Bipolar 2 From Inside and Out

Posts tagged ‘bipolar disorder’

Manicky June, Anxious July, Overwhelmed August

Once upon a time, when I was diagnosed with unipolar depression, I wished I had bipolar disorder so that at least I could get things done when I was manic. Then I met someone with bipolar disorder and learned how foolish that wish was. Her manic phase led her to begin projects she would never finish, make loud, inappropriate jokes, and have difficulty with social interactions.

I have bipolar 2, and am fairly well controlled on medication, so I don’t get hypomania often, and when I do, it doesn’t usually last very long. Last month, however, I had a manicky time, and the results of it will affect me for several months. In June I also started on a new medication – though one for my physical health, not my mental health. My primary care physician doubled my dose of thyroid supplement. It had an almost immediate effect. After about a week, I became stronger, steadier, in less pain, and – oh yes, – rather manic.

I tend to have the rapid cycling version of my disorder, so when I do get hypomanic, it seldom lasts more than a few days. This time, however, I have had a longer time to experience the hypomania in a way I can’t remember having had before.

Some good things happened and some bad things happened. I got tickets to two live music events that I desperately wanted to see, one in August and one in September. We went out to eat at least twice. I made appointments for tattoos for both myself and my husband, both also in August. I booked us for a weekend getaway vacation in August. I bought myself a pair of earrings to replace ones I had lost.

In other words, I spent a lot of money.

Then July came and I don’t know if we will have enough money to get through it all. I snapped out of the hypomania and reverted to anxiety, which is how my depression often expresses itself. I paid the major bills during the first week. I put us on a strict budget for groceries. I put a little money aside so that I could possibly get a t-shirt at one of the concerts. I determined that the tattoo studio takes credit cards. (I don’t really want to take this option, but if we run out of cash, I may have to.)

Money worries are among my triggers for anxiety and depression, along with thunderstorms, overscheduling, noise, and too many people. When August comes, I will certainly need the bed-and-breakfast getaway, because my nerves will by then be frazzled.

The real question, though, is will I have enough energy to enjoy all the plans I have made for August?

A friend, who goes to DisneyWorld fairly often, learned that he should not do what he calls the “Bataan Fun March,” trying to cram every possible attraction and experience into a single visit. Now he prefers a more leisurely Disney experience, visiting a few of his old favorites and a few new attractions, while leaving time for relaxed dining and time in the pool.

This would probably have been a better approach for me to apply to August. A few events then, a few in September.

It would be convenient if my hypomania returned in August, to allow me to do all the fun things I have committed to. But as we know, bipolar disorder is an unpredictable beast. In the past, I have missed concerts that I had no more spoons for. I have rescheduled appointments that I wasn’t physically or psychologically in any shape to attend. (Most of these were appointments with my therapist, who sometimes agreed to a phone session instead.)

But these commitments are ones that I can’t phone in. All of them require my actual, physical presence. I don’t want to cancel any of them, some I can’t cancel at all, and I can’t phone in any of them. My best hope is that my symptoms will allow me to both attend and enjoy, if that’s possible.

Maybe the new pep I am experiencing from the thyroid meds will help. It does seem to help regulate my moods a bit, as well as affecting my body. Maybe it will allow me to have more spoons for August. Maybe in September I can decompress. Maybe in October, I will be back somewhere near level ground.

Across the Spectra

Most often when “the spectrum” is mentioned, it’s the autism spectrum that springs to mind. There’s good reason for that. Autism affects varying people in varying ways and to various degrees.

But there are other conditions, disorders, and traits that vary across a spectrum as well: right brain/left brain, introvert/extrovert/, depressed/manic, and many others. The one I’m most familiar with, of course is the depressed/manic spectrum (or in my case depressed/hypomanic), but I’ve recently been reading about the other spectra I mentioned.

The first thing to know about spectra is that no one is fully at either end of the spectrum, or at least not all of the time. Think of a spectrum as the weight gauge on an old-fashioned scale at a doctor’s office. Most people’s weight tips the scale at somewhere other than the middle, and if they are all the way to one end or the other, the clinician moves the weight and starts over until the pointer rests in between the two extremes and the heavy weight falls somewhere between either end.

