Bipolar 2 From Inside and Out

Posts tagged ‘coping mechanisms’

The Overwhelming Problem

screaming (Uma painting)It’s been said that time is nature’s way of keeping one damn thing after another from being every damn thing all at once. I know that taking things one at a time—eating the elephant one bite at a time—is a sound idea.

However, every now and then the damn things gang up on you. The elephant is starting to go bad and you have to eat all you can right away – to use a disgusting metaphor that I will not take any further. (You’re welcome.)

Last month was one of those months. They happen every so often. But if they happen very often, I tend to get overwhelmed. And when I get overwhelmed for too long, my brain breaks. I have a meltdown, or I decompensate, or whatever the proper psychiatric term is. In practical terms, it means that I’m severely depressed and non-functional, for longer than usual. Days. Weeks. Months. Even years.

The things that overwhelm me are quite predictable – financial difficulties, health problems, relationship glitches, and free-floating anxiety of all sorts, either my own or my loved one’s. I know that these are situations that cause difficulty for everyone, but to a person with bipolar disorder, they can seem—or even be—insurmountable. Especially when they cluster and refuse to go away.

Over the years I have become good (or at least better) at recognizing when I am about to be overwhelmed. I know the symptoms—the whirling thoughts, the jumping-out-of-my-skin feeling, the insomnia, the inability to concentrate, and the feeling that doom or disaster is impending.

There is little I can do to stave off these feelings. But I know I have to. I have to keep functioning at some level, higher or lower, to maintain the things that I want to have – productive work, a loving relationship, a nice house, caring friends, and so forth. At the time of my last major breakdown, I came uncomfortably close to losing much of that.

I try my usual remedies for anxiety, of course. I distract myself. I color. I watch mindless TV. I play stupid clicky games on the computer. I turn off my phone. But if the anxiety builds up too much, if the feared disaster is real and really is impending, none of these works. The anxiety shreds my last nerve, and the depression starts to settle in. I isolate. I stay in bed. One task at a time, I stop being able to function.

I have taken one step that has helped, however. An anti-anxiety pill is one of my daily medications—one in the morning and one at night. A few years ago, as the stress was building and approaching overwhelming, I asked my psychiatrist if I could have permission to take one more a day if I needed it.

He agreed.

I have not needed to take the extra pill every day. Sometimes I take one in the mid-afternoon if I start feeling jumpy, twitchy, or panicky. Sometimes I take one at night if I haven’t gotten to sleep within 2 – 3 hours after taking my regular nighttime pills. I know it sounds strange that a depressant helps me stave off depression, but my diagnosis is actually bipolar disorder and anxiety disorder. The med catches me at the point where the one starts to turn into the other.

I’m glad my psychiatrist trusted me not to abuse what I consider a privilege as well as a necessity. By the time I made this request, of course, we had been working together for a number of years and had built up a certain trust. I think there have been only a couple of times when I have had to take two extra pills in a day—one in the afternoon and an additional one at night. And both times, I felt guilty about it and made sure I didn’t make it a habit.

I don’t want to start gobbling pills at the least sign of difficulty. All I want is to be able to eat my elephant in peace and in pieces.

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Structure in My Bipolar Days

I used to be a fly-by-the-seat-of-my-pants kind of gal. Work provided the only structure to my days, back when I was able to work in an office. It wasn’t always the same structure, depending on the job, of course. I have worked various shifts over the course of my checkered career—first, second, and third. I adjusted to them fairly well (except when I was working third shift and going to grad school in the mornings).

That all changed when I quit my last office job. I remember feeling so free. I basked in the ability to do freelance work whenever, run errands whenever, go to sleep and wake up whenever. Of course, I was hypomanic at the time, which I should have recognized because of the golden glow that seemed to envelop my days. Naturally, the crash came, along with the absence of freelance work to do. Then, when I fell into a deep depression, anything resembling a schedule fell apart. I didn’t have a specific time for going to bed or waking up, for eating, reading, errands including bill paying, and even showering. Without that structure, I had trouble finding a reason to get out of bed.

