Bipolar 2 From Inside and Out

Posts tagged ‘mental health’

As a Muse, Depression Sucks

Pencil tied in a knot on a white backgroundRecently, someone commented that I didn’t write like I was depressed, even though I actually was at the time I wrote.

This week I am even more depressed, so I thought I’d give you a look inside my head as I try to write while depressed and/or anxious.

::typing:: “Donald Trump Is Not a Monster. He may be a liar, a bully, and a misogynist who is uninformed, egotistical, and thin-skinned, but he is not a monster. Monsters are mythical. They are what we invented to be The Other. To say a person – Timothy McVeigh, Ted Bundy, Donald Trump – is a monster is to say that they are Other: not human beings. In reality, they are all human beings, who may have done monstrous things. But they are motivated by the same things as all humans: greed, fear, hate, sex, fame…”

::thinking:: No. That stinks. Half the people who read my Et Cetera, etc. blog will hate me because I said Donald Trump is not a monster and the other half will hate me because I compared him to Timothy McVeigh and Ted Bundy. I’ll offend everyone at once. Maybe I could write “How to Offend Everyone at Once.” No, that’s a terrible idea. My goal is not to offend.

::still thinking:: Why am I so afraid of offending anyone? Is it because when I’m depressed, my self-esteem is super-low and I can’t afford to lose any more friends? Is it because I’m female and was raised to be a people-pleaser? Then why haven’t I pleased more people? Is it because I don’t want to be called a “special snowflake”?

::still thinking:: My knee hurts.

::still thinking:: Maybe I should write something about education. What, though? The education issue everyone is talking about is Betsy DeVos. I only know about her what others have written. Writing about her would be useless and boring. Crap. It’s already Friday and I don’t have anything. I’m not going to have a thing to post this week.

::still thinking:: What’s another go-to topic? Books. I just re-read The Handmaid’s Tale and that’s totally relevant.

::typing:: “The Handmaid’s Tale: A Tale for Our Times”

::thinking:: No.

::typing:: “Written Thirty Years Ago and Still Relevant”

::thinking:: No. Hardly anyone reads my book posts anyway. How can I have been doing this for three years and not have more followers? Is that why I write? Ego gratification. I’m a sad, sad person who needs external validation instead of interior satisfaction.

::still thinking:: My husband doesn’t even read my posts half the time, even if I mention him. Maybe I could write about bipolar disorder and sex. No, I’d have to do too much research and I’m running out of time. Besides, with my luck, my husband would read that one and not want our sex life all over the Internet.

::still thinking:: My knee still hurts. How long have I been sitting at this stupid computer?

::typing:: “I Hear Voices” – I’ve been meaning to write that one.

::thinking:: No. I don’t hear voices like psychotics hear voices. All I hear are Pete Seeger singing pizza commercials or a men’s chorus or an NPR broadcast that I can’t quite make out. That’s boring. My life is boring. Besides, I’d have to do too much research and I’m running out of time.

::still thinking:: I could look up some quotes about bipolar and say whether I agree with them or not. More research again. Besides, who cares whether I agree with them or not?

::still thinking:: Maybe I could re-post one of my old posts. Wouldn’t that be cheating? If I can’t some up with something by tomorrow, I may have to. But that’s like admitting failure. Like I can’t write. Maybe I can’t write anymore. Maybe I’ve already written everything I know.

::still thinking:: Maybe I could write about not writing. Too boring? Too meta? Don’t people hate stream-of-consciousness? Especially stream-of-depressed-consciousness. It’s so bloody depressing. I’m so bloody depressed.

::typing:: Recently, someone commented that I didn’t write like I was depressed, even though I actually was at the time I wrote…

::thinking:: Now how am I going to illustrate this?

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mental health

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Parts of My Life I Miss the Most

Last month I wrote about how bipolar disorder had cost me – well, not the ability – but the capacity to read (http://wp.me/p4e9Hv-qp). I am intensely thankful that the concentration, focus, and motivation to read have returned as my healing has progressed.

But there are some other things that are missing from my life that I wish desperately that I could get back. Or wish I had never lost in the first place. (Depression is very much with me right now, so forgive me if I dwell in the past with my failures a bit.)

First are friends. I’ve written about this before too (http://wp.me/p4e9Hv-2W), but the subject was brought home to me recently when I received a fuck-off letter from a former friend I was trying to reach out to, in hopes of reestablishing the relationship. One of her main reasons for cutting me off was that every time we went out, she felt it was “her and me and my misery.”

