Bipolar 2 From Inside and Out

Posts tagged ‘anxiety’

Emotional Numbers

What’s the relationship between mood and emotions? How is the mind involved? Is it even possible to sort them out?

These days, people talk a lot about one’s Emotional Quotient, or EQ, also known as emotional intelligence, or EI. EQ is defined as “the capacity to be aware of, control, and express one’s emotions, and to handle interpersonal relationships judiciously and empathetically.” Emotions are “a natural instinctive state of mind deriving from one’s circumstances, mood, or relationships with others.” Mood is “a temporary state of mind or feeling.” Obviously, the definitions overlap somewhat.

All of these terms are used by the general public. EQ is the currently popular term. You can find any number of “tests” online that claim to determine your EQ. Often these are phrased in terms of your “personality” and may refer to enneagrams or other psychological theories. Other searches revert back to showing you your IQ, even if you were looking for EQ tests. Many of them charge money to show you the results. I’m not interested enough in my EQ to spend the money, though I took one of the tests. I might ask my therapist if she has a handle on what my EQ might be. I’d be happy with a subjective evaluation such as Excellent, Good, Average, Poor, or Terrible. Anything more, like a circular chart with bright-colored segments, I believe I’ll pass.

How do EQ and IQ tests compare? Healthline says, “IQ tests measure your ability to solve problems, use logic, and grasp or communicate complex ideas. EQ tests measure your ability to recognize emotion in yourself and others, and to use that awareness to guide your decisions.” So, completely different things. A person with a high IQ could have a low EQ and vice versa.

So, what else do the experts say about the difference between moods and emotions? “Moods can last for hours while emotions last anywhere from seconds to minutes, at most.”

There I would disagree.

At least, I have an opinion. An emotion is something I feel for a defined amount of time, usually a short one. My husband and I disagree and I feel an emotion of annoyance. But it seldom lasts for mere seconds. It can dissipate within a minute or last for several hours, depending on when we talk it out.

A mood lasts longer than that. Now that I’m relatively stable, my moods may last longer than a week, but less than years. Right now, I’m having a mood of anxiety, which has lasted for nearly a month, which doesn’t show much sign of pulling back, and which I’ve had to discuss with my therapist and my psychiatrist.

Moods certainly can last for more than seconds or minutes – hours, days, weeks, or longer – but emotions can last a long time too. Have you ever held a grudge? It’s not a fleeting emotion. It’s not a mood, but it can last for potentially years – even the rest of your life. What’s left? A state of mind? A personality trait? A decision?

In my research, I did come across a piece about EQ and various disorders. It was on a site that promotes a treatment center for drug abuse, so I don’t know how accurate it is. But it said that empathy, being a major component of EQ, will change in a person with depression. They may feel more empathy for a person who is also suffering, but less for a person who isn’t. This leads to numbness, they say, which may further impair one’s mental health.

In cases of ADHD, the center says, people may have trouble reacting to emotional stimuli and engage in “inappropriate behavior” for a situation. Without treatment and EQ, they may still feel internal restlessness.

Anxiety and EQ, they say, are complicated. Low EQ may mean detachment from things that threaten safety and self-esteem. On the other hand, people with anxiety and high EQ may have a tendency to be so empathetic that they overthink and lack the ability to self-regulate.

The treatment center says it can improve EQ and thereby improve self-awareness, self-regulation, motivation, empathy, and social skills, all in the context of addiction recovery. Whether this is true – whether raising EQ is possible and promotes benefits in understanding and behavior – is, as far as I can see, far from settled. It’s also unclear to me in which order this would happen. Would treating the mental condition raise the EQ, or would raising the EQ help treat the mental condition?

I also encountered a study that said high EQ is positively associated with good general physical health. Yet another investigated the correlation among EQ, a sense of belonging, and mental health among college students. Rejection in particular was associated with poor mental health outcomes.

I’d like to see more on the subject.

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A Haunting From 40 Years Ago

I was chatting with a potential customer the other day. She was interested in having me write a book on gaslighting – a fictionalized account of the experience she had with her soon-to-be ex.

I told her that I sympathized and that I had some experience with the topic, too. I was once in a relationship fraught with emotional abuse and gaslighting. “It was years ago,” I told her, “but the scars are still there.”

Suddenly, I stopped to think. That relationship took place over 40 years ago. For going on 41 years, I’ve been married to a man I met the weekend that everything blew up between Rex and me. But I had been truthful. The scars are still with me.

