Bipolar 2 From Inside and Out

Posts tagged ‘depression’

Mental Illness: Poverty and Privilege

Mental illness is not just an American problem. In fact, it’s a problem around the world, and perhaps much more acute in other nations, especially those plagued by poverty.

There’s no way to know for sure, but many – perhaps most – of the world’s mentally ill are undiagnosed, untreated, ignored. Because what do you do when you live where there’s no psychiatrist? No therapist. No medication. No help.

Your family may support you, shelter you, or shun you, depending on their financial and emotional resources and those of the community. But for many people, there is simply nothing.

Psychiatrist Vikram Patel, one of Time magazine’s 100 Most Influential People for 2015, is working to change that.

As a recent profile in Discover magazine put it, Patel and others like him have set out to prove “that mental illnesses, like bipolar disease, schizophrenia, and depression are medical issues, not character weaknesses. They take a major toll on the world’s health, and addressing them is a necessity, not a luxury.”

In 2003, Patel wrote a handbook, Where There Is No Psychiatrist: A Mental Health Care Manual, to be used by health workers and volunteers in poverty-stricken communities in Africa and Asia. A new edition, co-written with Charlotte Hanlon, is due out at the end of this month.

Patel, in his first job out of med school, in Harare, Zimbabwe, says he learned that there wasn’t even a word for “depression” in the local language, though it afflicted 25% of people at a local primary care clinic. There was little study of diagnosis and treatment in “underserved areas.”

Later epidemiologists learned to their surprise that mental illnesses were among the top ten causes of disability around the world – more than heart disease, cancer, malaria, and lung disease. Their report was not enough to spur investment in worldwide mental health.

Patel developed the model of lay counselors – local people who know the local culture – guiding people with depression, schizophrenia, and other illnesses through interventions including talk therapy and group counseling. By 2016, the World Health Organization (WHO) admitted that every dollar invested in psychological treatment in developing countries paid off fourfold in productivity because of the number of people able to return to work.

One objection voiced about Patel’s model is that the real problem is poverty, not depression or other mental illness. The argument goes that the misery of being poor, not a psychiatric illness, leads to symptoms and that Westerners are exporting their notions of mental health to the rest of the world, backed up by Big Pharma. Patel responds, “Telling people that they’re not depressed, they’re just poor, is saying you can only be depressed if you’re rich … I certainly think there’s been a transformation in the awareness of mental illnesses as genuine causes of human suffering for rich and poor alike.”

Of course the problem of underserved mentally ill people is not exclusive to impoverished nations. There are pockets in American society where the mentally ill live in the midst of privilege, but with the resources of the Third World – the homeless mentally ill, institutionalized elders, the incarcerated, the misdiagnosed, those in rural areas far from mental health resources, the underaged, the people whose families don’t understand, or don’t care, or can’t help, or won’t.

I don’t know whether Patel’s model of community self-help can work for those populations as well as they do internationally. This is not the self-help of the 1970s and 80s, when shelves in bookstores overflowed with volumes promising to cure anything from depression to toxic relationships. It would be shameful if the rich received one standard of care for mental health problems, while the poor had to make do with DIY solutions, or none.

But, really, isn’t that what we’ve got now?

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Mental Health

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Pill-Shaming

When I first started taking Prozac, when it was just becoming ubiquitous, my mother said, “I hear it’s a ticking time bomb!”

“Oh, dear!” I thought. “Mom’s been listening to Phil Donahue again.” (She had been, but that’s not the point.)

Back in the day, Prozac was hailed as a miracle drug and condemned as a killer drug. On the one hand, it was said to be a “magic bullet” for depression. On the other, it was supposed to result in addiction and suicide.

It’s probably true that it was prescribed too often to too many people who may not really have needed it. And it may have led to suicides—not because Prozac prompted such an action, but either because it was improperly prescribed or because it activated people who were already passively suicidal and pushed them into action.

At any rate, Prozac was not an unmixed blessing.

