Bipolar 2 From Inside and Out

Posts tagged ‘depression’

The Golden Glow and the Spoons

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Hypomania is as insidious as it is enjoyable.

I remember when I quit my 9–5 office job to go freelance. I remember when I made the decision. I had gotten my first bad review, ever, shortly after disclosing my bipolar disorder to my new boss.

I remember driving around shortly thereafter, running errands in the middle of the day. I felt the warm, golden glow that goes with either happiness or hypomania. I could wake when I pleased and work when I pleased. I could run those errands when I wanted. I could take my mother to her doctor’s appointments whenever I needed to. I could make and go to my own appointments as necessary.

Best of all, I felt as though I had enough spoons to do all this. I was able to keep up with the work and the errands and the appointments and, hey, if I got tired I could take a nap in the middle of the day.

But.

Eventually the glow wore off and the spoons ran out. Hypomania dumped me back into the depression I was oh-so-familiar with. I had more work to do and less energy to do it. My mother’s problems increased and I had to take over her finances as well as my own. I was teetering on the edge of a major depression, and then I fell off that cliff.

Anymore I don’t trust hypomania. First of all, I can’t distinguish it from actual happiness, competence, or satisfaction. I always question its sincerity and watch out of the corner of my eye for the coming crash. In other words, when I’m happy I can’t even enjoy happiness without reservation.

One way I keep track of my hypomania is by being aware of the number of spoons I have. If I’m flying on a hypomanic cloud, I feel replete with spoons. It never occurs to me that I will run out. When I’m experiencing garden-variety happiness, I still suffer at some point from lack of spoons. No matter how many pleasing things are scheduled for the day, I know deep inside that I cannot simply dive into all that bounty. My joy is measured out, as the poet said, in coffee spoons or in this case metaphoric spoons which I always visualize as small white plastic ones.

Stability for me does not mean that I can ignore my supply of spoons, either. I may be on an even keel, able to do most of what I want, but inevitably the spoon depletion hits, sooner or later. There is simply no more that I can do, much as I want to. And if I force myself past that point, I will surely pay for it in exhaustion, irritability, or isolation.

Spoons, therefore, run my life. If I am too happy, I have to watch for incipient spoon depletion.  If I am level, I know that I must still keep track of the spoons I use. And if I am low, my spoons can disappear altogether, to the familiar point of not being able to get out of bed.

I think the trap of hypomania is the worst of all. On a high like that I can lose track of my spoons – even forget that they are necessary. Fortunately, I don’t get the full-blown version of mania. I fear I would squander spoons recklessly, leaving me a terrible absence of any.

Spoons are a useful way to explain the energy demands of chronic and/or mental illnesses. My husband and I speak spoonie shorthand. But I wish I could experience that golden glow, that haze of happiness, that feeling of floating, without having to keep one eye on the spoon-meter.

 

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Bipolar Sex: Drought and Abundance

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Here’s something bipolar people talk about amongst themselves but not so much with the world outside: sex.

The two poles of bipolar, depression and mania, govern a person’s appetite for sex. A lot of other factors determine whether the sex will be any good, or good for the participants.

Of course the above is true for neurotypical people as well. Moods and emotions – things in the brain – have as much or more to do with sex than stuff in the body. Thinking about sex and wanting sex, for example, start in the brain and without them, nothing else is likely to happen anywhere else.

The depression side of bipolar sex is easy enough to map out. After all, some of the hallmarks of depression are numbness, inability to enjoy things that once gave pleasure, and a tendency to isolate. It’s hard to get your motor revving with all that going on.

Still, the depressed person may want to have sex, or at least want to want to. That’s the way it’s been with me. When I’m in a thoroughly depressed state, sex doesn’t even cross my mind. When I’m not quite as depressed, I think I might like to have sex but don’t have the energy for it. And when I’m relatively stable, there’s the meds.

