Bipolar 2 From Inside and Out

Posts tagged ‘anxiety’

Sensation in the Brain

I know there is no physical sensation in the brain. It cannot feel pain. It cannot feel touch. Even in a car accident when the brain sloshes from side to side and bashes against one side of the skull and then the other, the brain sustains injuries, but feels nothing.

That notwithstanding, twice in my life I have felt physical sensations in my brain – or at least what felt like them.

The first time was at the dentist. I am terribly phobic about dentists, so even for routine procedures I need anti-anxiety medication. This was not a routine procedure.

The dentist was very understanding. He put me in the children’s treatment room, which had brightly colored designs of cactus, coyotes, cowboys, all painted on the walls in comforting colors and playful attitudes.

He also brought in a traveling anesthesiologist so that I could be unconscious during the procedure instead of terrified. My husband was there with me, of course, both to drive me and to give me moral support. (It also turned out that he had to give permission for one of my teeth to be removed in the middle of the procedure while I was unconscious.)

While the anesthesiologist was putting me under, my husband and the dentist were casually chatting. My husband made a remark and the dentist said, “Oh, she can’t hear us now. She’s already pretty far under and won’t remember a thing.”

“I bet she will,” my husband replied. The bet involved giving me a word to try to remember when I awoke. They selected the word green.

“You mean like the color of my pants?” I said. They were actually more like olive drab.

“Yes,” the dentist replied. “Green – the color.”

Just for the hell of it, as I was sinking into unconsciousness, I silently repeated to myself the word green in a slow and steady manner: green green green – until the drugs took me under.

An unknown time later I awoke. The dentist asked me, “Is there something you were supposed to remember?” I shook my head groggily.

As soon as I did, I felt an odd sensation in the back of my brain. It was like a little bubble rising up through liquid. When the bubble reached the surface of whatever the liquid was, it burst and released the word green. “Green?” I said uncertainly.

“See?” said my husband. “I told you she would remember.”

The other sensation in my brain came about six weeks after beginning a new psychotropic medication. I had gone through a long, miserable time of trying drug after drug after drug – tapering off on one and ramping up on the next – all with no effect, except unpleasant ones.

Dr. R. was ready to recommend electroshock for me. And after such a long time – I think it may have been two years – of trying and failing with different medications, I was ready to take the plunge. I admitted as much in one of my sessions.

“There’s one more thing I’d like to try before we do that,” said Dr R. “Here is a prescription for lamictal”.

“Okay,” I said. “How does it work?”

“We don’t really know,” he replied. This was our standard conversation whenever he prescribed a new drug. I was used to it, but I always asked anyway.

So I tried it. And felt the usual nothing for almost six weeks. Then one day I was in my husband’s study and we were talking, when I felt it.

It was the physical sensation in the back of my brain of a light switch being flipped. I thought I heard an internal click. When that switch flipped, suddenly something in my brain changed. It remembered how to think and to feel and to not be miserable.

“Oh!” I said. “I remember this. This is the way my brain is supposed to work.” Since then it has kept working – not continuously in the proper manner – but often enough that I consider the drug a success.

I know that in both of those cases nothing happened in my brain that caused a physical sensation. Both times, my brain gave me a metaphor for what was happening. In the dentist’s office the metaphor was a bubble rising to the surface to explain coming out from under sedation – and a little bit of self-hypnosis.

In the case of the drug, the metaphor was the cliche of flipping on a light switch. This time something had changed in my brain, something biochemical. I should not have been able to feel it, but according to my brain, I did.

It seems I have a clever brain. It gave me ways to understand what was happening in terms I could relate to. The fact that I know the brain can have no physical sensations did not matter to my brain.

Human brains are amazing – and sometimes even in a good way.

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Mental Health

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In Defense of the Armadillo

Let’s consider the armadillo. Better yet, let’s consider this brief video. Take note of the armadillo’s defense mechanisms, if you will.

I have always identified with the armadillo, for a variety of reasons. It is the symbol of Texas music, which I love. I have a purse shaped like an armadillo. I also have toy armadillos, crocheted armadillos, wooden, stone, cement, armadillo jewelry, you name it. My uncle and I have a catch-phrase: El armadillo amarillo de mi tía es sobre la mesa.

