Bipolar 2 From Inside and Out

Posts tagged ‘anxiety’

Distance Psychotherapy: Is It for You?

By Alice / adobestock.com

I will make a confession: I have never used distance therapy, except for when I couldn’t drive to my therapist’s office, my husband wasn’t available to drive me there, or when I had the last-minute I-just-can’t-go-today feelings or I’m having-a-crisis feelings. This was in the days before teleconferencing, texting, and other long-distance forms of therapy, so occasionally my therapist would agree to do a telephone session, which I appreciated greatly. In general, they didn’t last as long as the standard psychotherapy 50-minute hour, but at times they were lifesavers.

Now, when everything seems to be online, and especially during pandemic lockdown, quarantine, or simply fears of going outside, tele-psychotherapy seems to be becoming a thing. Many services are now available via the internet, smartphones, and whatever way you pursue your online life.

I’ve been looking at these services, not because I need one now, but because I want to know what’s available in case I ever should. The APA (American Psychological Association) provides a lot of helpful information on the subject. Their site has provided a list of pluses and minuses regarding telehealth for psychology. They note: “With the current research and with the current technology, mobile apps and text messaging are best used as complementary to in-person psychotherapy…Research does show that some technological tools can help when used in conjunction with in-office therapy,” though “There are cases in which Web-conferencing or therapy via telephone does seem to be a viable option on its own for some people.”

Inc.com provides a helpful list of the pros and cons of online therapy. Some positive aspects are that:

  • People in rural areas or those with transportation difficulties may have easier access.
  • Most online therapy services cost less than face-to-face treatment.
  • Scheduling is more convenient for many people.
  • Individuals with anxiety, especially social anxiety, are more likely to reach out to an online therapist.

among the negatives are:

  • Without being able to interact face-to-face, therapists miss out on body language and other cues that can help them arrive at an appropriate diagnosis.
  • Technological issues can become a barrier. Dropped calls, frozen videos, and trouble accessing chats aren’t conducive to treatment.
  • Some people who advertise themselves as online therapists might not be licensed mental health treatment providers.

Despite the concerns, research consistently shows that online treatment can be very effective for many mental health issues. Here are the results of a few studies:

  • 2014 study published in the Journal of Affective Disorders found that online treatment was just as effective as face-to-face treatment for depression.
  • 2018 study published in the Journal of Psychological Disorders found that online cognitive behavioral therapy is, “effective, acceptable and practical health care.” The study found the online cognitive behavioral therapy was equally as effective as face-to-face treatment for major depression, panic disorder, social anxiety disorder, and generalized anxiety disorder.
  • 2014 study published in Behaviour Research and Therapy found that online cognitive behavioral therapy was effective in treating anxiety disorders. Treatment was cost-effective and the positive improvements were sustained at the one-year follow-up.
  • A recent review of studies published in the journal World Psychiatry compared people who received CBT treatment online with those who received it in person.  The two settings were shown to be equally effective.

One possible pitfall, warns APA, is that “online therapy or web therapy services are often not covered or reimbursable by most insurance providers. If you plan to be reimbursed, check with your insurance company first. Otherwise, prepare to pay for the full cost yourself.” The services I explored charge about $35 to $80 per week for unlimited messaging and one live session per week. MDLive provides a psychiatrist at $284 for the first visit and $108 afterward. (They have lower rates for seeing a therapist rather than a psychiatrist, and do accept insurance.)

Business Insider, in its article on the subject, dealt specifically with a service infelicitously known as Woebot. Unlike the other services, Woebot is a “chatbot” that substitutes artificial intelligence and natural language processing for a real, live therapist. It uses cognitive behavioral therapy. Their website claims that Woebot “is the delivery mechanism for a suite of clinically-validated therapy programs that address many of today’s mental health challenges, from generalized anxiety and depression to specific conditions like postpartum depression, adult and adolescent depression, and substance abuse.” Like a non-directive therapist, it asks probing questions and responds to questions and answers from the user. For now, it is free to users, though they seem to be exploring a paying model.