Now I’m stable on medication and therapy, and my days have fallen into more of a pattern. I still work at home, but for a company that gives me ghostwriting work. It has a built-in rhythm to it. Most of my assignments are 30,000 words long and due in 21 days. They want us writers to average 1,500 words a day. I divide that up into 750 words in the morning and 750 in the afternoon. I work weekends at this pace, too.

Fortunately, I find 1,500 words a day eminently doable. My daily schedule consists of mornings spent breakfasting, paying bills, keeping track of appointments, or making necessary phone calls (which is my usual role in running the household).

Then, mid-morning, my husband calls on his break from work. Part of the reason is to make sure I’m okay, but most of the time I’m fine and we simply talk, often about what I’ve scheduled for the rest of the week. (I keep track of his appointments and phone calls too. Sometimes I feel like I have a second job as Dan’s secretary.) After we talk, I begin my first stint of writing for the day, my first 750. I’m generally done in time to have lunch around 12:00. Dan calls again in the early afternoon, and I begin my second 750 afterward. When he gets home, we spend time together and have dinner around 7:00.

Those are my daily schedules, which I don’t really need a planner for. When it comes to weekly schedules, I do use a computer app. Our “weekend” is Sunday and Monday because of Dan’s work, but I work on my writing anyway. My calendar is filled with bills to pay by a certain date, appointments we each have to go to (which I remind Dan about), and notes indicating when my 30,000 words are due. I also make note of which weeks are for recycling. (The day before trash day, there’s frantic cleaning.) I have this and another blog that I post in on Sundays. I have a weekly internal schedule for that, too. I start writing them on Tuesdays, have them at least mostly finished on Fridays, tweak and tag them on Saturdays, and publish on Sunday mornings at 10:00.

Having these systems in place keeps me on an even keel which, after all, is my goal as a person with bipolar disorder. My days are predictable, but not boring because I don’t find writing boring, even if it’s on someone else’s topic. Does it seem too regimented? All I know is, it works for me.

This past week, I went on vacation, so for one week, my schedule was largely out the window. I looked forward to staying up late, sleeping late, having meals whenever we felt like it, spending time reading or shopping or sightseeing or watching movies whenever we wanted. Because, as much as I like my structure, I need a break from it at times. Sometimes I take a few days off between book assignments to work on other projects like organizing my jewelry armoire or my desk.

It’s a balancing act, really. Enough structure to keep me focused, but not so much that it becomes a rut. Dan’s phone calls help. Having time in the mornings and evenings before and after I write helps. And my most important routine, of course—taking my meds in the morning and at night. That’s a part of my day’s structure I never want to neglect.

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The Power of Awe

My husband asked me if I wanted to watch this movie, Operation: Arctic Cure. He knows I love stories about people who face hardship. Sometimes they triumph. Sometimes they fail. But they’re always out there trying. Dan also knows that I like stories of Arctic adventure—mountain climbers, exploration ships, races to the pole, and the like. So he figured the movie would be perfect for me. And it was.

It was a documentary telling the story of a handful of people cross-country skiing across Baffin Island, Canada, to reach Mount Thor, pictured above. What made this expedition different was that the participants were all people who had been injured in the wars in Afghanistan and Iraq. Most were soldiers, but one was a news correspondent who had been caught in an IED explosion and suffered traumatic brain injury (TBI). The other people on the expedition also had TBI or amputated limbs. And PTSD.

The people who conceived the expedition were hoping that the experience would somehow help them alleviate the PTSD. The teamwork, the effort, the hardships for a cause were all hoped to be therapeutic.

Another inspiration for the trek was Dacher Keltner’s book Awe. In it, the researcher on emotions posited that encounters with the wonders of nature could have beneficial effects on the brain and body. These outcomes would be largely self-reported, of course, but were backed up by scientific data. The participants took their cortisol levels, a measure of stress hormones, before the trip and twice a day during it. They also had sensors that recorded the length and quality of their sleep. And they kept video diaries, with their faces computer-analyzed for symptoms of stress through eye movement and changes in facial expression.

They did indeed encounter hardships. The skiers pulled heavy loads of their gear behind them. There was the numbing cold, vicious winds that held up their travel, and one amputee whose prosthetic caused so much pain that for one day she couldn’t walk. One of the men pulled her along with his own pack so she could stay with the expedition until she was able to adjust her foot the next day. They talked, of course, sharing stories of their war experiences and their families. One participant came to realize that he hadn’t been in touch with people he knew during the war and that he needed to be.

