Bipolar 2 From Inside and Out

Posts tagged ‘depression’

How I Learned I’m Not “Pathetic”

When I first went to my therapist, I often described my life and myself as “pathetic.” Slowly, as I made progress, I stopped doing that. It was a revelation that took some time to sink in. Here are some of the things my therapist said and did to help me overcome this harmful description of myself and my bipolar disorder.

Refusing to accept my description. This may seem like an obvious thing, but it had real meaning for me. I had been majorly depressed for approximately three years and bipolar as long as I could remember. I couldn’t do anything – get out of bed, shower, feed myself or the cats, or perform the tasks of daily living. (My husband picked up the slack. Thank God for him.) My therapist never said in so many words, “You’re not pathetic” or “Your thinking is wrong.” She just patiently spent the time with me and gave me tools I could use to get better.

You’d think I would take this as denying my perception of reality, which I ordinarily hate when anyone tries it. But this time, I welcomed it. It was nice at that point to have someone denying my perception because Dr. B.’s perception was so much more appealing than mine. It gave me something to shoot for – a time when I would no longer feel that “pathetic” was an apt description. She also let me cry it out, which I often did when I was feeling particularly pathetic.

Baby steps. (Also known as “Eat the elephant one bite at a time.”) My healing was slow, thousands of baby steps of accomplishing more and more. Because my therapist never gave up, neither did I. Baby steps take you only so far at a time – after all, they’re tiny. But over time, they add up to a measurable distance. As I slowly moved away from my “pathetic” label, I also moved away from feeling pathetic. Eventually, I was able to eat, if not the whole elephant, at least a larger portion of it through slow but steady progress.

Not that I didn’t sometimes backslide. Whenever I hit another depressive episode, my feeling of pathetic-ness came roaring back. It was only as I learned that some other feeling was possible that I was able to catch a glimpse of a time when pathetic might no longer describe me.

Saying, “Look how far you’ve come.” This is something that my therapist kept reminding me. Dr. B. noted that I was becoming able to get out of bed to come to her office. She would bring up the tools that I had acquired or developed to help myself leave the bad old days largely in the past. She would also point out that I not only remembered those tools, I was using them.

Sticking with me. Dr. B. was also there when I backslid. A couple of times I had made so much progress that I thought I was able to go it alone. But, sooner or later, I would need a “booster shot” of work with her to remind me of the things that I really already knew. When I was feeling too low to make it into the office, we would have phone sessions. When COVID hit and in-person visits became even more difficult or impossible to arrange, we began having videoconference sessions. Slowly, I worked up from every week to once every two weeks to once every three weeks – and am now meeting with her only once a month.

And, let me tell you, it feels great not to feel pathetic anymore.


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The Difference a Diagnosis Makes

I thought I had depression and that’s what I was first diagnosed with. Later, I learned that I really had bipolar disorder, type 2, with an anxiety disorder on top of it. Here’s what I learned on my journey to a proper diagnosis.

Understanding. Once I was diagnosed with bipolar disorder, a lot of things from my life started making more sense. I finally realized that some of the inane things I thought and did as a child/teen were attributable to hypomania. Being idiotically happy when I won a goldfish at a carnival, carrying it before me, grinning like a loon. Near-constant mirth when I read a novel parody, laughing long and loudly every time someone used a word or phrase that reminded me of it. Luckily, I didn’t have any money to spend, or I would have done that too, based on my later behavior. Even things I did as an adult before my proper diagnosis made more sense – flight of ideas, pressured speech, and the like.

Second opinion. Going to a different psychiatrist and finally getting the right diagnosis was, in many ways, like getting a second opinion. We don’t often hesitate to get a second opinion on matters concerning our physical health (and insurance companies may require it). Why is it different when it comes to our mental health? I’m not saying that doctor-shopping is a good idea or that a diagnosis of depression did me no good at all. It just took a different psychiatrist to put together all my symptoms in a way that made sense to me as well as to him.