It’s well known that medications for bipolar disorder can kill the sex drive and in men the ability to get or maintain an erection. Some drugs supposedly have less effect on sexuality, but I’ve never found the magic combination. Or the supposed sex-friendly drug has had side effects I can’t tolerate.

So if bipolar depression is largely a big zero for bipolar sex, how about mania?

Overactive sex drive combined with a lack of impulse control can lead to sexual excess. The tendency to minimize risk-taking behaviors means that some of that sex can be detrimental to one’s health, relationships, and self-esteem. Riding that wave is exhilarating, but then, inevitably, comes the crash and the need to pick up the pieces.

Full disclosure here: Since I have bipolar 2 and my hypomania tends to turn sideways and come out as anxiety, I don’t experience that manic sex high. On the whole, I think I am grateful for this. Sex has never been such an important part of my life that I would risk everything for it.

Once, though, I did experience what you might call a hypomanic sex drive. It smoldered for a long time, requited but unconsummated, until the right set of circumstances presented themselves. It was a restlessness, an obsessive thought, a longing for connection, rather than an ungovernable rush of need. It gave me, perhaps, a glimpse of what it might be like to be manic and sexually stimulated. But I’ll never really know.

I do know that I am glad I had the experience, whatever it was. I’m glad it was safe sex.  I’m glad it didn’t destroy relationships. But just to feel that desire again, even if only for a brief time, even with the anxiety it provoked – and there was lots – it was a kind of affirmation that my body and brain are still connected in some vital way.

Most of the time I limp along with only thoughts of sex too fleeting to act upon. And maybe this is not the best way to live, but I have made my peace with it. And once in a great while, every now and then, I still am reminded that I can have a sexual existence.

Even though I have bipolar.

Of course, as always, your mileage may vary.

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The Disability Tapdance

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Once I applied for disability for my bipolar disorder and I was turned down Then I took the process as far as I could with a lawyer and he eventually advised me to give it up too. Here’s my story.

I had gotten to the end of my proverbial rope and we had gotten to the end of our money. For over a year I had been sidelined by unremitting depression. There was nothing I could do and nothing my psychiatrist prescribed or my therapist said had helped. We had been living on my husband’s salary and what was in my 401K from when I had last been able to work.

At last my husband pointed out that we couldn’t hold out much longer. He encouraged me to apply for disability. I knew that there would be lots of hoops to jump through and that there was no guarantee of succeeding. But Dan was willing to go with me to the Federal Building and help me get through it. I certainly wasn’t capable of managing it on my own.

Between the two of us, we had looked up what sorts of documents I would need and had acquired them. I was glad we were able to do this because going back again and again for missing documents would have been a horror. I had my appointment with the intake person and went back home to wait.

There were more forms to come. My psychiatrist had to fill out a long one, of course, or write a letter, I don’t remember which. I had to pay him for his time and trouble in doing that but at that point it was just another step that needed taking.

The big step was the psychological interview where I had to perform my little song and dance and convince someone that I was truly disabled. Fortunately, the appointment was not downtown in the Federal Building but in a relatively nearby office building that I knew how to find. Then the hoop-jumping and tap dancing really began.

They tested my memory. They told convoluted stories and asked me questions about them such as the order in which things happened and why the characters did what they did. They were confusing.

They tested my spatial perception. They had me put together those cubes with triangles on them to match patterns they showed me. I still don’t know what that had to do with bipolar disorder.

Then came factual knowledge. I was good at that one. I admit I guessed when they asked me how big around the equator was. I knew the easy stuff like who wrote Tom Sawyer and such.

By the time they got to the word association test, I was very tired. First they gave a pair of words and asked what they had in common, easy ones like truck and train. Later they gave difficult pairs of words that seemed to have nothing in common, like acceptance and denial, but I was supposed to come up with a commonality anyway.

Finally, an interview. I remember the woman asking me if I knew what the saying, “What goes around, comes around” meant. I replied, “As you sow, so shall you reap” and she looked at me funny.