So, to use myself as an example (the one I’m most familiar with), when I am stable (properly medicated), I am close to the middle of the depressed/hypomanic spectrum, with the “weight” perhaps listing just a wee bit toward the depressed side. During depressive or hypomanic episodes, I slide toward one end or the other. No one is either all depressed or all hypomanic, though it feels like it at times, and people don’t stay at one end or the other all the time, except perhaps for the unmedicated person who has never had proper treatment and self-care.

Then consider the right-brain/left-brain scenario. When this theory was first proposed, it associated various traits with one or the other side of the brain. Type-A, energetic, risk-taking, mathematically oriented people were said to be left-brained, while shy, creative, language-loving, and risk-averse types were said to be “right-brained.”

This theory was extrapolated into the real world. Naturally, society at large was judged to be left-brained and that was deemed the better thing to be. These people got things done – businesspeople, politicians, scientists, and the like. Artists, writers, and other creative types were said to be right-brained, and not well adjusted to the left-brained society. There was even a book called Drawing on the Right Side of the Brain, which tried to harness that hemisphere in pursuit of artistic accomplishments and getting left-brained people in touch with their other “side” for a while.

Whenever I’ve taken one of those sided-ness tests, though, I almost always come out somewhere near the middle. What does this mean? I suppose either that my corpus callosum (which connects the two hemispheres) is particularly robust, or that I partake of both natures to some extent, more or less, and at different times. For example, I am mostly a stay-at-home reader and writer, but I am also a closet science geek, and like foreign travel, considered a risk-taking pursuit.

The same with introvert/extrovert (which seems to me to overlap considerably with right/left brainedness, and indeed with depressive/manic). I prefer to stay at home and pursue quiet activities like reading and writing, but I also enjoy going to science fiction conventions, which are known to be rather people-y. I can also tolerate moderate sized gatherings such as parties and book signings, as long as they aren’t filled with loud noise such as screaming children.

What I’m getting at here is that most scales are fairly useless and most people are somewhere in the middle of them, partake of both ends, and slide back and forth to some degree. I suppose there are people who are all one or the other, but I don’t know many and probably wouldn’t find them very interesting if there were.

On the Mind and the Body

The mind and the body are inseparable, part of the same organism. You can’t have one without the other. And each affects the way the other works.

Triggers are a good example. You see (or read) or hear or smell or touch something that unlocks an emotion in your brain. You then have a visceral reaction to that feeling – sweating, shaking, nausea, panic flight, or another physical manifestation.

These reactions are most commonly seen in severe PTSD and trauma related to abuse, but they can happen in less severe circumstances as well. Even something as seemingly innocent as tickling can put the brain in command of a bodily sensation. For example, once I was tickled to the point of pain, with the other person refusing to stop when I pleaded for him to. Ever since, my reaction to tickling is both physical and mental. My brain tells my body to shut down the physical sensation of touch. That may seem – and is – comparatively mild, and I don’t want to diminish the experiences of people suffering with PTSD and reactions to trauma. But it shows how my body and brain interact, almost in a feedback loop.

In circumstances like these, the body signals the brain and the brain tells the body how to react. It’s not like a person can choose whether to be traumatized or not by a trigger. The brain takes over.

Lately, I’ve been facing a fairly deep depression and have faced a lot of things that are triggers for me – financial problems, relationship troubles, overwork, etc. I’ve been feeling the bodily lethargy, exhaustion, psychic numbness, and neurasthenia that come with depression. These certainly affect my body, making me twitchy and nervous and unable to sleep (or to sleep too much), or unwilling or unable to face the world outside, some of the more noted hallmarks of depression and anxiety.

But after a recent visit to my primary care physician, I began to wonder if my body was influencing my brain in a rather direct way. Of course, before I got to see the physician, I had to fill out the depression screener, and as usual, I underplayed my symptoms by a bit. After all, I’m already under a psychotherapist’s and a psychiatrist’s care for it. It’s to be expected if I don’t present as all cheery and “normal.”

After chatting with the doctor about my symptoms (most, I thought, related to growing older), he ordered a bunch of tests for me. I’m to have a mammogram, a ColoGuard test, a bone scan to check my bone density, and had a whole bunch of blood tests.

