Bipolar 2 From Inside and Out

Posts tagged ‘bipolar disorder’

Body and Brain: Self-Image

I’m fat. I admit it. I haven’t been fat all my life, so this came as something of a surprise to me, but I’m dealing with it. I don’t know whether it’s my eating habits or my medication or some genetic thing that has caused me to gain weight, but there you have it. It could be any or all of those.

I’m not trying extreme diets or grueling workouts, though I admit that some exercise would be good for my mental condition as well as my body. I’m living with and acknowledging the fact that I am fat.

The thing is, when I think about myself, I don’t think of myself as fat. Perhaps I’m in denial about it. But I do know how much I weigh and that it’s over what I should, according to all the height vs. weight and BMI Index charts. And I don’t think of myself as thin. I just feel as though I’m still in my 30s and weigh what I weighed then, despite my body’s very clear rejection of those notions. I know I’m really in my 60s and have trouble getting up off the floor if I fall, in part because of what I weigh.

I’ve heard that everyone gets stuck in their head at a certain age and always remains that same age in their mind. It’s not quite like having an inner child of four or ten (or in my case, more like 15). I used to think I didn’t have an inner child until I remembered how much I still love chocolate milk, plush animals, and naps. And I do have that inner teen that wants to make up for all the things I missed when I was a depressed teen, like mad crushes and experimenting with fingernail polish and fake nails. But having an inner weight is different somehow. It’s like my brain and my body are clashing in some way.

At least I don’t have Body Dysmorphic Disorder. That’s when you see tiny, imperceptible flaws in yourself and magnify them until you think that’s all people see when they look at you. Technically, it’s not the same as anorexia because, in anorexia, you focus only on your weight even if you are thin. Anorexia is an eating disorder that you have as a reaction to your flawed perception of your body size. Dysmorphic Disorder is more about smaller perceived flaws such as balding or the size of your nose. (The Mayo Clinic does say that Body Dysmorphic Disorder can cause or be associated with eating disorders, low self-esteem, mood disorders, obsessive-compulsive disorder, and substance abuse. The DSM-5 does not classify Body Dysmorphia as an eating disorder. It’s confusing.)

One of the dangers of Body Dysmorphic Disorder is overuse of plastic surgery, which can be somewhat of an addiction in itself. Just watch a few episodes of the TV series Botched and you’ll see what I mean. There are always horror stories like the one in which a young man wanted to look like Michael Jackson and as a result of repeated surgery suffered the same health problems and conditions that the singer did.

If I had Body Dysmorphic Disorder instead of the ones that I do have, I might be undergoing multiple treatments of liposuction, “cool sculpting,” tummy tucks, gastric bypass, extreme fad diets, weight-loss pills, and other procedures. I don’t and won’t. I’m aware that those are only temporary fixes and leave you open to disappointment, infection, scarring, and other bad effects and complications that can be worse than your original condition and stay with you for life.

So, where does that leave me? Besides fat, I mean. I try to be body-positive about people who don’t conform to societal messages about weight, including myself. It’s a difficult thing to get over. The messages are relentless. I have found myself in the past thinking that fat is unappealing and in the present thinking that extreme thinness is dangerous. But that’s only in the abstract. Any number of men I’ve been attracted to have been anywhere from pudgy to fat, including my husband.

I realize that I may get a lot of pushback from people telling me of all the medical reasons I should lose weight. I’m not saying they’re wrong. I’m just saying that if I’m comfortable with being fat, they could at least be okay with my fatness as well. In other words, I already struggle with my mind. I don’t want to struggle with my body too.

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Divisions in the Mental Health Community

It’s sad when communities that ought to work together for the betterment of all are divided by strife. But that’s just what has been happening in the world of mental health.

Even saying “mental health community” is controversial. There are different segments of the population who say that “mental illness” is the more accurate term. Then there are those who advocate for the term “brain illness” while advocating for adequate supports and services.

Indeed, what to advocate for is another discussion. Many people are trying to root out the stigma that goes with having a mental illness. Others say that’s a waste of time – that what is really needed is advocacy for improved treatments and more accessible services. There is, of course, the possibility that one could advocate for both, but the issue seems to be that the stop-the-stigma people are pulling focus away from those who campaign for social and political (and financial) reform. The situation seems complicated by the fact that many “It’s okay to have difficulties” promos actually promote online therapy businesses.

