Bipolar 2 From Inside and Out

Posts tagged ‘depression’

Struggles and Tears

In the past week I have had to deal with:

  • My husband being out of town
  • Said husband driving home for 10 hours with faulty brakes
  • My insurance company going belly-up
  • My meds running out before new insurance could be implemented
  • My cat going missing
  • My check being late, so I could not pay mortgage, pay new insurance, pay for meds, pay power bill
  • Being immobilized and unable to leave the house

Out of all of those, which do you think came nearest to breaking my brain, causing me to catastrophize and dissolve into prolonged fits of weeping?

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Woodcut by Peggy McCarty. Used by permission.

If you guessed the missing cat, you’re right. One day she trotted out the deck door while I was feeding the dog, a thing she had never done before. I scooped her up and put her back inside, and resolved to close the door further in the future. Louise is 20 and rather thin, so it’s easy to misjudge what she can squeeze through.

When my husband got back (safely), he took over feeding the dog. Then the next day, Louise didn’t show up for her morning breakfast. Or lunch. Or dinner. She usually has a hearty appetite and meows quite loudly if a meal is late.

Naturally, I thought she had gotten outside again and was lost. We searched through the house, calling her name, and went around outside the house doing likewise. My husband thought she might be feeling poorly and holed up somewhere, most likely in the basement, which is also the garage and not easy to search because of all the clutter.

I thought she must have gotten out and succumbed to some fate out in the woods – a dog or other animal, the rain, hunger, illness and debilitation.

I was convinced she was gone for good. And I had thought I still had more time with her, despite her advanced age (20+). I was inconsolable. My precious cat, gone. No knowing what had happened to her. No chance to say goodbye. No way to comfort her in her last hours on earth.

Dan told me that everything would be all right, but I didn’t believe him.

Then, the next day, she showed up at mealtime, bellowing that she wanted food NOW! Dan had been right. She had hidden somewhere in the house and came out when she was ready to.  I had my darling Louise back, for however long she still has.

Then, after the long holiday weekend, the check came and I paid the bills and set up the new insurance and got my meds and went out to lunch with Dan and everything was all right.

Just a little while ago, I wrote about how having a cat saved my sanity (http://wp.me/p4e9Hv-jS) and how they can be good for people with mental disorders. I even said that losing a pet could teach us something about the grieving process.

But when my own cat disappeared, all that philosophizing went out the window (or the deck door). Louise was gone and I was bereft. Nothing anyone could say could make it better. And the situation was complicated by the fact that both one of our other cats and our dog are also ancient. I know I will go through their loss, and likely soon.

Will I hold up any better?

I really don’t know. The other cat and the dog are my husband’s, bonded to him the way Louise is bonded to me. Likely his grief will be greater than mine. Or maybe when they pass they will remind me of how close I came to losing Louise. Maybe I’ll be able to support him in his loss, or maybe my brain will break again. Maybe it will happen when I am more stable, with fewer disasters and near-disasters clustering around my head.

That’s the thing with pets. You never know how long you have with them. You never know whether you’ll be relatively stable when you have to face their loss.

But I know I won’t give them up. The loneliness of not having them is even worse than the pain of their going.

ETA: Dan’s ancient cat Garcia passed away peacefully at home this morning (Saturday). We were both with him at the end.

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Out of the House – At Last

Brandywine Falls

Brandywine Falls

If everything goes according to plan (which we all know it never does), this post will be publishing itself while I am at or on my way to this scenic location, Brandywine Falls in Cuyahoga National Park.

I was attracted to this particular location when I read on the Internet that, in addition to access via a 1.75-mile hiking trail, the falls could also be reached using a wooden boardwalk from a nearby parking lot.

This easy access appeals to me because I have balance problems and sometimes use a cane, as well as because I seldom leave the house and have difficulty walking any distance. My husband encourages me to get out and walk, reminding me that exercise is good for depressive episodes, but just getting out of the house for doctors’ appointments and a few errands leaves me with no spoons for recreational walking. It’s a pretty dreary life, though there is a nice window in my study, through which I can see shrubs and trees, the occasional hummingbird or squirrel, or that stupid bird that sometimes flies straight into the glass and bonks itself silly.

There were actually tears in my eyes when I mentioned the expedition to Dan.

“What’s the matter?” he asked.

“Would you drive a long way with me to do something that requires very little time to do?”

“What do you want to do?”

“See this waterfall,” I said, pointing at the screen. I explained about the parking lot and the boardwalk.

“How far is it?”

“Near Cleveland. About three hours. Each way.”

It sounded ridiculous even as I said it. A six-hour drive to walk a very short distance and look at a waterfall.

“We could stop along the way to get something to eat. Or we could pack a picnic. You could bring your camera and take nature photos.”

