Bipolar 2 From Inside and Out

Posts tagged ‘bipolar disorder’

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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When Journaling Doesn’t Work

If there’s one thing people tell you to do when you have a mental health issue, it’s to start a journal. They may not call it that. They may say it’s a place to write affirmations, or things you’re grateful for, or aspirations. But what they really mean is a journal, a written record of what’s going on inside you.

But sometimes that doesn’t work. You may not be in touch with your inner feelings yet enough to know what your dreams mean or whether you need to explore your inner child’s trauma. It may simply be too soon.

Writing isn’t a bad idea, though. It just may be a mistake to call it a journal or to try to make it a way to explore your inner life. But there are other things you can do while you’re waiting until journaling is right for you.

One avenue you can try is other forms of writing. Don’t even think about your difficulties and how to solve them. You can get to that later, probably with the help of a therapist. For now, just write poetry. About anything. Your cat. The tree outside your window. The guy you just met at a party. Literally anything. Don’t try to be deep. Don’t try to write something meaningful, something for the ages.

Just put words on paper. Lord knows, they don’t have to rhyme. And don’t show it to anyone. The idea isn’t to impress anyone with your innate poetic talent. It’s just to get used to the idea of putting words on paper. Sure, it will feel weird at first (especially if you do try to make it rhyme). You don’t have to set any kind of goal like writing a poem every day or even every week. Just every once in a while, sit down at your computer (or, if you must, sit with a legal pad under a lilac bush) and write a poem. Or revise one you wrote the week before.

If you feel so inclined, try setting your poem to music. Strum that old guitar you haven’t dug out in months, or noodle around on GarageBand. Don’t make it a chore. Try it, just for the heck of it. Or you can decide to scrap the poems and just play around with music. There’s nothing that says you have to write poetry. What you’re doing doesn’t have to involve words at all.

Or, if none of that appeals to you, pick up a pencil and doodle, the way you do when you’re on infinity hold on the phone. Start with boxes and squiggles. If one of them starts to look like a pirate chest, go for it. See if your doodle turns into that, or something else. Draw a cartoon face. Then draw a setting for it. Is this your pirate? Is it a bartender? Is it an astronaut? Or take an empty candy wrapper and tape it to a sheet of paper. What can you make of it? Is it the body of a bird? Does it remind you of a ballet dancer’s costume? Does it begin to look like the tree outside your window? Just keep doodling.

The point of all this is not to create Great Art or to spur Great Revelations about your inner life. The point is simply to let yourself play—with words, with sounds, with sketches. Or pottery. Or katas. Just get used to the idea of letting something inside you come out. It doesn’t have to be important and meaningful. If it’s meant to be, that will come later.

I tried to start a journal once. It was pathetic. I recorded my daily activities, which at the time consisted largely of deciding whether to get out of bed that day. I recorded what I felt (depressed). Each page, each day, was the same. It was boring and no help at all. I was a dud at journaling.

Instead, I started this blog. In it, I was free to write about myself, but also about what I saw and heard in the world around me—what other people thought about mental illness and whether I agreed with them. Things I’d heard in the news and how the stories made me feel—outraged or comforted or confused.

It wasn’t journaling. I learned a lot from it, though (primarily that journaling wasn’t for me). No affirmations. No dream analysis. Over the years, though, it’s given structure to my week and a place to say things that aren’t necessarily profound. To ask questions and grope for answers.

Go thou and do likewise. Or go thou and do something else. The medium doesn’t matter.

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Ambient Abuse: A Sigh and a Glare

I was a feminist, at least as I understood it at the time. I scoffed at the boys in high school who referred to the ERA as the Equal Restrooms Amendment. I went to a college that I chose for myself. I signed the loan for my first car. I read Men, Women, and Rape, The Burning Bed, Women and Madness, The Feminine Mystique, Sisterhood Is Powerful, and Ms. magazine.

I knew about domestic violence and swore that if an intimate partner ever battered me, I would not tolerate it for a minute. Either he or I would be gone. No second chances. One blow, and that was it.

So how did I end my college years involved with a man who never hit me but made my life miserable—more miserable than it was already with my undiagnosed and untreated bipolar disorder?

Chalk it up to the fact that my feminist education was incomplete. I had never heard of verbal abuse, emotional abuse, or gaslighting. I didn’t know how to respond to them when they happened to me. I didn’t even know at the time that they were happening to me. It took more years, more reading, and more talking about it, not to mention therapy, before I understood.

