Bipolar 2 From Inside and Out

Posts tagged ‘mental illness’

Does Immorality Cause Mental Illness?

Aaand…we have a new contender for what causes mental illness.  According to U.S. Attorney General William Barr, it’s a breakdown in Judeo-Christian morality. In fact, he blames a lot of woes on what he calls “secularism”:

Along with the wreckage of the family, we are seeing record levels of depression and mental illness, dispirited young people, soaring suicide rates, increasing numbers of angry and alienated young males, an increase in senseless violence and a deadly drug epidemic.”

Let’s look at that for a minute. Immorality causes wrecked families, depression and mental illness, suicide, violence, and drug epidemics. Lack of religion – or at least the proper Judeo-Christian one – brings on everything but the zombie apocalypse.

Steve Benen, writing for MSNBC, points out the flaws:

For one thing, it’s factually wrong. There are complex factors that contribute to problems such as drug abuse, gun violence, mental illness, and suicide, but to assume these issues would disappear in a more religious society is absurd. There are plenty of Western societies, for example, that are far more secular than the United States, and many of them are in better positions on these same social ills.

http://www.msnbc.com/rachel-maddow-show/ag-barr-blames-moral-upheaval-conspiring-us-secularists

Plus, Barr’s theory would have you believe that in the most religious places in the United States, such ills should not occur. Sadly, we have learned that no community is exempt from these tragedies. And it completely ignores the fact that many mass shooters and bombers cite the Bible as justification for their horrendous crimes.

Ah, but you say, those crimes are attributable to mental illness, which, as Barr tells us, is a product of the breakdown of moral values. It’s a simple equation to him: Immorality leads to mental illness leads to an increase in senseless violence. (As opposed to sensible violence, I suppose.)

And that’s where this slippery slope gets dangerous for those of us who have mental illnesses. Not only are we stigmatized by being blamed for mass violence, we are stigmatized by “ignoring” the cure for our disorders – adherence to the right religious values. (I think it’s fair to assume that Buddhist, Islamic, Baha’i, or Shinto religious values don’t count. In fact, to some religious people, such beliefs are tantamount to mental illness themselves.)

If mental illnesses can be cured by inculcating appropriate religious values, why are we spending so much money on psychologists and psychiatrists, medications, and hospital beds? According to Barr’s theory, that money would be better spent on religious indoctrination, especially for young people. There are many, especially in the halls of power, who agree with him.

You’d think that with the crumbling of the “pray away the gay” philosophy, these people would be hesitant to attempt changing someone’s internal constitution and thought processes simply through the exercise of religion.

Make no mistake, it’s an exercise that is doomed to failure. God does not miraculously grant the right balance of neurotransmitters to the faithful. He does not prevent or cure schizophrenia in those who pray to Him. He does not see to it that tendencies to mental disorders are not handed down through the generations in godly families. Mental illness can strike anyone and does afflict one in four people at some time in their lives. Surely that 25% of people are not all secularists. Just because people with mental disorders are sometimes shunned by faith communities (and that does happen) doesn’t mean that they aren’t religious enough.

Morality is not just for the mentally healthy and mental illness is not just for the immoral. If we let this absurd statement go unchallenged, we are setting ourselves up for more stigma, less funding, less freedom, less choice, and less dignity. If we make sure to oppose this dangerous notion whenever we encounter it, we are doing ourselves, our families and friends, and our nation a service. Educating people about mental illness may begin at home, but it needs to spread to society at large or we will be bombarded by more of these ridiculous, dangerous theories.

Black-and-White Thinking

 

My husband used to have only two categories when he reacted to something: It was fabulous or it was wrecked. There was nothing in between. If he cooked a dinner and I said it was “okay,” he heard “wrecked.” If I said “good,” he heard “wrecked.” Only the most superlative of adjectives would convince him that I appreciated his efforts.

Of course, this was a holdover from his childhood, one called “black-and-white thinking” or “all-or-nothing” thinking. And what that is, is a kind of cognitive distortion, a skewed way of thinking that does not represent reality,

Cogbtherapy.com has this to say about the subject:

A cognitive distortion is an automatic way of repeatedly interpreting a situation that causes us to not consider other ways of thinking about it. When we over-rely on cognitive distortions, we usually interpret events in such a way that fuels emotions such as anxiety, depression, or anger. All-or-nothing thinking is one such distortion.

All-or-nothing thinking refers to thinking in extremes. You are either a success or a failure. Your performance was totally good or totally bad. If you are not perfect, then you are a failure. This binary way of thinking does not account for shades of gray, and can be responsible for a great deal of negative evaluations of yourself and others.

http://cogbtherapy.com/cbt-blog/cognitive-distortions-all-or-nothing-thinking

Indeed, my husband was prone to depression and thinking poorly of himself. He would never be as good as his brother, as successful as his father and mother, as artistic or musical or smart as he wanted to be.

Fortunately, he eventually got over this. It’s really tiring to keep thinking of better and better ways to describe dinner. Now I can give accurate feedback, like “satisfying,” or “good enough.” Not everything has to be fantastic.

I must admit that I share in this kind of cognitive distortion. I think it may go with bipolar disorder, which, after all, includes swings from one end of the emotional spectrum to the other. But some people attribute it to my having been a Girl Scout or making straight As in school. What I remember is learning it from my parents. When a cousin, for example, screwed up, they would say with a tone of disgust, “Well, I guess some people have to learn from their mistakes.” What I heard was that some people, the good, smart people, didn’t have to learn from their mistakes because they didn’t make mistakes. It was a perfect set-up for making a little girl try to be perfect.

Later in life, I found some flaws in that line of thought. My first experience with a grade of D came in high school in Enriched Geometry. The “Enriched” part was having to do three-column proofs instead of two-column proofs, with the third column being the name or number of the theorem of corollary you were using. I thought that was stupid. You could always look up the theorem or corollary if you really needed to know it. As long as you knew how it worked, I thought, that should be enough. So I didn’t memorize them and I got a D. (Many years later, I was able to hang five pictures, four in a square and one in the middle, which proved to me that I did indeed know enough geometry to get by, theorems and corollaries or not).

I also learned that, according to my parents, perfection was only for me, not for other people. When some work friends of mine started living together, I expected my parents to freak at the sinfulness. They didn’t. But when I did the same thing, they refused even to enter the house.

I know that Cognitive Behavioral Therapy specializes in counteracting distorted ways of thinking, and maybe it would have helped me (or my husband) get over it more quickly or efficiently. But the lesson I eventually learned was that I could be not-perfect and it wouldn’t destroy me. I hung those pictures. I moved on from that relationship and my parents accepted me. I did end up in a job (editing) that requires one to be as nearly perfect as one can regarding as many details as possible, and I suppose that’s an example of turning a negative into a positive.

But if – that is, when – I make a mistake or miss perfection by however wide a margin, my thinking isn’t so disordered that I assume I’m a failure. Black-and-white has been replaced by all manner of shades of gray. That’s really where everyone lives.

Why People Don’t Believe in Mental Illness

Some people just don’t believe that mental illness exists. There are reasons for this. Not good reasons, but reasons.

I recently saw a meme that blamed mental illness on capitalism. There was no mental illness per se, only the toxic effects of a culture that compels us to put up with overwork and underpay, exploitation and inescapable drudgery. The stress of dealing with these conditions is what causes us – an increasing number of sufferers – to feel depression and anxiety.

There may be something to this, sort of. Environmental conditions that lead to stress and anxiety can certainly make mental illness worse, particularly those like bipolar disorder and other mood disorders. And, while capitalism may or may not be the cause, the majority of us are working harder with less to show for it than ever before. But the majority of us are not mentally ill.

My mother may have bought into this philosophy. She knew I had mental troubles, but she thought that if only I got a better job, I would be all better. Admittedly, finding a better-paying job that was less stressful would improve anyone’s mood, but it can do little or nothing for a clinical mood disorder.

Then there are people who seem to “believe” in mental illness, but really don’t. These are the people who acknowledge that mental illness exists, but think that it is a “choice” – that any person can choose happiness, health, or sanity merely by an effort of will. Those of us who can’t “pull ourselves up by our bootstraps” are simply not trying hard enough. The “choose happiness” people don’t seem to get that for most of us, our only choice is whether to get help from someone else – a doctor who prescribes a psychotropic, a therapist or counselor who listens or advises, or even a friend who reaches out.

And, of course, there are people who acknowledge mental illness, but think it is a good thing, the fount of creative brilliance. They point to Vincent van Gogh and his amazing art. They forget about the suffering, the self-harm, and the suicide.

But, romanticizing mental illness and even revering it do nothing to help people who actually have psychiatric conditions. It’s true that some people with mental disorders – Sylvia Plath and Dale Chihuly, to name two in addition to van Gogh – have created works of great art, beauty, and significance. But it’s certainly valid to wonder what they would have produced if they had not had the trials of mental illness to deal with. Would their work have been less inspired or more? It’s impossible to say. Personally, I believe that mental illness interferes with creativity more often than it enables it.

But the most common reason, I believe, that people don’t recognize the existence of mental illness is that it has never touched their lives, isn’t a part of their perceptions. A relative of mine once watched a talk show where women recounted dire experiences of having hysterectomies. “Those women are such liars,” my relative said. “I had a hysterectomy and it was nothing like that.” Her perception of reality – her personal experience – was extended to the whole world.

Similarly, when someone has no direct experience of mental illness, either by having a disorder themselves or by knowing someone very close to them with the disorder, the reality of mental illness itself comes into doubt. “No one I know has it, so no one does.”

Sometimes people who believe such things are capable of changing their minds, though. If a woman goes through a profound, long-lasting exogenous depression after the death of her husband, she may have more sympathy and understanding for people who have profound, long-lasting endogenous depression, or major depressive illness, as it’s more commonly known. Or a dear friend’s struggles to help a schizophrenic son may awaken her to what mental illness truly can be. Once it touches her life in some way, mental illness becomes real.

And since, according to statistics, one in four or five Americans will experience some type of mental or emotional disturbance in their lifetimes, the odds increase that people’s personal experience with mental illness will also increase accordingly.

In the meantime, those of us in the mental health community can help spread the word that mental illness does exist, that it affects the lives of millions of people, and that even people who are not directly affected need to understand how easily it can happen to someone they know.

Blaming mental illness on capitalism, overwork, or an insane world may be easy and may make us feel better by comparison, but it will do nothing to address the actual problem.

Permission to Be Depressed

Depression can be so riddled with guilt. Why am I not able to fake being okay? Why do I isolate when what I need is interaction?

Sometimes what I need is to give myself permission to be depressed. I have bipolar disorder 2, with a heavy depression component. It has overwhelmed me many times. I have fought against it, given in to it, tried to make compromises with it, tried to ignore it – almost any reaction you can imagine. Then I learned how to give myself permission to be depressed.

This is not quite the same as giving in to depression. It involves acknowledging that I am depressed and allowing myself to feel the feelings that I have. Of course, I don’t give myself permission to be permanently depressed. In a way, it’s more like giving myself permission to practice self-care and not to force myself to smile and bull my way past the depression. I recognize that I am depressed and do what I need to do to get through it. That may be staying in bed. It may be crying. It may be wallowing in sad music. These are things that I’m likely to do anyway when I’m depressed, but giving myself permission to do them is surprisingly freeing.

I used this technique probably for the first time when my husband and I went on a “barefoot” cruise vacation. It was something we both enjoyed and both want to do again someday.

But I knew from the beginning that depression might overtake me – probably would, at that time in my life – even while I was doing something enjoyable. Naturally, I didn’t want the depression to ruin the whole vacation, so I decided to give myself permission to do what I needed to do to cope with those feelings.

Most often, that involved retreating to my bunk for a nap. This enabled me to get away from other people when I was feeling overwhelmed and unable to socialize. Sure, I missed some of the onboard and shore activities, but I wouldn’t have enjoyed them anyway while in the metaphorical fog and darkness. I enjoyed what I could, then let myself not do what I didn’t feel up to doing. I didn’t try to make my husband stay with me and miss all the fun. There wasn’t anything he could do for me anyway. If the other passengers thought it was odd – and they did – they barely mentioned it to me. My husband told them I was tired. Seasickness was also a believable excuse.

In a way, having bipolar depression at that level is like having the flu. I feel bogged down and logy, inclined to cocoon, rest, and stay away from other people. I realize this is not always possible, but if it is, I can allow myself to do it. Fortunately, this spell of depression wasn’t so bad that it completely incapacitated me as it has at other times in my life. I was still able to feel enjoyment at some times, though not at others.

At other times, I’ve had to give myself permission to have anxiety. If a situation makes me anxious, I acknowledge that I am nervous, and do what I need to do. I can’t “think away” my anxiety, but sometimes I can get myself out of the situation at least temporarily. I do not have to sit and be anxious while people around me argue or shout at each other, one of my anxiety triggers. When I recognize how I’m feeling (which takes practice) and give myself permission to feel the way I feel, I’m better able to come up with coping mechanisms, such as leaving the room to get some fresh air or making myself a cup of tea.

You may notice that when I give myself permission to be depressed or anxious, part of my solution involves avoiding other people. That’s sometimes a hard thing to do. Isolation can certainly make depression worse, but it can sometimes also be necessary if pushing through, trying to smile, mingle, and socialize will make the depression worse in the end. And I have learned that if I try to do that, the depression comes along with me. Once a friend told me that it was like having a separate person with me, a person called Misery. Better to give myself permission to stay home and give myself some self-care.

What I can’t do is give myself permission to stay depressed or anxious. Giving myself permission is a very limited-time offer. It doesn’t work for those really lingering, midnight-dark depressions that last for weeks or months on end. Those, I have to fight. And while I’m depressed, I don’t give up on meds or therapy. Those are necessary to alleviate the depression instead of resigning myself to feeling it.

In Remission

My bipolar disorder is in remission. I know I’m not cured. There is currently no cure for bipolar. But I’ve reached a point where I’m stable enough that I don’t expect a crash or a buzz to descend on me at just any old time.

I still get moods, of course. They’re just not severe or long-lasting enough to be symptomatic. Yesterday, for example, I spent several hours wrestling with phone trees and people who wouldn’t switch me to a supervisor when all I was trying to do was straighten out a couple of bills that contained errors. Afterwards, I felt frustrated, cranky, and a bit sad. But those were normal emotions, based on what I had just gone through. After a nap I felt better, and dinner blew out the remaining cobwebs. Napping is definitely better than staying in bed the entire next day.

Of course, I didn’t achieve remission alone. It took years of doctor visits, therapy, and medications to reach this state. I am particularly grateful for mood levelers. For me, they actually do what they’re intended to do. They keep my moods within an acceptable range, or at least one that’s acceptable to me.

Too many people fear mood levelers, I think. Level moods sound boring – as though there are no variations, just a blank, straight line. That simply isn’t so. Mood levelers have pushed the spikes that used to go wild in either direction to a less extreme range. If you think of mood as an EEG, mood levelers prevent the lines from going off the charts, settling them to fluctuate within a middle range that most non-bipolar people have naturally.

I think the term “mood leveler” scares some people. They seem to think that such a drug would make them perfectly level, robotic, unchanging. They fear that any spark of personality or creativity would be lost.

That’s not the case. Instead, with level moods – and especially for depression-prone bipolars – a person has much more ability to explore his or her creative side.  I know that’s true for me. Now that my moods are stable and level, I’m able to get more writing done, but also to tell whether the work is good or needs serious revising before I post it.

My doctor recently increased the dosage of one of my medications, a mood leveler, because I was having trouble with hypomania that wouldn’t let me sleep. And it worked. I am now getting seven to eight hours of sleep each night and have enough energy to at least face the day, if not always to conquer it.

Don’t think mine has been a case of spontaneous remission. I’m not sure I believe that’s possible with bipolar disorder. It’s taken a lot of years and a lot of work to get to where I am today. For example, it took literally years for assorted doctors and me to find a combination of chemicals, a cocktail of psychotropics, that would work for me. And during all that time, it was as if I was not medicated at all. Only the right combo of drugs and dosages would unlock my brain and level my moods.

So, here I am, in remission – and I love it. My moods aren’t blunted, they’re leveled. I am not as fearful now that my extreme moods may return and wreak havoc on my life. Oh, I still have some symptoms and side effects that remind me I’m not cured. But now I know that remission is possible, with work, with luck, and with the right mood levelers.

Nothing to See Here

Many people with SMI are afraid that it shows, that other people can see automatically that there is something wrong with them. They feel as though they stand out in a crowd. Everyone notices them, and probably talks about them.

I have the opposite problem. My bipolar depression makes me feel invisible. It’s not just that SMI is often an invisible illness. It’s that I myself seem to become invisible. I think of myself as a particularly ineffectual ghost, frightening no one and unable to affect anything in my environment. Some people call this dissociation.

At first, I made the best of it. I’m especially invisible when I’m out in public and reading a book. So I found that if I was at a business convention and wanted to remain invisible, my best strategy was to sit alone at a table and read a book. Only once did a man approach me while I was so engaged. No one else ever did.

Apparently, though, I don’t need a book to disappear. Maybe it’s anxiety that makes me keep quiet when people around me are discussing something interesting. Maybe it’s my instinct not to be noticed so I won’t be subject to derision or worse. Either way, I can’t seem to catch anyone’s eye or add my bit to the conversation. I blend into the crowd, even if it’s only a crowd of three or four.

It’s almost like there’s some aura around me when I’m out in public that says, “Don’t notice me,” like Harry Potter’s cloak of invisibility. I do not use my invisibility for pranks or mischief, though. I don’t use it intentionally at all (except for using a book, as I mentioned).

Why do I think this invisibility is part and parcel of my bipolar disorder? It could be imposter syndrome at work. I feel so unworthy that I don’t want anyone to see me for what I am. Or it might be the anxiety component of my hypomania that keeps me from presenting myself more assertively. Or maybe people can see that I have a troubled mind and simply look away.

I am slowly learning to make myself seen and heard. I find that calling people by name makes it easier for them to see me. It seems to signal them that there’s another person in the vicinity. And once I even set up an occasion where I would be the center of attention, speaking about my bipolar disorder at a signing for my book.

I also use my writing to make myself “visible.” This blog (and my other one) and my books give me a presence, though not a physical one, even at a distance. When I see likes and follows and sales, I know that someone has noticed me, or at least discovered that I exist.

I sometimes think that going out in public more – practicing being visible – might help. But actually, that’s when I feel the most overlooked, the most unseen and unheard. The most lost.

Perhaps what I need is to go out and meet a specific person, someone who expects to see me. Then I could be guaranteed of one person who would see me.

But it has been suggested to me that I may not want to be seen at all – that I would prefer to fade into the background, not put myself forward and disappear from the stresses of being seen. Perhaps that is true, or at least once was.

Now I think I would prefer to be seen, flaws and all. If someone cannot tolerate the sight of me, a mentally disordered person, or glances over me as if I did not exist, I think I shall insist on being seen. I will use my voice, my (admittedly glitchy) brain, and my human physicality to assert that I exist, that I matter, that I have something to say.

And in social situations I will try to assert myself (if politely) to join the public discourse and add my two cents, whether the subject is mental illness or the latest bestseller.

I exist. I deserve to be seen. I will not remain invisible.

Mental Illness: Fact and Fiction

I’ve had a bit of experience with mental health and nonfiction, though none so far with bipolar fiction. But lately, I’ve been thinking about it.

Bipolar nonfiction is (comparatively) easy to write. There are numerous memoirs, essays, and blogs – including my own. Bipolar disorder has not appeared much in fiction, however. There are reasons for this.

First, let’s tackle the idea of mental illness in “genre fiction” (fantasy, science fiction, mystery, horror, and the like – not mainstream fiction, anyway). A friend of mine recently attended the World Science Fiction Convention in Dublin, Ireland, where they had a panel discussion on just that topic.

My friend reports that the panel “had a mental health nurse, a psychologist and some writers talking about portrayals of mental illness that got it right or wrong.”

He went on to add, “Consensus seemed to be that the Punisher completely nailed PTSD, that Drax in the first GotG movie nailed Aspie but that they rewrote him into a cute Manic Pixie Dream Creature for the second one; and the depiction of Sheldon from Big Bang is an abomination against God and Man.” (To unpack that just a bit, the Punisher is a character from Marvel, GotG means the “Guardians of the Galaxy” movies, and “Manic Pixie Dream Creature” is a riff on “Manic Pixie Dream Girl,” a trope in which one woman (the MPDG) opens the hero’s eyes to life lived fully so that he can then go off and win his One True Love, who is not the MPDG.)

I myself have no experience with the Punisher and saw only one of the GotG movies. Sheldon from The Big Bang Theory is a character I know a little more about. As I understand it, Sheldon Cooper is not intended to represent a person with any particular sort of mental illness (as he always points out, “My mother had me tested”). Still, the character exhibits behaviors that are often associated with Asperger’s, OCD, and perhaps some other mental illnesses or conditions.

I have read that Jim Parsons, the actor who portrays Sheldon, did no research on any of those conditions or illnesses because he didn’t want Sheldon to represent a person with any particular disorder. This allows the viewer to read into the character whatever he or she believes Sheldon’s “problem” is (if any).

But an important point was brought up in the book Philosophy and The Big Bang Theory. One of its essays questioned whether the audience should feel comfortable laughing at Sheldon. If one believes that he has a mental illness or Asperger’s, the answer is, of course, “no.” Yet most of the audience does – apart from those who see the portrayal as an “abomination.”

It’s so hard to get a portrayal of mental illness right, on TV or particularly in genre fiction. Take bipolar disorder, for example. Abigail Padgett’s Bo Bradley series of mysteries features a protagonist who has bipolar disorder. But most of the depiction depends on whether or not the character is having a manic episode at any given time. While the depiction is laudable – and I like the series immensely – it is telling that bipolar depression is seldom a plot element.

Perhaps this is because depression is too, well, depressing to write or read about. A character who is unable to leave her bed or who questions her very existence is hardly likely to move the plot forward. Searing depictions of depression, both bipolar and unipolar, have been written about, but almost exclusively in nonfiction. Even those can be hard to read for someone who experiences clinical depression.

Depression, however, did become a metaphor in the writing of J.K. Rowling. She has said that in her portrayal of “Dementors” in her Harry Potter fantasy epic, she was specifically thinking of depression and its soul-sucking effects on those who suffer from it. That’s genre fiction and that’s doing mental illness right.

In talking about mental illness and genre fiction, I’m deliberately ignoring the many portrayals of sociopaths in shows such as Dexter. Those are stereotypes too, but I’m wondering about less “drama-friendly” mental illnesses. Dissociative identity disorder seems to be one of the few other mental illnesses that feature prominently in popular forms of fiction, usually in the psyche of a villain. You could also count the many detective characters suffering from PTSD, a commonly used trope that is seldom examined closely but rather serves as a personality trait associated with violence.

I wasn’t at the convention and didn’t hear the panel (though I would have loved to), but it raised interesting questions. What would a protagonist (or other character) with bipolar disorder be like or do in what is too often a formulaic plot? Can a mentally ill character be portrayed accurately within the confines of genre fiction? Can mental illness be anything but a metaphor – or be experienced by a character other than one played for laughs? Is there any such book that I should be reading?

I don’t have the answers. But we need facts in fiction. We need understanding. We need representation. I haven’t tried to write fiction featuring a bipolar character, much less a main character who is bipolar. 

Maybe I should.

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