Bipolar 2 From Inside and Out

Posts tagged ‘coping mechanisms’

How a Cat Helped Me Stay Sane

Queen LouiseAny pet can help with mental health, really. But in my case, it was a cat.

I was living alone after a bad breakup that had shattered me, mind and spirit. After moving twice, once from another state and once from an apartment complex after I lost the job that paid for it.

I was damaged, and I was alone, in the upstairs of a small house in a small town. I asked my landlady if I could have a cat. She was dubious, but said yes.

I found a cat at a shelter. She was an adult tortoiseshell calico named Bijou. She was small and shy and quiet. The first night I took her home, she slept across my throat.

We needed each other. I needed someone to care about, to focus my attention outward on. She needed someone  to draw her out of her shell, to care for and about her.

We took it slowly. At first she didn’t like to be held. When I got home from work she would meet me at the door. I would pick her up, give her a quick kiss on the head, and set her right back down. Soon she learned that being held wasn’t such a bad thing.

Since then I have never been without a cat.

And they have improved my mental health. Pets do.

Pets entertain when we need distraction.  They can make us smile and even laugh.

Petting them brings tactile comfort and purring offers a soothing sound.

Caring for a pet makes us feel – be – needed. Even when we have a hard time caring for ourselves, a pet becomes a responsibility bigger than we are.

Losing a pet teaches us about the process of necessary grieving. Then getting another pet teaches us about the process of loving someone new, opening our hearts again.

Pets listen. They don’t judge.

Pets communicate with us, and teach us their personal language.

Pets are now being used as therapy animals and comfort animals for the anxious, the aged, prisoners – and psychiatric patients. The laws and policies regarding “assistance animals” are only just beginning to be enacted. They are far from catching up with the need.

Even visits with farm animals – lambs and chickens and ponies – are fulfilling vital roles in people’s lives.

I’ve written about “crazy cat ladies” before and even identified myself as one (http://wp.me/p4e9Hv-bI). There is a stigma that goes along with the label – yet another kind of stigma that we would be better off without. Admittedly, we can become obsessed with our companion animals, even to an extent that is unhealthy. They can be burdens, and annoyances, and expenses.

There are some people – perhaps people with rage issues, for example – who should not own pets. Having pets is a choice that should only be made if they and you fit together well. We’ve all read the stories and seen the pictures online of people who abuse pets horribly. Now those are the ones that I consider crazy.

Pets may not me be the right choice for other reasons. A person who travels a lot, or has extended hospital stays, may not be able to make the commitment. Germophobes and emetophobes may not be able to handle the inevitable messes that come with pets. Even pet fish need their bowls cleaned.

Personally, I would avoid fish, unless the care of, say, tropical fish fascinates you. And their placid swimming can be calming. But for most of us, a pet that interacts with us is preferable. Birds aren’t very cuddly, but they make agreeable (to some) sounds. Reptiles have their own fascination and aficionados. Me, I want something I can pet.

The picture that accompanies this post is of Louise (aka The Queen of Everything). She is 20 years old and, although she is hanging in there, I will be devastated when she goes. My husband’s 17-year-old cat, Garcia, has some health problems, though again, not terrible ones considering his age. Then there are our youngsters, Dushenka and Toby.

I don’t think it’s too much of a stretch to say that they are as much a part of my support system as I am theirs.

 

 

 

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How I Learned a Few Social Skills

I thought my social skills were bad until I encountered a woman who asked me, “Do you have mental problems?” (She recognized me from our mutual psychiatrist’s waiting room, but still….)

expression

With practice, however, I have been able to improve my casual conversation skills, at least enough to get by in some situations, as long as they don’t last more than an hour. Here are my secrets. They do take practice. I have been fortunate to have had people to practice with – friends, coworkers, and of course my husband.

Introductions. Actually, I taught this one to my husband. Often when we met someone that he knew, he would fail to introduce me, leaving me standing there like the proverbial bump on a log. He claimed that the problem was that usually he couldn’t remember the person’s name. “Just point to me and say, ‘This is my wife, Janet.'” Then I will stick out my hand to shake and say, “And you are?” That way we both learn the person’s name. It works like a charm, every time.

Very Brief Conversations. Conversation with strangers – just a sentence or two – is also relatively easy to learn. The trick is the innocuous comment and there are two ways to go about it. The first is to make the comment yourself – “Those are great shoes! They make your feet look really small.” “What a lovely handbag. My mother had one that was similar.” Make an observation and then a related remark, usually complimentary. They don’t even have to be true technically. If you can’t think of anything else to say, a comment on the color of an outfit is usually good. There’s hardly any way someone can take offense at “That’s a great shade of blue on you.”

