Bipolar 2 From Inside and Out

Posts tagged ‘anxiety’

Mood Music

Last week, I got to go out and hear live music—the Stray Cats, one of my favorite bands, were having a reunion tour with some new music, and I had tickets for it. I looked forward to it with great excitement (and a little anxiety, which proved warranted when a violent thunderstorm started as we were driving home on the highway). Aside from the thunderstorm, however, the evening was magical.

And I needed it. I’ve felt myself sliding toward the depressive end of the scale lately.

My Music

When I’m depressed, I always forget the power that music has to restore me. I have plenty of music accessible to me, on my Mac, Pandora, Spotify, and other sources. I even have Pandora on my iPad and my phone, so I can have music with me at all times. But I don’t remember, and I don’t make use of this inestimable resource that is always at my fingertips.

Of course, there’s nothing to compare with live music when it comes to restorative power, and I’ve been sorely short on that. I remember times in years past when I went out to hear live music as often as several times a week. Later in life, it became a lot less common, only happening every month or so. Now, it’s so uncommon that it doesn’t happen even once a year.

Listening to music—and singing along, loudly, enthusiastically, and totally off-key—clears the cobwebs out of my brain. I return to the same music over and over, favorite singers and songwriters, bands that no longer exist, artists who are now dead. I don’t object to new music, but it doesn’t hold all the memories, the weight and history, of music that I already love.

Bibliotherapy and Music Therapy

The idea of bibliotherapy is pretty well known. Self-help books abound (for all the good they do), and therapists sometimes recommend books and articles to their clients. Music as a part of formal therapy might be much more difficult to make work, however. One person’s soul-touching music is simply background music even to others who know that person well.

No one but me can prescribe what music “works” best for me on any given day. Are what I need raucous tunes to lift me up or calm ones to settle me down? Do I crave hearing a particular artist or band? Should I search out songs by a favorite songwriter that have been covered by others? Or do I simply click shuffle and let my vast playlist decide for itself?

There’s some science behind the idea that music can be good for people with depression. Listening to music has been associated with increases in neurotransmitters like dopamine, and the lessening of the levels of the stress hormone cortisol. Emotional release is another way that music works, allowing you to access feelings that you can’t actively name. “Active engagement,” such as playing an instrument, writing lyrics, or “intentional listening,” is also said to be good for grounding. It certainly activates more areas of the brain.

Still, we’re talking about some awfully subjective findings. A study-of-studies found that TAU (Treatment As Usual) with added music therapy “was superior to TAU alone for anxiety and functioning,” but that the combination “was not more effective than TAU alone for improved quality of life.” Maybe it’s just me, but I’d think that an improvement in anxiety and functioning is an improvement in quality of life.

Formal Music Therapy

That meta-study was looking at formal music therapy, however. What does that entail? One site I visited described individual and group music therapy like this:

“In individual music therapy sessions, a therapist works one-on-one with a client to address their specific needs. This personalized approach allows the therapist to tailor interventions to the client’s preferences, whether it involves playing instruments, songwriting or listening to music. Group music therapy sessions provide a supportive environment where people can engage with others through music. These sessions may involve collaborative music-making, improvisation or group discussions about the music’s impact. Group sessions foster a sense of belonging and provide opportunities for social interaction.”

I’ve never had that kind of music therapy. I’ve had to create my own with Pandora listening sessions and tickets to the Stray Cats. But I hope that if I’m ever in need of the formal variety, there will be some place where it’s available to me. For now, I’ll enjoy the subjective improvement in anxiety and functioning that I can build on my own.

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Wealth and Mental Health

It’s becoming more and more apparent that your socioeconomic status has a significant effect on your mental health. This is not to say that money buys happiness. It does mean that wealthy people can have mental health conditions related to their abundant resources, and that people who have mental disturbances often find their suffering to be greater if they are poor.

Little to No Money

It only makes sense that having severely limited funds can take a toll on a person. Finding money for rent, medical bills, childcare, retirement, or other recurring or one-time expenses can increase your worry and seriously affect emotional well-being. Financial hardship and mental distress often reinforce each other. These difficulties can be difficult—or even impossible—to escape.