What does all this have to do with bipolar disorder? I’m glad you asked.

Most of all, I admire the armadillo for its defense mechanisms, which resemble some of mine. For those of you who skipped the video, here’s a recap.

The armadillo has armor (obviously). I have tried to construct a similar impervious shell. When I have been even partially successful, it has proved counterproductive. When you wall off feelings, you wall off the good ones too.

The armadillo rolls up in a tight ball. I isolate. This has also proved counterproductive. If sorrow shared is halved and joy shared is doubled, then isolation – well, you do the math.

The armadillo leaps vertically when threatened. My anxiety makes me jump and release fight-or-flight hormones. This defense is also counterproductive, both for the armadillo and for me. One of the armadillo’s main predators is the automobile; the armadillo jumps straight up to bumper height. I waste energy on panicky behaviors even when I’m not threatened.

The armadillo has a low body temperature and is therefore useful for research on leprosy. This is not a defense mechanism, but it is a Fun Fact to Know and Tell. I have never had leprosy.

All things considered, the armadillo is not a good role model for a person (me) with bipolar disorder. But I like them anyway. They remind me that I need to check whether my defenses are doing me harm rather than good.

Plus, with my armadillo handbag I get lots of practice in the social skill of making light conversation strangers – and even children!

Erma

Erma

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Mental Health, Uncategorized

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Why I’m Not Like Sheldon Cooper

Obviously, I’m not a man or a theoretical physicist or a character on The Big Bang Theory. But also, I can’t say, as he often does, “I’m not crazy. My mother had me tested.” I’d like to have that t-shirt, but it would be false advertising.

I am crazy and my childhood was entirely free of psychological testing.

It probably shouldn’t have been, because the crazy had taken full hold during my tender years. Crippling depression. Massive anxiety. But both my parents were ordinary folk from Kentucky transplanted to a bland Ohio suburb. They stayed true to their roots and never considered testing or counseling for me or my sister. According to their upbringing, having crazy relatives might be upsetting or embarrassing, but that’s just the way it was. You tried to shelter them from the outside world – and vice-versa – but you didn’t involve agencies or doctors or hospitals.

My crazy got too obvious to ignore when I was in junior high school. I developed a nervous tic – my head would jerk up and to the left uncontrollably. This was very distracting, not only to me, but to whoever was sitting behind me in class. It got me noticed.

It did not, however, get me to a psychologist or other mental health professional. I didn’t want to see one anyway, because I had the irrational notion that being “shrunk” would go on my permanent record and I would never get into a good college.

Instead, I was taken to our family doctor. He prescribed Valium, which did stop the twitching but did absolutely no good for my depression.

Later, during my college years – at a good school, I might add – I had another run-in with Valium. This time my symptom was pain like a railroad spike being driven into the side of my head. Naturally, I thought it was a brain tumor.

I went to the doctor, who said, “I can do any test you want, but I can tell just by looking at you what your problem is. Your jaw is crooked.” He diagnosed me with temporomandibular joint (TMJ) disorder, explained that tension made my muscles contract unevenly and cause excruciating pain in my temples. He sent me away with a prescription for Valium. Which helped with the stabbing pain, but again not with the depression. (Also, I was self-medicating with wine, which just made the crazy train run faster.)

It was not until years later, after college, that I got half a diagnosis – depression – and a non-Valium prescription – Prozac. And many years after that until I got the more accurate diagnosis (bipolar 2) and an appropriate regimen of drugs, which does include Ativan, but not prescribed alone or with wine.

And that’s another thing I don’t have in common with Sheldon Cooper. He’s not taken any psychotropics (or wine) and is happily stuck in his supposed non-craziness. I’ve accepted my craziness, gotten help for it, and am slowly rising, if not above it, at least to where I can peek over the top of it.

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The Abilify Saga Continues

It turns out, Abilify works for me. Except now I have to work for Abilify. To afford it, I mean.

I now wake up around 7:30 or 8:00 instead of 10:00. I can concentrate long enough to read whole chapters of books, and am enjoying that immensely. I am able to get showered and dressed and go out to run a few errands. I can decide what to eat and even recognize when it’s time for me to eat.