Oh, they’ve faded since then. I no longer have aversions to the things I associate with him, like cobalt blue glassware and blue spruce trees. I don’t cringe and close up whenever anyone in the room is angry. I don’t put myself down before someone else has the chance to. I allow myself to feel anger when it’s called for. I listen to the kind of music I like, at high volume if I want, and don’t apologize for it. In fact, there’s lots I don’t apologize for anymore.

But the memories still affect me, all these years later. I still have flashbacks when someone uses one of his pet phrases, like “fish or cut bait.” I dream we’re in the same town and I’m afraid to run into him. I flash on his insistence that it be called “Eighth of January” whenever I hear the tune “Battle of New Orleans.” And now and then, the obscene song he wrote about me – supposedly as a compliment – pops into my head randomly. It’s doing it now as I write about it, of course.

I was at a formative stage in my life when all this – and more – happened. I was exploring newly discovered independence, dealing with the stresses of college, navigating my first serious relationship. I’m sure my lack of experience helped to make the situation particularly searing for me. At the time, no one ever spoke of gaslighting, and physical abuse was the only kind I had ever heard of.

When I was still just coming out of the fog of the relationship, my startle reflex was unnaturally sensitive. I’d react with alarm if my husband dropped a knife in the kitchen. I didn’t even have to see it. The sound was enough to make me flinch and cry out. (I don’t remember any specific incidents from the bad times that seem to be related to this, but there you have it.) For years, I was a jumpy little thing. My husband learned to let me know if he was about to make a loud noise so I could be prepared for it. I have only a little bit of that left – now I jump only when something very sudden or very loud happens.

It’s been suggested that I have some form of PTSD from the experience. I don’t know if that’s true, though I certainly have some of the symptoms. I was told once by a therapist that I do have it, but at the time it seemed wholly incomprehensible. Now that I look back on it, she may have been right, only I wasn’t ready to hear it. And my future therapists moved on to my problems with depression and bipolar disorder. Self-diagnosing is seldom legitimate, so I won’t say that I definitely have PTSD. But this all puts me in great sympathy with those who do.

PTSD or not, I can still see the lingering effects of that relationship even after 40 years. They say time heals all wounds, but in my experience, the wounds don’t heal so much as scar over. The effects are still there and visible, but they no longer bleed like they did.

Of course, defining the trauma is less important than recognizing it and its effects. And healing from it, which I am still doing 40 years later. It’s a work in progress – and so am I.

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My Emotional Protection Animals

I have what I refer to as emotional support animals – principally my husband. He goes with me to places and into situations that upset me, like a dentist appointment or a class reunion. He puts a comforting hand on my shoulder and encourages me.

My cats provide emotional support as well. They ground me when I’m upset and help me calm down. They give me something to focus my attention on instead of the turmoil in my head. They soothe me with their purring and distract me with their antics.

You would think that the animals I identify with most would be cats. I do believe that if I could be any animal, I would choose to be a cat – as long as I could be one of my own cats and not an unwanted, feral stray.

But the animals I identify most with are bunnies and armadillos. Here’s why.

There’s an expression among chefs – when they’re absolutely slammed with work, falling further behind with each passing minute, they describe the situation as being “in the weeds.” I use the phrase a little differently. I was experiencing a mixture of anxiety and depression, totally overwhelmed, though not necessarily with work. Every day brought new challenges that terrified me. Every day I found myself immobilized. And every day I found myself retreating. I felt like a little bunny hiding in the weeds.

That became the shorthand my husband and I used to describe the feelings. He would ask me how I was feeling, and I would reply, “I’m hiding in the weeds.” When I couldn’t express what I was feeling, he would say, “Are you hiding in the weeds?” and I would nod. That’s how I felt – like I had to hide from the flood of feelings and problems that beset me. Like I needed a screen of weeds to offer me what little protection they could. Like I had to be ready to jump at any minute the next time I sensed a threat.

I moved past this phase. After years of therapy and medication, I no longer need the weeds. I have stronger forms of protection that come from inside now. (My husband does calls me “Bunny” as a term of endearment, though.)

Armadillos are another story. Again, though, my fascination with them was in relation to another form of protection, seemingly more solid than weeds.