The other side of the equation is to get someone else to make a comment to you. This requires a prop most of the time. I used to carry a purse shaped like an armadillo, and that proved a great conversation starter. I memorized several responses that I could use when the other person said, “Oh, what an unusual purse!” I could say, “My mother gave it to me for Christmas one year” or “A friend found it in some catalog.” The purse went over  big, especially if there were children present.

Longer Conversations. These require more practice. Luckily at one of the jobs I had, there were a couple of people that I could invite out to lunch and practice conversation with. (I suspect that they knew what I was doing, but they never mentioned it. In effect, they played along.) Mary, for example, had two adopted children, and questions about them we’re always good for a few minutes of interesting listening. They also had a cat and a snake. Pets and children make good topics.

Sometimes it’s best to steer clear of work-related subjects, but if the person is really understanding, you may be able to vent. You should also be able to listen to the other person too. The secret to that is not to try to fix the problem. Simply listen and validate the person’s feelings. “That sounds awful! Does she do that all the time?”

Formal Settings. Mary also provided me with the opportunity to learn about a sometimes-necessary but difficult situation – funerals. Mary and a few other people invited me to go with them to the viewing of a person that I knew only slightly in a work context, so the stakes were low. From watching Mary and her friends, I learned that the proper procedure is to stand briefly at the coffin looking solemn, then go to the bereaved, shake hands or hug (depending on whether they proffer a hand or two arms), and say, “I’m sorry for your loss” or “My deepest sympathy” and at least one remark about the departed. It can be as simple as “He was a pleasure to work with” or “Everyone at work is going to miss her.”

Not Melting Down. Another important social skill is not having a major meltdown in front of other people. When I first visited my husband’s family, I became very uncomfortable quite often because everyone seemed to be yelling at each other. Loud, angry voices tend to upset me, especially if they continue for any length of time. The technique I developed was to go into the other room and make a cup of tea. Making tea is socially acceptable. (If you’re in the kitchen, go to the bathroom or step outside for fresh air.)

Much later I learned that my husband didn’t realize that his family reacted to even minor questions with argumentative responses in loud voices. To him, and to them, this was simply the normal style of conversation. It wasn’t what was normal in my family, and it triggered my aversion to confrontation. I guess whatever you grow with grow up with seems normal to you.

One other piece of advice: Don’t attempt flirting unless you have a coach. It’s really tricky and possibly dangerous. Not for the novice (especially not the kind of novice who wears a habit).

 

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mental health, Uncategorized

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A Bipolar Child

I suppose I was a bipolar child. I don’t really know, but I assume I was, because now I’m a bipolar adult.

I think I was more of a depressed child, which actually makes sense, since I have bipolar 2, with depressive episodes far outnumbering hypomanic ones. There were some times, though, when I would laugh loudly and inappropriately in class, triggered by a word that reminded me of something funny I’d read. There were times I’d walk around with a village-idiot grin because of some minor accomplishment like winning a live goldfish at a school fair.

Depressed child with toyBut mostly I remember misery. Tears. Loneliness. Hysterics. Confusion. Isolation. Hurt. Despair.

I’m fairly sure my depression wasn’t reactive, mostly, although parts of it surely were. The bullying, betrayals by friends, not understanding social conventions – all these were things that could easily make a person depressed, regardless of brain biochemistry.

But by and large my life was what would be considered pretty damned idyllic. I had stable, loving parents, a comfortable home in the suburbs with good schools, all the food I wanted, and as many toys as I could play with. I had a sister and a neighborhood full of children my age, but I remember being perpetually lonely. I had a good education, but looking back I realize that my illness prevented me from getting the most from it. There was no sexual or physical abuse or neglect. No one close to me died or suffered major trauma, at least until I was in high school and my parents suffered illnesses. Even then, they did a good job of keeping life as normal as possible. At the time we never felt it was a tragedy. It was just something we got through together.

That just leaves endogenous depression. Or at least the depression half of bipolar disorder. I remember one day walking home from elementary school and thinking, “All these houses look so pretty, but the people in them aren’t all happy.” It was somewhat of a revelation to me.  I had several major meltdowns, which I’ve written about before, and hundreds of smaller depressive episodes (http://wp.me/p4e9Hv-6J). I had nervous twitches and tics, and was prescribed Valium for them.

