Bipolar 2 From Inside and Out

Posts tagged ‘bipolar disorder’

Can I? Can’t I? Bipolar and Business

I work freelance at writing and editing, and as many of you know, that life is fraught with insecurity. How much work will I get? How much will I be paid for it? Will the check be enough to cover the mortgage and the health insurance? Anything else, like light and cable and phone, which I need in order to work from home?

Since  I’m bipolar, these questions are laced with more than the usual amount of anxiety. Especially since the progression toward my last major breakdown was a lot of what caused me to lose that 9–5, well-paying job. My attendance became spotty, my attention refused to focus, my relationships with coworkers went downhill, my evaluations took a turn for the worse, and I bailed.

I stayed immobilized for a long time, applied for disability (didn’t get it), then embarked on freelance work.

I’m much more stable now. I’ve have published this blog and my other one for over two years, and proved to myself that I can attend business meetings, at least once in a while. My paying work has built up to the point where we can at least live paycheck to paycheck, but not much more. Time to spread my wings?

So I started looking around for other jobs, in addition to my faithful, steady client who has sustained me for years now. First I asked them if they could send any more work my way. Then I started expanding my platform, as we say in the writing biz.

I joined LinkedIn. And there, one day, I saw a listing for someone who needed an editor. One with exactly my skillset. Precisely my experience. The kind of work I love to do.

But.

It was full-time, likely high-pressured, and 45 miles away (during rush hour). I knew those factors would make it impossible for me to succeed at the job, even if I got it.

But.

I wanted it. I wanted to have back the things I lost after my breakdown – my competence, my confidence, my pride. Oh, and the money too.

But.

Much as I wanted to, I couldn’t let myself apply for it. I didn’t want to trigger the kind of meltdown I had before. I didn’t want another period of literally years when I could do nothing – not work, not take care of myself, not cook, not read. Nothing.

So, with reluctance, I let the opportunity pass by. I went back to my blog posts and my irregular freelance work. I occasionally do some non-paying work for organizations like the International Bipolar Foundation (IBPF), or Sheknows.com, TheMighty.com, and even redtri.com. I lined up a gig editing a friend’s dissertation.

Then, as it sometimes happens, another opportunity appeared – a part-time paid position with a company that already knew my work. Steady work. Pay. Work at home. All this could be mine if I applied, passed the editing test, and was able to work the number of hours per week I rather optimistically said I could. I’ve taken the test (it was two hours long and grueling, the kind I used to give to other people). And now I wait, more or less patiently, never my best quality.

And while I wait, I wonder. Am I even capable of doing half-time paid work at home, plus my other freelance assignments, plus my blogs, plus the novel I’ve written about 1/3 of? Can I do the part-time job (if I get it), without my disorder screwing me up too badly to do it or anything else well? Is hypomania tricking me again? Do I have to give something up to get something better? Will it really be better?

The answer to all those questions is, “I don’t know.”

My disorder surely lost me the 9–5 job I once had. It made me give up the idea of trying for that similar job that seemed “just right.” But at least now I have some ambitions again.

Can I? Can’t I? This balancing act of higher ambitions and lowered expectations is delicate.

 

 

 

 

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mental health

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But What Happens in January?

Health insurance is a hassle, especially when you’re talking about mental health. And it’s an even bigger hassle when the government gets involved. That’s not necessarily a bad thing, but it does add a layer of complexity to the insurance process.

For quite a while I was uninsurable, or functionally so. My husband and I both had decent insurance when he worked for the county, but after he left that job, it was all downhill. We muddled through without coverage, paying for our meds out of pocket and avoiding the doctor’s office unless death seemed imminent or we had to have blood work. Mammograms, flu shots, and other preventive services fell by the wayside.

Then came the Affordable Care Act, aka Obamacare. Our pre-existing conditions were no longer a factor. My mental health coverage was guaranteed without going through the county’s EAP plan (Employee Assistance Plan, a six-week, take-the-therapist-we-give-you, cure-’em-quick affair).

