Bipolar 2 From Inside and Out

Posts tagged ‘mental health’

Reminders for New Year’s (and Beyond)

I’m not big on New Year’s resolutions. I can barely plan my day, let alone the whole year. And I’m also not big on making commitments I know I can’t or won’t keep.

Instead, I remind myself of certain behaviors I think I (maybe) can accomplish and refer to the list as often as needed. Here are a few suggestions that may be appropriate reminders for you as well.

You don’t have to drink alcohol at New Year’s Eve parties. Or ever, really. No one should try to pressure you into doing this, but if they do, simply saying, “No thanks,” should be enough. If the person is really pushy, you may have to ask, “Do you have soda or fruit juice?” You are not required to explain why you don’t want to drink alcohol, and you may want to forego attending parties that do not have such non-alcoholic alternatives in the future. You don’t have to attend parties at all, and “No, I can’t make it” is a perfectly reasonable response to an invitation. Or “Maybe next year.”

You don’t have to make New Year’s resolutions per se. You can have New Year’s intentions, small goals you don’t have to announce to the world at large and that you don’t have to beat yourself up over if you don’t fulfill them. Instead of resolving to jog every day, intend to get out of doors once a week, even if it’s only to walk to the mailbox and back. Baby steps, after all.

I hate to use the word “should,” but you should keep track of your medications, reorder them if they’re getting low, and see your prescribing physician if the scripts are about to run out. That’s just common sense that’s necessary for your mental health, not a resolution. These days, you may even be able to arrange to have meds delivered.

Try to engage in a hobby once in a while. Say, once a month. It honestly doesn’t matter what the hobby is. Read a book, or even a short story or magazine article. Knit or crochet. Repot a plant. Water a plant. Do a crossword puzzle. Bake your favorite cookies, then eat them all yourself if you want to.

Keep comfort objects nearby. These can be anything that soothes you. A music playlist. A stuffed animal. A scented candle. A cozy blanket or sweater. A favorite warm beverage like cocoa or green tea. Don’t be embarrassed about using them to ground yourself. Most neurotypical people won’t even notice if you’re wearing a favorite sweater or have a scented candle lit.

You can connect with people online. This counts as interacting with people. Say happy birthday. Forward a funny meme. You don’t have to make it specific to your condition, but there are plenty of people on Facebook, for example, who have bipolar disorder or PTSD or an autoimmune disorder. You don’t even have to interact with them. You can join a group, then just sit back and see what others post there.

Avoid triggers, if you can. That judgmental aunt. Your creepy cousin. Your boastful neighbor. Again, you have the right to say no and not explain why. (It’s the not explaining that’s the hardest.) Don’t watch movies that you find upsetting, whether it’s Die Hard or Rudolph the Red-Nosed Reindeer (which many people don’t like because of the implicit bullying).

Write about how you feel, if you want to. It could be a mood journal, a regular journal, a letter that you will never mail, a poem. Don’t feel that you have to show it to anyone. Tear it up afterward, if you want to.

You don’t have to face the new year as a whole. If you must have resolutions, resolve to get through the next week or even the next day.

Make an appointment with your therapist. Many therapists are offering tele-visits these days, so it’s easier than ever just to touch base or to work through a problem, a trigger, or feeling overwhelmed.

In other words, do whatever you can to get you through the next day, week, month, or season. The year will take care of itself, whether you make resolutions or not.

One-Time
Monthly
Yearly

Tip Jar

Make a monthly donation

Make a yearly donation

Choose an amount

$1.00
$5.00
$10.00
$5.00
$10.00
$20.00
$5.00
$10.00
$20.00

Or enter a custom amount

$

Your contribution is appreciated.

Your contribution is appreciated.

Your contribution is appreciated.

DonateDonate monthlyDonate yearly

Bipolar Questions and Answers

Have you heard of Quora? It’s like a crowd-sourced online question and answer center, where anyone can ask questions on practically any topic and request an answer from a specific person, or leave it up to whoever wants to answer.