During my high school years, it was suggested that perhaps I ought to go to the school district’s psychologist. (This was probably during the episodes of inappropriate laughter in class.) My parents, who were not really familiar with mental illness and psychiatry, asked me if I wanted to go. I didn’t. I probably should have, although back then – the seventies – it’s fairly unlikely that I would have been diagnosed with bipolar disorder, of any type. I might have gotten some help for the depression, though. They might have taken me off the Valium.

Like most lonely and misunderstood kids, and perhaps most depressive children, I found my salvation in books. They were friends, distractions, instruction manuals on how to survive, food for my emptiness, a place to lose myself when the world was too much with me. By and large it worked, at least as well as anything could – a self-prescribed and self-regulated form of instinctual bibliotherapy.

These were not books on how to make friends, or ones that promised to teach a child how to cope with emotions. They were for the most part pure escapism. Fantasy and science fiction, mysteries and adventures, literature and bestsellers – a complete mishmash of classics and trash. Those were my doctors, my therapists, my Prozac, my mood stabilizers.

I look back now on myself as a child – mentally disordered, undiagnosed, untreated – and wonder how I survived  as much as I did.

If I were a child these days, would I get the help that I needed then? Would my parents recognize that I was not just odd and unhappy, but mentally ill? Would I have been diagnosed properly? Medicated properly? Counseled properly?

With all that needs to go right and all that can go wrong during the process, it feels like getting help for a bipolar child certainly was – and perhaps still is –pretty much of a crapshoot. I made it through, but I hope it’s easier for a kid like me these days.

 

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The Week of Living Alone

Sometimes, when I get tired of my complicated life, I imagine what it would be like to start over someplace new, or what it might have been like if I had made different choices. I envision myself, living alone (well, with one cat), in a small town like Benson, AZ. I would have a small used book store or secondhand shop and live in a small apartment over it or behind it. I would have a couple of friends I met in my shop and go out to lunch or dinner once in a while, but mostly spend my free time listening to music, watching TV, or on the Internet.

Sounds simple and peaceful, doesn’t it?

Portrait of a young woman drowning, shark fin on the backgroundThis past week has convinced me that even such a stripped-down existence would not be possible for me. My husband was out of town for nine days, and I could barely manage.

Those of you who follow this blog know that my husband is my rock and my support. I often say I could not get through without him, and my recent experiences only reinforce that.

I didn’t begrudge his leaving, though I wish he had not been gone quite that long. His mother needed him to help her get ready to sell her house and move, and nine days was barely enough time to start on all that needed to be done. There are times she needs him as much as I do.

But coping on my own was difficult. I have paid work I have to do. It matches perfectly with my skill-set and I’m grateful to have it, but sometimes it’s just plain hard to do and hard to make myself do. And I have two blogs (the other is at janetcobur.wordpress.com) that I have made a commitment to posting in once a week, each. Plus, I have started writing a novel.

We have four cats, two of them ancient, and one dog, also ancient. I was afraid that one of them might die while my husband was away. (None did.)

As scary as the idea of coping with a dying or dead animal on my own was, just caring for them was difficult. They keep demanding food several times a day, you see, and they have no thumbs to open cans with. Then there’s the water bowls and the litter boxes. I used to live alone with one cat and manage okay, but that was many years and many meltdowns ago.

Then there was feeding me. Dan had stocked up on things I like before he left, but after the French bread pizzas were gone, I lived largely on salami sandwiches, cheese and crackers, and cereal. (I did eat vegetables. I had a small tray of sliced veggies and dip.) Once I made a couple of baked (frozen) fish sandwiches early in the week, but later I had devolved to the extent that my evening meal was peanut butter on a bagel. Another night I had mashed potatoes and a glass of red wine. Other meals I simply skipped.

Then there was Dealing With Stuff. Life Stuff. You know. The Stuff that happens to everyone sometimes piled up on me. I had to talk to (argue with) the utility company and the IRS. I had to pay bills. Life stuff leaves me exhausted.

Plus, I kept having to Go Out. Deposit my check. See the doctor. Pick up prescriptions. Buy cat food when I ran out. I wore pants more days last week than I had in the previous month. (Dan wanted me to water his butterfly garden daily, but it rained every day or night, so I didn’t have to put on pants and go out for that.) I treated myself to lunch twice when I had to go out to do those errands, but it was nearly impossible to decide where to eat.

