Bipolar 2 From Inside and Out

Posts tagged ‘depression’

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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Permission to Be Depressed

Depression can be so riddled with guilt. Why am I not able to fake being okay? Why do I isolate when what I need is interaction?

Sometimes what I need is to give myself permission to be depressed. I have bipolar disorder 2, with a heavy depression component. It has overwhelmed me many times. I have fought against it, given in to it, tried to make compromises with it, tried to ignore it – almost any reaction you can imagine. Then I learned how to give myself permission to be depressed.

This is not quite the same as giving in to depression. It involves acknowledging that I am depressed and allowing myself to feel the feelings that I have. Of course, I don’t give myself permission to be permanently depressed. In a way, it’s more like giving myself permission to practice self-care and not to force myself to smile and bull my way past the depression. I recognize that I am depressed and do what I need to do to get through it. That may be staying in bed. It may be crying. It may be wallowing in sad music. These are things that I’m likely to do anyway when I’m depressed, but giving myself permission to do them is surprisingly freeing.

I used this technique probably for the first time when my husband and I went on a “barefoot” cruise vacation. It was something we both enjoyed and both want to do again someday.

But I knew from the beginning that depression might overtake me – probably would, at that time in my life – even while I was doing something enjoyable. Naturally, I didn’t want the depression to ruin the whole vacation, so I decided to give myself permission to do what I needed to do to cope with those feelings.

Most often, that involved retreating to my bunk for a nap. This enabled me to get away from other people when I was feeling overwhelmed and unable to socialize. Sure, I missed some of the onboard and shore activities, but I wouldn’t have enjoyed them anyway while in the metaphorical fog and darkness. I enjoyed what I could, then let myself not do what I didn’t feel up to doing. I didn’t try to make my husband stay with me and miss all the fun. There wasn’t anything he could do for me anyway. If the other passengers thought it was odd – and they did – they barely mentioned it to me. My husband told them I was tired. Seasickness was also a believable excuse.

In a way, having bipolar depression at that level is like having the flu. I feel bogged down and logy, inclined to cocoon, rest, and stay away from other people. I realize this is not always possible, but if it is, I can allow myself to do it. Fortunately, this spell of depression wasn’t so bad that it completely incapacitated me as it has at other times in my life. I was still able to feel enjoyment at some times, though not at others.

At other times, I’ve had to give myself permission to have anxiety. If a situation makes me anxious, I acknowledge that I am nervous, and do what I need to do. I can’t “think away” my anxiety, but sometimes I can get myself out of the situation at least temporarily. I do not have to sit and be anxious while people around me argue or shout at each other, one of my anxiety triggers. When I recognize how I’m feeling (which takes practice) and give myself permission to feel the way I feel, I’m better able to come up with coping mechanisms, such as leaving the room to get some fresh air or making myself a cup of tea.

You may notice that when I give myself permission to be depressed or anxious, part of my solution involves avoiding other people. That’s sometimes a hard thing to do. Isolation can certainly make depression worse, but it can sometimes also be necessary if pushing through, trying to smile, mingle, and socialize will make the depression worse in the end. And I have learned that if I try to do that, the depression comes along with me. Once a friend told me that it was like having a separate person with me, a person called Misery. Better to give myself permission to stay home and give myself some self-care.

What I can’t do is give myself permission to stay depressed or anxious. Giving myself permission is a very limited-time offer. It doesn’t work for those really lingering, midnight-dark depressions that last for weeks or months on end. Those, I have to fight. And while I’m depressed, I don’t give up on meds or therapy. Those are necessary to alleviate the depression instead of resigning myself to feeling it.

In Remission

My bipolar disorder is in remission. I know I’m not cured. There is currently no cure for bipolar. But I’ve reached a point where I’m stable enough that I don’t expect a crash or a buzz to descend on me at just any old time.

I still get moods, of course. They’re just not severe or long-lasting enough to be symptomatic. Yesterday, for example, I spent several hours wrestling with phone trees and people who wouldn’t switch me to a supervisor when all I was trying to do was straighten out a couple of bills that contained errors. Afterwards, I felt frustrated, cranky, and a bit sad. But those were normal emotions, based on what I had just gone through. After a nap I felt better, and dinner blew out the remaining cobwebs. Napping is definitely better than staying in bed the entire next day.

Of course, I didn’t achieve remission alone. It took years of doctor visits, therapy, and medications to reach this state. I am particularly grateful for mood levelers. For me, they actually do what they’re intended to do. They keep my moods within an acceptable range, or at least one that’s acceptable to me.

Too many people fear mood levelers, I think. Level moods sound boring – as though there are no variations, just a blank, straight line. That simply isn’t so. Mood levelers have pushed the spikes that used to go wild in either direction to a less extreme range. If you think of mood as an EEG, mood levelers prevent the lines from going off the charts, settling them to fluctuate within a middle range that most non-bipolar people have naturally.

I think the term “mood leveler” scares some people. They seem to think that such a drug would make them perfectly level, robotic, unchanging. They fear that any spark of personality or creativity would be lost.

That’s not the case. Instead, with level moods – and especially for depression-prone bipolars – a person has much more ability to explore his or her creative side.  I know that’s true for me. Now that my moods are stable and level, I’m able to get more writing done, but also to tell whether the work is good or needs serious revising before I post it.

My doctor recently increased the dosage of one of my medications, a mood leveler, because I was having trouble with hypomania that wouldn’t let me sleep. And it worked. I am now getting seven to eight hours of sleep each night and have enough energy to at least face the day, if not always to conquer it.

Don’t think mine has been a case of spontaneous remission. I’m not sure I believe that’s possible with bipolar disorder. It’s taken a lot of years and a lot of work to get to where I am today. For example, it took literally years for assorted doctors and me to find a combination of chemicals, a cocktail of psychotropics, that would work for me. And during all that time, it was as if I was not medicated at all. Only the right combo of drugs and dosages would unlock my brain and level my moods.

So, here I am, in remission – and I love it. My moods aren’t blunted, they’re leveled. I am not as fearful now that my extreme moods may return and wreak havoc on my life. Oh, I still have some symptoms and side effects that remind me I’m not cured. But now I know that remission is possible, with work, with luck, and with the right mood levelers.

Nothing to See Here

Many people with SMI are afraid that it shows, that other people can see automatically that there is something wrong with them. They feel as though they stand out in a crowd. Everyone notices them, and probably talks about them.

I have the opposite problem. My bipolar depression makes me feel invisible. It’s not just that SMI is often an invisible illness. It’s that I myself seem to become invisible. I think of myself as a particularly ineffectual ghost, frightening no one and unable to affect anything in my environment. Some people call this dissociation.

At first, I made the best of it. I’m especially invisible when I’m out in public and reading a book. So I found that if I was at a business convention and wanted to remain invisible, my best strategy was to sit alone at a table and read a book. Only once did a man approach me while I was so engaged. No one else ever did.

Apparently, though, I don’t need a book to disappear. Maybe it’s anxiety that makes me keep quiet when people around me are discussing something interesting. Maybe it’s my instinct not to be noticed so I won’t be subject to derision or worse. Either way, I can’t seem to catch anyone’s eye or add my bit to the conversation. I blend into the crowd, even if it’s only a crowd of three or four.

It’s almost like there’s some aura around me when I’m out in public that says, “Don’t notice me,” like Harry Potter’s cloak of invisibility. I do not use my invisibility for pranks or mischief, though. I don’t use it intentionally at all (except for using a book, as I mentioned).

Why do I think this invisibility is part and parcel of my bipolar disorder? It could be imposter syndrome at work. I feel so unworthy that I don’t want anyone to see me for what I am. Or it might be the anxiety component of my hypomania that keeps me from presenting myself more assertively. Or maybe people can see that I have a troubled mind and simply look away.

I am slowly learning to make myself seen and heard. I find that calling people by name makes it easier for them to see me. It seems to signal them that there’s another person in the vicinity. And once I even set up an occasion where I would be the center of attention, speaking about my bipolar disorder at a signing for my book.

I also use my writing to make myself “visible.” This blog (and my other one) and my books give me a presence, though not a physical one, even at a distance. When I see likes and follows and sales, I know that someone has noticed me, or at least discovered that I exist.

I sometimes think that going out in public more – practicing being visible – might help. But actually, that’s when I feel the most overlooked, the most unseen and unheard. The most lost.

Perhaps what I need is to go out and meet a specific person, someone who expects to see me. Then I could be guaranteed of one person who would see me.

