Bipolar 2 From Inside and Out

Posts tagged ‘choice’

Can I Choose My Emotional Reactions?

Back before he started on his path to learning how to live with me, my husband used to refuse to say he was sorry if he hurt my feelings. “I didn’t mean to,” he would say.

“If you stepped on my toe without meaning to, you’d say you were sorry,” I replied.

“Yes, but if I stepped on your toe, I’d know I hurt you.”

“I tell you that you hurt my feelings. That’s how you know you did.”

“I can’t control your reactions. I say something and you react with hurt.”

“I can’t choose my reactions when you step on my toe. It hurts and I say ouch. It’s the same when you hurt my feelings.”

We’d go around like this for a while.

Later, he came around to the idea that I couldn’t control my reactions. There were things that he couldn’t see inside me, from my emotional triggers to my bipolar disorder. At last, he admitted that I couldn’t control my reactions and learned to apologize even for things he didn’t mean to do.

Later still, he claimed that maybe I couldn’t control my emotional reactions, but that I had control over what I did about them. I maintained that I couldn’t necessarily do that. My feelings were hurt and I cried. I could choose whether or not to leave the room or stop speaking to him, but the tears were not optional. They were not something I could choose or control. Believe me, I’ve tried.

Our admittedly small example has larger implications. There seems to be a lot of things we’re supposed to be able to control. In the illustration above, your mind, your relationships, your emotions, your actions, and your words are said to be things you can control.

I would disagree with some of that. As my experience with my husband showed, I couldn’t control my emotions – I didn’t choose them. I can’t control my relationships. There’s another person involved, with a lack of control over their emotions as well.

And my mind. When you live with serious mental illness (SMI), you’re acutely aware that, a lot of the time, you can’t control your mind. From overthinking at one end of the continuum to psychosis at the other, the mentally ill mind does what it will. Personal choice can’t control it. We’re not able to reach inside and change our brain chemicals or the past traumas that influence our minds and our choices. Sometimes medication and therapy can’t control the mind either.

There are also a lot of memes – and people’s opinions and statements – saying that we can control whether we are happy or not. “Choose happiness.” “The only difference between a good day and a bad day is your attitude.”

I’m not even sure that’s true for people who don’t have SMI. Emotions aren’t something that can easily be switched on and switched off. Before I was correctly diagnosed and properly treated, I simply had to go through a spell of depression and wait for it to pass. It’s still largely true for me, except that now I know that the depression will pass, and a lot sooner than it used to.

I don’t think that it’s a good idea to deny your emotions, either. If you feel hurt or sad, let yourself feel that feeling and work through it. It may be trying to tell you something – that you’re angry for a reason, for example, and need to address that reason. Or if you’re sad, recognize that there’s something making you sad and stay with that sadness for a while. Forcing yourself to behave cheerfully denies the reality of your emotions and merely puts a mask on them. And that’s not healthy. Sooner or later, those feelings will leak out from behind the mask or shatter it.

I’ve always been a great believer in choice. But there are things I don’t think a person can or should have to choose. Emotions and our reactions to them are not within our control. Our actions are – leave an abusive relationship, seek help for mental illness, take medication every day, and so much more.

But not everything about us is subject to choice, and I think it’s better to recognize that than to deny it.

(And for those of you who are curious about it, my husband and I have chosen to work on our individual and mutual problems and have accomplished 40 years of struggle and working together to control what we can accept and what we can’t. We choose that struggle and that work every day.)

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When Your Thoughts Run Away With You

Overthinking. It’s something we all do at times – so many of us that it cannot really be said that it is automatically related to mental illness. But in some cases, it is a symptom.

Let’s start with depression, a subject about which I know a thing or two. When I was in a depressive phase of my (undiagnosed) bipolar disorder, I could, as the saying goes, overthink a ham sandwich (once I actually overthought a BLT). When I was depressed and/or anxious, it seemed as though I had a recorder in my head that would play back for me every stupid thing I had ever done – even such a small thing as handing the wrong person a glass of water. At random moments, the memory would pop up, usually with full color and sound, and I would again castigate myself for being so stupid.

I agonized over decisions. Should I call a friend to tell him or her about a phone call I received that might affect them? One time it was the right thing to do, with positive consequences. Another time it was also the right thing to do, but with negative consequences. Dilemmas like that made it even more difficult to know what to do. Indecision paralyzed me. When I couldn’t figure out the consequences ahead of time, I couldn’t know if my decision was correct. Of course, this is true of most people and many decisions, but the dilemma would derail my thoughts and leave me vacillating.

Intrusive thoughts are quite often symptoms of depression and bipolar disorder, and they can be valid or nonsensical. Are my children getting an appropriate religious education? Where is my passport (when no trip is remotely planned)? They can keep one awake at night.