She did acknowledge that at times our friendship had been burdened by her misery too, but evidently that either didn’t count as much, or else mine lasted too long. (If it was too long for her, it was even longer for me.) I am very disappointed that, now that my “black dog” is smaller and on a leash, she found other reasons not to associate with me. To make it more ironic, she has been a therapist and now teaches psychology.

I also miss having a steady paycheck. My last 9-5 office job was over ten years ago, and since then my mental state has not allowed me to get and keep another such position. The security of knowing how much money I would have every month allowed me to plan.

And to travel. I really miss traveling. Admittedly, part of my inability to travel now is determined by my physical health. But my anxiety would make it just that much more difficult. Now I can barely get away for a weekend, and even then I must carefully monitor my moods, limit my activities, track my eating and sleeping, and avoid crowds.

One of my deepest regrets is that when I was undiagnosed and untreated, I couldn’t fulfill my potential. I attended an Ivy League university, but I can’t say I got out of it what I could or should have. I feel now that I skated by, impeded by many depressive spells, lack of focus and concentration, and confusion. I even took a year off to get my head together, but since that didn’t include getting help for my bipolar disorder, its value was questionable.

Lest this seem like nothing but whining (which my depression is telling is what it is), there are also some things that bipolar disorder has taken from me that I don’t miss at all.

Oddly, one of them is a 9-5 office job. While I do miss the steady paycheck, I absolutely don’t miss the things that came with it. Now, doing freelance work, I can fit my work around the things I need to do (like seeing my therapist) and the things I have to do (like slowing down when depression hits). I don’t have to get up at the same time every day and dress appropriately (if at all) and try to fit in and socialize with my co-workers. That was never easy for me and became nearly impossible after my big meltdown.

And, as much as I miss travel, I don’t miss business travel. Again, being “on” all the time, for days at a time, with no time or place to decompress, would be impossible now. Since we usually had to share hotel rooms, there wasn’t even a chance for any alone time, which I need a fair amount of. I could never get the hang of “team eating” either.

Finally, I don’t miss the boyfriend who took an already broken me and broke me worse. (I wrote about him in my post about gaslighting http://wp.me/p4e9Hv-pm.) My self-esteem was not great before the relationship, but afterward it went into negative numbers. Self-harm, self-medication, self-doubt, and negative self-talk were what I had instead. But Rex didn’t do it alone. He had my bipolar disorder there to reinforce his words and actions. And to not let me see what was happening.

Bipolar disorder is a balancing act, in more ways than one. It takes away good things from our lives. But my therapist reminds me that it also gives an opportunity – as I rebuild my life, I can choose which pieces I want to reclaim and which I want to discard. And the parts I can rebuild are what I should concentrate on.

And I will, once this spell of depression releases me.

 

 

 

 

 

 

 

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mental health

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Five Things Psychotherapy Has Done for Me

Why pay $250 an hour just to talk to someone?

That was my sister’s reaction when I said I was going to start seeing a therapist. This is my answer.

Mental health symbolWell, Lucy, while a psychiatrist doesn’t cost 5 cents anymore, therapy can be had for a lot less than $250. There are community mental health centers with sliding fee scales – which is what I was going to then. There is insurance, for now at least. I’ve even known psychotherapists who would accept less than their usual fee for long-time patients in temporarily dire straits.

And I’m not paying to talk to just “someone.” A therapist usually has at least an M.A., and sometimes a Ph.D. Psychiatrists have an M.D. or D.O. They have years of training, more years of experience, and colleagues they can consult if your problem is particularly challenging or out of their area of expertise. You can also find peer counselors, religious counselors, and proponents of every variety of therapy or treatment you can name, from neuro-linguistic programming to electroconvulsive therapy.

Now, as I reflect on my clueless sister, I’ve started thinking about all the things that therapy has done for me.

Diagnosis. When I first started going, back in the 80s, I could only afford one of those community mental health centers with the sliding fee scale. (At the time, I paid $5 per session.) There I was diagnosed with depression. The primary treatment they offered was “talk therapy,” but I had years and years of mental difficulties to talk about. Later, when I was seeing a psychiatrist, I was re-diagnosed with bipolar 2 and anxiety disorder. Suddenly, my past became a lot clearer, even if my present was still messed up.