What Is Ambient Abuse?

Until this week, I had never heard of “ambient abuse.” Often described as an aspect of gaslighting, ambient abuse creates a toxic environment in subtle ways. Even the person living in such an environment cannot see what is happening, and their friends and family can’t either. It’s blamed on the victim for “being too sensitive,” “imagining things,” or “overreacting.”

The term “ambient abuse” was introduced by Dr. Sam Vaknin, a narcissistic personality disorder expert. He explained it as a situation in which an abuser creates a hostile environment that fills their partner with fear, anxiety, and hypervigilance—without committing any obvious physical acts of violence. Dr. Christine Louis de Canonville, another expert on narcissistic abuse, describes ambient abuse as “psychological terrorism.” It creates a state of threat for the victim without ever directly threatening them.

Among the tactics used to foster this invisible ambient abuse are a sigh, a facial expression of contempt, the silent treatment, or eye rolls. The toxic atmosphere is created without saying a word or raising a hand.

In other words, it was something I was not prepared for.

My Experience With Ambient Abuse

In my case, it was a combination of the sigh and the glare. Delivered together, they told me without words that I had done something wrong, misjudged something, said something stupid, behaved inappropriately, or otherwise transgressed. I cooked dinner, but I didn’t stay to eat it because I left for a scheduled guitar lesson. I ate a sandwich without offering him a bite. I wanted to close the bathroom door while I was using the toilet. I wanted to listen to my favorite music, not his, while ironing. Little things? Certainly. But added up day after day and reinforced with the sigh and the glare, they added up to a technique designed to keep me in line.

People who haven’t lived with ambient abuse can’t understand the cumulative effects. But to the person who does live with it, ambient abuse can trigger stress. When it continues, the person affected lives in a state of hypervigilance, unable to ever relax. And along with that come the natural bodily and psychological consequences of stress: headaches, stomach aches, changes in eating habits, tight muscles, inadequate sleep, poor concentration, and even long-term health problems. I had several of those symptoms, plus the twitching muscles and stabbing pain that exacerbated my TMJ problem.

Breaking Free

There were plenty of other, more obvious reasons to leave, but getting away from ambient abuse was certainly a factor. I applied for a job in my home state and packed up and left on a day when he was at work. I was across the state line before he got home.

The man who became my husband knows enough that he realizes that the sigh-and-glare trigger me. So we found a way to make fun of it. If I make an error, I say, “Are you going to sigh and glare at me?” He then huffs and blows and puts on his “mean face,” with furrowed brows and squinting eyes.

Then we both snort and laugh.

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Update: The Keto Diet

Almost exactly a year ago, I wrote a post called “Is a Keto Diet Good for Bipolar?” In it, I examined the keto diet, one that involves consuming a very low amount of carbohydrates and replacing them with fat to help your body burn fat for energy. That means you should avoid sugary foods, grains and starches, most fruit, beans and legumes, root vegetables and tubers, low-fat or diet products, unhealthy fats, alcohol, and sugar-free diet foods.

What’s left? Good fats like avocados and EVOO, as well as meat, fatty fish, eggs, butter and cream, cheese, nuts, seeds, low-carb veggies, and herbs and spices.

So, what does that sound like—a diet high in meat and fats that avoids most fruit, beans, legumes, and ultra-processed foods? That’s right: the new upside-down food pyramid instituted by Robert F. Kennedy, Jr., the U.S. Health Secretary.

In that previous post, I talked about studies that examined the keto diet as applied to depression and bipolar disorder in particular. The bottom line I left to WebMD: “The advice from WebMD is that there is ‘insufficient evidence’ to recommend the diet as beneficial for mood disorders. They don’t recommend it as a treatment option. As with any diet plan, consulting your doctor first is a good idea.”

Now, however, RFK, Jr., is touting the benefits of a ketogenic diet as a “cure” for schizophrenia. The New York Times called it “an unfounded claim that experts say vastly overstates preliminary research into whether the high-fat, low-carbohydrate diet might help patients with the disorder.”

