Bipolar 2 From Inside and Out

Posts tagged ‘being overwhelmed’

Did Bipolar Disorder Lose Me Jobs?

I lost two jobs, one that I had held for 17 years, because of my bipolar disorder. I only realized this comparatively recently. In both cases, I readily admit that my work had gone downhill, but at the time (at least for the first job), it never occurred to me that bipolar disorder was the reason for my dismissal.

I was working at a publishing company as an editor, having worked my way up from editorial assistant. I had been the editor of two different magazines, assistant editor for a couple of others, and writer and proofreader for them all. (It was a very small company.)

As time went on, though, I became less and less reliable. I edited my magazines, but I had trouble dealing with people. I had particular trouble with an art director who didn’t like my cover choices (despite the fact that several of them had won awards), humiliated me in a staff meeting because of it, and reminded everyone about it later. She was toxic, sure, but I was unable to deal with the situation or even stand up for myself.

There were other humiliations that I tolerated because I didn’t have the wherewithal to quit. When, during the financial crisis, salaries were cut by 20%, mine was cut by 40%, which to me meant that I was twice as useless as, say, a salesperson.

I stayed, but I isolated myself. My office had a door and I used it, the only person in the company to do so. I knew that people thought this was odd behavior, but by that point, I didn’t care. I was let go with no explanation given.

Yes, the company was a toxic environment and no, I didn’t deal with it well. But the situations I put up with exacerbated my bipolar disorder until I was headed for the crash. When I was on the upswing I was able to do my assignments and, I like to think, do them well. But when things went bad, I was prey to the voices that told me I was no good. Losing the job proved that to me.

The next job I went to was editing textbooks. My supervisor knew me and knew that I had bipolar disorder. The fact that she understood helped me keep on an even keel for a while. I developed little techniques to stave off difficulties. But some of my coping mechanisms were unacceptable. (Apparently, it’s okay to have a cigarette break but not a crossword puzzle break.)

Then my supervisor left. I said to her, “I’m going to miss you,” and she replied, “I know.” Prophetic words. I was open with my new supervisor about having bipolar disorder and was quite taken aback when she asked, “What does that mean?” Unprepared to give a proper explanation, I blinked and replied simply, “It means I’ll have good days and bad days.”

From that point on, my performance and their satisfaction with me fell, until I received a bad review, the first one I had ever had. Before the six-month probation period was up, I left of my own accord, determined to make it as a freelancer.

There were personal circumstances at the time, including my disorder, that made me less capable. I became responsible for my mother’s health and finances. I could easily miss half a day of work just getting her to her various appointments. That no doubt affected many of my job functions, particularly my attendance and my ability to concentrate. My major breakdown began not long after I left that job.

The thing is, in 2008, the Americans with Disabilities Act (ADA) added bipolar disorder as a covered condition. Employers were (and as of this writing still are) required to provide “reasonable accommodations” to affected individuals. Examples of reasonable accommodations include job restructuring, part-time or modified work schedules, and “a change or adjustment to a job or work environment.”

To receive accommodations under the ADA, an employee must disclose their bipolar disorder (which I did, at least at the second job) and request accommodations (which I didn’t do, other than offering to work from home).

The EEOC (2009) has a publication called “Psychiatric Disabilities and the ADA,” which is available online at http://www.eeoc.gov/policy/docs/psych.html. Among their recommendations to help a bipolar employee continue to function in the work environment – maintain stamina and concentration; stay organized and meet deadlines; work with supervisors; and handle stress, emotions, and attendance issues – are these:

  • Allow flexible scheduling
  • Allow for time off for counseling
  • Allow work from home during part of the day or week
  • Provide space enclosures or private office
  • Allow telephone calls during work hours to doctors and others for needed support
  • Provide flexible leave for health problems
  • Allow the employee to make up time missed
  • Maintain open channels of communications between the employee and the new and old supervisor in order to ensure an effective transition

I know there are those who would consider such accommodations “coddling.” And I wouldn’t have needed them all, or all of them at the same time. But even an understanding of my closed door and my need to work at home would have helped.