I needn’t have worked so hard to make it sound attractive. Getting out of the house to go see something scenic and outdoors is something my husband has been longing for us to share.

Naturally, as soon as we agreed to go, my brain went into overdrive, doing my usual job of trying to anticipate everything. We would need to GoogleMap directions, of course. We would need some kind of waterproof bag with cold packs and bottles of water. Bandanas to moisten and wipe our sweaty brows (the temperature will likely be in the 80s and I don’t do well in heat). Bug spray. My cane and maybe a walking stick for him. At times like this, I tend to plan the Normandy Invasion.

This is a ridiculous idea/plan. After the last month and a half I’ve had, it’s a wonder that I’m not just crouched in a corner going beeble-beeble-beeble. But if it works, we may make the same drive in a few weeks to go to a horticultural center and canopy walk, if only so I can make the old, bad joke (You can lead a horticulture, but you can’t make her think) and we can meet up with some Cleveland-area friends we haven’t seen in far too long.

So. Getting out. Exercise. Nature. Relaxation. Fresh air. No computer access. Potential socializing. I don’t know whether these things will have any actual positive effects, but I like to think that my therapist will be proud of me.

Never mind that there are plenty of places nearer – even locally – to walk short distances and see nature. Never mind that my therapist often recommends that I take baby steps. This is a baby step. For God’s sake, I used to be able to hike in the Adirondacks. To travel. To Europe. By myself.

I don’t know why I was able to do that then, but can’t now. Bipolar disorder didn’t strike me suddenly, after I had done all those things. Maybe back then I was better at functioning. Maybe life and bipolar had not yet overwhelmed my ability to cope. Maybe I was in remission (or whatever they call it). Maybe I was hypomanic. It’s a mystery to me.

But maybe, just maybe, I can take this baby step toward reclaiming some of the things that used to bring me pleasure. It’s about damn time.

 

 

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A Bipolar Child

I suppose I was a bipolar child. I don’t really know, but I assume I was, because now I’m a bipolar adult.

I think I was more of a depressed child, which actually makes sense, since I have bipolar 2, with depressive episodes far outnumbering hypomanic ones. There were some times, though, when I would laugh loudly and inappropriately in class, triggered by a word that reminded me of something funny I’d read. There were times I’d walk around with a village-idiot grin because of some minor accomplishment like winning a live goldfish at a school fair.

Depressed child with toyBut mostly I remember misery. Tears. Loneliness. Hysterics. Confusion. Isolation. Hurt. Despair.

I’m fairly sure my depression wasn’t reactive, mostly, although parts of it surely were. The bullying, betrayals by friends, not understanding social conventions – all these were things that could easily make a person depressed, regardless of brain biochemistry.

But by and large my life was what would be considered pretty damned idyllic. I had stable, loving parents, a comfortable home in the suburbs with good schools, all the food I wanted, and as many toys as I could play with. I had a sister and a neighborhood full of children my age, but I remember being perpetually lonely. I had a good education, but looking back I realize that my illness prevented me from getting the most from it. There was no sexual or physical abuse or neglect. No one close to me died or suffered major trauma, at least until I was in high school and my parents suffered illnesses. Even then, they did a good job of keeping life as normal as possible. At the time we never felt it was a tragedy. It was just something we got through together.

That just leaves endogenous depression. Or at least the depression half of bipolar disorder. I remember one day walking home from elementary school and thinking, “All these houses look so pretty, but the people in them aren’t all happy.” It was somewhat of a revelation to me.  I had several major meltdowns, which I’ve written about before, and hundreds of smaller depressive episodes (http://wp.me/p4e9Hv-6J). I had nervous twitches and tics, and was prescribed Valium for them.

During my high school years, it was suggested that perhaps I ought to go to the school district’s psychologist. (This was probably during the episodes of inappropriate laughter in class.) My parents, who were not really familiar with mental illness and psychiatry, asked me if I wanted to go. I didn’t. I probably should have, although back then – the seventies – it’s fairly unlikely that I would have been diagnosed with bipolar disorder, of any type. I might have gotten some help for the depression, though. They might have taken me off the Valium.

Like most lonely and misunderstood kids, and perhaps most depressive children, I found my salvation in books. They were friends, distractions, instruction manuals on how to survive, food for my emptiness, a place to lose myself when the world was too much with me. By and large it worked, at least as well as anything could – a self-prescribed and self-regulated form of instinctual bibliotherapy.

These were not books on how to make friends, or ones that promised to teach a child how to cope with emotions. They were for the most part pure escapism. Fantasy and science fiction, mysteries and adventures, literature and bestsellers – a complete mishmash of classics and trash. Those were my doctors, my therapists, my Prozac, my mood stabilizers.