In fact, the Secretary said, “We now know that the things that you eat are driving mental illness in this country.” He claimed that an unnamed doctor at Harvard had cured schizophrenia, and talked of studies “where people lose their bipolar diagnosis by changing their diet.” He was apparently referring to a 2019 experiment in which two patients “experienced complete remission of symptoms” with the keto diet. He said both patients “were able to stop antipsychotic medications and have remained in remission for years now.” Dr. Palmer, who originally reported the results, made no comment for the Times story.

The post promoting the claims was taken down from the website when evidence was requested to support the assertions.

The ketogenic diet is popular but difficult to stick to with its emphasis on fats over carbs. It’s up to you whether you try it to treat a mental disorder, but my honest opinion is that you shouldn’t stop taking your meds or doing your therapy. Try the keto diet in addition to them if you want to. Stopping your meds with the help of a physician who can guide you in tapering off safely is essential. Don’t go cold turkey, even if you do think the keto diet might help you. It’s simply not safe.

Unlike RFK, Jr., I’m not giving medical advice, only my opinion. Your mileage may vary. Your primary care physician or psychiatrist knows you and your condition best. Ask their advice and follow it.

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Diagnosing Yourself

It’s hard enough for a mental health professional to properly diagnose someone. For someone with no training in psychology or psychiatry, it’s virtually impossible. Nonetheless, every day, there are people who decide that they are bipolar, or have autism, or ADHD, AuDHD, or some other diagnosis.

Many of them decide this based on the pop psychology that permeates our society. Some base their “diagnosis” on tests or surveys they take online. Perhaps others simply feel that the differences they see in themselves equal neurodivergence. It’s trendy, in other words.

Elizabeth M. Ellis, Ph.D., an ADHD specialist, wrote an article that was published in July 2025 in Medium, titled “No, You Don’t Have ADHD, and Here Are 5 Reasons Why.” I’ll summarize, in case you don’t have access to Medium.

Her five reasons are:

  1. ADHD is a neurodevelopmental Disorder. You do not “get” ADHD past the age of 12.
  2. You don’t have ADHD because part of the diagnosis is the fact that the symptoms of ADHD are evident in childhood.
  3. Functional Impairment. You do not have ADHD because you were/are not functionally impaired.
  4. ADHD has a chronic course with most cases persisting into adulthood, negatively affecting a person’s ability to use their strengths and abilities to live successfully. You have had a successful life. You do not have ADHD.
  5. Responding positively to stimulants does not mean that you have ADHD.

Basically, an adult who says they have ADHD is not familiar with what ADHD really is—the criteria for a diagnosis by a professional, when the condition appears, the impairments of ADHD that occur, and why taking ADHD medications that seem to make you more productive with less effort doesn’t mean you have such a disorder.

Why do people claim a diagnosis that they don’t actually have?

First, they may have a lack of understanding of what the condition is. They may think, for example, that ADHD makes a person extra-productive because they don’t get a “normal” amount of sleep. They like the idea that they are a genius who has turned the diagnosis to their advantage. Or they think that they have OCD because they are obsessively neat. They don’t know about the obsessive thoughts that are a hallmark of OCD, the reason for rituals other than cleaning, and the harm they fear will happen if they do not perform these rituals.

Similarly, they may believe they have bipolar disorder because their moods change quickly, sometimes more than once a day. But even ultra-rapid-cycling bipolar disorder doesn’t really work that way. What the person is feeling may be normal reactions to the world around them. They’re happy in the morning because they received a compliment on their work. They feel sad in the afternoon when a friend cancels a dinner date. But bipolar disorder, in general, means that moods change over days, weeks, months, or even years, often without a visible cause. The DSM lists the symptoms that go with bipolar disorder (and other disorders), how often they occur, how long they last, and how many of those symptoms add up to a diagnosis of bipolar disorder.

Most online quizzes that purport to diagnose whether you have any of these psychological or psychiatric disorders present questions that are superficial and shallow. They lack important elements. Even the depression screener that doctors’ offices now use ask how often a person feels a symptom and how long it lasts, and have a better chance of suggesting a possible diagnosis, and allow the doctor to interpret the results and advise the patient on what to do about it. Online quizzes can’t and don’t.

As far as I can tell, online quizzes regarding psychological issues are no more useful than those that ask what Star Trek character you most resemble or whom you should date. They may be interesting, but they are valueless. That’s why we have professionals and leave actual diagnosis to them.

And, for people who simply decide on a condition they think they have, they’re not merely inaccurate; they spread false ideas of what it means to have a psychological disorder. Their misunderstanding makes life more difficult for those who actually have the conditions.