The only problem (well, the major problem) was that, even with the ACA subsidy, the insurance cost us $650 per month. And my doctor started prescribing Abilify (cost: $800 per month, and wouldn’t you know, it wasn’t on the insurance plan’s formulary of preferred drugs). Fortunately, the generic came out soon after. It still wasn’t cheap, but it was somewhat lower.

The next year we switched plans. Unfortunately, the new company, a co-op, went under and we were transferred to yet another plan. It was no better than the previous one. In many ways, it was worse.

Prescriptions, for example. After getting them filled at our pharmacy for a certain number of months, we were told that almost all our meds MUST be ordered for home delivery, or the insurance company would not pay for them.

Which would be fine, as they were maintenance drugs. Except that meant paying $1100 for three months of generic Abilify, in addition to the monthly premium for the insurance. I can’t scrape together a lump sum like that, so through GoodRx coupons (https://www.goodrx.com/?c=criteo_au&utm_campaign=activeuser) and the local Kroger, I managed to get my prescription for under $200 per month.

Then the real fun started. My husband’s meds and my non-psychotropics went through the mail-order system easily. The ones my psychiatrist prescribed, not so much.

I’ve just spent the time between November 19 and now trying desperately to get the mail-order place and my doctor’s office to talk to each other, fax each other, send smoke signals or carrier pigeons to each other, to get me my drugs. As I gradually ran out of meds, which I’ve written about before (http://wp.me/p4e9Hv-kO).

I finally got a little action when I went to my doctor’s office, camped out in the waiting room, talked to one mail-order person on the phone while the receptionist talked to another one on another phone, and the nurse worked the fax machine. Then I went home, called mail order again, jumped up and down, threatened to hold my breath until I turned blue, asked for the supervisor, talked to the actual pharmacist, and almost burst out sobbing. Yesterday I got my pills.

This time when I had to pick a new insurance plan or renew my old one, I found one that was almost exactly as crappy as our previous one, but at one-third the cost. And the company representative says that all generics can be bought, at either the pharmacy or via mail order, at the same low co-pay. Including generic Abilify.

We’ll see.

The next problem is, as I’m sure you’re all aware, the president-elect and Congress have sworn to repeal Obamacare as soon as they get into office, whether or not they have a plan to replace it.

What will happen then?

Will I be able to get affordable insurance?

Will I be able to get insurance at all? (Even crappy insurance is better than none.)

Will it cover mental health services? Outpatient? Inpatient? Both psychiatrists and psychotherapists?

Will it cover psychotropic drugs at the same rates as others? Or will the meds that really work for me not be in the formulary of preferred drugs?

And how long will it be before even the crappy, but lower-cost, insurance that begins on January 1st, disappears?

I’m guessing (hoping) that our insurance won’t vanish immediately, given the pace at which the government usually moves. But repealing Obamacare (though not replacing it) has been touted as one of the first things the new administration will do. And anxiety is one of my psychiatric problems. How long will I have to wait, unknowing, to learn what those answers will be?

Generally, I have anxiety when I don’t know what’s going to happen. I catastrophize, then feel at least a little better when the answer comes. (It’s usually not as bad as I had anticipated.)

But this time, when the answer comes, will it lessen or increase my anxiety?

And will I be able to afford the medicine that keeps my anxiety in check and the psychiatrist who prescribes it?

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mental health

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Blogging While Bipolar: What I’ve Learned

Next month, this blog will be three years old, an unruly toddler of a blog with jam on its face and a sticky plush animal grasped in its fist. Except for one dry spell of about a month during the first year, I have posted every week in both this and my general purpose blog, Et Cetera, etc. (janetcobur.wordpress.com).

My husband often tells me that he’s proud that I am doing this and that I have stuck with it so long and faithfully. (He doesn’t often read my posts, but that’s another matter.)

nightblogWriting while bipolar is not always easy, but blogging has taught me a few things about myself.

Blogging is a substitute for going outside and having a social life. While it’s generally true that my disorder has abated over the years, at least from its worst, I am still unable – or perhaps unwilling is more accurate – to go outside for more than a doctor’s appointment, or a brief errand and lunch with my husband. But I am still connected to the outside world through my blog. I have friends, I have conversations, I get feedback. I have special blogging friends like Bradley, Raeyn, and Dyane. (I also live vicariously through Facebook, but that’s another story.)