For me, it was closer to a miracle drug. It was the first medication that had any significant effect on my depression. I noticed no side effects.

But Prozac is no longer the psychiatric drug of choice. Since that time, hundreds—maybe thousands—of psychotropic drugs have been introduced and widely prescribed. Many have proved just as controversial as Prozac. Indeed, the whole concept of psychiatric drugs is now controversial.

I belong to a lot of Facebook groups that encourage discussion on psychological matters and have a lot of Facebook friends with opinions on them, sometimes very strong ones. Some of the people with the strongest opinions are those who condemn certain classes of psychiatric drugs or that category of drugs altogether. They share horror stories of addiction, atrocious side effects, zombie-like behavior, and even death from the use of these drugs.

Benzos are the drugs that are most often condemned. And it’s true that they can be addictive if they’re misused. Whether that’s because a doctor overprescribes them or a patient takes more than prescribed I couldn’t say. But I maintain that benzos aren’t inherently harmful when prescribed appropriately and supervised professionally.

I have personal experience with benzos. They were the first psychiatric drug I ever took, meant to relieve a rather severe nervous tic that affected my neck and head during junior high school. I do remember walking off a short stepstool while shelving books in the library, but I was not injured and the misstep could be attributable to ordinary clumsiness, which was something I was known for (and still am). The benzos were discontinued when I got better. I also took benzos in college because of pain due to temporomandibular joint problems.

Now I have benzos that my psychiatrist prescribed “as needed” for anxiety and sleep disturbances. After all the years I’ve seen him and my history of compliance with prescribed medication, plus the very low doses, he had no hesitation prescribing, and I have no objection to taking them.

But some of the people I see online object to any psychiatric drugs whatsoever. Again, the most common complaints are addiction, side effects, and zombie-like behavior. Of course, I can’t—won’t—deny that they have suffered these effects. Psychotropics are known to affect different people differently. I’ve had side effects from many of the ones I’ve taken that were too unpleasant for me to continue taking the drugs. But after all the different meds I’ve tried during my journey to a combination of drugs that work for me, it would be a surprise if I objected to them altogether.

But I don’t. I’ve had cautious, responsible psychiatrists who’ve prescribed cautiously and monitored rigorously, listening to me when I reported side effects.

So, my personal experiences have been good. I know not everyone’s experiences have been, for a variety of reasons.

What I object to is the drumbeat of “all psychotropic medications are bad and ruin lives.” And the memes that show pictures of forests and puppies that say “These are antidepressants” and pictures of pills with the caption “These are shit.”

I hope those messages don’t steer people who need them away from psychotropic medications. And I hope that people who do need them find prescribers who are conscientious, cautious, and responsible in prescribing them. On balance, I think they’re a good thing.

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Mental Health

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Time Out From Life

I was stuck during my first year in college. I was a linguistics major and couldn’t see my way clear to a career in the field. I thought about changing my major to random ones like landscape architecture and hotel management. I had no passion for either one, but I figured at least I could get a job.

I was also suffering from a major depressive swing. I missed classes, though I managed to pass them. I couldn’t sleep. I spent hours in the middle of the night sitting in the hallway, staring at an ornate coloring poster on the opposite wall, hypnotized by its intricate black outlines.

I decided to take a year off. I was incapacitated and couldn’t go on at that time. I figured I could reassess my choice of majors while I pulled my head together. I always had the intention of going back at the end of that time out.

I also needed money for that next year of college, so I got a job as a cashier and waitress on the second shift at a local Frisch’s restaurant. I was a good cashier and a lousy waitress, and I spent quite a bit of time in the bathroom, crying into the roller towel. I learned how to swear. My coworkers noticed that I was either worried and anxious or numb and sad. (One manager asked me, “What does a girl your age have to worry about except am I pregnant?” The other told me to smile more. Needless to say, this was not helpful.)

That time out from college was important to me psychologically. It didn’t solve my problems, and I was still undiagnosed and unmedicated. I began to realize that my problems went further than what my major was. And I made friends at work and learned a lot about self-reliance. I had time and space to think. My parents and my high school friends formed my support system.

I did go back to college the next year. I changed my major to English, which was more satisfying and more in line with my interests (though not really better on career possibilities). I continued through the next three years without taking more time off. As you may have guessed, the anxiety and depression didn’t leave. I had a fling with a musician – my first – and when it ended, I didn’t know how to handle it. Then I had a totally disastrous relationship, fraught with gaslighting. Again, I had trouble sleeping. I lost weight. I drank too much. The swings between hypomania and depression were noticeable.

When I graduated, I went back to working at the restaurant, then got a job at an advertising agency as an assistant to the treasurer. I moved into my own apartment and began a long-distance relationship with my eventual husband. I considered going back to school for an M.A., again in English, which I eventually did. I was still untethered, but I went into treatment for depression. (It wasn’t until many years later that I learned that my diagnosis was really bipolar.)

A depressive swing also caused me to take a time out from work later in life. This was the one that lasted two years and had me applying for disability. (I didn’t get it.) It was only psychologically important in that it graphically demonstrated how badly I needed help. At least the time I missed from college was something I chose to do rather than something that blindsided me.

The takeaway from all this, I think, is that the ups and downs of bipolar disorder mean that my life was destined not to go smoothly. While I am pretty high-functioning – I was able to earn college degrees and hold various jobs, at least for a while – there have been times when my illness has overwhelmed me and I need time out from my “normal life.” And those occasions come on me unpredictably, as is the way of bipolar mood swings. While I haven’t needed to, or been forced to, take a time out lately, I know it could still happen. That’s just the nature of the disorder. I hope my medication and therapy will make the possibility less likely, though.

If you’ve taken a time out too, I’d encourage you not to think of it as a permanent thing. It could be something that you needed to do, and something that may have relevant significance for you as you look back on it, as was true for me. Most of all, I hope you get help and support to get through it.

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Mental Health

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What Is It With Showers Anyway?

Girl is choosing cosmetics in bathroomIt is fairly widely known that people with bipolar disorder and/or depression have trouble taking a daily shower. It’s not that we don’t know what’s involved in taking a shower, or why it would be good for us to do so, it’s simply that showering uses up a tremendous number of spoons.

Here’s what showering looks like according to Andrew Solomon, author of the now-classic The Noonday Demon:

I ran through the individual steps in my mind: You sit up, turn and put your feet on the floor, stand, walk to the bathroom, open the bathroom door, go to the edge of the tub…I divided it into fourteen steps as onerous as the Stations of the Cross.

I performed a similar exercise in one of my blog posts and here’s my version:

First I have to find a clean towel and a bar of soap, get undressed without seeing myself in the mirror, fiddle with the water temperature, wash and shampoo, dry off, find clean underwear, and that’s not even thinking about drying my hair and figuring out what I can wear! Oh, my God, I’ve used up all my spoons just thinking about it! I should just eat Cocoa Puffs and go back to bed.

Now let me say, first of all, that I don’t really like showers. I grew up taking baths and have never enjoyed the sensation of water spraying in my face. But with my bad back and bad knees, getting up from sitting in a bathtub is nearly impossible these days. (Please don’t ask me why anyone would want to sit in dirty water. Everyone says that when I say I prefer baths. I have a nice long soak, steeping in the clean water like a big teabag, and only then wash up and get right out. Used to, I mean.)

To most people, showering is a single act that requires the expenditure of a single spoon. Take a shower; that’s it. But for those of us with invisible illnesses, each separate step may require its own spoon. Take something as simple as finding a towel, for instance. Go to the linen closet, grab a towel and voilà! Only a fraction of a spoon, if that.

But surely you don’t think I have had the spoons to fold and put away my laundry. It is all there in a jumble on top of the dryer. (Who needs a wrinkle-free towel anyway?) I have to root around to find one, and maybe twice if a cat has thrown up on the first one I pick. (They love sitting on clean laundry.)

