Bipolar 2 From Inside and Out

Posts tagged ‘depression’

I Don’t Need a “Pep Talk”

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Here’s the thing. Many people, when you mention a problem, feel obliged to help you fix it or fix it for you. When the problem is related to mental illness, though, that can be counterproductive.

The fact is, most serious mental illness can’t be fixed, at least not by a friend or loved one. To try is to invite frustration on the part of the fixer and worse feelings on the part of the fixee.

Some of the worst help we are offered are pep talks, which are meant to be encouraging. Smile more. Keep trying. Other people have it worse. Everyone goes through this.

No, says my stubbornly glitchy brain. Everyone does not go through a major depressive episode. And when I’m having one is not the time I can concentrate on what constitutes “worse.” I can try all I want, but my bipolar disorder isn’t going to just go away. And smiling when I’m ready to cry is a suggestion that denies my perception of reality and encourages me to lie about my feelings.

You can see much of this kind of advice on Facebook, for example. There are always memes that exhort you to look on the sunny side, have a positive mental attitude, or choose to be happy. But it’s easy enough to scroll by them.

These pep talks hurt more when they’re offered in person by someone you know or even love, especially when that person knows you have a mental disorder. You can’t just scroll by someone you love telling you that, in effect, it’s your own fault that you don’t get better.

I know these sentiments are kindly meant (except for the ones that blame you for your own condition). But the reality is that we can’t cure ourselves of SMI by smiling, or jogging, or thinking happy thoughts, or eating turmeric. We can’t cure ourselves at all.

But we can make things better, through therapy and medication, and yes, through some things that are not cures themselves but adjuncts to healing – physical activity, engagement, mindfulness, self-care, and the like. Who knows? Maybe even turmeric.

So, if pep talks don’t work, what can you do instead? What might actually help your friend or loved one? Here are a few suggestions.

Treat the person with mental illness the way you would treat a person with any other illness. I’m not suggesting sympathy cards are appropriate, but a phone call or text message saying you care is usually welcome.

Listen without judgment. Don’t offer advice. If the person opens up to you, respect that. Don’t minimize the problems. If the person doesn’t respond, wait a while and try again.

None of that will “fix” the person, but you know what? Neither will a pep talk. My brain, for one, is simply unable to process them, digs in its metaphoric heels, and says, “Oh, yeah?”

So, what are some things you can say instead of giving a pep talk? Try these.

I’m here for you.

You can always call me.

I’m sorry you’re hurting.

Tell me if you need anything.

Do you need distraction?

Do you need to be alone for a while?

Do you need to talk?

What can I do for you? (The answer may be, “nothing,” but at least you cared enough to ask.)

If you are also suffering from SMI, there is even more you can do. You can say, “I understand how you feel,” and mean it. You can recommend a therapist. You can congratulate the person on any accomplishment, the kind that wouldn’t seem like an accomplishment to anyone else.

In general, stay away from platitudes, feel-good sentiments, and quick fixes – unless you know that the person responds well to that kind of encouragement. They’re too easy to say and too hard to follow through on. Save them for people who are simply having a bad day, not someone who has mental illness.

How I Became a Mental Health Blogger

Of course, blogging didn’t exist when I started writing. It was quite a journey ending up where I am today. Even mental health services were a big blank to me when I was young, something that no one I knew experienced or even talked about, except to make jokes about going to “Wayne Avenue,” the location of the nearest insane asylum (as we called it then).

But it’s hard to remember a time when I didn’t write. Childish poems fueled by voracious reading. Hideously depressive poems fueled by burgeoning bipolar disorder. (I still commit poetry from time to time, writing sonnets and villanelles about bipolar disorder.)

But before I returned to poetry with more structure, I indulged in free verse – unrhymed, unmetered verse that relied on the juxtaposition of images rather than formal style. I studied creative writing in high school and college. But the bipolar disorder was undeniably with me, influencing the topics I wrote about: “Two Ways of Looking at the Same Pain” and “Whiskey on the Knife,” a poem about self-harm, are two examples.

As my poetry developed, it started reading more and more like prose, strung out in sentences that relied on line breaks with twists and jarring pauses to create poetic effects. Eventually, I gave up on poetry and simply gave in to prose. I made my living doing prose, and nonfiction at that, writing for magazines about education, technology, child care, and even martial arts.

Bipolar disorder took that away from me. After being diagnosed with clinical depression for years, I finally was identified as having bipolar 2. It was treatment-resistant for many years and during that time I was often unable to write.

My mental health blog, which you’re reading now, grew out of a journaling exercise. I began by listing what I did each day – not much, as I was stuck in a major depressive episode and not able to do much. But once again, what started as something else turned into prose. And by that time blogging was a thing.

I started blogging largely as an exercise for myself, to explore bipolar disorder, its symptoms and treatments, and my particular version of it. I set myself the task of posting once a week, a schedule that I still keep. I wrote short essays and longer pieces, whatever I was thinking about at the time. Hardly anyone read the blog. I sometimes wonder if the title “Bipolar Me” was a turn-off, but really that summed up my knowledge about bipolar – my own experiences.

Slowly, I started finding my voice. and finding things to say with it. Things other than what was inside my own head. Oh, I still wrote about my symptoms and my meds and my coping mechanisms, major depression and hypomania, mood swings and roller coasters. But I also started approaching the wider world of bipolar. Bipolar in the news. Bad science reporting about bipolar. TV commercials about bipolar meds. Bipolar disorder and gun violence. All of this was still through the lens of my own experience, as I have no degree in psychology, counseling, or biochemistry, for that matter.

And I started reaching a wider audience. My writing appeared in The Mighty, Invisible Illness, IBPF, Thought Catalog, Medium, and as guest posts on other bloggers’ sites. Eventually, I had enough material to make Bipolar Me into a book of the same name. And then a sequel, Bipolar Us. Both are still available on Amazon and through other outlets.

I know I’m not in the same league with mental health bloggers like Pete Earley and Gabe Howard. They are true activists and influencers, as well as terrific writers. Their work reaches thousands of people with information, analysis, inspiration, and more impact than I will likely ever have.

But I won’t give up blogging just because I’m not the best. I’ll be here every Sunday, posting my bipolar thoughts and opinions, sharing my bipolar experience, and chronicling my bipolar life.

Caution: Wide Mood Swings

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Mood swings are universal. Everybody has them at one time or another.

Bipolar disorder is not just mood swings. Not everyone has moods that can last for months or years at a time or moods that are so extreme that they interfere with one’s daily life. The depths of despair and the rocketing highs are not what most people experience – and they should be glad they don’t. Bipolar disorder is a serious mental illness (SMI). It can be more or less severe, and it can be well or poorly controlled with medication and therapy, but the reality is that bipolar is a mood disorder, an illness, and a curse. 

Of course, the mood swings of bipolar disorder don’t always last for months or years. Sometimes you go spinning out of control every few weeks. This is called “rapid cycling.”

But even rapid cycling doesn’t describe the lightning-quick mood changes that can happen within a day or two. That’s called “ultra-rapid cycling,” and it’s like being whip-sawed by your brain. Those valleys and peaks come so closely together that you don’t even have time to catch your breath between them.

I think that the official criteria miss the mark on this. Many of them define rapid cycling as experiencing four mood swings within a year. Ultra-rapid cycling seems not to have a specific definition, but I and a lot of other people with bipolar disorder experience moods that swing not over the course of months, but over the course of weeks, or even days.

Ultra-rapid cycling blurs the lines into mixed episodes. Those are occasions when high and low moods occur at the same time. For many bipolar sufferers, this means simultaneous exaltation and despair, which is a terrible combination and a bitch to experience. For me, a person with bipolar type 2 whose hypomania expresses most of the time as anxiety, a mixed episode is a frightening blur of defeat and nervousness, a simultaneous feeling that the worst has already come and that it is about to descend to even lower levels. It’s like ricocheting off the insides of your own skull.

What to do at a time like this is a puzzle. Do I try the things that soothe me when anxiety strikes? Do I try self-care for depressed moods? Do the two strategies cancel each other out, leaving me swinging helplessly? Do I try to suppress both moods, knowing that the consequent numbness will make it all the more difficult for me to feel “normal” moods again? Once those walls are built, they are hard to tear down.

Ultra-rapid cycling and mixed episodes may be handy jargon to describe mood swings that don’t fit the common mode of bipolar disorder.  But they’re hell to live through. And since mood levelers, antidepressants, and anti-anxiety meds generally take a while to build up in the bloodstream enough to have an effect, there is little in the way of pharmaceutical help. An anti-anxiety pill may relieve the jitters and racing thoughts, but may also leave you more susceptible to the inevitable lows.

I don’t know if there’s much research going on regarding rapid cycling and mixed episodes. It seems like they’ve barely been named, much less defined or studied. And it’s true that there is a lot about plain old garden-variety bipolar disorder that remains to be understood and treated.

But for those of us who don’t fit the mold of months-long or years-long mood states, rapid cycling can be an uncomfortable way of life. When I was undiagnosed and unmedicated, I experienced those long, interminable lows. They did last months, years, until the depths of hell were all that I could see. The jags of ambition seldom visited me, but the creeping, lingering anxiety could easily take over. Now that I’m no longer subject to those excruciating extremes, I still am subject to the quick-change, rapid-fire series of moods. My mood levelers do work, in the sense that they reduce the peaks and valleys, but they never seem to put me on a totally even keel.

Perhaps that’s too much to expect. I’ll have to admit that I prefer a life of rapid- or ultra-rapid-cycling bipolar to the monotonous despair of long depressive cycles. At least now I have a firm conviction that the moods will end, or at least shift, to something more tolerable, and that that will happen sooner rather than later.

Given the choice between the lingering depths and the more rapid changes, I’ll take the one that doesn’t leave me in misery for years at a time.

 

Flap My Arms and Fly

Those of you who read my blog regularly know that I’m not a big fan of positive thinking memes. In fact, they have the opposite effect on me. Someone who claims that a positive attitude is all that I need to change my life is likely to get only a “pfui” from me. As a person with bipolar disorder, I sometimes have major depression, and no amount of thinking is going to pull me out of it. In fact, the only thinking I can do at times like that is likely only to pull me farther into the depths.

If affirmations and positive thoughts work for you, I say, good. If mindfulness and meditation are your jam, then I say, whatever works. But please don’t try to deny my perception of reality.

That perception is that there are some things that positive thinking can’t do. That there are some situations that are immune to positive thinking. That positive thinking can’t change the outcome of everything.

Admittedly, positive thinking can change one’s attitude toward one’s circumstances. One can choose, as my father did, to be determined, stubborn, and positive in the face of his diagnosis with multiple myeloma. It likely helped him live long past what his doctors expected.

But not everyone can do that, and maybe not everyone should. Elizabeth Kubler-Ross said that acceptance was the final stage of the process of dying, not the first. The same, I think, is true of grieving. Anger, denial, bargaining, and depression are natural responses to cataclysmic events, including diagnoses, and in this case, particularly diagnoses of serious mental illness.

Although my father was well-known for his “positive mental attitude” about his cancer diagnosis, I remember a time when he could not even say the word.  He swallowed it, leaving out the vowels: cncr. And I remember that at times he was in denial about his illness and tried to do things he was physically not capable of doing – even, at one point, walking down the short hall to the bathroom. Even positivity could not help him there.

I watch a lot of competition shows on TV – Chopped, Forged in Fire, etc. – and I often hear the contestants say that they are doing it to prove to their children that they can do anything they set their minds to.

A part of me always says, “Okay, then. Flap your arms and fly.”

I know that sounds cynical and bitter, but it’s also the truth. The contestant who was cut in the first round has not done what he or she intended to or believed he or she could do. After that, they espouse the more reasonable and attainable lesson that their children, or others, should try to follow their dreams and take that trial as a noble effort, even if it doesn’t end in victory.

I have bipolar disorder. There are some heights I can never fly to, no matter how hard I flap my arms. I know I will have to take medication for the rest of my life. I know that, even with medication, I will still experience mood swings. I know that I will never be able to really trust my moods – that a setback might send me teetering over the edge or a triumph might make me imagine that I can indeed fly.

And, you know what? I’m okay with that. What I’ve accomplished with the help of medication, therapy, and the support of my family and friends, is good and is good enough. My dreams are down-to-earth, not grandiose. I do not dream of flying, but of remaining as stable as I can, right here and now. I choose not to delude myself with unattainable goals.

My father didn’t think he was going to live forever, but he was determined to live as long as he could, and to enjoy what he could in spite of the pain. I think that’s as ambitious as someone with a catastrophic illness can get. I admire him for his sustained effort and his stubborn resistance to despair. I admire those of my friends – and there are some – who can choose not to be dragged down by the circumstances of life.

Maybe it’s different for me because my disorder by its nature involves a component of lowered mood. But my expectations are not to flap my arms and fly, but just to keep on keeping on.

Hitting the Plateau

Back in September, I wrote about my bipolar disorder being in remission and how much I loved that feeling. Now I’m not so sure. Maybe I’m not in remission. I’ve had significant setbacks, though not long-term ones. At one point I felt broken, but when that lifted I felt jazzed. Maybe I’m on a baseline and never wander too far off it. Maybe I’m stuck on a plateau, halfway between mental illness and mental health.

I ask myself, will I get any better?

It’s like when I had my second back operation (micro-laminectomy). When I went for a follow-up visit to the surgeon, I was no longer in pain. But I was slow and uncertain when walking and felt keenly that my physical capacities were diminished. “Will I get any better, or is this it?” I asked.

“You’ll improve,” said Dr. West. “It will take a while, but you’ll feel better.” And he was right. I did. But I still have some pain at times and sometimes I walk with a cane. I may be better, but I’m clearly not totally well. I’m not bitching (much). I know that once your back goes out, it never gets back to 100%. And I am truly grateful every day that I don’t suffer the excruciating pain of a bulging disk and a pinched nerve.

My bipolar disorder is like that. I am no longer suffering on a daily basis. My meds are working and haven’t changed much in years. My mood levelers are doing their job. But I still have symptoms. There are still things I can’t do, or do only with great mental effort. I’ve never been at 100% and don’t ever expect to be. And I am truly grateful every day that I don’t have the in-the-depths lows, the ever-edgy anxiety, for more than a few days at a time.

But I wonder, am I stuck on this plateau forever? Is this as close as I’ll ever come to mental wellness? Or maybe, I think, mental health is an illusion. I can’t remember a time when I was unaffected by my disorder. The plateau itself may be an illusion. Maybe I am still improving, in such tiny steps that I can’t see the change. Maybe a new medication or treatment will come along and remove more of my remaining symptoms. (I’m not counting on that, though.)

My bipolar disorder feels like it’s running a low-grade fever. I can get done my work and my blogs, but little more. I don’t feel in the least joyful. It may be that this is just real life getting me down –  the weather, politics, the endless details and frustrations I have to deal with while we’re rebuilding our house. Perhaps this is just a normal mood swing like everyone gets or a reactive depression to the aforementioned stressors.

That’s one of the constant worries once you have bipolar disorder – not trusting your feelings or your feelings about your feelings. Every setback scares me that I’m teetering on the edge, ready to plunge off that plateau. Realistically, I know that I am as stable as I’m likely ever to be.

My superpower seems to be overanalyzing. I may really be in remission.

Depression lies. Anxiety lies. So, perhaps, does the plateau.

I’m Not Giving Up on You

Not you, Rachel, and not you, Paul.

Rachel, I know that your life has been shitty lately. I know that your health problems are overwhelming you and your depression is dragging you down to the deepest levels. I know your brother’s death by suicide still resonates with you and makes you think that there is an easy way to end your pain.

Paul, I know that your life has been full of drama and trauma lately. I know that the tasks of daily living get the better of you and the future keeps retreating further and further away. I know that you have barely any spoons each day and feel compelled to spend them on others instead of on yourself.

But I won’t give up on either one of you.

Rachel, I will take your calls even when I’m exhausted and listen while you vent. I will support you in every way I know how. I will honor and thank you for your generosity when I know that you could easily focus only on your troubles. I will maintain contact even when I am low on spoons.

Paul, I will keep sending you reminders that I am thinking of you and offering you solace and support. I will willingly accept that you are not able to reply just now. I will not take that as a reason to make a break with you. I will keep trying.

Rachel, you know you can say anything to me, for I have surely been there. You know that your suicidal ideation makes me uncomfortable, but I won’t ask you never to speak of it. I have had those thoughts myself and gotten through them. I know you can too. I see all the things that you do to reach out to others and extend your goodness to them. I empathize with your difficult family situation. I don’t know what to do about it, but I will acknowledge the pain that it gives you.

Paul, you know that I have listened to you in the past and will continue to do so, no matter what it is you have to say. I will not let my own anxiety and depression stand in the way of listening to yours. Please know that I understand what you’re going through more than I can say or have ever said.

Rachel, please know that I celebrate with you even the smallest achievements you make. When you are able to stand up for yourself against City Hall, I applaud you. When you investigate ways to make your living situation better, I will not judge you, though they may seem harsh or unacceptable to others.