A seemingly endless time later my claim was denied and I got a lawyer to pursue it. By that time so much time had passed that I was coming out of the depression and was able to work a few hours a week. How much did I get paid per hour? he asked. “Thirty dollars,” I said, explaining that I could only work a very limited number of hours. It didn’t matter. As soon as I said thirty dollars the judge’s head would explode, evidently. Lawyer Joe recommended I drop the claim and I did. At least I was getting some work and some income even without disability.

It seemed that for me to get disability I would have had to be together enough not to need it, but sufficiently disabled that I would. Catch-22, as Joseph Heller said.

 

 

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Inspiration and Mental Illness

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I was manicky this week and it affected my blog writing. I had a post all ready to go this morning, but last night I thought about it and realized it was crap. It meandered, without focus. The ideas were confused. It sucked. So I got up this morning to write something different instead.

Many of you may recognize this aspect of mania or hypomania. You do something that you think is fantastic  while in the grip of mania and when you come down, you can’t see what you ever saw in it. Or you begin an ambitious project that you work on and work on but never can complete.

I was toying with the idea of “inspiration porn” – the sort of post or story or TV show that holds someone up as an ideal, usually because they’ve lost a bunch of weight and gotten themselves into shape, or have an illness or disability and managed to do – whatever – again. Think “The Biggest Loser.” Or amputees who’ve learned to eat with their feet. It’s put out there for entertainment and to make everyone feel good that whoever it is conquered whatever it was. It takes a regular person out of the context of their lives and reduces them to their condition. And the subtext is that if this brave person can become able to do or be whatever again, so can everyone else with the same problem.

It happened to a friend of mine who was at a gym on a treadmill. A woman came up to her and said how inspiring it was to see her working so hard to lose all that weight. “Excuse me?” was my friend’s reaction. She was doing it for herself, not for anyone else, and especially not to inspire some random stranger.

The thing is, there really isn’t any mental health inspiration porn. For one thing, it would make lousy TV. Oh, they’d get advertisers – all those purveyors of psychotropics that clog the airwaves. But who would watch a depressed person finally getting out of bed and taking a shower, unless she had a coach yelling at her?

Inspiration for those of us with mental health problems takes other forms. Celebrities who speak about their struggles with mental illness are one. They are inspiring because they break the taboo about talking about mental illness in public and because they have done so to help other people.

Then there are the superstars of mental health inspiration. Carrie Fisher, Glenn Close, and Jenny Lawson, to name a few. These are people who focus light on the difficulties and struggles of mental illness. Their communications don’t stop with the announcement that they have a condition and encouraging people to get treatment, though those are also good things. But the real inspirations are those who open their lives, take others with them through the journey of symptoms, treatments, relapses, small triumphs, and bigger successes. They speak and keep speaking and keep speaking their message. They don’t make the process sound easy, because it isn’t. And they speak with authenticity and authority because we know they’ve been there.

They do inspire us because they are honest and open, and they clearly care about helping others in the same proverbial boat.

We lost a true inspiration when we lost Mama Carrie. No one will ever really take her place. But you can tell that she was an inspiration by the many people whose life she touched and how they remember her. If someday they make a movie of her life, I hope it features not only her personal struggles, but all that she did for others. Her speaking and continuing to speak despite – or because – of her ongoing struggles.

We can carry on her work by doing the same, by shedding the stigma, by talking to others, even family and friends. Recently a friend “came out” to me that she takes an antidepressant and an anti-anxiety med (the same ones I take). I was proud of her, but I didn’t make a big deal of it. But I was impressed and pleased that she was able and willing to share even that much. She was saying that she was part of our tribe.

As Jenny Lawson reminds us, in this we are alone together. And that’s inspiring. 

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Back to Work – Full Time

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As is true with many of us who can manage to work only part-time while dealing with bipolar disorder, I was always one paycheck away from financial disaster.

Then the checks stopped coming.

When my main source of work dried up, that financial disaster loomed closer. I knew that it was time to try to go back to regular work. Full-time. Outside in the world, if need be, rather than in my home office, in my jammies.