And I can work. I have taken on a mega-project, which has required my attention up to eight hours a day, researching, writing, editing, and proofreading. I don’t know how well I’m doing (there are some differences of opinion about that), but I’m doing it, goddammit.

I may be pushing myself a little too hard, despite the new energy and focus. The other day I had to force myself, one pitiful step at a time, to address a dozen Christmas cards. “You have the list, you can put the addresses on the envelopes. You’ve got enough stamps, you can surely put them on the envelopes. (Don’t call me Shirley.) Better put return addresses on. You can do that much, then stop. You can slip the cards into the envelopes. How hard can that be? You had them printed with your names, so you don’t really have to sign them if you don’t want to and won’t have to fake your husband’s signature because he’s not here. That would be too much. Now lick the envelopes. All you have to do is stick out your tongue. Might as well take them to the mailbox. You need to get cat food out of the car anyway. Okay, now you can crash. Egg sauce, Ted.”

Many’s the year when all that was Just Too Much. According to the Mystic Law of Reciprocal Cards, we get about four nowadays, and are very grateful for those.

And grateful for the Abilify. Except it’s $800 a bottle, even for the tiny dose I’m taking. I got one free month and one discounted month ($650) from the manufacturer and have spent a lot of time since worrying and seeking solutions.

There will (we hope) be a generic in April. Yay.

I know someone who was taking it and has some left over.

I know someone in Canada.

Will my doctor prescribe a higher dosage so I can break them in half and stretch them (and the cost) out?

I may have at last solved the problem. After hours on the phone and hours more on hold, we finally have new insurance. It costs about as much per month as a bottle of Abilify, but the drug benefit kicks in before we’ve paid the deductible (which is way lower than previously). So our many, many other drugs will magically shrink to $15 per – or less with mail-away – and we’ll come out ahead. A little. Probably. If I can keep up the pace on work.

Plus, now we have dental, and oh lord do I need that. But that’s another story for another time.

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Mental Health, Uncategorized

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Dear Folks: Sorry I Haven’t Written Lately

This has been the longest trough I’ve had in a while, and I’ve been spending all my spoons on work, because the cats do insist on eating.

Tomorrow begins a new adventure: My psychiatrist has prescribed Abilify. The $800/month price tag seemed a tad bit high to me. We have insurance, but the benefits don’t really kick in until we meet the absurdly high deductible. A few months of Abilify would probably do it. (We couldn’t afford the gold plan. I think ours is aluminum, or maybe tin.)

The manufacturer does offer a free month’s trial and a discount card, so at least I can see if it works for me. If it does, I’ll figure out how to pay for more. (BTW, if your meds are way expensive, check out needymeds.org. They have a database of manufacturers, discounts, requirements, and contacts. My psychotherapist turned me to that.)

When Dr. R. prescribed Abilify, he told me that it could make me restless. “How will I know whether it’s the drug or my usual twitchiness?” I asked. “You’ll know,” he said. After reading the literature, I can see what he means.

So here I am with three work assignments (not particularly tight deadlines, though) and am about to start a drug that could feel either heaven-sent or hellish. Or just “meh,” I suppose, which would leave me exactly where I am now.

Wish me luck.

And tell me if you’ve had any experiences with Abilify. I know anecdotal evidence doesn’t mean squat to scientists, but I’m interested in hearing from people who have tried it, or seen how it worked (or didn’t) for a friend or relative.

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On Dithering

If dithering were a power source, I could light up Chicago. Good thing it burns nerve endings instead of fossil fuels.

The last couple of weeks have seen a lot of dithering and anxiety. I hardly ever get to enjoy the rush of hypomania – except for that one brief spell a few weeks ago – because it comes out sideways as anxiety.

I also have a third-degree black belt in catastrophizing.

Both have gotten a workout lately, since a cyst was discovered in my left breast. (I wrote flippantly about mammograms on my other blog, so irony gifted me with this.)

I checked my usual sources (Mayo Clinic website and a friend who is a biologist and had a lumpectomy), and the consensus was that I had only the remotest chance of the anomaly turning out to be anything really dire.