The “Aha Moment.” When I got my bipolar diagnosis, it was like a wake-up call. I instantly understood that my psychiatrist was right. Once I had that insight, I was able to explore my actual disorder in various ways – further sessions with him and with my psychotherapist, reading books and reliable online sources, sharing with other people who have the same diagnosis and listening to their experiences.

Getting the right meds. I had been taking medications for depression for many years. Then I learned that I might – did – need treatment with anti-anxiety medications, mood levelers, and other kinds of drugs that specifically targeted bipolar symptoms. I still needed meds for depression, but I needed a “cocktail” of drugs that addressed all my difficulties, not just one.

Going on maintenance meds. The process of settling on that cocktail of meds took a long and difficult time, but once I had the right diagnosis and the right meds, I was able to cut back to seeing a psychiatrist four times a year to get renewals on my “maintenance” medications. The process that stabilized me also allowed me and my doctor to make “tweaks” to the dosages to correspond with increased or lessened symptoms.

A new revelation. My learning about my disorder didn’t stop with my new diagnosis. Recently I learned that my depression could be what is called “dysthymia,” a type of depression that is roughly equivalent to the difference between mania and hypomania in bipolar 2. I wasn’t sure this applied to me, as my depressive episodes seemed long enough and severe enough to be considered major depression, but after consulting my therapist and other reliable sources, I began to see how a dysthymia diagnosis actually did correspond to my symptoms.

Having hope. The most important thing that the right diagnosis gave me was hope. Properly understanding my disorder and the correct treatments for it allowed me to hope that I could achieve stability and healing from all the years when I didn’t realize I was suffering from hypomania as well as depression. I could at last look forward to a life where my disorder didn’t control me. With help from my psychiatrist and the medications he prescribed, I have been able to live a contented and productive life. Work, stable relationships, and the other benefits of having proper treatment are achievable – and I have largely achieved my goals in life.

And my new diagnosis has been responsible for it.

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COVID News and Mental Health

Many people have been blaming COVID for depression and other mental health problems. They have said that quarantining and uncertainty have raised the level of anxiety in the general population, and quarantining has caused depression. These increased levels may be – probably are – accurately reported, but I don’t think they necessarily indicate an increase in the incidence of mental illness in our society.

The depression and anxiety that people are feeling are, I believe, natural and expected reactions to the pandemic conditions that prevail. I’m not trying to minimize these experiences, but most people have never experienced clinical depression or anxiety and so don’t understand the nature of the actual illnesses. What depression and anxiety the pandemic has caused is likely to clear up when (if) the pandemic does. This is situational depression and anxiety.

This is not to say that people experiencing pandemic-related depression and anxiety don’t need help. Of course they do. “Talk therapy” may do them a lot of good, and there has been an upswing in the number of online and virtual counseling services available. Whether these people need antidepressants and anti-anxiety meds is a question I’m not able to answer. My best guess is that they don’t, at least not long-term courses of drug treatment, as their symptoms are probably not indicative of mental illness. Short-term anti-anxiety meds may do some good.

I do think that the pandemic and the reactions to it have been triggering for many people who do have mental health conditions. People with OCD who are germophobic saw their most extreme fears become reality. People who have Seasonal Affective Disorder may have suffered more from lack of sunlight during the stay-at-home orders and quarantines.

Many people are in extreme denial, believing that the pandemic is a hoax and refusing to take any steps to prevent its spread. Is this a symptom of mental illness? I don’t see how threatening officials and doctors who promote pandemic precautions is a sign of mental health, but are the people who do this delusional or are they merely at one extreme end of the anxiety spectrum?

I understand that people’s perceptions of reality differ, but it annoys me when people deny mine, which currently is made up of snot and phlegm, as well as depression and anxiety. We can have these academic debates, but for my husband and me, at least, the pandemic has pushed us from believing that it is “out there” to realizing that it’s in here, in the most literal and alarming sense.

My husband has tested positive for COVID, and I have a terrible sore throat and cough, so I likely have it too. We’re resting and taking Coricidin until we hear from our doctors what to do. A dear friend has sent us a pulse oximeter, with instructions to get more help if our O-sats fall below 90.

