Bipolar 2 From Inside and Out

Posts tagged ‘bipolar disorder’

I Don’t Care If They Discover the Cause of Bipolar

Recently there have been several so-called “breakthroughs” in discovering the cause of bipolar disorder.

And I really don’t care.

Whatever they decide the cause is, I still have bipolar disorder. No matter if it’s toxoplasmosis, gut bacteria, or faulty synapses that are behind it, I still get to experience the lows and (sometimes) highs, the apathy and psychological pain, the weeping and despair, the irritability and touchiness, the anxiety and the gloom.

Knowing the cause will not alleviate my symptoms one bit.

I know that people believe that discovering the cause will bring us that much closer to a cure.

But will it really?

If the cause is genetic, how am I supposed to go back and change my genes? Or does anyone really believe that gene therapy will be available to the mentally ill when even hospital beds are denied them?

If the cause is viral, does that mean that a cure is right around the corner? We now know what virus causes AIDS – HIV was discovered in 1983 – but nearly 35 years later, a cure is still far away. Yes, there are treatments that improve health and extend life, but there are also treatments that alleviate some of the symptoms of bipolar disorder. Will any advances be orders of magnitude greater, or merely incremental? And how much money will be devoted to finding those treatments when Huntington’s disease, multiple sclerosis, and a host of other conditions are still without a cause, a cure, or sometimes even minimal treatments?

With most bipolar sufferers being treated (if at all) in community mental health centers, via EAPs, or through six-weeks-and-out insurance programs, what are the odds that any new breakthroughs and any new treatments that result will be available to the bipolar-on-the-street (or in the group home or even at home or at work)? Will someone really arrange MRIs or TMS or brain implants for the homeless?

With bipolar disorder once again considered a pre-existing condition and not given parity with physical ailments for insurance purposes, will any advances trickle down to us at all?

What do you want to bet that any breakthroughs regarding the causes of bipolar disorder will lead to more pharmaceutical research and yet another pill that costs more than the average person can pay or the average insurance will reimburse? And how long will that treatment take to get through the FDA pipeline to reach the people who need it?

Nor is knowing the cause of a disorder necessary to cure it. Isaac Semmelweis didn’t need to know the cause of childbed fever, a disease that killed thousands – perhaps millions – of new mothers. Germ theory wasn’t even developed until decades later by Lister and Pasteur. But Semmelweis knew that if only doctors washed their hands between conducting autopsies and putting their hands in pregnant women’s vaginas, the death rate would decrease.

So when I hear that there’s a new theory on the cause of bipolar disorder – and they seem to be coming with increasing frequency – I say, “Where’s the treatment? Where’s the cure? Who will be able to access it? Who will be able to afford it? When will it produce positive results for me and those like me?”

Get back to me when you’ve found something that will help. Until then, keep splicing your genes and culturing your bacteria and stimulating your synapses. I’m getting pretty good results with what you’ve already discovered. For now.

Don’t keep raising my hopes until you have something more than “mights” and “some days.”

 

 

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Picking Up on Feelings

As if it weren’t difficult enough to deal with my own feelings, at times I’ve had to wrestle with the feelings of others.

It started when I was a teen. I had already experienced my first major meltdown and was trying to put myself back together. Like most teens, I wasn’t really sure who I wanted to be. But unlike most teens, I was dealing with undiagnosed bipolar disorder and a shredded sense of self-esteem that made me even less sure of who I was, who I wanted to be, and who I ought to be.

I began to notice that I was picking up the characteristics of whomever I was with. When I was around Binky, I was light-hearted. When I was around Marie, I was a misfit. When I was around Fran., I was trying to fit in. And so on. Intellectual, silly, moody, outdoorsy, smart-alecky, boisterous, quiet – I became them all, in turn. None of them, it turns out, was really me. Or at least not completely me.

And when I was alone – who was I then? I was alone a lot of the time, and my default setting was depressed. I cried at unlikely songs. I hid in books. I cocooned before cocooning was a thing. I had a banner on my wall that said, “I’ve got to start acting more sensible – tomorrow!” I blamed my troubles on living in Ohio. I got drunk on ginger ale.

I was a fractured mess.