If I have to go to a business meeting I force myself to use some of those spoons showering and getting dressed and acting respectable. But I will pay for it later, collapsing after the meeting in need of a mega-nap.

Now here’s a little secret I’ll tell you. Most people believe you gain spoons by going out of the house – walking in the fresh air, meeting friends for lunch, shopping, going for a drive (does anyone do that anymore?). But the fact is that, according to Spoon Theory, you get a certain number of spoons every day when you wake up. You cannot gain, buy, beg, borrow, or steal any more spoons, not even by breathing fresh air. You can only spend them.

Given the mathematics of spoons, I don’t spend a single one that I don’t absolutely have to. Not going out? No shower. Have to go out for a loaf of bread or a drive-through meal? Wash up in the sink. If I need a shower between outings, my husband reminds me and facilitates by, for example, rummaging on the dryer for a clean towel and clean clothes or a clean nightshirt.

I need those spoons for doing my work at home in my smelly pajamas more than I do for the ordeal of showering.

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Mental Health

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Beating Bad Thoughts

I saw a meme today. It said:

“Just do what you can today, okay? It will be enough.”

Instantly my brain said, “No, it won’t.”

My brain, uncooperative at all but the very best times, has a habit of telling me bad things when I’m in a depressive episode: “You’re useless.” “You’re pathetic.” “Everything you do fails.”

For some reason, positive thinking memes and slogans bring out the worst in my brain. If a pass-along or a bumper sticker tells me that tomorrow will be brighter, my brain says, “No, it won’t.” If a meme says, ” I hope the situation you worry about favors you in the end,” it says, “Yeah, like that’s gonna happen.”

Is my brain simply cranky and uncooperative? Well, yes. But these intrusive thoughts reinforce and deepen my depression, chip away at what self-esteem I still have, deny my progress in healing, and make me resent the whole happy, smiley world that apparently everyone but me can see.

Is there anything I can do to make my brain shut up, or at least pipe down with all the negativity?

I’ll tell you what doesn’t work for me: daily affirmations. My brain tells me these are lies and that I shouldn’t believe them. I can’t look into a mirror and repeat five times, “I am a good, worthwhile person” or “I deserve happiness” or “I will overcome my problems.” It’s like the problem of seeing cheery, encouraging memes on the internet, only having to inflict them on myself. If anything, they make me feel worse.

If these sorts of things work for you, fine. I’ve no objection. I won’t make fun of you. I’m truly glad you’ve found something that helps you.

They just don’t work for me.

So what can I do?

I have gleaned two helpful hints from my therapist. Both are visualizations, and both are metaphors. And both involve animals. (They are variations on a technique called “thought stopping,” which is simpler and more direct. But I find visualizations easier to remember and do. I love metaphors.)

The first comes from a mindfulness meditation that Dr. B. asked me to try. I’m not much good at meditation, because of both my intrusive thoughts and my anxiety. Sitting still for that long is difficult, and so is emptying my mind of thoughts to concentrate on my breathing, for example.

The narration that guided the meditation had a solution for this. When your mind wanders and your thoughts drift off to somewhere else, think of them as puppies that wander away when you’re trying to teach them something. Gently corral them and nudge them back in the right direction. You don’t have to panic and shout, “There they go!” and run off after them. You just give them a little push toward where you want them to go. If they wander again, do the same thing. “What about the mortgage payment? Come back, little puppy. Over here.”

The other technique is for the kind of bad thoughts that I often get: anti-affirmations or negatives that deny any suggestion of peace or happiness or accomplishment. For these, Dr. B passed along an idea that another client had given her. Imagine that your bad thoughts are naughty cats, who jump on the kitchen table or try to go fishing in your aquarium. Then imagine spraying the bad thought (cat) with a bottle of water to make it stop what it’s doing and scram. “I never do anything right. Psssst! Psssst!”

When I’m profoundly depressed, I doubt even these clever dodges will work, though I’m certainly going to try them. But when I’m just starting on the slide down, I predict they’ll be just the thing to trick my brain into submission.

Take that, brain! Psssst! Psssst!

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Mental Health

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Bipolar Robbed Me of Reading

I don’t remember a time when I couldn’t read.

Except when bipolar disorder took it away from me.

I was what they call a “natural reader” – someone who learns to read without being taught. Someone who just picks it up out of the air. And for me, reading was like breathing. It kept me going, kept me alive. Reading was part and parcel of my identity. I was never without a book within reach. I read while eating, walking down the hall, going to sleep, riding in a car. (Fortunately, I didn’t get carsick.)

Throughout my undiagnosed childhood years, reading was a way for me and my brain to play nicely together. If I was depressed, I could lose myself in escapist fantasy. If I was hypomanic, I could soar on adventures. And during the in-between times, I had access to unlimited worlds – places, people, situations, ideas, conversations – both familiar and strangely new. Reading was my joy and my solace.

For many years, reading was therapeutic. I could not only lose myself and escape the unpleasantness of my disorder for a time, I could learn more about depression and bipolar disorder, compare my experiences with those of others who struggled with mental illness, discover how medicine and law and psychology and sociology could shine a light on my experiences. I could even (God help me!) read self-help books, which were popular at the time, and learn all sorts of theories and techniques that didn’t improve what was wrong with me.

Books and words were my life. I got degrees in English language and literature. I read for work and for fun. I edited magazines, wrote articles and (occasionally) children’s stories, and worked on textbooks.

Then my brain broke and reading went away.

I had a major depressive episode, which lasted literally years, and during that time I found it nearly impossible to read.

Why? My old companions, depression and hypomania.

Depression made me dull. I didn’t care about anything and found no happiness even in the books that had always been my refuge. I remember picking up a book that I more than loved and had returned to dozens of times, that had shaped my life in many ways, thinking that the familiar words would touch something still buried inside me. But this time there was no magic. Not even interest. The words were flat and dull, mere ink on the page or pixels on the screen. Reading – engaging with an author’s ideas, imagining characters, following plots and dialogue, discovering facts – was beyond me.

And hypomania? My version, instead of bringing euphoria, brought anxiety – an overwhelming twitchiness and fear of the unknown, jumping not just at shadows, but at the idea of shadows, things that had never happened. My attention span shrank to nearly nothing. I could barely read a few pages, not even a chapter, and when I was finally able to get back to a book, I was lost, disconnected.

Now that I have recovered from that episode, I am glad to say, I can read again. I read myself to sleep at night once again instead of crying myself to sleep. I devour entire chapters, keep at least two books going at once (one fiction, one nonfiction), delight in revisiting old favorites and seeking out new authors and genres (YA fiction and steampunk, recently) and topics. I’ve even picked up that beloved fantasy trilogy again and been swept away once more.

Not everything I read is uplifting. At the moment I’m deep into Cult Trip, a horrendous true account of an abusive sex cult in New Zealand. But I can tell when it’s getting too deep and frightening and switch over to Jasper Fforde’s Thursday Next literary fantasy Lost in a Good Book before the awful realities can drag me down.

And I can tell you this: It’s better to be lost in a good book than lost in your own broken brain.

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Mental Health

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Burnout Ahead

This was first published seven years ago. I’m glad to say that things are better now.

What do you get when you take two people, three doctors, eleven prescriptions, two pharmacies, and an insurance company?

No, wait – I’m not finished.

THEN add another person, two banks, a credit card company, a missing check, and a disputed charge.

Mix in bipolar disorder, clinical depression, and several months of previous stress.

What you get, first of all, is something that rhymes with fuster-cluck, and then a dangerous situation: Two people under pressure, neither of whom can function well enough to find any solutions, running out of psychotropics.

There is enormous inertia. You make a few calls, get a few responses. Fine, you think. That’s taken care of. Except that days later, it isn’t. There are overdraft notices, nearly exhausted supplies of psychotropics, and occasional fits of tears.