I’ve used it myself for answers to questions about Ireland and about gardening. But since my Quora “credential” says that I have bipolar disorder and have written two books on the subject, I get questions about bipolar (and other mental health topics), usually several a day. Some I can’t answer. Some have already been answered. But I answer a couple every day. I consider it part of my goal of spreading information about mental health wherever and whenever I can.

Here are some of the types of questions I’ve been asked and how I answered them. Maybe they’ll help some of my readers as well.

What is the best medication to take for bipolar?

This one is the question most commonly asked, and it is easy to answer. I don’t know which medication is right for you. Only you and your psychiatrist can figure that out, basically through trial and error. It may take a while to settle on a med or combination of meds will work for you with the maximum effects and the fewest side effects.

I am thinking of quitting my meds, as I don’t feel I need them anymore or am having bad side effects.

DO NOT DO THIS. There are dangers in going cold turkey, not the least of which is withdrawal symptoms. Work with your psychiatrist. She/he can help you decide whether it’s a good idea to quit a medication. If going off a med is a reasonable idea, your psychiatrist will help you do it safely, most likely tapering off on the med you are on and possibly ramping up on a med that works better or has more tolerable side effects.

Besides, meds for bipolar are supposed to make you feel better – but it’s not a one-time thing. You have to keep taking them to keep feeling “better.” And if you go off a med and then decide to go back on it, it may not work as well.

Would bipolar disorder be eradicated if everyone came from a loving, stable home?

Sadly, no. While bipolar disorder may have a genetic component and may run in families, it can affect any person in any family. I had the most stable, loving family you can imagine, and here I am with bipolar 2.

What causes bipolar disorder?

The jury’s still out on that. Some people will tell you the cause is genetic. Others will say it is caused by deficiencies or overproduction of chemicals and receptors in the brain. Still others will say that trauma, especially childhood trauma, can cause bipolar disorder. Personally, I don’t know for sure, but I suspect it could be any one of them, or any combination of the three.

How do I help a family member with bipolar disorder?

First, you may be able to help them manage their disorder. In the early stages, you can perhaps help them find a psychiatrist, drive them to appointments, pick up their medication, and so forth. Be supportive. Tell the person that you love them and hope they feel better soon. (They may not respond to you at the time, but later they will remember who stood by them and helped them.)

You can also help by helping the person practice self-care. Provide an environment that contains the things that comfort and help ground them – comfort food, soothing objects such as blankets or pillows, favorite scents, or even stuffed animals. Encourage them to bathe or shower and facilitate that: Have clean towels available and clean clothes or pajamas ready to wear. Make sure there is soap and shampoo handy.

For persons in the manic phase of the illness, you can accompany them when they go out, try to help keep them centered on projects at home, try to help them when it comes to overspending or other reckless behavior. Again, remind them that you love them and will be there for them now and when they feel better.

How do I deal with a narcissistic, bipolar boss?

You can’t know that your boss really has a personality disorder or a mood disorder unless you have read their medical files, which is illegal. They may have narcissistic traits or change their mind frequently (which is not the same as having bipolar disorder). You basically have two choices: Put up with it or quit. You will not be able to change your boss’s behavior.

I’m afraid my parents will find out I have bipolar disorder.

If you are underage, you can probably not hide it from them. It’s not a good idea to delay treatment until you are of legal age, though. You can ask your family practice physician to recommend a good psychotherapist or psychiatrist. You can ask your school counselor to help you find help. There are telephone and text hotlines. The best bet may be to talk to your family about it, in a quiet, low-stress environment and explain what bipolar disorder is and why you believe you have it. Their responses may surprise you.

Will I be bipolar for the rest of my life?

Unfortunately, the answer is yes. Bipolar disorder is not a disease like cancer that can in some cases be cured. It’s more like diabetes or asthma, in that you will have to live with it, cope with it, and have treatment for it, most likely for the rest of your life.

But it’s not a thing to be feared. If you have the proper support, such as therapy and sometimes medications, you can live a fulfilling, “normal” life, and accomplish many if not all your goals. I have bipolar disorder and have completed grad school; have a loving, stable marriage; own my own home; and do paid work. You are not tied to a future of despair or fears or bad effects.

Keep trying.

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.

Simone Biles: Mental Health Is Health Too

There’s been a lot of media interest lately in Simone Biles. The gymnast described by many as the Greatest of All Time withdrew from the Olympics, citing mental health reasons. Many news outlets and commenters have been understanding, but some have not. A Texas Deputy Attorney General, for example, called Biles a “selfish, childish national embarrassment,” which he apologized for six hours later. A podcaster called her “weak,” and said that her performance showed that “when things get tough, you shatter into a million pieces.” After Biles pulled out, the team won a silver medal, with the Russians getting the gold.

Many have compared Biles with Kerri Strug, who performed the vault in the 1996 Olympics, despite having an injured leg. At the time she was praised for her courage and strength, although it turned out that the American Women’s Gymnastic Team would have won the gold even without Strug’s dramatic vault.

Biles’s situation and its comparison with Kerri Struggs serves to reinforce the idea that only physical injuries are “real” and that talking about and acting on mental health matters is not acceptable. Yes, Olympic swimmer Michael Phelps has talked about his struggle with depression, but only after the Games were over. It was brave of him to talk about it, but he received little to no backlash after deciding to talk openly about depression and suicidal ideation.

As in so many other situations, mental health and mental disorders are considered less “real” than physical disorders. And the pressure put on athletes and Olympic athletes in particular can be a factor in damaging their mental health. Athletes have long been encouraged to “play through the pain,” even when that results in severe physical injury. Few have considered how playing through psychological pain affects athletes.

Added to the stress of competition and the pressures of fans, parents, and coaches to succeed, many athletes have suffered through physical and sexual abuse. Simone Biles has commented that she is part of the #MeToo movement that has brought attention to previously unrecognized instances of sexual harassment and exploitation. In a lengthy tweet, Biles revealed that she was one of the victims of team physician Larry Nasser, who is now in jail following over 100 counts of such behavior. “As I continue to work through the pain,” Biles tweeted, “I kindly ask everyone to respect my privacy. This is a process, and one that I need more time to work through.” She could have tweeted the same thing regarding her recent mental health problems.

Another factor in the language surrounding Biles’s decision to remove herself from the Olympic competition is how many people talk about how she personally denied “us” a gold medal (as if all Americans were in contention for the medal) or ceded the victory to the Russians. Ideological matters ought not to be a point of discussion regarding an athlete’s mental health. But they are. People forget that the Olympic Games are just that – games. Too much patriotic fervor is whipped up based on the outcome and the international goodwill of the Games has been lost.

Along with the fact that an amazing athlete was strong enough not to let the pressures of competition further affect her mental health. Simone should be praised for her decision, not called weak and childish.

On the Mind and the Body

The mind and the body are inseparable, part of the same organism. You can’t have one without the other. And each affects the way the other works.

Triggers are a good example. You see (or read) or hear or smell or touch something that unlocks an emotion in your brain. You then have a visceral reaction to that feeling – sweating, shaking, nausea, panic flight, or another physical manifestation.

These reactions are most commonly seen in severe PTSD and trauma related to abuse, but they can happen in less severe circumstances as well. Even something as seemingly innocent as tickling can put the brain in command of a bodily sensation. For example, once I was tickled to the point of pain, with the other person refusing to stop when I pleaded for him to. Ever since, my reaction to tickling is both physical and mental. My brain tells my body to shut down the physical sensation of touch. That may seem – and is – comparatively mild, and I don’t want to diminish the experiences of people suffering with PTSD and reactions to trauma. But it shows how my body and brain interact, almost in a feedback loop.