Then there are the different “what causes bipolar disorder?” schools of thought. For years we attributed it to a chemical imbalance – neurotransmitters such as norepinephrine, serotonin, and dopamine not performing their job properly. Now many people think it’s caused, or at least exacerbated, by something else – heredity and genetics, environmental and lifestyle issues, or some combination of them all. Treatment with psychotropic medications, which is the most common for bipolar, tends to lend credence to the neurotransmitter theory, although it’s generally accepted that we don’t have any real idea of how they work.

The drugs used to treat bipolar and other disorders such as schizophrenia are controversial too. Many people credit them with saving their lives. Some others describe them as “neurotoxins.” One typical Facebook post said, “They are powerful, toxic drugs which can cause a chemical lobotomy and terrible adverse effects such as akathisia, dyskinesia, Parkinson’s, dystonia, and many other tortuous, real effects. Many people are left on these drugs for life.” This is one of the milder posts reacting to psychotropic meds. Many also speak of withdrawal symptoms and lives ruined. They also state that Big Pharma is partly to blame: “The sale of psychiatric drugs will continue to increase and force will still be part and parcel of psychiatry….If we have hearts we will not expect psychiatry with all its terrible past of fear, force, and fraud to understand any human being or society!”

Treatment for various disorders, particularly schizophrenia, is widely debated as well. Some people are appalled by involuntary commitment or “forced hospitalization and drugging,” while others see it as a valid procedure for anosognosia (the inability to recognize that one has an illness), as this increases potential harm to self and others. “Assisted Outpatient Treatment” or AOT, a form of supervised drug administration for those who have been released from treatment facilities is gaining adherents. Lynn Nanos’s book Breakdown: A Clinician’s Experience in a Broken System of Emergency Psychiatry makes a strong argument for AOT.

In fact, psychiatry itself is a disputed issue, and not just by Scientologists who feel that all mental illnesses are caused by whatever it is that can supposedly be cured by their practices. (You can probably tell that I don’t give any credence to their beliefs.) But psychiatrist Dr. Thomas Szasz railed against psychiatry in books including Psychiatry: The Science of Lies and The Myth of Mental Illness. Here’s a quote from The Science of Lies:

Because there are no objective methods for detecting the presence or establishing the absence of mental diseases, and because psychiatric diagnoses are stigmatizing labels with the potential for causing far-reaching personal injury to the stigmatized person, the “mental patient’s” inability to prove his “psychiatric innocence” makes psychiatry one of the greatest dangers to liberty and responsibility in the modern world.

With divisions like these, it’s no wonder that mental illness diagnosis, treatment, and priorities are large contributors to the broken system in the United States. Is it a healthy debate? Are they irreconcilable differences? Is there something to be said on both sides? Does science back up any side or does passion prevail? And will any of these debates be resolved in the near future? I believe that until the community gets together on a lot of these issues, not much will get done that will truly help sufferers.

Why Can’t I Sleep? Why Can’t I Wake Up?

Image by fizkes

Often in the past, I went to bed at my usual time but woke up at 4:45 a.m. and couldn’t get back to sleep, no matter what. It was like I had a hamster on a wheel inside my brain.

Other nights I would go to bed early and couldn’t get to sleep for hours. I tried reading, but sometimes I read till 2:00 a.m. with no sleep in sight. (I know you’re not supposed to read when you want to get to sleep because it activates your brain, but it’s been my nighttime habit for decades. When I find that I am reading the same paragraph twice, I know it’s time to knock off and fire up the CPAP machine.)

Then again there are days when I feel the need to nap in the early afternoon. I try to resist, but if I give in, there are no refreshing catnaps for me. I’m down for two and a half hours typically. Then the whole sleep-wake cycle gets off course.

And when I’m in the middle of a depressive episode, I’ve been known to stay awake all night, obsessing and catastrophizing. There are also days I can’t get out of bed in the morning, or all day in some cases, though I don’t usually sleep well after them.

What is it with all the sleep disturbances? Well, I have bipolar 2, so that may have something to do with it. An article published by the National Institutes of Health (NIH) says, “Sleep disturbance is a core symptom of bipolar disorder. The diagnostic criteria indicate that during manic episodes there may be a reduced need for sleep and during episodes of depression, insomnia or hypersomnia can be experienced nearly every day.” They also note that insomnia and hypersomnia are early warning signs, or “prodromes,” of a bipolar episode occurring. In fact, sleep disturbance is the number one prodrome for mania, and is recognized by approximately 80% of those suffering from it as an indication of an impending episode.