I need structure, and blogging gives me that. I used to post randomly, whenever I felt like it. Pretty quickly I discovered that Sunday was the day when my blog got the most traffic, so I made that my official blog post day. Working at home as I do, I tend to lose track of where I am in any given week. Is it Tuesday? Thursday? It’s hard to tell. But having a writing schedule clears that up.

On Monday and Tuesday I pre-write – think about articles I’ve read or conversations I’ve had and jot down a few titles or ideas or URLs. On Wednesday I begin writing. My goal is to have a rough-ish draft by the end of Thursday and a nearly finished one on Friday. Friday and Saturday are for tweaking the writing, selecting a visual, and tagging. Then Sunday, I proof and post. (I also tweet a quote from my most recent post on Tuesday and a quote from an earlier post on Wednesday, plus a “coming attractions” post on Friday announcing Sunday’s topic.)

It’s a loose enough schedule that I can build in actual paying work around it.

For me, blogging and other forms of writing are better than journaling. My journaling quickly turned into whining. It was boring, even for me. I need real content to interact with, whether that be my blogs, a memoir, or the mystery novel I’m working on. Writing engages and invigorates my poor broken brain, giving it something to do other than wallow or turn to mush.

Even when I think I can’t write, I can still blog. Back when I was able to work full-time, I wrote and edited for magazines and textbooks. I used to boast that I could write 1000 words on anything. Blogging is more forgiving. I can stop at 500 words if that’s all I have to say. I can pick my own topics instead of writing to order based on someone else’s priorities. And that schedule I mentioned? It’s not an actual deadline, so I don’t have to worry about it whizzing past. When the pressure’s off, I can almost always make my Sunday goal.

Blogging validates me. I have two degrees in English (one from a pretty classy university) and worked in educational publishing for about 20 years. Then my brain broke and it all went away. Now that I’m writing regularly, I feel that in some way I’m using both my education and the skills I’ve built up.

By blogging, I prove to myself that bipolar disorder may have taken away some parts of my life, but it can’t have everything.

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mental health

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Relentless Holiday Cheer

a snowmanFor many of us with bipolar disorder, the holidays are hard to get through. There is stress caused by family, shopping, entertaining, and crowds. Or the celebrations of others can bring loneliness, isolation, immobility, and despair. Above all, there is the relentless, overwhelming, mandatory cheerfulness, and the expectation that we should feel that way.

As I write this, tomorrow is Thanksgiving. A bit over a week later is my birthday. Then comes Christmas. And, of course, New Year’s Eve and Day.

Every year these celebrations are a trial and a chore for me. I don’t know how you get through them, but this is what they usually look like for me.

Thanksgiving. We have no family in town, so it is just me and my husband. Actually, this is not bad, because it relieves us of the responsibility for massive cooking, anxiety-filled entertaining, and the always-dicey interactions with family. At most, it means we Skype with my mother-in-law while we all eat, which is taxing enough.

This year we are short on funds, so we’re having spaghetti instead of turkey. (I don’t like to do turkey anyway: http://wp.me/p4e9wS-2z.) Then we will indulge in our two traditions: the Thanksgiving episode of WKRP (“As God is my witness, I thought turkeys could fly.”) and the ceremonial playing of Arlo Guthrie’s “Alice’s Restaurant.” Then we nap. That’s it.

And what am I thankful for this year? I can’t think of much, except for my husband and cats, and that my pdoc just increased my Abilify. It hasn’t kicked in yet, except to make me sleepy, but, hey, a nap is on the schedule anyway.

Birthday. This is one of the big ones, with a zero at the end. My husband has already given me my presents (a variety of shoes and slippers). I can reliably predict that there will be a day-old baked good from where he works. No singing, no candles. That’s the way I like it. I’ll count the number of greetings I get on Facebook and feel miserable no matter what it is.

(My attitude toward birthdays is colored by the fact that a traumatic childhood event happened at a birthday party, although not my own.)