Later, in my 20s, as I went out in the world and began to interact with different people, I realized that I was picking up on their moods, rather than their character traits.

Most of those moods were unpleasant ones. And I reacted to them with – you guessed it – fear and depression.

Even if I was in a hypomanic state, I couldn’t maintain it if anyone around me was angry or depressed or resentful, or even just crabby. It felt like I was hanging on to my good feelings by my fingernails, and the least inattention would cause me to lose hold and crash.

As for anger and blame, there was no way I could do anything but cringe and apologize endlessly. (It was only much later that I learned how annoying apologizing and self-deprecation can be to those in the vicinity.)

One person became a master at using this to control me. A sigh and a glare were all it took.

Nor did the bad feelings have to be directed at me. I couldn’t be in a room with people who were yelling at each other. At times even disagreements on television would bother me.

I did develop a few coping mechanisms. If other people were the source of the bad feelings, I would make an excuse to leave the room. A breath of fresh air was usually too transparent, and you can only plead a bathroom break so many times, so making myself a cup of tea was my go-to excuse (which also led to a believable increase in bathroom breaks).

My husband has caught on to my interior mood sensor and reactions. Since even raised voices can trigger me, we’ve developed a signal that he needs to take it down a notch, usually when we’re talking politics – sometimes he even manages to chill out the emotional temperature of an entire room. And if he’s having a snit, I can ask him how long it will be till he gets over it and he lets me know whether it’s a big deal or not.

Now even sighing and glaring is a joke with us. He’ll puff like a steam engine and lower his eyebrows until they touch. Then we’ll both start laughing.

After my most recent and worst meltdown (which I’m surprised to realize was about ten years ago), my therapist told me that my shattered, scattered emotional state gave me a rare opportunity to choose which pieces of my former life I wanted to incorporate into my rebuilt self.

Maybe it’s a good thing I tried on those different identities as a teen, so I don’t have to now.

I know it’s a good thing that I’ve learned better ways to manage what emotions I allow into my life.

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To Sleep or Not to Sleep – That Is the Question

According to WebMD (which I find a pretty reliable source), “An inability to sleep is one of the key signs of clinical depression. Another sign of clinical depression is sleeping too much or oversleeping.” http://www.webmd.com/depression/guide/depression-sleep-disorder#1

So, apparently, with either unipolar or bipolar depression, either way you’re screwed when it comes to sleeping.

Most of what I could find online about depression and sleep talked about depression and insomnia. WebMD says:

An inability to sleep, or insomnia, can be one of the signs of depression…. Lack of sleep alone cannot cause depression, but it does play a role. Lack of sleep caused by another medical illness or by personal problems can make depression worse. An inability to sleep that lasts over a long period of time is also an important clue that someone may be depressed. http://www.webmd.com/depression/sleep-depression#1

But, they add, “a small percentage of depressed people, approximately 15%, oversleep or sleep too much.”

I seem to be in the 15% that sleep too much. I usually wake up around 7:00 or 8:00, take my morning meds, and go back to sleep until 9:30 or 10:00. Sometimes I have a little nap in the afternoon. (For me, a “little nap” is about two hours.) I take my nighttime meds at 11:00 and am asleep by 12:00.

That’s a lot of sleeping.

Of course, those are just averages, just when I’m depressed, and just when I have no deadline-dependent work to do. Many days lately, I have been getting out of bed when I first wake up and skipping the afternoon nap. But then I go to bed even earlier, though I usually read for a couple of hours.

On the other hand, I’m subject to mixed states, when depression and anxiety coexist. When that happens, I want desperately to sleep, but can’t turn off my idiot bipolar brain. I’ll lie awake thinking about my writing, or my finances, or any damn thing. I’ll wake up at 5:00 and do the same. Those are often the days when I try to work in a nap.

Back to WebMD. They note:

Doctors may sometimes treat depression and insomnia by prescribing an SSRI along with a sedating antidepressant or with a hypnotic medication. However, hypnotic drugs usually should be taken for a short period of time. http://www.webmd.com/depression/sleep-depression#

Part of my nighttime meds are an anti-anxiety drug and a sleeping aid, plus an SSRI and an atypical. So, am I overmedicated?