Where did Keltner’s book fit in? It proposed that the experience of awe, perhaps best encountered in nature, had healing properties. The expedition certainly had those awe-some experiences. They were far enough north to see huge displays of the Northern Lights. They conquered milestones such as reaching the Arctic Circle. And they made it to the foot of Mount Thor, a rugged landscape that features the world’s highest vertical cliff.

But those were subjective experiences. Was there science to back up Keltner’s claim and to validate the emotions described by the participants?

The measures of cortisol provided interesting feedback. In normal individuals, cortisol levels start high in the morning and decline through the day, leaving the body ready for peaceful sleep at night. The participants started the journey with cortisol levels significantly lower than average and rapidly declining throughout the day. By the end of the trek, their cortisol levels approached normal. And their sleep quality and length improved as well. One participant had a 40% increase in his sleep stats.

The movie followed the injured warriors during their trek, but not afterward, so it’s unclear whether the gains lasted. But they evidently experienced something profound. They spoke of the clarity from being in nature and the feeling of being a part of the world around them.

Many books and articles on self-care recommend being out in nature. Most of them talk about the benefits of sunlight, motion, and exercise. Keltner’s book and the film suggest a broader effect. The feeling of awe, of being one with the natural world, could increase a person’s peace, happiness, and a deeper connection to other human beings.

It was pointed out that you don’t have to travel to extreme environments to experience this awe. It’s all around us, if only our eyes are opened to it.

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How I Treat My Bipolar Disorder

There are many treatments for bipolar disorder, from SSRIs to EMDR and more. I must admit that I haven’t tried all of them, but I have encountered a few over the years. Some worked well, others not so much. But I’m doing well now, so I thought I’d share what works for me—my roadmap to stability.

Note that I said, “How I Treat My Bipolar Disorder.” That’s because my treatment is up to me. My psychiatrist or therapist can recommend a certain treatment, but whether I take that drug, undergo that procedure, or engage in therapy is ultimately my choice. I look at my providers as people who recommend treatments and help me implement them. But they don’t make the decisions. I do. Most of the time, I take their suggestions—they know more than I do about medications, for example. But I feel free to make suggestions, too, if the medication isn’t working like it’s supposed to or is having side effects I can’t deal with.

Meds

My med journey started (approximately 30 years ago) with the then-ubiquitous SSRI, Prozac. It worked well for me, relieving my depressive tendencies (I hadn’t been diagnosed with bipolar yet). Until it didn’t. That’s when my doctors started throwing drugs against the wall, hoping they would stick. Over the years, I’ve been on at least three different SSRIs, two NDRIs, two SNRIs, and a sedative-hypnotic. Probably other ones, too, that I don’t remember. (One of the side effects for one of them was memory loss.)

My previous psychiatrist experimented with a variety of meds until we hit on a cocktail that worked: an SSRI, a broad-spectrum anti-seizure drug, an atypical antipsychotic, and a benzo. My current psychiatrist mostly tweaks the dosages up or down when I need it. I’ve quit the sedative-hypnotic altogether and only take the benzo as needed. Recently, when I told him that I thought I was having mixed states, he upped the dosage of the atypical antipsychotic. (I don’t like to give the names of the drugs I’m taking because what works for me doesn’t necessarily work for others.)

I see the psychiatrist four times a year for med checks, though I can call if I have any adverse reactions or increased symptoms.

(When I was looking for illustrations to go with this post, I was astounded at the number of images of mushrooms that I saw. I guess it’s trendy now, but I’ve never tried them. There were also pictures of marijuana plants. There’s a medical dispensary in my area, but I’ve never pursued getting a prescription. I have taken CBD gummies, but the only effect they had was to make me foggy and dizzy, which I didn’t like. They did nothing for my moods. They didn’t even relax me; I was too nervous about my balance and the potential of falling.)

Therapy

Individual talk therapy is my go-to form of therapy, though I recently felt I could stop. (I keep the number handy in case I ever need it again.) I guess you could say I weaned myself off therapy. When I started I was going once a week; later, once every other week. When it got to three or four weeks between appointments, I decided it was time to fly on my own. I don’t know what particular kind of therapy I had—CBT or DBT, for example. She never said and I never asked.