Looking for work was a job in itself (https://wp.me/p4e9wS-zY). It turns out I’m overqualified for many things and underqualified for others, sometimes both at once.

And the specter of bipolar reared its fearsome head. Even if I found full-time work, could I do it? Especially out there where it’s all people-y? It’s been years since I’ve worked in such an environment and my last few years at it did not go well, as I was beginning to slide into a major, long-lasting bipolar depressive episode.

Looking for work at home was not much better. Even telephone jobs (customer service or order handling, please, not sales) required some experience and my Girl Scout cookie days were back when we still thought it was safe to go door-to-door. When I responded to work-from-home jobs, many of them turned out to be Uber or Lyft, which is hardly the same as work-at-home, if you ask me.

I found a couple of small gigs to tide me over. Then I found one that was really promising.

Proofreader.

They warned me during the phone interview that I was vastly overqualified. I told them that this kind of job was exactly what I needed at this point in my life and please to keep me in mind if any of the other candidates washed out.

The job was with a transcription service, proofing scripts of meetings and reports that other people had typed up from audio files. But there wasn’t much of it, and it didn’t pay very well.

Then they asked me if I would move up to typing. And whether I would do it full-time.

Those were separate questions. I’m not a fast or good typist. I never took typing in high school (though I discovered that I needed it once I got into college). All these years I’ve been faking it, looking at the keyboard and using at most six or seven fingers to type with. But I said I’d try and I did. I’ve been sweating over these typing jobs and they take me lots longer than they do for other, ten-fingered, trained typists, but I’ve been hitting my deadlines.

Full-time was another issue. I said I’d try, with the understanding that I’d go back to part-time if I couldn’t handle it. It’s certainly been a challenge, forcing myself to spend six or more hours at the keyboard five days a week (and then using my days off to write blogs and work on my novel). It’s exhausting. But at least I’m still in my jammies and ready to go to bed afterward.

And I’ve learned a few things. One is “Never volunteer.” Often the company has extra work with even tighter deadlines that pay more per minute and are up for grabs. I made the mistake of grabbing a couple. It nearly did me in, combined with my regular work. (I did get an Amazon gift card for working on the Fourth of July.) Full-time work is hard enough. Full-time plus is a meat-grinder, or I should say a me-grinder.

So now for the big question – did I disclose my bipolar disorder?

I did not. As long as could do the work, it didn’t seem relevant. Work-at-home is not the sort of gig where they make accommodations or modifications for those with disabilities. And if I can keep up my stability and relative mental health, and get time off for doctor’s appointments, my mental status shouldn’t be relevant.

But I’m thinking I may have to cut back to four days a week. Five days is running me ragged. And then in December, when I retire, I can give it up altogether or work only a couple of days a week.

I will have a fixed income, which has both good and bad points, but at least it will lift from me the crushing anxiety of “Will we make the mortgage this month?” (I never was able to get disability.)

So, for now at least, and for the next few months, I will be working full- or almost full-time, if only my bipolar disorder will let me.

Wish me luck.

(Full disclosure: That photo is not an actual representation of my writing space. Mine is littered with legal pads, stuffed animals, Kleenex, and water bottles.)

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Reaching Out and Reaching In

A lot has been said in recent days about reaching out when you’re in trouble psychologically. And that’s always a good idea. Reach out to your friends, your family, your therapist, your psychiatrist, your church or synagogue or temple.

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Unfortunately, not everyone has those resources. And sometimes when you reach out to them, they do not reach back to you or even respond in hurtful ways.

Sometimes – many times – you’re just not able to reach out. That’s true of me, anyway. When major depression hits me like a truck, I get immobilized. Uncommunicative. Isolated. I usually have the wherewithal to get to my therapist, if my husband drives me, but not much more.

My family and friends can tell when I’m in trouble. And they do reach out, even when I don’t reach back.