It’s possible. But I trust my psychiatrist, and I’ve been on this regimen for a number of years now. My bipolar symptoms are now fairly well controlled, I’m able to work, and with the help of my husband, I manage to get through most days with level moods, only mild depression, and only occasional hypomania. I’ve been on other drugs and other combinations of drugs that did not work as well, or gave me horrible and vivid nightmares or other side effects.

I don’t want to hear opinions on the drugs I take from people who are not M.D.s and have never met me, or as Jenny Lawson said recently, “something that every person who deals with mental illness dreads…well-meaning advice from others.” Believe me, whatever it is, I’ve tried it. That’s not why I’m writing this.

What I do have to say: Whether you sleep too much or not enough, bipolar disorder may be the cause. There are treatments, some involving meds, and others not. Meditation, for example, helps many people sleep. (My mother used to sing herself to sleep with hymns when she had insomnia.) It’s a thing to discuss with your psychiatrist and/or your psychotherapist. He or she may be able to help. You don’t have to go through sleep disruptions without treatment. Even with all the problems that sleep causes me, I’ve got a system that works well enough for me.

And … now my insurance company thinks it knows better than my psychiatrist and only allows me a sleeping aid every other day. Apparently my choices are pay for it myself or take Benadryl. Again, I’m not asking for advice. Just restful, restorative sleep.

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Mental Health

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Don’t Tell Me Not to Feel the Way I Feel

“Don’t be sad/angry/upset.”

“Calm down.”

“Smile. It’ll make you feel better.”

“Stop getting all revved up.”

Never in the history of ever has any communication of this sort had the desired effect on a person – especially one with bipolar disorder.

When you offer this sort of “advice,” what you are basically doing is telling the person not to feel the way they feel. Not only is this useless, it’s insulting.

It’s useless because ordering someone to feel a certain way simply won’t work. Saying, “Be cheerful” will not make it so. Emotions aren’t like flipping a switch on command. Even for neurotypical people, emotions are complex interactions of chemicals in the brain. While some people claim – or may perhaps be able to – shift their emotional state at will (from angry to merely annoyed or to neutral), it isn’t easy or natural. There’s a reason that you feel the way you do.

For the person with bipolar disorder, it’s even more difficult – if not impossible – to shift moods at a whim, especially someone else’s. Bipolar is a mood disorder. It affects moods and emotions in a nonstandard, often unpredictable way. Telling someone to alter their own brain chemistry merely by thinking about it is ludicrous.

Even if the bipolar person’s moods or feelings seem exaggerated or uncalled-for to you, that person is having an experience no different than when you feel elated or despairing or fearful. The emotions may even be more profound, less susceptible to alteration by force of will.

But telling bipolar people not to feel the way they feel is not just pointless, it is insulting. You are denying their perception of reality, invalidating their experience, dismissing their concerns, minimizing their problems, discounting their feelings. In effect, you are saying, “I don’t feel the same way, so your feelings are wrong. Change them to match mine.”

Imagine that you have written something – a report, a poem, whatever – and feel good about it. You’ve made your point and done it well. You’ve captured reality as you see it and communicated it in a way you think is clear and effective. Then someone comes along and reads it and says, “This is crap.” They have denied what you feel and believe. And even if they’re right, even if it is crap, they have profoundly insulted you. And, of course, they may be wrong.

Diagnosed bipolar people already know that their emotions do not run the same as other people’s. There’s no need to remind them of that. And bipolar people are generally doing what they can to alleviate their symptoms, be it through therapy, medication, mindfulness, meditation, or whatever works best for them. When you discount their feelings you are discounting them as persons. That can be anywhere from annoying to soul-damaging.

Adam Savage, of Mythbusters fame, sometimes wears a t-shirt that says, “I Reject Your Reality and Substitute My Own.” He is (I hope) talking about substituting a provable, scientific reality for a mythical, uninformed one.

But to go around substituting your own emotional reality for other people’s – and trying to make them agree with you – does a disservice to the people you think you are trying to help.

So, what would be better than saying, “Don’t feel ________”?

How about, “I know you feel _________ and I can see why.”

