Bipolar 2 From Inside and Out

Posts tagged ‘bipolar disorder’

What’s Good About Drug Commercials?

I’ve often bitched about TV (and, I assume, magazine) ads for psychotropics. I’ve said that I despise the fact that they make the entire public their own experts on what they need and shills for “Big Pharma.” I’ve complained that they hamper doctors by encouraging consumers to “ask if drug X is right for you” and to accept no substitutes. I’ve also said that the ads present unrealistic pictures of very serious mental conditions by making depression, for example, no worse than the flu or a hangover.

Nonetheless, I’ve decided that drug commercials do have some beneficial purposes and effects. They aren’t all evil after all. They send messages to the viewing public that are actually positive. These messages contradict the prevailing public conception that people with mental illnesses are different from other people – that the entirety of their lives is taken over by their illness. People with bipolar disorder change from the depths of despair to uncontrollable, laughing lunacy within the span of hours or even minutes. People with OCD are picture-straighteners and tile-counters. People with schizophrenia are violent criminals or raving crazies, often hospitalized for life. None of these brain illnesses can be treated, according to the general wisdom.

Modern drugs have improved people’s lives and improved the general public’s conception of what mental illness is like.

First, more of the commercials now present understandable views of what some mental illnesses are like. They do this primarily when they use analogies or metaphors. Bipolar mania is like climbing a house of cards that is destined to collapse inevitably at some point. Depression is like darkness, and medications can lessen it by bringing light. They even make the symptoms and side effects more understandable: tardive dyskinesia, for example, is depicted with actual twitches, intractable movements, and mobility issues.

Also, the ads do emphasize that there are treatments, if not actual cures, for disorders that the general public views in a stereotypical way. Take schizophrenia, for example. Most people associate schizophrenia with homelessness, psychosis, and/or raving unintelligibly. Yes, those are sometimes the consequences of the disorder, but they’re far from the whole story. I’ve seen commercials for schizophrenia medications that show a man with a family playing guitar, two women with schizophrenia calmly discussing their symptoms, and a comparison of daily pills and twice-yearly injections for treatment. They humanize an illness that too many view as intractable and untreatable.

I stand by most of my criticism of ads for psych meds. They are shallow and simplistic. They do promote self-diagnosing and self-prescription and demands on doctors. They minimize the good that talk therapy can do, concentrating instead on medical and pharmaceutical interventions. At the same time, though, these ads promote more accurate, healthier views of mental illnesses, even the most severe. They portray people who have the illnesses as having alternatives, socially productive lives, and “normal” interactions with others despite their psychiatric conditions.

I have no scientific evidence to support this theory, but my guess is that after viewing these ads, often several times a day, a poll would reveal changes in attitude. That, combined with the public service announcements about depression and even ads for telemedicine therapy sessions, may indeed make it more likely that people who live with these conditions without realizing it to better understand their own possible mental problems and those of their friends and family, and to have greater empathy toward them.

And those are good things. May the trend continue.

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Healing My Heart as Well as My Brain

My brain is notoriously glitchy. Whatever the current state of thought about what causes bipolar disorder, I feel the illness as residing in my brain. It’s a mood disorder, of course, but I can’t locate my moods in any place except my brain.

It’s taken a lot of time and effort – and money, to tell the truth – to get my brain to the point where I can live with it instead of in spite of it. It was badly in need of repair for so long that I didn’t quite realize that my heart needed repair as well.

Look, I know that bipolar moods come and go with little to no reason. That’s one of the hallmarks of the disorder. But the combination of depression and a train wreck of a relationship left me shattered. It’s hard enough to come out of that kind of depression, but add to it the fact that my first real love relationship had imploded so spectacularly and I was a total mess in both brain and heart.

I met my future husband about a week before I fled that situation, heading back to my hometown. After a couple of years of long-distance getting to know each other, he moved here, and together we started the process of helping me achieve healing.

Dan had experience working in psychiatric facilities, so he had some kind of an idea of what I had been going through. But he couldn’t help me psychologically – though he tried. It didn’t work. I needed professional help, from someone not personally or romantically involved with me. “Don’t come shrinking at me,” I once told him. If I had to rely on him for mental healing, I would become unhealthily dependent on him. What he could do was support me through the process. He was enormously patient, helping me with the small things like driving me to my therapy appointments. He sat with me when I cried and dispensed hugs liberally. It was a long journey to some kind of mental stability.

But my heart needed healing as well as my brain. I was emotionally damaged, as much as I was psychologically impaired. The two problems were intertwined, of course. My thinking and feeling lived in the same space – inside my head. And healing both problems had to happen concurrently.

There’s not a lot of point in having your moods stabilized when you’re hurting so badly inside. But a therapist can only do so much. I learned a lot about myself in therapy, but healing my heart was largely a joint project between my husband and myself.

It wasn’t quick or easy. After my previous relationship, I was not inclined to trust anyone with my heart. That’s one of the side effects of being gaslighted. I needed to relearn trust and renew my ability to let someone inside the barriers I had established. I needed relearn intimacy.

Intimacy isn’t just about sex, though it encompasses that too. Intimacy certainly relies on physical touch, which I definitely had trouble with. In my previous relationship, my bodily autonomy was not respected. Touch was an issue. Fortunately, Dan never uses anything except gentle touch.

Play was an issue, too. True intimacy involves being able to play together, and at some level play involves trust – trust that it won’t go too far, trust that it’s fun and not mean, trust that everyone is playing by the same “rules.” Dan is nothing if not playful.

Talk was always the biggest builder of intimacy for me, though. Call me a sapiosexual, but I find the ability to have deep, meaningful conversations a real turn-on. Dan and I have the best conversations. Sometimes I wake up when he does at 4:00 a.m. and we have tea and oatmeal and just chat in the morning. He helps me with ideas for my blogs and tells me things he read in his Archaeology magazine. We look up songs online and play them and sometimes we chair-dance. It’s play and conversation both, and we build intimacy that way.

So, it has taken a lot of work to heal my brain, but also my heart. Both are much better now.

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Do My Friends Really Like Me?

There have been times in my life when I thought I didn’t have a friend in the world, and my disorder was the cause of it. I was just too weird, too odd – unlovable. I didn’t fit in anywhere, with anyone.

Actually, it started in my childhood. I had the idea that my parents only loved me because they had to – because I was their child. Ergo, if I weren’t their child, they would never love me. This was very untrue and unfair, I now realize, but I lived the early part of my life believing it.

I had very little evidence that I could make friends. I just never seemed to get the hang of it. There were kids in the suburban neighborhood where I lived, but we didn’t form what you would call lasting friendships. As I recall, there were two sisters who tried to humiliate me with a cruel prank involving a Ouija board and tape-recorded “messages” from the beyond.

In third grade, children threw stones at me. I had to have three stitches in my forehead. Another kid chased me around the schoolyard with a hypodermic needle that I hope was imaginary. My “best” friend in junior high school literally kicked me in the ass in front of a group of younger kids, which led to the first major meltdown that I can remember.

Though now, looking back, high school was the time when I began to embrace my oddity. I wasn’t diagnosed yet, so I didn’t know that the depressive and manic episodes were responsible, but I was learning that there were people who would accept me regardless. I had a tight little group of three or four friends, most of whom are still my friends to this day. They taught me that lasting friendship was possible. In college, I acquired another tight little circle of friends – and one disastrous train wreck of a relationship that left me with defective coping mechanisms such as self-harm.

Since my diagnosis, I’ve found more friends. Several have not been able to adjust to my mood disorder and have broken off contact. It hurt badly, of course, but I could see their point. When I was at my lowest point, I was not able to be a good friend to them either.

So, how has bipolar disorder been involved in my friendships (or lack thereof)? First, with all the chaos inside my head and my constant need to deal with it, I didn’t have much energy left to find friends. When I did get close to people, I ended up pushing them away with my erratic behavior. Only a few kindred souls stuck with me.

I suffered from imposter syndrome too. I thought that it might look like I had friends, but they would soon realize how damaged I was and leave. Or I believed that I was faking being a friend and really had no idea how to go about it.