I look back now on myself as a child – mentally disordered, undiagnosed, untreated – and wonder how I survived  as much as I did.

If I were a child these days, would I get the help that I needed then? Would my parents recognize that I was not just odd and unhappy, but mentally ill? Would I have been diagnosed properly? Medicated properly? Counseled properly?

With all that needs to go right and all that can go wrong during the process, it feels like getting help for a bipolar child certainly was – and perhaps still is –pretty much of a crapshoot. I made it through, but I hope it’s easier for a kid like me these days.

 

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The Pluses and Minuses of Highs and Lows

Low polygonal shape mountain background with clouds.

Bipolar disorder comes with highs and lows – mania and depression, for those who still call it manic-depressive illness. Bipolar 2 comes with plenty of depression (trust me on this), but mania that doesn’t reach the heights of regular mania. Hence the term “hypomania” – low mania. Like “hypoglycemia” – low blood sugar. (Actually, low blood sugar can affect the bipolar person’s – or anyone’s – moods, but that’s a story for another time.)

So. Mania. Mania comes with pluses – exuberance, euphoria, ambition, confidence, and other good feelings. It also comes with minuses – risk-taking behaviors that can ruin relationships, careers, finances, lives.

Hypomania, however, is usually not so extreme. Sometimes you don’t even realize that you have hypomania at all, because it comes out sideways, as anxiety. This is what happened to me, and is the reason it took me so long to get the proper diagnosis of bipolar type 2.

Recently I have been exploring the realm of hypomania, and I’m here to report that, similar to regular mania, hypomania has its attractions and its drawbacks. And they are intertwined.

On the plus side, I have more energy – more spoons to spend. I can go longer between naps. I have now gotten out of bed, dressed, and out of the house for three days in a row. I can concentrate longer on the books I’m reading and spend more time with my husband and do some actual paying work.

On the minus side, I pay for that energy. It’s like borrowing spoons – you can’t keep doing it. Sooner or later the spoons have to be replaced. Right before my most recent spurt of energy, I had a need for a nap that turned into a mega-nap – almost six hours. I woke up just in time to get ready for bed. Then I slept at least ten hours more – maybe 12. It’s impossible to schedule these things, but I have left tomorrow open just in case my body and brain decide that’s payback day for the three days of activity.

Another plus is that my creative juices are flowing. I’m working ahead on blog posts because I know at the end of the month I have a huge commitment that will keep me from writing something for that Sunday. I’ve also taken steps to spiff up my posts with visuals. And I’ve been thinking that I ought to write some fiction.

However, there’s a however. The last time I had a creative spurt I almost talked myself into starting two new blogs, for a total of four. I have plenty on my plate already, what with these blogs and paying work and trying to find an agent for my book and getting ready for a writer’s conference. This is no time to start a big new project that could easily devour my time and my ability to do the things I already need and want to do. But I do now have a computer file set aside for notes and ideas that flit through my busy brain. Call that file “Later.”

And let’s not forget anxiety. It’s hard to find the pluses there, except that anxiety, if properly harnessed, helps me prepare. I suppose it sounds better if I call it anticipation instead of anxiety. Anticipating my upcoming dental work spurred me into putting together the financing for it. Anticipating the writers’ workshop allows me to prep for all the details – wardrobe, business cards, directions, strategies to cope with exhaustion – that would make my nerves fray even more at the last minute.

I assume I needn’t discuss the minuses of anxiety. Let’s just say that for me, they include regrettable and appalling physical symptoms that no one wants to hear about.

Any way you look at it, the dental procedures are going to be a low and the workshop a high. I can already predict some of the difficulties that will accompany the workshop boost. It’s harder to think of pluses related to the dental work. Except that I really need it done, and with luck it will (eventually) improve my looks, my breath, my health, my pain level, and my self-esteem. At least that’s what I’m telling myself now.

Bipolar disorder is often compared to a seesaw (or teeter-totter, if you prefer) or a swing set or a roller coaster – for some reason, usually as a form of amusement that involves ups and downs. The amusement is debatable and fleeting. But the ups and downs are with us always. Better to learn to ride this beast rather than let it ride us.

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The Teen in my Head

There is someone else living inside my brain.

I don’t have Dissociative Identity Disorder (DID, formerly called Multiple Personalities). I just have another me who pipes up from time to time. And, man, can she be annoying!

She’s 14 years old, and she doesn’t have a name. I don’t know when I acquired her, but I do know when she acts up.

She’s the one who frets when a friend doesn’t answer my IM. When he does, she squees, “He noticed me! He noticed me!” She’s the one who wants to buy ridiculous, useless – but amusing – things. She makes me eat that extra chocolate cookie, then frets about getting fat and pimply. She’s the one who is hooked on all the stupid clicky Internet games.