I went to group therapy when I was still undiagnosed, but it wasn’t helpful. Once, when my therapist was out of town, I went to a therapy group she recommended but had an adverse reaction to it. Another group just seemed to have a weird format and a book they used like a “bible,” and I didn’t get anything out of that, either. A few times, my husband and I went to couples therapy, and it seemed to help. Another time, we went to a few sessions with a different therapist and I felt shredded. She seemed to think that I was the “sick one” and my husband was the “normal one.”

Treatments

Most of the modern treatments I haven’t tried because medication and talk therapy work so well for me. I had a close brush with ECT, which frankly frightened me, when I went through multiple drugs for several years and nothing seemed to work. My psychiatrist gave me the information and gave me time to think it over and make my own decision. I was almost ready to try it when, miraculously, a different drug brought my mental function under control. But when it comes to TMS, ketamine, EMDR, et cet., I have no experience with them. I don’t believe in reflexology and won’t try herbal remedies because they might interact badly with my meds. Basically, because what I’m already doing works for me, I see no need to explore alternatives.

Self-Care

It’s hard for me to keep up with self-care. I do stick to a sleep schedule and get 8-9 hours a night, with occasional daytime naps. I don’t exercise. It’s hard enough just to walk with my arthritic knees and bad back.

My husband helps me enormously with self-care. He works at a store with a grocery section, and he makes sure I have a variety of food and beverages on hand—fruits and juices, fizzy water, bread, and cheeses, for example—and fixes meals with protein, starch, and vegetables. Left to myself, I would probably subsist mostly on peanut butter sandwiches and breakfast cereal. Back in the day, he used to drive me to my therapy appointments when I was too nervous or depressed to drive myself. Now he picks up my scripts at the pharmacy department in his store.

What’s the takeaway here? I’m not telling you that I have the answer for how you should treat your bipolar disorder. I know what’s worked for me, but you have to find a path that’s right for you. I merely offer my experiences for what they are—mine. You can create your own roadmap, too.

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People-Pleasing as Pathology

There are two schools of thought about people-pleasing. One is that it’s a good thing, that we should try to please other people. The other is that it’s a bad thing, a symptom of some psychological difficulty. Both theories have something to support them.

There’s an innate desire in most of us to be pleasant to the people we interact with. It reduces social friction and generally makes the world a more pleasant place. Pleasing people we have a close connection to is a way of expressing friendship and love. From that point of view, it’s hard to see how pleasing people could be a bad thing.

When people-pleasing goes bad, however, is when the desire to please others is not done from harmless or beneficial motives, but from pathology. The motives make a difference. And people who suffer from bipolar disorder often have tendencies that can result in unhealthy people-pleasing.

The first hazardous motivation is the desire for outside validation. It’s true that everyone needs validation from someone else at times. When my mother was taking care of my father during his final illness, she knew she was doing a good job. But she needed to hear it from someone else—me. I don’t think that was pathological at all. She was doing something very difficult and emotionally draining. It was just the two of them most days, and my dad, while appreciative, was part of their two-person system. Mom needed to hear someone outside say it.

But when you are empty inside and have no inner validation, you can need external validation all the time. And one of the ways you can get that is to always be accommodating. You provide for someone else’s needs to the exclusion of your own. While you’re filling up someone else’s reservoirs, you’re letting your own go dry. And that’s detrimental to your mental health.

Another motivation for people-pleasing is to avoid conflict and stress. Catering to someone else’s needs to keep things on an even keel is dangerous. A healthy relationship goes both ways, with both people trying to please the other. If you’re afraid that a dire situation will arise if you’re not perpetually accommodating, there’s a good chance that the relationship is abusive. People-pleasing in order to avoid physical or psychological damage to yourself is a big problem.

Low self-esteem can also cause a person to fall into excessive people-pleasing. You think that your only value lies in making other people happy. Of course, low self-esteem is not exclusively a bipolar trait. Depression, adverse childhood experiences, trauma, perfectionism, and cultural or societal expectations can also result in low self-esteem. But trying to build yourself up by being subservient is not the way to go.

Potential rejection can lead to a fear of not fitting in. People-pleasing in these cases is meant to ingratiate oneself with the in-group. The stereotypical new employee can “suck up” to people in higher positions or existing cliques to make others more likely to let them into important business or social circles. Bringing donuts, taking on extra assignments, and picking up the check at lunch are not in and of themselves bad things. But establishing a pattern of this kind of behavior is overkill—excessive people-pleasing in hopes of getting a reward.

One significant danger of people-pleasing is disappearing in a relationship. One person becomes the dominant partner and the other one is in the position of serving that person. Even people outside the relationship may notice the unhealthy dynamic. They may view the people-pleaser as an appendage and the dominant person as the center of the relationship.

Although the stereotype is that women are people-pleasers, either gender can have that role. Intimate relationships of any kind can be plagued with the problem, and other groups of people such as coworkers can contain one or more people-pleasers as well.

What’s the opposite of people-pleasing? People-helping that goes both ways. Reciprocal interactions that benefit both people are to be preferred. They keep a relationship in balance and lessen the possibility of one person, whether bipolar or neurotypical, disappearing.

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Positivity and Acceptance

Those who follow this blog have seen me rail against toxic positivity. When it’s not absurd, it’s insulting to those of us with mood disorders. No, we can’t just cheer up. If we could look at the bright side, we wouldn’t have depression or anxiety. You may be able to choose happiness, but I can’t. I’ve needed medication and therapy just to feel meh at times. If I could turn bipolar disorder off like a light switch, don’t you think I’d do it?

Toxic positivity can be seen nearly everywhere, in a lot of different situations: the self-help movement, of course, but also business, medicine, and even religion – as well as endless memes. American society is rife with toxic positivity. It appears in motivational business conventions and TED Talks. Salespeople are advised to think positively and envision success. Breast cancer survivors are advised to keep a positive attitude, to the extent that they are encouraged to tell how the disease has had a positive effect on their lives and relationships. (Expressions of fear, anger, and other natural emotions in response to the diagnosis are downplayed or discouraged.) Religions can exhort us to count our blessings or “manifest” our wants and needs by using positive thoughts to attract them.

Positivity becomes toxic when it is seen as the only method of coping with problems in life, even ones that have other solutions or none. Toxic positivity presents relentless cheer as the only acceptable reaction and a panacea for every difficulty. And toxic positivity leads people to demand that others take up the mindset and apply it to every situation, even devastating ones. As such, it denies the reality of human suffering and normal emotional responses. It’s a form of non-acceptance.

So, what is the alternative? What is a more natural – but still effective – technique for dealing with difficulties? How can those of us who have mood disorders or any other brain illness find ways to navigate through life without slapping on a smile and coercing our emotions to fit a certain mold?

Radical acceptance is one answer. Radical acceptance means that you accept your inner feelings and your outward circumstances as they are, especially if they are not under your control. You acknowledge reality without trying to impose a set of emotional mandates on it. Your acceptance and acknowledgment may involve pain or discomfort, but those are understandable, normal human conditions. They are natural conditions that evoke a natural response.

Rooted in Buddhist teachings and given a name by Marsha Linehan, the psychologist who developed dialectical behavior therapy (DBT), radical acceptance uses mindfulness to help people learn to face and regulate their emotions. Interestingly, one 2018 study found that accepting your negative emotions without judgment is a factor in psychological health.

With radical acceptance, when you encounter difficult situations and emotions, you note their presence without trying to suppress them. You accept them, as the name implies. This attitude can address – and reduce – feelings of shame and distress that you may feel, especially when you are not able to simply shut off those feelings and replace them with positivity. That doesn’t mean that you wallow in unpleasant feelings or allow unfortunate circumstances to stunt your responses.

Instead, you note the feelings – accept that they exist – and “hold space” for them within you. You appreciate that your emotions can lead you to new understandings of and reactions to your circumstances. For example, instead of adhering to the unattainable maxim that “Failure is not an option,” you can recognize when you have indeed failed and accept it as a natural part of life. You can then move on to a mindset of growth where you use that failure to inform your future actions. You develop a more accurate picture of the world and can begin implementing real solutions.