Medication. There has been a lot of it over the years. I started, as so many did, with Prozac, which had a noticeable effect on my depression. It was like the difference between watching a black-and-white TV that got only one channel that showed only tampon commercials, compared to a wide-screen color TV that got hundreds of cable channels. The meds I’m on right now keep me functional, at least enough to make a living and be creative.

Perspective. When I first started going to my current therapist, the word I used most often to describe myself was “pathetic.” I no longer call myself that. Dr. B. helped me view parts of my past in a different light and helped me develop techniques and strategies to deal with the problems I was facing at the time. Now she keeps me on track, reminding me that I have the tools to cope with many of my recurring problems. And she reminds me how far I’ve come since my “pathetic” days.

Couples counseling. When we married, I was still smack in the middle of clinical depression. (My husband had problems too, but I don’t want to talk about them here, except to say that a codependent and a depressive living together can never decide where to go for lunch. And that was the least of our difficulties.) Several times since then, we have had to turn to counselors to work on problems related to sex, money, and just plain living and communicating together.

Group therapy. Actually, though I’ve attended group therapy a few times, what I’ve learned from it is that it’s not for me. I do appreciate the fact that it’s there if I should need or want it, and that my therapist can recommend a group if she or he is going to be away for a while. Perhaps I just haven’t found the right group yet, although the support communities I’ve found online may serve part of the same purpose.

In short, therapy has given me my life, my sanity, my coping skills, my emotional strength, and my creativity back. And I can definitely say that professional therapy has been worth more than 5 cents, or whatever insights my sister could have offered.

 

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I’m Not Introverted. I Just Don’t Want to Leave the House.

Maybe you would call me an introvert. I stay in the house for weeks at a time, never sticking my nose out into the fresh air. I wear pajamas all day, most days. My husband does the grocery shopping, picks up my prescriptions, and does most of the other errands.

I go out when I have a doctor’s appointment or when Dan entices me out with the promise of a restaurant meal.

I don’t consider myself an introvert.

I do consider myself a social person.

Why, then, do I stay indoors?

First, because my bipolar disorder makes me sensitive to noise and crowds. Technically, I think this is more agoraphobia than introversion. I can handle being in small groups of people or audiences, but hundreds milling around, as at a mall, make me panicky. And forget places that are both noisy and people-y, like Chuck E. Cheese or other family-intensive restaurants.

Second, I like to be social – on my own terms. That largely means Facebook, Twitter, LinkedIn, various online bipolar support groups, IM, email, Skype, and the good old-fashioned telephone. In the years since I’ve been on Facebook, for example, I’ve connected more deeply with old friends and coworkers, reconnected with old schoolmates and Girl Scout troop members, gained new relationships with friends-of-friends, and discovered things I never knew about my acquaintances. I keep up with birthdays; look at baby, travel, and pet pictures; and cheer on accomplishments, as I would in person. (Except for the hugs. Virtual hugs are just not the same. But my husband takes up the slack there)

Most of all, I stay inside because I can. My husband enables me in this, as when he does the grocery shopping. We tried splitting the shopping, but even with the little runabout scooter-with-a-basket (mobility issues), I was overwhelmed and exhausted after shopping just one-half of the store.

I’m able to work, at least some, and the work I do is conducive to telecommuting. I can sit in front of my keyboard and monitor, in my pajamas, and still be a useful, productive member of society. I have clients and interact with them in the aforementioned ways.

I haven’t had an assignment that involves leaving the house in years – not even to do research. I used to have to visit libraries occasionally, and while they’re not known for being noisy and people-y, Google and the Internet put virtually any information I need right on my screen or hard drive.

Admittedly, getting out into the fresh air would be good for me. We live in a nice secluded area that would be good for walking, and there are any number of parks nearby, if I want variety. I know that going out and getting at least a small amount of exercise would be good for my bipolar depression, but I haven’t been able to force myself to do it yet. Going outside to walk involves getting out of my jammies into real clothes, and possibly taking a shower, either before I leave or when I get back. And many of you know what a challenge showers are for people with depression, bipolar or otherwise.

But again, this is a symptom of my bipolar disorder and the immobility it causes, rather than introversion. I’m not afraid of meeting people while out walking, or even having conversations with them. Usually “hi” is all that’s needed in these situations, and I have the ability to make small amounts of small talk appropriate to the occasion. (“Sure is windy today.” “Are those shoes comfortable?”) Since I seem to be riding a hypomanic swing these days, perhaps I’ll be able to get out and walk occasionally. I know my husband would heartily endorse the idea and most likely go with me to offer me encouragement.

Bottom line? I can go out amongst people if I want to. I just usually don’t want to.

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Can I? Can’t I? Bipolar and Business

I work freelance at writing and editing, and as many of you know, that life is fraught with insecurity. How much work will I get? How much will I be paid for it? Will the check be enough to cover the mortgage and the health insurance? Anything else, like light and cable and phone, which I need in order to work from home?

Since  I’m bipolar, these questions are laced with more than the usual amount of anxiety. Especially since the progression toward my last major breakdown was a lot of what caused me to lose that 9–5, well-paying job. My attendance became spotty, my attention refused to focus, my relationships with coworkers went downhill, my evaluations took a turn for the worse, and I bailed.

I stayed immobilized for a long time, applied for disability (didn’t get it), then embarked on freelance work.

I’m much more stable now. I’ve have published this blog and my other one for over two years, and proved to myself that I can attend business meetings, at least once in a while. My paying work has built up to the point where we can at least live paycheck to paycheck, but not much more. Time to spread my wings?

So I started looking around for other jobs, in addition to my faithful, steady client who has sustained me for years now. First I asked them if they could send any more work my way. Then I started expanding my platform, as we say in the writing biz.

I joined LinkedIn. And there, one day, I saw a listing for someone who needed an editor. One with exactly my skillset. Precisely my experience. The kind of work I love to do.

But.

It was full-time, likely high-pressured, and 45 miles away (during rush hour). I knew those factors would make it impossible for me to succeed at the job, even if I got it.

But.

I wanted it. I wanted to have back the things I lost after my breakdown – my competence, my confidence, my pride. Oh, and the money too.

But.

Much as I wanted to, I couldn’t let myself apply for it. I didn’t want to trigger the kind of meltdown I had before. I didn’t want another period of literally years when I could do nothing – not work, not take care of myself, not cook, not read. Nothing.

So, with reluctance, I let the opportunity pass by. I went back to my blog posts and my irregular freelance work. I occasionally do some non-paying work for organizations like the International Bipolar Foundation (IBPF), or Sheknows.com, TheMighty.com, and even redtri.com. I lined up a gig editing a friend’s dissertation.

Then, as it sometimes happens, another opportunity appeared – a part-time paid position with a company that already knew my work. Steady work. Pay. Work at home. All this could be mine if I applied, passed the editing test, and was able to work the number of hours per week I rather optimistically said I could. I’ve taken the test (it was two hours long and grueling, the kind I used to give to other people). And now I wait, more or less patiently, never my best quality.

And while I wait, I wonder. Am I even capable of doing half-time paid work at home, plus my other freelance assignments, plus my blogs, plus the novel I’ve written about 1/3 of? Can I do the part-time job (if I get it), without my disorder screwing me up too badly to do it or anything else well? Is hypomania tricking me again? Do I have to give something up to get something better? Will it really be better?

The answer to all those questions is, “I don’t know.”

My disorder surely lost me the 9–5 job I once had. It made me give up the idea of trying for that similar job that seemed “just right.” But at least now I have some ambitions again.

Can I? Can’t I? This balancing act of higher ambitions and lowered expectations is delicate.

 

 

 

 

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mental health

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But What Happens in January?

Health insurance is a hassle, especially when you’re talking about mental health. And it’s an even bigger hassle when the government gets involved. That’s not necessarily a bad thing, but it does add a layer of complexity to the insurance process.

For quite a while I was uninsurable, or functionally so. My husband and I both had decent insurance when he worked for the county, but after he left that job, it was all downhill. We muddled through without coverage, paying for our meds out of pocket and avoiding the doctor’s office unless death seemed imminent or we had to have blood work. Mammograms, flu shots, and other preventive services fell by the wayside.

Then came the Affordable Care Act, aka Obamacare. Our pre-existing conditions were no longer a factor. My mental health coverage was guaranteed without going through the county’s EAP plan (Employee Assistance Plan, a six-week, take-the-therapist-we-give-you, cure-’em-quick affair).

The only problem (well, the major problem) was that, even with the ACA subsidy, the insurance cost us $650 per month. And my doctor started prescribing Abilify (cost: $800 per month, and wouldn’t you know, it wasn’t on the insurance plan’s formulary of preferred drugs). Fortunately, the generic came out soon after. It still wasn’t cheap, but it was somewhat lower.

The next year we switched plans. Unfortunately, the new company, a co-op, went under and we were transferred to yet another plan. It was no better than the previous one. In many ways, it was worse.

Prescriptions, for example. After getting them filled at our pharmacy for a certain number of months, we were told that almost all our meds MUST be ordered for home delivery, or the insurance company would not pay for them.

Which would be fine, as they were maintenance drugs. Except that meant paying $1100 for three months of generic Abilify, in addition to the monthly premium for the insurance. I can’t scrape together a lump sum like that, so through GoodRx coupons (https://www.goodrx.com/?c=criteo_au&utm_campaign=activeuser) and the local Kroger, I managed to get my prescription for under $200 per month.

Then the real fun started. My husband’s meds and my non-psychotropics went through the mail-order system easily. The ones my psychiatrist prescribed, not so much.

I’ve just spent the time between November 19 and now trying desperately to get the mail-order place and my doctor’s office to talk to each other, fax each other, send smoke signals or carrier pigeons to each other, to get me my drugs. As I gradually ran out of meds, which I’ve written about before (http://wp.me/p4e9Hv-kO).

I finally got a little action when I went to my doctor’s office, camped out in the waiting room, talked to one mail-order person on the phone while the receptionist talked to another one on another phone, and the nurse worked the fax machine. Then I went home, called mail order again, jumped up and down, threatened to hold my breath until I turned blue, asked for the supervisor, talked to the actual pharmacist, and almost burst out sobbing. Yesterday I got my pills.

This time when I had to pick a new insurance plan or renew my old one, I found one that was almost exactly as crappy as our previous one, but at one-third the cost. And the company representative says that all generics can be bought, at either the pharmacy or via mail order, at the same low co-pay. Including generic Abilify.

We’ll see.

The next problem is, as I’m sure you’re all aware, the president-elect and Congress have sworn to repeal Obamacare as soon as they get into office, whether or not they have a plan to replace it.

What will happen then?

Will I be able to get affordable insurance?

Will I be able to get insurance at all? (Even crappy insurance is better than none.)

Will it cover mental health services? Outpatient? Inpatient? Both psychiatrists and psychotherapists?

Will it cover psychotropic drugs at the same rates as others? Or will the meds that really work for me not be in the formulary of preferred drugs?

And how long will it be before even the crappy, but lower-cost, insurance that begins on January 1st, disappears?

I’m guessing (hoping) that our insurance won’t vanish immediately, given the pace at which the government usually moves. But repealing Obamacare (though not replacing it) has been touted as one of the first things the new administration will do. And anxiety is one of my psychiatric problems. How long will I have to wait, unknowing, to learn what those answers will be?

Generally, I have anxiety when I don’t know what’s going to happen. I catastrophize, then feel at least a little better when the answer comes. (It’s usually not as bad as I had anticipated.)

But this time, when the answer comes, will it lessen or increase my anxiety?

And will I be able to afford the medicine that keeps my anxiety in check and the psychiatrist who prescribes it?

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mental health

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Blogging While Bipolar: What I’ve Learned

Next month, this blog will be three years old, an unruly toddler of a blog with jam on its face and a sticky plush animal grasped in its fist. Except for one dry spell of about a month during the first year, I have posted every week in both this and my general purpose blog, Et Cetera, etc. (janetcobur.wordpress.com).

My husband often tells me that he’s proud that I am doing this and that I have stuck with it so long and faithfully. (He doesn’t often read my posts, but that’s another matter.)

nightblogWriting while bipolar is not always easy, but blogging has taught me a few things about myself.

Blogging is a substitute for going outside and having a social life. While it’s generally true that my disorder has abated over the years, at least from its worst, I am still unable – or perhaps unwilling is more accurate – to go outside for more than a doctor’s appointment, or a brief errand and lunch with my husband. But I am still connected to the outside world through my blog. I have friends, I have conversations, I get feedback. I have special blogging friends like Bradley, Raeyn, and Dyane. (I also live vicariously through Facebook, but that’s another story.)

I need structure, and blogging gives me that. I used to post randomly, whenever I felt like it. Pretty quickly I discovered that Sunday was the day when my blog got the most traffic, so I made that my official blog post day. Working at home as I do, I tend to lose track of where I am in any given week. Is it Tuesday? Thursday? It’s hard to tell. But having a writing schedule clears that up.

On Monday and Tuesday I pre-write – think about articles I’ve read or conversations I’ve had and jot down a few titles or ideas or URLs. On Wednesday I begin writing. My goal is to have a rough-ish draft by the end of Thursday and a nearly finished one on Friday. Friday and Saturday are for tweaking the writing, selecting a visual, and tagging. Then Sunday, I proof and post. (I also tweet a quote from my most recent post on Tuesday and a quote from an earlier post on Wednesday, plus a “coming attractions” post on Friday announcing Sunday’s topic.)

It’s a loose enough schedule that I can build in actual paying work around it.

For me, blogging and other forms of writing are better than journaling. My journaling quickly turned into whining. It was boring, even for me. I need real content to interact with, whether that be my blogs, a memoir, or the mystery novel I’m working on. Writing engages and invigorates my poor broken brain, giving it something to do other than wallow or turn to mush.

Even when I think I can’t write, I can still blog. Back when I was able to work full-time, I wrote and edited for magazines and textbooks. I used to boast that I could write 1000 words on anything. Blogging is more forgiving. I can stop at 500 words if that’s all I have to say. I can pick my own topics instead of writing to order based on someone else’s priorities. And that schedule I mentioned? It’s not an actual deadline, so I don’t have to worry about it whizzing past. When the pressure’s off, I can almost always make my Sunday goal.

Blogging validates me. I have two degrees in English (one from a pretty classy university) and worked in educational publishing for about 20 years. Then my brain broke and it all went away. Now that I’m writing regularly, I feel that in some way I’m using both my education and the skills I’ve built up.

By blogging, I prove to myself that bipolar disorder may have taken away some parts of my life, but it can’t have everything.

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mental health

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Furry Friends and Helpers

I’m sure we’ve all seen memes that say the best therapist has four legs and fur. When I’ve been feeling cranky, I have occasionally written responses to the people who post them. They demean the very hard and real work that psychiatric and psychological professionals do. And after all, what do the memes really say? “Have a mental illness? Just get a dog.”

Still, there are circumstances in which an animal can help a person with a mental or emotional disorder. It’s not as simple as going to the pound and picking out a pup, though. For an animal to assist a psychiatric (or other) patient, there are a number of hoops for the person to jump through.

Most people nowadays are used to the presence – or at least the idea – of service animals such as seeing eye dogs. Less common are Therapy Animals, Emotional Support Animals (ESAs) and Psychiatric Service Animals (PSAs). But they all have parts to play in promoting and maintaining mental health in persons with bipolar and other emotional disorders.

Therapy animals are most often used with geriatric patients and children with emotional disturbances. In some nursing homes and convalescent centers you find programs that bring small animals to interact with the residents. Even farm animals – chickens, lambs, piglets – may spark memories that had been hidden away for years. The animals help residents get in touch with those memories and caregivers get in touch with residents. Libraries sometimes bring calm, well-behaved dogs in so that children can read to them. The soothing presence of a well-trained dog can help a child self-regulate her or his emotions – and get reading practice at the same time.

Emotional Support Animals are dogs or cats (or, less commonly, other animals such as miniature horses or guinea pigs) that live with and provide comfort to a person with a psychiatric disorder. Typically, in order for an emotional support animal to be allowed in rental housing, documentation such as a letter is required from a physician or mental health professional stating that the animal’s presence alleviates symptoms of a patient’s psychiatric condition – one that qualifies as a disability under the Americans with Disabilities Act (ADA).

Regulations covering comfort or emotional support animals apply mostly to residences and airlines, but not other places where service animals are allowed, such as stores, restaurants, and public buildings. There, health codes trump emotional support.

Some folks confuse Emotional Support Animals with Psychiatric Service Animals. They think that “training” a dog to offer a kiss on command, or jump in their lap, or be hugged is a task qualifying the animal as an official service animal. While these are indeed ways that an animal can calm a person in distress, service animals, including psychiatric service animals, must receive special training that teaches them how to alleviate the symptoms of an ADA-defined disability.

Legitimate tasks for PSDs (psychiatric service dogs) include counterbalance/bracing for a handler dizzy from medication, waking the handler at the sound of an alarm when the handler is heavily medicated and sleeps through alarms, doing room searches or turning on lights for persons with PTSD, blocking persons in dissociative episodes from wandering into danger (i.e., traffic), leading a disoriented handler to a designated person or place, and so on.

In The Possibility Dogs: What I Learned from Second-Chance Rescues About Service, Hope, and Healing, author Susannah Charleson recounts how rescue dogs – the unwanted, unlikely-to-be-adopted dogs that languish in shelters or are destroyed – have been matched with persons who need them.

One of the stories she tells involves training a dog to help a person with OCD. The dog was taught to identify when the handler had returned to the stove three times (to check the burners). Then the dog would interrupt the person, leaning against her leg to distract her. For a person who could approach a door but not go outside, the dog brought a leash to encourage leaving the house for a fun activity.

By the way, forget about cats as service animals. Just try training a cat to do anything it doesn’t want to do. (I know that cats have been trained to run obstacle courses for agility competitions, but that doesn’t really qualify as a service for an individual with a disability.) If you are able to register your cat as an Emotional Support Animal or get a medical/psychiatric recommendation, you may be able to have your cat live with you in a pet-free community, or have the fee for a pet waived. But that’s about it where cats are concerned.

So, animals can’t be actual therapists, but they can assist in treatment and life skills for people who need help with mental disorders. When I’m less cranky, I keep scrolling past the pet-as-therapist memes and feel grateful that my cats offer me emotional support, whether they’re trained to do so or not.

 

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Advice for the Bipolar Writer

Writing can be therapeutic – and more.

Writing can save your life – or someone else’s.

Every one of us, depressed, manic, or bipolar, has something to say.

I say, “Say it!”

Although I’ve never been one to respond to that ancient exercise in which you express your unspoken thoughts to an empty chair, I am a proponent of expressing your unspoken thoughts. I just think writing is a better way to do it.

Getting your thoughts and feelings down on paper or preserved in pixels is a positive, life-affirming action, even if your thoughts might not be. Giving voice to your inner workings can help you understand yourself and your brain better.

And if you choose to share them, they can help others too.

There are many different kinds of writing you can explore and experiment with until you find the one or ones that are right for you. Here are a few you can try.

Journaling. Many therapists recommend journaling to keep track of your moods and mood swings. You can also keep track of your exercise and sleeping and eating patterns in your journal. These factors may help you pinpoint physical symptoms that accompany your emotional ones. And you can get a read on how your meds affect your symptoms and how troublesome the side effects are.

Unsent letters. I have a separate file in my computer for these, just so I remember not to send them. I write letters not to send when I need to vent at or about a person, but am not sure whether I’m overreacting. I can express my feelings without taking the chance of ruining a friendship or hurting a loved one.

Sent letters. Sometimes, after you’ve let those letters or emails sit for a while, you decide that you do need to send them – or at least parts of them. Letters or emails are often the best way to communicate regarding difficult topics because you can think about what’s important to say, consider the best way to say it, and revise if your thoughts are not coming out the way you want them to. You still might want to wait a day before you send them, though.

IMs and comments. When you read someone’s post or a comment that really resonates with you, don’t hesitate to let that person know. If you don’t understand something in a post, just ask. If you disagree, feel free to do so politely. These are chances to open a dialogue, get more information, or correct misconceptions. They can lead to friendships if you comment regularly, but even a word or two of support or thanks can mean a lot to the writer.

Blogging. I started blogging because my journaling was boring and whiny, and I decided I had more important things to write about. There are basically two kinds of blogging about bipolar disorder. One is to share your experiences – your mood swings, your triggers, your relationships, your healing, your thoughts and meditations. The other is to write about issues related to bipolar disorder – treatments, stigma, social policy, news items, books, or opinions. Of course, you can combine both types of writing in your blog, which is what I try to do.

Blogging is powerful. It lets both professional and untrained writers speak their truth and share their thoughts. A blog about bipolar disorder has a “niche” audience – people interested in the subject themselves or because they have a friend or relative with the disorder. This means that you will likely never rival the Bloggess in numbers of readers, but you can touch the lives of hundreds of people.

Blogging does not have to be difficult. You can post every day or every week, every month, or just when it suits you. You can write informally or in a more academic vein. There are a number of platforms, such as WordPress and Live Journal, that make it easy for you to get started, and to make changes as your blogging needs evolve. You can add illustrations and video clips, and links to news stories or other blog posts. Eventually, you may want to have your own personal web page to host your blog.

Fiction and poetry. If you don’t want to put your own experiences out on the web for anyone to see, you could try transforming them into fiction or poetry, or inventing characters and plots that resemble you not at all. Many magazines and other outlets use short stories and poems, and works that feature bipolar characters and themes are not common. Fiction and poetry can be ways to reach an audience that might otherwise never learn about the reality of bipolar illness and its effects on people and relationships.

Longer works. You could even write a book (which is something I’m trying to do). There are many genres to choose from, including nonfiction, memoirs, and novels. Aside from Abigail Padgett’s Bo Bradley series of mysteries, there isn’t much fiction featuring bipolar characters that are true-to-life and not stereotyped. These are long-term projects and, truthfully, you (and I) may never finish them or have them published. But just the effort is worthy.

Whatever form of writing you choose, get started! Whether you write for yourself or for a larger audience, you can make a difference. And if you feel the desire, you should definitely try.

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mental health

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Self-Care and Sleep: Fact or Fiction?

Every article you see about self-care for bipolar disorder will tell you, Get enough rest or Get enough sleep.

Sleep is that golden chain that ties health and our bodies together.  – Thomas Dekker

But what did Thomas Dekker know? For many of us, proper, beneficial sleeping is easier said than done.

Neon light owlEven with my prescribed Ambien and Ativan, I’ve done the wide-awake-at-3:00-don’t-get-to-sleep-till-5:30 thing. And the unsettled-from-nightmares-afraid-to-go-to-sleep thing. (Also the just-one-more-chapter thing, but that’s my own fault.)

Then the next day I have to take a mega-nap (http://wp.me/p4e9wS-iO), which leads to guess what? More insomnia.

But this coin has another side as well. There are days when all I do is sleep. A full night plus (at least 10 hours), then a mega-nap, then right back to bed after dinner.

I don’t think I was awake for much of my childhood. I did a lot of napping. This might have been a defensive measure against encroaching depression. – Michael Ian Black

I know that part of my problem is my husband’s work schedule – third shift – and wanting to be awake at least at some of the same times that he is.

Another part of the problem is my medication. If I wake at 8:30 (yeah, I work at home) and take my meds, I’m down for the count again until at least 10:30. Or 11:00. Or even noon. I hope my clients think that I run errands in the morning or work on my projects with chat, IM, and phone turned off so as not to be disturbed.

And then there is my meal schedule, which is just as erratic as my sleep schedule. Most days I try to eat at least one good, full, hearty meal (another self-care recommendation, though they usually advise more than one meal). But after I eat – especially a hefty meal – I get postprandial torpor, the technical term for why you fall asleep on Thanksgiving after eating all that turkey. (And you thought it was the tryptophan.) And there comes another nap.

The repose of sleep refreshes only the body. It rarely sets the soul at rest. The repose of the night does not belong to us. It is not the possession of our being. Sleep opens within us an inn for phantoms. In the morning we must sweep out the shadows.  – Gaston Bachelard

But recently, it’s been the not-able-to-sleep thing. There’s a Tarot card that symbolizes the feeling – the 9 of Swords. In the Rider-Waite deck, the image is of a person sitting up in bed, hiding her face, with nine parallel swords floating in the background. I always refer to it as The Dark Night of the Soul. (The 6 of Cups usually means something like Childhood Memories, but for me it means “See Your Therapist.”)

(Note: I had a rather irregular introduction to the Tarot deck, and for me it acts sort of like a Thematic Apperception Test. I apologize to those of you I have just offended in one way or another.)

Sleep is when all the unsorted stuff comes flying out as from a dustbin upset in a high wind. – William Golding

Anyway, a recent event caused me a fair amount of trauma that I had to suppress at the time, and it came out immediately as bloody horrible nightmares the next time I slept. I haven’t had any more of those since, but I suspect they’re still lurking at the back of my brain.

That we are not much sicker and much madder than we are is due exclusively to that most blessed and blessing of all natural graces, sleep. – Aldous Huxley

I guess what I mean by all this is that sleep as self-care is wonderful, if it cooperates. But there are so many things that can go wrong and screw it all up – grief, guilt, depression, sorrow, anxiety, fear, loneliness, restlessness, obsessive thoughts, worries. It doesn’t feel like something that I have much control over.

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mental health

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