Psychologically speaking, overthinking and intrusive thoughts are definitely symptoms of OCD. Did I lock the door? Better check three times. Did I leave the stove on? Better check four times. Has the milk in the refrigerator expired? Did my cat get out the door when I wasn’t looking? Better go out and look around. Will I throw up when I ask my boss for a raise? Better not try. Does my aching knee mean I’m getting arthritis? Should I call my doctor about it? Will he think I’m imagining it? My mother only loves me because she’s my mother, not because of who I am. These kinds of thoughts can be disabling, crippling, or at the very least painful. They can cause you to doubt yourself and everything you do.

In mania, overthinking comes later. While you are spending or gambling or having risky sex or driving recklessly you don’t question it. It’s only later, when the episode wears off, that you have intrusive or obsessive thoughts. Oh, my God, why did I do that? How can I ever pay for all that? Are my finances so screwed up now that I can’t pay my rent? Did I binge drink and hurt someone? I’m so ashamed. I feel so guilty.

Cognitive Behavioral Therapy (CBT) may be one way to confront your intrusive thoughts and push them aside in favor of more productive thinking. Talk therapy of the usual sort may help you develop coping mechanisms for when your thoughts run away with you. And psychotropic medication may lessen or eliminate the underlying problem that causes you to have intrusive or obsessive thoughts. In my case, it was the latter two. I still get stymied by some decisions, but I don’t lie awake and think about them. I discuss them with someone else (my husband, my therapist) to get feedback. Then I make a decision and stick with it, or move on to thinking about something else.

Why People Don’t Believe in Mental Illness

Some people just don’t believe that mental illness exists. There are reasons for this. Not good reasons, but reasons.

I recently saw a meme that blamed mental illness on capitalism. There was no mental illness per se, only the toxic effects of a culture that compels us to put up with overwork and underpay, exploitation and inescapable drudgery. The stress of dealing with these conditions is what causes us – an increasing number of sufferers – to feel depression and anxiety.

There may be something to this, sort of. Environmental conditions that lead to stress and anxiety can certainly make mental illness worse, particularly those like bipolar disorder and other mood disorders. And, while capitalism may or may not be the cause, the majority of us are working harder with less to show for it than ever before. But the majority of us are not mentally ill.

My mother may have bought into this philosophy. She knew I had mental troubles, but she thought that if only I got a better job, I would be all better. Admittedly, finding a better-paying job that was less stressful would improve anyone’s mood, but it can do little or nothing for a clinical mood disorder.

Then there are people who seem to “believe” in mental illness, but really don’t. These are the people who acknowledge that mental illness exists, but think that it is a “choice” – that any person can choose happiness, health, or sanity merely by an effort of will. Those of us who can’t “pull ourselves up by our bootstraps” are simply not trying hard enough. The “choose happiness” people don’t seem to get that for most of us, our only choice is whether to get help from someone else – a doctor who prescribes a psychotropic, a therapist or counselor who listens or advises, or even a friend who reaches out.

And, of course, there are people who acknowledge mental illness, but think it is a good thing, the fount of creative brilliance. They point to Vincent van Gogh and his amazing art. They forget about the suffering, the self-harm, and the suicide.

But, romanticizing mental illness and even revering it do nothing to help people who actually have psychiatric conditions. It’s true that some people with mental disorders – Sylvia Plath and Dale Chihuly, to name two in addition to van Gogh – have created works of great art, beauty, and significance. But it’s certainly valid to wonder what they would have produced if they had not had the trials of mental illness to deal with. Would their work have been less inspired or more? It’s impossible to say. Personally, I believe that mental illness interferes with creativity more often than it enables it.

But the most common reason, I believe, that people don’t recognize the existence of mental illness is that it has never touched their lives, isn’t a part of their perceptions. A relative of mine once watched a talk show where women recounted dire experiences of having hysterectomies. “Those women are such liars,” my relative said. “I had a hysterectomy and it was nothing like that.” Her perception of reality – her personal experience – was extended to the whole world.

Similarly, when someone has no direct experience of mental illness, either by having a disorder themselves or by knowing someone very close to them with the disorder, the reality of mental illness itself comes into doubt. “No one I know has it, so no one does.”

Sometimes people who believe such things are capable of changing their minds, though. If a woman goes through a profound, long-lasting exogenous depression after the death of her husband, she may have more sympathy and understanding for people who have profound, long-lasting endogenous depression, or major depressive illness, as it’s more commonly known. Or a dear friend’s struggles to help a schizophrenic son may awaken her to what mental illness truly can be. Once it touches her life in some way, mental illness becomes real.

And since, according to statistics, one in four or five Americans will experience some type of mental or emotional disturbance in their lifetimes, the odds increase that people’s personal experience with mental illness will also increase accordingly.

In the meantime, those of us in the mental health community can help spread the word that mental illness does exist, that it affects the lives of millions of people, and that even people who are not directly affected need to understand how easily it can happen to someone they know.

Blaming mental illness on capitalism, overwork, or an insane world may be easy and may make us feel better by comparison, but it will do nothing to address the actual problem.

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