Of course, there are situations where radical acceptance is not appropriate. Abusive situations, for one, shouldn’t simply be accepted without being addressed. But neither will positive thinking resolve them. They require action, from seeking help from a trusted individual to leaving the situation to contacting law enforcement or an organization that can help.

But in other circumstances, radical acceptance may be an answer for some. For myself, I’ll just be satisfied if radical acceptance helps drive out toxic positivity. I don’t think it will, but a person can dream.

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Beating Bad Thoughts

I saw a meme today. It said:

“Just do what you can today, okay? It will be enough.”

Instantly my brain said, “No, it won’t.”

My brain, uncooperative at all but the very best times, has a habit of telling me bad things when I’m in a depressive episode: “You’re useless.” “You’re pathetic.” “Everything you do fails.”

For some reason, positive thinking memes and slogans bring out the worst in my brain. If a pass-along or a bumper sticker tells me that tomorrow will be brighter, my brain says, “No, it won’t.” If a meme says, ” I hope the situation you worry about favors you in the end,” it says, “Yeah, like that’s gonna happen.”

Is my brain simply cranky and uncooperative? Well, yes. But these intrusive thoughts reinforce and deepen my depression, chip away at what self-esteem I still have, deny my progress in healing, and make me resent the whole happy, smiley world that apparently everyone but me can see.

Is there anything I can do to make my brain shut up, or at least pipe down with all the negativity?

I’ll tell you what doesn’t work for me: daily affirmations. My brain tells me these are lies and that I shouldn’t believe them. I can’t look into a mirror and repeat five times, “I am a good, worthwhile person” or “I deserve happiness” or “I will overcome my problems.” It’s like the problem of seeing cheery, encouraging memes on the internet, only having to inflict them on myself. If anything, they make me feel worse.

If these sorts of things work for you, fine. I’ve no objection. I won’t make fun of you. I’m truly glad you’ve found something that helps you.

They just don’t work for me.

So what can I do?

I have gleaned two helpful hints from my therapist. Both are visualizations, and both are metaphors. And both involve animals. (They are variations on a technique called “thought stopping,” which is simpler and more direct. But I find visualizations easier to remember and do. I love metaphors.)

The first comes from a mindfulness meditation that Dr. B. asked me to try. I’m not much good at meditation, because of both my intrusive thoughts and my anxiety. Sitting still for that long is difficult, and so is emptying my mind of thoughts to concentrate on my breathing, for example.

The narration that guided the meditation had a solution for this. When your mind wanders and your thoughts drift off to somewhere else, think of them as puppies that wander away when you’re trying to teach them something. Gently corral them and nudge them back in the right direction. You don’t have to panic and shout, “There they go!” and run off after them. You just give them a little push toward where you want them to go. If they wander again, do the same thing. “What about the mortgage payment? Come back, little puppy. Over here.”

The other technique is for the kind of bad thoughts that I often get: anti-affirmations or negatives that deny any suggestion of peace or happiness or accomplishment. For these, Dr. B passed along an idea that another client had given her. Imagine that your bad thoughts are naughty cats, who jump on the kitchen table or try to go fishing in your aquarium. Then imagine spraying the bad thought (cat) with a bottle of water to make it stop what it’s doing and scram. “I never do anything right. Psssst! Psssst!”

When I’m profoundly depressed, I doubt even these clever dodges will work, though I’m certainly going to try them. But when I’m just starting on the slide down, I predict they’ll be just the thing to trick my brain into submission.

Take that, brain! Psssst! Psssst!

