Bipolar 2 From Inside and Out

Posts tagged ‘mental health’

Advice from the NYT

On December 30, 2024, the New York Times offered an article: “10 Ways to Keep Your Mind Healthy” in 2025, by Christina Caron and Dana G. Smith. Now, I’m not saying that their advice was bad. I’m just saying it didn’t go far enough. All of their recommendations are things we already know. Someone with a simple need for better mental health may get something from the article. But for someone with a mental disorder, it’s inadequate. Here’s what they said.

1. Move your body.

“If you’ve heard it once, you’ve heard it 1,000 times: Physical activity is one of the best things you can do for your brain.” Well, we have heard it 1,000 times. The Times notes that people feel better after a workout, but that ones who have a consistent exercise routine, there’s less risk of depression (and dementia). They attribute this to better blood flow and connections in the brain. This is hardly revolutionary advice.

2. Address your anxiety.

Easier said than done. NYT says: “Many Americans are anxious.” They suggest the following solutions. Face what makes you anxious to break the pattern of fear. They say that you can do this kind of exposure therapy with or without a therapist.

They also recommend that you focus on your values rather than anxiety. I’m not sure how this is supposed to work. One suggestion they give is to volunteer in your community. Then they advise that you not catastrophize—but they don’t tell you how to do that, except for journaling about whether you had an appropriate amount of worry compared to the situation.

3. Challenge your brain.

The authors note that this is “still up for debate,” but they say that crossword puzzles, reading, and brain games “can’t hurt,” especially regarding dementia. The most definite thing they way is that such pursuits “can’t hurt.” A professor of psychology adds that “chances are that’s probably good for your brain.” But “good for your brain” is a long way from mentally healthy.

4. Get a good night’s sleep.

Lack of sleep “can affect how they experience stress and negative emotions. They might also be more likely to ruminate, be quicker to anger, have more negative thoughts or find it harder to cope with stress.” Those are serious symptoms, and for once, the NYT recommends actual therapy—Cognitive behavioral therapy for insomnia, or C.B.T.-I. They note that it is more effective than medication. At last, some useful information!

5. Get unstuck.

Good idea, but how to do it? According to the NYT, you should conduct a “friction audit.” which basically means identifying your problems and trimming them away, whatever that means. They also recommend “futurecasting,” or imagining you aren’t stuck and what steps would get you there. “Try to do at least one step each day.” Baby steps are good, of course, but doing one per day isn’t practical for most people with mental disorders. A therapist might help with this, but the NYT is silent regarding that possibility.

6. Stay cool.

At last, something that you may not already know! “Studies show that hot days impair our cognition and make us more aggressive, irritable and impulsive.” Typical ways of cooling off are recommended: stay cool and hydrated, use air conditioning or a fan, spritz yourself with cold water or take a cool shower, or go to a nearby cooling shelter. Nothing there but obvious remedies.

7. Quiet your inner critic.

If only we could! The inner critic is a real thing, and it makes you miserable. But the trick is how to do it. The authors suggest “letting go of that nagging feeling…and giving yourself credit credit for what you accomplish.” They do quote a psychology professor who suggests using “you” or your name rather than “I” when you engage in internal dialogue, which I take to mean affirmations.

8. Take care of your physical health.

This sounds good; the body and brain, of course, are interrelated. The NYT recommends taking a quiz about your physical health that analyzes common health conditions and behaviors such as blood pressure, cholesterol, and exercise. It’s said to estimate your risk for depression, as well as dementia and stroke. But most general practitioners these days use a specific depression screening quiz with more questions particular to that condition.

9. Make a new friend.

This is a great idea. People with mental disorders need a support system which can certainly include friends as well as family. One problem is gaining the courage and social skills to make overtures. The Times notes that loneliness can increase brain inflammation that damages brain cells and the connections between them. Then the article recommends reaching out to a friend or family member, joining a club, or attending a support group. Reaching out is difficult for people with depression in particular. Waiting for someone to reach in to you is sometimes all you can manage.

10. Forgive — or don’t!

Contradictory advice? Certainly. The Times article suggests that “forgiveness is an emotional process rather than an endpoint.” So, should you or shouldn’t you? Maybe. Forgiving someone who’s hurt you may lead to fewer negative feelings, the Times says, but they also recommend a book called You Don’t Need to Forgive: Trauma Recovery on Your Own Terms by Amanda Gregory.