Christmas. The biggie. We exchange gifts ahead of time, without wrapping them. We go to the Chinese buffet. Dan watches a movie that I can’t stand, like Mr. Magoo’s Christmas Carol, or one I can sort of tolerate, like It’s a Wonderful Life. Or one I actually like, like Scrooged.

New Year’s Eve/Day. We used to go to a friend’s house for leftover Christmas cookies and singing “Oh, Danny Boy” on the porch (don’t ask), but she was one of the people who couldn’t put up with my bipolar isolation and tendency not to respond to invitations or to show up if I had. So that’s out now.

Dan’s family has a tradition of shaking their purses or wallets at midnight to ensure prosperity for the new year (it failed spectacularly last year). He’ll be working, so we can’t even kiss at midnight. I drink cheap champagne and go to bed early. We might have pork on New Year’s Day. Or not. But unless we have cole slaw or Dan opens a can of sauerkraut for himself, no cabbage.

If that sounds like a dreary holiday season, well, it is, but it’s all I can handle. I have tried. I really have. In years past I have bought Christmas sweaters and earrings and sent cards and entertained and done Secret Santas at work. I have had dinner with family. (Decorating is largely out, owing to the cats.) I have organized trips to fancy local buffets or restaurants. I have wrapped presents creatively (if sloppily) and even shopped off-line. I have baked spice cake and decorated sugar cookies with my friend Peggy. I have gone to community carol sings.

But no more. In many ways, like my life, my holidays have been pared down to the bare minimum. I approach them with dread and survive them with relief. They do not lift my spirits and nowadays I don’t expect them to.

It’s ironic that, though in many ways I am improving and healing and rebuilding my life, the holidays still defeat me. They are, at least for now, pieces that I can’t reclaim. I don’t think it would be much better if a bout of hypomania hit. I can just see myself buying presents for my far-flung friends, then bottoming out before I could mail them. You can’t time these things, after all.

The best I can wish for myself and for all of you is this:

Survive. Hold tight to whatever happiness you find. And please, please, get through this season any way you can.

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mental health

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Advice for the Bipolar Writer

Writing can be therapeutic – and more.

Writing can save your life – or someone else’s.

Every one of us, depressed, manic, or bipolar, has something to say.

I say, “Say it!”

Although I’ve never been one to respond to that ancient exercise in which you express your unspoken thoughts to an empty chair, I am a proponent of expressing your unspoken thoughts. I just think writing is a better way to do it.

Getting your thoughts and feelings down on paper or preserved in pixels is a positive, life-affirming action, even if your thoughts might not be. Giving voice to your inner workings can help you understand yourself and your brain better.

And if you choose to share them, they can help others too.

There are many different kinds of writing you can explore and experiment with until you find the one or ones that are right for you. Here are a few you can try.

Journaling. Many therapists recommend journaling to keep track of your moods and mood swings. You can also keep track of your exercise and sleeping and eating patterns in your journal. These factors may help you pinpoint physical symptoms that accompany your emotional ones. And you can get a read on how your meds affect your symptoms and how troublesome the side effects are.

Unsent letters. I have a separate file in my computer for these, just so I remember not to send them. I write letters not to send when I need to vent at or about a person, but am not sure whether I’m overreacting. I can express my feelings without taking the chance of ruining a friendship or hurting a loved one.

Sent letters. Sometimes, after you’ve let those letters or emails sit for a while, you decide that you do need to send them – or at least parts of them. Letters or emails are often the best way to communicate regarding difficult topics because you can think about what’s important to say, consider the best way to say it, and revise if your thoughts are not coming out the way you want them to. You still might want to wait a day before you send them, though.

IMs and comments. When you read someone’s post or a comment that really resonates with you, don’t hesitate to let that person know. If you don’t understand something in a post, just ask. If you disagree, feel free to do so politely. These are chances to open a dialogue, get more information, or correct misconceptions. They can lead to friendships if you comment regularly, but even a word or two of support or thanks can mean a lot to the writer.

Blogging. I started blogging because my journaling was boring and whiny, and I decided I had more important things to write about. There are basically two kinds of blogging about bipolar disorder. One is to share your experiences – your mood swings, your triggers, your relationships, your healing, your thoughts and meditations. The other is to write about issues related to bipolar disorder – treatments, stigma, social policy, news items, books, or opinions. Of course, you can combine both types of writing in your blog, which is what I try to do.