I’ve heard the theory that everyone has a mental age that they get stuck at. No matter how old they get, they always picture themselves at that age. Mine is somewhere between 28 and 34. So how did I end up with a 14-year-old?

My theory about her existence is that she is there to try to do what I never did when I was 14 – all the regular teen-age angst and frivolous stuff: mad crushes and pouting, self-obsession and discovering her sexuality, in-jokes with BFFs and trying out fingernail polish.

When I was actually 14, I did none of that. I was in a prolonged downward mood swing, made worse by puberty and the horrors of junior high school. I wrote depressing poetry and read French existentialists. If they had had hipsters back then, I suppose I would have been one.

When I feel her popping up in the back of my skull, most of the time I have to put her in a box and sit on the lid. It’s scary to let her take over. She’s rapid-cycling, impulsive, and worst of all, unmedicated. (I don’t know why my meds don’t affect her, but there you are, they don’t.)

Once in a while I let her out of the box. I let her enjoy some mad crushes (as long as she doesn’t do anything about them). I let her buy things that cost $20 or less. I let her talk me into fake fingernails (once!). I let her have some of the fun that I never had at that age.

The thing is, I don’t know if this is just a me thing, a female thing, or a bipolar thing.

I know I’m not completely alone in having a teen ride-along. I do know a man with DID who has an alter that is a teen girl. I could tell when she was out because she giggles a lot and buys junk food. A friend of mine who has suffered from depression also has a 14-year-old in her head. She has given her teen a name – Innie Me. Hers behaves a lot like mine.

I also don’t know whether having a teen living in my head is a good thing or a bad thing. It could be good, because it does give me access to the feelings and experiences I never had as an actual teen. My teen is better than I am at having fun.

On the other hand, I know it would be a bad thing if I let her have her way all the time. She needs that box and I need to sit on the lid. The trick is knowing when and how and for how long to let her out.

On an episode of Scrubs, one character remarks that no matter how old a woman gets, she always has an insecure 14-year-old inside her. I suppose that men have similar phenomena. Most people are said to have an inner child (although I think they are usually younger than 14). I think my husband’s inner child is usually about seven.

Certainly my teen is insecure. There’s no question about that. But she’s also enthusiastic, engaged, and energetic, as well as moody, dramatic, and confused. I think she may be related to the hypomanic part of myself, although I’m also sure some of my fits of apparently reasonless weeping have been her acting up.

My therapist knows about my 14-year-old. We have discussed her and her behavior and her moods several times. Dr. B. has never expressed surprise or shock or puzzlement at the idea. She does think it’s good that I’m learning to sit on the box lid when I need to. We’ve talked less about when it’s a good time to let her out. That’s something I still need to work on.

I guess I’ll have to learn to live with my 14-year-old, because I don’t think she’s going away anytime soon. And I don’t think I really want her to.

 

 

 

 

 

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Trigger Warning: Trigger Warnings

What is a trigger warning?

Let’s start with a more basic question. What is a trigger?

Just as a literal trigger activates a gun, a figurative trigger activates your mental disorder. It’s a stimulus that sets off either a manic or depressive phase, or a bout of PTSD.

Triggers are usually unique to the individual. What sets you off may not affect me at all.

Over the years I’ve learned what my triggers are, and so do most bipolar or PTSD sufferers. Loud noises and large crowds trigger my anxiety, which is why I could never work at a Chuck E. Cheese. My depressive phases don’t often have triggers except for bad dreams about an ex-boyfriend. Most of my depressive episodes just happen without a trigger.

Generally, one avoids triggers, because who needs more manic or depressive phases in addition to those that occur naturally, with no prompting?

A trigger warning is something else. It is a notice that someone puts at the beginning of a piece of writing to warn readers that the subject matter may be intense. Ordinarily, trigger warnings are given for major life events that have caused trauma and may cause flashbacks, severe stress  or other extreme reactions.

Some of the most common trigger warnings are for graphic depictions of rape, suicide, self harm, or physical or sexual abuse. The trigger warning says to a potential reader: If you don’t want to encounter this material, if you think it will make your illness worse, or cause you undue stress, don’t read any further.

Although we call relatively minor stimuli triggers, they usually do not require trigger warnings. If you’re going to write about having a fight with your mother, you probably don’t need to put a trigger warning on it. If your mother hit you in the face with a frying pan and sent you to the ER, you might need to place a trigger warning on your post about it.