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The Therapeutic Hug

The common wisdom is that a person needs four hugs a day for survival, eight for maintenance, and twelve for growth. I doubt that this is confirmed by any scientific studies and I doubt that it is true. If it were, there would be millions of people on Earth who would not survive. I would be one of them. Despite being married to one of the two truly world-class huggers I’ve met in my life, I do not get my four-a-day. And certainly not twelve. Assuming eight hours a day for sleep and eight hours a day for work, that would leave eight hours to work in twelve hugs. That’s one and a half hugs per hour, and I suspect half a hug just won’t do. In fact, I know it won’t. Scientific research has been done on the 20-second hug. It releases oxytocin, a pleasure and bonding chemical in the brain. Half a hug would need to be 40 seconds long to do the proper amount of good, and young lovers and newlyweds tend to be the only people who give hugs of that duration. Then there’s the question of what constitutes a hug. For greatest oxytocin effect, I would recommend the full body hug – toe to toe, torso to torso, heads on shoulders, arms tightly squeezing. But you probably can’t give that particular hug when you run into an acquaintance in the supermarket, especially not 20 seconds worth, without blocking the aisles. Other variations of hugs that may be less effective are the side-by-side one-shoulder squeeze (and the multi-person variant, the Big Group Hug), the manly back-thumping, and the A-frame hug (standing a distance apart and leaning in for a hug from the shoulders up). Then there are the virtual hug, often written ((hug)), with the number of parens indicating the length/intensity of the hug, and the proxy hug, in which you delegate a person to pass along a hug when you’re not able to be there. None of these seem really conducive to the 20-second, made-for-thriving hug. But, on some level, we know that hugs are therapeutic. Oxytocin or whatever, they make us feel better. Lots of hugging goes on at support and 12-step groups, and people who go to those daily might indeed make their recommended quota. I go to private psychotherapy, however. I’ve never hugged my therapist, and am not even sure whether it’s appropriate for therapist and client to hug. It would be awkward to ask, “Can I have a hug?” only to hear, “No. That’s unethical.” But I suppose it depends on the therapist and the client and how each feels about the subject. I know sex between therapists and clients is unethical, but hugs may be a gray area. Perhaps someone can enlighten me. Of course, there are people who do not like to – or are afraid to – touch other people. People who are aware of and skilled in responding to others’ body language may be able to see the little (or, let’s face it, large) cringe when one person sees another moving forward with open arms. If the non-hugger is quick enough, he or she can quickly stick out a hand for a hearty handshake, or the potential hugger will abort the hug and retreat to a friendly tap on the shoulder. But there are people who will swoop in and envelop you in an unwanted embrace and maybe even air kisses with smacking noises. I suspect these would be more likely to shut down oxytocin entirely, and possibly release adrenaline instead in a fight-or-flight response. As with sex, the safest route is to ask for consent – “Can I have a hug?” – and take no – “I’d rather not” – for an answer, without taking offense or pressuring – “Aw, c’mon” – and making things even more awkward. Still, the best advice I can give is to be proactive about hugging. Say, “I need a hug” when you do. Ask “Do you need/want a hug?” when a person you know seems to be in distress. Avoid hugging strangers, though. That hardly ever helps. At least wait until you’ve been properly introduced.

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Burnout Ahead

This was first published seven years ago. I’m glad to say that things are better now.

What do you get when you take two people, three doctors, eleven prescriptions, two pharmacies, and an insurance company?

No, wait – I’m not finished.

THEN add another person, two banks, a credit card company, a missing check, and a disputed charge.

Mix in bipolar disorder, clinical depression, and several months of previous stress.

What you get, first of all, is something that rhymes with fuster-cluck, and then a dangerous situation: Two people under pressure, neither of whom can function well enough to find any solutions, running out of psychotropics.

There is enormous inertia. You make a few calls, get a few responses. Fine, you think. That’s taken care of. Except that days later, it isn’t. There are overdraft notices, nearly exhausted supplies of psychotropics, and occasional fits of tears.

So you take another swing at it. More phone calls. More revolving phone trees. More dropped calls. More suggestions that you really need to get someone else to call someone other else to resolve it and here’s a handy 1-800 number that takes you to a department that never heard of you, your problem, or the companies you’re dealing with.

Yes, they all agree. It’s important that you don’t run out of your psychotropics. It would sure be nice if there were enough money in the account to pay the premium for the crappy insurance. It’s a mystery why no one has any record of the complaint you asked them to file.

Another day. Another no check. Another no drug delivery. By now we’re getting into mixed states: immobilizing depression and nail-biting, catastrophizing anxiety.

You look for possible work-arounds. Maybe the local pharmacy can sell you enough pills to tide you over. But, oopsie! Your bank balance just went from -$53 to -$82. And the insurance won’t pay for drugs at the local pharmacy anymore – only through mail order. Which brings us back to D’oh!