In circumstances like these, the body signals the brain and the brain tells the body how to react. It’s not like a person can choose whether to be traumatized or not by a trigger. The brain takes over.

Lately, I’ve been facing a fairly deep depression and have faced a lot of things that are triggers for me – financial problems, relationship troubles, overwork, etc. I’ve been feeling the bodily lethargy, exhaustion, psychic numbness, and neurasthenia that come with depression. These certainly affect my body, making me twitchy and nervous and unable to sleep (or to sleep too much), or unwilling or unable to face the world outside, some of the more noted hallmarks of depression and anxiety.

But after a recent visit to my primary care physician, I began to wonder if my body was influencing my brain in a rather direct way. Of course, before I got to see the physician, I had to fill out the depression screener, and as usual, I underplayed my symptoms by a bit. After all, I’m already under a psychotherapist’s and a psychiatrist’s care for it. It’s to be expected if I don’t present as all cheery and “normal.”

After chatting with the doctor about my symptoms (most, I thought, related to growing older), he ordered a bunch of tests for me. I’m to have a mammogram, a ColoGuard test, a bone scan to check my bone density, and had a whole bunch of blood tests.

The mammogram and bone scan I’ve scheduled, though they couldn’t work me in until September. (Evidently there is a lot of pent-up demand for hospital-based testing, as the hospitals weren’t doing non-elective stuff during the pandemic.)

Then the results started coming in. White and red blood cells, okay. Liver function, okay. Glucose and triglycerides, okay. Nearly everything within parameters.

I say “nearly” because I got a call from the doctor’s office saying that he wanted to double my thyroid medication. I had been taking a small amount, but now he figured I needed more.

I looked up the symptoms of hypothyroidism on the Mayo Clinic website, which seems trustworthy. They noted that that the condition may be attributed by the patient to growing older. I definitely noticed those: sensitivity to cold, muscle weakness or aches, and joint pain, all of which I feel.

Then there were other symptoms, which I had attributed either to my psychiatric diagnosis (bipolar II) or to the medications I take for it: fatigue, weight gain, thinning hair, impaired memory, and the biggie – depression.

Between the two sets of symptoms, I could see that the doctor had good reason to suspect my thyroid was out of whack and to prescribe an increased dose of the medication. I am now taking the higher dose and waiting to see what happens.

But it struck me: Maybe my symptoms were a combination of bipolar disorder and thyroid hormone deficiency. Maybe my body was trying to tell me something – that not all the symptoms I feel were caused by my glitchy brain. Maybe some of them were caused by my glitchy thyroid.

I have not been taking the new dosage long enough to see any effects, but I have hope. Perhaps, if and when the new dose kicks in, I will feel less of the lethargy, hopelessness, and other attributes of bipolar disorder.

Maybe my brain and my body have conspired to make me feel the way that I do. Maybe there is some relief to be had from treating my body with hormones, rather than just my brain with psychotropics. Maybe I’m not spiraling down into depression as thoroughly as I thought I was. Maybe a little tweak in my medication will help me to feel better.

Maybe if my body problems get worked out, my brain problems will not assert themselves so aggressively.

It is devoutly to be hoped.

Laughing Out Loud

There’s nothing funny about bipolar disorder. In fact, one of the ways that I know I’m having a spell of bipolar depression is that my sense of humor flies out the window. Nothing brings a smile or a laugh – not my husband’s awful jokes. Not my friend Tom’s silly songs. Not a funny movie like Arsenic and Old Lace.

I have been in a spell of depression for a little while now. As I mentioned last week, part of it may be reactive depression. But here’s the thing. Reactive depression feels the same as bipolar depression. You have the same sense of misery, loneliness, helplessness, hopelessness, anomie. But you know what caused it and that it will end pretty soon, relatively, unless you tip over into a true depressive episode, which can last a lot longer than that.

But yesterday I laughed. And that was a good thing. It didn’t pull me completely out of my depression, but it let me know that escape was possible, and maybe even starting.