Webmd discusses a number of ways that bipolar disorder is associated with poor sleep: either insomnia or hypersomnia (over-sleeping); decreased need for sleep; a circadian rhythm sleep disorder; REM sleep abnormalities which can affect dreaming; and co-ocurring sleep apnea (around a third of people with bipolar also have sleep apnea, which is associated with excessive daytime sleepiness and fatigue). Bipolar meds have also been known to affect sleep-wake patterns, as well as co-occurring substance abuse disorders.

What are the consequences? Sleep deprivation has demonstrated detrimental effects on cognitive functioning, particularly in teens and young adults. This has been observed in performing psychomotor vigilance tasks, working memory tasks, and cognitive processing tasks. No wonder a series of sleepless nights can result in a foggy or fuzzy-headed feeling!

Unfortunately, the advice given for how to counter the effects of sleep disturbance in bipolar disorder is almost indistinguishable from the advice given to the general population, such as incrementally moving bedtime and waking time until the desired period of sleep is reached; and not using electronics such as computers, cellphones, and TVs near bedtime. Some preventives that have worked with bipolar patients have included bright light therapy in the morning and the use at bedtime of supplements containing the naturally occurring hormone melatonin that the body releases in response to darkness.

My own experiences with sleep deprivation and bipolar disorder have been a mixed bag. For many years before I was diagnosed, I was subject to the difficulties caused by shift work, either third or second shift. (When I was on second shift, we sometimes extended our sleepless periods by playing cards or midnight miniature golf after the shift was over.) Third-shift work made me too tired to drive safely, especially if I was also working first shift the next day, which sometimes happened. My husband pitched in and picked me up on those days. My friends knew never to call me before noon.

For a while I took a prescribed sleep aid, but sometime during the last year realized that as my sleep-wake cycle was regulating to a more “normal” pattern, and that the sleep I got without the meds was more refreshing and conducive to clear thought in the morning. So I quit taking it, with the approval of my psychiatrist. Even though I work at home and make my own hours, my work schedule has become predictable as well. Now I wake around 6:00 or 7:00 a.m., check my emails and timeline, have some breakfast and start my work (when I have some). I break for lunch, then resume work in the early afternoon. (And pray I don’t get any more work that day, as sometimes happens.)

As for getting to sleep, it’s usually not a problem (except when it is). Any more, I take my nighttime meds, read for about 30 minutes, and drift off to sleep normally. I usually only need a nap if extra work requires that I stay up late in the evening or get up very early in the morning.

So, does “Sleep, that knits up the ravelled sleave of care,” as Shakespeare described it, exist for people with bipolar disorder? I’d say, not for everyone, but when it does, it’s always welcome. We all have our various sorts of “ravelled sleaves” that need tending to.

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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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Baby Steps Toward Healing

Once I attended a weekend photography workshop. One of my photos received praise as being innovative and interesting, one based on a technique I had seen a friend use. The rest of my photos missed the mark. I was frustrated by my lack of progress. The instructor reassured me, advising me that I should take (or was taking) “baby steps.” That photo provided a brief glimpse of what I could do if I kept at it.

My therapist has also reminded me of this numerous times. And she’s been right. Almost all the progress I’ve made in dealing with being bipolar has been gradual and incremental.

The baby steps process was long and arduous, lasting for years. The first step was taking Prozac, which helped me for a while, then didn’t. Most of the progress I’ve made with medication has been in tiny, discrete steps. My prescribing psychiatrists have never done anything quickly, which is in one way a blessing and in another a torment. They would try me on one drug, then wait to see the results, then try a different dose or a different drug altogether. Lather, rinse, repeat until progress at last occurred.

Progress in therapy has likewise been gradual over the years. First there were therapists who diagnosed me with depression, which was certainly true, though not the whole picture. And they helped, or at least a number of them did over the years. I learned a lot about depression in general and how it applied to me in particular. I also learned about relationships, and those insights helped my marriage.

Finally, I was given an accurate diagnosis of bipolar disorder 2 with anxiety. That was where the steps toward reaching some resolution regarding my medication really started. That was also when I started working with the therapist who reminded me about baby steps.

Although I had made steps toward healing in the past, I had taken a deep and protracted plunge into depression before I started going to her. Several years of it had left me immobilized, despairing. At my lowest point, I described myself as “pathetic.” There were going to be a lot of baby steps needed to get me out of that miserable place.

So we went to work. I liked the kind of therapy she practiced – non-directional, non-judgmental. (I had had problems with therapists who weren’t like that in the past. Needless to say, I made no progress with them. In fact, I even took steps backward.) There was a long way to go.