The mammogram and bone scan I’ve scheduled, though they couldn’t work me in until September. (Evidently there is a lot of pent-up demand for hospital-based testing, as the hospitals weren’t doing non-elective stuff during the pandemic.)

Then the results started coming in. White and red blood cells, okay. Liver function, okay. Glucose and triglycerides, okay. Nearly everything within parameters.

I say “nearly” because I got a call from the doctor’s office saying that he wanted to double my thyroid medication. I had been taking a small amount, but now he figured I needed more.

I looked up the symptoms of hypothyroidism on the Mayo Clinic website, which seems trustworthy. They noted that that the condition may be attributed by the patient to growing older. I definitely noticed those: sensitivity to cold, muscle weakness or aches, and joint pain, all of which I feel.

Then there were other symptoms, which I had attributed either to my psychiatric diagnosis (bipolar II) or to the medications I take for it: fatigue, weight gain, thinning hair, impaired memory, and the biggie – depression.

Between the two sets of symptoms, I could see that the doctor had good reason to suspect my thyroid was out of whack and to prescribe an increased dose of the medication. I am now taking the higher dose and waiting to see what happens.

But it struck me: Maybe my symptoms were a combination of bipolar disorder and thyroid hormone deficiency. Maybe my body was trying to tell me something – that not all the symptoms I feel were caused by my glitchy brain. Maybe some of them were caused by my glitchy thyroid.

I have not been taking the new dosage long enough to see any effects, but I have hope. Perhaps, if and when the new dose kicks in, I will feel less of the lethargy, hopelessness, and other attributes of bipolar disorder.

Maybe my brain and my body have conspired to make me feel the way that I do. Maybe there is some relief to be had from treating my body with hormones, rather than just my brain with psychotropics. Maybe I’m not spiraling down into depression as thoroughly as I thought I was. Maybe a little tweak in my medication will help me to feel better.

Maybe if my body problems get worked out, my brain problems will not assert themselves so aggressively.

It is devoutly to be hoped.

The Song as Self-Care

Almost six years ago, I wrote a blog post about music and its power to heal, or at least alleviate, depression. If you’ve been following this blog, you know that I’m currently in the middle of what may turn into a major depressive episode. Again, I return to thoughts of music.

I once gave my therapist a CD of the music I liked best. I had been telling her how I had been stereotyped and even ostracized for the kind of music I like best and was embarrassed to share it with others. (Okay, it was country music, or at least the style now known as Americana – not pop country.) She played snippets from several songs while I watched her not cringe at them.

It’s the music that moves me. I’ve heard a theory that the music we love and respond to when we’re in our late teens and early 20s is what we imprint on. No matter how much or what styles of music we listen to later in life, those are the tunes and songs that will move us, no matter how old we get. These were mine. Later in life I started listening to acoustic blues, light jazz, filk, and 70s oldies, but country/Americana is still what lives in me.

Right now, one of the things I’ve been feeling is emotionally constipated. And maybe it’s time to try allowing music to alleviate that logjam.

Whenever I’m really depressed, I forget how much power music holds. When I’m on an even keel, I semi-regularly throw myself “music parties.” I hole up in my study with my computer and let iTunes blast. I even sing along, though I’m a terrible singer. Sometimes my husband joins me for a while and we have guessing games. (Who’s that singing backup? Emmylou Harris. Who wrote this? No, Shel Silverstein, not Kinky Friedman.) Sometimes I look up music that resonates with Dan and download it for him.

But mostly, it is a solitary pursuit. I wrap myself up in the music and let it soothe me. Or I rock out to the music and let it energize me. Or I let the music reach inside me and pull out feelings I didn’t even know were in there. Sometimes I use the shuffle function and let it surprise me. Other times I thread a path through the songs, letting my brain tell me what to play next. (It’s one of the things I can rely on my brain for.)

Call it a way to provide myself some self-care without spending any money. Although massages and pedicures and lunches out with friends are often touted as good self-care methods, I can’t do any of those things when I’m depressed. For me, they just add extra stress – showering, getting dressed, going out among people. I love massages, but I love them when I’m feeling good, only just a bit tense. I love lunches out, but they can’t raise me out of depression. I like them better when even chicken and dumplings feels celebratory.

