Bipolar 2 From Inside and Out

Posts tagged ‘anxiety’

Having Pets and Service Animals

I’ve had cats for a little longer than I’ve been married. That’s more than 40 years. I’ve also had bipolar disorder 2 at least that long.

For me, the two go together. My cats give me things that help me through my difficulties—companionship, amusement, distraction, fascination, and, yes, even love. (I know cats are rumored to be aloof, but mine have been very affectionate. Maybe that’s just the kind of cat I bond with.)

I love it when they purr, of course, and when they nestle on my lap, but I also find it soothing to watch them wash themselves. I especially love it when they trust me enough to roll on their back, show their belly, and accept a belly rub.

I also know the difficulties. When you can’t even get out of bed, when you can’t make yourself eat, when you can’t take care of yourself, it’s hard to take care of another being. Even the very basics—feeding and watering, cleaning the litter box, or in the case of dogs, walking them—seem like just too much. You don’t want to bring an animal into that environment.

On the other hand, tending to the needs of another being can provide a reason to get out of bed, to keep moving. I have even heard of people who say that not wanting to abandon a pet has kept them alive.

But then, there’s the inevitable parting. It can rip your heart apart. You can grieve for weeks or more. You will swear you’ll never get another pet, but one day you do.

Dogs and cats are the most common companion animals, but birds and fish, rabbits, pot-bellied pigs, and even Guinea pigs and hamsters are good choices. Cats and dogs are the most demonstrative, but all pets need care.

There are also animals that can live with you and provide special support for you. These support or service animals can meet your needs for companionship and more. There are different types of these animals, with different functions and different requirements.

Emotional Support Animals

  • An ESA can be any pet that has a positive effect on your emotional state, such as calming you down when you’re anxious or agitated. Dogs and cats are the most common ESAs.
  • The Fair Housing Act requires landlords to allow ESAs even in pet-free buildings, and they are not allowed to charge extra for having the animal.
  • Landlords, however, may require a letter from a psychiatrist or doctor stating that you need an ESA.
  • ESAs do not require any training or certification.
  • ESAs are not allowed in businesses or restaurants that have a “No Pets” sign.
  • ESAs must fly as pets in airplanes, which usually means in the cargo hold.

ADA Regulations for Service Animals

  • A service animal is any breed or size of dog that is trained to perform a task directly related to a person’s disability.
  • They’re not required to be certified or go through a professional training program. The training can be provided by the owner.
  • They’re not required to wear a vest or other ID that identifies them as a service dog.
  • Many communities maintain a voluntary registry that serves a public purpose, for example, to ensure that emergency staff know to look for service animals during an emergency evacuation process. Some offer a benefit, such as a reduced dog license fee, for individuals who register their service animals. Registries for purposes like this are permitted under the ADA. An entity may not, however, require that a dog be registered as a service animal as a condition of being permitted in public places. This would be a violation of the ADA.
  • Examples of services that a service dog may perform include, but are not limited to: retrieving objects for a person in a wheelchair; reminding a person with depression to take their medication; alerting a person with PTSD of an oncoming panic attack; detecting the onset of a seizure in a person with epilepsy and making sure the person remains safe during the seizure.
  • Service animals are allowed to go with their person into restaurants and businesses, even ones that do not allow pets.
  • The only questions a business owner may ask are whether the dog is a service animal required because of a disability, and what work or task the dog has been trained to perform. They cannot ask what your disability is.
  • A business can ask that a service animal be removed if the dog is not housebroken or is out of control and the person cannot get the dog under control.
  • The Fair Housing Act, the Air Carrier Access Act, and the Equal Employment Opportunity Commission, not the ADA, cover service animals in those situations.
  • State and local laws may require service dogs to be licensed and vaccinated, if all dogs are required to be licensed and vaccinated.

Psychiatric Service Animals

  • Psychiatric Service Animals are a type of service animal covered by the ADA and the above regulations.
  • People with the following conditions may have Psychiatric Service Dogs: anxiety and panic attacks, clinical depression, phobias, bipolar disorder, ADHD, OCD, PTSD, schizophrenia, or autism.
  • Some tasks a Psychiatric Service Dog may be trained to perform include: interrupting repetitive or self-harming behaviors; reminding the person to take prescribed medication; creating a physical buffer or “space” in crowded areas; or waking the person from night terrors.
  • To get permission to own a Psychiatric Service Dog, under the Fair Housing Act, landlords may request a letter from a licensed healthcare provider verifying the disability-related need for the assistance animal.
  • Psychiatric Service Dogs need to be trained to perform tasks related to the person’s psychiatric disabilities.

Many places online provide training, registration, or certification for service animals, but these are not required under the ADA. Persons with disabilities have the right to train their own service animal. Vests, badges, or other identifying harnesses or markings that identify the dog as a service animal are not required.

You should be very cautious about an organization that provides training for service dogs. They are not required, as you may train the animal yourself. But they may prove helpful in training your animal. It’s up to you.

No one should order a service animal vest over the internet and use it with an untrained pet just to get them into places where only legitimate service animals are allowed. ESAs DO NOT qualify for this accommodation under the ADA. It also weakens people’s respect for ADA-approved service animals.

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To Sleep, Perchance to Sleep

Sleep is tricky when you’re bipolar. Depression equals too much; mania, not enough. There seems to be no Goldilocks zone.

I’ve been bouncing back and forth between oversleeping and not sleeping enough. Some nights, I lie awake until 3:00. Other nights, I go to sleep at midnight, but wake at 3:00, unable to get back to sleep. No matter which pattern starts the day, I invariably fall asleep while talking to my husband or watching TV, not even aware that I’m doing so. (We call these “kitten naps” instead of “cat naps” because my husband says I look like a kitten falling asleep, my head getting lower and lower until I fall on my face and am more or less sound asleep.)

I don’t know for sure what is causing my broken sleeping patterns, but I have a few suspects.

Meds. My psychiatrist has prescribed me a sleeping pill. It used to be a script for 30 at a time, so I could take one every night. Now I only get 15 per refill, so I can, technically, take them only every other night. The problem is that I don’t know on any given night which sort of night it will be: One when I fall asleep naturally and wake up in the middle of the night, or one when I can’t fall asleep and take kitten naps all day.

If I could predict, I could take a sleeping pill on the nights when I can’t get to sleep at all. But taking one after I’ve been asleep for a few hours doesn’t seem like a good solution, especially since I can’t take one every night.

My not-very-good solution has been to put one sleeping pill into every other day’s section of my pill caddy, never knowing which sort of night I will have. The sleeping pills don’t appear to have any effect at all on these odd sleep patterns, however.

Stress. Stress is another likely culprit. Things have been coming down hard and heavy lately. My husband has cataract surgery tomorrow morning, and that same afternoon I have Wound Care Clinic for a lesion on my heel. Dan needs me to drive him home from the surgery and both to and from the next day for his follow-up. I have an appointment that afternoon with Dr. G., my p-doc, so at least we can have a chat about my sleeping patterns and my meds.

Schedules. I work at home, but Dan has a regular job. I say regular, but I only mean 40 hours per week. How those 40 hours are divided up is crazy. Some days he goes in at 10:00 or 11:00 and gets home at a reasonable hour to have dinner together. Other days he works from 1:30 to 10:00, which means we’re both dead tired when he gets home. These schedules are not conducive to any kind of relaxing time together. When we’re awake at the same time, we usually have to talk about household business matters rather than anything we could bond over. Our meal schedules are irregular too, which can’t be helping my circadian rhythm. His days off are Monday and Tuesday, which is why all our appointments and errands are clustered there.

Pain. That lesion on my heel is a result of edema and a blister that burst. Right now it is the size of a quarter and looks like raw meat. I am told that it used to look worse and be bigger. Either way, it hurts when I have to walk on it, which is every day. I can only take Tylenol for it. I do have some stronger pain pills, but I can’t take them because I’ll have to drive Dan home from his surgery, and the drug takes five or six days to clear my system.

What to Do?

Dan’s work schedule is a given. There’s nothing to be done about it. The medical problems won’t back off for a while, as Dan has another eye that also needs to be operated on, with all the pre-surg and post-surg stuff lasting until just before Thanksgiving. My wound is healing, but very slowly, as I have to walk on that heel or use a wheelchair, so Wound Care Clinic will also continue for I don’t know how long. And who knows whether Dr. G can do anything for my screwed-up sleep patterns?

All I can figure is to keep going as we are until something lets up. We’ll manage somehow. We always do, together.

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Receiving Help

Sometimes it’s harder to receive help than it is to give help or to ask for it.

I’ve needed lots of help with my bipolar disorder over the years, and my husband has consistently been there to give it. His help has been the embodiment of the wedding vow “In sickness and in health.”

He’s held me when I’ve been depressed and tells me when it seems like I’m shifting into hypomania. He’s my “emotional support animal.” And he helps me with tasks of daily life like meals and showers.

Recently, though—well, really, throughout the past year—I’ve needed physical help as much as or more than emotional support. I’ve been through a series of physical challenges that started when I had a knee replacement and have progressed to the point where I am in pain every day and very nearly housebound. The kinds of help I’ve needed have been complicated and sometimes embarrassing.

I’ve been feeling guilty, needy, and insecure because my care requirements have increased so much. I know Dan is feeling insecure too, because he keeps asking me whether he’s taking care of me well enough. We’re both finding the situation stressful. I reassure him that he is doing a great job, and I try to make sure it’s not a thankless task.

Tonight we watched a movie on video together and had a pizza. It was a good break for both of us. But afterward, my bandages needed changing so I could get ready for bed. And so it goes.

Dan is about to experience his own set of physical needs as he needs a medical procedure, too. I hope I can repay a little of his care and kindness by giving some back to him. And I hope he’ll ask for help when he needs it. Like he does, I’ll do the best I can to give help while balancing both our needs.

Is all that confusing? Well, it’s no wonder. It’s a confusing topic, and I’m confused by it. Here’s what I know about help in a nutshell, though.

  • Asking for help. If you can do it, this is the first step. Ask for what you need. Ask as clearly and specifically as you can: “I’m feeling lonely/distressed/in pain. I need to talk to someone.” “My dressing needs to be changed.” “I need to eat something.” (Sometimes it’s easier if you phrase them as needs rather than wants. Asking for what you need makes it clearer that it’s not just a whim or something you could easily do without.) But if it’s all you can do at the moment, at least say, “I need help.” It improves the odds that you’ll actually get help. Then you can figure out the details later.
  • Giving help. If at all possible, give the person what they ask for. They know their own needs better than anyone else. Don’t guess. Sometimes the helper will need to ask questions to clarify. “Do you need to take your meds right now or with a meal?” “Which size bandage does this wound need?” If you can’t give the help right away, explain why not. “I’ll go to the store and pick up your other prescription. Then I’ll pick up lunch on the way back. Is that okay?” “I’ll be there in 20 minutes. Can you wait that long?”
  • Receiving help. This is the part no one tells you about, and it can be tricky. Say thank you, even if you didn’t get exactly what you asked for, and even if you’re in pain. Your helper is doing the best they can. Sometimes all they can do is part of what you need. Later, they may be able to do the rest of it.

All this is true, even if you have a paid caregiver. But if it’s a partner or family member, it’s even more essential.

Here are things to keep in mind:

You need help. Everyone does at one time or another. Everyone. No one is truly self-sufficient.

You deserve help. Help isn’t something you have to earn. Your needs are important.

You can get help. But in many cases, you have to ask for it. And you may have to keep asking. Don’t give up.

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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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mental health

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AI and Mental Health Concerns

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

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

AI as Therapists

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

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

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

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

Chatbots as Friends

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

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

AI and “Brain Rot”

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

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

Other Hazards of AI

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

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

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

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

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

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mental health

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Does Being Paranoid Make Sense?

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

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

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

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

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

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

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

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

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

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

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

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

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