Paul, please know that I wish only the best for you, even if I don’t always understand what it is that you need. I admire your continuing strength, even when I feel that it would be good if you could lay your burdens down for just a while. I acknowledge that I am not the person that can help you do this, much as I would like to.

The reason that I say these things is that I want you to know that there is someone who does truly understand and truly care. I have been where you are and have found my way out, at least a little. I remember the people – including you two – who have reached out to me even when I was not able to reach back. The very least I can do is to do the same for you.

When you are relieved of your burdens and can again see the light of day, I will be there to celebrate with you. I will not despair or think that you can never see that light.

I will not give up on you. I will not give up on any of my friends who are burdened with depression, anxiety, or some other difficulty. I will do what I can, because I must. There are people who have never given up on me. I know what that feels like, and I wish that same healing and help and health for you.

Should You Lie About Your Disorder?

We all know that when writing a resume, you should write either “good” or “excellent” when you refer to your health. Any other response will make it certain that your resume will be headed straight for the circular file.
But what about your mental health? Most resumes and most job applications don’t include a space for that, but what if they did? What would you answer? What should you answer? And should you tell the truth if you do answer?
 
In one corner of England, job seekers were encouraged to hedge their bets or to flat-out lie. The British newspaper The Guardian reported that welfare personnel “have urged jobseekers who have depression to hide their diagnosis and only admit on work applications that they are experiencing ‘low mood.'” 
 
Fortunately, there has been a backlash from mental health organizations, who describe the advice as an “outrage” likely to increase stigma. They point out that “the law provided protection to disabled people, including those with mental health problems, if their disability has a substantial, adverse, and long-term effect on normal daily activities.”
 
The welfare department in question brushed off the controversy by saying the suggestion was only “well-intentioned local advice” and encouraging people seeking jobs to “speak freely about a health condition or disability.” But that’s not a choice that everyone is willing to make.
 
Whether or not to disclose one’s mental health condition when applying for a job is not an easy decision. American law (at the moment) protects employees and potential employees under the Americans with Disabilities Act (ADA). But many people are rightly suspicious that disclosing a mental illness at the application is a one-way ticket to unemployment. Even when applications invite you to disclose and pointedly proclaim that they abide by EEOC regulations, many people choose not to disclose.
 
Disclosing after you’ve been hired or have been working at a place for a while is another matter. Many people (including me) have lost jobs because their bosses and coworkers don’t understand mental illness. There is plenty of motivation never to mention it.
 
That may not always be possible, however. Sometimes, the symptoms of bipolar disorder or another serious mental illness are obvious and negatively affect work. (I’m included here, too.) If a person isn’t able to do the work – for whatever reason – it’s understandable that they will be let go.
 
That brings us to the subject of accommodations that permit a person to do the work. Under ADA law, persons with disabilities, including mental disorders, are to be given “reasonable accommodations” to help them perform their job duties. For blind, deaf, or mobility-impaired workers, these accommodations are obviously necessary and most employers can and will provide them. (There is also no question as to whether to disclose these disabilities or not. Visible disabilities are more widely understood than invisible ones.)
 
Accommodations for mental disorders need not be difficult, either. Solutions such as flextime, work-at-home situations, or time off for appointments are more and more being offered to all employees, regardless of ability level, and these can certainly help people with mental illness, too. Other reasonable accommodations might include flexible break times, an office with a door or full-spectrum lighting, or the understanding that phone calls and emails need not be returned instantly. Of course, to receive these accommodations, one must disclose the disorder and negotiate the possible solutions, which can certainly be daunting, if not impossible, for those with anxiety disorders, for example.
 
But what we’re talking about here is not whether to disclose a disability on an application or to an employer. What we are talking about is misrepresenting a potentially disabling condition – or to use the less polite term, lying about it. I don’t have “occasional mood swings,” I have bipolar disorder. My depression is not simply a “low mood,” it can be debilitating. And I suspect that even admitting to a “low mood” might be greeted with something less than understanding by a potential or actual employer.
 
Ayaz Manji, a senior policy officer at a mental health charity in England, said of the semi-disclosure policy, “Anyone who discloses a mental health problem at work deserves to be treated with respect, and jobcentres should not be reinforcing stigma by advising people not to disclose.”
 
He’s right, of course. Disclosing or not disclosing is a hard enough choice for the mentally ill. Lying about one’s condition should not even be a consideration. And isn’t lying on resumes and applications an automatic cause for dismissal? 
 
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