Or “I can tell you’re feeling _______. How can I help you?”

In other words, start by acknowledging that the other person’s feelings are real. Then ask what the person needs. This lets the person know that you understand his or her feelings and that you would like to help in the way that the person thinks best.

If you know other things that have worked in the past, you could suggest them (after validating the feelings, of course). Would you like me to run a hot bath? Do you need a hug? Do you just need time alone? Do you want to talk about it? Maybe later?

It occurs to me that this is not really news to a bipolar person. The ones who need to read it are the ones who are doing the invalidating, not the ones who feel invalidated.

So, if you know someone like that – a friend or loved one, feel free to copy this post and give or send it to them, if you think it will help. I know it helped me when I figured out what was going on and what my husband and I could do about it.

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The Tools for Tackling Bipolar Disorder

When you’re facing bipolar disorder – which is, when you have it, nearly every day – there are some things you can do to lessen its hold on you. But in order to do so, you’ve got to have the right tools. Try to collect as many as possible for best effect.

Shall we take a look at what they are?

The Usual Suspects

  • medication – to tame your symptoms, level your moods, get your brain back in gear, and/or regulate your energy
  • psychiatrist – to prescribe your medications (a primary care physician may also do this)
  • psychotherapist – to discuss with you the issues you haven’t resolved, the problems you still have, and the things the medication can’t do

Self-Care 

The two most important tools you need for self-care are sleep and food. Without either, the body can’t function properly, and if the body doesn’t function, the brain is less likely to function properly either.

Ideally, the food should be nutritious and eaten regularly, but let’s face it, that doesn’t always happen. But you’ve got to give your body something to run on. If there are carrot sticks there, eat them; if there is mac-n-cheese, eat that. If there’s Raisin Bran, well, it’s easy to eat and requires no preparation. Try for at least one substantial meal per day – two is better, if you can manage it.

(Of course, this advice doesn’t count if you have an eating disorder. In that case, see your doctor or psychotherapist or support group.)

Support

Find support where you can – a friend who’s willing to listen, a support group online or in real life. Try for a combination of these and don’t rely on any one of them for too much. Maybe you have a friend you can phone once a week; a support group that meets every two weeks; and an online group or two of people who really understand, with links to helpful articles and blogs. Before you know it, you’ve got a support system, especially if you count your therapist (which I do) or have a supportive family (which I don’t).

Spoon Theory

If you don’t know what this is, see https://butyoudontlooksick.com/articles/written-by-christine/the-spoon-theory/. Basically, Spoon Theory is a way to measure how much energy you have on any given day – and an understandable metaphor for explaining your symptoms to others, and a shorthand for other people who are also up on the theory. It can also help alleviate the guilt of not being able to do all the things you are “supposed” to do in a day. It’s not an excuse, but an explanation.

Distraction

Let’s face it, it’s all too easy to dwell on your symptoms and how miserable you are. And if you’re at the bottom of the depressive well and your meds haven’t kicked in yet, there may be nothing you can do about it.

But maybe there is. Do you know a person who tells good jokes – or really bad ones? Do you have music you used to play but have forgotten about? Do you know of a TV show that features people whose lives are an even worse train wreck than yours? Do you have a go-to movie that never gets old no matter how many times you see it? (Mine is The Mikado. )

Creativity

If that distraction involves creativity, so much the better. Coloring books and pages for adults have been the trend for a while now. (Some of them are really for adults.) Jenny Lawson draws and also puts together tiny little Ferris wheels. I know someone who can make little sculptures out of drink stirrers or paper clips. The point is, you don’t have to paint masterpieces. Just keeping your brain and your hands occupied is a good idea.

Comfort

Soft warm, fluffy things and smooth, silky things are soothing. They just are. Cats and dogs come instantly to mind (they also provide distraction). But I also have a collection of teddy bears and other plushies that I sometimes cuddle with. These are “comfort objects,” which is an actual psychological Thing. (I wrote about them once: http://wp.me/p4e9wS-k9.) I even took a plush bunny with me when I went to have a sleep study.

