Bipolar 2 From Inside and Out

Posts tagged ‘books’

Trigger Warning: Trigger Warnings

What is a trigger warning?

Let’s start with a more basic question. What is a trigger?

Just as a literal trigger activates a gun, a figurative trigger activates your mental disorder. It’s a stimulus that sets off either a manic or depressive phase, or a bout of PTSD.

Triggers are usually unique to the individual. What sets you off may not affect me at all.

Over the years I’ve learned what my triggers are, and so do most bipolar or PTSD sufferers. Loud noises and large crowds trigger my anxiety, which is why I could never work at a Chuck E. Cheese. My depressive phases don’t often have triggers except for bad dreams about an ex-boyfriend. Most of my depressive episodes just happen without a trigger.

Generally, one avoids triggers, because who needs more manic or depressive phases in addition to those that occur naturally, with no prompting?

A trigger warning is something else. It is a notice that someone puts at the beginning of a piece of writing to warn readers that the subject matter may be intense. Ordinarily, trigger warnings are given for major life events that have caused trauma and may cause flashbacks, severe stress  or other extreme reactions.

Some of the most common trigger warnings are for graphic depictions of rape, suicide, self harm, or physical or sexual abuse. The trigger warning says to a potential reader: If you don’t want to encounter this material, if you think it will make your illness worse, or cause you undue stress, don’t read any further.

Although we call relatively minor stimuli triggers, they usually do not require trigger warnings. If you’re going to write about having a fight with your mother, you probably don’t need to put a trigger warning on it. If your mother hit you in the face with a frying pan and sent you to the ER, you might need to place a trigger warning on your post about it.

Online, the standard form for trigger warnings is first to state, often in all caps, TRIGGER WARNING and state the type of trigger it is – TRIGGER WARNING: SELF-HARM, TRIGGER WARNING: SUICIDAL THOUGHTS, etc. To be extra sensitive, the writer leaves a number of blank spaces or a few dots before beginning to write the difficult material. This gives the reader the choice of whether to scroll down and read it or not.

Trigger warnings have become controversial, particularly in schools and colleges. Many pieces of literature and even textbooks on history or sociology discuss difficult topics that may be triggering. For example, a novel might feature a rape as a plot point, or a history text might discuss slavery.

Some people believe that a trigger warning will help a prospective reader know whether reading further will provoke a strong reaction. Other people believe that trigger warnings are a way of coddling the weak and letting students avoid challenging material that is necessary for the class.

My own opinion is that a trigger warning is like chicken soup: It won’t hurt and might help. It may mean that a student asks for an alternative reading or assignment, but it also may mean that the student simply wants to be in a safe space – not surrounded by strangers, for example – before reading the material.

People that believe trigger warnings should not be given have usually not experienced the kind of emotional breakdown that can result from unexpectedly confronting a traumatic topic. Very likely they have never even been in the presence of someone who has had such an extreme reaction.

I suppose that ideally, we could all read any material and simply brush it off if we found it troubling. Unfortunately, for those of us with mental disorders such as bipolar illness, PTSD, and anxiety disorders, this is simply not possible. A trigger warning may prevent someone from having a public meltdown and others from having to witness one.

I don’t know why that should be controversial. It seems like simple courtesy to me.

Those Science Fiction Crazies

There has recently been a huge kerfuffle in the science fiction community regarding the Hugo Awards. You don’t really need to know much about it and probably don’t want to. Suffice it to say that two groups had it out over the past and future direction of science fiction and fantasy, and the meaning of the asterisk.

The awards have now been given, but still the blogosphere is full of recriminations, sour grapes, and schadenfreude.

What does this have to do with mental health? Aside from the fact that very smart people can behave like vicious toddlers, it’s interesting to note that the various sides in this dispute did not always, shall we say, acted rationally. You probably guessed that from the asterisks.

This phenomenon is not unique to the Hugo Awards. If you have never been to a science fiction convention, let me tell you about it.

Most of the people there will be very intelligent, obsessive about their particular fields of interest, lacking in social skills to various degrees, and will have a history of being outcast or bullied in their youth.

Does any of that sound familiar?

I’m not a psychologist (nor do I play one on TV), but I can’t help thinking that if you tested everyone at one of these events they would score higher than a random group of people on the autism spectrum. Simply put, the SF community appears to have more than its share of Aspies – and a fair sprinkling of bipolar, depressive, and OCD people.

When their oddities are carried to the extreme – and they often are – SF fandom can devolve into incivility that results in unconscionable threats and exceedingly ugly online behavior.

When you see these kinds of behavior, it is tempting to dismiss science fiction fans as being the caricatures that the media have instilled in us – clueless losers who live in their parents’ basements, show up at jury duty dressed in Star Trek uniforms, and insist that Harry should have ended up with Hermione.

Admittedly, to a certain extent that is true. If you look around at a convention you will almost certainly see a number of people who conform to that stereotype. I myself have a relative who could be Queen of the Get-a-Lifes.

What you may not see is that, despite the cluelessness, rudeness, sometimes elitist or misogynistic behavior, obsessiveness, and disregard for the feelings of others, the science fiction community is actually, at heart, a place where the non-typical person can find a group of like-minded individuals to talk with, obsess with, bond with, and occasionally practice social skills with. It fullfills a very real social and psychological need. Without the science fiction community, whether online or in “meatspace,” many of these people would have little or even no place to have much of a social life at all.

Certainly the stereotype is not true of all members of fandom. Most hold regular jobs in technical, creative, or other fields, have families and close relationships, and negotiate their way through modern society as well or poorly as anyone else. But there are consistencies in their background. Most are incessant readers and have been since childhood. Many have been the targets of cliques in school and the workplace. A number would be described by their neighbors as quiet loners (though this is not to imply that SF fandom harbors more spree killers  than any other group). They have odd senses of humor or in some cases none at all. In a very real sense, sf fandom is for them, as one song would have it, made up of “My Thousand Closest Friends.”

So if you happen to be in a hotel and find the meeting space is overflowing with people dressed as Klingons, robots, and giant furry animals, remember that they are mostly harmless and enjoying a moment of fitting in to a part of society that celebrates and honors their differences and shares their pride in their oddness. Where they can relax and be themselves, without worrying about seeming weird or threatening or being put down, avoided, or scorned. Think of it as a support group with parties, art shows, panel discussions, music, costumes, movies, and chocolate.

A lot of us with mental disorders are glad to know that such places exist. A lot of us wish we could find or make such places, too.

Maybe Another Manic Monday

The great Abilify experiment continues. I’m still roller-coastering, which is “normal” for me, but I really can’t tell whether the drug is affecting the ups and downs.

The highs and lows do seem to be higher and lower (respectively). I am dubious about this being a Good Thing. For several days I was so thoroughly depressed that I was ready to call Dr. R. and tell him I need to stop taking the drug. Then I leveled out to my usual place on the continuum – functioning, but not spectacularly well or consistently.

Now I think I’m starting to get manicky. One way I can tell is that I actually had fun, laughing and playing with my husband the other night and exulting in getting an old friend to walk straight into an awful joke. (Me: Have you heard the new Ebola joke going around. Him: No, what is it? Me: Eh, you probably won’t get it. Him: No, c’mon, try me. Me: That WAS the joke. Him (in evident pain): Oh! Oh! Oh! Oh! Oh! Oh!)

But the real clue that the upswing may be swinging more than it should. I’m thinking about starting more blogs.

I already have two – this one and a general purpose blog called Et Cetera, etc. (janetcobur.wordpress.com, if you’re interested). For over six months I met my goal of posting something in both of them once a week.

Then the big low hit me. But I’m back on track now, after several weeks’ absence.

The thing is, I have ideas for two other blogs. I just don’t know if I could handle them.

One would be Cats, Etc. – stories and anecdotes about life with cats, cat care and health, and so forth. We have three cats right now (Louise, Garcia, and Dushenka), plus many former fur-family members, so there would be no shortage of material.

The other idea is Books, Etc. I’m an avid reader, and though the bipolar has sapped my concentration so much that it varies between 20 minutes to two hours at a time, I’m starting to see some progress. And I find myself wanting to write about what I’m reading – maybe book reviews, maybe lists or quotations, maybe even some lit crit (my original background).

But could I maintain them? And not have them drain off the limited energy that I should use to do the freelance work that pays the bills.