So you take another swing at it. More phone calls. More revolving phone trees. More dropped calls. More suggestions that you really need to get someone else to call someone other else to resolve it and here’s a handy 1-800 number that takes you to a department that never heard of you, your problem, or the companies you’re dealing with.

Yes, they all agree. It’s important that you don’t run out of your psychotropics. It would sure be nice if there were enough money in the account to pay the premium for the crappy insurance. It’s a mystery why no one has any record of the complaint you asked them to file.

Another day. Another no check. Another no drug delivery. By now we’re getting into mixed states: immobilizing depression and nail-biting, catastrophizing anxiety.

You look for possible work-arounds. Maybe the local pharmacy can sell you enough pills to tide you over. But, oopsie! Your bank balance just went from -$53 to -$82. And the insurance won’t pay for drugs at the local pharmacy anymore – only through mail order. Which brings us back to D’oh!

This is not hypothetical. This is happening.

What do we do now?

Well, we split up the tasks. I work on the drugs and insurance end, while my husband works on the banking problem. We both hover over the mailbox, waiting for the check.

We take turns with symptoms. Both of us having a meltdown at the same time is not pretty. I’ve seen it. Trust me on this.

We do all we can do and then stop. For the moment anyway. When the pitch of my voice starts rising to dog whistle range and I start sniffling and tearing up, I know I’m just moments away from becoming incoherent, which may demonstrate the need for the psychotropics, but is not actually any help in getting them.

We try to take care of ourselves. Dan can sleep (I can’t), so he does. He buys me comfort foods (fried rice, mashed potatoes). I decide that this may not be the best time to be reading a new, fast-paced zombie apocalypse thriller and switch to a familiar old standby character study.

There’s never a good time for these cosmic pile-ups to happen, but now is unusually bad. The last few months have brought assorted financial and medical troubles (the two being related, of course), plus the death of three elderly pets within a couple of weeks of each other. Dan is dealing with the fact that the house he grew up in is up for sale. I haven’t been getting as much work as usual. Soon, I will have to look into expanding my client base or finding another line of work.

After I get the drugs. And after they start to work. Whenever that is.

Sorry I don’t have anything encouraging or amusing or informative to share this week. That’s just the way it is sometimes. And now is one of those times.

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Mental Health

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What Bipolar Disorder Has Cost Me

black backgroundWe lose a lot when we live with bipolar disorder – function, memory, friends, and even family.

But we also lose something more tangible – money. Or at least I did, and I know that a number of others have experienced this as well. Here’s how it went for me.

Work. I quit my full-time office job (possibly in a fit of hypomania). I had a new boss and had told her about my disorder. Her only question was, “What will that mean?” My answer was, “Sometimes I’ll have good days and sometimes I’ll have bad days.” (It caught me by surprise, so I didn’t have a more coherent or accurate answer.) Immediately after that, I began receiving bad evaluations, which I never had before. Was my performance really declining? It probably was, as I was heading into a major depressive episode.

But I wasn’t out of work quite yet. For a while I worked freelance, and pretty successfully. Then my brain broke, and there I was – unemployed. I had savings in a 401K, and we ran through all of that. Then my husband had a depressive episode and we ran through his 401K as well. And the money we got from refinancing our house.

Disability. Sometime in that stretch of time, my husband realized that our money was going to run out. He asked me to file for disability. Many of you know that story. I was denied. I got a disability lawyer. By this time – years later – I was able to work freelance again a bit, and my lawyer told me shortly before my appeal hearing was scheduled that the hearing officer’s head would explode when he learned what my hourly rate was.

Never mind that I could work only a few hours a week – maybe five, in a good week.

Insurance. Then there was insurance. As a freelancer, of course, I didn’t have any. My husband’s good county job had covered us, until he became unemployed too. I’m sure a lot of you know that story as well. No insurance. Huge pharmacy bills, and psychiatrist and psychotherapist, and doctor visits and the odd trip to Urgent Care.

Meds. Then my doctor put me on a new drug which cost $800 a month. I got a couple of months free from the drug company – just enough to discover that it really worked for me and I didn’t want to give it up.