My mother always knew when I hit a particularly bad spot because she could recognize it in my voice – it lacked animation, even if I was talking about something I loved. Not that I talked much or felt much. Depression can damp down all your feelings sometimes. You don’t cry, you don’t feel sad. You feel nothing. And it shows to someone who knows how to look and listen.

This is called “flat affect” by psychiatrists. The person’s face, voice, mannerisms do not reflect emotions, sometimes not even anxiety or despair. And sometimes people adopt a flat affect so as not to betray their inner turmoil. (It can still leak out around the eyes, even to relative strangers. And I don’t mean crying.)

My husband knows I’m depressed when I turn monosyllabic. Ordinarily, I enjoy talking to my husband about anything and nothing – things we’ve read or heard, what’s happening at work (his, mostly), funny things the cats did, and so forth. But when I stop responding and communicating, or respond only with “yeah,” “nah,” and “meh” sorts of answers, or don’t laugh or at least groan at his jokes, he knows I’m headed downward.

I stop communicating other ways, too. I don’t post on Facebook or only pass along the occasional pass-along. I skip commenting on posts regarding things I usually care about. I spend hours alone reading, if my sometimes-dubious powers of concentration let me. Or I sleep, and nap, then sleep some more. I certainly don’t leave the house or even make plans to go out. I don’t call friends. I isolate. I don’t reach out, like the memes say I’m supposed to.

I am fortunate to have friends that do reach out to me. John would lend me books, talk about them with me, and listen if I needed to vent. Peggy would call and invite me to visit, even when she knew I wasn’t leaving the house. Pete sometimes IM’s every day just to check in and JB assures me that when he IM’s and I don’t feel like chatting that’s still okay. Robbin calls me and tells me all about her life even when I can’t talk about mine, then says, “Let me know when you surface.” If she doesn’t hear from me for awhile, she calls again and reminds me that I can call her too. (She can also “read” my voice and knows when there’s some topic I’m avoiding.) My husband offers a hug or kisses me on the head. My mother prayed for me. I am fortunate indeed to have had people like these around me when I really need them.

Reaching out to others is good. So is reaching in to the suffering. Best is a combination of both. But that takes work and not everyone is able to do it.

If you can reach out, reach out.

If you can reach in, reach in.

If you’re lucky, you’ll meet in the middle, where hope lives.

 

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Would You Try Electroshock?

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In the course of dealing with my bipolar disorder, I had a near brush with electroshock. I managed to avoid it, but I did give it serious thought.

Now 60 Minutes has come out with a piece called “Is Shock Therapy Making a Comeback?” You can see the segment here: 60 Minutes.

ECT(electroconvulsive therapy, the modern name for the procedure), which is often done on an outpatient basis, works by inducing a brief seizure in a patient. The seizure, which lasts about a minute, releases multiple neurotransmitters in the brain, all at once. The patient is required to have someone to transport them to and from the appointment. Treatments are typically applied one or two times per week for 6-8 weeks.

In a brief article excerpted from the news show segment, Dr. Charlie Welch, of McLean Psychiatric Hospital, explains how ECT differs from how it was performed in the past: “What’s different first of all is that it’s done under general anesthesia with a muscle relaxant. So when the treatment is done, the patient is sound asleep and completely relaxed.” Call it a kinder, gentler shock treatment.

That was the procedure that my psychiatrist offered me after he had spent a number of years trying me on various medications that either didn’t work, or helped only partially.

My immediate reaction was negative. I recall thinking, “Fuck, NO! Keep away from my brain, you Nazi sadist!” After I calmed down a bit, I did some research.

ECT, my sources said, was a long way from the cruel, stigmatizing procedure portrayed in One Flew Over the Cuckoo’s Nest. The Internet was little help, though. The opinions and experiences of people who had undergone electroshock ranged from “It was hideous” to “It was a miracle.”

Truthfully, I was appalled by the notion of electrical jolts surging through my brain. My precious brain, which had both sustained me and betrayed me throughout my life.

Then I thought some more. So ECT sometimes causes memory loss. I already had that, thanks to some of my meds. I would be altering my brain with electricity. But hadn’t I been altering it for years with chemicals – medications that no one seemed to know how they worked?