Blogging is powerful. It lets both professional and untrained writers speak their truth and share their thoughts. A blog about bipolar disorder has a “niche” audience – people interested in the subject themselves or because they have a friend or relative with the disorder. This means that you will likely never rival the Bloggess in numbers of readers, but you can touch the lives of hundreds of people.

Blogging does not have to be difficult. You can post every day or every week, every month, or just when it suits you. You can write informally or in a more academic vein. There are a number of platforms, such as WordPress and Live Journal, that make it easy for you to get started, and to make changes as your blogging needs evolve. You can add illustrations and video clips, and links to news stories or other blog posts. Eventually, you may want to have your own personal web page to host your blog.

Fiction and poetry. If you don’t want to put your own experiences out on the web for anyone to see, you could try transforming them into fiction or poetry, or inventing characters and plots that resemble you not at all. Many magazines and other outlets use short stories and poems, and works that feature bipolar characters and themes are not common. Fiction and poetry can be ways to reach an audience that might otherwise never learn about the reality of bipolar illness and its effects on people and relationships.

Longer works. You could even write a book (which is something I’m trying to do). There are many genres to choose from, including nonfiction, memoirs, and novels. Aside from Abigail Padgett’s Bo Bradley series of mysteries, there isn’t much fiction featuring bipolar characters that are true-to-life and not stereotyped. These are long-term projects and, truthfully, you (and I) may never finish them or have them published. But just the effort is worthy.

Whatever form of writing you choose, get started! Whether you write for yourself or for a larger audience, you can make a difference. And if you feel the desire, you should definitely try.

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mental health

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Another Word for Stigma

Stigma concept.Recently I was reading an article online and came across a word I had never encountered before: sanism.

I don’t like it.

Oh, I realize that it’s meant to go along with all the other “isms” – words that point out how the world decides who is worthy of respect, then campaigns for the rights/recognition/understanding of the disrespected. There are lots of “isms,” some familiar by now, and others that just never quite made it.

racism

sexism

nationalism

feminism

elitism

ethnocentrism

ableism

lookism (This one didn’t catch on. It means that pretty people are advantaged.)

colorism (Not quite the same as racism, it refers to the idea that lighter shades of brown skin are preferable to dark ones.)

Not all of these terms are equally adequate. Sexism, for example, refers to the divide between male and female, and implies (though does not call out) heterosexism in particular. It ignores the experience of people with other kinds of gender expression – genderfluid, pansexual, and trans, for example. It probably should be “cis-sexism,” but then everyone would spend an hour explaining that when they tried to use it.

Ableism is another term that has problems. In its basic form, it contrasts the able-bodied against the disabled, or rather points out that the rights and even the humanity of the disabled are discounted. I bet some of you are wincing at the phrase “the disabled.” Times change and terms change. Right now the preferred term is “person with disabilities,” though we have been through other versions – “differently abled,” “physically challenged,” etc.

The general rule in these situations is to call people what they prefer to be called. But how do you know which term that is? Negro, Black, black, non-white, colored person, person of color, and probably a few I’m missing have had their day. And if you use Black, do you also have to use White? Many people do not understand the word Caucasian anymore, and certainly can’t explain why it means the same as white. Nothing you can say will satisfy everyone. Perhaps the best solution is simply to call everyone “Chuck,” or “Emily,” or “Mariko,” or whatever.

So. Back to sanism. My first problem is how to pronounce it. San-ism? Sane-ism? And if the latter, shouldn’t it be spelled saneism? Do we need a hyphen (sane-ism) to keep it from being mistaken for an unfamiliar religion?

But the real problem goes deeper than that. Sanism implies that there are two categories: sane and insane. If you’re not one, you’re the other (and discriminated against, but let’s put that aside for now).

Personally, I have a mental illness (bipolar 2), but I don’t think most people would classify me as insane. And there are many other people with OCD, PTSD, phobias, anxiety disorders, etc., who have difficulties because of them but are by no stretch of the imagination insane. Do we go back to the days when anyone with a neurosis was sane and anyone with a psychosis was insane? Does anyone still divide the world up that way, or has the DSM caught up with reality?

What, then, do we call ourselves? Non-sane? Not-sane? Mentally ill? Mentally challenged? Mentally unhealthy? Neurodivergent? Emotionally disordered? Nothing seems to encompass all of us. Nothing seems to work. But the “ism” suffix implies lining up two groups to make it easier to talk about the differences between them. It doesn’t always work perfectly – racism can be black/white, black/Asian, Hispanic/Anglo, etc. – and you sometimes have to define exactly what you mean.

Admittedly, the sane (able-minded? neurotypical?) have automatic, inherent advantages over whatever-we-decide-to-call-ourselves. Housing, jobs, even service in restaurants are weighted in favor of people with no psychiatric/psychological label or diagnosis.

But wait! We already have a word for that – stigmatized. Sanism sets up the contrast between those who consider themselves “normal” and those that the normal consider “abnormal.” In other words, stigmatized.

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.

We have mental or emotional disorders. We are discriminated against – hated, feared, shunted aside, diminished, discounted, blamed, or avoided – because of that.

That’s stigma.

That’s what we have to fight.

Not “sanism.”

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mental health

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The 5 Stages of Depression

One of my depression triggers has been well and truly tripped and I am experiencing the long plunge downward. It’s been quite a while since this has happened, but oh, how well I remember it.cracked egg conceptual image for birth

In the classical Five Stages of Grieving, depression is the fourth, right before acceptance. For me, in the Five (or however many) stages of depression, the first stage is (duh) depression. I guess the next four would be immobility, numbness, despair, and Total Meltdown.

Right now I would have to say that I am somewhere between depression and immobility. I got out of bed for a few hours today, and I am writing this. I managed to get a big project done before this bout of depression hit, which was a Good Thing. I also now have a good supply of meds on hand, which is, I think, an Even Better Thing.

The Best Thing is that I have Dan, my husband. He just made sure I got a hot meal and is now giving me space and alone time, which is what I need more than attempts at engagement. And a cat just licked my face, which would be comforting if he hadn’t just been licking his butt.

As Jenny Lawson says, depression lies. Right now it’s telling me I’m useless, helpless, guilty, and ashamed. I hope that at least some of these are lies, though at the moment they’re what my brain is telling me is true. Then add in a large helping of catastrophizing, which at the moment is more likely to happen than not. I can’t see a way out.

Since I’ve been through this process before, I know the things that will help (at least a little) and those that won’t. I’ll try to keep my brain engaged enough to continue writing, and I’ll try to intersperse the doom and gloom with some ideas I made notes on before all this hit. I feel a responsibility to this blog and its readers to keep the thing going as best I can.

Based on my estimate, this episode is likely to last a minimum of two months. Maybe this time I can stop the slide before Total Meltdown. Wish me luck.

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mental health

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The Scientific Tease

Fun doctor

I know the headlines and accompanying news stories are supposed to give us hope: New Treatments for Mentally Ill, Scientific Advances for PTSD Suffers, How Research Is Finding Causes – and Possible Cures – for Bipolar Disorder, Brain Science May Explain OCD.

But the reality is that those headlines are teasers. Once you read the story, you realize how little is new, how far from reality the science is, and how long it will be until the supposed cures make any difference.

I’ve written on the subject before (http://wp.me/p4e9Hv-7Z), and included a link to a short video that explains the scientific process, from original study up to the time when a new drug or treatment hits the market (http://www.vocativ.com/culture/junk-science/).

But drugs aren’t all the scientific world is offering for people with bipolar and other mental disorders. There are transcranial stimulators, magnets, fMRI, and other technologies that hold promise for at least understanding our illnesses and, in some cases, treating them. Studies of the human brain, DNA, epigenetics, neurotransmitters, precursor chemicals, and more are touted as ways to unravel the mysteries of why some people get mental illnesses and some don’t; why some medications work for some people and not for others; and how the medications that actually do work do what they do.

If you are buoyed by the hope these scientific articles and the advances they hold out, you may envision a world in which parents can tell when a baby is liable to depression and watch for early signs; a troubled teen can be diagnosed with bipolar 1, 2, or psychotic bipolar; which particular “cocktail” of drugs is the best fit for an individual; how a small machine can send signals to the brain that will ease the symptoms of, well, anything.

Unfortunately, that’s not true. Oh, there is scientific research going on – although there would be more if funding for mental health issues were taken more seriously. But not all that research will result in effective, practical treatments for mental illness – more closely targeted drugs, new understandings of various psychological models, new methods of diagnosis. A breakthrough, when it comes, may even be discovered as an unexpected side effect of something else entirely.

Besides, can you imagine these wonder drugs and diagnostic tools, and nanobot treatments (or whatever) making it to the vast majority of the mentally ill? Will psychologists be able to send clients to get an fMRI to pinpoint problems, and will the insurance pay for that? How would you convince a homeless schizophrenic to place his head in that clanking machine, hold still for half an hour, and answer question? How long will it take the FDA to study and approve a new drug, and will it cost $12,000 or more per year? And will insurance coverage even be available because it’s still considered “experimental”?

Frankly, I can’t see most of these heralded miracle treatments making their way down to the community mental health center level anytime soon, even once they’ve been developed, tested, proven, and put on the market. Like so much of medicine, I fear psychiatric advances will be available only to the rich or those with platinum-level insurance. And although one in four Americans will experience some form of mental illness in their lifetimes – and millions more friends, relatives, caregivers, and loved ones will be affected by it as well, psychiatric topics don’t draw government or university funding or charitable support the way other conditions like HIV, breast cancer, and heart disease do.

So forgive me if I see those uplifting headlines and think, “Pfft. More pie in the sky.” I do think progress is being made and will continue to be made, but I doubt whether it will be soon enough, or tested enough, or cheap enough, or available enough to benefit me. You younger folks, now – you may still reap the benefits of these remarkable advances. But in the meantime, while you’re waiting for that magic pill or Star Trek device, keep on taking the meds you’ve been prescribed, and talking to your psychotherapist, and building a support system, and taking care of yourself.

For now, let’s work with what we’ve got.

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mental health

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Self-Care and Sleep: Fact or Fiction?

Every article you see about self-care for bipolar disorder will tell you, Get enough rest or Get enough sleep.

Sleep is that golden chain that ties health and our bodies together.  – Thomas Dekker

But what did Thomas Dekker know? For many of us, proper, beneficial sleeping is easier said than done.

Neon light owlEven with my prescribed Ambien and Ativan, I’ve done the wide-awake-at-3:00-don’t-get-to-sleep-till-5:30 thing. And the unsettled-from-nightmares-afraid-to-go-to-sleep thing. (Also the just-one-more-chapter thing, but that’s my own fault.)

Then the next day I have to take a mega-nap (http://wp.me/p4e9wS-iO), which leads to guess what? More insomnia.

But this coin has another side as well. There are days when all I do is sleep. A full night plus (at least 10 hours), then a mega-nap, then right back to bed after dinner.

I don’t think I was awake for much of my childhood. I did a lot of napping. This might have been a defensive measure against encroaching depression. – Michael Ian Black

I know that part of my problem is my husband’s work schedule – third shift – and wanting to be awake at least at some of the same times that he is.

Another part of the problem is my medication. If I wake at 8:30 (yeah, I work at home) and take my meds, I’m down for the count again until at least 10:30. Or 11:00. Or even noon. I hope my clients think that I run errands in the morning or work on my projects with chat, IM, and phone turned off so as not to be disturbed.

And then there is my meal schedule, which is just as erratic as my sleep schedule. Most days I try to eat at least one good, full, hearty meal (another self-care recommendation, though they usually advise more than one meal). But after I eat – especially a hefty meal – I get postprandial torpor, the technical term for why you fall asleep on Thanksgiving after eating all that turkey. (And you thought it was the tryptophan.) And there comes another nap.