It happened like this:

My husband and I were sitting on the couch, watching TV. I was not enjoying it. Then a commercial came on about “man-boosting” pills that increase testosterone. It promised everything: strength, leanness, stamina, and outstanding performance in the bedroom.

Dan turned to me and said, “Hey, honey. Maybe I should try some of that. Improve my performance in bed-woo-woo-woo!

I turned and looked him straight in the eyes. I said, in a solemn, deadpan voice, without a trace of a snicker: Woo. Woo. I never got to the third Woo because we both dissolved in giggles. And it felt good – not only that I could laugh, but that I could make him laugh. Just thinking about it made us laugh all over again.

Today I am back to feeling overwhelmed, if a little less miserable, but still functioning on some kind of level. I don’t think my depression is over with. But for just a moment, I saw a ray of hope. Yes, it was over something stupid. Yes, I delivered the line with a flat affect. No, I didn’t know it was going to be that funny. I even thought Dan might be offended that I was making fun of him. But the important thing is that we both laughed. 

What I’m saying is that laughter, by itself, is not a cure for depression, however much the memes and the positive thinkers tell you that it is. But if laughter happens to you, it at least reminds you that the depression will end sometime – maybe quicker than you think. The giggles are building blocks that will help you climb up out of your hole, or at least see that there is a way out.

That’s a lot of philosophizing about two words (or syllables, really), and I’m not sure the magic would happen again if either one of us said Woo. But I am taking the memory of that moment with me, for whatever strength it can give me and whatever amusement will stay with me when this depression ends.

All Mixed Up

Leigh-Prather/Adobestock.com

As I mentioned a few posts ago, my psychiatrist and I are working on a medication change that will, I hope, pull me out of bipolar depression. The medication that we changed was a mood-leveler, which sounds like a productive way to start.

We’re increasing the dose, which means it shouldn’t take the time it would for the old drug to “wash out” of my bloodstream (and/or brain) while we’re waiting for the new one to kick in. I’ve been that route before, and it’s miserable.

While I haven’t noticed my moods becoming exactly stable since the change, I have noticed certain effects. I am able to get through the minimum of what I need to do each day, though nothing more. And I have noticed that I am getting irritable. This does not happen so much when I’m depressed. When I’m depressed, I don’t care enough about anything to be irritable.

In fact, irritability is one of the ways that hypomania manifests for me, before I get to the euphoria/super-productive/reckless spending stage. I get snappy with my husband about all his annoying habits, like never giving me a straight answer to a simple question. (What are you watching? A movie. What did you get at the store? Food.) I think he thinks he’s being funny, but I find it frustrating. Not that I don’t have annoying habits too, especially when I’ve either depressed or irritable.

So, I guess in one way, the irritability is a good sign. It doesn’t mean I have level moods yet, but it seems to mean that I’m not totally stuck in the depression. (I explained to my husband what was happening with me, and he seems to understand more. Though it remains to be seen if he’ll answer simple questions informatively.)

I think what I’m experiencing is a phenomenon know as mixed states. If to be depressed is to care about nothing and mania is to care about everything, a mixed state is some hellish combination of the two. Imagine being immobilized and jumpy all at the same time. That’s what it’s like, paradox that it is.

I haven’t had mixed states too often in my life, though I have had emotions that swerve drastically from happy to depressed in an instant (which is an extreme version, I think, of what’s known as ultra-rapid cycling). This is something different, though.

Now, I use up all my spoons early in the day and nap, or I stay up but go to bed at around 8:00. Ordinarily, if I went to bed that early, I’d read for a couple of hours, but these days half an hour or 45 minutes is it, tops.

Still, I think (or hope) that this mixed state of affairs is a step along the way to level moods that are higher than the numbness and not-caring of depression. It’s not comfortable to go through, but then neither is depression or mania, even hypomania.

It’s been about six weeks since the change in my medication. Within another four to six weeks, it will likely become apparent whether the change, once set in motion, will have an outcome I can live with. Until then, I need to spend my spoons as wisely as I can and try to remember not to snap at my husband, even when he’s being annoying.