Other telehealth counseling services include:

Amwell

Betterhelp

Brightside (depression and anxiety, not bipolar or mania)

Online-Therapy.com

ReGain (couples therapy)

Talkspace

teencounseling (will consult with parents)

If you decide to try online therapy, it’s best to compare services and determine what services they offer, at what price, and what the credentials of their therapists are. If you have already tried it, I would be glad to know the results. Feel free to comment.

 

 

A Letter From the Future to Bipolar Me

by sosiukin via adobestock.com

Dear Me:

You’re 13 years old now, and there are a few things you should know.

You have bipolar disorder. No one knows this, not even you. But a lot of people notice that you act “weird” at times. You have decided to embrace your weirdness, which is fine, but what you really need is psychological help. And medication.

Don’t pass up any chance to get that help. Your high school will recommend to your parents that you get counseling. When your parents leave the choice up to you, take it. It will not go on your permanent record, and you will still get into a college. A very good college, in fact.

I know that at times you sit alone and cry. Other times you laugh at things no one else finds funny. This is not just “weirdness.” This is a mood disorder, called bipolar disorder, type 2. Your mood swings will make it difficult for you to make and keep friends. Keep trying. The friends you will find are worth it and will stand by you when you really need them. You will not be alone in dealing with this.

Your choice to go to college out of state will be a good one. There you will have a variety of experiences that will make you grow in unexpected ways. Your mood disorder will go to college with you, though. Leaving Ohio will not mean you will leave bipolar disorder behind. You will still feel the mood swings, and most of them will be depression.

It’s a good idea to take that year off between freshman and sophomore year. I know it will feel scary, but at that point you will be in no shape to carry on with academics. Instead, you will get a job which, while not great, will introduce you to more new people and new ways of life. At least one of those people will stick with you till you are old and gray.

Returning to school will be a good decision. Your parents will support you in that decision. They won’t object to your year off, because they know you will go back. It still won’t be easy, but you will have a core group of friends that accept you, even though you are different from them.

Your bipolar disorder will follow you back to college. It will make you miss some opportunities and choose others that will not be good for your mental health. You will be unhappy most of the time, but you will find that music helps you through it.

Try not to self-harm. I know you will feel numb and want to feel something else, but cutting yourself is a bad decision and will not help. You will carry those scars forever.

When you meet Rex, though, you will be encountering a problem too big for you to handle, and the relationship will leave you scarred as well. It would be best if you were to steer clear of him altogether. But then again, you will find some true friends in his circle, and it would be a shame to miss them. Try your best to hold yourself together, remember what I said about self-harm, and don’t give up on who you are. You are not your disorder, and you will get through this, despite everything.

I know you never gave a thought to marrying, but you will meet a man and in a few years you will marry him. This, I assure you, is a good decision. He will stick by you no matter what and help you find help.

Going into the building that says “South Community Mental Health” will be a good decision. Whatever you will be feeling at this point – most likely misery – it’s not mentally healthy. This will be the place where you will start to climb out of the hole you have found yourself in.

At last, a doctor will tell you that you have bipolar disorder – most often depression, but also anxiety. He will work with you to find a combination of medications that will help you. When that happens, you will become reacquainted with your brain and relearn how to function in the world at large. Your brain will function in a new way, one with fewer out-of-control feelings. You will experience life more fully and be glad of your new outlook.

It won’t be quick, and it won’t be easy, but you will have therapists, and friends, and work, and love, all of which will help see you through. You will have bipolar disorder all your life, but it will not be your life, though it seems that way now.

Reach out for help whenever and wherever you find it. Cherish your friends. Keep trying, even when you want to give up. Better times are on the way.

I promise.

Love, me (older and maybe wiser)

Bipolar Conversation

This morning a podcast called Bi-Polar Girl was uploaded, and I was the interviewee. (You can find it on Apple, Amazon, and other podcast sources.) Here’s a look at what was like.