Then, with remarkable timing, the Affordable Care Act (aka Obamacare) came along and we were able to get insurance again. It wasn’t really affordable, though, costing only slightly less per month than the new drug. But it covered all our other prescriptions, too, so we came out a little ahead.

Budget. Since then, that’s the way it’s been going – month to month and disaster to disaster. My work is irregular and I never know how much I’ll get in any given month. My husband’s pay is steady, but meager – a little above minimum wage. We have managed to make our mortgage payments and keep the house, which my husband doubted we’d be able to do when I couldn’t work. I know in that respect, we’re way luckier than many families struggling with bipolar disorder.

Our latest disaster came this week, when our only remaining partially working vehicle (no reverse gear) blew out second gear as well. The money we had borrowed and put aside for major dental work that the insurance wouldn’t cover disappeared with a poof – and still wasn’t enough. We had to borrow more from an already fed-up relative. I don’t blame her. She never expected to have to keep bailing out her grown son and his wife when she herself was past retirement age.

Our Future. I don’t see anything changing. My mental disorder is under much better control, but I know I’ll never be able to work in a full-time 9–5 job again. Job opportunities are few for people our age anyway, despite anti-age-discrimination laws. And I’ve never tried applying for a job where I must ask for accommodations to offset my illness, but I’m sure employers find lots of reasons not to hire people who need those. Again, despite the laws.

So why am I telling you all this? Am I just whining and feeling sorry for myself? Well, yes, I am, but that’s not the point, really. Bipolar disorder takes a brutal toll on our emotional lives, our families, our relationships, and more. It can also put us on the brink of poverty, or in our case, one paycheck and one more disaster away from desperate straits. I know that there are bipolar sufferers, including some of my friends, in much worse straits.

It’s stressful.

And we all know how stress affects a person with bipolar disorder.

Badly.

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Who’s Crazy Now? A Guide to Gaslighting

“You’re crazy. I never said that.”

“That’s not the way it happened. You’re crazy.”

“No one believes you. You’re crazy.”

“You’re crazy. You’re just overreacting.”

What do these statements have in common? Obviously, they involve one person telling another that she or he is crazy.

More subtly, though, the speaker is saying that the other’s perceptions and feelings are invalid, untrue – wrong.

And that’s gaslighting.

Gaslighting describes a mind game that emotional abusers use to control their victims. (Gaslight is also an old movie, in which a husband uses the technique to try to convince his wife that she is insane. The victim of gaslighting is usually a woman and the perpetrator usually a man. Of course this is not always true. Either sex can be the gaslighter and either sex the gaslit.)

But what does gaslighting have to do with bipolar disorder? Someone who is in the depressive phase of bipolar – especially one who is undiagnosed – is especially susceptible to gaslighting. The very nature of depression leaves a person wondering, “Am I insane?” To have another person reinforcing that only strengthens the idea.

Back when I was undiagnosed and in the middle of a major depressive episode, I had an experience of being gaslit. My grasp on reality was not entirely firm at the time, both because of the depression and because I was physically, socially, and emotionally cut off from the outside world, family, and most friends. This isolation left the gaslighter, Rex, in a position of control.

I endured everyday denials of reality, like those mentioned above, but the most obvious one – the one that made me aware that I was being gaslit – happened when I suggested that we go for couples counseling. Rex asked if I was sure I wanted to, as he and the therapist could declare me a danger to myself and others and have me put away. That, of course, was not true and I knew it wasn’t, which gave me my first clue that something was amiss.

When we got to the sessions, Rex tenderly held my hand and spoke of how concerned he was about me and how much he wanted to help me get better. In other words, he was saying that I was the crazy one and that he wasn’t. That is the very basis of gaslighting – to make the other person seem or possibly even become crazy.

Once a person recognizes the gaslighting for what it is, she can begin learning to trust her own perceptions again. For a person in the grips of depression or mania, this will not be easy. I know it wasn’t for me.

