Bipolar 2 From Inside and Out

Posts tagged ‘bipolar disorder’

Lethargy Strikes

There are a hundred things I should be doing right now, but I keep putting them off. I need to gather up some financial documents, sort the laundry, pay bills, reorganize the pantry shelves, get my flu shot, and call in some prescriptions. Of those, the only one I’m likely to do is call the pharmacy.

I should even have written this blog post, or at least started it, a couple of days ago. There are a number of steps I still have to take before I publish it on Sunday. (It’s late Friday afternoon right now, while I’m trying to write.)

For several weeks now, I’ve been consumed by this overwhelming lethargy. I’ve been spending most of the days in the comfy chair, barely watching some asinine TV shows and occasionally read a chapter in a book I’d been looking forward to. I pet the cat. I have a bagel for lunch. I field dozens of spam calls.

I was like this when I had a severe depressive episode, so maybe I’m having another one now. But I’m not having the fits of crying and the total immobilization, so maybe not. My memory is bad. I have to keep track of all the doctors’ appointments for both my husband and me. I postpone paying the bills and sometimes forget which ones I’ve paid already.

Maybe it’s the physical pain or the meds for it, or the fact that I have to stop taking them Monday so I can drive Dan to his surgery a week from Tuesday. All I know is that I feel beat down.

Maybe it’s the fact that I’m coming up on a major birthday pretty soon. I feel old and tired, and the lethargy doesn’t help. Maybe it’s the rapidly approaching holiday season, not that I pay it much attention anyway.

At least insomnia isn’t a problem anymore. I’m getting to bed between 9:00 and midnight and waking up somewhere between 5:30 and 7:30. Sometimes I even get in a brief nap.

Mostly, though, I think I’m lonely. I don’t have any paying projects right now to distract me. When he’s not at work, my husband is consumed by yard work and outdoor projects. He usually gets home from work late, so we have an hour or two before bedtime. We usually watch a little TV and then go to bed. Lather, rinse, repeat.

Oh, I have Facebook friends and sometimes message with friends, but for the most part, I’m isolated most of the day. I do have my two blogs, but most of the time I feel like I’m tossing messages in bottles out into the ocean.

All the websites I checked said the same things and recommended the things I already know. Get good sleep. Reduce screen time. Exercise. Stay hydrated. Check B-12.

Last night I talked to my husband about my loneliness, and this morning he sat beside me, and we talked instead of him rushing out to do yard work. Then we were interrupted by an emergency family phone call. I had to rouse myself for that, to make numerous phone calls and initiate Messenger chats. Now we’re all waiting for something to happen. So I finished my blog posts and checked out the money situation. My nerves are keeping me active.

So maybe that’s the solution. Deal with emergencies. Collapse later.

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Having Pets and Service Animals

I’ve had cats for a little longer than I’ve been married. That’s more than 40 years. I’ve also had bipolar disorder 2 at least that long.

For me, the two go together. My cats give me things that help me through my difficulties—companionship, amusement, distraction, fascination, and, yes, even love. (I know cats are rumored to be aloof, but mine have been very affectionate. Maybe that’s just the kind of cat I bond with.)

I love it when they purr, of course, and when they nestle on my lap, but I also find it soothing to watch them wash themselves. I especially love it when they trust me enough to roll on their back, show their belly, and accept a belly rub.

I also know the difficulties. When you can’t even get out of bed, when you can’t make yourself eat, when you can’t take care of yourself, it’s hard to take care of another being. Even the very basics—feeding and watering, cleaning the litter box, or in the case of dogs, walking them—seem like just too much. You don’t want to bring an animal into that environment.

On the other hand, tending to the needs of another being can provide a reason to get out of bed, to keep moving. I have even heard of people who say that not wanting to abandon a pet has kept them alive.

But then, there’s the inevitable parting. It can rip your heart apart. You can grieve for weeks or more. You will swear you’ll never get another pet, but one day you do.

Dogs and cats are the most common companion animals, but birds and fish, rabbits, pot-bellied pigs, and even Guinea pigs and hamsters are good choices. Cats and dogs are the most demonstrative, but all pets need care.

There are also animals that can live with you and provide special support for you. These support or service animals can meet your needs for companionship and more. There are different types of these animals, with different functions and different requirements.

Emotional Support Animals

  • An ESA can be any pet that has a positive effect on your emotional state, such as calming you down when you’re anxious or agitated. Dogs and cats are the most common ESAs.
  • The Fair Housing Act requires landlords to allow ESAs even in pet-free buildings, and they are not allowed to charge extra for having the animal.
  • Landlords, however, may require a letter from a psychiatrist or doctor stating that you need an ESA.
  • ESAs do not require any training or certification.
  • ESAs are not allowed in businesses or restaurants that have a “No Pets” sign.
  • ESAs must fly as pets in airplanes, which usually means in the cargo hold.