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.

 

 

When Self-Care Seems Impossible

It seems the days when I most need self-care are also the days when I’m least able to accomplish it. I mean, when I can’t even get out of bed, I’m not likely to have the wherewithal to perform any kind of self-care regimen.

I’m not talking here about the take-yourself-to-the-spa type of self-care, either. That’s beyond my means and my capacity. What I’m thinking about are the most basic needs that must be met – meds, food, sleep, and the like. But there are sometimes things that prevent me from accomplishing even these.

Part of the reason, of course, has to do with lack of spoons. It takes energy to shower and dress, make a meal, go to appointments, and all the other tasks that should actually make me feel better. According to Spoon Theory, we wake up with an unknown amount of spoons every day and must choose how to spend them. Some days I wake up with only a few or even zero.

The other obstacle I’ve noticed that inhibits my self-care is my occasional inability to plan. Yes, I can make sure I eat at least one meal a day, but on some days only if I have gone to the grocery store earlier in the week and bought at least a box of Cocoa Puffs and some bottled water to keep by my bed. Not much of a meal, I know. It’s the bare minimum I can do, but sometimes all I can manage.

Taking my meds is the only part of self-care that is an essential that I don’t do without. I usually have that bottle of water right next to my bottles of pills, but even if I don’t, back in college I learned to swallow pills with only spit. But again, this takes a little planning – calling in prescriptions and getting to the pharmacy to pick them up.

On days when I have slightly more spoons, I have to plan and prepare for the days when I don’t have enough for proper self-care. Even the planning and preparing use up spoons.

But there are also days when I can manage a little self-care. On those days, if the spoons are low, but not completely nonexistent, I take shortcuts. I wash up in the sink instead of showering. I put a piece of salami between two pieces of bread and call it a meal. I put on clean pajamas and underwear instead of getting all the way dressed. I use mouthwash instead of brushing my teeth. I pet the cat instead of calling friends.

And I call it good enough.

Admittedly, those are some low standards for self-care. It would be nice if I could do more – and on some days I can. But on many days, the obstacles seem overwhelming. Inertia takes over and entropy sets in. I know it’s not good for me and can slow my recovery from spoon deficit spending, but that’s just the way depression is sometimes. It sucks you down into a hole that’s hard to climb out of when it’s at its worst.

But, thanks to the aforementioned meds and the minimal self-care I’m able to do, I know that one day I’ll be out of the hole and able to work on some proper self-care. Even plan for the next time that self-care seems impossible.

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.

 

When Trauma and Mental Illness Happen Together

Couples who experience serious trauma may go through the experience together, but they do not always stay together afterward. The death of a loved one, infidelity, the onset of a disease – many things can test a couple’s ability to cope with the event and with each other.

Serious mental illness can also be a relationship killer. Dealing with symptoms, treatments, medications, setbacks, hospitalization, mood swings, and just generally going off the rails is more of a task than many couples can handle.

Combine serious trauma and serious mental illness, though, and what you’ve got is a recipe for a new level of disaster.

One of the potential pitfalls is two people who grieve in different manners or on different timescales. One partner may feel it necessary to process events aloud and at length, while the other may prefer to process feelings internally, without conversation. One person may take a year to get over a death, while the other is still grieving after three or more.

Then there’s couple who have different agendas when it comes to whatever is troubling them both. One may feel that moving on is the best response to a traumatic event, while the other person can’t let go of the past.

Many relationships crack and break apart under the strain. And those are just for couples who don’t have mental disorders.

Now take an example (not completely at random) of a couple who have lost their home in a natural disaster. He suffers from depression. She has bipolar disorder. He grieves the loss of their home and all their belongings to a point that she considers excessive. She kicks into hypomania and focuses on the small details of their situation. He thinks she doesn’t grieve. She thinks he needs to help her address the future.

It will be easier for this couple to stay on track and stay together if they can talk about what has happened and what is happening. That may well involve talking with other people – a trusted friend, a professional counselor, even each other. But it’s important that both people feel that they are being listened to and, more importantly, being heard. And that’s not always something that the other partner can provide.

If the couple can talk to each other, their communication skills will be severely tested. Depressed people and those with bipolar disorder both tend to isolate in times of stress. Processing feelings may not be either person’s greatest strength. And those different timescales and differing agendas are likely to throw up roadblocks should they try to talk about it all.

Being aware that trauma and mental illness both have detrimental effects on a relationship may help. Although even previously strong relationships can be stressed to the breaking point, stepping outside oneself to try to understand the other person can be enlightening. Feelings that seem callous or stubborn or flippant or shallow can just be different ways of dealing with trauma. Thinking the way you feel is the only way to feel will severely impede healing.

If it sounds like I am trying to remind myself of all these things, well, I am. We lost our home in a tornado, and my husband and I were dealing with mental difficulties before that happened. I feel that I must be on alert now for any signs that our relationship is cracking. But it’s not just my problem. The disaster, and the mental disorders, and the relationship are things that we share. They have led to a tangle of emotions and reactions that aren’t predictable or rational or even helpful.

We know the basic things we need to do – take our meds, practice self-care (and help each other do so as well), talk when necessary and be alone when that is what’s needed. We have to keep our eyes on what’s important: our mental health and getting through these difficult times intact both personally and as a couple. And we need to see the humor where there is any. But this isn’t the ordinary sort of disagreement that lasts a day or a week. It’s something we’ll be working on long-term.

Wish us luck.

Emotional and Mental Work

I am weary to my bones and to my soul. As the spoonies say, I’m so out of spoons I can’t eat soup.
Physically, I haven’t done that much to wear myself out. A little light housecleaning. Running some errands. Answering emails and making phone calls. No heavy lifting, unless you count the time I had to help my husband push the washer back into place.
No, the heavy lifting I have been doing is emotional and mental. Make no mistake, that is work and it is exhausting. I am responding to a physical and emotional crisis that happened almost exactly a month ago. After the disaster (a tornado destroyed our house), my husband has done almost all of the physical heavy lifting.
The mental work is stuff that I’m easily capable of doing on a good day: dealing with bureaucracy, organizing the trivia of paperwork and daily life, paying bills, etc. Now, however, there is so much of it to deal with that I am falling behind. I haven’t kept up with sorting our receipts. I haven’t returned the phone call about the hole the cable guy made in the wall. I haven’t even listened to the voice mail about it. I haven’t responded to a friend’s request to look over an official letter she is writing.
The emotional work is entirely different. My husband is dealing with issues of grief, loss, and anger regarding the loss of our house and our possessions. Somewhere inside, I must be having similar feelings, but his are closer to the surface and he is able to express them more.
And I am having some difficulty dealing with this. First of all, angry men distress me, even if I’m not the object of their anger. It’s a throwback to other times and other relationships, a button that was pushed and has stayed mostly stuck in that position. Dan is doing his best to accommodate this quirk, trying to keep his voice down and his conversation rational when we speak of it. But I hear him when he is alone in his study, bellowing or wailing in emotional pain about something I do not fully understand.
My husband and I are operating from different places, with differing agendas, regarding the loss of our house and belongings. He invests his memories and emotions in things much more than I do. I look at what can be replaced and he looks at the irreplaceable – artifacts from his trips to Africa and Israel, for example. Those can’t even have a price put on them and there is no way to replace them. His grandfather’s diamond ring could be physically replaced, but not the sentimental value he attaches to it.
I do understand this, though not at the gut level he does. I do (or did) have possessions that meant a lot to me – a guitar, paintings a friend did, some carvings in semi-precious stones, some photos, of course (though some are stored on my computer, which survived). And I think the salvage company did a poor job of inventorying what they had to throw away and keeping what was small but important, letting us participate in the process. But my anger doesn’t extend to revenge fantasies.
All these feelings, both expressed and unresolved, are sapping my strength and my energy. I have gone back to my therapist for reminders of my coping mechanisms and validation on what I have been able to do – and to have a safe space to vent when all of this does begin to spill over.
And now I have decided to go back to work, on a reduced schedule at least. I don’t know if this is a good idea or a bad one, but it seems a necessary one. Perhaps it will provide a missing piece of familiarity in my life, something to anchor me. Perhaps a different kind of work will distract me from what I have been dealing with.
I know there’s still a lot of emotional and mental labor to do, but with help from my husband and my therapist, I believe I will get through it, especially if I pay some attention to self-care: taking my meds regularly, sleeping and eating regularly, taking breaks when I need them, taking comfort in our cats, and trying to eat the elephant one bite at a time.
This is one of the biggest elephants I can remember, though.

When Will My Breakdown Happen?

For those of you who follow this blog, this is another chapter in the saga of our experience with the Memorial Day tornado, which destroyed our house. My husband, who lives with depression, and I have been coping very well so far.

I saw my psychiatrist on Saturday. During the session, I mentioned that I hadn’t had a breakdown yet, but that I knew it was coming. “I hope not,” he replied.

Frankly, I think he’s being unrealistic. I keep saying it will come when we are settled in a living space, which we now are (a rental house) and when I don’t have to deal with insurance, housing, furniture, landlords, finances, utilities, and the thousand-and-one things that I’ve been in charge of dealing with. (Dan has been in charge of the more physical stuff, like salvage at our dearly lamented former house. He’s better at that and I’m better at working the phones and the computer.)

I think my brain will want to decompress with a crying jag and a couple of days in bed, at the very least. I plan to start work again next Monday, so it will likely happen during this next week. I know you can’t schedule these things, but I hope that’s the way it works out.

Dan is already at the ragged edge. He went back to work a couple of weeks ago, though physical health problems interfered with that somewhat. On Saturday he slept the whole day, having worked all night without sleep, owing to our moving out of the hotel and into the house in just a couple of hours. His emotions are also closer to the surface, too. He’s expressed anger at the salvage people and a need to cry when he sees what’s left of the house and our belongings.

Much as I dislike having breakdowns, or mini-melt-downs, or whatever you call them, I think sometimes they are both necessary and inevitable. When a bipolar brain gets too clogged up with the effort of coping during especially trying circumstances, it seems only natural that when the stress lets up even a little, that brain will need to let out all the feelings that have been suppressed while dealing with the crisis.

Bottling up your feelings is generally not a good idea, but sometimes you just have to in order to keep going. But like a shaken bottle of soda, the pressure builds up and there has to be a way to release it. The metaphoric bottle may simply explode, spraying shrapnel and its contents over everyone and everything within reach. This is not pretty, but it is understandable.

Keeping your feelings suppressed too long – putting them in a box and sitting on the lid – is not healthy, either. If you don’t allow yourself to feel the emotions and deal with them, they may fester and spring out of the box at the most inopportune time. Or you may turn off your emotions entirely and not be able to feel anything – including relief and satisfaction, in addition to the distress, anger, and/or despair that are in that box. A lot of us, including me, have done this for years in the course of our disorder. Feeling nothing but numbness can seem appealing if the alternative is chaos and pain.

So, in a way, I am hoping that I do have a bit of a breakdown, in a safe space where I can rage, weep, isolate, and grieve what we have lost. I don’t think I’ll be quite whole again until I have gone through the emotions that I’ve been putting off.

This week I’ve made an appointment with my psychotherapist, whom I stopped seeing about a year ago. I hope that she will be able to help me process the process, as it were. I think it’s definitely time for a “check-up from the neck up.” Maybe in her office, I will find that safe space and begin to feel the feelings that I know are hiding somewhere deep inside me.

 

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