Stubbornness

This may be the most important tool of all. Be stubborn. Take those meds, even if you hate them. Eat that egg, even if you don’t feel like it. Go to that appointment, even if will take all your spoons for the day. Call that friend, even if you don’t think a joke will help. Post on your support group, even if you feel you are alone.

We can’t let bipolar disorder beat us. Not when we’ve got so much to beat it back with.

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When Bipolar Disorder Wrecks Your Sex Life (NSFW)

I had a hot sex dream last night. That’s fortunate, as it’s the only hot sex likely for me these days. I have bipolar disorder 2 and tend toward the depressed.

I have only once experienced the hypomanic rush that leads one to the desire for uninhibited, crazy, insistent, steamy motel sex. So I can’t really tell you much about that, except to make sure it’s safe sex, even if it is spontaneous, wild, and compelling. Coping with the aftermath is also something I can’t help with.

So. Bipolar depression and sex. (I am writing from the point of view of a cis-gender heterosexual female, so YMMV.)

It will likely come as no surprise to you to learn that bipolar disorder has an effect on your sex life. And, aside from mania, that effect is to lessen or completely kill it. And there are varying levels: low libido, lack of desire, difficulty ejaculating, etc. The question is what to do about it. Here are some examples of advice:

[S]ex is a part of life and it’s a part you don’t want, or need, to hang up just because you have a mental illness…There are therapeutic techniques that can deal with hypersexuality or low sex drive, and, of course, there are always medical options as well.

http://www.healthyplace.com/blogs/breakingbipolar/2013/01/normal-sex-bipolar/

And this:

Getting bipolar disorder under control is the first step to improving your sex life. It’s easier to address these issues when your moods are stable. Many people with bipolar disorder have healthy relationships and satisfying sex lives. The key is working with your doctor to find the right treatment and talking with your partner about any sexual issues.

http://www.healthline.com/health/bipolar-disorder/sexual-health#outlook5

And that’s all well and wonderful, but how much does it actually help?

Not that I’m an expert, but here’s what I can say about the subject.

Realize that most of sex happens in the brain. The body goes along for the ride. If you’re bipolar, you’re already having trouble with your brain. It makes sense that you’d have trouble with sex too. Don’t beat yourself up. It can be a nuisance or a sorrow or a loss, but it doesn’t have to be a tragedy.

Decide how much sex you actually need in your life. Some people have naturally low sex drives and are quite satisfied with long gaps between sexual encounters or occasional masturbation. If this is the case for you, dandy. The real problem comes when you and your partner(s) have a mismatch in your sex drive. That’s where the talking comes in.

Ask for what you need and encourage your partner to do the same. And accept and/or give what you can. If you need a hug or a cuddle, ask for it. If your partner asks for one, give it. Don’t push for more right then. Even if you have no desire for “the act” yourself, you may be able to give your partner some of what she/he needs. Or vice versa. Of course, if you’re at the very depths, you may not even be able to ask for a hug. But if one is offered, don’t turn it down. Keeping that bond going may improve your connection when the depression has eased.

You can try different medications or see an endocrinologist, but don’t expect quick results. Or any, necessarily. The one drug that peps up your libido may also be the one that gives you side effects you can’t handle. And after years of trying different combinations of pills, you may decide, like I did, that having a reasonably functioning brain is more important to you than having regular sex. In other words, you may face a trade-off.

Listen to your body as well as your brain. I already know that my brain is not performing up to specs. Occasionally, when I’m reading a book or watching a movie or remembering a dream or thinking about an old friend, I feel something that reminds me of what it is to feel desire. If that happens, enjoy and encourage it. It’s a signal that you may not be totally numb from the neck down.

I could tell you that everything will be okay and you’ll soon be back to romping between the sheets with wild abandon. I haven’t seen statistics on it, but it seems unlikely. If you want to get your sex life started again, you’re going to have to work at it, just like you work at taming your bipolar disorder.

 

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Why Do I Write About Mental Illness?

I have bipolar disorder. But that by itself isn’t the answer. Here’s why I write about mental illness and mental health.

It’s what I do. I’m a writer. It’s what I would be, bipolar disorder or not. I’ve been writing since I was a kid, and writing and editing professionally for decades. But that isn’t the whole answer either.