It took a long time and a lot of healing before I could recognize what had happened, how my circumstances had been controlled, how my perceptions had been invalidated – how I had been gaslit. That was a vast revelation. It was like turning the tube of a kaleidoscope and seeing a different pattern come into focus. The elements that made up my life may have been the same, but the new perspective changed everything.

Having someone outside the situation who can validate your perceptions is an important tool in recovery. Sometimes a friend or family member can perform this function, but mental health professionals who have been trained in the process are often more successful. They are the people we often turn to to tell us that we are not crazy, that our feelings are valid, and that the mind game of gaslighting has affected us.

Getting help for the depression or bipolar disorder is also an important step in escaping the effects of gaslighting. With proper therapy and/or medication, a person’s thinking becomes more clear, accurate, and trusted. Turning off the gaslight is like turning on a different kind of light – one that illuminates your life, improves your clarity of vision, and begins to break through the gloom and despair.

And that light is more powerful than gaslight.

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Bipolars, Rollercoasters, and Sex

Wooden RollercoasterThe rollercoaster is the most common metaphor for bipolar disorder. But is it really the best one?

After all, a rollercoaster has long, abrupt downward swoops, and anticipatory highs. (At least the ones I’m familiar with. I won’t go on the ones that turn you completely upside-down. I understand the physics, but no. Just no.) Rollercoaster highs crank slowly, grindingly up. Mania isn’t like that. Boom! You’re suddenly at the top.

Nor are rollercoaster lows like the lows of depression. If they were, the downward slide would not be the exhilarating, thrilling part of the ride, and would not immediately be followed by another high. Instead, the rollercoaster would plod along through a lengthy trough, or maybe a tunnel (though not of love), with no idea of when the next up would come.

Perhaps a seesaw is a better metaphor. Its ups and downs are quick, and you can stay stuck in either position for an undetermined length of time. And a seesaw is all about balance.

But no. A seesaw requires a second person to operate correctly, and that is certainly not the experience of a bipolar person. Our brain chemistry or genetics or trauma alone is enough to get us going up and down.

A pogo stick? The spring gets squashed and then rebounds. But it’s a rhythmic bounce, not one that you don’t see coming until you’re in it. (If then.)

The basic problem with most of the usual metaphors is that they involve fun at some level. Bipolar is not fun. Oh, the mania may be enjoyable – for a time. But the gut-wrenching drop does not make you go whee!

So how about a soufflé? It can rise or fall, and you never quite know which it’s going to do.

Or a computer? It can open up the world, but is going to crash sometime, inevitably when you most need it to work.

I suppose we could split it up. Mania is a fountain and depression is a ditch. Depression is a b&w rabbit-ear TV and mania is streaming with 1000 services. Mania is a battery and depression is a dead battery.

The root of the problem is that no metaphor can adequately explain bipolar disorder. Even Spoon Theory, useful as it is, explains only the effects, not how the disorder itself works. A metaphor may capture one half of the experience – the ups or the downs – but not the reality of both.

If it’s not possible to explain bipolar disorder with a metaphor, why do we so often try to? Because, really, only people with bipolar know what it is like, and the experience even differs from person to person. A psychologist or psychiatrist may understand the mechanisms and the causes and the complications and the medications. But she or he is essentially watching from the outside.

My husband didn’t really “get” depression until he fell into depression himself which lasted a couple of weeks. “Now,” I said, “try to imagine that feeling lasting for months.” He couldn’t, but at least he was closer to understanding.

My mother-in-law, who doesn’t “believe in” mental illness, now has a clue too, since she experienced a profound reactive depression.

Neither of them really “gets” mania.

Maybe the best metaphor is that bipolar disorder is like sex. You can’t adequately explain it to someone who’s never had it. And even when you’ve had either sex or bipolar disorder, you only know what it’s like for you. You can generalize your experience and share commonalities, but basically, every case of bipolar is something a person goes through alone, or maybe alone together, as Jenny Lawson says.

Bipolar disorder.

It is what it is.

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