Dr. B. frequently reminded me of the importance of baby steps and, eventually, how far those steps had taken me. I learned coping mechanisms. I learned new ways of thinking. I learned to accept myself with the reality of my bipolar disorder, but without the constant misery. And, by the time my proper medications had kicked in, we were making some even bigger steps. But all my progress was built on a foundation of many, many baby steps along the way.

I think all therapy consists of a lot of little steps. I don’t know anyone who has had a great revelation that instantly moved them further along with their healing. I only got glimpses of what my situation could be like if I persisted. And along the way, I regressed at times, needing to re-learn the lessons I had been exposed to and re-taking the steps I had already accomplished. Progress is like that – two steps forward and one step back – especially with a disorder as cyclical as bipolar.

Anyway, I still go to therapy and still take baby steps toward whatever my future holds. I realize it will take a long time – probably the rest of my life – but I’m dedicated to the process.

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Self Image: Who Do I Think I Am?

Self-image is a problem shared by millions of people every day. Take women, for example. They are bombarded by relentless messages that they are too fat (or too thin); too plain; with inadequately full, shiny hair; or with un-perky, non-voluptuous breasts. (Men face messages too about their lack of muscles, excess paunch, thinning hair, or short stature – but nothing like the volume (in both senses) that women receive.)

Self-image is also a big problem for people – both women and men – who live with mental illness. It’s not always physical self-image. Sometimes we get messages about how we should think and feel from all the ads on TV and in magazines and on the internet that feature happy people interacting joyfully with their friends and families. The subliminal message is that if your life isn’t like that, the advertisers’ products will make it so that it is.

Of course, nowadays there are also ads that feature depressed or bipolar people, but they end the same way. Get online help or psychotropic meds and you’ll turn into one of those happy, joyful people living life to the fullest. For many of us, that’s not the way it is. There are treatment-resistant disorders, for example, and complex problems like OCD, PTSD, and schizophrenia that aren’t mentioned at all. (PTSD is sometimes addressed in the context of veterans helping one another, which is good, but the ads for this usually offer moral and financial support, rather than a more trauma-conscious solution.)

I’ve been through my own battles with self-image, and not all of them related to things I saw in the mirror. When I was a child, I endured bullying that made me feel unworthy and unable to fit in. As a teen, I saw myself as plain and unlovable. I even doubted my parents’ abundant love, thinking they loved me only because, as I was their daughter, they had to. Later, my self-image consisted of being a depressed person. That’s who I was and all I could see of myself.

When I was working, I saw myself as an imposter. I had a “respectable business lady disguise” that I could put on when desperately needed, but I knew it wasn’t accurate. Then, when I lost my job, I saw myself as a failure.

Still later, after my most severe breakdown, I defined myself as my husband’s “sick, crazy, crippled wife.” I know those are terms we’re not supposed to use, but that’s what my brain was telling me. (The “crippled” part was because I had mobility issues that necessitated two operations on my back, and thereafter used a cane.) I used it as an excuse not to go places, see people, or do things. Actually, my husband used it as an excuse too, though he didn’t phrase it that way. (Now he doesn’t.)

In short, my self-image was someone who was broken – and not “in the best way possible,” as Jenny Lawson says.

Years of therapy and medication have largely gotten me to the point where my negative self-images are no longer constantly haunting me. They still rear their ugly heads on occasion, but now they aren’t all-pervasive. My husband helps too. He says, based on photos, that I was cute when I was in high school and he would have dated me. (I still have my doubts about that.)

What I’m getting at is that a person’s self-image can and does change over time. I think I am more accurate now in thinking I am no longer cute, except maybe when I smile; still mobility-challenged but not so self-conscious about it; and, I would have to say, a “recovering” bipolar person.

We’re getting to the point where we don’t all or always think that what we see in the mirror reflects our worth or our true self. We’re learning not to believe our own or others’ negative messages about our appearance – though there is certainly still a long way to go.

What I’m not sure of is that we’re making much headway on redefining our self-images regarding our mental health or lack thereof. Despite all the positive affirmations we see and hear in so many memes and elsewhere, do they really sink in and change our thinking? Or is the only way to do that bound up in time, treatment, and the support of our family and friends? I’m just glad that it is possible to change, whatever the mechanism. My life is much more settled and happier now that I no longer see or define myself as I once did. That’s something I want to hang on to.

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Garden-Variety Jerks

I see a lot of questions of this kind: My neighbor/sister/friend does this [unpleasant behavior]. Is this caused by his/her bipolar disorder?