I know what you’re going to say: This article is intended for the general public. It makes no mention of the many things such as therapy and medication that can help you achieve a healthy mind if you have a mental disorder. That the actions mentioned are meaningful adjuncts to those interventions.

But the title is misleading. I first got treatment for my mental health when I saw a sign for a mental health clinic and realized that whatever I was feeling, it wasn’t mentally healthy. At that point I received therapy, and later was prescribed medication. And they truly helped.

I would hate to think that someone like me would ready this article and think that the suggested actions, by themselves, will make a person mentally healthy. They are great adjuncts to proper treatment but won’t solve many problems that people with mental disorders have. If, like me, your only realization is that you don’t feel mentally healthy, the article may prevent or delay getting significant treatment.

So, go ahead. Try all the advice in this article. But if you still don’t feel you’re on an even keel, seek other kinds of help.

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We Don’t Talk About It

When I was first diagnosed with depression (later bipolar disorder), my family was somewhat less than understanding. My father was concerned that he might have to go to family counseling, with the implication that it would involve analyzing or blaming him. My mother informed me that Prozac, which I was prescribed, was “a ticking time bomb” and later said that she thought that if I got a better job, I wouldn’t be depressed anymore. And my sister was dismissive about paying someone a lot of money just so I could talk.

I admit that I did not handle this terribly well. I missed the opportunity to educate my family about these psychological conditions. (I did tell my sister that I was going to a community mental health service that had a sliding scale for payment.) In my defense, I was new to the concepts too, and had barely begun to educate myself about them. I did gradually learn more, but their initial reactions kept me from saying much about it to my family.

As stigma goes, this was pretty mild. They didn’t try to tell me there was nothing wrong with me. They didn’t blame or shame me for reaching out for therapy (other than my sister). But because of this, I didn’t receive much support from my family which would have made my journey easier. That only happened when I married a man who knew something about psychology and learned what would help and what wouldn’t.

Stigma can be a familial problem, but it also happens at a societal level. But mental health concerns are very low on the list of many legislators’ concerns and priorities. Some have denied that mental illness even exists or responded to it by clearing away the unhoused or creating sober houses. Mental illness is seen as a consequence of PTSD, which is talked about mostly in the context of veterans, seldom about other causes like abuse. Also, most of the fundraising for veterans seems to concentrate on limb loss and traumatic brain injury. If funds are going to specific mental disorders other than PTSD, it isn’t emphasized, despite the need.

A lot of what we hear about mental illness is about SMI or serious mental illness. And that often gets conflated with the problems of homelessness, addiction, and violence. But what about all the people with Major Depressive Disorder, Bipolar Disorder, Anxiety Disorders, Personality Disorders, and even Schizophrenia who live in homes and families, who have families of their own, and who have jobs? They’re very rarely talked about. They don’t get emergency funding. They don’t require street psychiatry, emergency housing, forced commitment, and other services that are needed for the most severely ill. They’re not high-profile.

They’re called “high-functioning” and then largely ignored, left to deal with their disorders on their own. Many of them miss out on the therapy, meds, and lifestyle changes that might help them, either because they don’t know where to go or don’t have the funds to access them. Insurance pays for quick fixes of 6-8 weeks, which are the merest band-aid on their problems. Supportive families, biological or chosen, can help them maintain their relationships, living situations, and jobs, but public attention isn’t focused on them in any meaningful way. There are ad campaigns that say “It’s okay not to be okay” and encourage friends to reach out, but they’re vague and short on what to do when you realize you need help. Hotlines focus on suicide and self-harm. They’re certainly needed, but so are resources for the day-to-day, less dramatic disorders.

Stigma, confusion, lack of education, ignorance, and even hostility keep us from the conversations that might lead to actual, useful change. Let’s open up those conversations with our families, friends, coworkers, the press, local and national government, and anyone else who’ll listen. Blogging and maintaining a Facebook group (Hope for Troubled Minds) are among my contributions to the effort.

I’ll keep trying if you will.