But at my music parties, I don’t have to deal with any of that. I can stay in my pajamas and slippers. I don’t even have to comb my hair. I can exhibit all the common habits that go with depression and not have to use spoons trying to alleviate them.

So, tonight, I believe, it’s music party time. I’ll shut off my phone. I’ll close the blinds in case I want to chair-dance and don’t want nosy neighbors to have a view. I’ll invite my husband if he wants to be there, and not worry if he doesn’t. (What I call a “party” can easily be a party of one, and most often is.) I’ll unplug my headphones from the computer so the music can fill the room, as well as my head and my heart.

And maybe next week, I’ll have something to tell my therapist about – whether it helped or not.

Why Can’t I Cry?

There’s a lot that’s been happening around me that ought to have made me cry, but I just haven’t. There have been personal losses – the death and funeral of a dear friend. Occasions when I should have cried tears of joy – when an estranged friend wanted to reconnect with me. Professional losses – when I finally had to give up and admit that the novel I had spent years on was just not good enough to be published.

I’ve even thought about the deaths of some beloved animals, to see if that would make me cry. It didn’t.

In the past, I’ve never had trouble crying. As my bipolar disorder is largely bipolar depression, I have cried a lot – teared up, sobbed, wept – on occasions that were appropriate and some that weren’t.

I can’t even cry over the fact that I don’t seem able to cry.

There have been times in my life when I probably should have cried, but didn’t – when I was helping my mother pick out a dress to wear to my father’s funeral, for example. In that case, and in others like it, I postponed crying, or put my emotions in a box and sat on the lid.

Actually, I have had to do that many times throughout my life. Back when I was a teenager, an unmedicated person with bipolar disorder, and full of the volatility, despair, rage, and hormones of that time in life, I suppressed the impulse to cry, in order to look more “normal.”

It didn’t always work. For instance, some songs like Simon & Garfunkel’s “I Am a Rock” would almost always turn on the waterworks. But for the most part, I tried to suppress the need to cry.

The thing about it is, when you stuff down the ability to feel sadness or despair, just to survive, you can end up suppressing most of your other emotional reactions as well. Peace, humor, interest, gladness, tenderness all go into that box with the sadness and despair and you sitting on the lid.

That may be what has happened this time. I know I had to suppress my feelings to pick out a funeral outfit and attend the service. I felt despair over the end of my writing attempt, but I didn’t cry. I felt a sense of waiting to see how it would work out when the friend appeared to be reengaging.

I don’t know what else is in the box or how I can get it open again. I am not interested much in the TV shows I used to watch obsessively. I can read only a few pages of books that I would otherwise have devoured. I can’t remember the last time I laughed over something silly my husband said or did. I did not cry over the movie that he finds so very touching that he cries every time he sees it.

I am doing all the right things, though. I am taking my meds regularly and as prescribed. I have called the psychologist that I used to go to and made an appointment for a telehealth session. And I’m trying to figure out how to tell my psychiatrist all this when I go for my med check at the end of the month, if nothing else has worked by then.

Maybe one of those things will open the floodgates, un-stuff the box of stuff, and allow me to cry again, normally, when it’s needful.

But I don’t really know. Writing this post hasn’t done it.

Bipolar Disorder Has Turned Me Into a Pouty Child

I am blessed with many friends, online and off, who are as dear to me as anyone can be. We have laughed together, cried together, eaten together, danced together, sung together, joked together, mourned together, and loved together.

Now that I’m back in my cycles of depression and hypomania, hurtling around like a marble in a shoebox, I haven’t heard from any of them.

A lot of the contact I have with friends is on Facebook, and I have almost entirely stopped posting or replying, or otherwise interacting there. No one seems to have noticed. At least no one has called or IMed to check on me.

Am I ghosting them? No, because I don’t want the relationships to end. In fact I very much want them to continue. My scattered moods, primarily depression, have sapped my ability to reach out. It may be that they assume since I post my blogs every Sunday, I am all right.

I desperately want someone to reach out to me. This is selfish and childish and unworthy. If I want human contact, I should be able to reach out and initiate it myself. But I haven’t been able to. Between the exhaustion of depression and the exhaustion of hypomania, it’s difficult to make any kind of effort.