All this is messing with my head. I was entering a depressive phase anyway. Now I’m not sure if it was due to my bipolar disorder or my immune system crapping out. (Just FYI, my husband and I are both triple-vaxxed. He probably got the virus at work and undoubtedly passed it on to me. I can’t imagine I would test negative now.)

I don’t think our illness is life-threatening, though honestly, it could be. You never know with COVID. And now, that’s part of my reality.

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Releasing Old Ghosts

I don’t know what the proper term is (exorcise? banish? reject?), probably because I don’t believe in ghosts. What I do believe in are memories – persons and situations that haunt you, follow you, and inhabit your dreams.

I’ve had my share, especially of the dreams sort.

When I first got out of a truly destructive relationship, I was undiagnosed with bipolar disorder, medicated with valium (prescribed for temporomandibular joint syndrome) and self-medicated with wine. I was not in good shape.

For a long while, anything associated with that harrowing relationship, I shunned. Rex had like blue spruce trees. I avoided them. He had collected cobalt blue glassware. I could barely stand to look at them. He gave me heart-shaped boxes as gifts. I threw away every one I had, even the ones that were actually pretty and useful. He shamed me for my cooking. I gave it up. I gave up things I enjoyed, things that had been part of me. And I didn’t allow myself to explore things that Rex once loved.

He haunted me. I would have dreams in which I was going to meet him, where I was in a place I knew he might show up. I dreamed I was in his house, with cheerful parties going on around me as I panicked. I would have flashbacks to cruel things he had said, such as an obscene song he had written “in my honor.” Times when he said I had “betrayed his honor” for something as simple as cooking the wrong dish for a gathering. Plenty of others.

Now, it seems, the dreams have faded. I have reclaimed parts of my life I used to enjoy. I have banished things that were only his obsessions. The flashbacks are nearly gone.

What has helped me banish these destructive ghosts?

Time, of course, though you’d be surprised how many years it took. And it was gradual. He didn’t vanish from my brain like a puff of smoke. At times I still remembered music in particular – festivals and concerts we had been to together, the obscene song. (As I write this, they come bubbling up again.)

People. A few even from the time that the relationship was going on, who have helped me realize that I should not have been there, that I should not have gone through what I did, that I should have left sooner. I treasure these people. They saw me at my worst, knew me as I was recovering, and are still my friends today.

Other people – friends I had from long before Rex – have steadfastly remained in or reappeared in my life. I may have been bipolar and undiagnosed when I knew them, but these people stood by me, put up with my mood swings and odd behaviors. They have been part of my support system. And new friends, who have no association with those times, but who have had similar feelings and experiences.

Psychiatrists and therapists – also important parts of my support system for all these years. Ones who diagnosed my illness and medicated me properly so that I could deal with the issues that remained. Ones who helped me realize that I had some good memories from those times, that I could rebuild myself by retaining anything that I liked, that I had tools and techniques that I could develop and use to help me do that. I had done bargello needlework for Rex. I switched to cross-stitch. He called the kind of music I liked shit. I delved even further into it, reveled in it. Having developed a love of cats when I lived with him, I’ve never been without one again.

Love. One of the people I met during the next-to-last weekend of my time with Rex is now my husband. He has been with me through the dreams, the flashbacks, and the memories and has been the mainstay of my support system. And there are other people I love, and who have loved me back.

It seems strange that I was with Rex only a little over a year and it has taken me decades to work to this point where the memories have faded, the ghosts no longer haunt me, when it all seems like simply a bad time that has receded into, if not oblivion, at least only a clog that has slowly been removed from my psychological plumbing.

Now I know the right word. It’s time to flush those ghosts that plug up our mental and emotional systems.

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No, I’m Not Taking Bipolar Passively

It may look like I’m taking my disorder passively. I stay in bed a lot. I seldom leave my house. It’s true I don’t exercise or go out with friends or hike in the woods or volunteer at a charity or arrange spa days for myself or sleep under a weighted blanket. Those may be good, proactive things that people can do in terms of elevating mood and practicing self-care. But I don’t do any of those.