Online, the standard form for trigger warnings is first to state, often in all caps, TRIGGER WARNING and state the type of trigger it is – TRIGGER WARNING: SELF-HARM, TRIGGER WARNING: SUICIDAL THOUGHTS, etc. To be extra sensitive, the writer leaves a number of blank spaces or a few dots before beginning to write the difficult material. This gives the reader the choice of whether to scroll down and read it or not.

Trigger warnings have become controversial, particularly in schools and colleges. Many pieces of literature and even textbooks on history or sociology discuss difficult topics that may be triggering. For example, a novel might feature a rape as a plot point, or a history text might discuss slavery.

Some people believe that a trigger warning will help a prospective reader know whether reading further will provoke a strong reaction. Other people believe that trigger warnings are a way of coddling the weak and letting students avoid challenging material that is necessary for the class.

My own opinion is that a trigger warning is like chicken soup: It won’t hurt and might help. It may mean that a student asks for an alternative reading or assignment, but it also may mean that the student simply wants to be in a safe space – not surrounded by strangers, for example – before reading the material.

People that believe trigger warnings should not be given have usually not experienced the kind of emotional breakdown that can result from unexpectedly confronting a traumatic topic. Very likely they have never even been in the presence of someone who has had such an extreme reaction.

I suppose that ideally, we could all read any material and simply brush it off if we found it troubling. Unfortunately, for those of us with mental disorders such as bipolar illness, PTSD, and anxiety disorders, this is simply not possible. A trigger warning may prevent someone from having a public meltdown and others from having to witness one.

I don’t know why that should be controversial. It seems like simple courtesy to me.

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Bipolar Basics for the Newly Diagnosed

If you have recently been diagnosed as bipolar, there are a few basics you should know. You’ll likely find them out on your own, but it might take a while.

So, here are some tips.

    1. Being bipolar isn’t necessarily a tragedy. It’s a chronic illness. At times it’s better, at others, worse. It’s not a death sentence and it’s treatable. You can still live a reasonably full and satisfying life.
    2. You need help. To live with bipolar disorder, you need a support system. Unfortunately, your friends and family may not be all that supportive. Fortunately, there are online support groups. But the most important parts of your support system, at least at first, are your psychiatrist and your psychotherapist. I recommend having one of each – psychiatrist for medication, therapist for talk or cognitive behavioral therapy, or whatever works for you.
    3. You will most likely need medication. And the odds are good that you will need it for the rest of your life. Don’t panic. After all, diabetics need insulin, usually for life. You may hate taking pills, you may hate the idea that you are dependent on them, you may hate the fact that they remind you of your brain’s difficulty functioning. But realize that meds will make your brain’s functioning less difficult. They are worth the hassle.
    4. Everyone is different. Everyone’s symptoms are slightly different. Everyone’s medications are slightly different. Everyone’s reactions to their medications are slightly different. A support group can help you with general information, but they cannot tell you what is ultimately best for you. Your particular symptoms and your unique version of bipolar disorder may well require different medications, in different amounts, than your friends. And you may have different reactions to them. Some pills have no effect at all on one person and are life-savers for another.
    5. Getting better takes time. Once you have your diagnosis and your medication, don’t expect to feel better quickly. Most medications for bipolar disorder take a while to build up in the body. Six weeks is not unheard of. Then your doctor may assess how well the medication is working, and change the dose or even the medication itself. Then you may go through another six weeks of waiting for the new dose or drug to take effect. Each case of bipolar disorder requires a medication regimen tailored specifically to the individual, and that often takes some doing.
    6. There are several different types of bipolar disorder. The two main types are called type 1 and type 2. Type 1 is the classical bipolar disorder, which used to be called manic-depressive illness. Type 2, a more recently identified version of the disorder, often manifests as mostly depression, possibly with hypomania, a less severe version of the ups that accompany bipolar 1. Other forms of bipolar disorder are rapid cycling, in which one’s mood states alter quickly, even within a few hours. Another version of bipolar disorder is called mixed states. Mixed states occur when a person experiences both extremes of emotion at the same time – for instance, depression and irritability, or fatigue despite racing thoughts.
    7. The odds are that you already know someone with bipolar disorder, or at least some kind of mood disorder. One in four Americans will have a psychiatric or emotional illness at some time during their lives. Because we don’t talk about it, though, no one may ever know. Especially when the disorder is treated properly, a person with bipolar illness can maintain function in society and choose whether or not to share the diagnosis with friends and coworkers. Many people choose not to because of the stigma surrounding mental illness. It’s a valid choice, but it cuts the bipolar person off from possible support and understanding from others who may share the disorder.
    8. Relationships can be difficult but not impossible. Relationships are difficult for everyone. People with bipolar disorder have relationships that are difficult too. The disorder may make the relationships even more difficult, especially when the family member or loved one or even close friend does not understand the symptoms, the medication, the mood swings, the anxiety or fatigue, or all the other facets of bipolar. The best cure for this is education. However, it may not be possible for a relationship to survive bipolar disorder, just as a relationship may not survive trauma, grief, addiction, infertility, incompatibility, meddling relatives, infidelity, parenting, or a host of other conditions. It may be better to look at all the circumstances surrounding a troubled relationship rather than automatically blaming bipolar disorder for difficulties.
    9. Learn all you can. Because bipolar disorder is so little understood by the public, because it manifests differently in nearly every case, because a person can be actively suffering or in remission, because a person may have any of the different types of bipolar disorder, because everyone is different – the need to educate yourself and probably those around you is essential. The more you know, the less you’ll panic when a symptom you haven’t experienced before suddenly hits. Rely on reputable sources. Medical, psychiatric, or psychological websites are usually the best. Support groups can offer much information, but the people in a support group may not be any more well-informed than you are. And there are lots of people selling “miracle cures” that can lure a person away from needed medication and other services.
    10. Keep trying. It’s hard. It’s frustrating. It’s difficult. It’s painful. It’s confusing. But bipolar disorder is something you can live with, and even something you can rise above. The secret is to keep trying. Keep seeking out therapy and friends who support you. Keep taking your medication, even if you don’t want to. (Stopping your medication without advice from your doctor can be dangerous, so don’t try that.) Be stubborn. When you feel like giving up, tell yourself that maybe things will get a little better in the morning. Hang in there. You may not realize it, but there are people who need you in the world, who need you to be functioning and happy, who need you to keep fighting the disorder.

Do you have any other tips for the newly diagnosed? Please share them in the Comments section.

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Am I Ready to Stop Therapy?

I got my first hint that I might be ready to stop therapy when I realized how little I was going. Over the years I have scaled down from weekly sessions to biweekly.

Then I noticed that, effectively, I’ve been going only once a month. I’ve been forgetting appointments, showing up on the wrong day, oversleeping, feeling poorly physically, or having too much freelance work to do.

Of course, those could be signs that I’m in denial, that I’m resisting therapy, that we’ve hit a bad patch of difficult issues and I just don’t want to deal with them.

But I don’t think that’s what’s happening. Here’s why.

I’m stabilized on my medications and they’re effective. When my psychiatrist moved away a few months ago, he left me with enough refills to last until this month and a list of other psychiatrists. My PCP agreed to prescribe my psychotropics if I lined up another psychiatrist for emergencies. I’ve done that, though I couldn’t get an appointment before March.

And that doesn’t alarm me. I don’t have the oh-my-god-what-if-my-brain-breaks-again panics. I don’t have the feeling that my brain is about to break again. I’ve thought about it, and I’m comfortable with letting my involvement with the psychiatric profession fade into the background of my life.

As long as I keep getting my meds.

I have more good days and I’m beginning to trust them. Oh, I still question whether I’m genuinely feeling good, happy, and productive or whether I’m merely riding the slight high of hypomania. But really? It doesn’t seem to matter very much. A few days ago I reflected on a string of particularly good days – when I accomplished things, enjoyed my hobbies, and generally felt content. And I simply allowed myself to bask in those feelings.

That’s not to say I don’t still have bad days. After a few days of hypomania, I hit the wall, look around for spoons and don’t find any, and require mega-naps to restore me. (I’m intensely grateful that I work at home and can do that. Most offices don’t appreciate finding an employee snoring underneath her desk. And my cat-filled bed is much more comfy-cozy.)

I still get low days too, but they are noticeably dysthymic rather than full-out, sobbing-for-no-reason, Pit-of-Despair-type lows that last seemingly forever. I know – really know, deep within me – that they will last a day or two at the most. And just that knowledge makes me feel a little bit better.

My creativity, concentration, and output are improving. I can work longer, read longer, write longer, take on new projects, think past today or even next week. I can trust my muse and my energy, if not immediately when I call on them, at least within a reasonable time.

I have trouble remembering how bad it used to be. Recently I’ve made connections with several on-line support groups for bipolar and mental health. I find I’m astonished at the crises, the outpourings of misery, the questioning of every feeling and circumstance, the desperate drama of even the most mundane interactions. They are overwhelming. But I realized that it’s been a long time since they’ve overwhelmed me. I recognize that I could some day be in that place again – that’s the nature of this disease. But I have a good support system that I trust to help me not fall too far without a net.

I don’t have much to talk about when I go to therapy. There are issues I need to work on – getting older, getting out of the house more, reclaiming my sexuality. But most of those I feel competent to work out on my own.  My sessions are mostly an update on what’s going on in my life at the moment, plus a recap of my recurring problems. But those problems are ones I’ve faced before and know how to cope with. I already have the tools I need and use them without needing a reminder.