ADA Regulations for Service Animals

  • A service animal is any breed or size of dog that is trained to perform a task directly related to a person’s disability.
  • They’re not required to be certified or go through a professional training program. The training can be provided by the owner.
  • They’re not required to wear a vest or other ID that identifies them as a service dog.
  • Many communities maintain a voluntary registry that serves a public purpose, for example, to ensure that emergency staff know to look for service animals during an emergency evacuation process. Some offer a benefit, such as a reduced dog license fee, for individuals who register their service animals. Registries for purposes like this are permitted under the ADA. An entity may not, however, require that a dog be registered as a service animal as a condition of being permitted in public places. This would be a violation of the ADA.
  • Examples of services that a service dog may perform include, but are not limited to: retrieving objects for a person in a wheelchair; reminding a person with depression to take their medication; alerting a person with PTSD of an oncoming panic attack; detecting the onset of a seizure in a person with epilepsy and making sure the person remains safe during the seizure.
  • Service animals are allowed to go with their person into restaurants and businesses, even ones that do not allow pets.
  • The only questions a business owner may ask are whether the dog is a service animal required because of a disability, and what work or task the dog has been trained to perform. They cannot ask what your disability is.
  • A business can ask that a service animal be removed if the dog is not housebroken or is out of control and the person cannot get the dog under control.
  • The Fair Housing Act, the Air Carrier Access Act, and the Equal Employment Opportunity Commission, not the ADA, cover service animals in those situations.
  • State and local laws may require service dogs to be licensed and vaccinated, if all dogs are required to be licensed and vaccinated.

Psychiatric Service Animals

  • Psychiatric Service Animals are a type of service animal covered by the ADA and the above regulations.
  • People with the following conditions may have Psychiatric Service Dogs: anxiety and panic attacks, clinical depression, phobias, bipolar disorder, ADHD, OCD, PTSD, schizophrenia, or autism.
  • Some tasks a Psychiatric Service Dog may be trained to perform include: interrupting repetitive or self-harming behaviors; reminding the person to take prescribed medication; creating a physical buffer or “space” in crowded areas; or waking the person from night terrors.
  • To get permission to own a Psychiatric Service Dog, under the Fair Housing Act, landlords may request a letter from a licensed healthcare provider verifying the disability-related need for the assistance animal.
  • Psychiatric Service Dogs need to be trained to perform tasks related to the person’s psychiatric disabilities.

Many places online provide training, registration, or certification for service animals, but these are not required under the ADA. Persons with disabilities have the right to train their own service animal. Vests, badges, or other identifying harnesses or markings that identify the dog as a service animal are not required.

You should be very cautious about an organization that provides training for service dogs. They are not required, as you may train the animal yourself. But they may prove helpful in training your animal. It’s up to you.

No one should order a service animal vest over the internet and use it with an untrained pet just to get them into places where only legitimate service animals are allowed. ESAs DO NOT qualify for this accommodation under the ADA. It also weakens people’s respect for ADA-approved service animals.

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To Sleep, Perchance to Sleep

Sleep is tricky when you’re bipolar. Depression equals too much; mania, not enough. There seems to be no Goldilocks zone.

I’ve been bouncing back and forth between oversleeping and not sleeping enough. Some nights, I lie awake until 3:00. Other nights, I go to sleep at midnight, but wake at 3:00, unable to get back to sleep. No matter which pattern starts the day, I invariably fall asleep while talking to my husband or watching TV, not even aware that I’m doing so. (We call these “kitten naps” instead of “cat naps” because my husband says I look like a kitten falling asleep, my head getting lower and lower until I fall on my face and am more or less sound asleep.)

I don’t know for sure what is causing my broken sleeping patterns, but I have a few suspects.

Meds. My psychiatrist has prescribed me a sleeping pill. It used to be a script for 30 at a time, so I could take one every night. Now I only get 15 per refill, so I can, technically, take them only every other night. The problem is that I don’t know on any given night which sort of night it will be: One when I fall asleep naturally and wake up in the middle of the night, or one when I can’t fall asleep and take kitten naps all day.

If I could predict, I could take a sleeping pill on the nights when I can’t get to sleep at all. But taking one after I’ve been asleep for a few hours doesn’t seem like a good solution, especially since I can’t take one every night.

My not-very-good solution has been to put one sleeping pill into every other day’s section of my pill caddy, never knowing which sort of night I will have. The sleeping pills don’t appear to have any effect at all on these odd sleep patterns, however.

Stress. Stress is another likely culprit. Things have been coming down hard and heavy lately. My husband has cataract surgery tomorrow morning, and that same afternoon I have Wound Care Clinic for a lesion on my heel. Dan needs me to drive him home from the surgery and both to and from the next day for his follow-up. I have an appointment that afternoon with Dr. G., my p-doc, so at least we can have a chat about my sleeping patterns and my meds.

Schedules. I work at home, but Dan has a regular job. I say regular, but I only mean 40 hours per week. How those 40 hours are divided up is crazy. Some days he goes in at 10:00 or 11:00 and gets home at a reasonable hour to have dinner together. Other days he works from 1:30 to 10:00, which means we’re both dead tired when he gets home. These schedules are not conducive to any kind of relaxing time together. When we’re awake at the same time, we usually have to talk about household business matters rather than anything we could bond over. Our meal schedules are irregular too, which can’t be helping my circadian rhythm. His days off are Monday and Tuesday, which is why all our appointments and errands are clustered there.