So I went back to my doctor and said I would at least talk to the doctor who would perform the procedure. And I lined up a journalist friend to write about my experiences if her editor approved. (Note: In the 60 Minutes piece, former Massachusetts First Lady Kitty Dukakis gave permission to have her treatment filmed and broadcast.)

My psychiatrist, however, had one more medication that he wanted me to try before we took that next step. And it worked. So much for electroshock.

Now as to that side effect of memory loss – Dr. Sarah Lisanby of the National Institute of Mental Health in Maryland has developed a new treatment that seems to avoid that particular consequence.

The procedure is called Magnetic Seizure Therapy (MST) and it uses magnets (duh!) to stimulate more precisely focused seizures than ECT does. These focused seizures seem to avoid the parts of the brain associated with memories. As Dr. Lisanby told the 60 Minutes reporters, “For some people, ECT may still be needed. But if Magnetic Seizure Therapy could be effective without the memory loss who wouldn’t want to try that first?”

Would I try MST if I relapsed into treatment-resistant depression? I would certainly consider it, if it were out of the testing stage by then. And I’d do that before I signed up for ECT. While I have memories I’d prefer to forget, with my luck, those would be the ones left unaffected.

The cynical side of me says that these seizure-causing therapies are becoming more popular because insurance companies like the notion of a short course of 6-8 weeks of treatment instead of years of talk-and-medication. (Although Kitty Dukakis said that she has done ECT for years now and expects to continue into the foreseeable future.)

But I could be wrong. It is possible that some kind of treatment could be short in length but longer-lasting in effectiveness. I’m not ruling it out. At this point I’m not ruling out anything that could aid in my progress and my healing.

 

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Drug Therapy: The Short Form

From what I’ve read in Facebook support groups – and noticed from my own experience – the effects of antidepressants don’t always last as long as we might want.

My first psychotropic medication was, as nearly as I can remember, imipramine (Tofranil). At the time I was only diagnosed with unipolar depression, so it seemed like a good choice. Imipramine is what is called a “tricyclic” antidepressant because of its chemical structure. Many people complained of the side effects.

Tricyclics were about all the medical community had to offer until 1987, when Prozac hit the market, followed by its cousins Zoloft and Paxil. All of these were classified as SSRI drugs, ones that selectively acted on the neurochemical serotonin in the brain, rather than a wide variety of brain chemicals as the tricyclics had.

Since then we have listened to Prozac, talked back to Prozac, and been referred to as a Prozac Nation. Prozac has been hailed as a miracle drug, damned as a gateway to violence or suicide, and prescribed in phenomenal amounts.

And Prozac has helped me. After about six weeks on it, when the drug started to kick in, I was on a sailing trip. One of the crew said I was the passenger most at peace with myself that he knew. It was a revelation to me and a new way of thinking of myself.

Prozac changed my life – possibly saved it. And then, not so much. I moved on to other medications.

“Major Study Finds Antidepressants Work, But May Have Limitations,” by Brigit Katz, published on The Smithsonian.com, validates my perception.

Her article states, “A meta-analysis [or study of studies] of existing trials suggests that the drugs are mostly effective on a short-term basis for patients suffering from acute depression.” Katz’s article also cites articles in the New York Times and The Lancet that report similar findings.

The Lancet study “analyzed 522 double-blind studies that included 116,477 patients and 21 commonly prescribed antidepressants. The results of the study showed that all 21 of the antidepressants were more effective than placebos in reducing depressive symptoms during the first eight weeks of treatment.”

“The new analysis suggests, however, that the efficacy of the drugs may be limited,” Katz reports. “For one thing, the benefits applied in the short term, and only to patients who are suffering from acute major depression.” [emphasis added]

The Smithsonian.com article and the studies conclude that “while the new study suggests that antidepressants are more effective than a placebo, at least in some cases, media reports claiming [as an article in Newsweek did] that the research shows ‘antidepressants do work, and many more people should take them’ are not entirely accurate.”