So I’ve talked it over with my psychotherapist and I’m not completely quitting therapy, but I am cutting back officially to the once a month I seem to be going anyway. I know that if and when the bipolar starts giving me major trouble again, I can always call for an appointment or a telephone therapy session.

I’m not going to stop writing these posts. I still have a lot to say about where I’ve been, how I’ve got to where I am now, how things will go in the future, and all the many ways that mental illness affects society and vice versa.

You’re not getting rid of me that easily. I’m sticking around.

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Does “Natural” Treatment Work for Depression?

Not for everyone. Not all of the time.

Angel Chang recently posted on LittleThings.com “The 10 best natural ways to treat depression.” (See http://www.aol.com/article/2015/11/06/the-10-best-natural-ways-to-treat-depression/21260290/?ncid=txtlnkusaolp00001357) While she does acknowledge that “clinical depression is triggered from within, and very often need[s] medical attention” and “it’s imperative to consult your physician if you notice an abrupt change in your mood, feelings, or sense of well-being,” her article is about “easy” ways to treat depression yourself.

Unfortunately, her tips are not very helpful for me and many others who suffer from clinical bipolar or unipolar depression. Here’s how I respond to them.

Meditate. This is both nearly impossible when you have racing thoughts and a way to sink even lower if you can’t clear your mind of negative thoughts, which is one of the hallmarks of depression. And if you’re manic, even sitting still in one place for any length of time can be a challenge. After you’re stabilized on medication – go for it.

Eat Foods With Vitamin B. It may be true that vitamin B has been linked to neurotransmitters that we need more of, but preparing them is not realistic when I’m in the Pit of Despair. I try to imagine myself preparing a meal of fish, Swiss cheese, spinach, and eggs, and I just can’t. Or shopping for them, for that matter. I might be able to scramble an egg in the microwave, but that’s about it. (I wrote about food and depression recently: http://wp.me/p4e9Hv-db.) I do take a multivitamin along with my bedtime psychotropics, so I guess I can follow this advice a bit.

Set goals. Chang recommends starting with “small, daily goals.” When in full-blown depression, mine are about as small as you can get. Get out of bed. Make it through the day without crying. Take my meds. Poof! Out of spoons! The expert Chang quotes gives an example of a goal to work up to as washing the dishes every other day. To me, that implies a series of goals: Gather up dishes. Find soap. Fill sink. Wash a dish. Put in drainer. Repeat. My tip: Wash the spoons first!

Sleep on a schedule. Going to bed at the same time every night may be do-able, but getting up at the same time isn’t possible for me, which is one of the reasons I can’t hold a regular job. An alarm clock awakening me before my body is ready leaves me groggy and unfit to work. And there’s no guarantee that I’ll actually sleep during those scheduled hours, even with Ambien. Chang advises not taking naps, but I seldom make it through the day without one, even if I have slept eight (or nine or ten) hours. In fact, I love naps and consider them therapeutic, for me at least. Naps are my friends.

Get out of your rut. Structure is the only thing that keeps some of us going. And if we could find joy in a painting class, a museum, or making a new friend, as Chang suggests, we probably wouldn’t be depressed in the first place. J. K. Rowling described the Dementors in the Harry Potter books: “Get too near a Dementor and every good feeling, every happy memory will be sucked out of you. … You will be left with nothing but the worst experiences of your life.” She has stated that they are metaphors for depression. With every good feeling sucked out of you, you can’t see anything but the rut. I am told that for some people, Cognitive Behavioral Therapy (CBT) lessens the tendency to keep traveling in the rut. But “easy” and “natural”? I don’t know.

Talk. Chang is advocating talking with trusted loved ones, which is good as far as it goes. What it ignores is that friends and loved ones are not universally understanding of depression or supportive in dealing with it. She never suggests talking with a therapist or doctor. I don’t know why that’s less “natural” than talking with someone who has no training. Except you have to pay them (or your insurance does), but painting or language classes or art supplies aren’t free either.

Exercise. This is a classic antidote for depression, and I understand that it works for many people some of the time. But I would put this under the same heading as setting goals. I know it would be good for me, but motivation is hard to come by and immobilization thwarts me. But I wish I could take this advice. I looked into water aerobics, but there’s not a feasible program in my area.

Responsibilities. “Because you might feel down,” the article states, “you may also want to withdraw from your daily activities in life and your responsibilities at home or at work.” Yepper. “Try staying involved as much as possible in the causes you care deeply about, and take on new daily responsibilities. These can be as simple as volunteering at your local food pantry, or going back to work part-time.” Big nope. See getting out of your rut, above. For the clinically depressed, working even part-time is unimaginable, with responsibilities of the crushing sort.

