Bipolar 2 From Inside and Out

Posts tagged ‘depression’

Bipolar Moonshine

Honestly, the things they ask on Quora these days! Quora, for those of you not familiar with it, is a website that allows people to ask questions for “experts” to answer. Somehow, I have become one of the people that others come to with questions about bipolar disorder. (Also the Ivy League, but that’s another story.)

Some of the questions are serious, but others are less so. “If you could stay hypomanic all the time, why wouldn’t you?” “How can I get my bipolar dad to stay on his diabetes meds?” I actually had an answer for that: You can’t. And bipolar has nothing to do with it. 

I’ve answered a few of the questions if I had the time or if a good answer hadn’t already been given. Many of the answers are written by doctors, who can do a much better job than I.

Recently, however, I saw a question that I thought it wouldn’t take a medical degree to answer:

“Is bipolar disorder causally linked to lunar cycles?”

Impressed that the writer knew the difference between “causally” and “casually,” I responded:

“No. The cause, as far as we know, is a glitch in the brain between the synapses. There may also be a genetic or hereditary component. But nothing to do with the moon.”

To my surprise, I received a reply. The writer, while asserting that he or she was also bipolar, said that my response was “no answer at all” and incorrect. Acknowledging the genetic component I mentioned, the author then proceeded to enlighten me with an “unpublished hypothesis.” (He or she also claimed to be “a bipolar scientist,” though not a neurophysiologist.)

The argument was based on several points.

  • Sexual reproduction is always in response to lunar cycles.
  • This is based on gravity, illumination, and diurnal and lunar cycles/high tides.
  • Bipolar disorder is a disruption of sleep.
  • It first manifests at or near puberty, with the onset of hormonal cycles.
  • Something about teenagers having a different sleep cycle than adults, staying up later to reproduce while the parents sleep. (I can’t say I understood this part.)
  • During the full moon, hospitals and police report increases in both people out late at night and odd behaviors and emergencies.
  • Anecdotally, the writer noticed “elevated and depressed moods not necessarily linked to lunar cycles, but not necessarily independent of them either,” noting that “periods of mania occur during full and nearly full/new moon.”

The writer’s hypothesis, if I follow it correctly, is that bipolar disorder involves sleep-hormonal cycles related to the full moon, which evolved in the days before artificial lighting. This apparently gave a reproductive advantage of being awake at night because bipolar disrupts the sleep cycle. This is noted to be “an obvious evolutionary reproductive strategy.” There was more, but that was enough for me. (The writer admitted that statistics to prove any of this did not exist or had to be derived from “Bayesian statistical methods,” which one source I looked at called “a measure of the strength of your belief regarding the true situation.”)

So, where to start? First, if the writer thought he or she already knew the answer, why write in with the question? Obviously, to seek validation or to promote a theory (or to make me look like a fool).

I could answer each point individually. (I’m not a neurophysiologist either, but I do have some experience with rhetoric and logic. And bipolar.) But let’s just take a few.

Not all animals’ reproductive cycles are based on the moon, and neither are humans’. Women have menstrual cycles at all times of the month, and men don’t. (And what about bipolar men?)

Bipolar disorder can certainly cause a disruption of sleep, but is not caused by it. That is too simple an explanation for a complex disorder.

We’ll just skip that one about teenagers reproducing while parents sleep. Its connection with bipolar disorder is slim at best.

That one about the full moon is most likely anecdotal, as reported by police and emergency room workers, but no statistics (other than perhaps Bayesian ones) seem to bear this out. And the moon is full, nearly full, or new for more than half the month. Let’s also disregard the fact that bipolar cycles are seldom exactly a month in length. I had a depressive crisis that lasted several years.

Many causes have been theorized for bipolar disorder, from gut bacteria to early trauma to brain wiring. At the moment, as far as I know, the jury is still debating. Perhaps all of these are components of the cause, though I favor brain wiring as the principal cause. But given the actual science, I’m betting that the moon isn’t the answer.

What Does “Normal” Mean?

When I was young, I wanted like anything to be normal. I didn’t know what normal meant, but I knew I wasn’t it.

I had a lot of the trappings of what passed for normal in that day and age: parents still married, one sister, suburban house in a town with good schools, church down the street, same-age children living within a block, working father, stay-at-home mom, abundant books and toys, and vacations to visit the relatives.

But I knew. There was something different about me. Everyone else knew it too. I wasn’t normal. I was too sensitive, whatever that meant. I was precocious. I didn’t fit in and I didn’t know how to.