Pain. That lesion on my heel is a result of edema and a blister that burst. Right now it is the size of a quarter and looks like raw meat. I am told that it used to look worse and be bigger. Either way, it hurts when I have to walk on it, which is every day. I can only take Tylenol for it. I do have some stronger pain pills, but I can’t take them because I’ll have to drive Dan home from his surgery, and the drug takes five or six days to clear my system.

What to Do?

Dan’s work schedule is a given. There’s nothing to be done about it. The medical problems won’t back off for a while, as Dan has another eye that also needs to be operated on, with all the pre-surg and post-surg stuff lasting until just before Thanksgiving. My wound is healing, but very slowly, as I have to walk on that heel or use a wheelchair, so Wound Care Clinic will also continue for I don’t know how long. And who knows whether Dr. G can do anything for my screwed-up sleep patterns?

All I can figure is to keep going as we are until something lets up. We’ll manage somehow. We always do, together.

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My Guest Spot on a Mental Health Podcast

TW: Self-harm

Recently, mental health educator Ilona Poka asked if I would be interested in appearing on her podcast, Real Human Moments, to have a conversation on a topic that would reveal something about a personal struggle I had and wanted to explore in a way that might be helpful to others, or at least resonate with them.

Instantly, I said I would choose the topic of self-harm if Ilona thought that would fit in with the series. She said it would. The podcast will debut on Friday, Oct. 9, at 9:00 a.m. on YouTube and Spotify.

I’ve written about the subject of self-harm in this blog in the past, a decade or more ago. I figured it was time to revisit the subject and share my experiences with an audience who hadn’t seen those posts. For those people, here are some things I said that don’t duplicate what I said in the podcast:

The name does keep changing. The last I heard, the “approved” psychiatric term was “Non-Suicidal Self-Injury” (NSSI). Self-mutilation, deliberate self-harm, non-fatal self-harm, self-destructive acts, self-inflicted violence, parasuicide, and self-wounding are all names for the dangerous practice performed by desperate people. The subject still isn’t talked about much and carries a huge stigma. As if the mental and physical scars were not enough.

Some facts: Self-harm is not attempted suicide, though with some miscalculation it can lead to serious permanent injury or death. Most people associate it with teenage girls, but I’ve know at least one man in his 50s who cut himself fairly regularly. It is not a matter of attention-seeking, since most cutters hide their physical wounds.

As I understand it, the practice results from one of two phenomena: the build-up of painful pressure such as perfectionism, or a feeling of severe alienation to the point of numbness. Cutting is a coping mechanism, though a dangerous, dysfunctional, and unsuccessful one, to deal with pain.

Cutting isn’t going away if we ignore it. It won’t go away even if we do talk about it. (Or mock it, or gasp in horror.) But understanding self-injury is a big step.

Self-harm is basically a private thing – something we do and hide from the world. Some people are able to hide it even from their most intimate family and loved ones.

As most cutters and other people who self-harm do, I feel shame in recalling the act, and almost never speak of it. The reason I’m sharing the story in such a public forum is to let people know that not all self-harm consists of big dramatic gestures. It can start with a tiny scratch. But it is not something to be ignored. We need to talk about self-harm, educate about it, bring it out in the open, and let others know that it doesn’t have to continue.

And here are some resources for people who self-harm and the people who care about them.

S.A.F.E. alternatives https://selfinjury.com/

Self-Injury Outreach and Support: http://www.sioutreach.org (This does not appear to be active anymore, but there is a resource/FAQ sheet still available, and they recommend the book by Kim Gratz & Alexander Chapman. Freedom from self-harm: Overcoming self-injury with skills from DBT and other treatments. 2009, New Harbinger Publications. It is still available on Amazon.)

988 Crisis Hotline

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What’s Serotonin Syndrome? And How Do I Avoid It?

This week, I sent my husband to the pharmacy to pick up a prescription for me. The pharmacist told him to call me and put us all on the phone together. The prescription was for tramadol, a pain pill that I needed for a foot injury.

What the pharmacist wanted to know was whether I was aware of the possibility of serotonin syndrome. Of course, I said I was. At least I thought I was. After all, I had been on SSRIs for literally decades, and I’d heard the term before.

The pharmacist filled my scrip and included an informational leaflet on serotonin syndrome. I read it over, and that’s when I realized how little I really knew about the condition. But the thought occurred to me that it must be a fairly common thing, since they had leaflets about it on hand. (I found out it’s considered rare to uncommon, but handing out information seems wise nonetheless.)

I guess it shouldn’t have surprised me that a rare illness provokes such concern, given the number of people who take SSRIs—26 to 30 million in the US. There are approximately 4.5 million who take tramadol. I couldn’t find stats on how many people take both. Tramadol is a mild opioid that also affects serotonin receptors, so it is likely to amplify the effects of SSRIs.

And there’s the problem. The combination of the two drugs, or SSRIs and other drugs, can have the effect of increasing your serotonin without your realizing it.

In addition to reading the information sheet, which name-dropped tramadol as a particularly dangerous pairing with SSRIs, I decided to look it up online as well. I’m pretty particular about what online sources I use. (I use Wikipedia only to look up people’s bios, and I rely on sites like Mayo Clinic and Harvard Health for medical info.)