I think it is a sign that I’m still fairly well anchored that I haven’t rushed off and started them already. But the yearning to do more reading and writing keeps getting stronger. Maybe I could keep my current two at once a week, and do the others on alternate weeks. But that would still mean three blog posts per week, plus the freelance. Frankly, I don’t know if I could handle it. I keep asking myself, should I try? Or should I wait to see if my moods level out on the Abilify and it becomes clear whether they are Good or Bad Ideas, or even possible.

Words – both reading and writing them – have sustained me for most of my life. It was a sign of my most profound depression when I found myself unable to maintain enough focus to read. Now that I can again read and write to some extent, do I dare to push myself, push the boundaries? Can I? Should I?

Good thing I see my psychotherapist today.

Read Your Way to Sanity

As reported in Smithsonian magazine, “Doctors are now prescribing books to patients with depression, hoping that reading will help them find connections.”

Here’s the link, but I’ll hit the high spots for you. http://www.smithsonianmag.com/smart-news/doctors-are-now-prescribing-books-to-treat-depression-180948211/?no-ist

First, let’s note that this is third-hand information – from the U.K. National Health Service to the Boston Globe to the Smithsonian. (Fourth-hand, if you count this blog.) Many of the details and even the explanation of the concept may have lost quite a bit in the transitions. But here are the basics:

 If your primary care physician diagnoses you with “mild to moderate” depression, one of her options is now to scribble a title on a prescription pad. You take the torn-off sheet not to the pharmacy but to your local library, where it can be exchanged for a copy of “Overcoming Depression,” “Mind Over Mood,” or “The Feeling Good Handbook.” And depression is only one of over a dozen conditions treated.

There are also books prescribed for other conditions including, I presume, bipolar disorder. And they sound a lot the old self-help books of the sorts we read in the 1970s, of the Women Who Are Ambivalent About Women Against Women Against Feminism sort (h/t The Bloggess for that awesome title).

Back then I was diagnosed with depression, and back then the Common Wisdom said, “Depression is anger turned inward.” Now that we know more about brain biochemistry, neurotransmitters, and such, advice from a book called “Mind Over Mood” is not likely to be all that much help. And God spare me from anything called “The Feeling Good Handbook.”

Of course the Brits’ prescriptions are not actual bibliotherapy, which is a real thing, defined by  The American Library Association thusly:

The use of books selected on the basis of content in a planned reading program designed to facilitate the recovery of patients suffering from mental illness or emotional disturbance. Ideally, the process occurs in three phases: personal identification of the reader with a particular character in the recommended work, resulting in psychological catharsis, which leads to rational insight concerning the relevance of the solution suggested in the text to the reader’s own experience. Assistance of a trained psychotherapist is advised.

This is a much better idea, but again, it’s advisable to check the publication dates on those books. The extremely popular book I Never Promised You a Rose Garden was written before anyone really knew about the genetic and biological components of schizophrenia.

I’m sure there is modern fiction that would be useful in bibliotherapy. Personally, I think that the Dementors in J.K. Rowling’s Harry Potter books provide as good a description of depression as I’ve ever heard:

[T]hey glory in decay and despair, they drain peace, hope, and happiness out of the air around them… Get too near a Dementor and every good feeling, every happy memory will be sucked out of you. … You will be left with nothing but the worst experiences of your life.

Rowling herself has spoken about the connection:

It was entirely conscious. And entirely from my own experience. Depression is the most unpleasant thing I have ever experienced. It is that absence of being able to envisage that you will ever be cheerful again. The absence of hope. That very deadened feeling, which is so very different from feeling sad. Sad hurts but it’s a healthy feeling. It’s a necessary thing to feel. Depression is very different. I think [dementors] are the scariest things I’ve written.

As for me, I find insight into mental disorders primarily in nonfiction – though not necessarily in books with a psychiatric or psychological perspective. The Noonday Demon: An Atlas of Depression by Andrew Solomon is, I think, essential for any collection. It combines the author’s own experiences with historical, cultural, philosophical, and other ways people have thought and written about depression.

Generally, though, I prefer memoirs of people who have lived through or with the conditions they write about. Although my diagnosis is bipolar disorder type II, I also read memoirs about people with other conditions. There are many similarities of experiences, symptoms, feelings, and other aspects that I find familiar or helpful.

Being an ardent bibliophile as well as a psychiatric patient, I believe in the potential of bibliotherapy. Being a former consumer of self-help books, I sincerely doubt that genre will do much good.

On Dithering

If dithering were a power source, I could light up Chicago. Good thing it burns nerve endings instead of fossil fuels.

The last couple of weeks have seen a lot of dithering and anxiety. I hardly ever get to enjoy the rush of hypomania – except for that one brief spell a few weeks ago – because it comes out sideways as anxiety.

I also have a third-degree black belt in catastrophizing.

Both have gotten a workout lately, since a cyst was discovered in my left breast. (I wrote flippantly about mammograms on my other blog, so irony gifted me with this.)

I checked my usual sources (Mayo Clinic website and a friend who is a biologist and had a lumpectomy), and the consensus was that I had only the remotest chance of the anomaly turning out to be anything really dire.

Do you think that stopped my dithering?

Hell no! Of course not!

What could have gone wrong?

They could have stuck a needle in my breast to aspirate fluid and get a sample for the lab. (A friend who should know tells me that some people do this kind of thing for fun. Somehow, it doesn’t appeal to me.)

If the results were worse, I could have been scheduled for a lumpectomy. There was extra anxiety on this one because my friend almost had a mastectomy instead of a lumpectomy when the surgeon started making the wrong incision. (An operating room tech noticed, saving the day and the breast.)

And of course, my anxiety told me that a mastectomy could be in my future (either on purpose or accidentally, I suppose). My mother had a mastectomy, which added extra oomph to the dithering.

A mastectomy would suck for oh so many reasons. Cancer, surgery, body image issues, obviously.

Also, I would keep falling over to the right. And before the operation I’d have to take my breast on a farewell tour for all its friends and admirers.

Maybe worst of all, I would have to put up with all the pinkness and positivity. Not to denigrate this strategy for those who find it helpful, but I am not that person. Anyone with my brain chemistry is not going to respond to slogans and cheerleading and daily affirmations. (Reminder – As always with my posts, YMMV.)

Barbara Ehrenreich has written about this phenomenon in Bright-Sided: How the Relentless Promotion of Positive Thinking Has Undermined America.  Apparently many breast cancer survivors feel they must get something positive from the experience – appreciating life and family more and so on.

We’ve come a long way from Betty Rollins’s First, You Cry. Now it seems like we’re never supposed to.

The anticlimactic but welcome result came today: Everything is OK. I just need to keep up with yearly mammograms.

And now I can move on to the next thing that needs dithering about – the work I wasn’t able to do while I was catastrophizing.

My Brain, My Books

It used to be that I could never be found without a book within arm’s reach. I had a purse book, a nightstand book, a bathroom book, and a car book at the very least. (I kept them straight by having a different genre in each location.)

Now that I have a Nook e-reader, I have hundreds of books with me everywhere I go. But I’m doing a lot less reading.

I think it’s a function of my lack of concentration, but whether that’s the disorder or the meds, I couldn’t say.

I do know that when I was in the depths of my most recent breakdown, I barely read at all. I watched moronic reality shows like Trading Spouses, on the theory that these people’s lives were bigger train-wrecks than mine. And I watched cooking shows, because they were calming. (This was before cooking game shows really got going.)

During an earlier meltdown, I tried to watch sitcoms, but the relentlessly upbeat theme songs made me weep.

Now I have to hoard my concentration like I hoard my spoons. I am fortunate enough to be able to work freelance from home. But it’s the kind of work that sometimes has deadlines. On days when I can force myself to work, I can concentrate for about 2-1/2 to three hours at a spell. Some days I have to do two sessions like that with a nap in between, if a deadline is approaching too rapidly.

But when it comes to non-work activities, I can usually only concentrate for an hour at the most. Sometimes I try really hard so that I can watch a movie, but mostly I stick to half-hour or hour-long shows.

But reading takes concentration too, especially if the book has a plot (which I recommend) or is information-rich nonfiction. I do a lot of my reading in bed at night. (Yes, I know you’re not supposed to do that because it keeps you from falling asleep. But it’s a life-long habit.)

My mind flitters, the hamsters and sometimes the badgers stir, and I find myself several pages along with no idea what happened. At that point my need for distraction and my attention span collide and I have to find something moderately absorbing but short-term to do. It’s a good thing I have some games on my reader so I can play a hand of rummy or work a sudoku puzzle.

Reading has been one of the great joys of my life, since I was four, and it bothers me that I no longer have the ability to immerse myself in it the way I used to.

But, like so many other things, it’s something I’m having to learn to live with.

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