Nor are online quizzes the only culprits. There are also TV shows that have neurodivergent characters. I suppose I should be grateful that neurodiversity is mentioned at all, but the portrayals are often caricatures. Autistic people are seen, but only as nonverbal children who act out a lot or as savant doctors. People with Dissociative Identity Disorder (multiple personalities) are either sadistic killers or played for laughs. And I have yet to see a good portrayal of a person with bipolar. It would be awfully boring to have a show about a person who can’t get out of bed for weeks, then spends money or drives recklessly.

So, you’re not the person who can diagnose yourself. A psychiatric or psychological practitioner needs to do it. You might, of course, go to a psychiatrist and say, “Dr., I’m having these symptoms. Do you know what could be causing them, and can you help me deal with them?”

That’s the way to get diagnosed.

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A Bipolar Breakup

A recent issue of BP magazine had an article on surviving a breakup as a person with bipolar disorder. It noted that “a split can trigger manic or depressive episodes.” It also noted that “there’s typically a period of destabilizing upheaval as the newly single adjust to life on their own, perhaps in different surroundings.”

I can vouch for the mood episodes and destabilizing upheaval. My senior year in college, I experienced a breakup that was not just destabilizing but devastating. At the time, I was not diagnosed, but it’s now clear that I was in the grip of a major depressive episode, between not having any idea what would happen to me after college and the train wreck that was the relationship.

The article also described how to maintain stability, avoid dangerous rebounds, and prioritize self-care when a relationship ends. They advised readers to avoid rebound relationships, not stop their medication, see or seek a mental health professional, avoid isolation by using their social support network, take their time, and allow themselves to heal.

This is no doubt good advice, but it’s easier said than done. I wasn’t able to put all of it into practice. I had no mental health professional (and wasn’t ready to look for one), and was unmedicated, unless you count the benzo I was given for my TMJ problem and the wine our neighbors poured for me.

As for rebound relationships, I met the man I would eventually marry the weekend before I left where I was living to return to my home state. But it’s hard to call it a rebound relationship, as for over a year, we saw each other only twice, but simply corresponded. So I guess you could say I took my time.

However, one year wasn’t all I needed to heal. Neither the flashbacks and nightmares nor the crying were finished in that time. I had to repair my relationship with my parents. I had to realize that I needed psychiatric help and begin that journey. I had to rebuild my social support system and find the wherewithal to interact with them.

When you consider everything, it took more than a decade. By the time my “rebound” guy and I got married, I was still not healed. He had to cope with my distress as I tried to shake off the memories. He tried to understand my longstanding depression (but really couldn’t until he experienced a depression of his own). The people in my support system soon realized that I would back out of plans, often at the last minute, and that if I did show up, I could be preoccupied and uncommunicative.

The good news is that I finally did heal. My husband and I now have a strong relationship unclouded by the specter of that failed one.

So, what would I advise someone to do in the aftermath of a bipolar breakup?

First of all, take the time you need to heal, and don’t worry if it doesn’t happen quickly. The death of a relationship engenders grief. And as with the death of a person you cared about, grief takes as long as it takes. There is no official timeline or cut-off point. I’m not saying you should dwell on a past relationship, but that there are many facets to such a breakup, and you may have to heal from one after another. You can’t rush it, so don’t try. Unresolved memories and grief can pop up again when you least expect them.

Next, while you’re taking your time to heal, also take the time to do the work. Find a therapist or psychiatrist and go to your appointments faithfully. If they give advice (they may not), take it. If they give you homework, do it. If they say something that resonates with you, think deeply about it. See where it fits into your life and your situation. If it doesn’t seem to do so, discuss it further in a later session.

Finally, don’t overlook “glimmers.” These fleeting reminders of the things that remain good in your world are worth treasuring. What they are will be personal to you. The sight of a blue jay flying past your window or hummingbirds fighting over a feeder. The smell of cinnamon rolls baking. The sound of a song you love being played over the sound system of a restaurant you visit. The cuddly warmth of a blanket or a hug. The taste of your favorite kind of chocolate. Use all your senses to identify the presence of things that bring you, if not joy, at least a smile.

Give it time. You will get over that relationship.

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Lifelong Meds?