(This hearkens back to a pet peeve of mine: that headline writers (who are almost never the authors of the articles) do a poor job of summarizing articles in favor of more definitive or appealing descriptions of the text. https://wp.me/p4e9Hv-Br)

At any rate, the meta-analysis bears out my experience. Although I was bipolar 2, my disorder first manifested as major depression. I got relief from Prozac, results that later diminished. Since my proper diagnosis I have found more relief from a combination of an SSRI, an anticonvulsant medication often used for bipolar disorder, and an atypical antipsychotic also useful for bipolar as well as schizophrenia. Even though I do not have seizures or schizophrenia, these medications work for me and have not worn off for several years now.

So, what’s the takeaway from all this? I think it is that, if your medication for bipolar or depression seems to be “wearing off,” your perception may indeed be valid. But that’s no reason to give up on psychotropics altogether. People and their disorders differ in ways we just don’t know. You can ask your doctor to try a different medication or combination of medications that may work better for you.

The benefits of medication for psychiatric disorders do not simply go away just because the effect of one does.

Read more: https://www.smithsonianmag.com/smart-news/major-study-finds-antidepressants-work-may-have-limitations-180968452/#vjLKOqe2JdKEWOe3.99

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On Pain and/or Suffering

Recently, when I was reading Every Patient Tells a Story: Medical Mysteries and the Art of Diagnosis by Lisa Sanders, I came across this:

Eric Cassell, a physician who writes frequently about the moral dimensions of medicine, argues, in a now classic paper, that pain and suffering are very different. Pain, according to Cassell, is an affliction of the body. Suffering is an affliction of the self. Suffering, writes Cassell, is a specific state of distress that occurs when the intactness or integrity of the person is threatened or disrupted.

Later, when I was reading M Is for Malice, by Sue Grafton, I read this: “Pain was better than anxiety any day of the week and sweat was better than depression.”

The universe seemed to be telling me to focus my attention on pain and/or suffering.

Cassell (as quoted by Sanders), could have been (but probably wasn’t) talking about bipolar disorder when he defined suffering as “a specific state of distress that occurs when the intactness or integrity of the person is threatened or disrupted.” I certainly don’t feel intact or integrated while in the midst of a bipolar episode – either hypomanic or depressive. I suffer. My personhood is certainly threatened and disrupted.

It’s common to hear bipolar described this way: “I suffer from bipolar disorder.” I prefer to say “I live with bipolar disorder,” which I feel is more accurate. It’s always there, but I’m not always suffering. I live with it and it lives with me.

I think Cassell was wrong, though, about pain being a purely bodily sensation. I addressed the concept back in the early days of this blog. with a post called “Depression Hurts” (https://wp.me/p4e9Hv-6Z). In it I claimed that bipolar (or depression specifically) caused physical pain as well as emotional pain. I still maintain that one is as valid as the other and that they are virtually inseparable. The mind and the body not being entirely separate, or separable, you see. You get both for the price of one.

Grafton, on the other hand, through her character Kinsey Millhone, was talking about the physical act of running. We all know by now (or should) that exercise is recommended for those who have bipolar disorder or other mental/emotional conditions. But again, there is this idea that physical discomforts (pain and sweat) are better than emotional distress (anxiety and depression). She seems to be saying that pain is the antidote for suffering.

This can be dangerous territory. As someone who used to self-harm, I can easily see how one might think that pain is preferable to anxiety, or numbness, or dissociation – to suffering, that is. But in such cases, pain is really just another aspect of suffering, expressed in bodily terms. Again, the two are inextricably intertwined.

Personally, I would be delighted to avoid all four sensations – pain, anxiety, sweat, and depression. But I don’t think that’s possible, even with avoiding both exercise and self-harm. Sweat is the easiest to dispense with, thanks to modern toiletries, but there have been plenty of times when my anxiety has caused me to sweat. Think about being summoned to a tax audit, for instance, and you’ll see what I mean. Pain is unavoidable; no one goes through life without stepping on a nail or some such. Anxiety and depression occur at least occasionally in the neurotypical as well as the mentally disordered.