Too much serotonin causes serotonin syndrome. The effects of the increased dose include both physical and mental symptoms, from the mild (shivering and mild tremors) to the serious (coma and even death). Body temperature can become dangerously high. Cedars-Sinai lists possible effects as:

Seizures

Tremors

Muscle twitching or jerking

Restlessness or agitation

Sweating, nausea, vomiting, or diarrhea

Dilated pupils

Confusion

Rapid heart rate or blood pressure changes

High fever

I am pleased to report that I haven’t experienced any of the symptoms of serotonin syndrome (though some, like confusion and shivering, might be hard to spot in my case. I get confused easily when I’m trying to write and have to stop to take a phone call, and I always feel cold.) I am also pleased to report that I am weaning off the tramadol, taking one-half twice or three times a day rather than a whole one four times per day.

Still, just because I haven’t suffered much, if any, ill effects from the combination of tramadol and serotonin is no reason to take the chance of serotonin syndrome lightly. Other high-risk combinations with SSRIs include other SSRIs, MAOI inhibitors, some opioids, migraine meds, OTC cough medicine that contains dextromethorphan, St. John’s wort, some antibiotics or anti-nausea meds, and stimulants. A health care professional or pharmacist can explain these interactions in more detail.

Anyway, I’m not bashing SSRIs, as so many people are these days. They have saved my life and done the same for countless others. Are they overprescribed? Almost certainly, but so are antibiotics.

What I’m saying is to know the real dangers, educate yourself about them, and be careful.

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Bipolar Creativity

Does bipolar disorder enhance creativity or hinder it? That’s the question, and it’s one I want the answer to as much as anyone. After all, I am a writer, blogger, and editor. (And if you don’t think being an editor is creative, you’re probably thinking of a proofreader. I’m one of those, too.)

BP Hope magazine recently published a series of articles on the topic. In one, writer Francisco X. Stork wanted to say to a mother who reported that her son refused to take his bipolar meds, fearing that they would stifle his creativity, “If her son truly has bipolar disorder, then whatever he thinks he’s doing while in its grip is not art.”

That’s harsh, but I have an inkling of where he was coming from. Stork says that what he wrote under the influence of mania and even hypomania was “gibberish.” He points to his four published, well-received novels as being products of his creative powers while medicated properly for his bipolar disorder.

I think the operative words there are “medicated properly.” Stork adds, “Does medication affect my work? Yes. But not nearly as much as the unfettered symptoms of bipolar disorder do.”

I’m not saying that medication is necessary in order to be creative. There are no doubt and no doubt have been many creative people who were unmedicated or improperly medicated. Most of them we don’t know about because they lived before bipolar was a diagnosis or proper medication existed.

Stork’s opinions bear out my own experience. I write two blog posts of around 500-800 words each, almost every week since 12 1/2 years ago. I’ve been told by others and seen for myself that when depression or hypomania creeps up and attacks me, I lose not the overall ability to write, but the ability to write well. When I’m depressed, I write depressing things or have a hard time writing at all. I usually force myself to do it, but it’s certainly not my best writing. And when I’m hypomanic, I’ve been told (and believe) that my writing is unfocused, rambling, and/or poorly structured.

BP Hope ran another article by Donna Jackel. The key takeaways included these:

  • Mild hypomanic traits, like extra energy and fast thinking, may boost creativity, while severe symptoms can hurt it.
  • Mania may spark ideas, but mood stability can make it easier to focus and follow through.
  • Treatment doesn’t mean losing creativity, and stopping medication to protect it can carry serious risks.

Those points, I feel, are important. Jackel reports that “A review pooling 13 studies and nearly 1,900 people found a real, but very small, connection between bipolar disorder and creative-thinking scores — one that showed up mainly when people were feeling stable or had mild symptoms, and disappeared during depressive episodes. Mood state, in other words, may matter just as much as the diagnosis itself.”

Kay Redfield Jamison has also addressed the question in her many books. One question she has asked is “Does hypomania cause creativity, or do the two simply run in parallel?” And one answer may come from Sheri L. Johnson, PhD, a psychology professor at UC Berkeley, who studied people who self-identified as highly creative and living with bipolar disorder, and found that “More than half the participants described unique states of creative thinking that benefitted their work.” More than half also “considered creativity central to their identity.” She hopes that these findings will help reduce the stigma surrounding bipolar disorder and other mental illnesses.

The links between bipolar and creativity are complex. Other research has shown that “People with stronger hypomanic traits came up with more ideas overall, but when judges rated how good those ideas actually were, they scored lower on average….A flood of ideas during hypomania, in other words, isn’t the same as a flood of good ones.”

Painter Missy Douglas recommends performing other creativity-related tasks while manic or hypomanic, such as running errands and preparing her materials. “I come up with a lot of complex, involved ideas for new projects in the studio during these times, but bringing them to fruition doesn’t normally happen until I’ve calmed down, if ever,” she adds.

Creative activities can help mitigate bipolar symptoms, however. Art therapy that includes sketching, painting, and even ceramics and making collages is a way to experience emotional release. Writing and journaling are good for mood management. Other people find music and movement good as coping tools, or use expressive dance for emotional regulation.

