Bipolar 2 From Inside and Out

Posts tagged ‘mental illness’

Do I Have PTSD?

Once a therapist I was considering going to put down on my form that I was suffering from PTSD. She based this on the fact that I was having nightmares and flashbacks to the toxic relationship that I counted as a significant part of my past.

It was rubbish, I thought. I had never been in the Vietnam or Iraq war. And her idea of my trauma was that I supposedly had been coerced by an older man into doing sexual things that, had I been in my right mind, I would have objected to.

I chose a different therapist, who was bemused, to say the least, at that therapist’s notes. I had had a relationship with an older man and done sexual things that were not precisely the plainest vanilla, but I had surely not been coerced into them. (The gaslighting was a separate issue, one I did not recognize at the time.)

I still have the dreams of being back in his house, and I am occasionally triggered by things that remind me of the relationship, especially when I am depressed or otherwise vulnerable, but by and large, I don’t think that I have PTSD based on that.

Then, recently, I was hit with a more physical trauma. I survived a tornado that destroyed the house I was living in, taking the roof off the second floor where I was sleeping. I have also had nightmares about that and anxiety whenever there are storms and lightning. So, do I have PTSD now?

Let’s see. For starters, mirecc.va.gov provides a “civilian checklist” of PTSD symptoms:

  • Avoid activities or situations because they remind you of a stressful experience from the past
  • Trouble remembering important parts of a stressful experience from the past
  • Loss of interest in things that you used to enjoy
  • Feeling distant or cut off from other people
  • Feeling emotionally numb or being unable to have loving feelings for those close to you
  • Feeling as if your future will somehow be cut short
  • Trouble falling or staying asleep
  • Feeling irritable or having angry outbursts
  • Having difficulty concentrating
  • Being “super alert” or watchful on guard
  • Feeling jumpy or easily startled

To begin with, many of the symptoms which I have are also indicative of depression, anxiety or bipolar disorder – loss of interest in enjoyable pursuits, sleep problems, difficulty concentrating. And I have noticed a few of the other signs – jumpiness and irritability, for example.

But, by and large, aside from the dreams and flashbacks, I have few symptoms that are attributable to PTSD but not to bipolar disorder.

I was talking with my therapist the other week and posed the question to her: Could I have PTSD?

“There are all kinds of trauma,” she said, “and all kinds of reactions to it.” I think what she meant was that I didn’t need to worry about having a specific label. I have been through traumatic events and I have had reactions to them. The reactions and symptoms may not rise to the level that constitutes clinical PTSD, but I have been affected by them nonetheless.

I don’t want to minimize the suffering of those who have been diagnosed with PTSD or those who are suffering from it without ever acquiring the label. I know that what I have experienced cannot compare to what some of them have experienced, and I can only hope it never does.

But still I think there are a lot of us out there who could count ourselves among the “walking wounded,” who have experienced physical or psychological traumas and still have adverse reactions to them. Call it borderline PTSD or some other type of stress disorder, if using the label PTSD seems arrogant or insensitive.

But know that there are other traumas besides war that can leave a person damaged, struggling to find themselves among the shards of a shattered world. We may not have lost a part of our physical selves, but the damage to our psyches can be just as real.

 

 

Growing May Take a While

I saw a meme the other day that said, “Grow through what you go through.” I thought to myself, “This is going to take a while.”

Now, I’m not saying that the meme promotes a bad idea. I just mean that it’s not as easy as the meme makes it sound. Memes are like that. They encapsulate a difficult and painful process into a succinct platitude that never captures the reality of what it purports to express.

It is certainly possible to grow because of bad experiences that you have gone through, and I have surely done this. But it hasn’t been quick or easy. Not that it is for anyone, but especially not for people with serious mental illnesses.

Bipolar disorder, and bipolar depression in particular, often leads one to recall and obsess about the very things one would most like to forget. (Of course, this happens with unipolar depression, too.) It’s like having a recorder in your head that replays the most painful, embarrassing, humiliating, or devastating events in your life. And there is no “off” button or even a “pause.”

Getting through something is not the same as getting over something. And growing through something is something else again. It takes as long as it takes. There is no way to rush it or to speed it up.

Take grief, to choose an example that most people with and without mental disorders are familiar with. I saw a TV show once in which various characters were concerned that the hero had not “gotten over” the death of a friend as quickly as they thought he should. I remember thinking, “That’s stupid. There’s no arbitrary limit on how long a person should grieve.” I know that in days past, a mourning period of a year was customary, with restrictions on dress and activities. That’s stupid too. It may take a few months or a year or the rest of your life, depending on how close you were to the deceased and the circumstances of her or his death.

Deaths don’t have to be physical, either. The death of a relationship can be just as soul-searing, as traumatic, as a literal death. It’s still a loss and one that you may have put your whole heart and soul into.

Of course, it’s great if you can grow through the experience. It’s possible to acquire a new depth of spirit when you go through something traumatic. You can emerge stronger and more resilient and more compassionate because of the experience. I think that’s what the meme was talking about.

But if the trauma – the death or separation or other experience – is fraught with pain as well as grief, then growing through it can be even harder and take even longer. A son whose abusive mother dies has feelings that can hardly be expressed, a jumble of emotions that’s almost impossible to articulate, much less grow through. The end of a relationship with a gaslighter may evoke relief as well as grief, conflicting emotions that can impede growth. These and other situations can call up memories and feelings that one wants to escape, not dwell on. But processing them seems perhaps the only way of growing through them.