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Being There

Sometimes there’s just nothing you can do. A friend or family member is in distress—depressed, angry, disappointed, anxious, frustrated, or whatever. They may have experienced major trauma or be in the throes of some emotional upheaval. There’s no way you can solve the problem, and sometimes it’s simply better not to try. Not every problem can be fixed, and not everyone wants you to fix their problem. Sometimes it’s simply futile because there is no solution. Sometimes it’s insulting to even suggest that you might be able to fix it.

What do you do then? You sit with the person as they experience their feelings and say nothing. They don’t need advice. They don’t need conversation. They simply need the presence of another person. They just need you to be there.

Therapists sometimes recommend that when you have a strong feeling, you sit with it for a while. You don’t jump up and try to do something that will make it go away. You don’t ignore it. You don’t try to ignore it. You simply sit with the feeling and feel it. Later, there will be time to talk about it. First, you simply identify the feeling, if you can, and then be there with it.

Being there for another person is a great gift to them. In the face of strong emotion, they may not have the ability to talk about it. Having someone who will simply lend their presence in a time of turmoil gives comfort when it’s needed, unobtrusively.

You don’t have to simply sit when you’re being there for another person. You can touch them, place a hand on their shoulder. You can make them a cup of tea. You don’t ask if they want one. You just do it. The tea will be there if they need a soothing beverage. You will be there if they need a soothing presence.

Our society is so action-oriented these days. When we can’t solve a problem, we feel helpless. And that may be true. We’re helpless to change the situation, helpless to cheer up our friend, helpless to take pain away.

But being there may be the only action that is needed. The power of being there is the promise that, if your friend does need something concrete, something that you can offer, you will be there to provide it. In the meantime, there is nothing that either of you needs to do. Being there is the offering.

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Where to Go First

Most of the advice about depression that’s out there says that the first place to go for help is your primary care physician. That may seem counterintuitive. After all, doctors are notorious for being oblivious to psychiatric problems. Either they dismiss them, assuming that all their complaints (especially those of women) are “all in their head,” or they over-diagnose mental illnesses and pass out pills indiscriminately. At least, those are the stereotypes.

The reality can be far different. Family doctors can absolutely have a positive role to play in diagnosing and treating mental illness.

The last time I went to my primary care physician (for a nail fungus), the nurse practitioner, after taking my vitals, proceeded to ask me the questions collectively known as the Depression Screener. “Do you feel like a burden to your family/do you no longer enjoy things you used to All the time/Most days/Sometimes/Once in a while/All the time” and so on.

My blood pressure was high that day and I see a psychiatrist and take all kinds of psychotropics. I’m sure all that is in my file. “Can’t you just put down that I’m anxious and depressed and leave it at that?” I asked.

“Let’s go through it anyway,” she said. And so we did. No surprises. I was anxious and depressed.

The depression screener may not have been useful for me, but it is for lots of people. There are a lot of seniors, for example, who are living with depression without realizing it. Children, too. Teens. People of all ages. Finding them and getting them help when it’s in the early stages can help them avoid a life of misery and despair.

Not every person gets to find out through the screener. My mother, who was in a nursing home, made some remarks that suggested to me that she was depressed—extremely depressed, including suicidal ideation. I excused myself, found her doctor, and told him what she said, and that I believed she needed antidepressants. Rather than pushing back, he believed me and prescribed them.

Of course, it’s easy enough to beat the screener. The answers are fairly obvious. In fact, I know one person who gave all the answers that would keep him out of the psych ward. But fortunately, most people answer the questions truthfully and get the help they need.

But back to primary care physicians. They’re also helpful in cases of depression, anxiety, and other mental disorders. They know about the most common antidepressants and other psychotropics and can prescribe them to get you through until you can see a psychiatrist. They can give you a referral to a psychiatrist. And, difficult as it is for a first-timer to get a prompt appointment, they can keep monitoring your condition, prescribing as needed, until there’s finally someone who’s taking new patients. My own family doctor was willing to keep prescribing all my medications when one psychiatrist retired and I had to find a new one and wait for an appointment.

My primary care physician is part of my treatment team.

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What Gaslighting Isn’t

Gaslighting is a form of emotional abuse, but it’s not the only one.

Gaslighting is a very particular kind of emotional abuse in which the perpetrator tries to make the victim think she (or he) is crazy. They do this by denying their perception of reality.

Gaslighters say things like, “I (You) never said that.”

“You’re making that up.”

“That never happened.”

“I don’t remember saying (doing) that.”

And of course, “You’re crazy.”

There are other kinds of emotional abusers, however. One of them is the puts the victim in a position of “learned helplessness.” This often starts with “love bombing,” or flattering and professing love until the victim is hooked. This often happens when the two people live together.

Suddenly, there’s a change. The victimizer turns hateful, putting the victim down. They say things like, “You’re stupid.”

“You’re ugly.”

“You can’t do anything right.”

“You’re lucky to have me. No one else would have you.”

The, just as suddenly, the victimizer changes. Again, they’re all love and kisses, flowers and gifts, positive messages. The victim thinks they’ve changed. They believe the promises to do better, to be more attentive and loving.

These are lies. The victimizer has no intention of changing .hey’re just stringing the victim along. This is called “intermittent reinforcement.” The victim goes on hoping that the good side of their partner is the real one and all the losing statements and gestures are true. So they keep hanging on.

The situation is even more complicated if there is physical abuse—battering—going on. The victimizer is likely to do the same things as the emotional abuser. They apologize extravagantly and promise never to do it again. They can also blame the victim, saying, “I wouldn’t hurt you if you didn’t make me so mad.”

There are other tactics the abuser uses to tie the victim to them. They cut off the victim from their family and friends. They keep tight control of the finances. Children and pets are also obstacles that keep the victim helpless (this is also called “learned helplessness”).

But that’s not gaslighting. That’s emotional and physical abuse. For it to be gaslighting, the quality of tricking the victim into believing they’re going crazy, that their reality is false. Of course, the gaslighter may also use some of the techniques of the emotional abuser in addition.

The word “gaslighting” is a trendy word these days. Most of the time, what someone means when they use the word is emotional or physical abuse, or living with a narcissist.

However, as different as these problems are, there is one solution to all of them: Get out. Staying with a gaslighter, emotional abuser, or physical abuser is a losing proposition. They won’t change, no matter how many times they say they will.

Getting out will be difficult. The abuser will usually have the situation rigged so that’s difficult for the victim to do. Lack of money, lack of friends, isolation, maybe no transportation, no place to go are all impediments to escape. And though police response may be improving, it’s often not, especially if there hasn’t been battering. And we know how well restraining orders don’t work.

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The Varieties of Grief

Loss and grief affect us all. If you’re lucky enough that they haven’t yet, they’re coming. You won’t know when or why or how, but they’re unavoidable. There’s no way to prepare for them, either. Loss and grief rock your emotional balance and your mental health.

You’ve no doubt heard of Elizabeth Kubler-Ross’s Five Stages of Death and Dying—denial, anger, bargaining, depression, and acceptance. (Some people say there are seven stages, including the usual five plus shock and guilt.) The stages apply to other kinds of grief besides death and dying.

The thing is, not everyone experiences grief in the same way. You may not experience all five (or seven) of the stages or not in the order they’re usually presented. You might skip anger, for example, or begin with depression. It depends on the type of loss you’re experiencing and your psychological makeup. If you suffer from clinical depression, for example, it’s easy to get stuck in that stage of grieving a loss. If you have anger management issues, you might experience that before you get to denial, or you might skip over bargaining.

Nor is there a time limit on grief. The experts say that six months to a year is a “normal” time for grief to last. Obviously, this is not hard and fast. If it takes you two years or more to return to full functioning, that’s how long it takes. No one should push you to “get over it” in what they consider to be an acceptable length of time (but they probably will).

That said, there is a condition called Prolonged Grief Disorder. When grief lasts for years and interferes with your daily life and functioning, you may be suffering from it. If this is the case, you should consider getting professional help.

Grief enters your life in any number of ways, and not always ones you expect. Here are some of the common and less common ones.

Death

Death is what you usually think of when you consider grief and loss. This is usually the death of a loved one, but it can even be caused by the death of a public figure such as John F. Kennedy or someone you look up to and admire even if they’re not a family member or close friend. Even the death of a beloved pet can lead to very real grief that often is not understood by others.

Loss

There are kinds of loss other than death. If you work at your dream job and the company suddenly goes under or you are let go, you can feel grief and go through the same stages of grief as someone who experiences a death. You might be in denial, for example, or experience a period of bargaining or anger. Losing your home to financial reversals or a natural disaster is another example.

Health

If your health deteriorates severely, you can experience grief or a sense of loss over the things you used to be able to do. If you lose a limb, for example, or are paralyzed by disease or accident, you can feel grief over your new situation and again, denial, anger, bargaining, and depression. Even normal aging and the loss of abilities that often accompany it can cause you grief.

Relationships

The death of a relationship can also cause grief. Whether it’s by divorce, estrangement, or abandonment, you suffer because of the loss. You could obsess over the good times you spent together or be troubled by memories of the relationship when you least expect them, such as when you encounter a reminder of the person.

Ambiguous Grief

Ambiguous grief occurs when the outcome of a situation is unknown. A missing child is an obvious example. You don’t know whether they’re still alive or whether they’ve been abducted and killed. You bounce between hope and despair. You may be angry at God for allowing the situation or at the police for not solving the case quickly. If you have a loved one who is homeless and experiencing a serious brain illness, you may not know where they are or if they’re safe. You imagine the worst. You could blame yourself, even if it’s not logical. Bargaining is one typical response, a case of the “if only’s.”

There are support groups for many kinds of grief, such as for the bereaved, crime victims, or those with a family member in hospice. (This could be called anticipatory grief.) Other kinds of grief, such as grief over the loss of a job, home, or friend, usually don’t have any kind of support group. Friends and family members may try to offer support, but that’s not the same as a group with a mental health professional as a facilitator. Being with other people who have also experienced a particular variety of loss or grief can be a profound relief or lead to healing and acceptance. At the least, it’s a safe, nonjudgmental space where you can process your feelings.

Grief is deeply personal. Although there are commonalities to the experience, there is no one blueprint for grief. What you experience is in some ways unique to your situation. Length and depth of grieving can’t be quantified or predicted.

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Prayer and Bipolar Disorder

My mother believed in the power of prayer, and thought I should do more of it. I can’t say she was wrong. She prayed for self-improvement (for God to take away her bitterness at a relative) and for social issues (returning prayer to schools). I don’t know whether she ever prayed for an end to my bipolar disorder (she kept most of her praying private between her and God), but I never have. I don’t think it works that way.

So, what do I think about bipolar disorder and prayer? I think there are many things about bipolar disorder that you could pray about.

You could pray that science finds better treatments for bipolar disorder.

You could pray that you find a support system that helps you (or give thanks for the one you already have).

You could pray that you find a therapist, or a therapy, or a psychiatrist, or a medication that helps you. (Though I would recommend putting some effort into doing this one yourself as well as praying.)

You could pray that you have the strength to get out of bed in the morning or the peace to sleep at night.

You could pray for understanding of what you’re going through—from another person, an employer, the world at large, or even yourself.

You could pray that you don’t do too much harm while in the grip of mania or depression.

You could pray that you will recognize when someone is reaching out to you and that you will have the ability to accept.

You could pray that you have the courage to reach out to someone else, and the wisdom to keep reaching.

In my opinion, what you can’t do is “pray away” the bipolar disorder. If you’ve got it, you have to find a way to live with it. If prayer helps you do that, more power to you. But, again, in my opinion, prayer is not a cure for the disorder. There are some things that are meant for religion or philosophy to make better, and things that science has a better shot at.

You can point to various miraculous remissions of cancer or other diseases, or make the argument that removing demonic possession would now be called healing of mental illness. And if those give you comfort or hope, again, good for you.

St. Dymphna is the patron saint of the mentally afflicted (though personally, I think she should be the patron saint of abused children). If she, or God, or some other higher power of whatever religion or denomination or sect can lessen your suffering, go for it.

I just don’t believe that you—or I—personally will be cured of bipolar disorder by prayer.

Feel free to disagree with me.

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What Does FINE Mean?

I get tired of acronyms—letters that spell out a word and may also stand for the first letters of a word. NASA is okay with me, but I dislike SMART goals, TSA, ATF, and every other government agency. Even more annoying are ones that go on too long and are mystifying to those not already in the know. For example, HHGttG stands for Hitch-Hikers Guide to the Galaxy to SF (science fiction) fans or SMoF (Secret Masters of Fandom).

There are also lots of slogans that make more or less sense, depending. Just Say No. Just Do It. Me Too. Hold My Beer. Keep on Truckin’.

Plenty of acronyms are associated with mental illness, too. SMI. AOT. CARE Courts. BPD. There’s also the infamous FINE. When someone asks how you are and you tell them, “fine,” what that really stands for is Freaked out (or fucked up), Insecure, Neurotic, and Emotional (or empty).

One acronym I’ve been seeing lately is ASK, which stands for Acknowledge, Support, Keep-in-touch. It’s meant to be the “Stop, Drop, and Roll” of how to help a friend who’s having emotional difficulties. I’ve seen PSA (another acronym) ads promoting it on Showtime and MTV (another acronym that is no longer valid). As slogans go, it’s not too bad, although Acknowledge seems a little vague until it’s explained, but Support and Keep-in-touch are pretty clear.

The acronym ASK is associated with the Active Minds organization. Their website is easily findable if you enter “Active Minds” into Google. (The search term ASK brings up too many unrelated hits.) The website it takes you to offers interactive YouTube and “digital experience” links that demonstrate the principles.

Less memorable is ALGEE Assess risk, Listen nonjudgmentally, Give reassurance and information, Encourage appropriate help, and Encourage self-help. It’s a “Mental Health First Aid Action Plan” for helping someone in mental or emotional distress. Assess risk refers to risk of suicide, which may be too complicated a task for non-professionals. The second E, Encourage self-help, refers to suggesting “self-care, self-help strategies, or other ways to get support, such as going out for coffee to talk things over.” Personally, I think the acronym ALGEE is not very memorable and the explanation of the letters is not exactly intuitive.

The slogan that I found most puzzling (although it did get my attention, so it was effective there) is “Seize the Awkward.” The phrase focuses on the idea that, while it may feel a little difficult or awkward to speak to a friend about mental health concerns, you should accept that feeling as natural, then move past the awkwardness and start a helpful or meaningful conversation. The Seize the Awkward website has a lot to offer. There are nine ads for young adults featuring popular or famous spokespeople from music, sports, and other categories. The Ad Council has also provided GIFs, Instagram images, and posters you can use to spread awareness on your own site or location. There is a Campus Toolkit which includes resources on break-ups, loss, suicide, LGBTQ suicide, and racism.

I hereby retract my objection to Seize the Awkward because of its memorability and thoroughness. It’s wonderful. Right up there with Just Do It.

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When You’re Threatened

We’ve all heard the phrase fight-or-flight and know generally what it means—the two basic reactions to threats. The fight-or-flight response to threats was a literal life-saver for our ancestors. If they were being attacked by a saber-tooth tiger, for example, their best bets were to try to kill it or to run away from it. It was a simple matter of survival.

Nowadays, however, we don’t find ourselves in that sort of situation very often, unless we encounter a bear or other dangerous animal. For most of us, the obvious response is to run away. There have been accounts of people who were able to fight off mountain lions, but most times, it’s just not realistic to fight unless there’s no other choice.

But when it comes to psychology, the fight-or-flight response often refers to a response to a verbal or emotional attack. When someone yells at you, you can either fight back by attacking them verbally too, or by running away, leaving the situation. Fighting back is usually counterproductive and fleeing is sometimes not physically possible or only a temporary solution. If you’ve been in a physically or emotionally abusive situation, you know what I mean.

There are other reactions to threats that are possible, and they’re not usually under your control. The first is to freeze. Of course, this would not be a very good reaction to a vicious animal unless you believe it won’t attack if you don’t move either toward or away from it. If the attack is already underway, freezing prevents you from trying any other, potentially better, reaction.

It’s not a very helpful response to a psychological threat, though. It can make the other person escalate their behavior. I’ve experienced this in the case of someone who was emotionally abusive. I froze and couldn’t respond to what he was saying. He responded by saying he wanted to kick me when I didn’t answer. We were on the phone, though, so he had no way to do it at the time. And by the time we were back home, he didn’t repeat the threatening remark, which I now realize was a verbal threat only, an expression of anger but not an actual threat of physical violence. At the time, though, it was frightening. If anything, I froze more.

The other potential reaction to a threat (and one that also begins with f) is to fawn or try to appease the threatening person. You give in to what they’re saying or promise to do better. You could retreat into people-pleasing mode and try to defuse the conflict that way. Or you could try to smooth over the situation with expressions of love and devotion.

This isn’t a very helpful response, either. Basically, it gives the threatening or abusive person what they want—compliance and “good behavior.” It may defuse the situation in the present moment, but it can set up a pattern in which you always respond with self-blame or praise for the abuser.

Fawning can be a tactic that you learned in your early childhood. If your parents or caregivers withheld praise or insisted on superior performance, you may have learned that you had to “perform” in order to receive love. That trait can persist in adulthood.

Another reaction that’s been suggested is “face.” This is proposed as the preferred reaction to verbal or emotional threats. It means standing firm when a threat of this kind happens. Admittedly, it seems to be the most mature option, a choice rather than an automatic reaction. And it could disarm the threatening person since you don’t react in an expected way to the threat. But the “face” reaction takes practice. It doesn’t come naturally to someone who feels truly threatened. And it can be read as defiance, which could escalate the situation.

Still, facing the threat preserves a person’s self-esteem and sense of agency. And for those reasons, it’s worth a try, if you feel it’s safe.

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The Overwhelming Problem

screaming (Uma painting)It’s been said that time is nature’s way of keeping one damn thing after another from being every damn thing all at once. I know that taking things one at a time—eating the elephant one bite at a time—is a sound idea.

However, every now and then the damn things gang up on you. The elephant is starting to go bad and you have to eat all you can right away – to use a disgusting metaphor that I will not take any further. (You’re welcome.)

Last month was one of those months. They happen every so often. But if they happen very often, I tend to get overwhelmed. And when I get overwhelmed for too long, my brain breaks. I have a meltdown, or I decompensate, or whatever the proper psychiatric term is. In practical terms, it means that I’m severely depressed and non-functional, for longer than usual. Days. Weeks. Months. Even years.

The things that overwhelm me are quite predictable – financial difficulties, health problems, relationship glitches, and free-floating anxiety of all sorts, either my own or my loved one’s. I know that these are situations that cause difficulty for everyone, but to a person with bipolar disorder, they can seem—or even be—insurmountable. Especially when they cluster and refuse to go away.

Over the years I have become good (or at least better) at recognizing when I am about to be overwhelmed. I know the symptoms—the whirling thoughts, the jumping-out-of-my-skin feeling, the insomnia, the inability to concentrate, and the feeling that doom or disaster is impending.

There is little I can do to stave off these feelings. But I know I have to. I have to keep functioning at some level, higher or lower, to maintain the things that I want to have – productive work, a loving relationship, a nice house, caring friends, and so forth. At the time of my last major breakdown, I came uncomfortably close to losing much of that.

I try my usual remedies for anxiety, of course. I distract myself. I color. I watch mindless TV. I play stupid clicky games on the computer. I turn off my phone. But if the anxiety builds up too much, if the feared disaster is real and really is impending, none of these works. The anxiety shreds my last nerve, and the depression starts to settle in. I isolate. I stay in bed. One task at a time, I stop being able to function.

I have taken one step that has helped, however. An anti-anxiety pill is one of my daily medications—one in the morning and one at night. A few years ago, as the stress was building and approaching overwhelming, I asked my psychiatrist if I could have permission to take one more a day if I needed it.

He agreed.

I have not needed to take the extra pill every day. Sometimes I take one in the mid-afternoon if I start feeling jumpy, twitchy, or panicky. Sometimes I take one at night if I haven’t gotten to sleep within 2 – 3 hours after taking my regular nighttime pills. I know it sounds strange that a depressant helps me stave off depression, but my diagnosis is actually bipolar disorder and anxiety disorder. The med catches me at the point where the one starts to turn into the other.

I’m glad my psychiatrist trusted me not to abuse what I consider a privilege as well as a necessity. By the time I made this request, of course, we had been working together for a number of years and had built up a certain trust. I think there have been only a couple of times when I have had to take two extra pills in a day—one in the afternoon and an additional one at night. And both times, I felt guilty about it and made sure I didn’t make it a habit.

I don’t want to start gobbling pills at the least sign of difficulty. All I want is to be able to eat my elephant in peace and in pieces.

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mental health

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