It’s what I have to do. I have plenty of topics to write about besides mental illness. Over the years I have written poetry; a few children’s stories; and articles about martial arts, religion, cats, education and teachers, technology, architecture, and other subjects. In addition to this blog, I have another – janetcobur.wordpress.com – in which I write about whatever crosses my mind or my path – books, news, humor, and the things that made me name my blog Et Cetera, etc.

But this blog is the one that I have to write. It started as journaling but quickly – in a matter of weeks – became more.

It’s what I am. Mentally ill, that is. A life-long acquaintance with – or rather, experience of – a mental illness makes the subject one that goes to the bone. I can’t call up a memory from my childhood that doesn’t involve desperation, sobbing, and disaffection, or fragile, giggling glee at things no one else noticed or cared about. My college years were marred by distress, anxiety, and apathy. My adulthood has been marked by breakdowns, immobility, and psychotropics. I can’t get away from the subject, even if I try.

I have the skills for it. I have read a lot about mental illness and bipolar disorder, in self-help books, more scholarly works, memoirs, and even fiction (http://wp.me/p4e9Hv-nE). I have an academic background and an intelligent layperson’s knowledge of science and psychology. I can share that perspective with others.

It helps me and others understand. Examining aspects of bipolar disorder necessitates that I learn more about it – and therefore about myself. Planning, writing, and editing posts help me clarify my thinking about this illness I live with every day. Sometimes I am just too close to it until I step back and look at it from a different or even new perspective. That’s one of the benefits for me.

The feedback I get – comments from readers and other bloggers – leads me to believe that what I write has value for them too.

It needs to be talked about. The general public – society at large – doesn’t understand mental illness. There are widespread jokes, misunderstandings, and inaccurate media portrayals. Above all, there is discrimination – in jobs, housing, medical treatment, the legal system, and more. There is more trash talked about mental illness and psychotropics every time there is a mass shooting incident or a domestic terrorist bombing.

One of the solutions to these problems is education. Most of the writing I’ve done in my life has been on (or near) the subject of education. I consider myself an advocate for education. And now I am an advocate for education about mental illness. That education should start in public and private school health or social sciences classes. It should continue in adulthood for those who never learned it in school.

Celebrities like Glenn Close and Richard Dreyfuss have big names and big audiences and a vital message to spread about mental illness. I don’t have the big name or the big audience, but I do what I can.

Because the people, including me, who live with bipolar disorder and other mental illnesses every day, need messages of hope and sympathy and experience and activism and explanation and thought and outrage and kindness.

And that’s why I write about mental illness.

 

 

 

 

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Self-Care for Overwhelming Days

It’s been said that time is nature’s way of keeping one damn thing after another from being every damn thing all at once … However, every now and then the damn things gang up on you.

– me, “The Overwhelming Problem,” http://wp.me/p4e9Hv-hy

It’s also been said, by Canadian astronaut and all-around awesome guy Chris Hadfield, that he managed to stay alive in space by always asking himself, “What’s the next thing that might kill me?” If, for example, the most immediate danger were running out of oxygen, the next thing to do would be to check your tank and hoses.

I find that attitude soothing in a way, and helpful in getting through one of those every-damn-thing days. It’s not traditional positive thinking, but it does help you set your priorities.

Today and yesterday and the day before have been examples of every-damn-thing days. I’ve gotten through by asking myself, “What’s the next thing I absolutely have to do?”

It starts when I wake up and can involve the simplest of decisions: Do I take my meds first or do I pee first? Pee first. Pee first is almost always the correct answer and is one of the Mystic Rules of Self-Care.

Do I get dressed or do I eat something? I don’t absolutely have to get dressed yet, because I’m not going out anywhere yet, so eat something. Eat something is almost always the correct answer and is another of the Mystic Rules of Self-Care.

This can get me through the entire day. What is the next thing I absolutely have to do? Get dressed. What is the next thing? Go to the bank and get money. What is the next thing? Pay the power bill. Those are absolutes if I want to have a functioning computer. And I do. Very much.