This is not hypothetical. This is happening.

What do we do now?

Well, we split up the tasks. I work on the drugs and insurance end, while my husband works on the banking problem. We both hover over the mailbox, waiting for the check.

We take turns with symptoms. Both of us having a meltdown at the same time is not pretty. I’ve seen it. Trust me on this.

We do all we can do and then stop. For the moment anyway. When the pitch of my voice starts rising to dog whistle range and I start sniffling and tearing up, I know I’m just moments away from becoming incoherent, which may demonstrate the need for the psychotropics, but is not actually any help in getting them.

We try to take care of ourselves. Dan can sleep (I can’t), so he does. He buys me comfort foods (fried rice, mashed potatoes). I decide that this may not be the best time to be reading a new, fast-paced zombie apocalypse thriller and switch to a familiar old standby character study.

There’s never a good time for these cosmic pile-ups to happen, but now is unusually bad. The last few months have brought assorted financial and medical troubles (the two being related, of course), plus the death of three elderly pets within a couple of weeks of each other. Dan is dealing with the fact that the house he grew up in is up for sale. I haven’t been getting as much work as usual. Soon, I will have to look into expanding my client base or finding another line of work.

After I get the drugs. And after they start to work. Whenever that is.

Sorry I don’t have anything encouraging or amusing or informative to share this week. That’s just the way it is sometimes. And now is one of those times.

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Mental Health

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Stuffing Your Feelings in a Box

Cardboard box with the zipper isolated on white backgroundWe all know it’s a bad idea to stuff your feelings, especially if you then pile food or alcohol on top of them.

The thing is, sometimes you need to suppress a feeling, for just a little while, in order to get through a difficult situation. When that happens, I put my feelings in a box.

Here’s an example. My father was dying, and had only days to live. We all knew it. My mother, who didn’t drive, asked me to take her shopping for something to wear at his funeral. “Do you mind if I don’t wear black?” she asked. “If you don’t mind that I do,” I replied.

It was my first encounter with a close family death, and I had to get through this awful, wrenching shopping trip. I had to keep my composure so that my mother could keep her composure. I had to steer her away from a flowered dress, which would have been fine for church, to a navy suit and a lighter blue top, which would be suitable for a funeral but not so somber that she couldn’t wear it for anything else. All while my father lay in the hospital, dying painfully of bone cancer.

My feelings were complicated and I absolutely could not afford to feel them at that time. I had to stuff them in a box and close the lid on them until my mother’s needs had been met. Then I could let them out, in a time and place where it was safe to, in the presence of a person I could trust with those feelings.

When such circumstances arise – and they will, in one form or another – I recommend using a box, one in which the feelings will be out of sight for a while. A box is small; only a few feelings will fit in it. If you think the feelings are going to leak out, you can sit on the lid. Then, when it has served its purpose, you can rip the box open (or gently lift the lid) and feel the feelings. Cry. Rage. Grieve. That’s the important part.

You have to experience the grief or fear or even the crushing weight of guilt in order to come through it and heal.

But why put feelings in a box instead of something stronger? Who wants to feel those negative emotions anyway? Aren’t we better off without them? Shouldn’t you just build a wall around them to keep them from breaking out?

We’ve all tried it. It works for a while. But a couple of consequences go with the practice. First, all of your feelings get trapped behind that wall – the good as well as the bad. When you find yourself disconnected from all your feelings, life is a gray blur. In your depression or anxiety or fear or rage, you may not have had many good feelings. But when you build that wall, you cut off even the possibility of having them.

Second, you’re only postponing the pain. The wall will leak sometimes; your unpleasant feelings will come out some way – in your dreams, around your eyes, in sudden spurts, or trickling back into your everyday life. Worse, the wall may shatter – fail altogether, releasing all those feelings in an unstoppable torrent, only stronger and more concentrated from having been confined. They overwhelm both you and anyone in the vicinity. It’s not pretty. And it’s destructive – to you, your mental health, your healing, your employment, your relationships – to every aspect of your life.

If feelings are behind a wall, you may be able to tell yourself they don’t exist. But if you stuff them in a handy box, you can choose the time and place to open it – and yourself – back up.

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Mental Health

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