I was in my 20s when I started taking Prozac. Now I’m nearing 70 and still taking SSRIs, though the names have changed over the years.

When I was first diagnosed with depression (which was before I was diagnosed with bipolar 2 and anxiety), I understood it to be a lifelong condition. When my diagnosis changed, I still thought of it as a lifelong disorder requiring lifelong treatment. So far, that has proved to be true. I have been on antidepressants ever since and fully expect to stay on them forever, or at least until a cure is at last found.

Recently, however, the New York Times published an article that examined whether the received wisdom was still true. Did someone, once prescribed antidepressants, whether for depression, OCD, PTSD, or another mental illness, have to continue taking them for the rest of their life? The article noted that the FDA’s approval of the drugs was based on trials that lasted only a few months. Other “in-depth” studies lasted two years or fewer. The Times also noted, “Current clinical guidelines do not specify the optimal amount of time they should be taken for.”

Many people stop taking antidepressants on their own, based on side effects and a dislike of them, the fact that the drugs seem to stop working (either fairly quickly or over the long term), or simply because they dislike taking pills. According to the Times, however, “The answer depends on your symptoms, diagnosis, response to the medication, side effects, and other factors—all things to discuss with a medical professional.” In other words, cold turkey isn’t the way to go. With psychotropic drugs such as benzos, it’s positively dangerous, and quitting antidepressants brings the risk of falling back into the depression you and your doctor were trying to alleviate. Tapering off the drug with the help of your prescribing physician is recommended.

And about those side effects—some disappear over time as the body gets used to the medication, but others, particularly annoying ones like weight gain, sexual dysfunction, and possibly increased heart symptoms, linger. A doctor can prescribe a different drug in hopes that the side effects will not be so severe, but they may only be similar or worse. Patients generally don’t like tinkering with their medication and having to wait weeks until the effects appear and the side effects disappear. It’s a tedious and discouraging prospect.

What do the clinical guidelines say? Experts say that antidepressants, once they work, should be taken for four to nine months. Any quicker than that, relapse may occur. To maintain the positive effects, they should be taken for two to four years. Taking them for longer periods is sometimes advised, depending on how long the depression lasted and whether the patient has had several depressive episodes. Long-term use depends on whether the illness has continued for a long time and whether the depression is very severe, causing hospital stays and a loss of the ability to perform daily functions.

All in all, says Dr. Paul Nestadt, the medical director of the Center for Suicide Prevention at the Johns Hopkins Bloomberg School of Public Health, “I’m still of the opinion that, in people who have real depression, the benefits outweigh the risk.”

So, continuing to take antidepressants is really up to me and my doctor. At this point in my life, I see my doctor quarterly for a med check. We sometimes tinker with the dosages, based on my symptoms at the time, but for the most part, we stick with what has been working. As the saying goes, “If it ain’t broke, don’t fix it.” And since it ain’t broke, I’m content to keep taking my antidepressant (and other medications) for the foreseeable future.

Note: This post is not medical advice and should not be taken as such. Discuss medical questions with your physician, especially before stopping a medication.

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Love, Hate, and Mania

Mania, or in my case hypomania, is easy to love. It creates a buzz that carries you along, although you’re not always sure where to. Ordinary things become extraordinary, and extraordinary things become magical. I love mania. It can be fizzy, like champagne.

I hate mania, too. When it leaves, it leaves a hole behind. It leaves depression that’s like a nasty hangover. And many times, it can leave consequences. Sometimes dangerous. Sometimes shameful. Always unexpected.

I’m in the grip of hypomania right now. I recently got through a series of medical difficulties. Now, I’m back home, and not dependent on nurses and aides to bring me meals and wipe my ass. It’s glorious. And I’m celebrating by enjoying a burst of benevolence. It’s holiday time, and I’m back to my computer with a debit card and a desire to shop. That gives me an excuse, if not a reason.

I’m buying gifts for Dan and a few friends. I’ve bought so many for Dan that, now that the packages have started arriving, even I am a bit embarrassed. Fortunately, he has a birthday in April, and I can save some of the gifts for that.

In the past, Dan had the advantage. He could follow me around and watch what I oohed and aahed over, then sneak back and get it for me. But I am buying exclusively online now because I rarely go out. Dan doesn’t know how to buy online. I’ve offered to show him, but all the financial stuff goes to me, so I’d know where he bought stuff and how much he spent on it. This leaves only the store where he works to buy gifts. And he says he doesn’t know what to get me anymore, as I spend most of the day in pajamas and don’t wear earrings at home, so clothes and jewelry are pretty much out.