  • Prepping. Before we recorded the podcast, my anxiety kicked in, and I tried to overprepare. I bombarded the hosts with emails asking what I should be prepared to talk about or what questions they were going to ask me. Basically, they told me we were going to “wing it” and have me tell my story.
  • History. The thing we talked about most was when I started showing signs of bipolar and when I was diagnosed. I explained that I was showing signs of it as early as my high school years, how I decided to seek treatment after college, and how I was mistakenly diagnosed with major depression for years before receiving the proper diagnosis and medication.
  • Meds. We discussed medication in some detail – pill-shaming, how every person reacts to meds differently (so it’s useless to “recommend” a particular drug to friends or support group members). We talked about the side effects of various medications, including the fact that the most-feared one seems to be weight gain. One particular point of discussion was how many people are afraid that taking medications to treat their disorder will stunt their creativity or turn them into “zombies.” Snowflake (one of the hosts) and I agreed that our creativity and ability to work were actually improved while on medication, because it enabled us to focus and do more creative work.
  • Family. We also talked about the fact that I have no children and my reasons for that. (We also introduced some of our pets during the Zoom call, or they introduced themselves. Just try to keep an animal out of a Zoom call.) I shared that I felt it would be unfair to a child to have a nonfunctional mother, that I was afraid of going off antidepressants while pregnant, and postpartum depression afterward. Snowflake shared her story of medications, potential side effects, pregnancy, and postpartum depression.
  • My publications. I talked about my blog and my books, Bipolar Me and Bipolar Us. In particular, we discussed gaslighting, which features in my second book, and how people with bipolar are more susceptible to it. Both Snowflake and I shared how we had encountered gaslighters in our own lives.
  • Groups. Chacoman, the other host, questioned me about whether I was involved in any local or regional support groups, and I had to admit that I’m not. Now, during the pandemic, group meetings are problematic at best, but I don’t react well to groups at any time, due to my anxiety (which is how my hypomania manifests). In my case, outreach is limited to my blogs and books, and membership in online support groups.
  • Miscellaneous. We got off topic a number of times. I don’t want to make it sound like the interview was all serious or grim. We also talked about our pets, positive relationships, college memories, and even politics.
  • Plans. I talked about how my next book will be a mystery, with a bipolar main character, and received positive feedback on the idea.

All in all, it was a good experience, worth overcoming my anxiety for. I had only participated in a podcast once before, a not-altogether-successful interview about my first book with an interviewer who had obviously not read it and was more interested in whether any of my family members were also creative. (It was supposed to be a podcast about first-time authors.)

This was not the same sort of thing at all. I told my story, as the hosts had recommended, and we had a genuine, far-ranging conversation about not just my own experiences with bipolar disorder, but with how others cope with it as well. Actually, I learned a lot about myself, from how much my anxiety – and especially social anxiety – still affect me, to how much my teen years illustrated my journey into depression.

So, here’s a big thank you to Snowflake and Chacoman for the opportunity to share with them and their audience. I would absolutely do it again. It helped me step out of my comfort zone and, I hope, will help the listeners as well. It’s a form of outreach that I had never considered, but one that I found valuable – and just plain fun!

 

 

When Overthinking Takes Over

Overthinking, or analysis paralysis, as it’s sometimes known, is the great immobilizer. Your brain goes temporarily out of control and prevents you from making choices, doing things you need to do, or even getting out of bed in the morning. There are many ways in which it can accomplish this and ways in which you can fight it.

Night thoughts. When you’re trying to get to sleep and your thoughts keep revolving like a small rodent on an exercise wheel, that’s what my friends and I call “Hamster Brain.” Really, the only way to stifle these thoughts is to get up and do something else. Clean, read, exercise, get your tax documents in order – anything that tires your brain and/or your body. Then try sleeping again.

Random thoughts. Sometimes the oddest thoughts occur at the oddest times. Once it occurred to me that I didn’t know whether my passport was up to date. A friend was worried about her children’s religious education. If possible, check out whatever has popped into your head. I dug out my passport and saw that it was, indeed, up to date. My friend couldn’t get an immediate answer, but later received validation that, yes, she had done all right by her boys.

