Bipolar 2 From Inside and Out

Posts tagged ‘mental health’

Read Your Way to Sanity

As reported in Smithsonian magazine, “Doctors are now prescribing books to patients with depression, hoping that reading will help them find connections.”

Here’s the link, but I’ll hit the high spots for you. http://www.smithsonianmag.com/smart-news/doctors-are-now-prescribing-books-to-treat-depression-180948211/?no-ist

First, let’s note that this is third-hand information – from the U.K. National Health Service to the Boston Globe to the Smithsonian. (Fourth-hand, if you count this blog.) Many of the details and even the explanation of the concept may have lost quite a bit in the transitions. But here are the basics:

 If your primary care physician diagnoses you with “mild to moderate” depression, one of her options is now to scribble a title on a prescription pad. You take the torn-off sheet not to the pharmacy but to your local library, where it can be exchanged for a copy of “Overcoming Depression,” “Mind Over Mood,” or “The Feeling Good Handbook.” And depression is only one of over a dozen conditions treated.

There are also books prescribed for other conditions including, I presume, bipolar disorder. And they sound a lot the old self-help books of the sorts we read in the 1970s, of the Women Who Are Ambivalent About Women Against Women Against Feminism sort (h/t The Bloggess for that awesome title).

Back then I was diagnosed with depression, and back then the Common Wisdom said, “Depression is anger turned inward.” Now that we know more about brain biochemistry, neurotransmitters, and such, advice from a book called “Mind Over Mood” is not likely to be all that much help. And God spare me from anything called “The Feeling Good Handbook.”

Of course the Brits’ prescriptions are not actual bibliotherapy, which is a real thing, defined by  The American Library Association thusly:

The use of books selected on the basis of content in a planned reading program designed to facilitate the recovery of patients suffering from mental illness or emotional disturbance. Ideally, the process occurs in three phases: personal identification of the reader with a particular character in the recommended work, resulting in psychological catharsis, which leads to rational insight concerning the relevance of the solution suggested in the text to the reader’s own experience. Assistance of a trained psychotherapist is advised.

This is a much better idea, but again, it’s advisable to check the publication dates on those books. The extremely popular book I Never Promised You a Rose Garden was written before anyone really knew about the genetic and biological components of schizophrenia.

I’m sure there is modern fiction that would be useful in bibliotherapy. Personally, I think that the Dementors in J.K. Rowling’s Harry Potter books provide as good a description of depression as I’ve ever heard:

[T]hey glory in decay and despair, they drain peace, hope, and happiness out of the air around them… Get too near a Dementor and every good feeling, every happy memory will be sucked out of you. … You will be left with nothing but the worst experiences of your life.

Rowling herself has spoken about the connection:

It was entirely conscious. And entirely from my own experience. Depression is the most unpleasant thing I have ever experienced. It is that absence of being able to envisage that you will ever be cheerful again. The absence of hope. That very deadened feeling, which is so very different from feeling sad. Sad hurts but it’s a healthy feeling. It’s a necessary thing to feel. Depression is very different. I think [dementors] are the scariest things I’ve written.

As for me, I find insight into mental disorders primarily in nonfiction – though not necessarily in books with a psychiatric or psychological perspective. The Noonday Demon: An Atlas of Depression by Andrew Solomon is, I think, essential for any collection. It combines the author’s own experiences with historical, cultural, philosophical, and other ways people have thought and written about depression.

Generally, though, I prefer memoirs of people who have lived through or with the conditions they write about. Although my diagnosis is bipolar disorder type II, I also read memoirs about people with other conditions. There are many similarities of experiences, symptoms, feelings, and other aspects that I find familiar or helpful.

Being an ardent bibliophile as well as a psychiatric patient, I believe in the potential of bibliotherapy. Being a former consumer of self-help books, I sincerely doubt that genre will do much good.

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Mental Health, Uncategorized

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The Un-Merry-Go-Round

I submitted this for a mental health anthology and swore that if it wasn’t selected, I would post it here. It wasn’t. so here it is.

 

Back when I was diagnosed with depression (unipolar) and anxiety, I secretly envied the manic-depressives (as we called them then). At least if I had a manic phase, I thought, I could get something done.

 

Then I met Kate, who was bipolar – and not well controlled on medication, to say the least. My envy lasted through her ambitious plans to make identical green velvet Christmas dresses for her three daughters. And vanished when I saw her tear them apart, recut them, start over, change her mind multiple times. You can write the ending to this one. There were no dresses, not by Christmas and not ever.

 

Kate was riding the roller coaster – perhaps the most common metaphor for bipolar disorder – the peaks and troughs, swooping crashes, anticipatory climbs, stomach-clenching vertigo, and, for some, an abrupt stop at the end.

 

Type 2 bipolar is not like that. Type 2 is what my new psychiatrist diagnosed. Except I seldom got the hypomanic mini-jags of ambition and purpose. Instead, it came out sideways, as anxiety.

 

The challenge for both my doctor and me was finding the right mix of drugs to get me functional and keep me functional, at least at some sort of reasonable level.

 

While supposedly unipolar, I had been through most of the different sorts of antidepressants and anti-anxiety meds, including, of course, Prozac. When the increasing side effects of each outweighed the diminishing relief, I went through a lengthening list of tricyclics, SSRIs, and so forth. I learned not to ask, “How do they work?” I couldn’t get an answer. The more basic question was, “Do they work?”

 

I can’t remember all the combinations now. My memory has become Swiss cheese after the spectrum of chemicals I tried. (Actual conversation: “Doctor, I’ve been having some rather embarrassing memory lapses. I asked a friend how her father was doing, when he had been dead for three months.” “Yes, that medication will do that. Stop taking it.”) But in addition to (instead of?) the Prozac, I remember buspirone, Wellbutrin, imipramine. Desyrel, Lexapro? I think so. Effexor, Sinequan? Maybe. No MAOIs or lithium, though.

 

What I do remember all too well is when my brain broke. I don’t know what else to call it: nervous breakdown, decompensating, mental and emotional collapse. It wasn’t the first time this had happened, I later realized, but it was by far the most severe. That’s when I climbed on the merry-go-round.

 

It wasn’t a carousel. No painted ponies or dolphins or elephants or zebras with fantastical, bright bridles of flowers and whimsical saddles, steadily but gently leaping to the calliope music like the calming rhythm of waves.

 

This was a merry-go-round of the type that is no longer allowed on playgrounds because of the danger. A wooden platform, painted a color no longer identifiable, a metal pole speared through the center. Bent metal pipes dividing the surface into rough pie-wedges. No power to make it twirl but the force of children pushing and then jumping on, not to thrilling acceleration, but only to inevitable slowing. No lilting music; only creaks and rattles. No scents of popcorn and cotton candy; only playground dust and much-used sneakers.

 

The metaphoric merry-go-round would start rotating with each new pill or combo that promised (or at least proffered) “Better Living Through Chemistry.” I couldn’t handle the side effects of some – hideously vivid nightmares or the feeling of wanting to jump out of my skin. Others had side effects that I could live with, but little or no therapeutic effect. “There’s another drug I’d like to try” was the constant refrain.

 

The merry-go-round creaked on for years. Literally. With each new med, I had six weeks or so of slowly sliding back into the numbness and misery as my body sloughed off that chemical. Then six or so more weeks, waiting for the new one to work or not, prove tolerable or not, be any better than the last drug or not. Each new drug cycle amounted to a minimum of three months of hell. More, sometimes, as the doctor slowly, cautiously ramped up the dosage to gauge the effects, both intended and incidental. Lather, rinse, repeat.

 

Those years are mostly a blur to me now. I remember sleeping a lot. I remember sitting on the sofa watching “reality” shows so I could see people whose lives were train wrecks worse than mine. I recall not having the wherewithal to add water and nuke a cup of macaroni and cheese. Not bathing. Not feeding the pets. Not paying bills. Not reading. Not caring.

 

I know now how lucky I was to have a husband who lived the vow about “in sickness and in health” and took up the enormous quantity of slack required. He put up with a distant, unresponsive wife; frequent and apparently unprovoked bouts of sobbing; irrational panics; and all the other symptoms he knew by then he couldn’t fix. He didn’t know about the suicidal thoughts, or if he suspected, he never mentioned it. He often asked how he could help, but really, there was nothing else he could do.

 

Then came the day that my psychiatrist said we were just about out of options. He was thinking of recommending electroshock (or ECT, electroconvulsive therapy, its current version). As he talked about how it wasn’t like the bad old days and really showed quite good results in some people, his voice seemed to fade and I heard my inner voice screaming, “Fuck, NO! Keep away from my brain, you Nazi sadist!”

 

I had heard how in the 1950s electroshock was used as a way to punish or control unruly, uncooperative, nonconforming women. And of course everyone knew about the Cuckoo’s Nest. The Snake Pit. As far as I was concerned, electroshock was right up (or down) there with icepick lobotomy, the frighteningly efficient epitome of former psychiatric treatments.

 

Reeling, I made it to my car and immediately called a friend, a scientist, one of the most rational people I know, to talk me down. Her extremely sensible advice was to do some research. Research was something I knew about and remembered how to do.

 

I started digging. The Internet was little help. The opinions and experiences of people who had undergone electroshock ranged from “It was hideous” to “It was a miracle.” I kept looking and questioning and slogging through the research as well as the dense fog around me. I lost one friend, my long-time go-to guy for comparing our conditions and our meds, who said, “Do it immediately or I will kick your ass.” (Hint: Advice phrased as a threat of violence doesn’t help, or have the desired effect.)

 

So there I was, on a merry-go-round that had jolted to a sudden, sickening stop by the notion of electrical jolts surging through my brain. My precious brain, which had both sustained me and betrayed me throughout my life. The only part of my body I ever really loved.

 

What was I doing, considering altering that unique organ with electricity? But the brain in question kept pondering.

 

Electroshock caused memory lapses. I was already having those.

 

I would be allowing doctors to tinker with and alter the functioning – perhaps even the structure – of my brain. But really, hadn’t I been doing those very things with chemicals for years?

 

I went back to my psychiatrist, ready to tell him I was at least willing to talk to the doctor who did the shocking.

 

Then I got a surprise (at least as much as anything repeated for years can be a surprise). “There’s one more drug I’d like to try,” he said. “Lamictal. It’s an anti-seizure drug.”

 

“I don’t have seizures. How does it work?”

 

“We don’t really know.”

 

Oh, why the hell not try it? One more spin around the playground.

 

More misery. More weeks of weaning off and ramping up. More weeks of no change. The same-old same-old.

 

And then one day, something did change. It was such a clear sensation, physical as well as mental. I felt a sudden click in my head – an actual click, like someone throwing a switch located about two inches inside the back of my skull. I could hear my brain saying, “Oh, yeah. I remember this. This is how thinking and feeling are supposed to work.”

 

The click wasn’t a flick from a magic wand. I still had a long way to go, rebuilding the parts of me that I still could and still wanted to. Setbacks. More fiddling with the dosages. The creation of a crazy cocktail of drugs to keep the crazy at bay. But I was on my way back to functioning, with the help of anti-depressant, anti-anxiety, and anti-seizure drugs, plus a sleeping aid. And lots and lots of psychotherapy.

 

So what did I learn from this process? Not “There’s always hope.” I gave up hope lots of times, every time another med didn’t work. Not “Desperate times call for desperate measures.” I am infinitely glad I did not have electroshock. “It’s always darkest before the dawn”? Please. No truly depressed person believes that crap.

 

The lesson I took was “Stubbornness is a virtue.”  It saved our marriage countless times. It saved my father’s life for five times longer than the doctors gave him. And it saved my sanity.

 

“Stubbornness is a virtue” is different from “There’s always hope.” Even when you do give up hope, when you know it’s hopeless, when you realize the merry-go-round is grinding to its inevitable halt, you keep pushing it. Hopelessly, if you must, but stubbornly. As long as it takes.

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Mental Health

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From Panicky to Manicky

I’ve been having one of my rare, slightly manicky  upswings for the last few days.

Why? And about what?

Well, I survived the business meeting/lunch on Wednesday. I prepared for it with a lot less anxiety than the last time (hair, outfit, jewelry, car, arrival time – all came together with astonishing speed). I even made it through lunch without my hand tremors causing me to dibble all over myself. Yay me!

And although the subject matter could have felt like an attack directed at me, it didn’t. I didn’t get defensive (well, maybe a little) and I help uncover some problems that indirectly supported my point of view.

Maybe I am getting better at this stuff, or remembering how I used to do it.

Also, I was not completely spoon-depleted that evening or the next day, as I had told my husband to expect.

I’ve donated small amounts of money ($25 and under) to a few charities and causes. I don’t know if this is cause or effect of the upswing, but who cares? I was motivated, and I did it. A small enough accomplishment for many people, but summoning the will to care and to act constitute progress.

I have supported a friend in his first solo freelance venture, predicted its astoundingly rapid success, and reveled in it with him. It’s a good feeling to share, even if my own freelance efforts have been less spectacular (though significant to me).

I won’t deny that this upswing makes me wary that a crash may be on the way. You know how feeling happy always seems like tempting fate? With bipolar disorder, I know that there will always be another downswing waiting around the corner for me.

But at least, for now, I can enjoy the good. And that’s a major improvement.

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Mental Health

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A Grain of Salt

This week has been pretty bad. I tried to poke my nose out from under the rock where I’ve been hiding from the world.

Bad idea. I was instantly overwhelmed by the crazy-stupid-crazy of various sorts that has been sucking up all the oxygen lately. Read James Thurber’s story “The Box.” I was safe in the box and then I tried to come out.

Mistake. The sheer volume of malignant idiocy in the world seemed to have increased exponentially in the intervening week. I tried to stay away from it, refused to dip my smallest nerveless toe into Facebook threads on topics I have strong opinions about. A friend called to see whether I was okay, and I had a mini-meltdown.

I really thought my brain was going to break again.

It wasn’t just the relentless assault from the outside, though that was more than plenty.

I also had internal stress. My work. My difficulty forcing myself to do it. My exhaustion once I had done it. My total lack of spoons, even plastic ones.

The friend who called suggested a day off, comfort food, a book, cats. All good suggestions, and I tried them all.

The problem was, when I shut off all that other noise, memories began haunting me. Ones from years ago that I’ve never been able to suppress completely. From a time in my life when my psychiatric problems were undiagnosed and untreated, my body began to be plagued with conditions I still live with, my self-esteem was nonexistent, and my soul was being sucked dry by a person who might have helped, but made all of those things worse.

Today is still rough, but I had one good memory return. My husband bought a watermelon and I sprinkled a piece with salt.

This was a thing that my family used to do in the summertime – sit at the backyard picnic table and eat watermelon lightly sprinkled with salt. (And of course compete to spit seeds the farthest.)

The combination of salt and sweet is a trend among foodies these days, with the new sensation, salted caramel. Believe me, we were not foodies. Served with the watermelon were home-made popsicles made from Kool-Aid in Tupperware molds.

But for me, watermelon with just a touch of salt was one of the hallmarks of summer that I have not experienced in years. It was right up there with going barefoot and climbing trees.

My husband tried the melon with salt, but it didn’t do the same for him. It’s not one of his childhood pleasures, and he hates to add salt to anything, even popcorn. But at least he tried it, and listened to my story.

Mostly when a memory leaps suddenly into my mind, it’s the haunting kind. But every once in a while, I get salted watermelon. And I am grateful.

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Mental Health

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How I Function (When I Do)

I recently was involved in an online discussion. I probably should have been doing something else at the time, but it caught my interest and I jumped in.

It was (or at least became, in part) about getting up, getting dressed, and doing the work (or art or whatever). One person stated that she worked at home, but she needed to get out of her pajamas and get into regular clothes as a signal and reminder to herself that it was time to work.

I work at home too, and when I can make myself do the work, I do it in my pajamas. I reserve getting dressed for when I have to go outside the house – maybe three or four times a month. Pulling myself together that way takes much effort, many spoons, that I need to invest in doing the work.

So am I high-functioning or low-functioning? Yes.

We also discussed Dale Carnegie’s admonition, “ACT enthusiastic and you’ll BE enthusiastic.” This advice comes in various forms: Fake it till you make it. You get good at what you practice.

It doesn’t work that way for me. I can pull myself together for a limited time and on the phone, talking to a client, for example. I can fake it for that long. In my pajamas. A few months ago I had to drive to a face-to-face, multi-person business meeting – all together, about a half a day. By the time I got home, I was not just fried, but extra-crispy. Even the next day, I was too exhausted to do much more than get out of bed. It did not result in my being any more pulled-together thereafter.

So I was high-functioning for half a day and low- to non-functioning for a day and a half.

I suspect that most of us go bouncing back and forth between high- and low-functioning, with an occasional pause in the middle. It probably goes with the mood swings.

There are high-functioning activities I can (sometimes) do: earn money and blog, for example. There are also ones that I used to be able to do, but now can’t: cope with taxes, travel abroad or on business, tolerate crowds. And there are things I can do for a limited time or with help: grocery shop, cook a little. Also things I can do, but not as well as I did before my brain broke: solve puzzles, analyze, concentrate.

I suppose you could count napping as something I can do better now. I am a truly high-functioning napper. Not much of an accomplishment, maybe, but it beats the hell out of insomnia!

 

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Mental Health

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For Sharing

http://www.upworthy.com/these-9-college-students-want-to-tell-you-about-their-mental-illnesses?c=ufb1

Don’t give in to stigma. If you dig this video, share it so more people with mental illness can leave shame behind.

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Mental Health

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Can’t Write Today, So Here’s a Cat

maggie

I have been avoiding the Internet for days (and TV news and commentary as well) because I just can’t handle it right now. Actions, reactions, reactions to the reactions, et endless cetera. I’m depressed enough without all that.

There are plenty of thoughts I have on the Isla Vista shootings, and the media coverage of it, and mental health, and gun regulations. I’m sure most of them have already been said, and probably better than I could, and everything about the subject makes me angry, confused, outraged, despairing, hopeless, helpless, and majorly depressed.

Then there’s everything I’ve read lately about bodily autonomy and male privilege and the “war on women” (why does everything have to be a war?) and politics and climate change and all of those make me angry, confused, outraged, despairing, hopeless, helpless, and majorly depressed too.

But it is TBT, so here is a picture of Maggie, a cat who saw the glowing design on Dan’s forehead that reads “Sucker.” He instantly scooped her up and brought her home. She was thereafter totally devoted to him. He could arouse her to a fever pitch of writhing and seduction with only the use of his voice. I mean, if they had been the same species, I wouldn’t have stood a chance.

Maybe next week I’ll have pulled myself together a bit and can write about something. For now, I’ll just say the best things that have happened to me today are a head-bonk, a nose-touch, and two nose-licks from Dushenka (Little Soul) with the Crazy Eyes.

Dushenkacu

Yours truly,

A Truly Crazy Crazy Cat Lady

 

 

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Mental Health

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A Mother? Me?

Ah, the shrieks of laughter and squeals of delight from playful children! They cut through me like a light saber through Jell-O. I’m hyper-sensitive to loud or high-pitched noises.

A while back, one of my blogging buddies was speculating on whether she wanted to or ought to have a child, despite her disorder. I have no answer or even advice for her, but but here is what I think about motherhood and Bipolar Me.

When we got married, my husband really wanted to be a father some day. To tell the truth, I never gave it much thought really, since I had never expected to be married.

At that time in my life I was barely medicated and had a lot of meltdowns and breakdowns and up-and-down cycles (mostly down) ahead of me.

Looking back, I am glad that I never became a mother. The thought alone overwhelms me.

First of all, I would have been a really bad mother. It would have been unfair to a child to have a mother who would disappear into her room for days at a time, not communicate for weeks at a time, be depressed for months – or years – at a time. Not to mention not being able to enjoy anything. Put that person in charge of a live human child for 18+ years?

I know there must be people who do it, but I don’t even really understand how non-biploar people manage it.

Second – and this is the part that is going to sound selfish to those people she feel that childless-by-choice women are all selfish – but I needed all the resources I had to construct and reconstruct myself. As Gloria Steinem reportedly said, I didn’t give birth to a child because I was giving birth to myself. I still am, after my most recent and most monumental breakdown, still trying to salvage what I can of my psyche, seeing what pieces still fit, and learning to live with the things that are no longer present – or maybe never were.

And I had all kinds of irrational thoughts on the subject of motherhood. The one time I thought about motherhood, it was because my father was dying, and I wanted him to see his grandchild if there was going to be one.

Also, I was terrified of losing myself. My husband had some issues of his own and was, let’s say, way too close to his inner child. I thought he and a child would outnumber me and I would be the mean one, the killjoy, the Other.

As time went on, I grew less and less inclined to even be around babies or small children. And my husband would go into a funk if one of our friends had a baby. Eventually, he decided that if he wasn’t going to be a father, he could be a mentor, a helper, a healer, to other children and former children. Maybe even his inner child.

Now having a child is no longer even a possibility. And I’m good with that.

 

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Mental Health, Uncategorized

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Misery and Math

One day, when I had too much time on my hands, I came up with a theory: The Mathematics of Misery.

Basically, there are two stages of misery – wallowing and getting over it.

In my theory, the wallowing stage is necessary. You need to feel the misery, own the feeling, and try to figure out what (if anything) caused it. If you omit this stage, you won’t learn whatever lesson there is.

Then you move on to the getting over it stage. Ideally, the getting over it should involve eliminating the cause of the misery. (Keeping in mind that there are laws against homicide and you’re probably at that awkward age when you can be tried as an adult. I know I am.)

Now, here comes the mathematics.

According to my theory, the proper proportion should be 20 percent wallowing and 80 percent getting over it. But for me, that’s an unreachable goal (especially before I was medicated). Thirty to 35 percent wallowing is more realistic. It’s when the scale tips over 50 percent wallowing that you definitely need to get help. Preferably professional help. And I’ve been way over that tipping point.

It’s like the stupid scale in the doctor’s office. I just keep trying to slide the weight closer to the getting over it end.

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Mental Health

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Posting Weakly

Today I don’t feel like writing at all. It’s been a tough week.

Although I usually try to say something about mental health in general, bipolar disorder specifically, something relevant that caught my eye in the news, or a piece of my past that might be interesting or informative, today I can’t.

I’m very depressed. Or feeling sorry for myself. Sometimes I can’t tell the difference.

There’s a convention in July that I would really, REALLY like to go to. I could see many friends, including one I haven’t seen in literally years and have been fearing I may not have the chance to again (maybe irrational thinking, maybe not). I would have intellectual stimulation, friend, parties, laughs, all sorts of fun available to me.

And I can’t go.

Some of the reasons are practical. We can’t afford it. My husband has to work. Driving that far and carrying luggage would trigger back pain and the walking required would rapidly exhaust me. If I went, I might well spend much of my time flat on my back in a hotel room, wiped out or communing with Vicodin.

The other reasons I can’t go have to do with my mental disorders. I barely leave the house as it is, except for doctor and therapist appointments. A day with a few simple errands uses up every spoon I have and sometimes the next day’s as well.

But mostly, it’s my over-sensitivity to the crowds and the noise. I can’t tolerate either one for more than a few minutes without a panic attack or a meltdown. Neither of which is pretty and neither of which would add to my enjoyment of the convention, or anyone else’s, for that matter.

I’m now thinking about all the things I can no longer do for physical or mental reasons. My therapist would tell me to look at how far I’ve come – all the things I can do now that I couldn’t do a few years ago, like write a blog and maintain a goal of posting weekly.

She’s right, of course, but for now I just need to go back to bed, and try again to accomplish something after a nap.

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Mental Health

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