The memes say that if you have a depressed friend, reach out to them, even when they can’t reach back. And there have been times when my excellent friends did that, back when I had been in the Pit of Despair. And they kept reaching, even when I didn’t respond.

I guess I miss those days – not the Pit of Despair – but the little parachutes of care that rained down and demanded nothing. The phone calls “just to check in” or to distract, the invitations that I was never going to be able to make myself go to or reciprocate, the awful jokes that I might not even be able to laugh at.

I understand that everyone is fighting their own battles these days, with isolation, anxiety, panic, and other reactions to the pandemic, the lockdowns, the vaccines, the separated families. Mental health struggles, especially including depression and anxiety, are spreading to people who have never experienced them before. A lot of people are suffering, and a lot of people don’t know what, if anything, they can do about it. People have had to resort to Zoom weddings and funerals and outside-the-window visits to relatives in nursing homes.

Part of the problem, I suspect, is that I have been so relatively stable and functional for so long now. I made it through a tornado and a year of home dislocation and all the associated disruptions and bureaucracy without having one of my famous meltdowns. So, now, when even I have not been expecting or experiencing any psychological trauma to speak of, it’s easy to understand that no one else has seen it or noticed.

Then there’s my husband. He is my rock, my caregiver, my “emotional support animal.” Ordinarily, he takes up most of the slack in making me feel seen and heard and cared for. But unfortunately, he is having depression and anxiety of his own right now. He has recently had health problems, has changed jobs, and has physically strenuous activities he must complete, within a deadline. Of course, he is reacting with depression and anxiety of his own. And when both of us are depressed and anxious at the same time, it’s not pretty. We don’t have enough psychic stamina to help ourselves, much less each other.

So, I understand why it isn’t happening. But I miss the check-ins I’m not getting. The calls that don’t come. The personal long-distance reach-in. The wave from outside the window.

I’m not quite to the point of, “Nobody likes me. Everybody hates me. I guess I’ll go eat some worms.” But close.

Hypomania and Exhaustion

I’ve done so much. I should feel exhausted. I do feel exhausted. Why do I keep doing so much?

The answer, of course is hypomania, or maybe a mixed state.

I had been thoroughly depressed over my writing, as I sent out query after query to agents, and getting back rejections or the horrifying limbo of “no response means no.” I kept doing this for nearly four months, until I had apparently run out of agents to query. (I know that can’t be literally true. There are thousands of agents in New York alone, but I had been through all the usual lists and gone pretty far down the Google pages.) Yet I trudged along, depressed but pushing myself. Get the queries done. Get my work done. Get these blogs done. Go to bed. The same the next day. Call it functioning depression. I was still in motion, doing what I told myself had to be done, but enjoying none of it (or anything else).

Then I got an invitation to try out for some work-for-hire (which is sort of like ghostwriting, only different). Instantly, preparing submissions (three of them!) for this gig consumed me. And I kept on with the queries, the work, and the blogs. But I was tipping over into hypomania.

I wrote the submissions insanely quickly, when I knew I should have taken the time to analyze them, polish them, try a couple of different drafts. But no. I found myself pushed to get them done and get them out there. Or rather, I pushed myself to do it.

My submissions were rejected, but this time instead of slipping back into a funk of depression, I wrote a nice note saying that if another opportunity like this came up to please consider letting me apply again. They responded to the note, seeming astonished that I had sent it, and complimenting me on my attitude. Nothing like a pat on the head to keep the juices flowing.

It was at about that point that hypomania truly hit. I focused everything on my writing. I reworked the first three chapters that I had been submitting to agents and submitted them to still more. I started taking on extra work assignments. I took only brief breaks to eat a bowl of soup, then plunged back into it again. I had trouble getting to sleep and trouble sleeping, even though I was so exhausted that I turned in early each night. And I woke early, ready to keep on keeping on.

Then the miracle happened. I got a positive response from an agent. They wanted to see more of my work. I tweaked the newly revised first three chapters and sent them in. Now I’m waiting, nearly bouncing out of my chair, for them to respond. I just know that they will want to see the whole novel and become my agents. I do know that the deal is a long way away from being sealed, but hope after so long of slogging through my depression, hypomania has taken control.