Anyway, I’m definitely manicky. I can tell. And I’m definitely spending more than I should. Fortunately, I just got paid for a freelance job I did, more than I usually get, so I haven’t gotten us into financial trouble, though it was a close thing. The check came just in time.

So. I’ve loved buying presents. I hate that I almost overdrew the bank account. I’m happy that I was saved by a check. I hate that the shower of presents may embarrass Dan, who won’t be able to reciprocate in a like manner.

Manic and hypomanic episodes are like that. A buzz and then self-doubt. A thrill and then regret.

I used to wish that I had mania too, instead of just depression. My theory was that if I were manic, I would get more accomplished. But I once knew a woman who had bipolar 1, rather than 2, so her manic episodes were more extreme. And her plans crashed and burned around her. She would start a project, tear it up, and redo it, even more than once. Her sense of humor was extreme and not really funny. (Once she mimed swallowing a whole bottle of pills.)

After that, I no longer wanted to be manic. But, as it happens, when my depression stabilized, my hypomania had more room to express itself. I haven’t indulged in the more dangerous behaviors, like drinking and driving. But this month, I can’t deny that I have hypomania.

I’m getting better at telling when it’s going to happen. Once I’m in the episode, I know. I feel the buzz. I notice the bank account dwindling.

Dan notices when I’m getting manicky, too. I can usually tell him that I feel it coming on and check it out with him. But this time, secrecy was part and parcel (literally) of it. Once it was getting beyond my control, I told him. Not about almost overdrawing our account, though. Once there was money back in the bank account, it didn’t seem necessary.

I’m not quite over this episode. I’m cooled down enough to rein in the buying. Just a couple more small presents for friends. I swear. It’s progress, anyway.

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What Won’t Work

Actor/comedian Stephen Fry discovered at age 37 that he “had a diagnosis that explains the massive highs and miserable lows I’ve lived with all my life.” It was, of course, bipolar disorder. In documentaries, podcasts, and books, he has talked very openly about his condition, spreading the word about stigma and the necessity of getting help.

Fry once said, “You can’t reason yourself back into cheerfulness any more than you can reason yourself into an extra six inches of height.” And he’s right. If one could, I would have done so. With years of debate behind me and an extensive knowledge of rhetorical fallacies, I can argue nearly any proposition into the ground. I should have been able to reason my way out of depression.

But no.

Fry was right. There’s no way to reason cheerfulness into your life. Emotions are not so easily controllable, especially if you have bipolar disorder or another mental illness.

Nor can you reason yourself into having thicker skin. Throughout my youth, I was described as “too sensitive.” I was genuinely puzzled. I had no idea how to make my skin thicker (and it was never explained to me how such a thing could be done). It took a long time and many life lessons and mistakes to make any progress at all.

There are other things that won’t make you mentally well, either. Expecting the first medication you try to be the cure is unrealistic. It can take a long time (in my case, years) before a medication or even a combination of medications will ease your suffering. And if you can’t work out a medication regimen that works, other treatments such as ECT, TMS, EMDR, or ketamine therapy are not guaranteed to work, or at least not completely. If you go into those kinds of therapy expecting a complete cure, you may be disappointed.

Trying to wait it out or tough it out is likewise ineffective. Again, this is a strategy I have tried. I used to believe that my depressive episodes would abate if only I waited through them until they went away naturally. Eventually, my mood might improve slightly, but that was due to another mood cycle kicking in. Naturally, depression was still there, waiting for me to fall back into it.

I know this may be controversial to say, but religion won’t cure mental illness, either. Having a supportive religious community around you can be an asset—if you happen to find a church, synagogue, mosque, or other community that treats people with mental illness in a caring way. Prayer and sacred music can be a great adjunct to other treatments, but by themselves, they’re not a cure.

Exercise and yoga are not cures. They are also great adjuncts to other treatments. They can increase your number of spoons—if you have enough spoons to do them. But if someone with bipolar disorder or depression can’t manage to get out of bed, how are they going to avail themselves of the benefits?

Likewise nature. It’s a great way to lift your spirits to walk among spring flowers or autumn leaves or to plant a vegetable garden. But again, you have to be at a certain level of recovery to be able to do these things.