Next comes a real decision: K-Mart is right next door to where I pay the power bill. Do I stop in and get the loaf of bread I need and maybe some underwear, or do I eat first? I eat first. (See above Mystic Rules.) By the time I finish my banh mi (if I’m out and dressed and in motion, I may as well make the most of it), it’s pouring rain. Do I absolutely have to go back to K-Mart, walk through a wet parking lot, and get that loaf of bread? I do not. I go home. One errand (two if you count the bank, and I do) is a major accomplishment for me.

After I get home, there is no “next thing I absolutely have to do,” so I switch to “What is the next thing I could do?” Say there are three choices: take a nap, watch TV, do some work. Obviously, the work is out. I am spoonless by now. I decide to watch TV until closer to bedtime, then go to bed.

If there is work that absolutely has to be turned in the next day, I get up early and do it when I have a fresh supply of spoons. (After peeing first and taking my meds.)

There is also an element of creative procrastination to this. (See http://wp.me/p4e9wS-ct.) It’s like sorting your tasks into three piles: absolutely, would be nice, and meh. Not that I’m recommending writing them down. That’s not flexible enough. Throughout the day, an event can wander down the progression. “Buy loaf of bread” started out as Category 2, but the rain pushed it into Category 3. I ate the other half of my banh mi for dinner and bought bread the next day. And if I hadn’t had the banh mi, I still had a jar of peanut butter as a back-up plan. Eating it straight out of the jar is pretty depressive, but you do what you have to do when your spoons run out and you still need self-care. (Have I just discovered another Mystic Rule?)

Of course, I’m describing a moderately-functioning day. There are other days when the categories shut down after peeing and meds.

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When You Think Other People Are Talking About You

You know when you feel sure that other people are talking about you? You notice them whispering, or looking at you, or studiously not looking at you, and you think, what are they saying about me?

Two smiling friends sharing secret in coffee talkPsychologists call those feelings “ideas of reference.” (If you alter your behavior because of the supposed scrutiny, they’re known as “delusions of reference.”) Ideas of reference are often associated with paranoia. However, if you ask clinically depressed or bipolar people, you will find that many of them have them as well.

I know I have. It’s hard not to. You already feel that you’re not really normal (whatever that means) and you’re afraid that it shows. If people can see that you’re not like everyone else, they’re bound to be talking about it. Never mind that your difference is a mental one; you’re sure that everyone can tell just by looking at you that you’re crazy.

In actual fact, the people you think are talking about you usually aren’t – until you go over to them and defensively berate them or accuse them of doing so. Then you can be sure they will be talking about you after you leave.

Except perhaps in junior high school, most people in everyday life do not spend their time discussing how odd the people around them are. (Except for those people who take pictures of others at Walmart and then post them on the internet.) But the average person is too involved in his or her own daily life to give more than a passing glance to a stranger. The people you see whispering behind their hands are most likely developing their own secrets or gossiping about someone you don’t even know.

Even if the people are talking about you, ask yourself – so what? Do their opinions really matter? I know that you want to say yes, they do. But in the larger scheme of things, they don’t. Your life will not change in the slightest if they are saying they don’t like your haircut or that they heard you bite your nails. Malicious gossip and social bullying are separate matters. But again, you don’t really know that these people are saying anything that’s actually harmful.

Perhaps you feel it’s more significant if the people you think are talking about you are family members, coworkers, or friends. They may really be talking about you. The point is, even if they are, you have no idea what they’re saying. Most of the time they speak in low tones so as not to upset you, never realizing that that upsets you more. Tell yourself they could be planning a surprise party or talking about Aunt Edna’s affair with a younger man. Not everything is about you.

Ideas of reference may be a factor in imposter syndrome – the feeling that you are not really successful, competent, or talented, but are just faking it, and that everyone around you can tell. Or perhaps your ideas of reference are like intrusive thoughts – sudden, distressing notions that pop into your head, seemingly without cause or warning. These can be anything at all, from “I wonder if my passport has expired” to “Who would miss me if I died?” to “Those people are talking about me.”