As I reached my tween and teen years, I encountered a dilemma. I desperately wanted to be normal. Normal kids had friends, got to hang out with each other, laughed and smiled a lot, wore what was in fashion. They gave off an aura of being normal. I longed for that. I was in love with the idea of normalcy.

But every time I tried, I failed. I was always too weird, too emotional, too smart, too something.

So I began to hate the idea of normalcy. If I didn’t fit in, then by God, I would scorn the idea of fitting in. I would embrace non-normalcy. I would hang with the few other misfits I could find. I would eschew the latest fashions and trends. I didn’t rebel, exactly. I was too timid for that (yet another too).

And I blamed the suburb and the Midwestern state where I lived. Maybe this kind of normal was bland, spiritless, and hum-drum. Maybe I was right not to want to be of it.

So, of course, I tried the geographical cure, going away to college, where I thought the people would be more like me, where there would be enough diversity that I could find others like me and finally fit in. Be normal within a different definition of normal.

And it worked, at least partially. But by that time it was too late for me to ever be normal.

What happened was that bipolar disorder caught up with me. I had probably been struggling with it all the time I was a weird kid who didn’t fit in. Other kids threw rocks at me. My moods were extreme. I cried and laughed at things that were neither sad nor funny. Being betrayed by a friend sent me into a severe meltdown.

By the time I was in college, there was no doubt that I was struggling with a mood disorder, although we didn’t have that term for it at the time. At the time it seemed like major depression and for the most part, it was, or at least that was the only mood I could identify.

Years later, when I got a proper diagnosis and the right medication, it was easier to look back and see my bipolar tendencies slowly building over the years. But I’ll admit something – I still both love and hate the idea of normalcy. I still want to fit in and I’ve found a few groups where I seem to. But I also want to embrace my oddness, celebrate my differences, glory in my assorted varieties of geekiness.

I never want to go back to that lost, lonely, spinning-out-of-control kid who was always too much or not enough. My lifestyle helps since I don’t have to try to fit in at a nine-to-five office job. My husband helps, as I was at least normal enough to find one. And my writing helps, so I can work out some of my conflicting emotions and bipolar moods through this blog and other venues.

Here’s another reason to hope: Matt Norris, a blogger at The Thinking Orc, recently wrote:

Disapproving of people who aren’t “Normal” went from a virtue to vice within my lifetime. The shift in public morals changed the rules on what it took to be seen as a good person. It used to be about not doing anything weird, and looking down on anybody who did. Now it’s about not doing anything cruel, and looking down on anyone who does.

Besides, to quote songwriter Steve Goodman, “I may not be normal, but nobody is.” I know that now. So in that sense, I do at last fit in.

I Hate My Job, But I Don’t Hate My Life

The other day I found myself thinking, “I hate my job. I hate my life.” But then I stopped. The truth was that I do hate my job, but I don’t hate my life.

There have been times when the two thoughts absolutely went together. I well remember getting up in the morning and thinking, “Now I have to go to the bad place where they make me unhappy.” Unfortunately, the thought would color my whole day. Instead of unwinding after a rotten day – or a whole series of them – I brooded about what came before and dreaded what would come the next day. I was caught in a loop of bad thoughts and they wouldn’t let me go, or enjoy, or relax. My life seemed to stretch out into an unending series of more of the same.

Of course, that was when I was deep in bipolar depression, improperly medicated, and unaware of self-care. Oh, the job was indeed pretty terrible. I was an editor, a writer, and a proofreader, tasks and occupations I normally enjoy. There’s something wonderful about taking something mediocre and making it good, or even taking something bad and making it better. Once or twice I even got compliments on the job I was doing.

But at that time, when I hated it, the job was a misery. A reorganization had put the editorial department under the marketing department, which had been true in fact for a long time but was now formally acknowledged, with a resulting new chain of command. Anything I wrote was essentially a puff piece for some advertiser. Three senior editors were fighting over my time and attention, each determined that I should work on their project first and foremost.

I wasn’t quite ready for a major breakdown, but I was close. I hated both my job and my life.

Now I have a tedious and basically unfulfilling job. I transcribe audios of boring business meetings and lawyer consultations, relieved only by the occasional podcast. On top of that, I’m a really crappy typist, so it takes me hours to do a job that others could zoom through. Add in foreign accents and mumblers, and you get a job that brings me no joy, but only a modest paycheck.

But for some reason it also suits me. I work four days a week, at home in my pajamas. No one is looking over my shoulder. If I make my deadlines (and I do), I can expect fairly steady work, except during the holiday season. I earn enough to supplement my social security without going over their limit on extra income.