Changes in your physical circumstances may lighten your mood for a while, but they aren’t a cure. My mother used to believe that if only I got a better job, my depression would lift. And it did, but only for a little while. It certainly didn’t cure me. There were plenty of things about the job and about my brain that brought the depression roaring back.

So, what are we left with? Therapy and meds, and other medical treatments such as ECT, TMS, and maybe ketamine or other novel medications. One can hope that science will discover better ways, like fMRI, that can determine which treatments will be more effective. But it’s far from clear how soon that will be and when they will be available to the average person.

So, when is your reason an asset? When you’re deciding which treatment and which adjuncts are right (or possible) for you. For example, I had to think long and hard—and do extensive research—on whether I should try ECT.

I’m not a doctor, and Your Mileage May Vary, but for now, all I can recommend is to keep on keeping on with what we know can work. There’s no guarantee that these options will work, at least not for everyone. But they’re the best options we have.

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The Difference a Diagnosis Makes

Is a diagnosis of mental illness a bad thing or a good thing? It depends on whom you ask.

On one hand, some argue that a diagnosis is merely a label. It puts people into neat little boxes defined by the DSM and determines how society reacts to and treats them. (The DSM, of course, is for doctors, but some version of what it says sneaks out into the general public. Then it’s fair game for tossing around and labeling people by the uninformed or the barely-informed.)

The labels are harmful, this school of thought goes. A schizophrenic is violent and incurable. Bipolar disorder means daily giant mood swings and real danger if said person goes “off their meds.” Narcissists, gaslighters, and sociopaths are people who act in any way that you don’t appreciate. Autism, notoriously and according to people who should know better, is the gateway to a valueless life.

With diagnosis come stereotyping and shame. Rather than reacting to these harmful effects, some people focus instead on what creates the stereotyping and shame—the diagnosis, which is seen as a lifelong label. Protests decrying this labelling happen outside psychiatric and psychological gatherings and garner media attention. And if that makes life easier for a person with a diagnosis or generates greater understanding, then it’s a good thing.

Diagnosis-as-label is an example of the harm that diagnosis can do. Nor is it limited to the general public. Once a person is in the system with a diagnosis of whatever condition, they’re generally stuck with it. Reassessment and a realization that a diagnosis is misapplied come too rarely. Personality disorders, for example, are squishy around the edges. Similar criteria could lead to a diagnosis of narcissistic personality disorder or sociopathy, to use an extreme example. Careful consideration will distinguish between the two, but how often are such distinctions applied? Once “in the system” with a particular diagnosis, a person tends to remain in that slot despite different doctors and different treatments.

But that’s not the way it’s supposed to be. A diagnosis, rather than being a lifelong label, is meant to be a signpost pointing toward likely development of the illness and ways to treat it successfully. That’s the ideal, of course, and sometimes, being only human, practitioners can get sloppy or too narrowly focused and add to the ills of bad diagnosing.

I can truly speak only for what happened to me. At a certain point in my life, I didn’t know what was wrong with me, but it was clear to me that I was not mentally healthy, the term used at the time. I went to a community mental health center and was diagnosed with major depression. That was a good diagnosis, as far as it went. It put my life more squarely in focus and allowed me to get the medication and therapy I so desperately needed.

I lived for many years with that diagnosis and was considerably helped by the treatments for it. But, eventually, a doctor put together the puzzle pieces and rediagnosed me. Instead of having depression, I had bipolar disorder, type 2, with anxiety. This diagnosis more clearly reflected my symptoms and led to more effective treatment. In that way, one diagnosis improved my life, and a second, more accurate one improved my life more. I can only think of this as a good thing.

Was the diagnosis seen by some as a label and a stereotype? Of course. I can think of one particular coworker, hearing that I was bipolar, gave me the look that said, “You have two heads,” pasted on a strained smile, and backed away slowly. But, on the whole, the diagnosis helped me.

A recent article in the New York Times had this to say about diagnosis: “The shame that once accompanied many disorders has lifted. Screening for mental health problems is now common in schools. Social media gives us the tools to diagnose ourselves. And clinicians, in a time of mental health crisis, see an opportunity to treat illnesses early….As our diagnostic categories expand to include ever milder versions of disease, researchers propose that the act of naming a malady can itself bring relief.”

It’s something to hope for, anyway.

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