The repose of sleep refreshes only the body. It rarely sets the soul at rest. The repose of the night does not belong to us. It is not the possession of our being. Sleep opens within us an inn for phantoms. In the morning we must sweep out the shadows.  – Gaston Bachelard

But recently, it’s been the not-able-to-sleep thing. There’s a Tarot card that symbolizes the feeling – the 9 of Swords. In the Rider-Waite deck, the image is of a person sitting up in bed, hiding her face, with nine parallel swords floating in the background. I always refer to it as The Dark Night of the Soul. (The 6 of Cups usually means something like Childhood Memories, but for me it means “See Your Therapist.”)

(Note: I had a rather irregular introduction to the Tarot deck, and for me it acts sort of like a Thematic Apperception Test. I apologize to those of you I have just offended in one way or another.)

Sleep is when all the unsorted stuff comes flying out as from a dustbin upset in a high wind. – William Golding

Anyway, a recent event caused me a fair amount of trauma that I had to suppress at the time, and it came out immediately as bloody horrible nightmares the next time I slept. I haven’t had any more of those since, but I suspect they’re still lurking at the back of my brain.

That we are not much sicker and much madder than we are is due exclusively to that most blessed and blessing of all natural graces, sleep. – Aldous Huxley

I guess what I mean by all this is that sleep as self-care is wonderful, if it cooperates. But there are so many things that can go wrong and screw it all up – grief, guilt, depression, sorrow, anxiety, fear, loneliness, restlessness, obsessive thoughts, worries. It doesn’t feel like something that I have much control over.

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Reaching the End of My Cope

Helpless Woman Holding RopeAnymore, I don’t very often have days when I can’t get out of bed, but this week I had one. It doesn’t matter now what caused it, but I am feeling the lingering aftereffects. Today I had no choice but to get out of bed, and I thought as long as I’m up, I might as well blog.

(Actually I can blog in bed too, since my tablet will take dictation, but it’s not optimal.)

I had been headed for bed-bound all week – the slowly creeping whelms; the feeling of being nibbled to death by mice; the recent trauma of two pets’ deaths; a game I couldn’t win, couldn’t break even, and couldn’t get out of. Expected relief came three days too late.

Aside from not eating, not getting out of bed meets many of my needs – quiet, rest, naps, not having to fight off the numbness and care about anything. And yes, there’s some feeling sorry for myself in there too. I won’t try to deny it. Staying in bed is a big messy wad of self-pity, anhedonia, lack of energy, trying to stave off thoughts, and generally not being able to give a shit about anything. It is more than sadness. It is as J.K. Rowling described the Dementors: You feel as if you will never be happy again. In other words, there’s nothing worth getting out of bed for.

When I was searching for images to go with this post, I entered “end of rope.” I guess I expected to see cute kittens dangling and inspirational quotes like “Hang on Baby, Friday’s Coming!”

Instead, what I found were endless images of nooses. Nooses by themselves or with people in them. Overturned chairs under nooses. Photos, illustrations, every conceivable image of nooses. According to the visual imagination of illustrators and photographers, “end of one’s rope” means suicide. There were some images of frayed or broken ropes, but the nooses were in the lead by at least four to one. (There were also a few nautical pictures with coiled ropes, but they weren’t statistically significant.)

That’s not what I mean by “end of my rope” – not dangling kittens OR nooses. Staying in bed all day, being unable to function, is a long, long way from suicide. Indeed, I find it a mechanism that staves off thoughts of nooses. Staying in bed admits of the possibility that tomorrow, or maybe the next day, I will have the wherewithal to drag myself out of that bed. Or that something will force me out of the bed and I will have to respond, as it happened today.

Hence the title of this piece. I have not reached the end of my rope – certainly not to find a dangling noose at the end of it. I have not reached the end of my hope, because I believe that some day (I hope soon) I will be out of the bed (at least as far as the sofa, and then who knows?). But when I stay in bed all day, I have reached the end of my cope.

This is not exactly the same as reaching the end of my spoons, because I don’t use up any spoons by lying in bed. And I don’t really know, or perhaps don’t believe, that I will have a new supply the next day.

I expect that some people will beat me up for being so useless as to give up for even a day, to be unable even to try. I know I’m beating myself up over it too. But today I am out of bed, for at least part of the day, and I am writing. That means there’s at least an inch of rope left. An inch of cope.

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