But dealing with the problems of inadequate money can strengthen connections among family members and close friends. Shared hardships foster shared sacrifice, as well as negotiation and compromise skills. People with little money must work through problems and conflicts because they have few alternatives. This process can be distressing, but it also fosters trust, resilience, and intimacy. The Harvard Study of Adult Development has found that strong social bonds predict long, happy lives better than intelligence, genetics, or money.

Perhaps surprisingly, socioeconomic difficulties may also lead to alterations in the brain, particularly in children. This link seems to run through parts of the brain that keep a person awake and alert. The circuits change in children who get less sleep, face more stress, or spend lots of time on social media. All of these factors increase with lower economic, educational, and social opportunities. It’s been noted that preteens who grow up in areas with fewer monetary resources and less social support particularly show brain differences that are measurable on MRI scans. Researchers have voiced surprise at how strongly socioeconomic opportunity correlates with brain differences. Studies that link cognitive performance to brain differences without taking socioeconomics into account “may require reevaluation,” according to experts. “We need to find out how socioeconomics is becoming biologically embedded.”

Lots of Money

Many Americans believe that more money would improve their mental health. That can be true some of the time. Money can alleviate many of the problems that people on lower socioeconomic levels face. The wealthy don’t worry about where rent and food money will come from, how to get a job, or how to get to their job. They don’t have the problem of even a relatively minor illness or injury plunging them deep into medical debt.

When problems do arise, notes psychologist David H. Rosmarin of Harvard, the well-off assume that they can make problems (he gives as examples a son’s gambling losses or a daughter’s extreme depression) disappear via the application of money. “Parents with less resources would have no choice but to quickly confront the painful realities their children were facing,” Rosmarin observes.

Money can resolve most of those problems, providing stability and freedom. However, the ultra-wealthy can find themselves lacking hardship-developed strengths and descend into family conflict and emotional disconnection. Their relationships rely on control and expectations rather than shared bonding experiences.

Though they may have family, friends, coworkers, and even servants around them, the wealthy can easily feel isolated and alone. And loneliness has been shown to increase the risk of health problems such as cardiovascular disease, stroke, depression, and early death by roughly 30%, despite wealthy people’s broader access to top-quality health care.

My Experience

I grew up in a middle-class family, and local schools were among the best in the area. It seems that socioeconomic factors didn’t contribute much to the brain illness I began to develop as a child. The only time I experienced distress at a lack of money was when I was told that there wasn’t much money for higher education and that I should go to a community college. (I reacted to this with tears and distress at first, then applied for good schools and scholarships. Eventually, I went to an Ivy League school with multiple financial supports.)

When my husband and I got married, we were both out of work and on food stamps (as they were known back then). Later, we both got jobs that had good salaries attached to them. Rather than experiencing loneliness and disconnection, we had already built a basis of cooperation and negotiation as we worked through the hard times. We enjoyed each other and our families’ and friends’ love and support throughout. When we began to get ahead in our finances, we traveled, but felt the strain of not seeing each other often enough when we were home because of long hours working. All through this period, though, in bad times and good, I suffered from bipolar disorder. Money seemed to make little difference in that.

Now that I’m mentally more stable, I find that I am able to deal more effectively with financial crises, which, given the economy, arise fairly regularly. I do experience severe anxiety and worry at times, but have so far been able to work my way through them.

I’m not denying what the researchers say about brain differences in children from lower socioeconomic levels or that the wealthy have different sorts of emotional problems. But being aware of the possibilities of such problems and getting mental health assistance when necessary can make the difference between a distressed situation, whether well-funded or not, and a tolerable one.

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Off My Meds, But Not by Choice

I’ve been off my meds for about a week now, and it’s really getting to me.

I didn’t go off them on purpose. It was an accident. I tried to get back on them as soon as I could. But I kept encountering roadblocks.

It happened like this. My husband and I flew down to Florida to pick up a car that his mother was giving us. We drove it home to Ohio, stopping at a nice hotel in northern Georgia. When we got home, I discovered that the bag I keep my pills in was gone.

Replacement Pills

Let me start by saying that yes, I am an idiot. I had simply taken the bag of pills and put it in our travel duffel. I know I should have one of those pill caddies so I could divide up my meds and take with me only as many as I need. But I didn’t, so when the bag disappeared, so did my entire supply for the month. I had to start replacing them.

My non-psychotropics were no problem. I simply went on my PCP’s patient portal, explained what happened, and requested new prescriptions. The doctor’s office sent them promptly to my pharmacy. I called the pharmacy to let them know what was going on. They sounded like it was no big deal. They did say that, as I was basically asking for a refill before it was time for one, my insurance company likely wouldn’t pick up the tab. That was fine. All my scripts were generics, and the pharmacy had a discount card that they applied to the costs, so it wasn’t a big financial hit. The next day, I had my physical medication needs restocked. No big hassle.

The psychotropics, not so much.

Hassles

We arrived home and discovered that the bag of prescriptions was missing late on Friday. I called the hotel we stayed at to ask whether the bag had been found. They said they would check with housekeeping the next morning. It actually took until Monday for them to determine that no, housekeeping denied all knowledge of the bag of pill bottles.

I called our pharmacy Saturday morning to find out what the process would be to refill them. I had a hunch it wouldn’t be as straightforward as the other prescriptions had been. I was right.

I would have to see my doctor to get new prescriptions ordered. They worked me in on Tuesday, the first day he was in the office. I was also told that I would need to make a police report. Two of my prescriptions were for controlled substances, an anti-anxiety med and a sleep aid. I naively thought those were the only two I’d have trouble refilling.

I tried to picture myself calling the police four states away, saying that I most likely left my medications in the hotel room, and could they please investigate. Maybe police departments are used to this kind of thing, but even if they do it all the time, I assumed that the wheels of justice would grind slowly, and they wouldn’t make it a priority. Not when it was likely a case of stupidity, not a crime.

I went to the doctor’s office on Tuesday. He listened to my story, agreed that I should have a pill caddy, and sent new prescriptions to the pharmacy over the computer. I saw him do it. I thought that would be the end of it.

Phone Tag

That was not the end of it. When I called the pharmacy to see when my meds would be ready, I was told that they couldn’t fill the prescriptions because it was too soon. I explained again about the missing bag of prescriptions and was told that I had to get new prescriptions and file a police report. I told them that I had seen the doctor just that morning and had watched him send the new prescriptions. And that the doctor had not told me I had to file a police report under these circumstances.

The pharmacy told me that the doctor had to verbally authorize filling the prescriptions early. Fine. I thought that the pharmacy would reach out to the doctor’s office, as they do when there are no refills on a prescription. But no. The doctor’s office would have to call them. By that time, the doctor’s office was closed, and Dr. G. wouldn’t be back in until Thursday.

Wednesday was spent alternately making calls to the pharmacy and the doctor’s office. The pharmacy said that speaking to the medical assistant would be good enough. But, of course, again, they didn’t mention that the office would have to call them. I spent the day trying to get the two entities to talk to each other. Each time I called the pharmacy, I spoke to a different person who had no notes on what had gone before and started all over about it being too early to refill and needing a police report. Each time I called the doctor’s office, I was told they had spoken to the pharmacy or had just left for the day.

Thursday, I had been unmedicated for a week. I wasn’t sleeping more than three hours a night, and my anxiety was working overtime. I was mentally dizzy from all the runarounds and explanations. I couldn’t remember whom I had talked to last or what I’d told them. I didn’t have enough executive function to write everything down, with a timeline and names. My voice as I spoke to the various parties was rising in pitch and lowering in coherence.

At last, I called late Thursday afternoon, and my prescriptions were ready. But only the controlled substances. The mood stabilizer and SSRI hadn’t been filled. It was too soon, I was told. Oh, they were new prescriptions? Had I filed a police report?

I’m going online right now and ordering a pill caddy.

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No Longer Trapped

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

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

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

Logistics Are Difficult

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

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

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

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

Psychological Effects

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

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

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

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

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Self-Care Definitions

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

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

A Better Definition

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

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

The Self-Care Box

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

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

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

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

Today’s Self-Care

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

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

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AI and Mental Health Concerns

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

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

AI as Therapists

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

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

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

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

Chatbots as Friends

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

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

AI and “Brain Rot”

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

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

Other Hazards of AI

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

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

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

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

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

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Does Being Paranoid Make Sense?

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

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

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

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

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

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

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

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

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

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

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

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

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Staying Home

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

I almost never leave my wonderful house.

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

But not often.

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

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

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

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

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

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

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

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

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Distance Therapy and Chatbots

TW: suicide

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

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

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

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

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

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

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

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

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

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

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mental health

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Anxiety Lies, Too

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Anxiety lies.

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