All in all, bipolar disorder may not be good for creating art, but creating art can be good for bipolar disorder.

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Living With a Bipolar Family Member

Let’s start with this: A bipolar family is like any other family. They have good times and bad. They live with each other; they fight with each other; they care about one another. They deal with each other’s differences and problems. But they have the added stressor that one or more members of the family have bipolar disorder.

What does this mean for a family? It does mean that there are likely to be difficulties that other families don’t face. Depending on how severe the disorder is, whether the family supports their relative in getting treatment, and the resources available to them, their lives will look quite different.

My Family

My family was unprepared for me to develop bipolar disorder. They knew that I was different, and often didn’t know what to do with me, particularly when I went into depressive episodes and retreated from the world, crying hopelessly. I remember this happening in seventh grade in particular. I had been publicly humiliated at a birthday party and spent days curled up in a bean bag chair, sobbing uncontrollably. My parents knew that something was very wrong.

Nothing happened for quite a while. When I was in high school, my behavior had gotten so off-kilter that it was recommended I go see the district psychologist. My parents left the choice up to me, and I didn’t go, for reasons that now seem completely ridiculous. I should have taken the opportunity.

Later still, when I was diagnosed and medicated with Prozac, my family was encouraging, but had some issues. My mother, who got a lot of her information from TV talk shows, said she had heard that Prozac was a “ticking time bomb.” My father had no objection to my therapy as long as he didn’t have to go (which no one had ever mentioned). But they continued to give me love and emotional support throughout, though they never really understood my condition or what I was going through. I don’t think they ever did, but they never gave up on me.

Other Families

I think it’s vitally important for family members of someone with bipolar disorder to learn all they can about the disorder. This will require bravery and openness on their part. But learning all you can about bipolar disorder will help you help your family member in the best possible way.

Of course, the kind of support a person with bipolar needs will differ greatly depending on how severe their symptoms and their disorder are. If they are subject to mild to moderate depressive phases, don’t try to “cheer them up.” It won’t work. Instead, talk therapy and/or medication, or, if they’re in a more severe depressive phase, an alternative therapy like TMS or ECT may be called for. Hospitalization is definitely an option if the family member has suicidal ideation.

If they’re in a manic phase, don’t just tell them to “calm down.” That won’t work either. Instead, help them be more grounded and keep potentially harmful behaviors in check. How you do this will vary depending on how their mania manifests. If they are given to reckless driving, for example, you keep the car keys and drive them where they need to go. If they’re an overspender, keep the credit cards and PIN numbers out of reach.

Help your bipolar family member in specific ways. Encourage them to seek therapy. If needed, drive them to their therapist appointments. Pick up refills of their medications for them. Get them a pill caddy to make it easier to take their medications as prescribed.

If your family member is experiencing delusions or psychosis, don’t argue with them about hallucinations, which are very real to them. They may also be suffering from anosognosia, which means they don’t even recognize that they are ill. You may have to intervene more directly, whether that means taking them to the emergency room or admitting them to a psychiatric facility. Do all you can while keeping yourself and the rest of your family members safe. If you or your loved one is in immediate danger, don’t wait—take action!

Kinds of Support

It may seem that you are taking agency away from your family member, and that is to some extent true. But until they’re more stable and able to demonstrate agency over their own condition, helping them negotiate the practicalities of their illness is likely the best thing you can do. You can’t change your family member’s disorder or change them; in most cases, all you can do is support them.

Remember there’s help available. In addition to your local or county National Alliance on Mental Illness (NAMI) chapter, you can get in touch with Depression & Bipolar Support Alliance (DBSA), the Bipolar Caregivers website, or bphope.com, which has online support groups. That last link will take you to a page that lists other organizations and resources that may be available to help you.

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Wealth and Mental Health

It’s becoming more and more apparent that your socioeconomic status has a significant effect on your mental health. This is not to say that money buys happiness. It does mean that wealthy people can have mental health conditions related to their abundant resources, and that people who have mental disturbances often find their suffering to be greater if they are poor.

Little to No Money

It only makes sense that having severely limited funds can take a toll on a person. Finding money for rent, medical bills, childcare, retirement, or other recurring or one-time expenses can increase your worry and seriously affect emotional well-being. Financial hardship and mental distress often reinforce each other. These difficulties can be difficult—or even impossible—to escape.

But dealing with the problems of inadequate money can strengthen connections among family members and close friends. Shared hardships foster shared sacrifice, as well as negotiation and compromise skills. People with little money must work through problems and conflicts because they have few alternatives. This process can be distressing, but it also fosters trust, resilience, and intimacy. The Harvard Study of Adult Development has found that strong social bonds predict long, happy lives better than intelligence, genetics, or money.

Perhaps surprisingly, socioeconomic difficulties may also lead to alterations in the brain, particularly in children. This link seems to run through parts of the brain that keep a person awake and alert. The circuits change in children who get less sleep, face more stress, or spend lots of time on social media. All of these factors increase with lower economic, educational, and social opportunities. It’s been noted that preteens who grow up in areas with fewer monetary resources and less social support particularly show brain differences that are measurable on MRI scans. Researchers have voiced surprise at how strongly socioeconomic opportunity correlates with brain differences. Studies that link cognitive performance to brain differences without taking socioeconomics into account “may require reevaluation,” according to experts. “We need to find out how socioeconomics is becoming biologically embedded.”

Lots of Money

Many Americans believe that more money would improve their mental health. That can be true some of the time. Money can alleviate many of the problems that people on lower socioeconomic levels face. The wealthy don’t worry about where rent and food money will come from, how to get a job, or how to get to their job. They don’t have the problem of even a relatively minor illness or injury plunging them deep into medical debt.

When problems do arise, notes psychologist David H. Rosmarin of Harvard, the well-off assume that they can make problems (he gives as examples a son’s gambling losses or a daughter’s extreme depression) disappear via the application of money. “Parents with less resources would have no choice but to quickly confront the painful realities their children were facing,” Rosmarin observes.

Money can resolve most of those problems, providing stability and freedom. However, the ultra-wealthy can find themselves lacking hardship-developed strengths and descend into family conflict and emotional disconnection. Their relationships rely on control and expectations rather than shared bonding experiences.

Though they may have family, friends, coworkers, and even servants around them, the wealthy can easily feel isolated and alone. And loneliness has been shown to increase the risk of health problems such as cardiovascular disease, stroke, depression, and early death by roughly 30%, despite wealthy people’s broader access to top-quality health care.

My Experience

I grew up in a middle-class family, and local schools were among the best in the area. It seems that socioeconomic factors didn’t contribute much to the brain illness I began to develop as a child. The only time I experienced distress at a lack of money was when I was told that there wasn’t much money for higher education and that I should go to a community college. (I reacted to this with tears and distress at first, then applied for good schools and scholarships. Eventually, I went to an Ivy League school with multiple financial supports.)

When my husband and I got married, we were both out of work and on food stamps (as they were known back then). Later, we both got jobs that had good salaries attached to them. Rather than experiencing loneliness and disconnection, we had already built a basis of cooperation and negotiation as we worked through the hard times. We enjoyed each other and our families’ and friends’ love and support throughout. When we began to get ahead in our finances, we traveled, but felt the strain of not seeing each other often enough when we were home because of long hours working. All through this period, though, in bad times and good, I suffered from bipolar disorder. Money seemed to make little difference in that.

Now that I’m mentally more stable, I find that I am able to deal more effectively with financial crises, which, given the economy, arise fairly regularly. I do experience severe anxiety and worry at times, but have so far been able to work my way through them.

I’m not denying what the researchers say about brain differences in children from lower socioeconomic levels or that the wealthy have different sorts of emotional problems. But being aware of the possibilities of such problems and getting mental health assistance when necessary can make the difference between a distressed situation, whether well-funded or not, and a tolerable one.

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Having Both a Child and a Mental Illness

The New York Times recently ran an article by Christina Caron saying that scientists have begun “to study how adults with challenging health conditions weigh parenthood.” Readers of the Times reported that “they were worried about the possibility of passing along mental illness to a child or maintaining their own well-being under the stresses of raising a family.” In one study, people who said they had poor mental health also said that they were less inclined to have children.

Here’s how this has played out in my life.

When I got married, I was in my 20s. My husband wanted children, and I figured if I had a baby, I should have it before I turned 30. Later on, I moved up that timetable. My father was terminally ill, and I thought it would be a good thing if he could see his grandchild before he died.

That was before I was diagnosed with bipolar disorder. After that, I began questioning the wisdom of having a child. My husband, Dan, not to mention his mother, still wanted one, and this became a point of contention. Dan felt the lost potential of a child for many years. When the recession hit, we didn’t have the money to have a child. (We could barely keep up with our own and our cats’ needs for food and health care.)

When my major depressive episode hit, it became apparent to me, at least, that I should not become a parent. I wasn’t able to cope well with my regular, child-free life. How could I possibly cope with the demands of being a mother? Would it be fair to be a mother who was so depressed she couldn’t care for a child properly? Would it be fair to Dan to ask him to do the majority of the many tasks associated with a child?

Even after I pulled out of that depression, I knew there was no guarantee that it wouldn’t happen again. I gave up on the idea of becoming a mother.

Why does mental illness prevent many people from considering parenthood?

There’s the problem of genetics. We know that anxiety and depression, as well as schizophrenia and other brain illnesses, run in families, leaving potential parents to worry that their child might have those diagnoses, too. If I had a child, would I be setting them up for a lifetime of mood swings and medication? Once Dan started on antidepressants, too, after an alarming spell of depression, passing along our disorders seemed even more possible.

Another question is about physical as well as mental health during pregnancy. Once I was diagnosed, I was put on a revolving regimen of multiple psychotropic drugs. Would it even be safe to take them while pregnant? Would they harm the fetus? Cause problems like too-high blood pressure for me? Make the chance of a miscarriage more likely?

And if I stopped taking the meds while pregnant, what would that do to me? Would my fluctuating hormones combine with my fluctuating moods to make my mental health even worse? And once I had the child, would I be more prone than the average mother to experience postpartum depression? Given my history of depression, it seemed a real possibility.

The Times article also discussed societal and family pressure to have a child.

This pressure can make a woman feel guilty or unnatural if she doesn’t want to have a child. There’s already stigma surrounding mental illness. Add the stigma regarding being child-free, and you’re doubling down on guilt, shame, and denial.

Fortunately, my parents didn’t pressure us, and Dan’s brother provided the Reily family with a suitable number of children and grandchildren. But we did get the usual inquiries: When are you going to have a baby? (Note: It was when, not if.) The young daughter of a friend asked why we didn’t have children. Her mother told her that not every couple does, and she seemed to accept that without further questioning. A couple of friends talked about how we had good genes and should pass them along.

Now I’m well past the age at which I have a choice to make. My same-age friends are revelling in their recent grandchildren, and I heartily celebrate their happiness with them.

The people interviewed for the Times article said they had no regrets about their choices.

Neither do I.

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Book Roundup

I read a lot. I mean, a lot. Of course, my bipolar disorder has a thing or two to say about that. When I’m depressed, I don’t have the energy to read. And when I’m hypomanic, I don’t have the attention span to read. During my worst episode, which lasted over two years, I read practically nothing. Fortunately, I came through that and am now reading again, if not with the speed of consumption that I had when I was younger, at least with the same satisfaction.

I read my books on an e-reader so I can take 1,000+ books with me wherever I go. (I can also read on my phone, if necessary. I’m never without something to read close to hand.)

Among the books that fill my virtual shelves are many on psychological, psychiatric, and assorted mental health topics. I thought I’d share with you a list of what I have, and I invite you to share any others you know of with the readers of this blog. To be sure, I haven’t listed or read all of them. My TBR list is so long that, if it were made of physical books, I could easily be crushed if they toppled over on me. But here’s a look at an assortment of what’s available. Let’s start with Jenny Lawson, one of my favorite writers, and go on from there.

• Let’s Pretend This Never Happened: A Mostly True Memoir; Furiously Happy: A Funny Book About Horrible Things; Broken (in the Best Way Possible); How to Be Okay When Nothing Is Okay, by Jenny Lawson; Hyperbole and a Half: Unfortunate Situations, Flawed Coping Mechanisms, Mayhem, and Other Things That Happened and Solutions and Other Problems, by Allie Brosh.

The four books drawn from Lawson’s chaotic life present astoundingly funny takes on depression, anxiety, and other illnesses and treatments. Her most recent, How to Be Okay, is a compendium of “tips and tricks” for fighting against these conditions, neatly packaged in chapters that each deal with one aspect of them. Also notable are Hyperbole and a Half: Unfortunate Situations, Flawed Coping Mechanisms, Mayhem, and Other Things That Happened and Solutions and Other Problems, both by Allie Brosh, who gives very accurate accounts of depression, embellished with cartoon drawings. Other books attempt the same feat with less success: The Hilarious World of Depression, by John Moe; and Surviving Mental Illness through Humor, by Alyson Herzig and Jessica Azar.

• Coming of Age on Zoloft: How Antidepressants Cheered Us Up, Let Us Down, and Changed Who We Are – Investigative Journalism on Psychiatric Medication and Identity, by Katharine Sharpe. Prozac Nation, by Elizabeth Wurtzel. Prozac Monologues: A Voice From the Edge, by Willa Goodfellow. Prozac Diary, by Lauren Slater.

These books, taken together, give accounts of the lives lived and societal effects of the group of antidepressants that most people have heard of. From success stories to denunciations and questioning, together they provide an in-depth look at how Prozac and Zoloft have affected both patients and our society.

• Sybil Exposed: The Extraordinary Story Behind the Famous Multiple Personality Case, by Debbie Nathan; The Great Pretender: The Undercover Mission That Changed Our Understanding of Madness, by Susannah Cahalan; The Psychopath Test: A Journey Through the Madness Industry, by Jon Ronson.

Exposés of two of the most famous psychological narratives of our time, both shine a light on the narratives and point out serious flaws. Nathan‘s Sybil Exposed discusses the book Sybil: The Classic True Story of a Woman Possessed by Sixteen Personalities, by Flora Rheta Schreiber, and the flaws with that narrative and the dependence “Sybil” developed on her psychiatrist and the author. The Great Pretender is about the Rosenhan experiment, in which volunteers were admitted to psychiatric wards for minimal reasons, and examines their difficulty in being let out. Ronson‘s book is lighter, with interviews detailing when “a potential hoax being played on the world’s top neurologists takes him, unexpectedly, into the heart of the madness industry.”

• Switching Time: A Doctor’s Harrowing Story of Treating a Woman with 17 Personalities, by Richard Baer.

Switching Time is an account of a woman with Dissociative Identity Disorder (multiple personalities), written by the doctor who undertook her treatment.

• An Unquiet Mind and Touched With Fire, by Kay Redfield Jamison; Manic: A Memoir, by Terri Cheney; Madness: A Bipolar Life, by Marya Hornbacher.

Jamison‘s books are the gold standard for accounts of mania and mania’s association with creativity, respectively. Cheney‘s memoir focuses on her own experience with bipolar disorder. Hornbacher is also the author of Wasted: A Memoir of Anorexia and Bulimia. Her book on Type I rapid-cycling bipolar disorder illuminates her diagnoses.

• Darkness Visible: A Memoir of Madness, by William Styron; The Noonday Demon: An Atlas of Depression, by Andrew Solomon.

Literary greats Styron and Solomon discuss their experiences with depression and recovery in a pair of important books. Darkness Visible conveys “the full terror of depression’s psychic landscape.” The Noonday Demon is particularly thorough and “examines depression in personal, cultural, and scientific terms.”

• No One Cares About Crazy People: The Chaos and Heartbreak of Mental Health in America, by Ron Powers; Breakdown: A Clinician’s Experience in a Broken System of Emergency Psychiatry, by Lynn Nanos.

These two books are searing indictments of the societal response (or lack thereof) to mental health care in the United States. They’re important, and they lay bare the many difficulties that patients, families, and clinicians have within the “system.” Another book from a different era, Ten Days in a Mad-House, by Nellie Bly, is an exposé of conditions in a “lunatic asylum” in 1887. Her revelations led to reforms in the treatment of psychiatric patients in what was also a broken system of the time.

• The Bell Jar, by Sylvia Plath; Red Comet: The Short Life and Blazing Art of Sylvia Plath, by Heather Clark.

Confessional poet Sylvia Plath wrote with raw feeling about her psychological troubles, leaving a document that still resonates down the years. Clark‘s biography is a much-needed examination of Plath’s life and her marriage to poet Ted Hughes.

• Girls and Their Monsters: The Genain Quadruplets and the Making of Madness in America, by Audrey Clare Farley; Hidden Valley Road: Inside the Mind of an American Family, by Robert Kolker; Schizophrenia: A Brother Finds Answers in Biological Science, by Ronald Chase.

Both Girls and Their Monsters and Hidden Valley Road are about familial patterns of mental illness. Kolker‘s book, about schizophrenia, is particularly good. Schizophrenia approaches the disorder from the perspective of a brother who is a scientist wanting to discover answers.

• Tangentially Related

The Neuroscientist Who Lost Her Mind, by Barbara K. Whitaker; Another Kind of Madness: A Journey Through the Stigma and Hope of Mental Illness, by Stephen P. Hinshaw; Life of the Mind Interrupted: Essays on Mental Health and Disability in Higher Education and Even If You’re Broken: Bodies, Boundaries and Mental Health, by Katie Rose Pryal; (Don’t) Call Me Crazy, by Kelly Jensen; The Woman They Could Not Silence: One Woman, Her Incredible Fight for Freedom, and the Men Who Tried to Make Her Disappear, by Kate Moore; Rosemary: The Hidden Kennedy Daughter, by Kate Clifford Larson; My Lobotomy: A Memoir, by Howard Dully and Charles Fleming; Just Like Someone Without Mental Illness Only More So, by Mark Vonnegut; Girl, Interrupted, by Susanna Kaysen; The Man with the Electrified Brain: Adventures in Madness, by Simon Winchester.

Whitaker‘s book relates how her brain tumor mimicked schizophrenia. Hinshaw‘s is about his father’s recurring mental illness, but has a lot to say about stigma. Pryal’s two books talk about the difficulties of navigating higher education while living with a mental illness; and about sexual assault and mental illness. Jensen presents essays and other writers’ perspectives on mental illness. The Woman They Could Not Silence presents the life of Elizabeth Packard, committed to an asylum in 1860 by her husband, on flimsy grounds, and her decades-long struggle to escape and to shine a light on the abuses of the system. Rosemary tells the story of Rosemary Kennedy, who was “different” from a young age and kept out of the limelight. The book details her lobotomy and tragic life with its aftereffects. My Lobotomy recounts Dully‘s lobotomy at a very young age and his struggles to recover from it. Vonnegut, son of the famous writer, details his chaotic upbringing, manic episodes, and decision to become a pediatrician. The basis for the famous movie, Girl, Interrupted, recounts the author’s two years in a ward for teenage women and the other patients she meets there. Noted author Simon Winchester describes a series of several nine-day periods of psychosis or dissociative states, and how ECT allayed them or failed to.

• Books I Don’t Recommend

The Myth of Mental Illness: Foundations of a Theory of Personal Conduct, by Thomas S. Szasz; Committed: Dispatches from a Psychiatrist in Training, by Adam Stern; A Bipolar Life: 50 Years of Battling Manic-Depressive Illness Did Not Stop Me From Building a 60 Million Dollar Business, by Steve Millard; I Never Promised You a Rose Garden, by Hannah Green (Joanne Greenburg); Shrinks: The Untold Story of Psychiatry, by Jeffrey A. Lieberman; Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America, by Robert Whitaker.

Szasz questions the whole notion of psychiatry. Stern presents a very superficial look at an intern’s experience on a psych ward. Millard barely acknowledges his disorder in his “you-too-can-succeed” narrative. Rose Garden was wildly popular in its day, but presents a now-discredited explanation of schizophrenia. Shrinks purports to tell the “‘astonishing’ story of psychiatry’s origins, demise, and redemption.” Anatomy of an Epidemic blames the rise of psychiatric disorders and medications on psychiatry.

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