Your every mood. Depression – and particularly bipolar depression – can make you doubt your every mood. Am I just sad, or am I teetering on the edge of a major depressive episode? Do I feel good, or am I just kidding myself? Maybe I’m trying to cover my depression with a smile. You can analyze your moods until you really don’t know what you feel. Look for clues in your life. Did a beloved pet die recently? You may be experiencing reactive depression, nor clinical depression. If you feel happy, don’t analyze – just go with it!

• Your every move. Sometimes it seems that you have a little recorder in your brain that keeps a copy of every foolish thing you’ve ever done or said, and plays them back at unexpected moments. Most people I know with depression experience this and end up beating themselves up over events long-gone. It may be a comfort to know that, with time and proper treatment, that recording machine goes away, or at least plays back your words and actions less often. If you notice that happening, it is a sign of healing.

Decisions. Making decisions, especially important ones, is a hallmark of analysis paralysis. Weighing choices can be difficult for anyone. Depression can cloud your thoughts and make it even more difficult. Should I use what energy I have to meet friends for coffee? Should I tell my employer about my depression? Should I take a full-time job?

For life-altering decisions, careful thought, not overthinking, is needed. Make a list of pros and cons. Talk to a trusted friend about the situation. If what you can’t decide is less earth-shattering, use a simpler solution. Flip a coin. Draw a number out of a hat. Anything to make the decision for you. If you do that, you’ll quickly discover if that’s the choice you really want.

The good and the bad. Overthinking often comes down to deciding what is good for you and what is bad for you. At times like these, focus on your mental state. Will this career decision make my depression worse? Is this spending decision really my hypomania talking? The question you need to ask may be “How do I feel about this?” rather than “What do I think?”

Going off on a tangent. Once in a while, you may be thinking about one thing, only to have your brain flit to something else and start obsessing about it. I once heard a metaphor regarding mindfulness and meditation: When you find your thoughts wandering off-track, imagine them as a puppy that wants to wander off. Gently corral it and pull it back. Then go back to what you were originally thinking about. It may be necessary to do this several times until the “puppy” gets the idea and doesn’t wander off.

I’m often subject to analysis paralysis. It’s been said that I have a third-degree blackbelt in overthinking. I like to think, though, that I get into such traps less often now, or at least get out of them more quickly. Really, overthinking adds nothing good to your life and mental well-being – indeed, it detracts from them. For many of us, overthinking is sometimes inevitable. Developing a few techniques to deal with such thoughts can be a blessing.

 

What’s the Difference Between Anxiety and Mania?

kues1 from adobestock.com

Ha!, you say. That’s an easy one. I know the answer to that. It’s like the difference between walking on pins and needles and walking on eggshells. For me, anxiety is the pins and needles, while mania is produces the eggshells. Pins and needles hurt more, but eggshells are easier to break. Anxiety causes me more pain, but mania has me treading carefully on a fragile edge.

Anxiety and Mania

I know more about anxiety than mania. My diagnosis is actually bipolar 2 with anxiety disorder. As such, I never really experience true mania. Hypomania is about as far as I get. And believe me, that’s enough. 

First, let’s start by admitting that anxiety and mania have a lot in common. At least they do in my life. Both of them make me frantic. Both of them make me obsessed with money. Both disrupt my eating habits. And both of them make me very very twitchy.

Frantic. Both anxiety and hypomania make me feel frantic, like there is something that I need to be doing to alleviate them. I know this isn’t true, that they are out of my control, but it feels that way. I get all revved up inside, a nagging, prickly feeling that jangles my nerves and irritates my brain. I try desperately to think what it might be that would calm the feeling, but there is nothing this side of an anti-anxiety pill, which might or might not help.

Obsessed with money. With anxiety, I obsess about the bills and how I am going to pay them. With mania, I obsess about what money I do have and how I can best spend it. Since this is, after all, hypomania, I tend not to go on wild spending sprees, but I have been known to buy myself or my husband presents, telling myself that the costs are comparatively reasonable and that at least I have limited myself to a non-extravagant amount. (Which may be the anxiety and the hypomania arguing with each other.) With anxiety, I try to anticipate all possible bills and juggle their amounts, due dates, and relative necessity (power cut off or trash removal cut off). I take on extra work, not because I think I have the wherewithal to do it, but because I want the extra money, no matter what it costs me in terms of physical and emotional energy.