I also have medications that stabilize me and a much better knowledge of self-care. Working at home for only one boss is part of that. So is taking meal breaks whenever I want them and spending that time with my husband. Eating nutritious meals. Letting myself say, “I hate it! I hate it!” after a particularly trying assignment. Reading a book before I go to bed. Snuggling with the kitties. Allowing all these things to seep beneath my skin and feed my soul.

I don’t belong to the regular-massage-and-decadent-chocolates school of self-care. Maybe I’m a simple soul, but I prefer the everyday comforts that make my life not a misery and help me appreciate what I can of my situation. Not that I’ve got anything against either massages or chocolate. But to me, they are special indulgences rather than a part of my daily self-care.

In the end, medication and self-care are what keep me going, hating my job, but not my life.

The Languages of Love and Bipolar Disorder

In 1995, Dr. Gary Chapman published his popular relationship book, The Five Love Languages. In it he proposed that there are different ways – or “languages”  – that people use to communicate their love. Problems happen when one partner doesn’t speak the same language as the other; for example, when one gives the other literal gifts while the other yearns for time together.

I’ve been thinking quite a bit about love and bipolar disorder lately and it occurred to me that the five love languages could be a helpful lens for looking at relationships. In particular, they might help a person realize what the other one needs when experiencing symptoms of the disorder.

Here are the five love languages and how they might be helpful if you are in a relationship with someone who has bipolar disorder.

Words of affirmation. I’m not talking here about the kinds of affirmation we are supposed to look in the mirror and give ourselves. I mean words of affirmation that come from outside, from another person, and are gifts of love. Everyone needs affirmations at times, but for people whose love language is words of affirmation, they can be positively soul-feeding.

For the bipolar person, these affirmations can be as simple as, “Thank you for coming out with me,” or “Congratulations on getting the bills paid,” or even, “I know you can do it,” or “I knew you could do it!” And for the bipolar person who struggles with self-esteem, imposter syndrome, or lack of motivation, these can be the words that keep us going.

Quality time. Quality time doesn’t have to mean an elaborate outing or a two-week vacation. It can be as simple as sitting on the sofa with your partner watching a movie, or cooking together. Especially when there’s something else you could be doing. Giving up that other activity to spend time with your loved one is another kind of love-gift.

Quality time – extended periods of togetherness – can be extra special to someone with bipolar who feels lonely, isolated, or unlovable. Just the idea that someone wants to spend time with you, even though you can barely stand to be with yourself, sends a powerful message.

Receiving gifts. There are people who value physical gifts and see in them the care and attention that another person spends selecting just the right thing. Diamond rings are unnecessary. In this language of love, a simple houseplant can even be preferable.

You probably shouldn’t expect a physical gift to “cheer up” a person with bipolar depression. As with any gift, the important thing is knowing what the person values and providing it to them. Comfort objects such as plush animals, mp3s of calming or favorite music, or a weighted blanket to ward off panic may be just the thing. Even a silly coffee mug with an appropriate saying can become a treasured item.

Acts of service. If the person you love values acts of service, then your way of speaking that love is accomplished when you do something for her or him. Doing the dishes or some other chore that usually falls to the loved one is one example.

For the bipolar person, acts of service that speak of love may be as simple as handling phone calls and visitors, or doing the shopping when he or she just can’t face the grocery store. “I’ll do it for you” is a powerful message that says, “I care about you and want to help ease your burdens.”

Physical touch. Strange as it may seem, some people never think of physical touch as a language of love unless they’re talking about sex. Of course, the physical and emotional intimacy of sex can speak love, but other kinds of touch do just as well for some people.

Bipolar people in the manic phase can have a high sex drive and appreciate some sexual attention even if you wouldn’t ordinarily want it at that time of day, for example.  But the bipolar person can crave touch without sex as well. Hugging and cuddling, sitting close with an arm around the shoulders, and even a touch on the shoulder as you leave a room can speak volumes.

The important part of this is to learn and know what your partner values – what language of love she or he speaks – and to give it to them. Mixed signals, speaking the language that you would want instead of the one that your partner does, will not be processed as love. Physical gifts to one who hears love in affirmations will miss the mark.

Obviously, the best thing to do is to ask your partner which “language” they speak. But she or he may not even realize that there are different languages or which one is theirs. Observation, attention, and even trial and error may be necessary to get the communication going. But if you want to speak love to a person with bipolar disorder, these are communication skills that can be vital.

What My Husband Has Learned From My Bipolar Disorder

First, let me say I’ve learned a lot from my husband and from my bipolar disorder. The two of us have been married for more than 35 years and I’ve been bipolar all that time. I’ve learned a lot from him about caregiving, steadfast love, and coping, among many other things.