I do all the “required” things, like visiting my psychiatrist regularly and taking all my meds faithfully. But when it comes to more active practices, I fall far short of the “ideal.”

It may look like I’m passive, but in reality, fighting bipolar disorder is a constant struggle for me. It just mostly happens inside my head.

First, there’s tracking my moods. This takes an active awareness of my behaviors and what they may be telling me about my moods. If I find myself spending more money than usual, I may realize I’m drifting into hypomania. If I can’t laugh at jokes anymore, I may be headed towards depression. If I receive an unexpected bill and start to feel overwhelmed, I may be in line for an anxiety attack.

Even activities that seem ultimately passive or ordinary may require positive activity for me. Answering a phone call may take a lot of effort, even if I know it’s a friend calling. Going to the grocery, as mundane an activity as possible, can take a lot of effort on my part – getting out of bed, getting showered and dressed, going out of the house, choosing from the many options at the grocery, carrying my purchases indoors. These are actions that may not seem related to my mental health, but are. And I must struggle internally with doing them. It takes up psychic energy, not just physical.

And what about seeing my psychiatrist and taking my meds? These, though they may seem minimal, are not passive actions either. As with grocery shopping, I must convince myself – even force myself – to keep track of my appointments and show up at them bathed and clothed. I must monitor how much of my meds I have left and pick up refills. (Or order home delivery for meds and groceries, if possible.)

When even the smallest efforts seem to take too much, well, effort, trying to accomplish them is at heart a mental battle – to think of what needs doing, convince myself I need to do it, plan for it, prepare myself to do it, attempt to do it, and, if I fail, try again later.

Lying in bed may seem the ultimate in passivity, but there can be a constant, very real struggle going on. On one hand, there’s trying to get to sleep and stay asleep. On the other hand is the struggle to get out of bed and do something – anything. Even if my struggles aren’t successful, that doesn’t mean that I am passive. They can be exhausting (though not enough to sleep). They can require tremendous mental effort, which is sometimes more difficult than the active kind for a person with a mental disorder.

So, no, I am not taking bipolar passively. I am fighting to get through it, to conquer it, to keep it at bay, to not let it win. Giving up would be the ultimate passivity, and I’m not going to allow myself to do that. I will continue struggling with my disorder as best I can, determined to do all I can to meet it actively, with intention, and with repeated efforts if necessary. And not beating myself up when I find myself being reactive rather than proactive. It’s important for me to remember that I’m doing the best I can with what I have. And that I dare not be truly passive when it comes to my mental disorder, lest it take over again.

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The Time I Was (Sort of) Hospitalized

When I was a teenager, being hospitalized for mental illness was a big joke. The local facility was located on a street called Wayne Ave. Wayne Ave., despite whatever else was located there (a pizza restaurant, I think), was shorthand for “crazy.” (This was no doubt an annoyance to people who actually lived on Wayne Ave., of which there were many. Now the former mental facility is a Hospice.) I knew by then that I was mentally unbalanced, but it never occurred to me that I would end up in Wayne Ave. It was an address used only to tease other kids, which was uncomfortable enough.

By the time I got to college, I was aware that I was in trouble, mentally. I had turned down the offer to see the school district psychologist in high school, delusionally afraid that it would show up in my permanent record and prevent me from getting into a good (or any) university.

I did, however, get into a very good university. (No idea if they took my lack of mental health treatment into consideration.) But by this time I was really suffering mentally and emotionally. I tried at least one therapy group, but was able to breeze through it without making any notable progress, thanks to my ability to “act normal” for an hour at a time.

Still, I figured it was just a matter of time until my mental disorders manifested themselves sufficiently to be generally noticed. Maybe even noticed enough to be diagnosed. And I was waxing delusional. I felt sure that at some point in my life I would be hospitalized for my illness. I just wanted to make it through college and work at a paying job for at least two years, if I could, in hopes of getting Social Security. (I said I was delusional.)

Along the way, though, I was (sort of) hospitalized for mental illness. I say “sort of,” because I went to the university clinic, a small facility with about a dozen beds, most of them used for students with flu and the like. (There was a sort of witticism going around campus: It’s a short trip from Willard Straight (the student union building) to Willard State (the nearest psychiatric facility). Again, going to a psychiatric facility was considered a joke.)

I was nearing the end of a disastrous relationship, self-injuring, self-medicating, and vaguely suicidal. I checked in to the campus clinic. I don’t remember much of it, my brain obviously not working too well at the time. I had to tell them I wasn’t really suicidal, or else they would have called my parents, which I definitely didn’t want.

I do remember a nurse who would look in on me as I lay in bed crying. I don’t remember what if any treatment they prescribed. In my memory, mostly they just let me cry.

One very peculiar thing happened, though. The man of the disastrous relationship “checked me out” for an evening (much as you would check out a library book) to go to a dinner with someone in editing or publishing that he thought might help me get that coveted job after college. I don’t remember the dinner being a hit, and of course no job ever came from it. Then I was checked back into the clinic for a few more days of crying. I don’t remember how long I stayed or why I was finally released. It was altogether a peculiar experience, and the gaps in my memory have swallowed most of it.

I don’t think it actually helped me at all, other than to confirm to me that I was indeed ill, with some kind of mental disorder, and to reinforce my delusions. It also, I think, hastened the dissolution of that relationship, which proved to be a good thing in the long run. Was it all a ploy by the boyfriend to establish that I was the “sick one” for the purposes of couples counseling, which I had convinced him to try at one point? I’ll never know.

But since that time, I have never been hospitalized for my bipolar disorder. I have been properly diagnosed and treated. I now take psychotropic meds faithfully and see a therapist. I have been working for decades (except during a major depressive episode, when I learned how hard indeed it is to get Social Security for a psychiatric disability).

I suspect my hospitalization was far from typical. After all, it was dozens of years ago and not in a dedicated mental hospital or ward. I can’t say whether it helped me or not. But it’s an experience I never want to repeat – and, at last, something I never expect to endure again.

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What Is Bipolar Disorder Like?

There are a number of metaphors that try to express what it’s like to have bipolar disorder, and none of them is accurate. Thanks to television commercials for bipolar medications, we have even more metaphors, none of which express the reality of the disorder. Maybe, at heart, it is futile to try to come up with a metaphor. The map is never the territory. But let’s examine some of the most common and see where they succeed and where they fail.

Depression

The Black Dog

Winston Churchill was notoriously given to episodes of depression, and he referred to them as “The Black Dog.” It would come and go, but when it was with him, he descended into the depths. (Of course, this did not prevent him from becoming Prime Minister of England and making significant policy decisions and speeches during World War II.)

Dementors

J.K. Rowling has said that the soul-sucking monsters that appeared in the Harry Potter books were metaphors for depression, being able to remove not only joy and happiness from a person’s soul, but the memories of those emotions, and the possibility of ever feeling them again. (Incidentally, once out of the Dementors’ grasp, chocolate is said to help the person recover.)

Masks

This one is popular in TV commercials. A woman (almost always a woman) holds a smiley-face mask in front of her face to cover up her sad expression. Then, after she takes psychotropic medication, she puts the mask in her purse or pocket and suddenly reveals her own smiling face. Or a stock photo shows one person with a brown paper bag over his or her head with a sad face drawn on with marker. This bothers me because it implies that medication takes effect almost immediately, but I suppose there’s no way to show the six-week lag in TV ads.

Fog

The underlying metaphor here is being lost and being unable to find your way out. Everything around you is gray (and most likely rainy) and indistinguishable. It’s difficult to impossible to find your way through. This is actually a fairly accurate metaphor for severe depression or a major depressive episode. The sense of futility, of immobilization or being lost, of being unable to see a way out, is common to people with depression.

Anxiety

Skin

One of the most common sensations reported by people with anxiety is being about to jump out of their skin, or feeling itchy or twitchy all over. The itchiness or twitchiness may manifest in actual physical symptoms, in which case they’re a perception, not a metaphor anymore.

Electricity

The feeling of shocks running through the body or the brain is another way we describe anxiety. It can feel like jolts of current that only add to the twitchiness or agitation.

Indecision

Sometimes the paralyzing side of anxiety is represented by having too many choices or being unable to decipher a map. Instead of being agitated, the person is stymied and motionless. Make no mistake, this is a symptom of anxiety as much as it is one of depression.

Mania

House of cards

This metaphor comes to us thanks to a TV commercial. A person suffering from mania confronts a pyramid made of playing cards, climbs it, and keeps climbing until there are only a few cards left, with the idea that they will ultimately tumble. There’s no indication, though, that the person with mania built the pyramid of cards themselves, and the medication kicks in before the stack ever falls.

Soaring

The feeling of flying is often associated with mania. Soaring far above the mundane and the insignificant, the person with mania feels a sense of grandeur and empowerment, the ability to do anything – and to sustain it. Of course, sustaining the feeling never quite happens. Persons flying high with mania never see the inevitable crash that is coming.

Bipolar Disorder

Playground equipment

The seesaw. The teeter-totter. Even the swings. These metaphors certainly catch the up-and-down, back-and-forth motion of bipolar cycles. There are just two things wrong with these metaphors: They portray movements of equal length. And they’re fun. Bipolar moods do not come on a schedule or last a predictable amount of time. And there’s nothing fun about bipolar disorder.

Rollercoaster

A rollercoaster is perhaps the most common metaphor for bipolar disorder. It improves on the playground equipment analogy some. A rollercoaster, like bipolar, can be scary, especially the first time you experience it. It does involve up and down motions of unequal length. But the rollercoaster has the process backward. The climb up is slow, not an exhilarating whoosh. The swift ride to the bottom is the exciting part, which of course it isn’t. And, of course, once you’ve been through the whole route once, you have to get off and pay to get on again.

We use these metaphors because it’s almost impossible to convey what bipolar disorder is like to someone who’s never experienced it. And they can never convey the reality. Among those of us who have experienced the disorder, we use them as shorthand to describe the feelings we share, at least to some degree, with one another and with others, in hopes that they’ll “get it,” even just a bit.

But language has its limits, especially when it comes to describing what’s going on with our brains and emotions. Sometimes metaphors are as close as we can get.

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Following My Moods

When I was a teen and undiagnosed with bipolar disorder, I had a weird reaction to people around me – I would pick up their moods and personalities and found myself mimicking them. I suppose it was a way for me to try on other personalities that I might someday integrate into my own, when I was stable enough to do so.

When I was a little older, I began journaling, which quickly turned into blogging. My journals were repetitive and boring, consisting mostly of “Felt depressed. Went to post office.” It didn’t seem helpful to me, though I know journaling is helpful to a lot of people. It helps them express what is happening to them and how they feel about it. In that way, it’s like a diary. Going back over a journal after, say, a year or so of writing (not necessarily every day) can help a person track their moods and their triggers. People can note their physical surroundings and emotional response and note whether seasons or weather, food and drink, interactions with certain persons, or other life circumstances have an effect on their moods and can help identify events that bring on depression or mania.

There are variations of this. One friend of mine used Facebook as his “diary.” He would look back through a year of his posts and conversations to determine when depression had struck him (there were fewer posts during those time periods).

In my own case, my husband and I have noticed that our moods follow each other’s. When I am depressed for a few weeks, he becomes depressed, too. When I am hypomanic, his mood lifts and he finds more joy in his own life. We do things together, like baking or watching our favorite TV shows together or going for day-long or even weekend getaways.

The same is true the other way around. When Dan is depressed or angry or just plain surly, I find it extremely difficult to maintain even a level mood. His mood creeps in and takes over mine. I sometimes try to maintain a level mood when this happens, but it is very difficult. I find myself struggling not to lose whatever peace or joy I have. I find myself frustrated by his depression or annoyance, to the point where I want to tell him to snap out of it. (I try not to do this. It doesn’t help anyway.)

If we both hit lows at the same time, or experience anger simultaneously, it gets fairly ugly. That’s when we fight, or both retreat to our rooms, or spend time away from each other, indulging in our own pursuits. Admittedly, such contemporaneous moods don’t hit very often, but when they do, it’s hell.

Both of us have learned techniques to respond to these “following” or simultaneous moods. We generally need more space or alone time. We ask each other for what we need and if the other is able to give it (hugs, for example). We offer what we are able to do, if there is indeed anything we realize might help.

Mostly, though, we just wait for the moods to pass and for both of us to return to a level state. I continue taking my meds and writing my blogs.

Interestingly, it was my husband who first noticed these “following” moods. Over the years, he has become pretty perceptive about both our feelings. It may help that he has studied and even worked in psychological settings for a while (no, that’s not where we met), but I think his real education has been living with me for almost 40 years. In all that time, you begin to notice patterns.

At one time my blogs did record my day-to-day (or week-to-week) feelings and actions. Sometimes they still do. But anymore, I find myself exploring other aspects of bipolar disorder and mental illness in general. I don’t believe I’ve said all there is to say about my feelings and symptoms, but this blog has allowed me to stretch out and consider the wider world of mental health.

Apparently, my husband is getting better at it too.

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Another Kind of Depression – Dysthymia

Of all the types of depression that get discussed – major depressive disorder, exogenous depression, endogenous depression, bipolar depression – there’s one type that isn’t talked about very often: dysthymia. The word comes from Greek, where it is made up of dys (bad or ill) and thymia (mind or emotions). But in clinical terms, dysthymia has a more exact meaning than “ill humor” or “bad mood.” I had always assumed that it came along a scale of severity that ranged from major depression through dysthymia to stability to hypomania to mania. It could be that I was mistaken.

Johns Hopkins Medical has this to say: “Dysthymia is a milder, but long-lasting form of depression. It’s also called persistent depressive disorder. People with this condition may also have bouts of major depression at times.” So, it’s milder, but long-lasting, persistent, and may occur in people with major depression. Not very specific, is it?

Johns Hopkins also notes that to diagnose dysthymia, “an adult must have a depressed mood for at least 2 years (or one year in children and adolescents).” The Mayo Clinic also refers to it as “Pervasive Depressive Disorder.”

Dysthymia seems like a “squishy” diagnosis, as the signs and symptoms overlap so greatly with major depressive disorder.

Garden-variety depression or “Major Depressive Disorder,” again according to the Mayo Clinic, “affects how you feel, think and behave and can lead to a variety of emotional and physical problems. You may have trouble doing normal day-to-day activities, and sometimes you may feel as if life isn’t worth living.” The risk factors and symptoms of the two disorders are virtually the same.

However, major depressive disorder, according to multiple sources, must last around two weeks, while dysthymia lasts for two years or more. Personally, I can’t see how this is called “milder.” Alternating between the two conditions is sometimes referred to as “double depression.”

I have thought of dysthymia as milder, and perhaps it is what I have now that my depression is pretty well controlled by medication and therapy. I no longer have extreme symptoms such as the self-harm and suicidal ideation.

Then again, one of my major depressive episodes lasted three years or more, with no visible letup. Was that relatively mild? It sure as hell didn’t feel like it.

Perhaps it doesn’t matter what you call it. The experience of the disorder seems to me more important than the label put on it. I haven’t looked the conditions up in the DSM (I don’t have a copy). But all my life I have been diagnosed with depression or major depression (before my diagnosis was changed to bipolar type 2 with anxiety, and it seems pointless now to call myself dysthymic. Maybe I’ll ask my psychotherapist when I see her next week if she can shed any light on this confusing nomenclature. Maybe she’ll have a handle on which of these I technically have.

However you want to name it or frame it, though, I have – and probably have had since I was a child – some version of the disorder, and have applied the treatments for it (meds and therapy for both), and now experience occasional episodes of the “milder” version, though they certainly don’t last two years.

