Bipolar 2 From Inside and Out

Posts tagged ‘anxiety’

Permission to Be Depressed

Depression can be so riddled with guilt. Why am I not able to fake being okay? Why do I isolate when what I need is interaction?

Sometimes what I need is to give myself permission to be depressed. I have bipolar disorder 2, with a heavy depression component. It has overwhelmed me many times. I have fought against it, given in to it, tried to make compromises with it, tried to ignore it – almost any reaction you can imagine. Then I learned how to give myself permission to be depressed.

This is not quite the same as giving in to depression. It involves acknowledging that I am depressed and allowing myself to feel the feelings that I have. Of course, I don’t give myself permission to be permanently depressed. In a way, it’s more like giving myself permission to practice self-care and not to force myself to smile and bull my way past the depression. I recognize that I am depressed and do what I need to do to get through it. That may be staying in bed. It may be crying. It may be wallowing in sad music. These are things that I’m likely to do anyway when I’m depressed, but giving myself permission to do them is surprisingly freeing.

I used this technique probably for the first time when my husband and I went on a “barefoot” cruise vacation. It was something we both enjoyed and both want to do again someday.

But I knew from the beginning that depression might overtake me – probably would, at that time in my life – even while I was doing something enjoyable. Naturally, I didn’t want the depression to ruin the whole vacation, so I decided to give myself permission to do what I needed to do to cope with those feelings.

Most often, that involved retreating to my bunk for a nap. This enabled me to get away from other people when I was feeling overwhelmed and unable to socialize. Sure, I missed some of the onboard and shore activities, but I wouldn’t have enjoyed them anyway while in the metaphorical fog and darkness. I enjoyed what I could, then let myself not do what I didn’t feel up to doing. I didn’t try to make my husband stay with me and miss all the fun. There wasn’t anything he could do for me anyway. If the other passengers thought it was odd – and they did – they barely mentioned it to me. My husband told them I was tired. Seasickness was also a believable excuse.

In a way, having bipolar depression at that level is like having the flu. I feel bogged down and logy, inclined to cocoon, rest, and stay away from other people. I realize this is not always possible, but if it is, I can allow myself to do it. Fortunately, this spell of depression wasn’t so bad that it completely incapacitated me as it has at other times in my life. I was still able to feel enjoyment at some times, though not at others.

At other times, I’ve had to give myself permission to have anxiety. If a situation makes me anxious, I acknowledge that I am nervous, and do what I need to do. I can’t “think away” my anxiety, but sometimes I can get myself out of the situation at least temporarily. I do not have to sit and be anxious while people around me argue or shout at each other, one of my anxiety triggers. When I recognize how I’m feeling (which takes practice) and give myself permission to feel the way I feel, I’m better able to come up with coping mechanisms, such as leaving the room to get some fresh air or making myself a cup of tea.

You may notice that when I give myself permission to be depressed or anxious, part of my solution involves avoiding other people. That’s sometimes a hard thing to do. Isolation can certainly make depression worse, but it can sometimes also be necessary if pushing through, trying to smile, mingle, and socialize will make the depression worse in the end. And I have learned that if I try to do that, the depression comes along with me. Once a friend told me that it was like having a separate person with me, a person called Misery. Better to give myself permission to stay home and give myself some self-care.

What I can’t do is give myself permission to stay depressed or anxious. Giving myself permission is a very limited-time offer. It doesn’t work for those really lingering, midnight-dark depressions that last for weeks or months on end. Those, I have to fight. And while I’m depressed, I don’t give up on meds or therapy. Those are necessary to alleviate the depression instead of resigning myself to feeling it.

In Remission

My bipolar disorder is in remission. I know I’m not cured. There is currently no cure for bipolar. But I’ve reached a point where I’m stable enough that I don’t expect a crash or a buzz to descend on me at just any old time.

I still get moods, of course. They’re just not severe or long-lasting enough to be symptomatic. Yesterday, for example, I spent several hours wrestling with phone trees and people who wouldn’t switch me to a supervisor when all I was trying to do was straighten out a couple of bills that contained errors. Afterwards, I felt frustrated, cranky, and a bit sad. But those were normal emotions, based on what I had just gone through. After a nap I felt better, and dinner blew out the remaining cobwebs. Napping is definitely better than staying in bed the entire next day.

Of course, I didn’t achieve remission alone. It took years of doctor visits, therapy, and medications to reach this state. I am particularly grateful for mood levelers. For me, they actually do what they’re intended to do. They keep my moods within an acceptable range, or at least one that’s acceptable to me.