There certainly are behaviors of people with bipolar disorder that are unpleasant to those surrounding them. Not taking showers for a week when the person is depressed is one of them. Another, when the person is in the grip of mania, is having sex outside a relationship. Being unable to leave the house is a bipolar-related behavior. So is gambling away your savings. So is standing you up or ghosting you. And blaming themselves for everything. And taking on too many projects and finishing none of them. Talking too fast or too slowly.

Playing their music too loud or parking across your driveway is not a bipolar-related behavior. Neither is littering. Or insisting that you take the garbage out. Or yelling when they are angry. Or becoming huffy when you criticize them.

There are some behaviors that may or may not be bipolar-related – for example, talking about themselves too much. This could be an indication that the person is depressed and brooding (if the talk is about how worthless they are) or manic and aggrandizing (if the talk is about how great they are). Or it may just be that the person has low or high self-esteem that doesn’t rise to the level of pathology. Feeling that everyone is picking on them could go either way. So could taking offense at every little remark. It’s sometimes hard to tell, particularly if you’re not a psychologist.

It’s more than a little weird that people are willing to attribute all kinds of bad behavior to mental illness. But think of all the racist haters and killers that are assumed to be mentally ill. While some may be, it’s an automatic and often unwarranted assumption. It takes away from the attention that ought to be given to real mental disorders and it perpetuates the stigma associated with mental illness. Or it assumes that racism and hatred are mental illnesses. These are extreme cases, of course.

Sometimes bad behavior is not due to mental illness at all. Sometimes what you’re dealing with is a garden-variety jerk. To address the picture above, it’s not pathology to be messy and it’s not a sign of mental illness to be mad at a roommate for being messy.

There’s not a lot you can do if the behavior you object to is caused by mental illness. You may have to simply understand or let the annoyance go. The person may resent that you assume their behavior is a sign of mental illness, even if it is. And about all you can do in that case is help the person get help if you can.

When you’re dealing with a garden-variety jerk, there are other sorts of remedies you can apply. You can call the police on the neighbor with the loud stereo. You can ask the messy roommate to straighten up or leave. You can set boundaries of what you will and won’t put up with and enforce those boundaries firmly but fairly when they are violated.

Of course, there’s always the possibility that the person in question has a mental illness and is also a jerk. If you can figure out what to do in those cases, please let me know.

I’m not saying that mental illness should be an excuse for bad behavior or absolve a person of the consequences of their actions. I am saying that it’s easy to assume that all bad behavior is due to mental illness, just as much as it’s easy to assume that all bad behavior comes from being a jerk, or worse.

In a lot of cases, you simply have to live with it.

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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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Of All the Things I’ve Lost…

The quotation from Mark Twain goes, “Of all the things I have lost, I miss my mind the most.” It’s a little annoying, at the least, when people repeat it. Those of us with psychiatric diagnoses don’t actually lose our minds, but we do lose a lot of other things along the way.

Friends

I’ve certainly lost friends because of my bipolar disorder. I can think of two in particular who were very dear friends, but cut off all contact with me when I was at the depths of my depression and they feared I was suicidal. I reached out to them a few times and even sent them a copy of both my books, but got minimal response. I still miss them, though they now live in another state and it’s unlikely that we’ll ever see each other again, even in social settings we all used to frequent.

Jobs

Twice I lost jobs largely because of my bipolar disorder. The first time, I had been isolating a lot, keeping the door to my office closed and barely interacting with any of the other employees. While an open door wasn’t technically a requirement of the job, I was the only editor who habitually hid behind a closed one, and it wasn’t taken well. I’m afraid I got a reputation as being difficult and uncommunicative. Finally, after several incidents where my emotions ran away with me, I was let go.

The second time was at the job I had directly after that job ended. At first, I did all right in the department where I was assigned. Then my boss left and the department was disbanded. I was transferred to another editing group, and there my difficulties began. The people there misunderstood my attempts at humor. My boss didn’t understand bipolar disorder and when she asked, “What does that mean?” I was caught off-guard and made a brief, unhelpful remark to the effect of “Sometimes I have good days and sometimes I have bad days.” I could see her thinking, “What makes you different than anyone else?”

Finally, I was put on probation, the only time in my entire career when that ever happened to me. I decided to leave before they could fire me. Then I went into a period of hypomania about not having to work there anymore and starting a freelance career, which did not turn out as well as I had hoped.

Intellectual abilities

I know a lot of people worry that when they have a disorder such as bipolar, or even when they take medication for it, they will lose some of their brainpower. I never felt that way, but looking back I can see that the disorder also disordered my thinking. Moods of despair and exhilaration interfered with my cognitive functions. In addition to the general dulling of feelings during depression, I also lost the ability to concentrate enough to read, formerly one of my primary and best-loved activities. Even as I mourned the loss of my reading, I was simply unable to pick up a book and follow its contents. I took to watching mindless TV shows instead – really bad ones.

Enjoyment

Just as I no longer found joy in reading, I no longer found other activities enjoyable or interesting as well. I used to love cooking, especially with my husband, but when depressed, I could barely microwave a cup of mac-n-cheese. I loved good conversation with friends, but I barely talked to anyone and ignored friends’ overtures. I enormously enjoyed traveling, but couldn’t summon the energy even for a day trip.

Confidence

I used to be able to do all kinds of things by myself – attend business conventions (and science fiction conventions) and write articles for publication, for example. When I was suffering the most from bipolar disorder, I could do none of these things. When I went to conventions, I needed a bolt hole and spent as much time as I could in my room. At that point, I couldn’t write about my condition or even send emails to friends. One of my friends said, when I was considering ECT, “Write about it! That’s what you do!” But it wasn’t what I did anymore. Putting pen to paper – or words on a screen – was not even a possibility. I asked someone else if she would write about it instead.

Things I haven’t lost

Of course, most of these things came back to me once I was properly diagnosed and medicated. I now read every night, write my blogs every week, travel here and abroad, and make friends that I keep in touch with. I discovered that some of my friends had stuck by me, even when I was in the depths. I still can’t work in an office, but I have found work I can do from home. I enjoy travel again. And if I’m a little slower to get a joke or find a word, it doesn’t bother me so much. I know my brain is just fine, except for occasional glitches.

Losing all those things made me realize just how good my life is now that I am back to being myself. I have my mind back, if it was ever lost at all.

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Hypomanic, Anxious, and Overextended

My hypomania and my anxiety are fighting each other. Here’s what happened to start the quarrel.

There wasn’t much work for me over the holidays and into February. The transcription company that I freelance for didn’t have many assignments to give out, and, being part-time, I was low on the list to get them. Plus, one of the company’s biggest clients was leaving. And my husband and I got COVID, so it was impossible for him and difficult for me to work.

The job at the transcription company isn’t great. I make a few hundred dollars a month, which is a good supplement to my Social Security and my husband’s pay. I’m really a crappy typist, though, so it takes me longer to finish assignments than it does for most people. I work only four days a week, but it feels like full-time.

But, with the job likely to go away entirely, my anxiety was triggered. I figured it was time to look for a new part-time gig, maybe one that wouldn’t be as taxing.

I started my job search and eventually found a company that was hiring remote online tutors, which seemed perfect for me. My bipolar disorder makes it difficult for me to work in an office, especially in a 9-to-5 job. I’ve done it in the past, but don’t think I could anymore.

Then good news came – the transcription job wasn’t going away after all. A new client had signed on (though the work hasn’t started to come in yet, so I have no idea what the pattern of assignments will be).

I didn’t want to give up on the tutoring job. (I haven’t started yet, as they are still processing my paperwork.) I figured I might be able to do both, tutoring on the three days per week that I wasn’t transcribing, or in the mornings between assignments. The tutoring gig requires only five hours per week, though you can take on more.

Then I got a lead on a job editing, which is my real love when it comes to work. And I began to wonder whether I could do that in addition to both the tutoring job and the typing job.

Of course, that’s hypomania talking. I don’t get hypomania very often and when I do, I have a hard time recognizing it. My husband sometimes notices it before I do and gently reminds me when he sees me starting to go overboard. “You’d be awfully busy,” he said, looking dubious. It made me stop and think. For one thing, it made me think that it might not have been a good idea to buy the new computer that the tutoring job would require. For another, my time off with him is precious, and I wouldn’t like losing that.

The typing job is supposed to get rolling again, but I like it the least, as it isn’t a good use of my real skill set. But I’ve been doing it for several years now, so I’m kind of used to it. The prospect of having no extra money coming in scares me, though, enough that I am really considering getting that second part-time job. That’s my anxiety talking as well as my hypomania.

Realistically, I ought to just stay with the job I have and hope that the new client works out. Now that that is a possibility, maybe I should give up the idea of more work. But the uncertainty that I’ve recently experienced tells me that I ought to have another way to jump, just in case.

Which will win – my anxiety, my hypomania, or my husband’s common sense? I really want that editing job . . . .

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