I am (sort of) still contemplating my WIP (work in progress, a sequel to the novel that might now become real), thinking I need to rethink it entirely or try a different plot altogether. I am still taking on extra work, though it exhausts me. During my brief breaks from work, I scour the internet for presents for my husband’s birthday, and spend more than I had intended for more presents than I had planned.

And I am writing this blog post the day before I need to post it, rather than the three to four days I usually allow myself to write it. And I still need to polish the post for my other blog. And pay bills. And find a place for us to get a health check that’s required by my husband’s employer. (I have already set up appointments for our vaccine shots.)

I think it is most likely that if the agent rejects my work after all this, I will once again sink into depression – the I’m not worthy anything, I’m a fool to have put this much energy into it, I should just give up kind. Cutting back my activity to the bare minimum – work and blogs. Sleeping more, enjoying it less. Enjoying everything less. My old familiar functioning depression that is only possible because of the meds I take that don’t allow me to swing too far down.

I know people who, when you try to tell them about hypomania, tell you to enjoy it while you have it. They don’t know how wrong they are.

Laughing Out Loud

There’s nothing funny about bipolar disorder. In fact, one of the ways that I know I’m having a spell of bipolar depression is that my sense of humor flies out the window. Nothing brings a smile or a laugh – not my husband’s awful jokes. Not my friend Tom’s silly songs. Not a funny movie like Arsenic and Old Lace.

I have been in a spell of depression for a little while now. As I mentioned last week, part of it may be reactive depression. But here’s the thing. Reactive depression feels the same as bipolar depression. You have the same sense of misery, loneliness, helplessness, hopelessness, anomie. But you know what caused it and that it will end pretty soon, relatively, unless you tip over into a true depressive episode, which can last a lot longer than that.

But yesterday I laughed. And that was a good thing. It didn’t pull me completely out of my depression, but it let me know that escape was possible, and maybe even starting.

It happened like this:

My husband and I were sitting on the couch, watching TV. I was not enjoying it. Then a commercial came on about “man-boosting” pills that increase testosterone. It promised everything: strength, leanness, stamina, and outstanding performance in the bedroom.

Dan turned to me and said, “Hey, honey. Maybe I should try some of that. Improve my performance in bed-woo-woo-woo!

I turned and looked him straight in the eyes. I said, in a solemn, deadpan voice, without a trace of a snicker: Woo. Woo. I never got to the third Woo because we both dissolved in giggles. And it felt good – not only that I could laugh, but that I could make him laugh. Just thinking about it made us laugh all over again.

Today I am back to feeling overwhelmed, if a little less miserable, but still functioning on some kind of level. I don’t think my depression is over with. But for just a moment, I saw a ray of hope. Yes, it was over something stupid. Yes, I delivered the line with a flat affect. No, I didn’t know it was going to be that funny. I even thought Dan might be offended that I was making fun of him. But the important thing is that we both laughed. 

What I’m saying is that laughter, by itself, is not a cure for depression, however much the memes and the positive thinkers tell you that it is. But if laughter happens to you, it at least reminds you that the depression will end sometime – maybe quicker than you think. The giggles are building blocks that will help you climb up out of your hole, or at least see that there is a way out.

That’s a lot of philosophizing about two words (or syllables, really), and I’m not sure the magic would happen again if either one of us said Woo. But I am taking the memory of that moment with me, for whatever strength it can give me and whatever amusement will stay with me when this depression ends.

My Triggers

By shane / adobe stock.com

Bipolar disorder is a funny thing. It can come on with no warning. One moment you’re fine, and the next you’re in the infinite doldrums or jagging on a spike of enthusiasm. Most of the time, it’s like that. The moods come on unexpectedly and stay as long as they want.

Sometimes, however, there are things in your life that seem to trigger a bout of depression or mania.  This isn’t quite the same as what’s commonly called a trigger. In the usual sense, a trigger is something in your past, like a traumatic memory, that comes bursting through when you read, see, or otherwise encounter a reminder of that memory. Suddenly, you are thrown back into the situation that triggered you, reliving the trauma, feeling as if you were still there, re-experiencing it. Triggers are most commonly associated with PTSD (or Post Traumatic Stress Disorder). Many people associate PTSD and its flashbacks with veterans and war, but other traumas, such as rape, assault, and natural disasters can also cause PTSD.

Trigger warnings are controversial. Some people need a warning that the content – especially books, blog posts, or films – may trigger a suppressed or otherwise traumatic memory and leave the person caught up in the sensations during a public moment, such as in a classroom. Obviously, people with traumatic memories would prefer to avoid this, so a trigger warning is placed at the beginning of a story, novel, or even a song that deals with rape, domestic abuse, or other traumas, especially ones depicted in a particularly graphic manner.

To other people, reacting to a trigger is an admission of fragility, at best, or at worst, an excuse for avoiding content that most people can easily handle. This is part of the mindset that leads to calling the severely traumatized “snowflakes” for their perceived inability to deal with stimuli that “normal” people take for granted. They do not understand the power of traumatic memories or the power they have over people who have been through trauma. They consider such people weak. They consider themselves strong, even if – or especially if – they have been through traumas themselves.

In general, my life has been less traumatic than some, more traumatic than others. There are memories that invade my dreams, situations that cause me panic, and stimuli that rev me up. I am not in control of these stimuli, or what they do to me.

Most of the stimuli trigger depression in me, as my bipolar disorder is heavily weighted towards depression. (In fact, I was diagnosed with unipolar depression before a psychiatrist finally recognized my condition as bipolar 2 with anxiety.) When I encounter one of these “personal” triggers, I am panicked, unable to communicate, and immobilized, or nearly so, and must rely on the help of others, especially my husband, to get me through. There’s no telling how long that depression will last.

Primary among my triggers is what I call “the rotten ex-boyfriend who almost ruined my life.” It was a toxic, gaslighting relationship that left my soul sucked dry and my emotions shattered. Fortunately, I do not often encounter anything that reminds me of those days. A friend I met during that time, in fact, has helped me heal both then and for many years thereafter.

Still, I have dreams – ones where I am traveling to the man’s house, ones where I am in the house but he is not present, and ones in which he is. I wake feeling vaguely seasick and nervous. The feeling persists like a hangover through most of the next day. It interferes with my ability to do work and to interact with people. My reactions used to be much worse, with specific words even able to throw me into panic and depression.

Another thing that triggers me is disastrous financial matters, or at least ones that I perceive that way. IRS dealings are by far the worst. A letter with that return address throws me into a panic. Once I even collapsed on the street after an IRS engagement and was unable to get up without assistance. Overdue bills and dealing with personal finances are triggers, exacerbated by the fact that I pay most of the bills, despite the fact that I make less than half the money. This is one of my contributions to the household since there are many things I am unable to do. Such situations leave me with my head in my hands, shaking and catastrophizing, unable to do what must be done until I calm down. (My husband is by now adept at helping me do this.)

And I have one of the more “traditional” trauma triggers – a natural disaster. A year and a half ago, our house was destroyed by a tornado. At the time it hit, I was upstairs in the bedroom. I remember the roof coming off. I remember putting a pillow over my head and hoping for the best. For many months I suppressed the trauma. But now it has come out. When the wind blows very hard or the rain blows sideways, I panic. Despite the fact that upstairs is the very place I shouldn’t go, that’s where I end up – in bed with a pillow over my head. (I also avoid movies like Twister. I’m not even sure I should try The Wizard of Oz.)

As for hypomanic triggers, I have few. Most of my hypomanic flights are unexpected, lifting me up with no warning. Although they can be exhilarating, they are also dangerous. One of the hazards is unwise spending, which of course can lead to the aforementioned financial depression triggers.

One trigger that takes me as near as I ever get to hypomanic sexuality, though, is a sensory, rather than a situational, trigger. For some reason, the smell of Irish Spring soap brings up the heat in me. I distinctly remember the first occasion on which I noticed this. A coworker walked past me and I smelled the distinctive scent. It started my juices flowing. Later, we became lovers. My reaction to Irish Spring is less extreme these days, but it still triggers a memory of the feeling. I seldom encounter the scent anymore, as my husband prefers Zest.