Too many people fear mood levelers, I think. Level moods sound boring – as though there are no variations, just a blank, straight line. That simply isn’t so. Mood levelers have pushed the spikes that used to go wild in either direction to a less extreme range. If you think of mood as an EEG, mood levelers prevent the lines from going off the charts, settling them to fluctuate within a middle range that most non-bipolar people have naturally.

I think the term “mood leveler” scares some people. They seem to think that such a drug would make them perfectly level, robotic, unchanging. They fear that any spark of personality or creativity would be lost.

That’s not the case. Instead, with level moods – and especially for depression-prone bipolars – a person has much more ability to explore his or her creative side.  I know that’s true for me. Now that my moods are stable and level, I’m able to get more writing done, but also to tell whether the work is good or needs serious revising before I post it.

My doctor recently increased the dosage of one of my medications, a mood leveler, because I was having trouble with hypomania that wouldn’t let me sleep. And it worked. I am now getting seven to eight hours of sleep each night and have enough energy to at least face the day, if not always to conquer it.

Don’t think mine has been a case of spontaneous remission. I’m not sure I believe that’s possible with bipolar disorder. It’s taken a lot of years and a lot of work to get to where I am today. For example, it took literally years for assorted doctors and me to find a combination of chemicals, a cocktail of psychotropics, that would work for me. And during all that time, it was as if I was not medicated at all. Only the right combo of drugs and dosages would unlock my brain and level my moods.

So, here I am, in remission – and I love it. My moods aren’t blunted, they’re leveled. I am not as fearful now that my extreme moods may return and wreak havoc on my life. Oh, I still have some symptoms and side effects that remind me I’m not cured. But now I know that remission is possible, with work, with luck, and with the right mood levelers.

Nothing to See Here

Many people with SMI are afraid that it shows, that other people can see automatically that there is something wrong with them. They feel as though they stand out in a crowd. Everyone notices them, and probably talks about them.

I have the opposite problem. My bipolar depression makes me feel invisible. It’s not just that SMI is often an invisible illness. It’s that I myself seem to become invisible. I think of myself as a particularly ineffectual ghost, frightening no one and unable to affect anything in my environment. Some people call this dissociation.

At first, I made the best of it. I’m especially invisible when I’m out in public and reading a book. So I found that if I was at a business convention and wanted to remain invisible, my best strategy was to sit alone at a table and read a book. Only once did a man approach me while I was so engaged. No one else ever did.

Apparently, though, I don’t need a book to disappear. Maybe it’s anxiety that makes me keep quiet when people around me are discussing something interesting. Maybe it’s my instinct not to be noticed so I won’t be subject to derision or worse. Either way, I can’t seem to catch anyone’s eye or add my bit to the conversation. I blend into the crowd, even if it’s only a crowd of three or four.

It’s almost like there’s some aura around me when I’m out in public that says, “Don’t notice me,” like Harry Potter’s cloak of invisibility. I do not use my invisibility for pranks or mischief, though. I don’t use it intentionally at all (except for using a book, as I mentioned).

Why do I think this invisibility is part and parcel of my bipolar disorder? It could be imposter syndrome at work. I feel so unworthy that I don’t want anyone to see me for what I am. Or it might be the anxiety component of my hypomania that keeps me from presenting myself more assertively. Or maybe people can see that I have a troubled mind and simply look away.

I am slowly learning to make myself seen and heard. I find that calling people by name makes it easier for them to see me. It seems to signal them that there’s another person in the vicinity. And once I even set up an occasion where I would be the center of attention, speaking about my bipolar disorder at a signing for my book.

I also use my writing to make myself “visible.” This blog (and my other one) and my books give me a presence, though not a physical one, even at a distance. When I see likes and follows and sales, I know that someone has noticed me, or at least discovered that I exist.

I sometimes think that going out in public more – practicing being visible – might help. But actually, that’s when I feel the most overlooked, the most unseen and unheard. The most lost.

Perhaps what I need is to go out and meet a specific person, someone who expects to see me. Then I could be guaranteed of one person who would see me.

But it has been suggested to me that I may not want to be seen at all – that I would prefer to fade into the background, not put myself forward and disappear from the stresses of being seen. Perhaps that is true, or at least once was.

Now I think I would prefer to be seen, flaws and all. If someone cannot tolerate the sight of me, a mentally disordered person, or glances over me as if I did not exist, I think I shall insist on being seen. I will use my voice, my (admittedly glitchy) brain, and my human physicality to assert that I exist, that I matter, that I have something to say.

And in social situations I will try to assert myself (if politely) to join the public discourse and add my two cents, whether the subject is mental illness or the latest bestseller.

I exist. I deserve to be seen. I will not remain invisible.

Do I Have PTSD?

Once a therapist I was considering going to put down on my form that I was suffering from PTSD. She based this on the fact that I was having nightmares and flashbacks to the toxic relationship that I counted as a significant part of my past.

It was rubbish, I thought. I had never been in the Vietnam or Iraq war. And her idea of my trauma was that I supposedly had been coerced by an older man into doing sexual things that, had I been in my right mind, I would have objected to.

I chose a different therapist, who was bemused, to say the least, at that therapist’s notes. I had had a relationship with an older man and done sexual things that were not precisely the plainest vanilla, but I had surely not been coerced into them. (The gaslighting was a separate issue, one I did not recognize at the time.)

I still have the dreams of being back in his house, and I am occasionally triggered by things that remind me of the relationship, especially when I am depressed or otherwise vulnerable, but by and large, I don’t think that I have PTSD based on that.

Then, recently, I was hit with a more physical trauma. I survived a tornado that destroyed the house I was living in, taking the roof off the second floor where I was sleeping. I have also had nightmares about that and anxiety whenever there are storms and lightning. So, do I have PTSD now?

Let’s see. For starters, mirecc.va.gov provides a “civilian checklist” of PTSD symptoms:

  • Avoid activities or situations because they remind you of a stressful experience from the past
  • Trouble remembering important parts of a stressful experience from the past
  • Loss of interest in things that you used to enjoy
  • Feeling distant or cut off from other people
  • Feeling emotionally numb or being unable to have loving feelings for those close to you
  • Feeling as if your future will somehow be cut short
  • Trouble falling or staying asleep
  • Feeling irritable or having angry outbursts
  • Having difficulty concentrating
  • Being “super alert” or watchful on guard
  • Feeling jumpy or easily startled

To begin with, many of the symptoms which I have are also indicative of depression, anxiety or bipolar disorder – loss of interest in enjoyable pursuits, sleep problems, difficulty concentrating. And I have noticed a few of the other signs – jumpiness and irritability, for example.

But, by and large, aside from the dreams and flashbacks, I have few symptoms that are attributable to PTSD but not to bipolar disorder.

I was talking with my therapist the other week and posed the question to her: Could I have PTSD?

“There are all kinds of trauma,” she said, “and all kinds of reactions to it.” I think what she meant was that I didn’t need to worry about having a specific label. I have been through traumatic events and I have had reactions to them. The reactions and symptoms may not rise to the level that constitutes clinical PTSD, but I have been affected by them nonetheless.

I don’t want to minimize the suffering of those who have been diagnosed with PTSD or those who are suffering from it without ever acquiring the label. I know that what I have experienced cannot compare to what some of them have experienced, and I can only hope it never does.

But still I think there are a lot of us out there who could count ourselves among the “walking wounded,” who have experienced physical or psychological traumas and still have adverse reactions to them. Call it borderline PTSD or some other type of stress disorder, if using the label PTSD seems arrogant or insensitive.

But know that there are other traumas besides war that can leave a person damaged, struggling to find themselves among the shards of a shattered world. We may not have lost a part of our physical selves, but the damage to our psyches can be just as real.

 

 

The Stressor I Didn’t Realize I Had

You’ve seen those lists of life stressors, the ones where they assign you so many points for each stressful life event that occurred during the past year and use the total to calculate the likelihood of your becoming physically ill. Death of a spouse or child is at the top of the list, for 100 points. Marriage, divorce, taking out a mortgage (or losing your home), and even retirement are on the list.

The lists you find in various places differ in the details. Some list only ten major stressors, while others list 20 or more. (Nowhere in any of the lists does being diagnosed with, or living with, a serious mental illness appear. Apparently, only physical illnesses are considered stressful.)

I’ve managed to avoid a lot of the major stressors this year, though I can count retirement, my husband’s heart attack, and losing our home in my total. But there was one life event on one of the lists that I hadn’t even considered: changing one’s residence.

When I thought about it I could understand it, though. Moving is a major disruption of your life. It entails endless details, physical effort, and a need for psychological stamina. Packing up your life in boxes is itself a stressful process. (Hell, I get stressed just packing for a vacation.)

In the past month and a half, we’ve moved a total of four times, if you count the night we were evacuated from our tornado-damaged house to the Red Cross shelter. (Not that we did any packing for that. The rescue squad just yelled, “Grab your medications and come with us!”) We then moved to a hotel, then a pet-friendly hotel, and finally to a rental house where we can stay for up to a year while our house is rebuilt. (We had good insurance.)

It was the last move that was possibly most traumatic, though it was the one that brought us closest to a “normal” situation. A whole house. A full kitchen. A backyard. A mailing address. Like the hotels, it came with various rented amenities such as linens and dishes that made the transition easier, but it was still foreign to us.  We’ve been here for a couple of weeks now and are adjusting, but it’s undeniable that the whole process has stressed us very badly.

I know that we are fortunate in so many ways. The closest we came to true homelessness was the day spent in the Red Cross shelter. We both survived the tornado physically intact, and so did our cats. We know we still had a lot to be thankful for, and we were, and are.

The tornado was the really big stressor, but I only recently realized how much stress the constant moving added to the toll. As a person with bipolar disorder, I find all these moves jarring as well as stressful. I like to cocoon, rarely leaving the house. I want my comfort objects around me. The series of moves tapped into my fear of abandonment, my anxiety around packing, and my feeling of being overwhelmed by life. My husband, who is given to depression, feels the loss of all the things that embodied his memories very keenly. Our local paper observed that many of the tornado victims were suffering PTSD. I may be among them, as I have had tornado dreams and other sorts of upsetting ones.

Will we succumb to stress-induced physical illness? Who knows? Have we been suffering from the psychological effects of stress? Definitely. If you had asked me two months ago whether moving was a stressor, I would most likely have said yes.  But I had no idea of the reality. We had intended to stay in our home for the rest of our lives. When suddenly that became not an option, we came unmoored both physically and psychologically.

Stability has always been a problem for me, but now my husband and I have even less of it than usual. When we finally get a chance to settle in, take a deep breath and a day off, perhaps the stress will lift a little. But until then, we’ll keep slogging through it.

 

My Emotional Support Animals

As I mentioned last week, my home was destroyed in the Memorial Day tornadoes. Although I was upstairs in bed when it hit and blew the roof off, I emerged physically without a scratch. The emotional effects have not begun to hit me yet, except for a feeling of numbness. Part of what’s keeping me together is my emotional support animals.

The first and most important is my husband. He earned this title when I had to go to the dentist a few years ago (which terrifies me). “Can I bring my emotional support animal?” I asked, gesturing toward Dan. It was meant as a joke, to lighten the mood, but he indeed came into the procedure room with me, sat in a chair in the corner, and placed his hand on my ankle, the only part of me he could reach. And it really did help, that physical contact that helped keep me grounded, and a sympathetic pat from time to time. 

He was much more than that to me this time around. Dan was at work when the tornado hit. I called him and told him the roof was gone. “I’ll be there,” he said. Although his work is only about three or four miles away, it took him an hour to reach me. He drove into our plat until he couldn’t drive anymore, blocked by downed power lines. Then he set off on foot.

It was midnight dark and all the landmarks were gone, as the many trees had fallen or been blown away. It took him an hour to navigate that last half mile. He crawled over huge tree trunks. He fell backward into a creek. He clawed his way up a muddy bank. He lost track of where he was in relation to the house. He had no flashlight. 

But he got to me and we huddled together amongst the dust, dirt, and insulation until the rescue people came. He looked after me at the shelter, made sure I ate and got a shower, and generally acted as my interface with the Red Cross and church volunteers until we left there for a hotel, where we stayed for almost a week.

Meanwhile, back at the house, our cats remained. Every day we had to go to the shell of our home, give Toby and Dushenka food and water, and make sure they were still okay. We couldn’t get them out of the house for days because there was no way to carry them through the obstacle course of trees, branches, utility cables, roofing, boards, and other debris.

Days later a path to the house was cleared and we were able to rescue them. The motel where we were living did not allow pets, but our vet agreed to board them as long as necessary and our insurance agreed to pay for it. They were treated for the difficulties they suffered from having tried to clean their fur when it was matted with insulation. We were their emotional support animals, visiting them and loving them, and playing with them, and making sure they got good care. They needed us and caring for them gave us something to focus on besides ourselves and the devastation in our lives.

Finally, we were moved to a hotel that was pet-friendly and our little family was reunited. It really is an emotional comfort to have our cats with us again, sleeping on the bed with us, exploring the room, and returning that little bit of peace and normality to us. It’s now less of just a hotel room and more of a temporary home.

In a way, taking care of the cats has provided emotional support for us as well. When we need comfort, there is someone there to respond with affection and trust. When we are lonely, there is another being there to pet and cuddle. When we get short-tempered, we can find solace and distraction in their purring.

Our cats aren’t trained service animals, of course. But they give us emotional support just the same, especially when our ability to support each other wears thin. We and our animals have been emotional supports for each other and helped us bear up under these difficult times so that we can be the emotional support animals when needed, too.

 

Anxiety Says No, but Mental Health Says, “Do It!”

It’s tough enough for someone with bipolar or depression or anxiety to go outside, where it’s all people-y. It’s another level of achievement when such a person deliberately puts herself or himself out into the public eye.

But that’s just what I did this week. My publisher arranged for me to do a reading and signing of my book at a local branch of a national bookstore. And I agreed to do it. Thursday night was my debut.

Let me go back a few steps. I do have some experience speaking in public, so it wasn’t going to be a completely novel experience. Those occasions were, shall we say, a bit distant in time, mostly before my bipolar disorder reached its heights (or depths). In high school, I did debate and extemporaneous speaking. In grad school, I taught introductory English classes. During my somewhat-less-than-successful business years, I once addressed a power breakfast meeting. I even opened with a joke.

I was prepared to open with a joke (or at least a witticism) this time, too. But my plans soon flew out the window.

I had prepared – or over-prepared, probably – somewhat obsessively. I spent spoons like they were disposable plastic. I picked out an outfit and a back-up outfit, including earrings and back-up earrings. I did my hair. I agonized over which pieces from my book to read, then printed them out in huge type so I wouldn’t have to squint at them. I took an anti-anxiety pill and Immodium, just in case. I was fortunate that Thursday was my day off and also my husband’s, so he could be present as my emotional support animal, wearing one of my book t-shirts.

My expectations, such as they were, took a nose-dive when only two people showed up – both friends of mine, one of whom had already bought my book. It was time to rearrange my plans on the spot, not really one of my strong suits. Why had I knocked myself out making plans if the universe wasn’t going to cooperate with them? I had thought that at least half a dozen people would turn up. I was trying to keep my expectations reasonable, after all.

I’ll admit that when I saw such a small audience, I felt a wave of despair. In actuality, it proved good that they were both friends of mine, because they were a receptive audience who wished me well.

Given the meager audience, though, I abandoned my introduction (though I worked my joke in later). These people already knew me. I gave a brief synopsis of “What is bipolar disorder?” and plunged into my readings.

I had tried out one of my readings previously, when I was on a podcast for indie authors. Of course, I had no eye contact with my audience then and no real idea how my performance went over. On Thursday, I explained Spoon Theory, as it came up in one of the pieces I was to read. I had chosen two of my more light-hearted pieces, though on serious topics (psychotropics and side effects, and cognitive dissonance). Then I finished with a reading of a piece on why I write about bipolar disorder and why I put myself out there to the extent that I do in this blog and my book, and indeed my public appearance.

The big surprise of the evening came when I invited a Q&A session. My husband fed me questions to get things started and my friends also had queries. What I hadn’t been expecting, however, was that a few people in the bookstore cafe where this all occurred got sucked into the discussion and had questions of their own, though they had no idea that the event was scheduled at all. One worked at a local university and had heard his students talking about having bipolar disorder. Another was a woman studying psychology in order to become a counselor. I didn’t always have the answers, and I’m sure I bobbled some of the explanations, but I did my best to come up with reasonable answers about treatments and medications, self-care, and so on.

Then came the signing portion of the evening. I signed a book for one of my friends and the counselor-in-training asked me to sign her notebook with any little inspirational words I might have. (I winged it. I was tired by then and am not usually inclined to be inspirational.)

Then my husband and one of my friends and I went out for milkshakes, which I highly recommend as a way to decompress after such a fraught experience.

All things considered, I’m glad I took the risk and gave it the old college try, as it were. If nothing else, it was good practice for the next time I speak in public, perhaps when my second book comes out.

The reason that I write about bipolar disorder and my experiences with it is that I want to share what I’ve learned and lived. I think I did that Thursday, even if not to the extent that I had hoped. I don’t regret the anxiety and the preparation that went into it and, all things considered, count it as a win. When I think about the melt-downs I could have had – before, during, and after – I feel pride that I kept my depression and anxiety at bay for long enough to share information about bipolar and healing and mental health.

I think it was worth putting myself out there.

 

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