But it has been suggested to me that I may not want to be seen at all – that I would prefer to fade into the background, not put myself forward and disappear from the stresses of being seen. Perhaps that is true, or at least once was.

Now I think I would prefer to be seen, flaws and all. If someone cannot tolerate the sight of me, a mentally disordered person, or glances over me as if I did not exist, I think I shall insist on being seen. I will use my voice, my (admittedly glitchy) brain, and my human physicality to assert that I exist, that I matter, that I have something to say.

And in social situations I will try to assert myself (if politely) to join the public discourse and add my two cents, whether the subject is mental illness or the latest bestseller.

I exist. I deserve to be seen. I will not remain invisible.

Where Is My Home?

You know that feeling of dislocation you get when you’re bipolar and depressed? Like you don’t belong anywhere. Like you just don’t fit in. Like even the things around you aren’t real. That has happened to me concerning one of the things that gives most people contentment and grounding and even joy: home.

I’ve never been literally homeless, unless you count the day I spent in a Red Cross shelter after a tornado destroyed our house. I have no idea what it’s like living on the street, though I know a lot of the seriously mentally ill do. It’s just that none of the places I have lived have felt like home to me.

Maybe it’s the fact that I have real difficulty bonding with things and places (and, even at times, people). Making the emotional investment seems pointless when everything seems unreal, when anything can be taken away or even just disappear, like so many things have: my stability, my capacity for positive emotions, my ability to feel.

I don’t remember the house my family lived in when I was born. I don’t even remember how old I was when we moved into the house where I grew up. I have a vague memory of standing on tiptoes, trying to peer over the counter and into the sink, so maybe four? Whenever it is you’re that tall. 

That home is the only one that ever felt like home to me, and I had to stake a claim on a space within it to feel that. One day, in a burst of hypomania, I decided to move out of the room I shared with my sister and lay claim to the other bedroom, one that we saved for visits from Grandma, which happened once a year or less. One roller and some yellow and orange paint later, I had a room that no one else wanted to stay in. It was mine, one square corner of the house.

But inside I always believed that I belonged – could belong – somewhere else. When the time came for college, I attempted the “geographical cure” and moved out of state to what I thought would be a more stimulating environment, one conducive to fitting in.

It worked about as well as the geographical cure ever does, which is to say, not very. All the time I was there, I never experienced anything that felt like a home. I lived in a different place every year: dorm room, sorority house, rented apartment, and a house with other people. (That house was designed, built, and possessed by someone else. There was never a chance that it would be my home.)

After college came a series of apartments. I don’t remember even trying to make them more homelike. In one of the places, I remember hanging bedsheets over the windows instead of buying curtains. Not even clean, new sheets. (One astute friend remarked, “You didn’t think very much of yourself back then.”)

Next came marriage and another series of rentals. Someone else had a key to them and could – and did – come and go whenever they wanted. Eventually, we landed in a house we had a chance to buy from the owner. But it was dark and shabby and pedestrian and fed right into my recently diagnosed depression.

The desire to find a home of our own grew. We managed to find a house that was above our price range, really, but irresistible. This was a place, I thought, I could finally call home.

The only thing was, it wasn’t a home to us. My husband still thought of his parents’ house as “home.” This house, as special as it was, wasn’t his home and therefore wasn’t our home. I loved the house, but felt somehow detached from it. It had all the comforts of home, but something was missing. Something inside me. This was the house that the tornado destroyed.

We moved from shelter to hotel to rental house, which is where we’re living now. All the furniture and even the dishes are rented too. We’ve hung some of our art collection on the walls, which has helped, but there is no way that this can ever fill that need in me for a home.

Our old house is being rebuilt. We are working with an architect and a contractor to make it a space that we have contributed to, helped shape, and will get to furnish, pretty much from scratch. I have hopes, especially now that my bipolar depression shows itself less often, that this can be my home. There will not even be the specter of Dan’s parents’ house, which has been sold, his ties to it broken.

Will this house be the home I’ve been looking for? Will I be able to fall in love with it, to bond to it, the way you do to a special person? I don’t know. I haven’t really had such a space in my life.

But maybe this is my chance. Maybe this will be the place I truly belong. My home.

Mental Illness: Fact and Fiction

I’ve had a bit of experience with mental health and nonfiction, though none so far with bipolar fiction. But lately, I’ve been thinking about it.

Bipolar nonfiction is (comparatively) easy to write. There are numerous memoirs, essays, and blogs – including my own. Bipolar disorder has not appeared much in fiction, however. There are reasons for this.

First, let’s tackle the idea of mental illness in “genre fiction” (fantasy, science fiction, mystery, horror, and the like – not mainstream fiction, anyway). A friend of mine recently attended the World Science Fiction Convention in Dublin, Ireland, where they had a panel discussion on just that topic.

My friend reports that the panel “had a mental health nurse, a psychologist and some writers talking about portrayals of mental illness that got it right or wrong.”

He went on to add, “Consensus seemed to be that the Punisher completely nailed PTSD, that Drax in the first GotG movie nailed Aspie but that they rewrote him into a cute Manic Pixie Dream Creature for the second one; and the depiction of Sheldon from Big Bang is an abomination against God and Man.” (To unpack that just a bit, the Punisher is a character from Marvel, GotG means the “Guardians of the Galaxy” movies, and “Manic Pixie Dream Creature” is a riff on “Manic Pixie Dream Girl,” a trope in which one woman (the MPDG) opens the hero’s eyes to life lived fully so that he can then go off and win his One True Love, who is not the MPDG.)

I myself have no experience with the Punisher and saw only one of the GotG movies. Sheldon from The Big Bang Theory is a character I know a little more about. As I understand it, Sheldon Cooper is not intended to represent a person with any particular sort of mental illness (as he always points out, “My mother had me tested”). Still, the character exhibits behaviors that are often associated with Asperger’s, OCD, and perhaps some other mental illnesses or conditions.

I have read that Jim Parsons, the actor who portrays Sheldon, did no research on any of those conditions or illnesses because he didn’t want Sheldon to represent a person with any particular disorder. This allows the viewer to read into the character whatever he or she believes Sheldon’s “problem” is (if any).

But an important point was brought up in the book Philosophy and The Big Bang Theory. One of its essays questioned whether the audience should feel comfortable laughing at Sheldon. If one believes that he has a mental illness or Asperger’s, the answer is, of course, “no.” Yet most of the audience does – apart from those who see the portrayal as an “abomination.”

It’s so hard to get a portrayal of mental illness right, on TV or particularly in genre fiction. Take bipolar disorder, for example. Abigail Padgett’s Bo Bradley series of mysteries features a protagonist who has bipolar disorder. But most of the depiction depends on whether or not the character is having a manic episode at any given time. While the depiction is laudable – and I like the series immensely – it is telling that bipolar depression is seldom a plot element.

Perhaps this is because depression is too, well, depressing to write or read about. A character who is unable to leave her bed or who questions her very existence is hardly likely to move the plot forward. Searing depictions of depression, both bipolar and unipolar, have been written about, but almost exclusively in nonfiction. Even those can be hard to read for someone who experiences clinical depression.

Depression, however, did become a metaphor in the writing of J.K. Rowling. She has said that in her portrayal of “Dementors” in her Harry Potter fantasy epic, she was specifically thinking of depression and its soul-sucking effects on those who suffer from it. That’s genre fiction and that’s doing mental illness right.

In talking about mental illness and genre fiction, I’m deliberately ignoring the many portrayals of sociopaths in shows such as Dexter. Those are stereotypes too, but I’m wondering about less “drama-friendly” mental illnesses. Dissociative identity disorder seems to be one of the few other mental illnesses that feature prominently in popular forms of fiction, usually in the psyche of a villain. You could also count the many detective characters suffering from PTSD, a commonly used trope that is seldom examined closely but rather serves as a personality trait associated with violence.

I wasn’t at the convention and didn’t hear the panel (though I would have loved to), but it raised interesting questions. What would a protagonist (or other character) with bipolar disorder be like or do in what is too often a formulaic plot? Can a mentally ill character be portrayed accurately within the confines of genre fiction? Can mental illness be anything but a metaphor – or be experienced by a character other than one played for laughs? Is there any such book that I should be reading?

I don’t have the answers. But we need facts in fiction. We need understanding. We need representation. I haven’t tried to write fiction featuring a bipolar character, much less a main character who is bipolar. 

Maybe I should.

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