The human condition itself involves feeling both pain and suffering. Bipolar disorder involves both pain and suffering. Well, what do you know? We’re only human, after all.

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Mental Health

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Knitting Away Depression and Anxiety

Photo by Athena, Creative Commons

Last week I dissed a story that I read online about self-care for bipolar disorder, which consisted of praise for sleep, pets, and creativity, things which anyone with bipolar already knows are good for their mental health.

It was pointed out to me by someone who should know that I was wrong to make fun of the researchers, since they were students learning valuable lessons about how to conduct research studies in the first place. Which led me to believe that it was all the reporter’s fault for presenting their results as news.

Anyway, as an apology to researchers and grad students everywhere, I’m now going to praise a research study that would otherwise get a “well, duh” from me.

Huffington Post (UK) shared the good news:

Knitting could save the NHS [National Health Service] vital funds because it leads to a healthier population, reducing depression and anxiety, slowing the onset of dementia and distracting from chronic pain, a new report has found.

The study was primarily focused on the benefits of knitting for the aging, but since depression and anxiety were two of the conditions that it reportedly relieves, I thought it might be relevant to bipolar disorder too. Now someone can do a study to confirm or deny this idea.

The report added that knitting “is a sociable activity that helps overcome isolation and loneliness, too often a feature of old age,” and, I might note, of mental illness.

There are many, many articles that extol the benefits of creative pursuits for those with bipolar disorder and other mental illnesses. Although the notion of “basket-weaving” is outmoded and stigmatizing, other creative activities are commonly suggested as part of self-care. (I discussed this in a post called “Tools for Tackling Bipolar Disorder.”)

Coloring seems to be the most popular recent trend, but drawing, painting, collages, and all sorts of needlework are well thought of too. (I would certainly put crocheting in the same category as knitting.)

But then there’s the other side of bipolar – mania. I don’t know a lot about creativity and mania because I only get hypomania. But I do know that when I’m hypomanic I can get a lot of writing done. (Whether it’s good writing is another question.)

However, if you’ll forgive anecdotal evidence, I once knew a woman who did experience full-blown mania as part of her disorder and was not well controlled on medication. One year at Christmas she decided to make green velvet dresses for all three of her daughters.

As she spoke of her progress over the ensuing weeks, however, it was clear that the project was not going well. She kept rethinking – and redoing – all the sewing. She didn’t like the design, or she didn’t think they’d fit right, or she saw some other flaw. She never finished the dresses.

Other people may have better experiences with mania and creativity, of course. I hope you’ll share with me if you have.

The idea of creativity as a way to be sociable intrigues me. Sewing circles are a time-honored tradition among neurotypical people as well as those with mental disorders. (A friend of mine and her cronies had what they called the “Stitch and Bitch Club.”) Needlepoint, quilting, and indeed all of the fabric arts can be group activities.

For those who aren’t into those kinds of needle-centric activities, there are classes in scrapbooking, drawing, painting, ceramics, sculpture, or other creative art forms, often available through local adult education programs, museums, or shops that sell arts and crafts supplies. And of course, writers’ groups abound at bookstores and other venues (though presenting one’s own work at such a gathering may be too daunting for some with self-esteem issues).

I should probably get involved with a writer’s group myself. I’ve had to give up needlework because of my eyesight and shaking hands. But I’m all for doing something for my brain. Lord knows, it needs all the help it can get.

 

References:

http://www.huffingtonpost.co.uk/entry/knitting-linked-to-health-benefits-including-reducing-depression-and-slowing-dementia-report-reveals_uk_5aa63cb0e4b07047bec7feee?ncid=tweetlnkukhpmg00000001

knitforpeace.org.uk

“Tools for Tackling Bipolar Disorder” https://wp.me/p4e9Hv-uT

 

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Mental Health

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