Now Dan is back. I had to put on pants again so we could return his rental car.

But you see what I’m getting at here.

My fantasy of retreating to a simpler life is not feasible. It simply wouldn’t work. The everyday tasks and trials of managing a shop, caring for myself and a pet, negotiating all the stuff of life would overwhelm me. Oh, when I’m hypomanic and can sometimes focus, I might do all right for a while, but life – even a very basic one – would eventually overwhelm me. There are so many things I can no longer do, at least not without serious amounts of help and support.

I can muddle through for a while mostly on my own. I am getting better. But not better enough to live independently, at least not right now.

 

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Who’s a Spoonie?

With all the talk about cultural appropriation lately, I’m hesitant to wear Kokopelli earrings or eat at the Chinese buffet. I understand that some people object to Canadians playing Englishmen who are pretending to be Japanese for a production of The Mikado is offensive or racist. I don’t always agree, but I understand the principle involved. Even I, a WASP, find Mickey Rooney’s character in Breakfast at Tiffany’s to be egregious, appalling, and insulting to everyone involved, including the audience.

Hand XrayBut recently there’s come the claim that those who are not entitled to it are appropriating Spoon Theory language. And in this case, “entitled to it” means someone with an “invisible illness” – chronic pain, chronic fatigue, and other conditions that do not announce themselves to the public with visible cues such as wheelchairs, crutches, missing limbs, or guide dogs.

If you don’t already know Spoon Theory, you should. You can find the explanation here: http://www.butyoudontlooksick.com/articles/written-by-christine/the-spoon-theory/. Basically, “spoonies” have only a limited amount of energy units per day, represented by spoons. Spoonies must use a ridiculous amount of spoons to get through tasks that others accomplish normally in the course of life – showering, driving to work, driving home, fixing dinner, et endless cetera.

In fact, on any given day a Spoonie may not have enough spoons to get out of bed and get showered and dressed. It’s not that Spoonies are lazy; they may have only three metaphoric spoons that day, compared to a non-Spoonie’s typical, oh, I don’t know, 20? 30?

A few weeks ago, I wrote about whether bipolar disorder and other mental disorders are invisible illnesses: https://bipolarjan.wordpress.com/2016/03/06/is-bipolar-disorder-an-invisible-illness/. (I said they mostly are.) As far as I’m concerned, we’re Spoonies and “entitled” to Spoonie language. Most of us have had the experience of not having enough spoons to spend on a morning shower, having to choose between hygiene and, say, eating breakfast.

So now, apparently, the general public is picking up Spoonie language – saying “I’m out of spoons” when they simply mean “I’m tired” or “That was an exhausting day. I’m done.” And some Spoonies resent that. See http://m.dailylife.com.au/news-and-views/dl-culture/stop-appropriating-the-language-that-explains-my-condition-20160113-gm4whc.html

I have two things to say about it. The first is that language is always growing and changing. But it does it on its own, without our control. (Unless we’re France. France at least tries.) We may wish to eradicate the “n-word,” but we can’t. It’s less socially acceptable to use in polite company, but you know people still use it. Read the comments section on any social media post about President Obama if you don’t believe me.

The second thing is that at least Spoon Theory and language are entering the mainstream. People without invisible illnesses are at least getting a clue of what it means. They may not have the details right, but at least now when we explain it to them, they won’t be starting from scratch.

And after all, isn’t that how Spoon language started – as a way to begin a conversation on what invisible illnesses are and how they affect our lives? Not a secret language that only those who know the password and handshake can use.

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Is Bipolar Disorder an “Invisible Illness”?

Empty Chairs Laid Out For Meeting

Yes and no.

First, a little on the concept of invisible illnesses. These are the sorts of afflictions that are not apparent on first looking at a person – conditions such as fibromyalgia, chronic fatigue syndrome, celiac and Crohn’s diseases, diabetes, epilepsy, lupus, Lyme disease, and many others.

Disabled-world.com says, “Many people living with a hidden physical disability or mental challenge are still able to be active in their hobbies, work and be active in sports. On the other hand, some struggle just to get through their day at work and some cannot work at all.”

Most mental disorders are invisible illnesses by that definition. There isn’t a sign around our necks that proclaims “Bipolar,” “Social Anxiety Disorder,” “PTSD,” “Depression,” or even “Schizophrenia.”  The word “Crazy” isn’t tattooed on our foreheads. Our mere appearance doesn’t give away our “secret.”