I ghosted people without intending to when I went into a depressive episode. If I met them when I was manicky, I might be the proverbial life of the party, entertaining with my peculiar sense of humor. The next time they saw me, though, I might be an uncommunicative, weepy lump.

Still, there are people who have known me through the whole range of my moods and my disorder, and I am confident that they are my true friends. They really like me (shades of Sally Field!) and some even love me. I have Facebook friends that I keep in touch with regularly. They provide me a link to the outside world. I have IRL friends whom I see occasionally (we tend to live in different states). I even have a few friends nearby.

I love my friends. Because of how hard they’ve been to come by, I value them greatly. They have stood by me. They have invited me to dinner, to their parties, and on their vacations. They have comforted me when I was down, distracted me when I was anxious, and enjoyed my company when I’ve been stable. They’ve cried on my shoulder and I have cried on theirs. They’ve bought my books. Some have even lent me money when I really, really needed it. They have become my family of choice.

I treasure every one of my friends – especially my husband, who is my best friend. I wouldn’t be where I am today without them.

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What’s Really Scary

It’s very nearly Halloween and there are lots of scary things out there, from costumes to movies. But here’s what I find scary.

My number one fear is the return of my bipolar symptoms, especially the depression. I’ve been mostly stable for years now, with only occasional and relatively mild symptoms when I relapse. But I still remember what it was like and I don’t want to go back there. The misery and the hopelessness. The numbness and the pain. The lack of joy, or contentment or, for that matter, even blankness.

Hypomania isn’t as scary, though I know it can and does recur from time to time. I don’t have a history of extreme symptoms and, with my husband’s help, I’m able to navigate the ones that do occur.

I can handle it if I get mild “breakthrough” symptoms when I encounter triggers. I have coping mechanisms in place, including simply waiting for them to pass, because I know they will. That trust in my resiliency – and my medications – has grown over the years.

Still, there’s always the thought in the back of my mind that the efficacy of my meds could wane. I could crash again. There’s no guarantee.

Then there’s the fear that I could develop a batch of new symptoms, triggered by God only knows what. I know that some people with bipolar disorder have hallucinations, hearing or seeing things that aren’t there. One friend of mine has heard voices for years, and another one is visited at times by an imaginary animal. (He doesn’t mind it; he says it’s always been pleasant.) Again, not likely, but then again, my brain has already been proven to be glitchy.

Of course, I do find other things scary. I am terrified of bees, wasps, ticks – anything that impinges on my dermal boundaries. I’ve been stung once and suffered no symptoms beyond the usual, but it did nothing to allay my fears. In fact, I took beekeeping in college, hoping that I would get over the fear. That didn’t work either. I still freeze, shake, scream, cover my head, or run. It’s a phobia, though not a crippling one. It doesn’t bother me enough to try eradicating it via therapy. Besides, if the beekeeping class didn’t help with desensitization, I’m not sure what would.

But there are less personal fears that I have too.

Some are societal problems. Stigma regarding serious mental illness still exists. And although people increasingly seem to be concerned about “mental health,” it turns out what they really mean is usually substance abuse or crime. Initiatives and funding tend to focus on those problems, sometimes to the exclusion of actual brain illnesses – except maybe schizophrenia, and then only as it relates to violence or homelessness. Of course, those are real problems, but there are a lot more people who need to be helped that aren’t getting attention, funding, or treatment.

Speaking of treatment, that’s another subject that’s frightening. It just isn’t available in many locations. I don’t know what the situation is regarding available beds in my geographic area, but I doubt there are many, given national trends and the complete lack of an inpatient ward at the hospital nearest me. If I did experience more extreme symptoms, I’m not altogether sure I could get good, prompt treatment.

Finding a psychiatrist or a therapist can also be difficult, bordering on impossible. When Dr. R., my longtime psychiatrist, retired, I tried to find a new one. I called the doctors he recommended, but none had openings. I turned to my primary care physician, who at least agreed to continue my psychotropics until I could find a psychiatrist. Six months later, I got in to see someone. And that was only for med checks. I had slightly better luck finding a therapist, but it was by no stretch of the imagination a breeze. Fortunately, both have managed to avoid retiring.

Call me a pessimist (okay, I’m a pessimist), but I also fear that things aren’t going to get much better anytime soon.