What can you do if you have ideas of reference? Resist the urge to ask if the people are really talking about you. That will only make things awkward and worse. Ignore them if you can. (This is not the same as the bad old non-advice about ignoring bullies. You know when a bully targets you. With ideas of reference, you never really know if your fears are true.) Since you didn’t actually hear what the people said, you can realistically assume they were talking about someone or something else entirely. Imagine that one is telling the other that her slip is showing. (Do people still wear slips? I know they don’t wear pantyhose anymore.)

If you feel you must react, use a minimal response such as the good ol’ side-eye, which is sufficiently ambiguous that the person (who may also have ideas of reference) can assume it’s directed at someone else.

Another suggestion I’ve heard is to work with your therapist on issues of self-esteem and self-concept, or to try cognitive behavioral therapy. Some medications may help too. Still, if you feel you can manage it, I think the best idea is to tell yourself “So what?” and move on.

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Discrimination: Mental Illness and Disability

A while back I wrote a post called “Another Word for Stigma” (http://wp.me/p4e9Hv-oz), which was about the new-to-me term “sanism” and how it set up a dichotomy between the sane and the insane. While sanism may have been intended to reframe the discussion about mental health issues, I said, “We already know that stigma exists surrounding mental illness. We don’t really need the word ‘sanism’ to redefine it. Or to pit us against one another.”

When applied to mental illness, “ableism” is another word that subtly reinforces stigma. It implies that, unlike the neurotypical population, those of us with mental disorders are differently abled, mentally challenged, or – dare I say it – disabled.

Many of us – including me – have applied for disability and many – including me – have been turned down. Despite that, many of us live with varying levels of ability and disability, which are nearly impossible to see and therefore to prove.

When I applied for disability, I was in the depths of what would once have been called a nervous breakdown. I had mental deficits, emotional instability, trouble performing the skills of daily life, inability to hold a job – certainly at the level that I formerly had, or possibly not at all. My thoughts were disordered. My life was disordered. I got by only with the help of a caregiver – my husband. If that’s not at least partial disability, I don’t know what is.

By the time my claim was denied and my disability lawyer was prepping me for a hearing, however, I was, if not well, at least better. I had found part-time work that I could do at home, which provided as much income as disability would have. At his suggestion, I dropped my claim. Perhaps I shouldn’t have, because the lack of medical benefits has been a constant difficulty.

So, am I disabled? I would have to say, partly. I still cannot hold a full-time job – certainly not without accommodations – and my caregiver (still my husband) has to help me with many of the tasks of daily living.

The notion of requiring accommodations leads us to the subject of discrimination. Employers are required by federal law to provide “reasonable accommodations” to persons with disabilities, according to the Americans with Disabilities Act (ADA), for conditions including “a physical or mental impairment that substantially limits one or more major life activities,” and also to “a person who has a history or record of such an impairment, or a person who is perceived by others as having such an impairment. The ADA does not specifically name all of the impairments that are covered.”

“Reasonable accommodations” are not defined for mental disabilities, but examples of accommodations for other conditions include modifying work schedules, as well as leave flexibility and unpaid leave. But just try telling a prospective employer (as you are entitled to do) that you will need flexible hours to accommodate appointments, panic attacks, or other phenomena; or asking someone you work for to give you unpaid leave for a hospitalization. I think you know the result as well as I do.

One problem is that these forms of discrimination – which is what they are – are damnably hard to prove, as onerous and unlikely as being classified disabled in the first place. Yet the protections against these forms of discrimination are defined by law. But how many of us have the wherewithal to challenge them, prove our cases, and get by while waiting for the results of a lawsuit?

Even the act of asking for an accommodation opens us to yet another instance of stigma, and the outcome depends on the individual knowledge and understanding of an employer, when it should follow the law. We approach employers and prospective employers hat in hand, asking for – but not expecting – to get the treatment that is legally, rightfully ours.

In these days of rampant discrimination against people of any number of races, religions, national or ethnic origins, sexual orientations, and disabling conditions, our voices may not be the first to be heard. But we, the neurodivergent, the mentally ill, the emotionally disabled, the psychiatric patients, and our caregivers and loved ones deserve to be free from the effects of ableism, discrimination, and stigma.

Let’s speak up, keep educating about our issues, and support each other in banishing stigma, ending discrimination, and putting ableists on notice that we will not shut up until our rights are acknowledged.

 

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