Unwind and relax. If your depression comes with anxiety like mine, this idea is a non-starter. Unless you count drinking as relaxation, though it isn’t the best idea if you’re on meds.

Stay off caffeine. Okay, I can pretty much do this one, except for one cup of coffee or a caffeinated soda to get me started in the morning.

“Did you learn something new about how to naturally treat symptoms of depression?” the article ends. Not really. Well, except for the B vitamins. We’ve all heard these kinds of advice before. They’re good tips for situational or reactive depression, but largely not feasible for the chronically, clinically, biochemically depressed. In a way they add up to the much-hated “Just stop it. You must want to be depressed or else you’d be doing all these great things.”

But try them if you can, perhaps in addition to medical treatments. Maybe some of the ones that won’t work for me will for you. In the meantime, get help. See your therapist and/or psychiatrist. Keep taking those meds. Those may not be “easy, natural” ways to treat depression, but if they work, isn’t that the larger point?

P.S. Do NOT Google “CBT.” Spell out “Cognitive Behavioral Therapy.” Trust me on this one.

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Is My Cat Bipolar?

It sure seems like it. She lies around all day, barely moving. Then at any given time she races through the house pursuing nothing at all. Afterward she lies back down, immobilized again. It looks an awful lot like rapid cycling.

I’m not going to get into the debate here of whether animals have emotions or humans are simply anthropomorphizing. Of course animals have emotions, and act on them. Our cat Maggie could snub you so you really knew you’d been snubbed. Another cat, Shaker, was mortally offended if you stuck a whisker on the top of her head and made “beep beep” noises. Our dog Bridget has deep anxiety around strangers, both human and canine. She has been known to wet herself, or my husband’s shoe. Polar bears can experience boredom. I have it on good authority that sheep can hold a grudge.

But can animals experience mental illness? Recently the BBC examined the question in an article by Shreya Dasgupta.(http://www.bbc.com/earth/story/20150909-many-animals-can-become-mentally-ill)

The article is long and rather technical, citing genetic studies I’m not capable of summarizing and using words like “telomere.” But the Beeb’s resounding answer to the question is yes. Not only can animals feel emotion, they can suffer from mental disorders. The report says:

To our eyes, many animals seem to suffer from forms of mental illness. Whether they are pets, or animals kept in ill-managed zoos and circuses, they can become excessively sad, anxious, or even traumatised….There is growing evidence that many animals can suffer from mental health disorders similar to those seen in humans.

It was decades ago that I first heard about polar bears on Prozac, due to their pacing obsessively or swimming repetitively back and forth. (I did wonder how the vets calculated the dosage – by body weight or brain size.) Of course, rather than psychotropics, what the bears really needed was more appropriate-sized enclosures.

Stress and social deprivation seem to be two of the factors that can bring on mental illness – particularly depression or PTSD – in animals. Dogs that serve in combat zones have been known to have trouble adjusting to civilian life. And the death of an animal’s relative or beloved human companion has been anecdotally linked to profound grief and even death.

The BBC notes that all the evidence we have for animal mental illness comes from pets, captive animals, and research specimens:

That probably reflects our own preferences for certain animals. “It’s the animals that we find very charismatic, like elephants or chimpanzees, or animals that we share our homes with, like dogs,” that command our attention, says animal behaviour expert Marc Bekoff.

But do wild animals really suffer from mental disorders? It’s practically impossible to tell.

For one thing, wild animals cannot bare their souls to therapists. For many reclusive wild animals, we know so little of what is normal behavior that we would be hard pressed to identify abnormal responses to environmental stressors.

Still, the experts say, even invertebrates like octopi and honeybees seem to suffer from, if not what we would call mental illness, at least maladaptive reactions to trauma.

Severe psychiatric illnesses like schizophrenia seem to go with higher intelligence. (Octopi are actually quite smart.) But again, how can you tell whether a dolphin is hallucinating? It may be that animals with extreme mental illness are weeded out by evolution, as their erratic behavior may lead to early death and loss of the ability to pass on their genes.

Is this true for humans as well? Are mental illness and intelligence correlated? As yet, there is little consensus. Sometimes the debate boils down to chicken-and-egg levels. Do people with lower intelligence experience more depressed because they are unable to accomplish what they want to do? Or does depression make it more unlikely that they will accomplish what they wish for? (Most of the studies seem to relate to depression.)

As the BBC report says, “Mental disorders seem to be the price animals pay for their intelligence. The same genes that made us smart also predisposed us to madness. There’s nothing shameful in that.”

Except, of course, that in humans there is stigma. Cats, now – they can get away with acting as crazy as they want. We’ll just call it adorbz and post it on YouTube.

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