Eating habits. Both anxiety and hypomania make me eat too much. With anxiety, no doubt I am trying to fill an existential hole or find something to distract me from my worries. With hypomania, I crave the relatively safe sensations of rum raisin ice cream; cinnamon Danish; or salted, buttery popcorn.

Twitchy. Both anxiety and hypomania can cause the shakes, tremors in my hands and arms and legs. Alas, not for me the euphoria of true mania, but the inherent sensation that I’m doing something wrong at some level. I can’t even enjoy hypomania without guilt.

There are differences, however.

Anxiety leaves me immobilized, in a way that hypomania just doesn’t. You’d think with all that nervous energy vibrating around my body and brain, I would hyper myself into a frenzy. Instead, all the jitters cancel each other out, leaving me with no place I can go to escape. My fears leave me paralyzed. The money worries leave me unable to decide what bill to pay first. I can’t decide whether it’s better to stay awake and try to read (if I have enough ability to concentrate), or take that anti-anxiety pill and try to rest, if not sleep.

Mania can make me productive, in a way that anxiety can’t. When I’m hypomanic, I can write, or at least put words on the screen. (Whether they’re any good or not is anybody’s guess.) But at least I have the illusion of motion, the impetus to create. That extra energy seems more focused, at least in comparison with anxiety. When I hit a hypomanic jag, I sometimes try to get ahead on my blogs, or at least jot down titles and ideas that I hope I can decipher and develop later.

Neither state of mind is preferable. Anxiety is the more painful and hypomania the more fragile. Anxiety is more familiar to me and hypomania more rare and even exciting. But I can’t choose. I can’t say that I like hypomania more than anxiety, although it does seem to have more benefits. But I know that it can be destructive and futile, promising things that it can’t fulfill.

Given the choice, I’d rather not walk on pins and needles or on eggshells. Level ground is fine with me.

 

The Big Disruption

alphaspirit/adobestock.com

I don’t know if I’ll be able to make a blog post next week unless I can write an extra one this week and save it. Next week at this time we’ll be moving from the three-bedroom house we’re currently living in to a one-bedroom apartment, where we expect to stay for three months at the maximum.

The circumstances that led to this situation are complex and the whole process has been feeding into my triggers and issues. No, bipolar disorder won’t stay on hold for even two weeks so we can get this accomplished.

Overthinking. First and perhaps foremost, I hate cleaning, packing, and moving, especially when there’s a time limit on them. I even hate packing for vacations. (I’m okay once the vacation has started. It’s just the lead-up to it that gets me.) When I pack, I always overthink and almost always overpack, as if I’m planning for the Normandy invasion. This is exhausting.

Anxiety. I often have anxiety dreams about packing and moving, usually having to do with moving into or out of a dorm at college. This was indeed a stressor for me, as I lived someplace different every year and went home over the summer. Apparently, it has never quite left my psyche. This set of moves will be unpleasantly like those – a massive, frantic rush at the beginning of summer and another set of the same, though one hopes not as frantic, at the beginning of fall.

Uncertainty. What happened to us is that our house was destroyed by a tornado a year ago. Since that time, we have been living in a house provided for us by the insurance company. Now, however, they’ve put us up here as long as they care to and our former house isn’t completely rebuilt and ready for re-occupancy yet. We’ve had just over a month to make alternative arrangements. Combine that with trying to get a three-month lease, and a one-bedroom was all we could find. (We call it “The Shack.”)

Belonging. I’ve had a hard time bonding with places where I’ve lived – they’ve never truly felt like home to me – and I hope that the rebuilt house, which we are completely furnishing, will have that feel of “mine.” But The Shack will feel the least like home since any I’ve lived in since college. Even my study, where I do my writing, will be a utility room with a table and chair rather than a desk. Nor will we have much in the way of furnishings. A bed, a television, two chairs, boxes for bedside tables, and not much else. The rest is in storage or not to be delivered until permanent move-in.

Immobilization. It is the one-year anniversary of the tornado and we will be swept up in a virtual tornado of packing and moving. I have already noticed tornado dreams and severe storm-related anxiety as the date approaches. I anticipate being virtually immobilized just when I need to be most productive and proactive. It already feels overwhelming.

Isolation. And no, there is no one around who can help us move. It’s just me and my husband, with maybe a little help from U-Haul and Two Men and a Truck. My husband suffers from depression, and between that and my bipolar disorder, we’ve been isolating so much that even with pizza and beer we couldn’t pull together a work gang.

We’ll get through, I know. And we’ll get through living in The Shack until it’s time to go home at last. I just wish I could see a clear path between now and then.

Caution: Wide Mood Swings

imageBroker – stock.adobe.com

Mood swings are universal. Everybody has them at one time or another.

Bipolar disorder is not just mood swings. Not everyone has moods that can last for months or years at a time or moods that are so extreme that they interfere with one’s daily life. The depths of despair and the rocketing highs are not what most people experience – and they should be glad they don’t. Bipolar disorder is a serious mental illness (SMI). It can be more or less severe, and it can be well or poorly controlled with medication and therapy, but the reality is that bipolar is a mood disorder, an illness, and a curse. 

Of course, the mood swings of bipolar disorder don’t always last for months or years. Sometimes you go spinning out of control every few weeks. This is called “rapid cycling.”

But even rapid cycling doesn’t describe the lightning-quick mood changes that can happen within a day or two. That’s called “ultra-rapid cycling,” and it’s like being whip-sawed by your brain. Those valleys and peaks come so closely together that you don’t even have time to catch your breath between them.

I think that the official criteria miss the mark on this. Many of them define rapid cycling as experiencing four mood swings within a year. Ultra-rapid cycling seems not to have a specific definition, but I and a lot of other people with bipolar disorder experience moods that swing not over the course of months, but over the course of weeks, or even days.

Ultra-rapid cycling blurs the lines into mixed episodes. Those are occasions when high and low moods occur at the same time. For many bipolar sufferers, this means simultaneous exaltation and despair, which is a terrible combination and a bitch to experience. For me, a person with bipolar type 2 whose hypomania expresses most of the time as anxiety, a mixed episode is a frightening blur of defeat and nervousness, a simultaneous feeling that the worst has already come and that it is about to descend to even lower levels. It’s like ricocheting off the insides of your own skull.

What to do at a time like this is a puzzle. Do I try the things that soothe me when anxiety strikes? Do I try self-care for depressed moods? Do the two strategies cancel each other out, leaving me swinging helplessly? Do I try to suppress both moods, knowing that the consequent numbness will make it all the more difficult for me to feel “normal” moods again? Once those walls are built, they are hard to tear down.

Ultra-rapid cycling and mixed episodes may be handy jargon to describe mood swings that don’t fit the common mode of bipolar disorder.  But they’re hell to live through. And since mood levelers, antidepressants, and anti-anxiety meds generally take a while to build up in the bloodstream enough to have an effect, there is little in the way of pharmaceutical help. An anti-anxiety pill may relieve the jitters and racing thoughts, but may also leave you more susceptible to the inevitable lows.

I don’t know if there’s much research going on regarding rapid cycling and mixed episodes. It seems like they’ve barely been named, much less defined or studied. And it’s true that there is a lot about plain old garden-variety bipolar disorder that remains to be understood and treated.

But for those of us who don’t fit the mold of months-long or years-long mood states, rapid cycling can be an uncomfortable way of life. When I was undiagnosed and unmedicated, I experienced those long, interminable lows. They did last months, years, until the depths of hell were all that I could see. The jags of ambition seldom visited me, but the creeping, lingering anxiety could easily take over. Now that I’m no longer subject to those excruciating extremes, I still am subject to the quick-change, rapid-fire series of moods. My mood levelers do work, in the sense that they reduce the peaks and valleys, but they never seem to put me on a totally even keel.

Perhaps that’s too much to expect. I’ll have to admit that I prefer a life of rapid- or ultra-rapid-cycling bipolar to the monotonous despair of long depressive cycles. At least now I have a firm conviction that the moods will end, or at least shift, to something more tolerable, and that that will happen sooner rather than later.

Given the choice between the lingering depths and the more rapid changes, I’ll take the one that doesn’t leave me in misery for years at a time.

 

Persistence of Memory

It is spring, sunny and pleasant, but the wind is blowing at 20 miles per hour. The boughs of the fir trees sway dramatically. The bird feeder glints in the sun as the light catches its swinging arc.

I am anxious.

There is a thunderstorm. Those same trees are tormented by strong winds. The hard rain doesn’t fall but blows sideways. Golfball-sized hail pelts the ground. I swear I can see lightning flash close to our house.

I am panicking.

About ten months ago, my life was changed when I lived through a tornado. Everyone says it was a miracle I survived. I was on the second floor of my house, with no time to get to the basement, when the roof came off. Assaulted by a maelstrom of flying dirt, insulation, and debris, I put a pillow over my head and hoped for the best. And I came through it without a scratch, although the house was damaged so badly that it had to be torn down. It’s being rebuilt right now and we hope to move in in a couple of months.

After the tornado passed, I was calm. I even slept with that filthy pillow as I waited for my husband and the rescue squad to come and extricate me from the bedroom. As the days passed, I had to deal with a lot of things that reminded me of the tornado – staying in a Red Cross shelter, dealing with the insurance company, going back to the house to rescue our pets and salvage a few belongings that had been in the least-damaged part of the house.

As time went by, I told my story again and again to friends and acquaintances who asked about it. Without exception, they were amazed not just at my survival, but at how incredibly calmly I talked about it and how I didn’t seem to be suffering from any post-traumatic effects.

Then why is it that, ten months later, I seem to be experiencing the anxiety and panic that should have struck me then? Heavy rain makes me nervous. Strong winds disturb me. Lightning makes me jump.

My husband thinks that it is because we are getting closer to the anniversary of when it all happened. And it is again tornado season in Ohio. I think it was not completely irrational of me to be afraid of the storm last week. I just wonder why it happened after all this time. Have I been in denial for ten months? Does it sometimes take that long for post-traumatic stress to manifest?

A friend of mine had a similar experience when her car was nearly hit by lightning. At first, she said, she was still able to drive to work. But as time went on, she became more and more frightened of driving through rain. As she put it, “Over time, my anxiety ramped up rather than down.” She had to have de-sensitization treatment.

Her explanation for the delayed reaction was that “the long-term memory encoded it.” Perhaps it’s possible that the lightning for her and the tornado for me lingered in short term memory and did not become troublesome until they were fully stored in our long-term memory banks. That sounds counterintuitive, but it may be right.

Will I be comfortable on the second floor of the house when we finally occupy it? Will I be able to sleep in the bedroom? Will every thunderstorm send me racing to the basement?

I just don’t know.

Hitting the Plateau

Back in September, I wrote about my bipolar disorder being in remission and how much I loved that feeling. Now I’m not so sure. Maybe I’m not in remission. I’ve had significant setbacks, though not long-term ones. At one point I felt broken, but when that lifted I felt jazzed. Maybe I’m on a baseline and never wander too far off it. Maybe I’m stuck on a plateau, halfway between mental illness and mental health.

I ask myself, will I get any better?

It’s like when I had my second back operation (micro-laminectomy). When I went for a follow-up visit to the surgeon, I was no longer in pain. But I was slow and uncertain when walking and felt keenly that my physical capacities were diminished. “Will I get any better, or is this it?” I asked.

“You’ll improve,” said Dr. West. “It will take a while, but you’ll feel better.” And he was right. I did. But I still have some pain at times and sometimes I walk with a cane. I may be better, but I’m clearly not totally well. I’m not bitching (much). I know that once your back goes out, it never gets back to 100%. And I am truly grateful every day that I don’t suffer the excruciating pain of a bulging disk and a pinched nerve.

My bipolar disorder is like that. I am no longer suffering on a daily basis. My meds are working and haven’t changed much in years. My mood levelers are doing their job. But I still have symptoms. There are still things I can’t do, or do only with great mental effort. I’ve never been at 100% and don’t ever expect to be. And I am truly grateful every day that I don’t have the in-the-depths lows, the ever-edgy anxiety, for more than a few days at a time.

But I wonder, am I stuck on this plateau forever? Is this as close as I’ll ever come to mental wellness? Or maybe, I think, mental health is an illusion. I can’t remember a time when I was unaffected by my disorder. The plateau itself may be an illusion. Maybe I am still improving, in such tiny steps that I can’t see the change. Maybe a new medication or treatment will come along and remove more of my remaining symptoms. (I’m not counting on that, though.)

My bipolar disorder feels like it’s running a low-grade fever. I can get done my work and my blogs, but little more. I don’t feel in the least joyful. It may be that this is just real life getting me down –  the weather, politics, the endless details and frustrations I have to deal with while we’re rebuilding our house. Perhaps this is just a normal mood swing like everyone gets or a reactive depression to the aforementioned stressors.

That’s one of the constant worries once you have bipolar disorder – not trusting your feelings or your feelings about your feelings. Every setback scares me that I’m teetering on the edge, ready to plunge off that plateau. Realistically, I know that I am as stable as I’m likely ever to be.

My superpower seems to be overanalyzing. I may really be in remission.

Depression lies. Anxiety lies. So, perhaps, does the plateau.

Asking for What You Need

I saw a post on a bipolar Facebook page that asked what coping mechanisms people used. There were the usual responses about self-care, which is certainly a fine coping mechanism. But it’s far from the only one.

I’ve learned any number of coping mechanisms over my years in psychotherapy. There’s “looking at how far I’ve come.” There’s “leaving the room when my anxiety gets too bad.” And there’s always one of my favorites: “petting the cat.”

But the answer I put down was “asking for what I need.”

It’s a good coping mechanism because no one can read minds. No one else knows what I need. And, short of them guessing and hoping to hit on the right thing, the only thing I can really do is ask.

I can ask my therapist whether we can work on my anxiety today. I can ask my friend to check in on me daily for a while. I can ask my husband for a hug, or alone time, or some distraction.

Of course, I don’t always know what it is that I need at any given time. At times like that, I can simply ask for things that might help or have helped in the past, like the aforementioned hug or alone time. My husband has been with me for so long and is so familiar with my bipolar disorder that he knows a number of things that are likely to help, and he can suggest them. If all else fails, he suggests I go to bed, or read, or listen to music, all things which can calm or center me. Sometimes he simply puts on my favorite movie, to help draw me out.

Closely tied to the mechanism of asking for what I need is the technique of negotiation. I may know what I want or need, but the other person may not be capable of providing it, or at least not right then. If a friend can’t take my phone call, I can suggest an alternative: Call me after 10:30 or sometime tomorrow. If I need distraction and my husband has to go to work, he can suggest that we go out to lunch the next day.

We’ve developed a shorthand for such situations. When the only thing I can do is say, “help,” he responds with, “help how?” If I can then come up with a suggestion, I do. A lot of the time he is able to provide what I need. But sometimes he just isn’t. Maybe he isn’t able to get me out of the house for lunch. So instead I say, “I need comfort food.” He usually says, “You can get that.” Or he may respond with what it is that he can do: “There’s cheese and crackers here. Will that do?”

Asking for help isn’t easy, and Lord knows negotiating for what you need isn’t either. Both take lots of practice. And there is always the possibility that another person simply cannot supply what you need. That’s where self-care comes in. I know down deep that a nap, or comfort food, or music may help me, and if no one else can provide them, I can usually do it myself.

Receiving help may not be easy, either. Asking for what you need can make you feel, well, needy. And receiving help from someone else may make you feel guilty or unworthy. But the fact is that you – all of us – need help at times and that learning how to ask for and accept help is a valuable skill. And a totally valid coping mechanism.

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