Distance Psychotherapy: Is It for You?

By Alice / adobestock.com

I will make a confession: I have never used distance therapy, except for when I couldn’t drive to my therapist’s office, my husband wasn’t available to drive me there, or when I had the last-minute I-just-can’t-go-today feelings or I’m having-a-crisis feelings. This was in the days before teleconferencing, texting, and other long-distance forms of therapy, so occasionally my therapist would agree to do a telephone session, which I appreciated greatly. In general, they didn’t last as long as the standard psychotherapy 50-minute hour, but at times they were lifesavers.

Now, when everything seems to be online, and especially during pandemic lockdown, quarantine, or simply fears of going outside, tele-psychotherapy seems to be becoming a thing. Many services are now available via the internet, smartphones, and whatever way you pursue your online life.

I’ve been looking at these services, not because I need one now, but because I want to know what’s available in case I ever should. The APA (American Psychological Association) provides a lot of helpful information on the subject. Their site has provided a list of pluses and minuses regarding telehealth for psychology. They note: “With the current research and with the current technology, mobile apps and text messaging are best used as complementary to in-person psychotherapy…Research does show that some technological tools can help when used in conjunction with in-office therapy,” though “There are cases in which Web-conferencing or therapy via telephone does seem to be a viable option on its own for some people.”

Inc.com provides a helpful list of the pros and cons of online therapy. Some positive aspects are that:

  • People in rural areas or those with transportation difficulties may have easier access.
  • Most online therapy services cost less than face-to-face treatment.
  • Scheduling is more convenient for many people.
  • Individuals with anxiety, especially social anxiety, are more likely to reach out to an online therapist.

among the negatives are:

  • Without being able to interact face-to-face, therapists miss out on body language and other cues that can help them arrive at an appropriate diagnosis.
  • Technological issues can become a barrier. Dropped calls, frozen videos, and trouble accessing chats aren’t conducive to treatment.
  • Some people who advertise themselves as online therapists might not be licensed mental health treatment providers.

Despite the concerns, research consistently shows that online treatment can be very effective for many mental health issues. Here are the results of a few studies:

  • 2014 study published in the Journal of Affective Disorders found that online treatment was just as effective as face-to-face treatment for depression.
  • 2018 study published in the Journal of Psychological Disorders found that online cognitive behavioral therapy is, “effective, acceptable and practical health care.” The study found the online cognitive behavioral therapy was equally as effective as face-to-face treatment for major depression, panic disorder, social anxiety disorder, and generalized anxiety disorder.
  • 2014 study published in Behaviour Research and Therapy found that online cognitive behavioral therapy was effective in treating anxiety disorders. Treatment was cost-effective and the positive improvements were sustained at the one-year follow-up.
  • A recent review of studies published in the journal World Psychiatry compared people who received CBT treatment online with those who received it in person.  The two settings were shown to be equally effective.

One possible pitfall, warns APA, is that “online therapy or web therapy services are often not covered or reimbursable by most insurance providers. If you plan to be reimbursed, check with your insurance company first. Otherwise, prepare to pay for the full cost yourself.” The services I explored charge about $35 to $80 per week for unlimited messaging and one live session per week. MDLive provides a psychiatrist at $284 for the first visit and $108 afterward. (They have lower rates for seeing a therapist rather than a psychiatrist, and do accept insurance.)

Business Insider, in its article on the subject, dealt specifically with a service infelicitously known as Woebot. Unlike the other services, Woebot is a “chatbot” that substitutes artificial intelligence and natural language processing for a real, live therapist. It uses cognitive behavioral therapy. Their website claims that Woebot “is the delivery mechanism for a suite of clinically-validated therapy programs that address many of today’s mental health challenges, from generalized anxiety and depression to specific conditions like postpartum depression, adult and adolescent depression, and substance abuse.” Like a non-directive therapist, it asks probing questions and responds to questions and answers from the user. For now, it is free to users, though they seem to be exploring a paying model.

Other telehealth counseling services include:

Amwell

Betterhelp

Brightside (depression and anxiety, not bipolar or mania)

Online-Therapy.com

ReGain (couples therapy)

Talkspace

teencounseling (will consult with parents)

If you decide to try online therapy, it’s best to compare services and determine what services they offer, at what price, and what the credentials of their therapists are. If you have already tried it, I would be glad to know the results. Feel free to comment.

 

 

A Letter From the Future to Bipolar Me

by sosiukin via adobestock.com

Dear Me:

You’re 13 years old now, and there are a few things you should know.

You have bipolar disorder. No one knows this, not even you. But a lot of people notice that you act “weird” at times. You have decided to embrace your weirdness, which is fine, but what you really need is psychological help. And medication.

Don’t pass up any chance to get that help. Your high school will recommend to your parents that you get counseling. When your parents leave the choice up to you, take it. It will not go on your permanent record, and you will still get into a college. A very good college, in fact.

I know that at times you sit alone and cry. Other times you laugh at things no one else finds funny. This is not just “weirdness.” This is a mood disorder, called bipolar disorder, type 2. Your mood swings will make it difficult for you to make and keep friends. Keep trying. The friends you will find are worth it and will stand by you when you really need them. You will not be alone in dealing with this.

Your choice to go to college out of state will be a good one. There you will have a variety of experiences that will make you grow in unexpected ways. Your mood disorder will go to college with you, though. Leaving Ohio will not mean you will leave bipolar disorder behind. You will still feel the mood swings, and most of them will be depression.

It’s a good idea to take that year off between freshman and sophomore year. I know it will feel scary, but at that point you will be in no shape to carry on with academics. Instead, you will get a job which, while not great, will introduce you to more new people and new ways of life. At least one of those people will stick with you till you are old and gray.

Returning to school will be a good decision. Your parents will support you in that decision. They won’t object to your year off, because they know you will go back. It still won’t be easy, but you will have a core group of friends that accept you, even though you are different from them.

Your bipolar disorder will follow you back to college. It will make you miss some opportunities and choose others that will not be good for your mental health. You will be unhappy most of the time, but you will find that music helps you through it.

Try not to self-harm. I know you will feel numb and want to feel something else, but cutting yourself is a bad decision and will not help. You will carry those scars forever.

When you meet Rex, though, you will be encountering a problem too big for you to handle, and the relationship will leave you scarred as well. It would be best if you were to steer clear of him altogether. But then again, you will find some true friends in his circle, and it would be a shame to miss them. Try your best to hold yourself together, remember what I said about self-harm, and don’t give up on who you are. You are not your disorder, and you will get through this, despite everything.

I know you never gave a thought to marrying, but you will meet a man and in a few years you will marry him. This, I assure you, is a good decision. He will stick by you no matter what and help you find help.

Going into the building that says “South Community Mental Health” will be a good decision. Whatever you will be feeling at this point – most likely misery – it’s not mentally healthy. This will be the place where you will start to climb out of the hole you have found yourself in.

At last, a doctor will tell you that you have bipolar disorder – most often depression, but also anxiety. He will work with you to find a combination of medications that will help you. When that happens, you will become reacquainted with your brain and relearn how to function in the world at large. Your brain will function in a new way, one with fewer out-of-control feelings. You will experience life more fully and be glad of your new outlook.

It won’t be quick, and it won’t be easy, but you will have therapists, and friends, and work, and love, all of which will help see you through. You will have bipolar disorder all your life, but it will not be your life, though it seems that way now.

Reach out for help whenever and wherever you find it. Cherish your friends. Keep trying, even when you want to give up. Better times are on the way.

I promise.

Love, me (older and maybe wiser)

Psychological Tactics of Abusers, Gaslighters, and Cults

Image by Vadim Gushva via adobestock.com

Once upon a time, I lived with a man who, I later realized, was a gaslighter. (This was in the time before gaslighting became trendy and well-known.) For a while after I left, I had no notion that I had any harsh feelings towards him. It was only later, after I had been away for a while, that I realized what my buried feelings were and what damage he had done. The experience was responsible for parts of who I am today, including my strength and resilience.

For a time, though, right after my deeper feelings began surfacing, I realized that I had been psychologically controlled. I began to read up on the phenomenon. Some of the subjects I devoured were accounts of and theory of domestic physical and psychological abuse, mind control, and cults. They fascinated me – how the human mind and spirit could be so affected by another person or persons that they acted in irrational ways, defended their abusers, changed their personalities, and gave up their lives, either figuratively or literally. I don’t mean to compare my experience to the suffering that the people I read about have gone through, or to the suffering that still exists. All that I knew was that I had been manipulated, and was desperate to find out how, if not why.

I started with the easiest subject to find information about – domestic abuse. I will say that my gaslighter never harmed me physically and only once said something that could be taken as a violent thought towards me. But I learned, particularly, about intermittent reinforcement. This happens when the abuser switches between telling the victim that he loves her and she is wonderful, and that she is stupid or ugly or otherwise worthy of abuse. These mixed signals keep the victim coming back, on the theory that sometimes the person is so nice and loving. “It must be that I make him mad without meaning to,” she thinks.  Thus, she is hooked and less likely to leave.

My gaslighter also used intermittent reinforcement and mixed signals to keep me hooked. I stayed much longer than was good for my mental health.

Learning about mind control – “brainwashing,” kidnapping, and so forth, gave me little insight into my own situation, except that some of the principles were to isolate the person being controlled, to control the environment such as when the person slept or ate, and to be that person’s only source of information or reality. I had been relatively isolated physically, had little control over schedules, and, while TV news was available, it was always filtered through the gaslighter’s sensibilities and opinions. Again, I am not comparing my suffering to that of other people. I don’t believe, really, that suffering can or should be compared.

Learning about cults took me even farther from my own experience, but I was fascinated by it nonetheless. I soaked up information about Jim Jones and Jonestown, Heaven’s Gate, Scientology, and others. Especially interesting to me were stories of people who had escaped from cults. (One of my Facebook friends escaped from a religious cult, which took advantage of her PTSD and bipolar disorder to ensnare her. She supports others who have been victimized by cults and spreads information on cults and the tactics they use.) All I can say is that leaders of cults are usually charismatic, often reject societal sexual norms, and mentally coerce their followers to isolate from family and to finance the cult leader’s lifestyle.

Gaslighting, which I have written about many times (https://wp.me/p4e9Hv-pm, https://wp.me/p4e9Hv-C2, https://wp.me/p4e9Hv-Ir, https://wp.me/p4e9Hv-Cu) most resembles domestic abuse, though usually without the physical violence. It uses the tactics of intermittent reinforcement, isolation, verbal abuse, cults, and mixed signals to convince the victim that her perceptions of reality are invalid – in extreme cases, that she is going insane.

All of these forms of abuse do harm to their victims, in varying degrees. I was lucky to be able to leave my gaslighter when and how I did, and I will forever be grateful to the people who have helped me heal from the experience.

If you are in any of these situations – domestic violence, emotional abuse such as gaslighting, or being victimized by a cult, the best advice is: Get out now. Leave while you still can, before something worse happens. And get help, both from your friends and family, if possible, and from a professional counselor who has experience with these issues. It could save your happiness, your sanity, or even your life.

 

Resources

https://www.goodreads.com/list/show/72664.Nonfiction_resources_on_abuse_and_domestic_violence

National Domestic Abuse Hotline https://www.thehotline.org/

https://nymag.com/strategist/article/best-books-on-cults-reviewed-by-experts.html

https://www.women.com/sophiematthews/lists/books-on-gaslighting-101718

Tag Cloud

%d bloggers like this: