Bipolar 2 From Inside and Out

Posts tagged ‘depression’

Coming Down From a Manic Jag

I have been manicky lately, and it has expressed itself, as it does for so many people, with spending money we don’t have. Or at least spending money we’re supposed to be getting but don’t have yet on things which we can’t afford until we get it.

The thing is, we have a nice lump sum of money coming, but we don’t know when it will arrive. And instead of sensibly waiting for it to arrive, I have already begun spending it. A new-old truck for Dan; passport applications for us both; tattoos for us both; concert tickets; clothes and maps and guidebooks and airline tickets for a trip we plan to take next year; a short getaway vacation last week; gardening and home improvement supplies. Just to name a few.

All this leaves us very little for necessities like mortgage, electricity, internet (essential for my work), and even food. We can probably live on our credit card for a while, but I know that’s only a temporary solution, and a bad solution at that, even though the credit company increased my credit limit so we could pay for the airline tickets.

Of course, I am mostly responsible for all this spending. Some of the expenditures wouldn’t wait – the airline tickets, which we had to buy immediately to lock in the current price, and the passports, which I understand can take months to arrive and we shouldn’t wait till the last minute to apply for.

But for other purchases, Dan has been enabling me – “You know you want to go hear Emmylou Harris,” for example. “She’s one of your heroes.” “Might as well get the ticket for Rodney Crowell, too. How likely is it that he’ll be playing in this area again, at least anytime soon?”

Now the proverbial chickens are coming home to roost. Last week I had to deal with a guy at the door who was there to shut off our electricity unless I gave him a check for the past-due balance on the spot. The credit card company may come to regret the limit increase. I’m sure they gave it to me because I regularly paid them more than the amount due, and I can’t do that anymore.

I realize this is relatively minor compared to some spending jags that people in the manic phase of bipolar have gone on – gambling debts, for example, and even ones that end in homelessness. But the spending adds up, and we are strained past our limit until that windfall finally arrives.

Naturally, because that’s the way things go, now that I have come to and realized the reckless spending, it has triggered my anxiety. Financial troubles have always been one of my triggers, but it’s appalling to realize that I have dug this hole myself.

And naturally, because that’s the way things go, that anxiety triggers my depression – maybe not a full-blown depressive episode, but enough to affect my life and actions. I isolate. I grow surly with my husband. I have trouble sleeping or sleep too much.

In truth, I am angry with myself and with this damned disorder. When I get manicky, I generally am able to limit my spending to amounts of $25 or less, if sometimes for several such items (or meals). But this time I have overwhelmed myself, and my husband as well. I know we’re not supposed to use bipolar disorder as an excuse for bad behavior, but I can’t help thinking that hypomania is involved at some level. The idea of live music and foreign travel were just so irresistible. I couldn’t make myself wait until a better time.

We’ll get through this, I know. Someday the expected check will come and I can start straightening out some of the mess I’ve created. But until then, anxiety and depression will be my companions. I hope the mania stays fully tamped down until then. At least, I’ll take my meds and hope so. And not skip my therapist appointment in a week and a half. We haven’t had much to discuss lately, but now I’m sure we do.

When Depression Doesn’t Go Away

Back in the day, I suffered from treatment-resistant depression. (This was likely due to the fact that what I had was actually bipolar 2, but never mind that for now.) My psychiatrist prescribed me medication after medication, but none of them worked, or at least not for long. We got into a seemingly endless spiral of trying one drug, adding another, weaning me off one drug and ramping up another, then another and another.

Some of them just plain didn’t work. Others had intolerable side effects, from vivid horrible nightmares to making me feel like I was about to jump out of my skin.

All this went on for certainly months – maybe years. (Memory problems were one of the many intolerable side effects.)

Eventually, my doctor reached the correct diagnosis, and then there were months of trying medications that were targeted for bipolar disorder instead of plain depression with anxiety. Again, nothing worked, or didn’t work adequately.

Nowadays, there are non-pharmaceutical methods of coping with treatment-resistant depression, including ECT (better known as electroshock), TMS (transcranial magnetic stimulation), and ketamine treatment.

I never had any of these treatments, since my psychiatrist and I finally worked out a drug combo that brought me back to balance, with only minor tweaks in dosage over the years. Nonetheless, I’ve become interested in the alternate means of dealing with treatment-resistant depression, and here’s what I now know. (If you want a patient’s own experience with ECT, TMS, and ketamine treatment, look up Kitty Dukakis or read some of the Bloggess’s posts.)

ECT, or electroconvulsive therapy, is what used to be known as shock treatment. For a long time it went the way of prefrontal lobotomy, stigmatized as a cruel and harmful procedure. The portrayal of ECT in Ken Kesey’s novel One Flew Over the Cuckoo’s Nest and then the movie of the same name were major influences in terrifying the general public, leading to a nearly complete disavowal of its use.

It’s making a comeback, though. The theory behind it is that electric stimulation of the brain will shock the brain back into normal functioning. The American Psychiatric Association notes that it is now performed under anesthesia, with medical personnel attending the procedure. They report improvement in 80% of patients.

(ECT is the alternative treatment that I was ready to try when none of the drugs prescribed for me proved effective. Then my doctor wanted to try one last drug, and that was the one that did the trick.)

TMS, or transcranial magnetic simulation, is described by the Mayo Clinic as “a noninvasive procedure that uses magnetic fields to stimulate nerve cells in the brain to improve symptoms of depression.” It’s also called rTMS, or Repetitive Transcranial Magnetic Stimulation, because more than one treatment is generally needed. The theory is that the magnetic pulses stimulate areas of the brain involved with mood control and depression. It doesn’t cause seizures or require anesthesia. The exact mechanism of how it works isn’t really understood, but that’s true of many other treatments for depression, including medications.

Harvard’s Health Blog reports that rTMS helps about 50% to 60% of people who did not respond to drug treatment “experience a clinically meaningful response.” They do note that treatments, “while encouraging, are not permanent,” which is true of many other forms of treatment.

Ketamine is the newest of the treatments for treatment-resistant depression. Ketamine was once known as a “party drug” called “Special K,” described by the DEA as “a short-acting anesthetic with hallucinogenic effects.” As a treatment for depression, however, it is thought to “enable brain connections to regrow,” according to scientists at Yale. The American Association of Nurse Anesthetists notes that ketamine “is not a first-line therapy for psychiatric disorders,” but then, neither are ECT and TMS.

Ketamine can be administered via nasal spray, but for psychiatric purposes (including to treat bipolar disorder and PTSD) it is often given as a series of infusions. An article in The Lancet says that “Ketamine is thought to act by blocking … receptors in the brain.” Another article by doctors at the National Institutes of Health comments that ketamine “has a robust and rapid effect on depression, which was seen immediately after the administration of ketamine and sustained at the end of 1 month.” Repeated treatments are generally necessary.

I don’t know about other patients and doctors, but after years of drug therapy not working, I was ready to give almost anything a try. ECT was next on the list, and the only likely alternative, as TMS and ketamine were not available at that time. I’m just glad that now patients and their doctors have more options when depression resists drug treatment and “talk therapy.” And I hope that even more alternatives become available for people with depression who are desperate to find a treatment that works for them.

Fake It Till You…Can’t

I used to have a couple of suits hanging in my closet. One was oatmeal-colored. One was blue tweed. One was rust-colored. I had a couple of silk blouses and a jacket or two that I could wear over a dress.

I called them my “Respectable Business Lady” disguises.

At the time I was working at a 9-to-5 job where the dress code was pretty casual. Fridays were jeans days, not casual days. But every so often I had to go to meetings or business conventions, and for them, I needed the disguises. I was dressing to “fit in” and to give an impression that I was competent and stable.

I don’t honestly know if the suits worked as a disguise, but I made it through meetings and conventions fairly successfully (I think), if I was allowed to collapse afterward, at home or in a hotel room. I think the disguises were as much to remind me how to behave as they were to convince people that I was indeed respectable and a business lady.

Nevertheless, I can’t really buy into the “fake it till you make it” philosophy that has been so popular in self-help books, including those promoting business and entrepreneurship help. I had no notion of becoming a respectable business lady by wearing those suits. I was always going to be awkward and out of my league. I was only trying to pretend by using protective coloration.

The essence of “fake it till you make it” is practice. As the saying goes, you get good at what you practice. Unfortunately, you can’t practice not having bipolar or another disorder. You can practice assorted coping mechanisms and get better at doing them, but they’re a solution to some of the symptoms, not the disease.

I don’t think that “fake it till you make it” really applies to people with mental health problems. No matter how much or how long you fake it, your mental disorders are not going to disappear, though they may ease up at times. I certainly don’t think the business lady disguises made me go into remission for a week or a weekend. They were merely a coping mechanism and nothing I practiced enough to get really good at.

One danger of trying to fake your way through mental illness is that you can fall into the trap of what’s called “smiling depression.” When this happens, people don’t notice that you’re miserable because your smile makes it seem you are happy. It’s another disguise, but not a permanently successful one.

Once I was teaching a class, and several women gathered around another woman and asked her what was wrong. “I didn’t think it showed,” she said. “No, honey,” I said, “it leaks out around the eyes.” She wasn’t crying or anything like that, but we could all tell something was wrong, despite her smile. We offered her conversation and sympathy until she pulled herself together a bit.

I’ve never been able to school my face into any kind of smiling depression anyway. If some people have “resting bitch face,” I have “resting sad face.” I can’t count the number of times when I didn’t feel particularly sad, but someone asked me what I was sad about. Of course, I was probably suffering from low-grade depression, like a low-grade fever, but at the time I was undiagnosed and had no idea that I had a mental problem that caused me to look that way.

Basically, what I’m saying is that when you have a mental illness like bipolar disorder, you can fake being psychologically together for a while, but you can’t sustain it forever. Certainly not until you “make it.” After I took off my Respectable Business Lady disguise, I would revert to my original self, as far from a respectable business lady as ever. Sometimes it would take me days to recover enough to feel that I was functioning again on any sort of level.

I think it’s better, ultimately, to admit who you are and what you need rather than to try to disguise or fake it. Even if your authentic self is depressed and miserable, getting help for it is still better than trying to cover it up.

Across the Spectra

Most often when “the spectrum” is mentioned, it’s the autism spectrum that springs to mind. There’s good reason for that. Autism affects varying people in varying ways and to various degrees.

But there are other conditions, disorders, and traits that vary across a spectrum as well: right brain/left brain, introvert/extrovert/, depressed/manic, and many others. The one I’m most familiar with, of course is the depressed/manic spectrum (or in my case depressed/hypomanic), but I’ve recently been reading about the other spectra I mentioned.

The first thing to know about spectra is that no one is fully at either end of the spectrum, or at least not all of the time. Think of a spectrum as the weight gauge on an old-fashioned scale at a doctor’s office. Most people’s weight tips the scale at somewhere other than the middle, and if they are all the way to one end or the other, the clinician moves the weight and starts over until the pointer rests in between the two extremes and the heavy weight falls somewhere between either end.

So, to use myself as an example (the one I’m most familiar with), when I am stable (properly medicated), I am close to the middle of the depressed/hypomanic spectrum, with the “weight” perhaps listing just a wee bit toward the depressed side. During depressive or hypomanic episodes, I slide toward one end or the other. No one is either all depressed or all hypomanic, though it feels like it at times, and people don’t stay at one end or the other all the time, except perhaps for the unmedicated person who has never had proper treatment and self-care.

Then consider the right-brain/left-brain scenario. When this theory was first proposed, it associated various traits with one or the other side of the brain. Type-A, energetic, risk-taking, mathematically oriented people were said to be left-brained, while shy, creative, language-loving, and risk-averse types were said to be “right-brained.”

This theory was extrapolated into the real world. Naturally, society at large was judged to be left-brained and that was deemed the better thing to be. These people got things done – businesspeople, politicians, scientists, and the like. Artists, writers, and other creative types were said to be right-brained, and not well adjusted to the left-brained society. There was even a book called Drawing on the Right Side of the Brain, which tried to harness that hemisphere in pursuit of artistic accomplishments and getting left-brained people in touch with their other “side” for a while.

Whenever I’ve taken one of those sided-ness tests, though, I almost always come out somewhere near the middle. What does this mean? I suppose either that my corpus callosum (which connects the two hemispheres) is particularly robust, or that I partake of both natures to some extent, more or less, and at different times. For example, I am mostly a stay-at-home reader and writer, but I am also a closet science geek, and like foreign travel, considered a risk-taking pursuit.

The same with introvert/extrovert (which seems to me to overlap considerably with right/left brainedness, and indeed with depressive/manic). I prefer to stay at home and pursue quiet activities like reading and writing, but I also enjoy going to science fiction conventions, which are known to be rather people-y. I can also tolerate moderate sized gatherings such as parties and book signings, as long as they aren’t filled with loud noise such as screaming children.

What I’m getting at here is that most scales are fairly useless and most people are somewhere in the middle of them, partake of both ends, and slide back and forth to some degree. I suppose there are people who are all one or the other, but I don’t know many and probably wouldn’t find them very interesting if there were.

On the Mind and the Body

The mind and the body are inseparable, part of the same organism. You can’t have one without the other. And each affects the way the other works.

Triggers are a good example. You see (or read) or hear or smell or touch something that unlocks an emotion in your brain. You then have a visceral reaction to that feeling – sweating, shaking, nausea, panic flight, or another physical manifestation.

These reactions are most commonly seen in severe PTSD and trauma related to abuse, but they can happen in less severe circumstances as well. Even something as seemingly innocent as tickling can put the brain in command of a bodily sensation. For example, once I was tickled to the point of pain, with the other person refusing to stop when I pleaded for him to. Ever since, my reaction to tickling is both physical and mental. My brain tells my body to shut down the physical sensation of touch. That may seem – and is – comparatively mild, and I don’t want to diminish the experiences of people suffering with PTSD and reactions to trauma. But it shows how my body and brain interact, almost in a feedback loop.

In circumstances like these, the body signals the brain and the brain tells the body how to react. It’s not like a person can choose whether to be traumatized or not by a trigger. The brain takes over.

Lately, I’ve been facing a fairly deep depression and have faced a lot of things that are triggers for me – financial problems, relationship troubles, overwork, etc. I’ve been feeling the bodily lethargy, exhaustion, psychic numbness, and neurasthenia that come with depression. These certainly affect my body, making me twitchy and nervous and unable to sleep (or to sleep too much), or unwilling or unable to face the world outside, some of the more noted hallmarks of depression and anxiety.

But after a recent visit to my primary care physician, I began to wonder if my body was influencing my brain in a rather direct way. Of course, before I got to see the physician, I had to fill out the depression screener, and as usual, I underplayed my symptoms by a bit. After all, I’m already under a psychotherapist’s and a psychiatrist’s care for it. It’s to be expected if I don’t present as all cheery and “normal.”

After chatting with the doctor about my symptoms (most, I thought, related to growing older), he ordered a bunch of tests for me. I’m to have a mammogram, a ColoGuard test, a bone scan to check my bone density, and had a whole bunch of blood tests.

The mammogram and bone scan I’ve scheduled, though they couldn’t work me in until September. (Evidently there is a lot of pent-up demand for hospital-based testing, as the hospitals weren’t doing non-elective stuff during the pandemic.)

Then the results started coming in. White and red blood cells, okay. Liver function, okay. Glucose and triglycerides, okay. Nearly everything within parameters.

I say “nearly” because I got a call from the doctor’s office saying that he wanted to double my thyroid medication. I had been taking a small amount, but now he figured I needed more.

I looked up the symptoms of hypothyroidism on the Mayo Clinic website, which seems trustworthy. They noted that that the condition may be attributed by the patient to growing older. I definitely noticed those: sensitivity to cold, muscle weakness or aches, and joint pain, all of which I feel.

Then there were other symptoms, which I had attributed either to my psychiatric diagnosis (bipolar II) or to the medications I take for it: fatigue, weight gain, thinning hair, impaired memory, and the biggie – depression.

Between the two sets of symptoms, I could see that the doctor had good reason to suspect my thyroid was out of whack and to prescribe an increased dose of the medication. I am now taking the higher dose and waiting to see what happens.

But it struck me: Maybe my symptoms were a combination of bipolar disorder and thyroid hormone deficiency. Maybe my body was trying to tell me something – that not all the symptoms I feel were caused by my glitchy brain. Maybe some of them were caused by my glitchy thyroid.

I have not been taking the new dosage long enough to see any effects, but I have hope. Perhaps, if and when the new dose kicks in, I will feel less of the lethargy, hopelessness, and other attributes of bipolar disorder.

Maybe my brain and my body have conspired to make me feel the way that I do. Maybe there is some relief to be had from treating my body with hormones, rather than just my brain with psychotropics. Maybe I’m not spiraling down into depression as thoroughly as I thought I was. Maybe a little tweak in my medication will help me to feel better.

Maybe if my body problems get worked out, my brain problems will not assert themselves so aggressively.

It is devoutly to be hoped.

The Song as Self-Care

Almost six years ago, I wrote a blog post about music and its power to heal, or at least alleviate, depression. If you’ve been following this blog, you know that I’m currently in the middle of what may turn into a major depressive episode. Again, I return to thoughts of music.

I once gave my therapist a CD of the music I liked best. I had been telling her how I had been stereotyped and even ostracized for the kind of music I like best and was embarrassed to share it with others. (Okay, it was country music, or at least the style now known as Americana – not pop country.) She played snippets from several songs while I watched her not cringe at them.

It’s the music that moves me. I’ve heard a theory that the music we love and respond to when we’re in our late teens and early 20s is what we imprint on. No matter how much or what styles of music we listen to later in life, those are the tunes and songs that will move us, no matter how old we get. These were mine. Later in life I started listening to acoustic blues, light jazz, filk, and 70s oldies, but country/Americana is still what lives in me.

Right now, one of the things I’ve been feeling is emotionally constipated. And maybe it’s time to try allowing music to alleviate that logjam.

Whenever I’m really depressed, I forget how much power music holds. When I’m on an even keel, I semi-regularly throw myself “music parties.” I hole up in my study with my computer and let iTunes blast. I even sing along, though I’m a terrible singer. Sometimes my husband joins me for a while and we have guessing games. (Who’s that singing backup? Emmylou Harris. Who wrote this? No, Shel Silverstein, not Kinky Friedman.) Sometimes I look up music that resonates with Dan and download it for him.

But mostly, it is a solitary pursuit. I wrap myself up in the music and let it soothe me. Or I rock out to the music and let it energize me. Or I let the music reach inside me and pull out feelings I didn’t even know were in there. Sometimes I use the shuffle function and let it surprise me. Other times I thread a path through the songs, letting my brain tell me what to play next. (It’s one of the things I can rely on my brain for.)

Call it a way to provide myself some self-care without spending any money. Although massages and pedicures and lunches out with friends are often touted as good self-care methods, I can’t do any of those things when I’m depressed. For me, they just add extra stress – showering, getting dressed, going out among people. I love massages, but I love them when I’m feeling good, only just a bit tense. I love lunches out, but they can’t raise me out of depression. I like them better when even chicken and dumplings feels celebratory.

But at my music parties, I don’t have to deal with any of that. I can stay in my pajamas and slippers. I don’t even have to comb my hair. I can exhibit all the common habits that go with depression and not have to use spoons trying to alleviate them.

So, tonight, I believe, it’s music party time. I’ll shut off my phone. I’ll close the blinds in case I want to chair-dance and don’t want nosy neighbors to have a view. I’ll invite my husband if he wants to be there, and not worry if he doesn’t. (What I call a “party” can easily be a party of one, and most often is.) I’ll unplug my headphones from the computer so the music can fill the room, as well as my head and my heart.

And maybe next week, I’ll have something to tell my therapist about – whether it helped or not.

On the Couch From the Couch

(Actually, from my desk chair, but you get the idea.)

This week I tried teletherapy, one of the workarounds that psychiatric patients have turned to in order to promote their own mental health, especially during the pandemic.

I know there are various online companies that specialize in teletherapy, or other health conditions plus psychiatric ones. Among these are Talkspace, Betterhealth, and Brightside, plus meditation and mindfulness apps such as Insight Timer. I wrote about the phenomenon back in January (https://bipolarme.blog/2021/01/10/distance-psychotherapy-is-it-for-you/).

In that post, I said that I hadn’t needed to try teletherapy yet, though I did mention having had telephone sessions with Dr. B., my psychotherapist. These were set up when I was unable to make it to my sessions, whether for transportation or psychological reasons. They helped but were not ideal, of course, because we couldn’t see each other’s faces and body language. Now, of course, with the proliferation of tablets, smartphones, and apps like Zoom, that’s no longer a hindrance,

Lately, I’ve been feeling a need to go back into therapy and by default I had to use teletherapy, as Dr. B. still isn’t seeing clients in person. (I had done Zoom calls for various other purposes, so I knew the drill.) We set up a Webex appointment and I thought about what topics to bring up, since I hadn’t seen her in so long.

I still don’t know all the advantages and disadvantages of commercial teletherapy, but I wasn’t tempted to try it.

First of all, I hate breaking in a new psychiatrist/therapist under any circumstances, as I had to do when my regular psychiatrist retired and moved. At this point, even the Reader’s Digest version of my life – or even just my mental health journey – would take several sessions. And I don’t trust therapy that starts without knowing my diagnosis, my medications (including the ones I’ve tried that didn’t work), what triggers me, at least a summary of my major depressive episodes, what therapy I’ve had so far, what I learned from it, my family and childhood and relationships, and more.

Not to say that a person couldn’t help me at all with my current situation (possible onset of a major depressive episode) without the backstory, but all that history informs what I’m going through now and why. Going through it would take several tele-sessions before we ever got to my current problem.

So, Dr. B. agreed to see me promptly and I appreciated it greatly. I was able to skip all the history and just get to the meat of my problems. She was able to remind me of some of the things that have helped me in the past and suggest some new things as well. And we set up another appointment for next week. One of the things she recommended was that I check with the psychiatrist who prescribes my meds, as I’ve been having some trouble with sleep. (Fortunately, my next appointment with Dr. G. was within the week. I see him only four times a year for maintenance.)

I had my appointment with Dr. G. He refilled all my meds, but had little to suggest about any of my other problems. He heartily agreed with my decision to go back to seeing Dr. B. He told me that one of my meds which I thought I might switch from nighttime to daytime was the kind that built up to a certain level in the bloodstream and it didn’t matter when I took it. And he suggested I make an appointment with my primary care physician regarding a matter that seemed not to be psychiatric in nature. (I agreed, and will do that as soon as the holiday weekend is over.)

So, where does this leave me? In touch with three doctors who know me and know my conditions. Set up with regular appointments to keep an eye – and an ear – on my symptoms. Reassured that my meds are functioning as they should, even if my brain isn’t.

All in all, I don’t feel better, but I feel better about it, if you know what I mean.

In One Side and Out the Other

For a while, I managed to do it. I spent literally years writing a mystery novel. Optimistically, I sent it to over 180 agents. A lot of nothing. At last, one of them was honest enough to tell me what was wrong with the manuscript, instead of just saying, “not right for us” or not answering at all.

And they were absolutely right. Once it was pointed out to me, I could see exactly what they were saying. I had had beta readers vet the first four chapters and gotten positive responses. They didn’t know anything about writing, or possibly even reading with a writer’s perception. But that wasn’t their fault. It was mine, for not selecting my readers more carefully.

Did all this depress me? Hell, yes, it did. I wouldn’t be human if it didn’t.

But I’m also bipolar. Depression for me isn’t just regular depression. Bipolar depression is something different. A darker place. A deeper pit. One that can be almost impossible to claw and climb one’s way up from.

When I was a teenager and undiagnosed and unmedicated, I had several major depressive episodes, and any number of smaller ones. Since at that time I had no idea what was going on or how to get help, I developed a philosophy: Go through it until you come out the other side.

Basically, it meant that I was staying depressed until I magically became un-depressed, whether it was because my brain chemistry backed off enough to let me see a way out, or hypomania kicked in (though I didn’t know what that was at the time). Basically, I suffered through it until I didn’t anymore.

And I thought that was the way it had to be. In one side, wait till I came out the other.

Later in life, I had other major depressive episodes. I tried a lot of things for them, including therapy and medication, but still the best I could manage was to wait it out – even though it took literally years.

Right now I’m in a similar position. All the rejection has put me back in that deep pit, and I don’t see a way out of it. I can’t even think of a new thing to write. Or a way to fix the book that failed. I am even applying for other writing gigs, but so far they have brought only more rejection. I don’t want another major depressive episode, but I can feel myself slipping. It does sound like reactionary depression, a result of the rejections, the realization of bad writing, and other recent blows involving deaths and other traumas. But it feels like endogenous depression, the kind that comes from inside, with wobbly neurotransmitters the major cause.

Of course, I’m a little better off than when I was a teen. I have a proper diagnosis – bipolar type 2 – and proper medication. I still have work that I can do – transcription – which is boring and ill-paying, but keeps me from sitting all day in front of the TV, watching train wreck shows that remind me that other people have more screwed-up lives than I do. I have self-care. I have my husband to be my caregiver.

But basically, I am just waiting to come out the other side.

I am doing the things I ought to do to get me out the other side. I am taking my meds. I have an appointment next week – a telehealth session with the psychologist that I haven’t seen in a year. In the past, she has done phone sessions with me when I wasn’t physically or mentally able to come in, so I know those do me good. And at the end of the month, I see my psychiatrist for a med check (15 minutes). I’m not sure how a session that short will help me in finding the other side to come out of.

I just wonder how far away the other side is.

Why Can’t I Cry?

There’s a lot that’s been happening around me that ought to have made me cry, but I just haven’t. There have been personal losses – the death and funeral of a dear friend. Occasions when I should have cried tears of joy – when an estranged friend wanted to reconnect with me. Professional losses – when I finally had to give up and admit that the novel I had spent years on was just not good enough to be published.

I’ve even thought about the deaths of some beloved animals, to see if that would make me cry. It didn’t.

In the past, I’ve never had trouble crying. As my bipolar disorder is largely bipolar depression, I have cried a lot – teared up, sobbed, wept – on occasions that were appropriate and some that weren’t.

I can’t even cry over the fact that I don’t seem able to cry.

There have been times in my life when I probably should have cried, but didn’t – when I was helping my mother pick out a dress to wear to my father’s funeral, for example. In that case, and in others like it, I postponed crying, or put my emotions in a box and sat on the lid.

Actually, I have had to do that many times throughout my life. Back when I was a teenager, an unmedicated person with bipolar disorder, and full of the volatility, despair, rage, and hormones of that time in life, I suppressed the impulse to cry, in order to look more “normal.”

It didn’t always work. For instance, some songs like Simon & Garfunkel’s “I Am a Rock” would almost always turn on the waterworks. But for the most part, I tried to suppress the need to cry.

The thing about it is, when you stuff down the ability to feel sadness or despair, just to survive, you can end up suppressing most of your other emotional reactions as well. Peace, humor, interest, gladness, tenderness all go into that box with the sadness and despair and you sitting on the lid.

That may be what has happened this time. I know I had to suppress my feelings to pick out a funeral outfit and attend the service. I felt despair over the end of my writing attempt, but I didn’t cry. I felt a sense of waiting to see how it would work out when the friend appeared to be reengaging.

I don’t know what else is in the box or how I can get it open again. I am not interested much in the TV shows I used to watch obsessively. I can read only a few pages of books that I would otherwise have devoured. I can’t remember the last time I laughed over something silly my husband said or did. I did not cry over the movie that he finds so very touching that he cries every time he sees it.

I am doing all the right things, though. I am taking my meds regularly and as prescribed. I have called the psychologist that I used to go to and made an appointment for a telehealth session. And I’m trying to figure out how to tell my psychiatrist all this when I go for my med check at the end of the month, if nothing else has worked by then.

Maybe one of those things will open the floodgates, un-stuff the box of stuff, and allow me to cry again, normally, when it’s needful.

But I don’t really know. Writing this post hasn’t done it.

Functioning While Bipolar

Bipolar disorder is a funny thing. Mine leaves me alone part of the time. Until it doesn’t.

I have had full-blown depressive episodes, with the sobbing and the immobility and the wretchedness and everything else associated with it. I have had one major episode that lasted for three years straight, plus everything else from minor breakdowns to that vague, lingering miasma that comes when you’re untreated and you don’t know that what is really happening to you is clinical depression.

I have also had full-blown anxiety attacks, the sort that leave you twitching all over, feeling like you’re about to jump out of your skin, gasping for breath, and imagining that every driver on the road is swerving into your lane. I’ve twitched and shaken and stammered. I’ve scratched myself. I’ve hidden under the covers until I can’t breathe. I’ve taken anti-anxiety meds that did nothing at all.

Right now I am sufficiently medicated and have been relatively stable long enough that I think what I have is functional depression or maybe high-functioning depression, or whatever you want to call it. I have enough wherewithal to work part-time from home, do other writing-related projects (like this blog and my other one), and do assorted tasks like paying bills and making business-related phone calls. (Occasionally, if the phone tree is lengthy enough and the person on the other end is uncooperative enough, I have a small-scale meltdown. My voice goes up in pitch and tears start rolling down my face. My husband takes over the transaction when he notices that.)

But secretly, I know depression is lurking and can rear its ugly head again with little or no provocation – a trigger or nothing at all. So can anxiety, which is how my brain usually responds to hypomania. It’s a little like those commercials for psychotropic meds you see on TV, where the person has a little sign with a smiley face and hides behind it. Except that’s not quite accurate.

I understand that high-functioning depression is also called “smiling depression.” That’s not my experience of it. I’ve almost never been able to “fake it till I make it,” slapping on a happy expression when inside I’m dying. Besides, it doesn’t work, as far as I can tell. The depression or the sorrow always leaks out around the eyes. I’ve seen this in myself and in other people.

Before I was treated, I used to have what you’d call “resting sad face.” Once a boss of mine encouraged me to smile more (and is there anything more annoying?). I didn’t feel particularly sad at that moment, though I’m sure that I had at least a low-grade depression, like a low-grade fever. But I was at my job, and functioning even then, if not very well or cheerfully.

The phrase “high-functioning” gets used a lot to describe certain varieties of autism. I don’t have autism and I’m not an expert on it, but my suspicion is that high-functioning depression is similar in some ways. I don’t always react the way other people expect me to. I feel out of my depth a lot, especially in environments with lots of people or lots of noise. But that doesn’t stop me – or lots of other people – from carrying on with what I need to do to be a functioning member of the populace.

But back to bipolar disorder. Even if someone seems to be “high-functioning” doesn’t mean he won’t have a meltdown sooner or later. Even someone who “slaps on a smile” may let it drop once she is alone. Even someone who is “coping well” may not be coping at all tomorrow or next week or next year. Sometimes you can’t tell on the surface what someone is going through inside. Like I said, bipolar disorder is a funny thing.

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