We have a lot of the same problems that people with other invisible illnesses have. Spoon theory, for example. For bipolar people, simply taking a shower requires so many spoons that we seldom go out. (I count myself among that number.) People who don’t know or understand Spoon Theory often don’t understand why we don’t accept their invitations or cancel at the last minute, or simply don’t show up. You lose a fair number of friends that way.

On the other hand, a mental disorder is not always invisible. People can see us burst into tears for no apparent reason, or go into the bathroom at a party and never come out. They can see our shaking hands, confused looks, and depressed expressions. They can hear our awkward attempts to socialize “appropriately.” They may not know what is wrong, but they can often tell something is.

When we realize this is happening, there are various strategies we try. We can leave the situation – entirely or partially (my go-to is to leave the room on the pretext of needing to make a cup of tea). We can try to brush it off or laugh it off (“Sorry. My nerves are bad today” or “I don’t know why I said that. Must be a brain-fart”). We can try the half-truth/half-joke (“Oops. Guess my meds just haven’t kicked in yet”). We can ignore whatever is happening and hope everyone else does too.

Or we can own it. “I have social anxiety disorder and need to be in a less crowded space than the mall.” “I won’t be able to go to the carnival with you because my PTSD is triggered by loud noises.” “I may come to your party if my bipolar disorder will let me.”

We can also address the subject when there isn’t a situation looming. During a phone conversation or an IM chat, we can let the other person know that we have a mental disorder – an invisible illness. It doesn’t have to be dramatic and dire. Casually may be the best way to handle it. “I know you’re wondering why I didn’t go to the movies with you last week.” “When I saw my doctor yesterday we talked about my physical health and my mental health too.” “You know that character on that show that has PTSD? I have that too, but it’s not exactly like on the show.”

If that sounds risky, you’re right. It can be. There will be people who still don’t get it. People who “don’t believe in” mental illness. People who try to brush it off. People who offer the latest vitamins or super foods or Eastern philosophy as the cure-all.

But you’ll also find people who say, “Oh, my brother-in-law has that too” or “Okay. But I’m still your friend” or “What can I do to help?”

So those are the choices, basically.

Take a chance. Or stay invisible.

Neither choice is right or wrong for everyone. Mental illness is very personal.

You decide.

 

 

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I May Have Miscounted My Spoons

This week I actually got out of the house, going for lunch and a little shopping with an old friend. (Another friend of mine calls these “pants days” because they obviously require putting on pants, for going out farther than the mailbox.)

After less than three hours I went home, did some work, and promptly collapsed. All told, I think I was either active, sociable, or some combination thereof for at most five hours – most likely more like four. That for me is an exceptional day of fortitude, stamina, spoons, and hypomania.

However, I have gotten myself into a situation that will require much more than that. I am going to a writer’s conference – three days of thrill-packed seminars, lunches and dinners, and other business and social-type events. I’ve done half-day business meetings lately, but nothing so extended, crowded, or spoon-depleting. It will hit a lot of my anxiety triggers – crowds, noise, small talk, social events, and more. I know that by the time we gather for dinner in the evening, I’ll already be extra crispy.

The three days of the conference will not allow for much of any downtime – although I have fantasized about asking someone who’s staying in the hotel if I can borrow a room for an afternoon nap. (The conference is local so I don’t have a room of my own or it wouldn’t be a problem. Less of one, anyway. All I’d have to do would be pick which seminars to skip. But the idea of asking a relative stranger for the use of a room or the idea of a relative stranger letting me use a room is pretty ludicrous.) Fortunately, I have to get the car home by 10:00 so my husband can go to work. That means I can’t stay for the after-hours socializing, even though that’s said to be one of the highlights. But it does mean I get a few more hours in pjs instead of pants.

Back before I had my most recent major meltdown, I was able to attend business conventions and do at least most of the requisite functions. I could and did give little talks at power breakfasts or afternoon cocktail parties – even opened with a joke. I could meet and greet the public at our booth – “howdy and shake,” as my father would have called it. I could have lunch with potential writers. I could almost interact with our sales force.

Those days are long past. So now I ask myself, how can I build up my stamina for the writers conference? Maybe it’s time for me to try to reclaim some of those parts of myself.

It feels like I’m going to be training for a marathon – or maybe the Normandy invasion. I know that in order to get through it, I will have to prepare in advance: writing my Sunday blog posts before the conference starts, assembling my wardrobe, checking out the parking situation, stocking up on business cards, and all the other little details that make me so frantic at the last minute.

Perhaps during the next two months I can keep track of how many pants days I’m able to have and gradually increase them. Perhaps I can arrange more lunches and shoppings. Perhaps I can improve my usual record of doing only one major thing per day. Perhaps I can try to work up to three pants days in a row.

The conference itself is certainly a massive and major incentive. Plus I’ve already paid for it – yet another reason to get myself in shape to take advantage of it.

Right now the conference looks like rather an ordeal, but I hope that by the time it rolls around I’ll be in good enough shape to both enjoy it and benefit from it. At least it’ll be a group of writers, and humor writers at that. They’re known for being at least a little odd. Maybe I’ll fit right in. I’ll be the one napping on a couch in the hotel lobby in fuzzy slippers. And pants.

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mental health

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Bipolar Basics for the Newly Diagnosed

If you have recently been diagnosed as bipolar, there are a few basics you should know. You’ll likely find them out on your own, but it might take a while.

So, here are some tips.

    1. Being bipolar isn’t necessarily a tragedy. It’s a chronic illness. At times it’s better, at others, worse. It’s not a death sentence and it’s treatable. You can still live a reasonably full and satisfying life.
    2. You need help. To live with bipolar disorder, you need a support system. Unfortunately, your friends and family may not be all that supportive. Fortunately, there are online support groups. But the most important parts of your support system, at least at first, are your psychiatrist and your psychotherapist. I recommend having one of each – psychiatrist for medication, therapist for talk or cognitive behavioral therapy, or whatever works for you.
    3. You will most likely need medication. And the odds are good that you will need it for the rest of your life. Don’t panic. After all, diabetics need insulin, usually for life. You may hate taking pills, you may hate the idea that you are dependent on them, you may hate the fact that they remind you of your brain’s difficulty functioning. But realize that meds will make your brain’s functioning less difficult. They are worth the hassle.
    4. Everyone is different. Everyone’s symptoms are slightly different. Everyone’s medications are slightly different. Everyone’s reactions to their medications are slightly different. A support group can help you with general information, but they cannot tell you what is ultimately best for you. Your particular symptoms and your unique version of bipolar disorder may well require different medications, in different amounts, than your friends. And you may have different reactions to them. Some pills have no effect at all on one person and are life-savers for another.
    5. Getting better takes time. Once you have your diagnosis and your medication, don’t expect to feel better quickly. Most medications for bipolar disorder take a while to build up in the body. Six weeks is not unheard of. Then your doctor may assess how well the medication is working, and change the dose or even the medication itself. Then you may go through another six weeks of waiting for the new dose or drug to take effect. Each case of bipolar disorder requires a medication regimen tailored specifically to the individual, and that often takes some doing.
    6. There are several different types of bipolar disorder. The two main types are called type 1 and type 2. Type 1 is the classical bipolar disorder, which used to be called manic-depressive illness. Type 2, a more recently identified version of the disorder, often manifests as mostly depression, possibly with hypomania, a less severe version of the ups that accompany bipolar 1. Other forms of bipolar disorder are rapid cycling, in which one’s mood states alter quickly, even within a few hours. Another version of bipolar disorder is called mixed states. Mixed states occur when a person experiences both extremes of emotion at the same time – for instance, depression and irritability, or fatigue despite racing thoughts.
    7. The odds are that you already know someone with bipolar disorder, or at least some kind of mood disorder. One in four Americans will have a psychiatric or emotional illness at some time during their lives. Because we don’t talk about it, though, no one may ever know. Especially when the disorder is treated properly, a person with bipolar illness can maintain function in society and choose whether or not to share the diagnosis with friends and coworkers. Many people choose not to because of the stigma surrounding mental illness. It’s a valid choice, but it cuts the bipolar person off from possible support and understanding from others who may share the disorder.
    8. Relationships can be difficult but not impossible. Relationships are difficult for everyone. People with bipolar disorder have relationships that are difficult too. The disorder may make the relationships even more difficult, especially when the family member or loved one or even close friend does not understand the symptoms, the medication, the mood swings, the anxiety or fatigue, or all the other facets of bipolar. The best cure for this is education. However, it may not be possible for a relationship to survive bipolar disorder, just as a relationship may not survive trauma, grief, addiction, infertility, incompatibility, meddling relatives, infidelity, parenting, or a host of other conditions. It may be better to look at all the circumstances surrounding a troubled relationship rather than automatically blaming bipolar disorder for difficulties.
    9. Learn all you can. Because bipolar disorder is so little understood by the public, because it manifests differently in nearly every case, because a person can be actively suffering or in remission, because a person may have any of the different types of bipolar disorder, because everyone is different – the need to educate yourself and probably those around you is essential. The more you know, the less you’ll panic when a symptom you haven’t experienced before suddenly hits. Rely on reputable sources. Medical, psychiatric, or psychological websites are usually the best. Support groups can offer much information, but the people in a support group may not be any more well-informed than you are. And there are lots of people selling “miracle cures” that can lure a person away from needed medication and other services.
    10. Keep trying. It’s hard. It’s frustrating. It’s difficult. It’s painful. It’s confusing. But bipolar disorder is something you can live with, and even something you can rise above. The secret is to keep trying. Keep seeking out therapy and friends who support you. Keep taking your medication, even if you don’t want to. (Stopping your medication without advice from your doctor can be dangerous, so don’t try that.) Be stubborn. When you feel like giving up, tell yourself that maybe things will get a little better in the morning. Hang in there. You may not realize it, but there are people who need you in the world, who need you to be functioning and happy, who need you to keep fighting the disorder.

Do you have any other tips for the newly diagnosed? Please share them in the Comments section.

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Am I Ready to Stop Therapy?

I got my first hint that I might be ready to stop therapy when I realized how little I was going. Over the years I have scaled down from weekly sessions to biweekly.

Then I noticed that, effectively, I’ve been going only once a month. I’ve been forgetting appointments, showing up on the wrong day, oversleeping, feeling poorly physically, or having too much freelance work to do.

Of course, those could be signs that I’m in denial, that I’m resisting therapy, that we’ve hit a bad patch of difficult issues and I just don’t want to deal with them.

But I don’t think that’s what’s happening. Here’s why.

I’m stabilized on my medications and they’re effective. When my psychiatrist moved away a few months ago, he left me with enough refills to last until this month and a list of other psychiatrists. My PCP agreed to prescribe my psychotropics if I lined up another psychiatrist for emergencies. I’ve done that, though I couldn’t get an appointment before March.

And that doesn’t alarm me. I don’t have the oh-my-god-what-if-my-brain-breaks-again panics. I don’t have the feeling that my brain is about to break again. I’ve thought about it, and I’m comfortable with letting my involvement with the psychiatric profession fade into the background of my life.

As long as I keep getting my meds.

I have more good days and I’m beginning to trust them. Oh, I still question whether I’m genuinely feeling good, happy, and productive or whether I’m merely riding the slight high of hypomania. But really? It doesn’t seem to matter very much. A few days ago I reflected on a string of particularly good days – when I accomplished things, enjoyed my hobbies, and generally felt content. And I simply allowed myself to bask in those feelings.

That’s not to say I don’t still have bad days. After a few days of hypomania, I hit the wall, look around for spoons and don’t find any, and require mega-naps to restore me. (I’m intensely grateful that I work at home and can do that. Most offices don’t appreciate finding an employee snoring underneath her desk. And my cat-filled bed is much more comfy-cozy.)

I still get low days too, but they are noticeably dysthymic rather than full-out, sobbing-for-no-reason, Pit-of-Despair-type lows that last seemingly forever. I know – really know, deep within me – that they will last a day or two at the most. And just that knowledge makes me feel a little bit better.

My creativity, concentration, and output are improving. I can work longer, read longer, write longer, take on new projects, think past today or even next week. I can trust my muse and my energy, if not immediately when I call on them, at least within a reasonable time.

I have trouble remembering how bad it used to be. Recently I’ve made connections with several on-line support groups for bipolar and mental health. I find I’m astonished at the crises, the outpourings of misery, the questioning of every feeling and circumstance, the desperate drama of even the most mundane interactions. They are overwhelming. But I realized that it’s been a long time since they’ve overwhelmed me. I recognize that I could some day be in that place again – that’s the nature of this disease. But I have a good support system that I trust to help me not fall too far without a net.

I don’t have much to talk about when I go to therapy. There are issues I need to work on – getting older, getting out of the house more, reclaiming my sexuality. But most of those I feel competent to work out on my own.  My sessions are mostly an update on what’s going on in my life at the moment, plus a recap of my recurring problems. But those problems are ones I’ve faced before and know how to cope with. I already have the tools I need and use them without needing a reminder.