But he’s also learned a few things from living with me and my disorder. I asked him to tell me about it, and here’s what he said he learned.

He can’t fix me or control my emotions. (Of course, the corollary to this is neither can I.) “It’s not necessarily my fault when she feels bad and it’s not my responsibility to make her feel better,” he says. This particular lesson caused both of us a lot of trouble early in our marriage. Dan would blame himself for my moods and become angry when he couldn’t do anything to make me feel better or even respond to his attempts. He was in there trying, but he had to learn to let go and help me find ways to work toward my own healing.

He knows my comfort items and my triggers. Over the years, Dan has learned that while he can’t make me better by himself, he can help me get the things that bring me comfort and avoid the things that trigger me. For example, he knows I find watching cooking shows calming. Him, not so much. But often he joins me on the sofa while I indulge. “Sometimes I’ll sit and be with her even if I’m not really interested in the cooking shows,” he says. “Just to be with her. I do it because I want to be with her.” Sometimes I do that with him too, when he watches shows about treasure hunting or weird science. Sometimes we even sit together and watch shows we both like, such as Forged in Fire.

He has also learned about things that trigger my anxiety, such as loud noises. “I have to be mindful if she’s in a place where loud noises affect her,” he says.  “If I do have to hammer or pound on something, I give a warning so that she’s not blindsided or startled by it.” “There’s going to be a crashing noise,” he says, or “Everything’s okay. I just dropped a pan.” He also lets me know where he’s going to be and how to get hold of him in case I panic badly.

He knows to ask, offer, or get out of the way. I can be needy at times, but don’t always know what it is I need. At times like that he’ll ask, “Do you need a hug? Do you need to eat?” Other times he’ll simply give me that hug or put on one of my comfort movies (The Mikado or The Pirates of Penzance usually draws me out of bed). If neither one of us can figure out what might help, he’ll simply let me alone until I feel better or until I think of something.

If I do ask for something I need he’ll say, “You can get that.” If he can’t do what I need, we’ll sometimes negotiate a partial solution. Or he’ll give me the tools to do it myself.

He knows how to help with self-care. Like so many people with bipolar disorder, I find that taking a shower, getting dressed, and going out requires quite a number of spoons, sometimes more than I have. Dan helps with that. For example, he’ll give me a clean towel and clean clothes, and remind me that I need that shower. Or he’ll encourage me to get out of the house by negotiating how many errands we’ll do on a given day or by including a stop at a bookstore or a favorite restaurant among them.

He knows that self-care is important for him too. Sometimes he’s the one who needs that hug or that alone time, and he asks for it. He knows that I have learned that he needs these things too and that I will ask him what he needs, or offer it, or say, “You can get that” to him. As the saying goes, you can’t pour from an empty vessel.

A lot of what we’ve both learned from my bipolar disorder are just the things that any partners need to learn: Tolerance. Give-and-take. Negotiation. Touching. Sharing. Civility. Support. We’ve both grown from the experience and that to me is very important. This marriage would never have worked if either one of us had stayed stuck in the way we were in the early days.

Self-Medicating: Bipolar and Booze

Self-medicating – using alcohol or drugs to dull the emotional pain of a mood disorder – is pretty common among people with bipolar and other mental disorders, particularly the undiagnosed.

It’s a dangerous thing to do. People with major depression are said to be twice as likely to develop a drinking problem if they self-medicate with alcohol a lot. Then there’s the possible interaction between alcohol or drugs with a person’s prescribed meds.

To be perfectly honest, there were times in my life when I self-medicated with wine, beer, or liquor. During one particularly dark time, when I had been prescribed benzos for a physical ailment, that was thrown into the mix. And, again with the honesty, I still sometimes have wine or beer with dinner, though I know I shouldn’t. I could say that I know how much I can drink without it affecting my reaction to my meds, but the fact is that I just shouldn’t.

Recently, however, a study was published in the journal Nature Communications which said that “getting drunk causes the same molecular changes in the brain as taking rapid antidepressants.” Here are the basics.

It was a study done on mice, which means it’s a long way yet from applying to human beings. The set-up was this: Mice were given alcohol, then placed in a container of water. Being passive and willing to drown was taken as an indication that the hapless creature was depressed. Sure enough, the mice that were given alcohol proved to be more active and energetic in trying to swim, which was taken as a sign of not being depressed.

The study did not end happily for any of the mice, however. Their brains were examined to determine how the alcohol achieved its antidepressant effects.  The scientists say that changes in the boozy mouse brains showed that alcohol has effects on neurotransmitters that were similar to the way antidepressants affect the brain. That’s a long way from saying that alcohol is good for the depressed, though.