Do you think that stopped my dithering?

Hell no! Of course not!

What could have gone wrong?

They could have stuck a needle in my breast to aspirate fluid and get a sample for the lab. (A friend who should know tells me that some people do this kind of thing for fun. Somehow, it doesn’t appeal to me.)

If the results were worse, I could have been scheduled for a lumpectomy. There was extra anxiety on this one because my friend almost had a mastectomy instead of a lumpectomy when the surgeon started making the wrong incision. (An operating room tech noticed, saving the day and the breast.)

And of course, my anxiety told me that a mastectomy could be in my future (either on purpose or accidentally, I suppose). My mother had a mastectomy, which added extra oomph to the dithering.

A mastectomy would suck for oh so many reasons. Cancer, surgery, body image issues, obviously.

Also, I would keep falling over to the right. And before the operation I’d have to take my breast on a farewell tour for all its friends and admirers.

Maybe worst of all, I would have to put up with all the pinkness and positivity. Not to denigrate this strategy for those who find it helpful, but I am not that person. Anyone with my brain chemistry is not going to respond to slogans and cheerleading and daily affirmations. (Reminder – As always with my posts, YMMV.)

Barbara Ehrenreich has written about this phenomenon in Bright-Sided: How the Relentless Promotion of Positive Thinking Has Undermined America.  Apparently many breast cancer survivors feel they must get something positive from the experience – appreciating life and family more and so on.

We’ve come a long way from Betty Rollins’s First, You Cry. Now it seems like we’re never supposed to.

The anticlimactic but welcome result came today: Everything is OK. I just need to keep up with yearly mammograms.

And now I can move on to the next thing that needs dithering about – the work I wasn’t able to do while I was catastrophizing.

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The Un-Merry-Go-Round

I submitted this for a mental health anthology and swore that if it wasn’t selected, I would post it here. It wasn’t. so here it is.

 

Back when I was diagnosed with depression (unipolar) and anxiety, I secretly envied the manic-depressives (as we called them then). At least if I had a manic phase, I thought, I could get something done.

 

Then I met Kate, who was bipolar – and not well controlled on medication, to say the least. My envy lasted through her ambitious plans to make identical green velvet Christmas dresses for her three daughters. And vanished when I saw her tear them apart, recut them, start over, change her mind multiple times. You can write the ending to this one. There were no dresses, not by Christmas and not ever.

 

Kate was riding the roller coaster – perhaps the most common metaphor for bipolar disorder – the peaks and troughs, swooping crashes, anticipatory climbs, stomach-clenching vertigo, and, for some, an abrupt stop at the end.

 

Type 2 bipolar is not like that. Type 2 is what my new psychiatrist diagnosed. Except I seldom got the hypomanic mini-jags of ambition and purpose. Instead, it came out sideways, as anxiety.

 

The challenge for both my doctor and me was finding the right mix of drugs to get me functional and keep me functional, at least at some sort of reasonable level.

 

While supposedly unipolar, I had been through most of the different sorts of antidepressants and anti-anxiety meds, including, of course, Prozac. When the increasing side effects of each outweighed the diminishing relief, I went through a lengthening list of tricyclics, SSRIs, and so forth. I learned not to ask, “How do they work?” I couldn’t get an answer. The more basic question was, “Do they work?”

 

I can’t remember all the combinations now. My memory has become Swiss cheese after the spectrum of chemicals I tried. (Actual conversation: “Doctor, I’ve been having some rather embarrassing memory lapses. I asked a friend how her father was doing, when he had been dead for three months.” “Yes, that medication will do that. Stop taking it.”) But in addition to (instead of?) the Prozac, I remember buspirone, Wellbutrin, imipramine. Desyrel, Lexapro? I think so. Effexor, Sinequan? Maybe. No MAOIs or lithium, though.

 

What I do remember all too well is when my brain broke. I don’t know what else to call it: nervous breakdown, decompensating, mental and emotional collapse. It wasn’t the first time this had happened, I later realized, but it was by far the most severe. That’s when I climbed on the merry-go-round.