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On My Own

Earlier this month, my husband went away for 11 days to visit his 96-year-old mother, leaving me at home to fend for myself. I didn’t object to his going (though that hasn’t always been the case on other occasions). But it left us both concerned about how I was going to manage without him for nearly two weeks.

My husband helps me with most of my self-care needs. I guess I shouldn’t even call it self-care because he does so much of it. He makes sure I eat regularly, shops for food, and usually prepares dinner. He recognizes when I’m overwhelmed and gives me a hug. He helps me get ready if I have to go out. He does most of the physical chores. (I do the ones involving a computer, like correspondence, bill-paying, and scheduling appointments.) He calls me twice a day to make sure I haven’t fallen and been unable to get up. If I don’t answer the phone, he rushes home on his break to help me. I really don’t know what I would do without him.

For 11 days, though, I was going to have to. We hadn’t been apart this long for years.

Since one of my major self-care problems is forgetting to eat or not having the energy to make myself something to eat, he stocked up with all the things I like that were easy to fix and eat: juice, cola, ginger ale, yogurt, cans of soup, whole wheat bread, bologna and salami, assorted kinds of cheese, applesauce, and those little frozen meals for useless people like me. There were muffins and frozen waffles for breakfast, peanut butter and mac-n-cheese and spaghetti for lunch and dinner, and even jello and pudding for dessert. Everything that needed heating was microwaveable.

I often eat in my study, where there is a little tray table, so we devised a strategy for getting to and from the refrigerators. The time when I trip and fall most often is when I’m carrying several items and lose my balance. He came up with the idea that I should carry my food items in a plastic grocery bag to and from my room. We have hundreds of those bags. And it worked. I didn’t fall once. I don’t know why we didn’t think of that before.

He still called me every day, though of course there was nothing he could do for me if I fell. In fact, he called me much more often than twice a day, just to talk. We found the thing we miss most when we’re away from each other is simply shared conversation.

I developed a little routine to see me through the days. In the morning, I would have breakfast and watch a cooking show till I was awake and alert enough to start my day. Then I would do my work in the mid-morning until lunch. After lunch, more writing. After dinner, music or TV, or more work, if I had an especially pressing assignment. Go to bed early. Lather, rinse, repeat. Repetitive, certainly, but it seemed to work.

So, what did I learn from this exercise? Well, first of all, I found out that 11 days on my own is a doable thing – if we anticipate difficulties and prep for them. That I am able to continue my daily rhythms and keep up with my work, eating, and sleeping. That I experienced no recurrence of my bipolar symptoms even though my usual environment had changed. (I had been worried about depression or anxiety setting in.) That the loss of my husband’s presence wasn’t crippling. That we managed to retain our important connection despite the physical distance between us.

That photo with this post isn’t entirely accurate, though. I didn’t meet my own needs completely on my own. My continuing self-care still required my husband’s help. But once the systems were in place, I managed. On my own.

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Three Days in the Life

What’s it like to have bipolar type 2? Here’s a look at three typical days.

It’s a day when I’m depressed. I wake up late and try to decide whether to get out of bed. I do so in order to take my meds, since I have to go to the bathroom anyway. If I have anticipated this depression, I will have left a box of Cocoa Puffs by my bedside, and these constitute my breakfast.

If I stay in bed all day, I am bored, because I can’t even focus enough to read. Everything I try to read means nothing to me. If I get up, I spend a large part of the day on the sofa, watching horrible reality shows that remind me that there are other people with crappy lives too. I skip lunch. I forget that I have an iPod with thousands of songs on it. I skip therapy appointments because I’m unable to get up and dressed and drive there. I feel numb and useless and pathetic. My brain reinforces this belief.

In the evening, I cry. I weep. I sob. Snot runs from my nose. I have circling thoughts about every stupid, embarrassing thing I’ve ever done. I try to wait till my husband’s asleep so he won’t hear me crying. I wake in the middle of the night, still crying.

I have anxiety attacks too, particularly when I’m in bed at night. I wake gasping. My husband holds me and strokes my hair until I fall asleep again. It’s really all he can do for me.

My psychiatrist and I keep trying different meds, but none of them does more than take the edge off a little. I still can’t function.

There is nothing I can do to change any of this. I can’t cheer up. I can’t even see a time when I won’t feel this way. This goes on every day for months. For years, even. I’d hope for an end to this, but I have given up on hope.

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It’s a day when I’m hypomanic. I wake up early, not exactly refreshed, but with a more-than-usual alertness. I take my meds, then go downstairs and have a muffin and a container of yogurt for breakfast.

I go to my computer and start writing. I may have an assignment – typing or ghostwriting – or I may just work on new blog posts. The momentum of writing stays with me and presses me to keep going. I write lots, but badly. Maybe I forge ahead and write another blog post or volunteer for more typing. I forget that I need lunch.

I jump around from project to project. I scroll and scroll through Facebook. I check my email every few minutes. I go to clothing websites and order underwear and pajamas and blouses. I look at jewelry, too. I check my bank account at least four times.

I don’t read, because nothing holds my attention. I watch competition shows because of the excitement. I try to listen to music, but I can’t finish one song without flipping to another.

I may notice that I’m hypomanic and try to control it. This goes on for a week or so. I hope it ends soon.

______________________________________________________________

It’s a day when I’m stable. I wake up after nine hours of sleep and take my meds. I have a bowl of oatmeal and a cup of tea for breakfast. I check my calendar and see what I have scheduled for the next few days, such as an appointment with my therapist or finishing my writing or typing assignment. I have peanut butter and fruit for lunch.

I do my work. I reread what I wrote when I was hypomanic and immediately start revising it – if I haven’t already submitted it. I take on new assignments and try to space them out so they’re not overwhelming. Sometimes I even succeed. I keep a calendar on my computer with dates of appointments for both me and my husband, when assignments are due and when bills need to be paid, and which week is recycling week.

I meet with my therapist once a month via video chat and see my psychiatrist four times a year for medication updates. The only time I miss one of those is when my car is at the mechanic.

I’m very close to “normal.” I hope this goes on forever.

This post first appeared on The Mighty.

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Murder and Delusions of Grandeur

Sometimes when I’m hypomanic, I write. I think that my writing is terrific. This does not always prove to be the case.

I wrote a murder mystery for literally years on and off. I put heart, soul, and sweat into it. I kept revising. I had a bulletin board with index cards of plot points that I moved around, trying to find the best sequence and flow. At last, one day I declared it finished.

I sent a query and a sample to over 100 agents and publishers. I waited. I kept a list of everyone I contacted about my novel, and I marked them off the list when they rejected me. None of them bit except the you-pay-us types that I had accidentally included and scorned. My prospect list was long, so this went on for months.

No doubt I was hypomanic when I decided the novel was done, and when I sent those queries. I wasn’t even deflated when I started getting rejections back. Out of 100 queries, I thought, surely there would be some takers. Maybe there would even be a bidding war for the publishing rights. I started doing research for the sequel and even started writing it.

As I waited, I basked in thoughts of success. I would be a guest at mystery conventions. I would do a book tour. I even imagined that I would receive the Edgar Award (mystery’s Oscar) for Best First Novel. I pictured myself receiving the email telling me that I was nominated and the phone call informing me that I had won.

Of course, I eventually came down when one of the rejections actually told me why my manuscript was being rejected and what was wrong with it. Faced with that reality, I had to admit that I had deluded myself. I had needed to rework the novel a lot more before submitting it. I had needed to workshop it with fellow writers, preferably those who knew something about mysteries. (I had sent the first few chapters to some volunteer beta readers, but they had made comments only on small details, not the structure, pacing, or characters.) I realized at last that I had submitted a manuscript that had a great prologue, but that everything after that needed serious work. Despite the time and effort I had put into it, it just wasn’t good enough. And that was the reality.

That was the longest spell of hypomania I’ve ever had – about a year. Of course, I was doing other things while I wrote and while I waited. I had some depression and some mixed states, but not about my mystery novel. I was exhilarated with that.

What I had were delusions of grandeur. I imagined the success without putting in enough work to achieve it. Despite the evidence of all the rejections, I persisted in believing that I had produced something wonderful and worthy. I anticipated plaudits and acknowledgment of my writing prowess and remarkable achievement. My hypomania was giving me messages that I was great, just as my depression had always given me messages that I was nothing. And I was deluded. I believed the hypomanic messages.

I have abandoned that manuscript and taken up other projects. I have also abandoned my research and writing for a sequel. I still have problems recognizing the actual merits of my writing, or lack thereof. I try to keep my expectations in check. I have some successes and some failures, though none nearly as monumental as the mystery. I live with my limitations instead of flying with my fantasies. Have I lowered my horizons? Well, yes. But I like to think that now, at least most of the time, I view the horizon where it really is.

I did love the exuberant feelings that I experienced. They gave my life a sense of meaning. If I learned anything from the experience, it was that I couldn’t, or at least shouldn’t, pin my sense of personal worth on something that isn’t real.

Of course, when I’m in the grip of hypomania, it’s hard to realize that.

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Body and Brain: Self-Image

I’m fat. I admit it. I haven’t been fat all my life, so this came as something of a surprise to me, but I’m dealing with it. I don’t know whether it’s my eating habits or my medication or some genetic thing that has caused me to gain weight, but there you have it. It could be any or all of those.

I’m not trying extreme diets or grueling workouts, though I admit that some exercise would be good for my mental condition as well as my body. I’m living with and acknowledging the fact that I am fat.

The thing is, when I think about myself, I don’t think of myself as fat. Perhaps I’m in denial about it. But I do know how much I weigh and that it’s over what I should, according to all the height vs. weight and BMI Index charts. And I don’t think of myself as thin. I just feel as though I’m still in my 30s and weigh what I weighed then, despite my body’s very clear rejection of those notions. I know I’m really in my 60s and have trouble getting up off the floor if I fall, in part because of what I weigh.

I’ve heard that everyone gets stuck in their head at a certain age and always remains that same age in their mind. It’s not quite like having an inner child of four or ten (or in my case, more like 15). I used to think I didn’t have an inner child until I remembered how much I still love chocolate milk, plush animals, and naps. And I do have that inner teen that wants to make up for all the things I missed when I was a depressed teen, like mad crushes and experimenting with fingernail polish and fake nails. But having an inner weight is different somehow. It’s like my brain and my body are clashing in some way.

At least I don’t have Body Dysmorphic Disorder. That’s when you see tiny, imperceptible flaws in yourself and magnify them until you think that’s all people see when they look at you. Technically, it’s not the same as anorexia because, in anorexia, you focus only on your weight even if you are thin. Anorexia is an eating disorder that you have as a reaction to your flawed perception of your body size. Dysmorphic Disorder is more about smaller perceived flaws such as balding or the size of your nose. (The Mayo Clinic does say that Body Dysmorphic Disorder can cause or be associated with eating disorders, low self-esteem, mood disorders, obsessive-compulsive disorder, and substance abuse. The DSM-5 does not classify Body Dysmorphia as an eating disorder. It’s confusing.)

One of the dangers of Body Dysmorphic Disorder is overuse of plastic surgery, which can be somewhat of an addiction in itself. Just watch a few episodes of the TV series Botched and you’ll see what I mean. There are always horror stories like the one in which a young man wanted to look like Michael Jackson and as a result of repeated surgery suffered the same health problems and conditions that the singer did.

If I had Body Dysmorphic Disorder instead of the ones that I do have, I might be undergoing multiple treatments of liposuction, “cool sculpting,” tummy tucks, gastric bypass, extreme fad diets, weight-loss pills, and other procedures. I don’t and won’t. I’m aware that those are only temporary fixes and leave you open to disappointment, infection, scarring, and other bad effects and complications that can be worse than your original condition and stay with you for life.

So, where does that leave me? Besides fat, I mean. I try to be body-positive about people who don’t conform to societal messages about weight, including myself. It’s a difficult thing to get over. The messages are relentless. I have found myself in the past thinking that fat is unappealing and in the present thinking that extreme thinness is dangerous. But that’s only in the abstract. Any number of men I’ve been attracted to have been anywhere from pudgy to fat, including my husband.

I realize that I may get a lot of pushback from people telling me of all the medical reasons I should lose weight. I’m not saying they’re wrong. I’m just saying that if I’m comfortable with being fat, they could at least be okay with my fatness as well. In other words, I already struggle with my mind. I don’t want to struggle with my body too.

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Divisions in the Mental Health Community

It’s sad when communities that ought to work together for the betterment of all are divided by strife. But that’s just what has been happening in the world of mental health.

Even saying “mental health community” is controversial. There are different segments of the population who say that “mental illness” is the more accurate term. Then there are those who advocate for the term “brain illness” while advocating for adequate supports and services.

Indeed, what to advocate for is another discussion. Many people are trying to root out the stigma that goes with having a mental illness. Others say that’s a waste of time – that what is really needed is advocacy for improved treatments and more accessible services. There is, of course, the possibility that one could advocate for both, but the issue seems to be that the stop-the-stigma people are pulling focus away from those who campaign for social and political (and financial) reform. The situation seems complicated by the fact that many “It’s okay to have difficulties” promos actually promote online therapy businesses.

Then there are the different “what causes bipolar disorder?” schools of thought. For years we attributed it to a chemical imbalance – neurotransmitters such as norepinephrine, serotonin, and dopamine not performing their job properly. Now many people think it’s caused, or at least exacerbated, by something else – heredity and genetics, environmental and lifestyle issues, or some combination of them all. Treatment with psychotropic medications, which is the most common for bipolar, tends to lend credence to the neurotransmitter theory, although it’s generally accepted that we don’t have any real idea of how they work.

The drugs used to treat bipolar and other disorders such as schizophrenia are controversial too. Many people credit them with saving their lives. Some others describe them as “neurotoxins.” One typical Facebook post said, “They are powerful, toxic drugs which can cause a chemical lobotomy and terrible adverse effects such as akathisia, dyskinesia, Parkinson’s, dystonia, and many other tortuous, real effects. Many people are left on these drugs for life.” This is one of the milder posts reacting to psychotropic meds. Many also speak of withdrawal symptoms and lives ruined. They also state that Big Pharma is partly to blame: “The sale of psychiatric drugs will continue to increase and force will still be part and parcel of psychiatry….If we have hearts we will not expect psychiatry with all its terrible past of fear, force, and fraud to understand any human being or society!”

Treatment for various disorders, particularly schizophrenia, is widely debated as well. Some people are appalled by involuntary commitment or “forced hospitalization and drugging,” while others see it as a valid procedure for anosognosia (the inability to recognize that one has an illness), as this increases potential harm to self and others. “Assisted Outpatient Treatment” or AOT, a form of supervised drug administration for those who have been released from treatment facilities is gaining adherents. Lynn Nanos’s book Breakdown: A Clinician’s Experience in a Broken System of Emergency Psychiatry makes a strong argument for AOT.

In fact, psychiatry itself is a disputed issue, and not just by Scientologists who feel that all mental illnesses are caused by whatever it is that can supposedly be cured by their practices. (You can probably tell that I don’t give any credence to their beliefs.) But psychiatrist Dr. Thomas Szasz railed against psychiatry in books including Psychiatry: The Science of Lies and The Myth of Mental Illness. Here’s a quote from The Science of Lies:

Because there are no objective methods for detecting the presence or establishing the absence of mental diseases, and because psychiatric diagnoses are stigmatizing labels with the potential for causing far-reaching personal injury to the stigmatized person, the “mental patient’s” inability to prove his “psychiatric innocence” makes psychiatry one of the greatest dangers to liberty and responsibility in the modern world.

With divisions like these, it’s no wonder that mental illness diagnosis, treatment, and priorities are large contributors to the broken system in the United States. Is it a healthy debate? Are they irreconcilable differences? Is there something to be said on both sides? Does science back up any side or does passion prevail? And will any of these debates be resolved in the near future? I believe that until the community gets together on a lot of these issues, not much will get done that will truly help sufferers.

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Why Can’t I Sleep? Why Can’t I Wake Up?

Image by fizkes

Often in the past, I went to bed at my usual time but woke up at 4:45 a.m. and couldn’t get back to sleep, no matter what. It was like I had a hamster on a wheel inside my brain.

Other nights I would go to bed early and couldn’t get to sleep for hours. I tried reading, but sometimes I read till 2:00 a.m. with no sleep in sight. (I know you’re not supposed to read when you want to get to sleep because it activates your brain, but it’s been my nighttime habit for decades. When I find that I am reading the same paragraph twice, I know it’s time to knock off and fire up the CPAP machine.)

Then again there are days when I feel the need to nap in the early afternoon. I try to resist, but if I give in, there are no refreshing catnaps for me. I’m down for two and a half hours typically. Then the whole sleep-wake cycle gets off course.

And when I’m in the middle of a depressive episode, I’ve been known to stay awake all night, obsessing and catastrophizing. There are also days I can’t get out of bed in the morning, or all day in some cases, though I don’t usually sleep well after them.

What is it with all the sleep disturbances? Well, I have bipolar 2, so that may have something to do with it. An article published by the National Institutes of Health (NIH) says, “Sleep disturbance is a core symptom of bipolar disorder. The diagnostic criteria indicate that during manic episodes there may be a reduced need for sleep and during episodes of depression, insomnia or hypersomnia can be experienced nearly every day.” They also note that insomnia and hypersomnia are early warning signs, or “prodromes,” of a bipolar episode occurring. In fact, sleep disturbance is the number one prodrome for mania, and is recognized by approximately 80% of those suffering from it as an indication of an impending episode.

Webmd discusses a number of ways that bipolar disorder is associated with poor sleep: either insomnia or hypersomnia (over-sleeping); decreased need for sleep; a circadian rhythm sleep disorder; REM sleep abnormalities which can affect dreaming; and co-ocurring sleep apnea (around a third of people with bipolar also have sleep apnea, which is associated with excessive daytime sleepiness and fatigue). Bipolar meds have also been known to affect sleep-wake patterns, as well as co-occurring substance abuse disorders.

What are the consequences? Sleep deprivation has demonstrated detrimental effects on cognitive functioning, particularly in teens and young adults. This has been observed in performing psychomotor vigilance tasks, working memory tasks, and cognitive processing tasks. No wonder a series of sleepless nights can result in a foggy or fuzzy-headed feeling!

Unfortunately, the advice given for how to counter the effects of sleep disturbance in bipolar disorder is almost indistinguishable from the advice given to the general population, such as incrementally moving bedtime and waking time until the desired period of sleep is reached; and not using electronics such as computers, cellphones, and TVs near bedtime. Some preventives that have worked with bipolar patients have included bright light therapy in the morning and the use at bedtime of supplements containing the naturally occurring hormone melatonin that the body releases in response to darkness.

My own experiences with sleep deprivation and bipolar disorder have been a mixed bag. For many years before I was diagnosed, I was subject to the difficulties caused by shift work, either third or second shift. (When I was on second shift, we sometimes extended our sleepless periods by playing cards or midnight miniature golf after the shift was over.) Third-shift work made me too tired to drive safely, especially if I was also working first shift the next day, which sometimes happened. My husband pitched in and picked me up on those days. My friends knew never to call me before noon.

For a while I took a prescribed sleep aid, but sometime during the last year realized that as my sleep-wake cycle was regulating to a more “normal” pattern, and that the sleep I got without the meds was more refreshing and conducive to clear thought in the morning. So I quit taking it, with the approval of my psychiatrist. Even though I work at home and make my own hours, my work schedule has become predictable as well. Now I wake around 6:00 or 7:00 a.m., check my emails and timeline, have some breakfast and start my work (when I have some). I break for lunch, then resume work in the early afternoon. (And pray I don’t get any more work that day, as sometimes happens.)

As for getting to sleep, it’s usually not a problem (except when it is). Any more, I take my nighttime meds, read for about 30 minutes, and drift off to sleep normally. I usually only need a nap if extra work requires that I stay up late in the evening or get up very early in the morning.

So, does “Sleep, that knits up the ravelled sleave of care,” as Shakespeare described it, exist for people with bipolar disorder? I’d say, not for everyone, but when it does, it’s always welcome. We all have our various sorts of “ravelled sleaves” that need tending to.

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