The premise of the experiment sounds a little shaky to me. I mean, assuming the swimming mice to be less depressed than the drowning mice strikes me as just a wee bit anthropomorphic. Plus, the mice seem to have been situationally depressed (by being left to drown), rather than chronically, as in clinical depression. However, the brain study seems more interesting to me. After all, it compared the effects of alcohol directly with the effects that antidepressants have on neurotransmitters and said that the former “mimicked” the latter.

What’s the takeaway from all this? Well, first of all, it’s hardly blanket permission for the depressed to go out and indulge indiscriminately. Further experiments are needed, presumably ones that will work their way up the animal kingdom until they come to depressed humans, though one hopes that they are not thrown into water to sink or swim.

If those further studies go the same way as the mouse study, I rather imagine the result will be something like the medical advice that you can take a glass of red wine to stave off heart disease – not a blanket approval, but the use of a potentially hazardous thing to ward off a potentially worse thing. Of course, that will not apply to alcoholics or others who must avoid the substance altogether for any of a variety of reasons.

I also note that the study focused on the effects of alcohol in relation to depression only. The manic phase of bipolar disorder was not part of the study and drinking while manic is well known to be a really bad, though often occurring, thing. Of course the same can be said of drinking and depression.

For now, the best advice is simply not to drink if you are depressed or bipolar. Don’t use me as an example. I’m not sharing this to encourage anyone to indulge in potentially destructive, even lethal, behavior. As always, Your Mileage May Vary, especially when compared with that of drunken, depressed, or dead mice. But drinking is still far from a good idea for the bipolar.  And don’t mix it with benzos either.  Trust me on this. It’s a slippery slope.

 

When You Don’t Want to Live, but You Don’t Want to Die

“I hope I don’t wake up tomorrow morning.”

That is the classic thought of someone suffering from passive suicidal ideation. It’s not really a desire to die by suicide. It’s just a way of expressing how much it hurts to be you.

It’s not active suicidal ideation, the kind where you make an actual plan to kill yourself, even if you never put it into practice. It’s passive, meaning that you’d like to be dead but don’t intend on doing anything about it. It’s like asking the universe to take over and do it for you.

I’ve certainly had passive suicidal thoughts. Once I was very stressed and depressed while coming home from a business conference. I clearly remember thinking, “Maybe the plane will go down and keep me from having to deal with all this.” I certainly had no plan to rush the cockpit with a box cutter or anything like that. I just wanted my pain to be over. I wanted the choice taken out of my hands.

Another time I was at a business meeting in a swanky hotel that had rooms surrounding the lobby on numerous floors. I remember being on the 16th floor, looking down at the atrium beneath with what felt like idle curiosity. Would it annoy the hotel more, I wondered, if I landed on the carpeted area, necessitating a thorough cleaning or total replacement? Or would they be more upset if I landed on the marble floor portion of the lobby, making a bigger mess and potentially chipping the surface? (And was it just a coincidence that business meetings made me contemplate my mortality or did they just come packed with a lot of stressful triggers?)

At neither time was I actively suicidal. I’ve been there once too, and this was completely different. When I was suicidal, I had actual plans and plenty of means to carry out any one of them. I’m not going to discuss what those plans were. (The difficulty of choosing among them may have been what kept me from actually doing it. By then my depression had lifted just enough for me to get help.)

It was easy enough later to make jokes about the passively suicidal occasions and most people took them as exactly that – jokes. It was even plausible that they were jokes. I used to talk about jumping out a window, adding that it wouldn’t work because I lived in a basement. It was only much later that I thought about it and realized that I needed help even on those occasions. After all, isn’t pain the source of much humor and the downfall of many comedians?

Passive suicidal ideation is asking yourself “what if?” What if my troubles were over? What if my pain was gone? What if all I had to do to accomplish this was to let that bus hit me instead of stepping out of the way?

The important thing to remember is that someone passively suicidal is in great psychological pain and wants not to feel that way anymore. In that respect, it’s similar to cutting or other self-harm. And like those acts, it doesn’t end the pain at all. It may be a temporary escape valve, but it’s not a solution.

Passive suicidal ideation is certainly a bad thing and an excellent reason to see your psychiatrist or therapist as soon as possible. If you hear a friend or loved one talking this way, encourage them as strongly as possible to seek help. Let a professional decide if the person has passive suicidal ideation or active suicidal ideation. It is entirely possible that passive suicidal ideation will lead to the more active kind and even to death if it is not dealt with.

Tag Cloud

%d bloggers like this: