back on the past – not merely for one year, but for my whole life. I look forward to the future – the idea that there are still good things to come. I look back at how far I’ve come. I look forward to how far I can go.

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How Do You Find Relief From Stress?

Stress is a major factor in my life, and I’m sure it is in your life as well. As far as I can tell, there is no one these days that doesn’t suffer stress. I don’t know any millionaires or billionaires, but I imagine that, perhaps counterintuitively, even they suffer stress. There’s the stress of keeping their businesses going, watching their investments shrink when the stock market tanks, and stress in their personal lives. It’s hard to feel sorry for the very rich, but I can at least understand that they do have stress.

Yet, the stress I feel as someone with SMI is different. It’s not just the normal stress that comes with day-to-day life – bills, health, family, and the buildup of petty annoyances, et endless cetera. There are stressors specific to people with mental illness.

There’s the stress of symptoms or waiting for them to come back or get worse. There’s the stress of trying to find a therapy – medication or otherwise – that will help. The stress of trying to make a living or get on disability. Avoiding our triggers. Trying to find or maintain relationships. Remembering to take medication every day. The things we think of as stress relievers can be counterproductive, too. Booze or drugs, overeating, over-shopping, and other compulsive behaviors can actually add to the stress. Even performing self-care activities can cause stress – guilt over not doing the things we “should” do like exercise or meditation.

Having a caregiver can help lessen some stress. Caregivers can’t completely eliminate stress, however. In fact, they can be the cause of certain kinds of stress – worry about whether they’ll show up, whether we’re putting them through too much stress, or whether they resent us, to name a few.

So, what are some ways to relieve stress that don’t cause more stress?

My go-to stress reliever is music. When it all gets to be too much, I have myself a little music party. Usually, I party by myself, but sometimes my husband joins me, at least for the first half hour or so of it. I have plenty of slow, sad songs on my computer, but my music parties emphasize loud, raucous tunes. My playlist also contains silly songs (think Dr. Demento). I am fortunate enough to have a number of friends who are singer-songwriters and who specialize in the ridiculous, so I’m amply supplied. Sometimes I bounce around from song to song as they occur to me. Other times, I let the shuffle feature pick. An hour or two and I’m unwound enough to sleep.

My cats also provide distraction from stress. For some reason, I find it calming to watch cats wash themselves. The sound of purring is a stress reliever, and one of our cats snores (daintily) while she sleeps. Besides, they generate lots of alpha waves, and those are contagious.

I do also want to address the use of CBD/THC products for stress relief. I don’t have much experience with this, so I’ll have to defer to people more knowledgeable than I am. And I certainly don’t want to encourage anyone to break any laws. But I understand that one of the difficulties of using CBD in particular can be balancing the relaxing effects with potential paranoia. Still, many people find CBD to be a sleep aid, and good, restful sleep is a major stress reliever. At the moment, in my state (Ohio), PTSD and Tourette’s are the only mental disorders for which medical marijuana can be prescribed. Other forms of CBD such as hemp products are more widely available, including online.

What you actually do for stress relief matters less than that you do something. Maybe for you, that’s a massage or a warm bubble bath. But maybe it’s hugs, music, grounding exercises, meditation, or yoga. Whatever you find relieves your stress, making time for it on a daily basis isn’t a bad idea. That way, you’ll be in practice when the stress does hit.

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Are Holistic Approaches to Mental Health Useful?

Well, first of all, the answer to that question depends on what you mean by “holistic.” If you mean treatment that considers the mind, body, and soul, I certainly have to say yes. All three are inextricably intertwined and healing one tends to heal the others as well.

Certainly, the mind is involved – that’s implicit in the word “mental.” To many, this means the brain as the location of the mind. Increasingly, this also means thinking of and referring to mental illnesses as brain illnesses. And the competing theories of what causes depression and bipolar disorder, for example, have had something to do with the brain. Perhaps neurotransmitters in the brain are not behaving the way they are supposed to, or processing traumatic events causes brain illnesses (certainly true in PTSD), or genetics is responsible. whichever it is, the brain is involved.

It’s not controversial to say that the body and the mind are linked in the most profound ways. What affects one affects the other. Mental illness has demonstrable effects on the body, all the way from not being able to care for oneself physically to having a shortened life span. Treatment programs for mental illness often include an exercise component, which causes physical changes in the body and brain. Depression in particular is known to be alleviated by even small amounts of exercise. The exercise partially relieves the depression, which makes it more likely that the depressed person will be able to exercise. It’s a cycle that benefits both the body and the mind.

As far as the soul goes, I don’t feel theologically competent to make any definitive statements. I do know, however, that many people find that spiritual practices such as prayer help them cope with the effects of brain illnesses. It may be subjective, but what works, works. I personally don’t believe that prayer cures mental illness, but even if it just makes the sufferer feel more at peace and more comforted, that’s a component of healing that’s important.

Holistic healing that recognizes the interconnectedness of these three aspects of the person is, in my opinion, more likely to be more effective than any one of them alone.

Then there’s the other thing people often mean when they say “holistic healing.” To many, holistic healing means avenues of treatment beyond the scope of Western medicine. Herbal medicine, meditation, homeopathy, acupuncture, yoga, and crystal healing are among the avenues that have been explored.

There is certainly some validity to herbal medicine. It’s been practiced for thousands of years and the results are well-known, particularly by indigenous peoples who have passed that knowledge on throughout the years. Chamomile, lavender, passionflower, and saffron have been studied for mitigating anxiety or depression in cancer patients, with favorable risk-benefit profiles compared to standard treatments. Ginseng is another popular herb for relieving mental conditions. St. John’s wort has been used as a treatment for depression for hundreds of years, and so has valerian for anxiety. And there are many vitamins and supplements such as B vitamins and zinc that might have beneficial psychological effects.

Unfortunately, there hasn’t been a lot of rigorous scientific study of plant-based medicine. For people who gather herbs and plants from the wild, there’s no telling the potency or amount of the active substance that may be present. Even in herbal products sold at health food stores, there is little standardization, so you don’t always know what you may be getting in terms of dosage.

Meditation and yoga are popular adjuncts to talk therapy and/or medication for psychological problems. In fact, these days, they seem to be promoted as a panacea for mental health. They’re particularly popular recommendations in corporate settings, where they’re seen as a low-cost alternative to more expensive treatments that would affect the company’s health insurance costs.

Nonetheless, meditation and yoga do have beneficial effects on mood disorders such as anxiety and depression, and may be helpful for conditions such as PTSD as well. Any amount of exercise is commonly recommended for people with depression and bipolar disorder. The effects are cyclical. The more one exercises, the more one feels able to get going with exercise. Yoga, being low-impact, is something that can be tried by nearly everyone. I’d still say they are adjuncts to traditional treatments for mental illnesses rather than a first-line approach.

Then there are practitioners of alternative medicine. These therapies range from acupuncture to chi balancing to aromatherapy to biofeedback to reflexology to reiki. Let’s start with one that has some science to back it up.

Acupuncture and its cousin acupressure have solid adherents behind them. Johns Hopkins Medicine says that acupuncture is useful in treating anxiety, depression, insomnia, nervousness, and neurosis, though more studies need to be done. And who am I to argue with Johns Hopkins? If they say it’s effective or even promising, I’m willing to say it falls inside the spectrum of helpful approaches.

Reflexology, not so much. The idea that there are areas on the feet that correspond to body parts and can be helped by foot massage is not scientifically proven for health in any body parts, either anatomically or physiologically. (It hasn’t been disproven either, but you can’t prove a negative.) It’s based on the idea that “energy lines” throughout the body somehow combine in the feet (or hands) to produce a map of the body. It is recommended for anxiety and stress relief.

On the other hand, the massage practice of concentrating on muscles that are tensed is much more well-documented. The Mayo Clinic has said that it can reduce stress and anxiety, and even mentions it as a treatment for depression and seasonal affective disorder (SAD). The thing is, any practice that reduces stress is good for relieving anxiety. Whether or not massage has any effect on serious mental illness (SMI) is doubtful.

Relief from tension is, of course, possible when a person believes that a particular technique can reduce it. So if you believe in aromatherapy, for example, it may help you relax. It’s the placebo effect. I’d rather stick with massage.

Then there are approaches that simply don’t work. Homeopathy is supposed to work on the theory that if a substance is good for the body, introducing a single drop of it into water will be effective in the treatment of a disorder. Never mind the science (though there are rigorous studies that say homeopathy simply doesn’t work), the math doesn’t support this. Diluting a substance to the extent that there are minuscule, millionth amounts per glass of water – or even less – just isn’t sufficient to do anything. If there are larger concentrations of the substance, in which there can be alcohol or heavy metals like iron and lead, there may be drug interactions or serious side effects. In 2017, the FDA alerted consumers that some homeopathic teething tablets contained excessive amounts of the toxic substance belladonna. Belladonna is also said to be a treatment for bipolar disorder and schizophrenia.

Crystals are another way that alternative practitioners attempt to cure assorted diseases and conditions. Jasper and tiger’s eye are recommended for anxiety and lepidolite or citrine for depression. Smoky quartz is even said to relieve suicidal thoughts. I wouldn’t count on it. Again “energy fields” of the body and “vibrations” of the various stones, minerals, and crystals are supposed to combine to affect mental and physical health. I own and wear any number of crystals for their beauty, but have never felt any healing effects. The only benefit I see is if a stone is carried in the pocket as a “worry stone,” which the person can rub to induce a calming effect, an early version of the “fidget spinner,” as far as I can see.

Still, proponents of these alternatives to traditional Western medicine will continue to hope for beneficial effects. The National Center for Complementary and Integrative Health says that Americans spend over $30 billion annually on alternative health care. I say, “Let the buyer beware.”

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What If My Symptoms Come Back?

It’s inevitable. Once you’ve dealt with a mental illness, you’re afraid it will come roaring back, even if you’ve been stable for a long time. You wonder if your medications will stop working. You dread “breakthrough” episodes that will put you back in the same awful space you thought you had escaped from. You have flashbacks or dreams that take you to places you thought you had left far behind. You imagine you hear someone call your name and wonder if it’s a symptom. Sometimes, something you never thought of as a trigger will catch you by surprise and send you right back to the dark place, the anxious place, the out-of-control place.

Those fears are not unwarranted. All of those things could happen. For many people, they do. For most, the thoughts pop up at odd moments, even when you’re doing well. They’re unpredictable. That’s part of what makes them so scary – the knowledge that you have no control over these thoughts of recurrence.

It certainly happens to me. I obsess over my own thoughts. I fear dropping back into depression. I wonder if I’m exhibiting hypomanic behavior without realizing it. I overanalyze nearly every feeling I have if it has the slightest hint of a symptom of bipolar about it.

That’s when it’s good to have a strong support system – a person or persons you can talk to and check in with. Someone who recognizes your baseline behavior and when you start to depart from it. Someone who understands your disorder and what the symptoms might be.

I’m fortunate to have a support system in place, though it consists of only two or three people at this point – my therapist, my husband, and to some degree my prescribing psychiatrist. I see my psychiatrist only four times per year for med checks, but I can tell him when I think I’m experiencing symptoms and ask whether he thinks it’s something that warrants a change in meds.

I see my therapist approximately once a month, and she has a better handle on intrusive thoughts and whether they are irrational or not. She provides a “sanity check” for me. Most of the time, she reassures me that they’re normal (or nearly so). Sometimes, she tells me if I should bring them up with my psychiatrist the next time I see him. Mostly, she listens, which is what I think a good therapist does.

The mainstay of my support system, however, is my husband. He understands bipolar disorder from years of living with me and living through my mood swings. He knows my baseline level of behavior and when I begin to depart from it. For example, he can recognize when I am starting to get hypomanic and suggest to me that I might be beginning an episode. Or, if I feel like I might be getting manicky, I can ask him if he sees the symptoms in me or not. If I’m having delusions that other cars are swerving into my lane, he can suggest I take an anti-anxiety med.

Four former members of my support system are no longer there, two because they recognized my symptoms increasing and were not able to deal with them, and two lost to death. Even though my husband and my mental health providers help keep me on an even keel, I do miss the additional input. I need reassurance when I am doing well and help when I begin to veer off course.

This month, however, I am doing better. I just postponed my therapist appointment because I have no pressing issues that need addressing this month. May it stay that way.

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Not Breathing Affects Our Mental Health

My husband and I both have sleep apnea. We also both have depression, or at least he does and I have bipolar disorder with a pretty hefty depressive bent.

Sleep apnea is a medical condition in which a person stops breathing multiple times a night. The body responds to this by resuming breathing after a second or two, but sleep disruption has already occurred. For my husband, this occurs up to 60 times a night, while it happens to me more like six times. (Technically, my version is called “hypopnea” (hypo+pnea – low+breath; apnea, a+pnea – no+breath.))

The body depends on breathing, of course, for oxygen, but it also depends on sleep – which is disrupted in sleep apnea – for proper functioning. REM sleep, for example, is vital for dreaming, which has multiple beneficial effects on the body and mind. REM sleep has been known to be altered in depression, and studies have suggested that it is involved in modulating mood symptoms, including psychological distress in general.

One of the more observable symptoms of sleep apnea is loud and prolonged snoring, which both my husband and I have suffered from. While I was traveling with my mother, she even requested that I let her go to sleep first since my snoring kept her awake.

But what does sleep apnea actually do to the sufferer’s brain? Surely lack of oxygen to the brain has some effect.

Indeed it does.

According to research conducted at UCLA, “gasping during the night that characterizes obstructive sleep apnea can damage the brain in ways that lead to high blood pressure, depression, memory loss, and anxiety.”

Sleep apnea has been associated with difficulty concentrating, memory problems, poor decision-making, depression, and stress. Psych Central reports that untreated sleep apnea increases the chance of anxiety by over three and a half times; depression, by more than three times; severe psychological distress, by not quite three times; and suicidal thoughts, by more than two and a half times. Sleep apnea has also been associated with PTSD. The Journal of Clinical Sleep Medicine recommends that “in individuals with [obstructive sleep apnea] and psychiatric illness, treatment of both disorders should be considered for optimal treatment outcomes.”

Studies suggest that sleep apnea is linked with changes in at least two neurotransmitters in the brain (GABA and glutamate) that combine and coordinate signals that help regulate emotions, thinking, and some physical functions. Researchers plan to investigate whether treatments for sleep apnea will help these brain chemical levels return to normal.

SSRIs (selective serotonin reuptake inhibitors) such as fluoxetine and sertraline (Prozac and Zoloft) are thought to be valuable in treating sleep apnea. One study indicated that SSRIs may be a good treatment option for [sleep apnea], particularly for those [patients] with epilepsy. Another study showed a link between “having sleep apnea and increased odds of having a mental health issue” or symptoms such as anxiety or thoughts of suicide.

Treatments for sleep apnea include dental appliances to be worn while sleeping, lifestyle changes, and even surgeries. These treatments sometimes address snoring directly, but not the underlying mechanism. The more effective treatment is “positive air pressure,” delivered by CPAP machines.

CPAPs use positive air pressure to keep the sleeper’s airway from collapsing, which is what impedes their breathing and jolts thie brains into resuming it. They consist of a unit that generates air pressure, a hose and mask to deliver it, and assorted straps to keep the hose in place throughout the night. The masks can be ones that cover the entire nose and mouth or cannulas that are simply placed in the nostrils. There are also cushions on the masks or available separately that reduce discomfort as well as waking up with “mask face.” Many people find the masks uncomfortable to wear all night, but others use them not only at night but also for naps. Unlike a ventilator, the CPAP doesn’t breathe for a person. It allows them to breathe more effectively on their own.

Diagnosing sleep apnea requires a “sleep study” ordered by a doctor. Assorted leads are attached to the subject, who then spends all night sleeping (or trying to). Breathing rate, heart rate, oxygen saturation, and other parameters are measured and a record is kept of the number of times the subject stops breathing during the night. This is sent to the doctor, who can then prescribe a CPAP unit and mask.

Dan and I both use CPAP machines. They are a bit inconvenient, especially when we travel and have to take power cords so we both can use them at the same time (and power converters when we travel abroad). When it comes to packing, the machines are a bit bulky and somewhat heavy. Still, we take them with us religiously.

Has sleep apnea treatment improved our mental health? It’s hard to tell, especially since we’re both taking SSRIs anyway. I know correlation isn’t causation, but our depression and bipolar have certainly eased up since we started getting treatment and our sleep cycles have become more regular. But if all it does is stop the snoring, that’s still a win for us.

So, if you snore a lot and have mental health issues, you might want to be tested for sleep apnea and treated if you do. Like chicken soup, it can’t hurt and might help.

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Remote Work and Mental Health

Nowadays, many workplaces have a toxic culture or at least a dysfunctional one. They demand – not just expect – more from their employees than any human being should have to, or be willing to, give. Sixty-hour weeks. Twelve-hour days. Giving up weekends and holidays. They treat employees as fungible things that can be easily replaced and regularly are, especially if they don’t live up to the brutal “standards” that are supposedly required by the free market.

Toxic workplaces are also full of toxic people. Bullying of employees and coworkers is common. Gaslighting even happens, more regularly than we’d like to admit. Required conformity and enforced corporate “team-building” parties and picnics suck the meaning out of workplace enjoyment. Exhortations that the workplace is a “family” and then behaving in ways that belie this are rampant – false, harmful, and destructive.

Corporate practices aren’t human-friendly, much less family-friendly. Flexible working hours, job-sharing, onsite childcare, remote work, part-time work, and extended sick and other types of leave are largely reserved for only the highest echelons or never even considered for any workers. Health and disability insurance are nonexistent or ultra-expensive for workers because of the monetary costs to the company. Discussions about the stress caused by work end in suggestions to try yoga. Employee Assistance Programs (EAPs), if they exist, provide some therapy, but only with a provider of the company’s choosing and usually only for six weeks or so.

Then along comes the COVID pandemic. Suddenly, corporations and other, smaller businesses were faced with the difficulties of staffing during lockdowns and quarantines. All of a sudden, workers weren’t so available or so desperate. Owners had to scramble to hire enough workers to keep the wheels turning. Some businesses were forced to raise wages. Others had to rethink corporate travel to cut costs.

And some turned to remote work. Not all could, of course. Some jobs simply can’t be done from home. Construction workers, wait staff, airline attendants, and countless others were simply let go or put on furlough, many of them without even partial pay. But many jobs, particularly office jobs, were the sorts that could be done from home, on the phone or via computer. And that proved beneficial both for the affected companies and for the mental health of their workers. Bosses suddenly realized that work-from-home even improved the bottom line, reducing overhead. It soon became clear that home-workers were able to be as or even more productive when not being constantly interrupted by mandatory meetings and other useless exercises.

How did telecommuting affect workers’ mental health? First, remote workers were spared from many aspects of toxic workplaces. Micromanaging became largely unfeasible.

This certainly helped improve their working conditions and stress. So did getting respectably dressed only from the waist up, especially for those of us with limited spoons. Being able to step away from the computer for a half-hour or more to do something about chores or even hobbies provided a welcome break. Lunches could now be taken whenever you were hungry and last more than 30 minutes. Even spending more time with pets reduced stress and provided emotional support that’s next to impossible in most workplaces.

Many of the stresses that so exacerbate mental health conditions were at least lessened. People were more comfortable in their own homes, with comfort objects and self-care items more readily available. Those with a greater need for alone time suddenly had more of it. If they found that they could work better or more productively part-time at home, it was a benefit for the companies as well.

Of course, not all bosses took to this new way of working. Once they figured out that employees could be more productive when working at home, some of them upped output requirements. They could insist that employees remain logged in during standard working hours, making flex-time less doable. Or they started requiring more output from those telecommuting, or scheduling Skype meetings that cut into employees’ time.

I work at home, remotely, and have for a number of years. I do so because I have been fortunate enough to find jobs that pay (though not a lot), jobs that match my skill set, jobs that aren’t 9-5, and jobs that are conducive to working around my days of depression and hypomania. I’ve considered going back to work in an office from time to time when funds were low, but not enough to actively pursue it. Truth to tell, I don’t think I’ll ever be able to do that again, and not just because I like working in my pajamas. (For those who are curious, I’m doing transcription and ghostwriting at the moment. They provide a supplement to Social Security and allow me time to work on my blogs.)

Did toxic work environments cause mental illness? Probably not, though they have pushed some people closer to the edge and others past the breaking point. It’s hard to work in corporate culture with any kind of mental disorder (except possibly narcissism). For these people, remote working is a blessing. COVID has been devastating, but one of its side effects has been to improve working conditions for millions of people – and especially those living with mental illnesses.

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Anxious in Ireland

So not us.

Over the last couple of months, I’ve written about the anxiety I’ve been having regarding our vacation in Ireland. There’s been the overplanning, overscheduling, overspending, and the trying to make sure that everything went perfectly (like that was going to happen). I had anxiety about whether I would pack too much or too little, whether I could sleep on the plane, whether I could find things to eat comfortably (after recovering from dental surgery). Anxiety about whether I could find help with my mobility challenges in the airports and at my destinations. Anxiety about driving on the left. Et endless cetera.

As my therapist noted when I spoke to her after my return, it was good I took my anti-anxiety meds with me. (I made sure to pack them, even though I haven’t been taking them every day since consulting with my prescribing psychiatrist. I packed all my other psychotropics too, of course. I also carried my sleeping aid, which I’ve also stopped taking regularly, for the plane flights, but didn’t need it.)

Many of the anxieties I encountered in Ireland did indeed have to do with driving. I tried driving the rental car once, but I was too nervous to continue that. My husband ended up doing all the driving and I navigated. After some bad experiences with the GPS unit that the car rental company provided, we switched to using Google Maps on my phone, both of which fortunately worked in Ireland. I was in charge of transmitting the directions to Dan and trying to translate kilometers into miles for him.

One of the first difficulties we had before we defaulted to Google Maps was when we were heading to our first bed-and-breakfast reservation (the accommodations were arranged in advance by the travel company, so I didn’t have to have anxiety about where we were going to sleep each night). The GPS took us on a series of narrow, stony roads that ended up with us running off the one lane and into a ditch. After the initial shock and the realization that we couldn’t simply rock the car out of it, though, I wasn’t really all that anxious, perhaps because it was late at night and I was emotionally as well as physically exhausted.

I had a flashlight in my purse (something I almost always carry). My husband took it and set off on foot to find help, while I waited with the car. In about half an hour he returned with a local couple of lovely, helpful people, who drove us and our luggage to the b-n-b (which was actually quite nearby). They also came back in the morning to pull the car out of the ditch and pulled out a minor dent for us, and they accepted a modest amount of Euros for all their help. All things considered, it could have been much worse. I fell into bed that night and slept soundly.

During the whole trip, I never got really used to the driving situation. Dan noticed that I was making humming noises as we drove and bracing my hand on the dashboard (or the roof) at times. He called this “vibrating” and gently reminded me that I had the anti-anxiety meds with me. Eventually, I got used to taking them every morning before we began our day’s wanderings. My vibration was particularly noticeable when we passed another car or when I thought we were swerving too close to the edges of the road (the ditch situation made this seem all too plausible). Parking in cities – and indeed simply trying to navigate in them – also triggered my anxiety.

Then there were the godawful problems with our flights and our finances. Back in December, the airline had changed our flight out but never notified us about it, so we showed up at the airport four hours after our flight left. I spent several hours on the phone with the airline, our bank, and our credit card company trying to make arrangements for the first flight out the next day and the money to pay for it (since we were considered no-shows). Fortunately, I went into task-oriented mode (which I am sometimes capable of) and shuffled money and flights around before I collapsed. We did miss our scheduled first day in Ireland, though.

Getting a flight back was even worse. There was a problem with our COVID certification (we needed an antigen test, not just a triple-vax card) and later flights were booked solid. In the end, we had to spend two days in a Dublin airport hotel while trying to make arrangements with a dying phone and no charging cable. Dan came through there too when I was at the end of my proverbial rope (or in this case cable) and managed somehow to get a replacement. But by then we were out of money and I had to ask friends and family to PayPal us money for the extra nights in the hotel. It was all quite nerve-fraying and close to panic-inducing.

We’re back home now and I have settled down quite a bit, though I’m still dealing with financial repercussions, which have always been one of my major anxiety triggers. But I’m not taking the anti-anxiety pills daily anymore. And, as always, Dan is helping me.

The good news is that, throughout and despite all this, we managed to have a great time in Ireland. Sure, I had anxiety – and quite a bit of it – but I was still able to enjoy the country, the scenery, the food, the activities, and the wonderful people. We’re already talking about saving to go back.

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Traveling – and Planning – While Bipolar

Traveling is often a challenge for people who have bipolar disorder. Some people can’t do it at all or can’t even leave their houses, which I certainly sympathize with. I really do. There have been times in my life when I could travel and times when I could not, because of my mental state.

Right now, I’m able to. I’m taking advantage of this to go with my husband to Ireland for ten days. We started planning this trip last fall, which has, of course, given me plenty of time to overthink everything – but not to reconsider. I think this will be one of the best things we have ever done together, apart from getting married.

If everything (and by everything I mean Facebook) works right, this post will appear while I’m overseas. I didn’t want to just skip a week in my blog, so I’m trying out the feature that lets you schedule posts ahead of time. I worry that it won’t work, which in the greater scheme of things wouldn’t really be so bad. Just more overthinking.

In addition to overthinking, I am over-scheduling and over-packing. I have been bothering our travel agent with questions about driver’s licenses and phone service. I have made reservations for eight different scenic places and interesting events. (I think they require reservations because of COVID, because they don’t want too many people to show up for tours at the same time.) I have a list of things I need to do before we leave. Every time I cross one thing off, I add another at the bottom. I used to be able to pack for a long weekend for both of us with only one tote bag, but those days are long gone. My list of what I will need to have with me threatens to spill over my luggage allowance.

In the past when I’ve traveled, I’ve had some success with giving myself permission to feel the way I feel – to take a day off from activities if I feel low, for example. This time, what with all the pre-booking, I may not be as inclined to do that. We do have days scheduled with less driving around and I have noted times when we can simply explore local pubs and restaurants. We’re even bringing along a card game in case we feel too useless to leave our bed-and-breakfast.

I have no guarantees that my mood swings will abate while I’m gone, of course. Making sure all my meds are refilled and packed is top on my to-do list. That’s much more important than packing a card game. I can see myself getting cranky about getting to the various locations in time for our reservations, but I’ve been fairly stable lately, so I hope I don’t tip over into something worse than grumpiness. At least my husband will be there to help me laugh and decompress.

I think that time to decompress is necessary while traveling. It may have been my hypomania that told me to make reservations for every occasion. And I hope the looming shadow of my bipolar disorder doesn’t sabotage the whole thing. This vacation is very important for us, which probably means I have too much invested in it, and I don’t mean just monetarily. It’s most likely the last time we’ll ever be able to travel abroad, so I want to make the most of it.

I just hope that making the most of it doesn’t send me tipping over the edge into depression or hypomania. I’m never good psychologically with financial affairs or not knowing what’s going to happen. I’ve seen those tendencies in myself increase with time. I hope that this vacation is what I need to shake me loose from some of those feelings. I hope that I will look back on it, after this bit of writing becomes public, and realize that I have proved my relative stability by being able to go through what is intended to be a magical time. But I guess expecting magic is too big an expectation to put on a vacation.

Hypomanic, Anxious, and Overextended

My hypomania and my anxiety are fighting each other. Here’s what happened to start the quarrel.

There wasn’t much work for me over the holidays and into February. The transcription company that I freelance for didn’t have many assignments to give out, and, being part-time, I was low on the list to get them. Plus, one of the company’s biggest clients was leaving. And my husband and I got COVID, so it was impossible for him and difficult for me to work.

The job at the transcription company isn’t great. I make a few hundred dollars a month, which is a good supplement to my Social Security and my husband’s pay. I’m really a crappy typist, though, so it takes me longer to finish assignments than it does for most people. I work only four days a week, but it feels like full-time.

But, with the job likely to go away entirely, my anxiety was triggered. I figured it was time to look for a new part-time gig, maybe one that wouldn’t be as taxing.

I started my job search and eventually found a company that was hiring remote online tutors, which seemed perfect for me. My bipolar disorder makes it difficult for me to work in an office, especially in a 9-to-5 job. I’ve done it in the past, but don’t think I could anymore.

Then good news came – the transcription job wasn’t going away after all. A new client had signed on (though the work hasn’t started to come in yet, so I have no idea what the pattern of assignments will be).

I didn’t want to give up on the tutoring job. (I haven’t started yet, as they are still processing my paperwork.) I figured I might be able to do both, tutoring on the three days per week that I wasn’t transcribing, or in the mornings between assignments. The tutoring gig requires only five hours per week, though you can take on more.

Then I got a lead on a job editing, which is my real love when it comes to work. And I began to wonder whether I could do that in addition to both the tutoring job and the typing job.

Of course, that’s hypomania talking. I don’t get hypomania very often and when I do, I have a hard time recognizing it. My husband sometimes notices it before I do and gently reminds me when he sees me starting to go overboard. “You’d be awfully busy,” he said, looking dubious. It made me stop and think. For one thing, it made me think that it might not have been a good idea to buy the new computer that the tutoring job would require. For another, my time off with him is precious, and I wouldn’t like losing that.

The typing job is supposed to get rolling again, but I like it the least, as it isn’t a good use of my real skill set. But I’ve been doing it for several years now, so I’m kind of used to it. The prospect of having no extra money coming in scares me, though, enough that I am really considering getting that second part-time job. That’s my anxiety talking as well as my hypomania.

Realistically, I ought to just stay with the job I have and hope that the new client works out. Now that that is a possibility, maybe I should give up the idea of more work. But the uncertainty that I’ve recently experienced tells me that I ought to have another way to jump, just in case.

Which will win – my anxiety, my hypomania, or my husband’s common sense? I really want that editing job . . . .

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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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