Bipolar 2 From Inside and Out

Posts tagged ‘coping mechanisms’

Black-and-White Thinking

 

My husband used to have only two categories when he reacted to something: It was fabulous or it was wrecked. There was nothing in between. If he cooked a dinner and I said it was “okay,” he heard “wrecked.” If I said “good,” he heard “wrecked.” Only the most superlative of adjectives would convince him that I appreciated his efforts.

Of course, this was a holdover from his childhood, one called “black-and-white thinking” or “all-or-nothing” thinking. And what that is, is a kind of cognitive distortion, a skewed way of thinking that does not represent reality,

Cogbtherapy.com has this to say about the subject:

A cognitive distortion is an automatic way of repeatedly interpreting a situation that causes us to not consider other ways of thinking about it. When we over-rely on cognitive distortions, we usually interpret events in such a way that fuels emotions such as anxiety, depression, or anger. All-or-nothing thinking is one such distortion.

All-or-nothing thinking refers to thinking in extremes. You are either a success or a failure. Your performance was totally good or totally bad. If you are not perfect, then you are a failure. This binary way of thinking does not account for shades of gray, and can be responsible for a great deal of negative evaluations of yourself and others.

http://cogbtherapy.com/cbt-blog/cognitive-distortions-all-or-nothing-thinking

Indeed, my husband was prone to depression and thinking poorly of himself. He would never be as good as his brother, as successful as his father and mother, as artistic or musical or smart as he wanted to be.

Fortunately, he eventually got over this. It’s really tiring to keep thinking of better and better ways to describe dinner. Now I can give accurate feedback, like “satisfying,” or “good enough.” Not everything has to be fantastic.

I must admit that I share in this kind of cognitive distortion. I think it may go with bipolar disorder, which, after all, includes swings from one end of the emotional spectrum to the other. But some people attribute it to my having been a Girl Scout or making straight As in school. What I remember is learning it from my parents. When a cousin, for example, screwed up, they would say with a tone of disgust, “Well, I guess some people have to learn from their mistakes.” What I heard was that some people, the good, smart people, didn’t have to learn from their mistakes because they didn’t make mistakes. It was a perfect set-up for making a little girl try to be perfect.

Later in life, I found some flaws in that line of thought. My first experience with a grade of D came in high school in Enriched Geometry. The “Enriched” part was having to do three-column proofs instead of two-column proofs, with the third column being the name or number of the theorem of corollary you were using. I thought that was stupid. You could always look up the theorem or corollary if you really needed to know it. As long as you knew how it worked, I thought, that should be enough. So I didn’t memorize them and I got a D. (Many years later, I was able to hang five pictures, four in a square and one in the middle, which proved to me that I did indeed know enough geometry to get by, theorems and corollaries or not).

I also learned that, according to my parents, perfection was only for me, not for other people. When some work friends of mine started living together, I expected my parents to freak at the sinfulness. They didn’t. But when I did the same thing, they refused even to enter the house.

I know that Cognitive Behavioral Therapy specializes in counteracting distorted ways of thinking, and maybe it would have helped me (or my husband) get over it more quickly or efficiently. But the lesson I eventually learned was that I could be not-perfect and it wouldn’t destroy me. I hung those pictures. I moved on from that relationship and my parents accepted me. I did end up in a job (editing) that requires one to be as nearly perfect as one can regarding as many details as possible, and I suppose that’s an example of turning a negative into a positive.

But if – that is, when – I make a mistake or miss perfection by however wide a margin, my thinking isn’t so disordered that I assume I’m a failure. Black-and-white has been replaced by all manner of shades of gray. That’s really where everyone lives.

Permission to Be Depressed

Depression can be so riddled with guilt. Why am I not able to fake being okay? Why do I isolate when what I need is interaction?

Sometimes what I need is to give myself permission to be depressed. I have bipolar disorder 2, with a heavy depression component. It has overwhelmed me many times. I have fought against it, given in to it, tried to make compromises with it, tried to ignore it – almost any reaction you can imagine. Then I learned how to give myself permission to be depressed.

This is not quite the same as giving in to depression. It involves acknowledging that I am depressed and allowing myself to feel the feelings that I have. Of course, I don’t give myself permission to be permanently depressed. In a way, it’s more like giving myself permission to practice self-care and not to force myself to smile and bull my way past the depression. I recognize that I am depressed and do what I need to do to get through it. That may be staying in bed. It may be crying. It may be wallowing in sad music. These are things that I’m likely to do anyway when I’m depressed, but giving myself permission to do them is surprisingly freeing.

I used this technique probably for the first time when my husband and I went on a “barefoot” cruise vacation. It was something we both enjoyed and both want to do again someday.

But I knew from the beginning that depression might overtake me – probably would, at that time in my life – even while I was doing something enjoyable. Naturally, I didn’t want the depression to ruin the whole vacation, so I decided to give myself permission to do what I needed to do to cope with those feelings.

Most often, that involved retreating to my bunk for a nap. This enabled me to get away from other people when I was feeling overwhelmed and unable to socialize. Sure, I missed some of the onboard and shore activities, but I wouldn’t have enjoyed them anyway while in the metaphorical fog and darkness. I enjoyed what I could, then let myself not do what I didn’t feel up to doing. I didn’t try to make my husband stay with me and miss all the fun. There wasn’t anything he could do for me anyway. If the other passengers thought it was odd – and they did – they barely mentioned it to me. My husband told them I was tired. Seasickness was also a believable excuse.

In a way, having bipolar depression at that level is like having the flu. I feel bogged down and logy, inclined to cocoon, rest, and stay away from other people. I realize this is not always possible, but if it is, I can allow myself to do it. Fortunately, this spell of depression wasn’t so bad that it completely incapacitated me as it has at other times in my life. I was still able to feel enjoyment at some times, though not at others.

At other times, I’ve had to give myself permission to have anxiety. If a situation makes me anxious, I acknowledge that I am nervous, and do what I need to do. I can’t “think away” my anxiety, but sometimes I can get myself out of the situation at least temporarily. I do not have to sit and be anxious while people around me argue or shout at each other, one of my anxiety triggers. When I recognize how I’m feeling (which takes practice) and give myself permission to feel the way I feel, I’m better able to come up with coping mechanisms, such as leaving the room to get some fresh air or making myself a cup of tea.

You may notice that when I give myself permission to be depressed or anxious, part of my solution involves avoiding other people. That’s sometimes a hard thing to do. Isolation can certainly make depression worse, but it can sometimes also be necessary if pushing through, trying to smile, mingle, and socialize will make the depression worse in the end. And I have learned that if I try to do that, the depression comes along with me. Once a friend told me that it was like having a separate person with me, a person called Misery. Better to give myself permission to stay home and give myself some self-care.

What I can’t do is give myself permission to stay depressed or anxious. Giving myself permission is a very limited-time offer. It doesn’t work for those really lingering, midnight-dark depressions that last for weeks or months on end. Those, I have to fight. And while I’m depressed, I don’t give up on meds or therapy. Those are necessary to alleviate the depression instead of resigning myself to feeling it.

Do Distractions Help?

Well, not when you’re driving, certainly. But when you have bipolar disorder, sometimes they do.

Of course, bipolar disorder is a distraction from life itself. And that’s not good. But every once in a while, it’s worthwhile to give bipolar a taste of its own medicine. Now, I’m not saying that distractions are good when you’re trying to meditate or in a therapy session. But sometimes, when you’re locked in your own head, you need something outside of you to unlock it.

Personally, I need distractions a lot. And, given the popularity of coloring books and fidget spinners, so do a lot of other people. Fortunately, I have found many ways to be distracted. Some of my favorites are music, bad jokes, cooking shows, sleep, and cats.

These don’t always work when I’m in the depths of depression, though I try them even then. But when I’m hypomanic, buzzing around without a landing site, they can help.

Music gives me both a chance to focus and a place to dissipate my energy. There are plenty of songs that express my feelings of depression, but also a number that encourage me to let out the feelings of flying, of soaring, of digging life – Little Richard’s version of “Get Rhythm,” for example, or the songs that have punctuated my life with my husband.

Again, bad – or even good – jokes are no help to me when I’m depressed. But when I’m obsessing about some anticipated (perhaps never to materialize) crisis, they can pull me back from the edge. (Once I called up a silly friend and said I needed a distraction. He said, “Look at the grouse! Look at the grouse!,” a joke I didn’t get until later, when someone explained it to me.)

Cooking shows keep me grounded in a way. So does actual cooking. I’ve found that when I’m tense and about to lose it, making a cup of tea or heating a pan of soup grounds me, even if I have no desire for tea or soup. Making it for someone else is even more grounding. Cooking shows, even if I have no intention of ever trying the recipes, have a similar grounding effect. Unlike movies or dramatic shows, I know that nothing terrible will happen, unless you count a chef cutting her finger.

Sleep may be hard to do when my brain is whirling, but if I can accomplish it, my brain gets a reprieve and perhaps even a respite with a hot-n-juicy dream (though not nearly often enough). I love the feel of cotton or flannel nightshirts or pajamas. I love the quiet and the dark. I love the giving up of the stresses of the day and surrendering to temporary oblivion.

Even sleep in the middle of the day soothes me. If I’ve been unable to sleep the night before, a mega-nap the next day can reboot my brain and replenish my spoons. It may seem like an escape (and in some ways it is), but sometimes escape is what I need.

And as for cats, they help me in so many ways. I find watching them wash themselves hypnotic and comforting. I find snuggling with them in bed soothing. I find their antics infinitely distracting. I find caring for them takes me out of myself and requires that I focus on another being.

If I’m able to focus (which is not always the case), I find reading a suitable distraction as well. I have a few “comfort books,” old favorites that I can return to with an assurance that nothing too alarming will happen. I can lose myself and my anxieties in the struggles and triumphs of others. I can find distraction in tales of things I will never experience, like mountain climbing or space flight.

I have tried some of the tried-and-true distractions as well. I have several coloring books and a plethora of colored pencils. I have sudoko and mahjong programs and word puzzles on my computer. I have my writing, which, while not always soothing, does refocus my concentration and provide an outlet for any troubling feelings I may be experiencing.

Being bipolar, I find that my brain is both my enemy and my friend. It sustains me and betrays me. And it provides me ways to escape from its less sustaining moments. After all, if I didn’t have distractions, I would be locked within my brain with no relief from the tricks it plays on me. I’m glad that there are ways that I can escape, at least for a little while.

Did Bipolar Disorder Lose Me Jobs?

I lost two jobs, one that I had held for 17 years, because of my bipolar disorder. I only realized this comparatively recently. In both cases, I readily admit that my work had gone downhill, but at the time (at least for the first job), it never occurred to me that bipolar disorder was the reason for my dismissal.

I was working at a publishing company as an editor, having worked my way up from editorial assistant. I had been the editor of two different magazines, assistant editor for a couple of others, and writer and proofreader for them all. (It was a very small company.)

As time went on, though, I became less and less reliable. I edited my magazines, but I had trouble dealing with people. I had particular trouble with an art director who didn’t like my cover choices (despite the fact that several of them had won awards), humiliated me in a staff meeting because of it, and reminded everyone about it later. She was toxic, sure, but I was unable to deal with the situation or even stand up for myself.

There were other humiliations that I tolerated because I didn’t have the wherewithal to quit. When, during the financial crisis, salaries were cut by 20%, mine was cut by 40%, which to me meant that I was twice as useless as, say, a salesperson.

I stayed, but I isolated myself. My office had a door and I used it, the only person in the company to do so. I knew that people thought this was odd behavior, but by that point, I didn’t care. I was let go with no explanation given.

Yes, the company was a toxic environment and no, I didn’t deal with it well. But the situations I put up with exacerbated my bipolar disorder until I was headed for the crash. When I was on the upswing I was able to do my assignments and, I like to think, do them well. But when things went bad, I was prey to the voices that told me I was no good. Losing the job proved that to me.

The next job I went to was editing textbooks. My supervisor knew me and knew that I had bipolar disorder. The fact that she understood helped me keep on an even keel for a while. I developed little techniques to stave off difficulties. But some of my coping mechanisms were unacceptable. (Apparently, it’s okay to have a cigarette break but not a crossword puzzle break.)

Then my supervisor left. I said to her, “I’m going to miss you,” and she replied, “I know.” Prophetic words. I was open with my new supervisor about having bipolar disorder and was quite taken aback when she asked, “What does that mean?” Unprepared to give a proper explanation, I blinked and replied simply, “It means I’ll have good days and bad days.”

From that point on, my performance and their satisfaction with me fell, until I received a bad review, the first one I had ever had. Before the six-month probation period was up, I left of my own accord, determined to make it as a freelancer.

There were personal circumstances at the time, including my disorder, that made me less capable. I became responsible for my mother’s health and finances. I could easily miss half a day of work just getting her to her various appointments. That no doubt affected many of my job functions, particularly my attendance and my ability to concentrate. My major breakdown began not long after I left that job.

The thing is, in 2008, the Americans with Disabilities Act (ADA) added bipolar disorder as a covered condition. Employers were (and as of this writing still are) required to provide “reasonable accommodations” to affected individuals. Examples of reasonable accommodations include job restructuring, part-time or modified work schedules, and “a change or adjustment to a job or work environment.”

To receive accommodations under the ADA, an employee must disclose their bipolar disorder (which I did, at least at the second job) and request accommodations (which I didn’t do, other than offering to work from home).

The EEOC (2009) has a publication called “Psychiatric Disabilities and the ADA,” which is available online at http://www.eeoc.gov/policy/docs/psych.html. Among their recommendations to help a bipolar employee continue to function in the work environment – maintain stamina and concentration; stay organized and meet deadlines; work with supervisors; and handle stress, emotions, and attendance issues – are these:

  • Allow flexible scheduling
  • Allow for time off for counseling
  • Allow work from home during part of the day or week
  • Provide space enclosures or private office
  • Allow telephone calls during work hours to doctors and others for needed support
  • Provide flexible leave for health problems
  • Allow the employee to make up time missed
  • Maintain open channels of communications between the employee and the new and old supervisor in order to ensure an effective transition

I know there are those who would consider such accommodations “coddling.” And I wouldn’t have needed them all, or all of them at the same time. But even an understanding of my closed door and my need to work at home would have helped.

When Self-Care Seems Impossible

It seems the days when I most need self-care are also the days when I’m least able to accomplish it. I mean, when I can’t even get out of bed, I’m not likely to have the wherewithal to perform any kind of self-care regimen.

I’m not talking here about the take-yourself-to-the-spa type of self-care, either. That’s beyond my means and my capacity. What I’m thinking about are the most basic needs that must be met – meds, food, sleep, and the like. But there are sometimes things that prevent me from accomplishing even these.

Part of the reason, of course, has to do with lack of spoons. It takes energy to shower and dress, make a meal, go to appointments, and all the other tasks that should actually make me feel better. According to Spoon Theory, we wake up with an unknown amount of spoons every day and must choose how to spend them. Some days I wake up with only a few or even zero.

The other obstacle I’ve noticed that inhibits my self-care is my occasional inability to plan. Yes, I can make sure I eat at least one meal a day, but on some days only if I have gone to the grocery store earlier in the week and bought at least a box of Cocoa Puffs and some bottled water to keep by my bed. Not much of a meal, I know. It’s the bare minimum I can do, but sometimes all I can manage.

Taking my meds is the only part of self-care that is an essential that I don’t do without. I usually have that bottle of water right next to my bottles of pills, but even if I don’t, back in college I learned to swallow pills with only spit. But again, this takes a little planning – calling in prescriptions and getting to the pharmacy to pick them up.

On days when I have slightly more spoons, I have to plan and prepare for the days when I don’t have enough for proper self-care. Even the planning and preparing use up spoons.

But there are also days when I can manage a little self-care. On those days, if the spoons are low, but not completely nonexistent, I take shortcuts. I wash up in the sink instead of showering. I put a piece of salami between two pieces of bread and call it a meal. I put on clean pajamas and underwear instead of getting all the way dressed. I use mouthwash instead of brushing my teeth. I pet the cat instead of calling friends.

And I call it good enough.

Admittedly, those are some low standards for self-care. It would be nice if I could do more – and on some days I can. But on many days, the obstacles seem overwhelming. Inertia takes over and entropy sets in. I know it’s not good for me and can slow my recovery from spoon deficit spending, but that’s just the way depression is sometimes. It sucks you down into a hole that’s hard to climb out of when it’s at its worst.

But, thanks to the aforementioned meds and the minimal self-care I’m able to do, I know that one day I’ll be out of the hole and able to work on some proper self-care. Even plan for the next time that self-care seems impossible.

When Trauma and Mental Illness Happen Together

Couples who experience serious trauma may go through the experience together, but they do not always stay together afterward. The death of a loved one, infidelity, the onset of a disease – many things can test a couple’s ability to cope with the event and with each other.

Serious mental illness can also be a relationship killer. Dealing with symptoms, treatments, medications, setbacks, hospitalization, mood swings, and just generally going off the rails is more of a task than many couples can handle.

Combine serious trauma and serious mental illness, though, and what you’ve got is a recipe for a new level of disaster.

One of the potential pitfalls is two people who grieve in different manners or on different timescales. One partner may feel it necessary to process events aloud and at length, while the other may prefer to process feelings internally, without conversation. One person may take a year to get over a death, while the other is still grieving after three or more.

Then there’s couple who have different agendas when it comes to whatever is troubling them both. One may feel that moving on is the best response to a traumatic event, while the other person can’t let go of the past.

Many relationships crack and break apart under the strain. And those are just for couples who don’t have mental disorders.

Now take an example (not completely at random) of a couple who have lost their home in a natural disaster. He suffers from depression. She has bipolar disorder. He grieves the loss of their home and all their belongings to a point that she considers excessive. She kicks into hypomania and focuses on the small details of their situation. He thinks she doesn’t grieve. She thinks he needs to help her address the future.

It will be easier for this couple to stay on track and stay together if they can talk about what has happened and what is happening. That may well involve talking with other people – a trusted friend, a professional counselor, even each other. But it’s important that both people feel that they are being listened to and, more importantly, being heard. And that’s not always something that the other partner can provide.

If the couple can talk to each other, their communication skills will be severely tested. Depressed people and those with bipolar disorder both tend to isolate in times of stress. Processing feelings may not be either person’s greatest strength. And those different timescales and differing agendas are likely to throw up roadblocks should they try to talk about it all.

Being aware that trauma and mental illness both have detrimental effects on a relationship may help. Although even previously strong relationships can be stressed to the breaking point, stepping outside oneself to try to understand the other person can be enlightening. Feelings that seem callous or stubborn or flippant or shallow can just be different ways of dealing with trauma. Thinking the way you feel is the only way to feel will severely impede healing.

If it sounds like I am trying to remind myself of all these things, well, I am. We lost our home in a tornado, and my husband and I were dealing with mental difficulties before that happened. I feel that I must be on alert now for any signs that our relationship is cracking. But it’s not just my problem. The disaster, and the mental disorders, and the relationship are things that we share. They have led to a tangle of emotions and reactions that aren’t predictable or rational or even helpful.

We know the basic things we need to do – take our meds, practice self-care (and help each other do so as well), talk when necessary and be alone when that is what’s needed. We have to keep our eyes on what’s important: our mental health and getting through these difficult times intact both personally and as a couple. And we need to see the humor where there is any. But this isn’t the ordinary sort of disagreement that lasts a day or a week. It’s something we’ll be working on long-term.

Wish us luck.

Emotional and Mental Work

I am weary to my bones and to my soul. As the spoonies say, I’m so out of spoons I can’t eat soup.
Physically, I haven’t done that much to wear myself out. A little light housecleaning. Running some errands. Answering emails and making phone calls. No heavy lifting, unless you count the time I had to help my husband push the washer back into place.
No, the heavy lifting I have been doing is emotional and mental. Make no mistake, that is work and it is exhausting. I am responding to a physical and emotional crisis that happened almost exactly a month ago. After the disaster (a tornado destroyed our house), my husband has done almost all of the physical heavy lifting.
The mental work is stuff that I’m easily capable of doing on a good day: dealing with bureaucracy, organizing the trivia of paperwork and daily life, paying bills, etc. Now, however, there is so much of it to deal with that I am falling behind. I haven’t kept up with sorting our receipts. I haven’t returned the phone call about the hole the cable guy made in the wall. I haven’t even listened to the voice mail about it. I haven’t responded to a friend’s request to look over an official letter she is writing.
The emotional work is entirely different. My husband is dealing with issues of grief, loss, and anger regarding the loss of our house and our possessions. Somewhere inside, I must be having similar feelings, but his are closer to the surface and he is able to express them more.
And I am having some difficulty dealing with this. First of all, angry men distress me, even if I’m not the object of their anger. It’s a throwback to other times and other relationships, a button that was pushed and has stayed mostly stuck in that position. Dan is doing his best to accommodate this quirk, trying to keep his voice down and his conversation rational when we speak of it. But I hear him when he is alone in his study, bellowing or wailing in emotional pain about something I do not fully understand.
My husband and I are operating from different places, with differing agendas, regarding the loss of our house and belongings. He invests his memories and emotions in things much more than I do. I look at what can be replaced and he looks at the irreplaceable – artifacts from his trips to Africa and Israel, for example. Those can’t even have a price put on them and there is no way to replace them. His grandfather’s diamond ring could be physically replaced, but not the sentimental value he attaches to it.
I do understand this, though not at the gut level he does. I do (or did) have possessions that meant a lot to me – a guitar, paintings a friend did, some carvings in semi-precious stones, some photos, of course (though some are stored on my computer, which survived). And I think the salvage company did a poor job of inventorying what they had to throw away and keeping what was small but important, letting us participate in the process. But my anger doesn’t extend to revenge fantasies.
All these feelings, both expressed and unresolved, are sapping my strength and my energy. I have gone back to my therapist for reminders of my coping mechanisms and validation on what I have been able to do – and to have a safe space to vent when all of this does begin to spill over.
And now I have decided to go back to work, on a reduced schedule at least. I don’t know if this is a good idea or a bad one, but it seems a necessary one. Perhaps it will provide a missing piece of familiarity in my life, something to anchor me. Perhaps a different kind of work will distract me from what I have been dealing with.
I know there’s still a lot of emotional and mental labor to do, but with help from my husband and my therapist, I believe I will get through it, especially if I pay some attention to self-care: taking my meds regularly, sleeping and eating regularly, taking breaks when I need them, taking comfort in our cats, and trying to eat the elephant one bite at a time.
This is one of the biggest elephants I can remember, though.

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