Armadillos are covered, of course, with bands of scales that protect them from most dangers. They can also roll up in a ball to protect their soft underbellies. I tried to develop hard scales that would prevent trauma from invading my fragile emotional makeup. At times I even rolled up into a ball (or at least a fetal position) when I had a meltdown.

Eventually, I did learn that if you wall off your feelings, it’s hard to get back in touch with them. And the good emotions get blocked off as well as the bad ones. The armadillo armor was not a viable solution for the long term.

I also learned that the armadillo has another defense mechanism. It jumps straight up about two feet into the air, presumably to escape from or startle any predators. Unfortunately for the armadillo, their main predator is the automobile. The little critter’s jump puts it at just the right height to be smashed by the car’s bumper. As a defense mechanism goes, it’s not really what you’d call successful.

That’s when I realized that neither were mine. When I got jumpy – when my anxiety was out of control – I was often smashed by onrushing difficulties, the very ones I was trying to escape.

So, bunnies are out. Armadillos are out. Where can I find an animal to identify with in terms of protection? We’re back to cats, I guess. They at least have claws that they can choose to extend or sheathe. I like the idea of bringing out a defense mechanism only when I really need it.

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When I Need to Feel Normal

A lot of the time, I live with sort of a low-grade dread, kind of like coming down with a fever. I’m well-known for overthinking and catastrophizing. The combination is exhausting.

When anything alarming happens, I ratchet up into an agitated state. It could be anything – a relationship problem, a looming financial disaster, a health scare. I respond with racing thoughts, trembling hands, and sleep disturbances. I find myself at 2:00 a.m., wide awake though a little bit foggy, with no real idea what I should do. Most of the time, there isn’t really anything I can do.

This happened a lot when I was in college. My life was complicated then – well, it always has been and still is. I wasn’t particularly worried about my grades or about graduating. No, it was other things that occupied my troubled mind. A difficult relationship was ending in great turmoil. I had lost a lot of weight and didn’t look or feel healthy. I had to pack, move, and find a job. My parents were coming for the graduation ceremony and I didn’t want them to see me in such distress. It was all overwhelming.

I had insomnia that summer. I would find myself lying on the sofa, wide awake, my brain on overdrive, with only a large black cat to keep me company while everyone else in the house slept. That cat kept me anchored in a way. He distracted me with his solidity and his insistent purring. He was a soothing presence that helped me not feel totally alone, without putting any demands on me.

It was that summer when I learned a technique I could use when everything seemed to be spinning out of control. I found that I could ground myself and stop all the whirling thoughts, at least for a while, by doing something small and totally normal. Making myself a cup of tea was my go-to. The familiar actions of finding a mug and a teabag, heating the water, and steeping the tea gave me something physical to do that would get me out of my head and back into my body. No matter how distraught I was, I could always manage to make a cup of tea. It’s not a demanding task. I could do it practically by rote. But it was so familiar – so completely normal – that it was a form of reassurance.

It turns out that the feeling of normalcy can soothe other people too. Once that summer, my uncle Phil was also having a hard time sleeping. Like me, he was afflicted by personal problems and feeling out of touch with his body and tangled up in his head. I busied myself making him a can of soup. It kept me from getting swept up in his turmoil, and it helped him become calmer as he watched me puttering around the kitchen. Again, it was all so normal that it soothed us both.

Now, when I have racing thoughts and distress, I try to find something manageable and entirely normal to do – something I can do automatically, without expending any thought. Putting out fresh food for the cats. Making lists. Watering a plant. Anything that I can do with little expense of energy or thought. In a way, it’s kind of a mindfulness exercise, paying attention to the steps involved and experiencing every movement as I go about accomplishing my normal little task.

This technique doesn’t work for me if I’m having a full-blown panic attack, but maybe it at least helps me stave one off if I catch it creeping up on me. It’s one of my more effective – and non-counterproductive – coping mechanisms.

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The Year Past, The Year to Come

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

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

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

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

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

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

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

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

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

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

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

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How Do You Find Relief From Stress?

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

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

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

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

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

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

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

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

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

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Are Holistic Approaches to Mental Health Useful?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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What If My Symptoms Come Back?

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

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

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

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

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

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

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

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

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

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Not Breathing Affects Our Mental Health

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

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

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

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

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

Indeed it does.

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

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

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

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

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

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

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

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

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

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

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Remote Work and Mental Health

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

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

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

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

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

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

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

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

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

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

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

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