In a way, I wish the various authorities would make up their minds and quit changing the labels. In another way, I don’t care what the labels are (unless they affect insurance companies and what treatments they allow). I experience this disorder in the way that I experience it. Most of the time I simply call it depression, and I don’t see how it helps to subdivide it. When I hit rock bottom, I call it a major depressive episode. When I’m relatively stable, I call it “in remission.” These may not be the technically correct terms, but they’re what make sense to me.

I don’t know whether other people with bipolar disorder make these fine distinctions, or simply think of their shifting moods as lows and highs, depression and hypomania or mania, or whatever.

But do we really need more labels? Isn’t lived experience good enough? Does the definition affect how our doctors treat us? Are there going to be more subdivisions in the future (a trend which seems particularly rampant right now, as with autism, Asperger’s, high-functioning, low-functioning, and more and more variations)? Does what we call it really help anyone get better?

Maybe I’m wrong here, but I don’t think so.

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Coming Down From a Manic Jag

I have been manicky lately, and it has expressed itself, as it does for so many people, with spending money we don’t have. Or at least spending money we’re supposed to be getting but don’t have yet on things which we can’t afford until we get it.

The thing is, we have a nice lump sum of money coming, but we don’t know when it will arrive. And instead of sensibly waiting for it to arrive, I have already begun spending it. A new-old truck for Dan; passport applications for us both; tattoos for us both; concert tickets; clothes and maps and guidebooks and airline tickets for a trip we plan to take next year; a short getaway vacation last week; gardening and home improvement supplies. Just to name a few.

All this leaves us very little for necessities like mortgage, electricity, internet (essential for my work), and even food. We can probably live on our credit card for a while, but I know that’s only a temporary solution, and a bad solution at that, even though the credit company increased my credit limit so we could pay for the airline tickets.

Of course, I am mostly responsible for all this spending. Some of the expenditures wouldn’t wait – the airline tickets, which we had to buy immediately to lock in the current price, and the passports, which I understand can take months to arrive and we shouldn’t wait till the last minute to apply for.

But for other purchases, Dan has been enabling me – “You know you want to go hear Emmylou Harris,” for example. “She’s one of your heroes.” “Might as well get the ticket for Rodney Crowell, too. How likely is it that he’ll be playing in this area again, at least anytime soon?”

Now the proverbial chickens are coming home to roost. Last week I had to deal with a guy at the door who was there to shut off our electricity unless I gave him a check for the past-due balance on the spot. The credit card company may come to regret the limit increase. I’m sure they gave it to me because I regularly paid them more than the amount due, and I can’t do that anymore.

I realize this is relatively minor compared to some spending jags that people in the manic phase of bipolar have gone on – gambling debts, for example, and even ones that end in homelessness. But the spending adds up, and we are strained past our limit until that windfall finally arrives.

Naturally, because that’s the way things go, now that I have come to and realized the reckless spending, it has triggered my anxiety. Financial troubles have always been one of my triggers, but it’s appalling to realize that I have dug this hole myself.

And naturally, because that’s the way things go, that anxiety triggers my depression – maybe not a full-blown depressive episode, but enough to affect my life and actions. I isolate. I grow surly with my husband. I have trouble sleeping or sleep too much.

In truth, I am angry with myself and with this damned disorder. When I get manicky, I generally am able to limit my spending to amounts of $25 or less, if sometimes for several such items (or meals). But this time I have overwhelmed myself, and my husband as well. I know we’re not supposed to use bipolar disorder as an excuse for bad behavior, but I can’t help thinking that hypomania is involved at some level. The idea of live music and foreign travel were just so irresistible. I couldn’t make myself wait until a better time.

We’ll get through this, I know. Someday the expected check will come and I can start straightening out some of the mess I’ve created. But until then, anxiety and depression will be my companions. I hope the mania stays fully tamped down until then. At least, I’ll take my meds and hope so. And not skip my therapist appointment in a week and a half. We haven’t had much to discuss lately, but now I’m sure we do.

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