At any rate, it is my experience that triggers can arise from sensory memories, from dreams, from upsetting situations. I have few triggers related to textual representations, though I am not immune to those in films (I left the movie “What Dreams May Come” before it was over and waited in the lobby until it was over).

What I can say is that people’s triggers do not make them “snowflakes.” Triggers elicit visceral reactions that are no less real for not being visible to outsiders. While I don’t advise purging any possible triggering material from, say, academic curricula, I do think a trigger warning on syllabi or blog posts is only polite, and possibly psychologically necessary.

 

Are Lobotomies Gone for Good?

By alexlmx/adobestock

If I were a few decades older, I might have undergone a lobotomy. Treatment-resistant bipolar disorder (or manic depression, as it was called then) and schizophrenia are some of the disorders lobotomies were recommended for. It was thought that such mental illnesses were caused by faulty connections in the brain and that the cure was to sever those connections. Lobotomy pioneer Antonio Egas Moniz received a Nobel prize for inventing the operation.

The main problem was it didn’t always work as planned. There were other problems as well, such as the flattening of affect and severe brain damage (what a surprise). The most noted person to have a lobotomy (also called leucotomy) was Rosemary Kennedy, the developmentally delayed sister of John and Robert.

There were two kinds of lobotomies, though only the method differed. The prefrontal lobotomy involved drilling holes in the patient’s skull in order to get to the frontal lobes, where the trouble was thought to lie. The other, and to me more alarming, version was called the transorbital lobotomy. The “orbit” in transorbital refers to the eye socket. An instrument was introduced into the brain by going through the eye socket (without disturbing the eye) and used to sever the connections between the frontal lobe and the rest of the brain. Around 50,000 lobotomies were performed in the U.S., most between 1949 and 1952

Doctor Walter Freeman was the champion of the transorbital lobotomy, often called “icepick surgery” for the slender instrument that was inserted and then swooped about, in hopes of severing the faulty brain wiring. Dr. Freeman was so adept at this that he could perform many of these surgeries in a day, and indeed performed around 3,500 during his career, including 2,500 icepick lobotomies. He once performed 228 of the procedures in a two-week period and taught the technique to countless other doctors. Some of his patients underwent more than one lobotomy.

Eventually, the lobotomy came into disrepute for A) being the horrible invasion that it was, B) reducing many patients to an emotionless or brain-damaged state, and C) being depicted in Ken Kesey’s 1962 novel One Flew Over the Cuckoo’s Nest as a punitive, brutal, and unnecessary procedure. The lobotomy all but disappeared from the psychiatric and surgical landscape.

But wait! Lobotomies may be out of fashion, but psychosurgery (or “functional neurosurgery”) is still performed for treatment-resistant mental illnesses. In these operations, however, rather than randomly severing neural connections, the surgeon removes the areas of the brain thought to be the cause of the psychiatric problem. Modern versions of psychosurgery include “amygdalotomy, limbic leucotomy, and anterior capsulotomy,” none of which I know enough about to comment on. Suffice it to say that the days of drilling burr holes in patients’ skulls or taking an icepick to their brains are, as far as I can determine, gone. 

Psychosurgeries are now performed rarely, deep brain stimulation being the preferred form of treatment, especially for non-psychiatric conditions like Parkinson’s or treatment-resistant seizures. And they’re always performed under anesthesia. The patient’s consent is required.

Electroshock therapy is much less invasive and is still used today, although in a lower-key and safer manner than the original procedure – under sedation and with lower amounts of electricity. It still has side effects, such as the loss of short-term memory for the period surrounding the treatment.

Electroshock therapy was considered in my case because of my long-term, treatment-resistant case of bipolar 2, which involved years-long depressive episodes. At first I was terrified, but after doing some research and talking to knowledgeable people, I was just about ready to agree to it. At that point my psychiatrist suggested we try one more drug first – which worked, alleviating (though not curing) my condition like turning on a switch.

(Side note: When I began researching lobotomies, I found that the book My Lobotomy, by Howard Dully, was particularly interesting. The story didn’t follow the usual pattern. Instead, it seems, Dully’s hospitalization and operation (in 1960, when the boy was 12) were largely instigated by his stepmother, who wanted him out of the way, though schizophrenia was diagnosed by Dr. Freeman (see above) before the transorbital procedure.)

 

 

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