 

It wasn’t a carousel. No painted ponies or dolphins or elephants or zebras with fantastical, bright bridles of flowers and whimsical saddles, steadily but gently leaping to the calliope music like the calming rhythm of waves.

 

This was a merry-go-round of the type that is no longer allowed on playgrounds because of the danger. A wooden platform, painted a color no longer identifiable, a metal pole speared through the center. Bent metal pipes dividing the surface into rough pie-wedges. No power to make it twirl but the force of children pushing and then jumping on, not to thrilling acceleration, but only to inevitable slowing. No lilting music; only creaks and rattles. No scents of popcorn and cotton candy; only playground dust and much-used sneakers.

 

The metaphoric merry-go-round would start rotating with each new pill or combo that promised (or at least proffered) “Better Living Through Chemistry.” I couldn’t handle the side effects of some – hideously vivid nightmares or the feeling of wanting to jump out of my skin. Others had side effects that I could live with, but little or no therapeutic effect. “There’s another drug I’d like to try” was the constant refrain.

 

The merry-go-round creaked on for years. Literally. With each new med, I had six weeks or so of slowly sliding back into the numbness and misery as my body sloughed off that chemical. Then six or so more weeks, waiting for the new one to work or not, prove tolerable or not, be any better than the last drug or not. Each new drug cycle amounted to a minimum of three months of hell. More, sometimes, as the doctor slowly, cautiously ramped up the dosage to gauge the effects, both intended and incidental. Lather, rinse, repeat.

 

Those years are mostly a blur to me now. I remember sleeping a lot. I remember sitting on the sofa watching “reality” shows so I could see people whose lives were train wrecks worse than mine. I recall not having the wherewithal to add water and nuke a cup of macaroni and cheese. Not bathing. Not feeding the pets. Not paying bills. Not reading. Not caring.

 

I know now how lucky I was to have a husband who lived the vow about “in sickness and in health” and took up the enormous quantity of slack required. He put up with a distant, unresponsive wife; frequent and apparently unprovoked bouts of sobbing; irrational panics; and all the other symptoms he knew by then he couldn’t fix. He didn’t know about the suicidal thoughts, or if he suspected, he never mentioned it. He often asked how he could help, but really, there was nothing else he could do.

 

Then came the day that my psychiatrist said we were just about out of options. He was thinking of recommending electroshock (or ECT, electroconvulsive therapy, its current version). As he talked about how it wasn’t like the bad old days and really showed quite good results in some people, his voice seemed to fade and I heard my inner voice screaming, “Fuck, NO! Keep away from my brain, you Nazi sadist!”

 

I had heard how in the 1950s electroshock was used as a way to punish or control unruly, uncooperative, nonconforming women. And of course everyone knew about the Cuckoo’s Nest. The Snake Pit. As far as I was concerned, electroshock was right up (or down) there with icepick lobotomy, the frighteningly efficient epitome of former psychiatric treatments.

 

Reeling, I made it to my car and immediately called a friend, a scientist, one of the most rational people I know, to talk me down. Her extremely sensible advice was to do some research. Research was something I knew about and remembered how to do.

 

I started digging. The Internet was little help. The opinions and experiences of people who had undergone electroshock ranged from “It was hideous” to “It was a miracle.” I kept looking and questioning and slogging through the research as well as the dense fog around me. I lost one friend, my long-time go-to guy for comparing our conditions and our meds, who said, “Do it immediately or I will kick your ass.” (Hint: Advice phrased as a threat of violence doesn’t help, or have the desired effect.)

 

So there I was, on a merry-go-round that had jolted to a sudden, sickening stop by the notion of electrical jolts surging through my brain. My precious brain, which had both sustained me and betrayed me throughout my life. The only part of my body I ever really loved.

 

What was I doing, considering altering that unique organ with electricity? But the brain in question kept pondering.

 

Electroshock caused memory lapses. I was already having those.

 

I would be allowing doctors to tinker with and alter the functioning – perhaps even the structure – of my brain. But really, hadn’t I been doing those very things with chemicals for years?

 

I went back to my psychiatrist, ready to tell him I was at least willing to talk to the doctor who did the shocking.

 

Then I got a surprise (at least as much as anything repeated for years can be a surprise). “There’s one more drug I’d like to try,” he said. “Lamictal. It’s an anti-seizure drug.”

 

“I don’t have seizures. How does it work?”

 

“We don’t really know.”

 

Oh, why the hell not try it? One more spin around the playground.

 

More misery. More weeks of weaning off and ramping up. More weeks of no change. The same-old same-old.

 

And then one day, something did change. It was such a clear sensation, physical as well as mental. I felt a sudden click in my head – an actual click, like someone throwing a switch located about two inches inside the back of my skull. I could hear my brain saying, “Oh, yeah. I remember this. This is how thinking and feeling are supposed to work.”

 

The click wasn’t a flick from a magic wand. I still had a long way to go, rebuilding the parts of me that I still could and still wanted to. Setbacks. More fiddling with the dosages. The creation of a crazy cocktail of drugs to keep the crazy at bay. But I was on my way back to functioning, with the help of anti-depressant, anti-anxiety, and anti-seizure drugs, plus a sleeping aid. And lots and lots of psychotherapy.

 

So what did I learn from this process? Not “There’s always hope.” I gave up hope lots of times, every time another med didn’t work. Not “Desperate times call for desperate measures.” I am infinitely glad I did not have electroshock. “It’s always darkest before the dawn”? Please. No truly depressed person believes that crap.

 

The lesson I took was “Stubbornness is a virtue.”  It saved our marriage countless times. It saved my father’s life for five times longer than the doctors gave him. And it saved my sanity.

 

“Stubbornness is a virtue” is different from “There’s always hope.” Even when you do give up hope, when you know it’s hopeless, when you realize the merry-go-round is grinding to its inevitable halt, you keep pushing it. Hopelessly, if you must, but stubbornly. As long as it takes.

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From Panicky to Manicky

I’ve been having one of my rare, slightly manicky  upswings for the last few days.

Why? And about what?

Well, I survived the business meeting/lunch on Wednesday. I prepared for it with a lot less anxiety than the last time (hair, outfit, jewelry, car, arrival time – all came together with astonishing speed). I even made it through lunch without my hand tremors causing me to dibble all over myself. Yay me!

And although the subject matter could have felt like an attack directed at me, it didn’t. I didn’t get defensive (well, maybe a little) and I help uncover some problems that indirectly supported my point of view.

Maybe I am getting better at this stuff, or remembering how I used to do it.

Also, I was not completely spoon-depleted that evening or the next day, as I had told my husband to expect.

I’ve donated small amounts of money ($25 and under) to a few charities and causes. I don’t know if this is cause or effect of the upswing, but who cares? I was motivated, and I did it. A small enough accomplishment for many people, but summoning the will to care and to act constitute progress.

I have supported a friend in his first solo freelance venture, predicted its astoundingly rapid success, and reveled in it with him. It’s a good feeling to share, even if my own freelance efforts have been less spectacular (though significant to me).

I won’t deny that this upswing makes me wary that a crash may be on the way. You know how feeling happy always seems like tempting fate? With bipolar disorder, I know that there will always be another downswing waiting around the corner for me.

But at least, for now, I can enjoy the good. And that’s a major improvement.

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Ack! Ack!

Oh noes! Another business meeting/training session/lunch!

On Wednesday – not much time to get ready.

Panic? Check.

Hair appointment? Check.

Therapist appointment? Check.

Everything else? Not check.

Will I ever be able to do this again without freaking out? Guess that’s a question for my therapist.

Bonus Material (Actual Conversation)

Me (distraught): I have to find something to wear!

Husband (helpful): What about that white thing you wore last time?

Me (gently): It’s June, and that was a turtleneck with long sleeves.

Husband (no particular tone of voice): Oh.

(I didn’t bother explaining that it was actually off-white and I couldn’t wear the same thing to two of these events in a row. The seasonal thing was a big enough information bite.)

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For Sharing

http://www.upworthy.com/these-9-college-students-want-to-tell-you-about-their-mental-illnesses?c=ufb1

Don’t give in to stigma. If you dig this video, share it so more people with mental illness can leave shame behind.

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