So I’ve talked it over with my psychotherapist and I’m not completely quitting therapy, but I am cutting back officially to the once a month I seem to be going anyway. I know that if and when the bipolar starts giving me major trouble again, I can always call for an appointment or a telephone therapy session.

I’m not going to stop writing these posts. I still have a lot to say about where I’ve been, how I’ve got to where I am now, how things will go in the future, and all the many ways that mental illness affects society and vice versa.

You’re not getting rid of me that easily. I’m sticking around.

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mental health

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Self-Harm Revisited

If that title isn’t enough of a TRIGGER WARNING for you, I don’t know what is.

Not long ago I saw on the web a video with the title “Is scratching self-harm?” Well, of course it is, I thought. The video agreed with me.

It seems like the low end of the spectrum, not as extreme as as what most people think of as self-harm, but a form of it nonetheless. Scratching, pinching, hair pulling, and the like are probably considered subclinical next to cutting and burning. But they are still problems. They can escalate into worse self-harm.

In another article (http://www.upworthy.com/this-researcher-who-studies-self-injury-explains-why-people-do-it-and-why-he-did-it?c=ufb1) I saw this definition for self-harm:

“Self-injury is intentional damage to body tissue (that doesn’t include body modifications like piercings, tattoos, and scarification) without suicidal intent.”

So, yes, scratching is self-harm. It is intentional. It is damage to body tissue. and it does not indicate suicidal intent.

Scratching sounds so minor. We scratch ourselves all the time when we have an itch or an insect bite. We scratch ourselves accidentally on protruding nails. Occasionally we draw blood. We wash it off, slap on a band-aid, and that’s that.

But when scratching escalates to self-harm, it can indeed be serious. For one thing, scratches have a tendency to become infected, infection of the sort can lead to further tissue damage – and if untreated, to more serious complications.

There is also the potential for further harm because the scratching will scab over. Then the desire to scratch off the scabs kicks in. When this happens, the scratches never heal. And yes, that’s both a fact and a metaphor.

My own experience with scratching came when I was working at a job that required me to monitor burglar alarms. The alarms tended to go off – whether there was a burglary or not – during thunderstorms. When a storm hit, a dozen or more alarms could go off simultaneously, or at least in rapid succession. I had to call the owners of the businesses, or emergency services as required.

One night during a particularly bad storm, I missed one of the alarms. I did not call the owners until I looked back at the record. When I called, it was 45 minutes since the alarm. I knew I had made a mistake, and a bad one. The owners of the business would not be happy. My boss would not be happy. I was not happy.

I sat alone by the monitors and imagined the trouble I was in. I started scratching my right arm – long slow strokes from nearly the wrist to nearly the elbow. Repetitively. Obsessively. Painfully. I believe I was punishing myself for making a bad mistake. Perhaps there was some thought that if I inflicted the pain, I would escape further consequences of my mistake.

Of course that makes no sense. It’s an example of the irrational thinking that goes with self-harm.

I don’t cut anymore, as I discussed in a previous post (http://wp.me/s4e9Hv-cutters). I also don’t scratch the way I did that night. I still have a tendency to pick scabs. Occasionally if I have an insect bite, I will scratch it to blood and then pick the scabs on that. I try not to. My husband helps me by reminding me not to pick at scabs or to put band-aids on them. I try to rub instead of scratch, or use lotion.

Jenny Lawson (aka the Bloggess) has admitted in her most recent book, Furiously Happy, that she scratches past the point of bleeding and pulls her hair enough to create bald spots. It’s clear that she considers this self-harm. Her husband tries to help her with it too.

But self-harm is basically a private thing – something we do and hide from the world. Some people are able to hide it even from their most intimate family and loved ones. I know I wore long sleeves to cover the dreadful scratch on my right arm. It healed from a scratch to a pink scar and then to a white scar. Now I can’t even see it anymore through the freckles.

But I don’t need the visible reminder. I remember how it felt to do it, how it felt after I did it, and how I felt as I watch the scars slowly fade. its nothing I’m proud of, except for the fact that I survived it and no longer do it.

As most cutters and other people who self-harm do, I feel shame in recalling the act, and almost never speak of it. The reason I’m sharing the story in such a public forum is to let people know that not all self-harm consists of big dramatic gestures. It can start with a tiny scratch. But it is not something to be ignored. We need to talk about self-harm, educate about it, bring it out in the open, and let others know that it doesn’t have to continue.

And that it can start with something as small as a scratch.

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mental health

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