That process cannot be rushed. It may take years of bad dreams and flashbacks – at least it did for me – as well, perhaps, as a period of therapy that, like grief, takes as long as it takes to make progress in growing through whatever happened. From outside the situation, it may seem like the person is wallowing in the pain or grief. But on the inside, the process of growing may be occurring at a rate that you can’t see or understand.

In other words, if a person has been through a trauma, don’t expect him or her to “get over it” on what you think is a proper timescale. Some plants, like dandelions, grow incredibly rapidly. Others, like oaks, grow incredibly slowly. For each, it takes as long as it takes.

 

The Stressor I Didn’t Realize I Had

You’ve seen those lists of life stressors, the ones where they assign you so many points for each stressful life event that occurred during the past year and use the total to calculate the likelihood of your becoming physically ill. Death of a spouse or child is at the top of the list, for 100 points. Marriage, divorce, taking out a mortgage (or losing your home), and even retirement are on the list.

The lists you find in various places differ in the details. Some list only ten major stressors, while others list 20 or more. (Nowhere in any of the lists does being diagnosed with, or living with, a serious mental illness appear. Apparently, only physical illnesses are considered stressful.)

I’ve managed to avoid a lot of the major stressors this year, though I can count retirement, my husband’s heart attack, and losing our home in my total. But there was one life event on one of the lists that I hadn’t even considered: changing one’s residence.

When I thought about it I could understand it, though. Moving is a major disruption of your life. It entails endless details, physical effort, and a need for psychological stamina. Packing up your life in boxes is itself a stressful process. (Hell, I get stressed just packing for a vacation.)

In the past month and a half, we’ve moved a total of four times, if you count the night we were evacuated from our tornado-damaged house to the Red Cross shelter. (Not that we did any packing for that. The rescue squad just yelled, “Grab your medications and come with us!”) We then moved to a hotel, then a pet-friendly hotel, and finally to a rental house where we can stay for up to a year while our house is rebuilt. (We had good insurance.)

It was the last move that was possibly most traumatic, though it was the one that brought us closest to a “normal” situation. A whole house. A full kitchen. A backyard. A mailing address. Like the hotels, it came with various rented amenities such as linens and dishes that made the transition easier, but it was still foreign to us.  We’ve been here for a couple of weeks now and are adjusting, but it’s undeniable that the whole process has stressed us very badly.

I know that we are fortunate in so many ways. The closest we came to true homelessness was the day spent in the Red Cross shelter. We both survived the tornado physically intact, and so did our cats. We know we still had a lot to be thankful for, and we were, and are.

The tornado was the really big stressor, but I only recently realized how much stress the constant moving added to the toll. As a person with bipolar disorder, I find all these moves jarring as well as stressful. I like to cocoon, rarely leaving the house. I want my comfort objects around me. The series of moves tapped into my fear of abandonment, my anxiety around packing, and my feeling of being overwhelmed by life. My husband, who is given to depression, feels the loss of all the things that embodied his memories very keenly. Our local paper observed that many of the tornado victims were suffering PTSD. I may be among them, as I have had tornado dreams and other sorts of upsetting ones.

Will we succumb to stress-induced physical illness? Who knows? Have we been suffering from the psychological effects of stress? Definitely. If you had asked me two months ago whether moving was a stressor, I would most likely have said yes.  But I had no idea of the reality. We had intended to stay in our home for the rest of our lives. When suddenly that became not an option, we came unmoored both physically and psychologically.

Stability has always been a problem for me, but now my husband and I have even less of it than usual. When we finally get a chance to settle in, take a deep breath and a day off, perhaps the stress will lift a little. But until then, we’ll keep slogging through it.

 

When Trauma and Mental Illness Happen Together

Couples who experience serious trauma may go through the experience together, but they do not always stay together afterward. The death of a loved one, infidelity, the onset of a disease – many things can test a couple’s ability to cope with the event and with each other.

Serious mental illness can also be a relationship killer. Dealing with symptoms, treatments, medications, setbacks, hospitalization, mood swings, and just generally going off the rails is more of a task than many couples can handle.

Combine serious trauma and serious mental illness, though, and what you’ve got is a recipe for a new level of disaster.

One of the potential pitfalls is two people who grieve in different manners or on different timescales. One partner may feel it necessary to process events aloud and at length, while the other may prefer to process feelings internally, without conversation. One person may take a year to get over a death, while the other is still grieving after three or more.

Then there’s couple who have different agendas when it comes to whatever is troubling them both. One may feel that moving on is the best response to a traumatic event, while the other person can’t let go of the past.

Many relationships crack and break apart under the strain. And those are just for couples who don’t have mental disorders.

Now take an example (not completely at random) of a couple who have lost their home in a natural disaster. He suffers from depression. She has bipolar disorder. He grieves the loss of their home and all their belongings to a point that she considers excessive. She kicks into hypomania and focuses on the small details of their situation. He thinks she doesn’t grieve. She thinks he needs to help her address the future.

It will be easier for this couple to stay on track and stay together if they can talk about what has happened and what is happening. That may well involve talking with other people – a trusted friend, a professional counselor, even each other. But it’s important that both people feel that they are being listened to and, more importantly, being heard. And that’s not always something that the other partner can provide.

If the couple can talk to each other, their communication skills will be severely tested. Depressed people and those with bipolar disorder both tend to isolate in times of stress. Processing feelings may not be either person’s greatest strength. And those different timescales and differing agendas are likely to throw up roadblocks should they try to talk about it all.

Being aware that trauma and mental illness both have detrimental effects on a relationship may help. Although even previously strong relationships can be stressed to the breaking point, stepping outside oneself to try to understand the other person can be enlightening. Feelings that seem callous or stubborn or flippant or shallow can just be different ways of dealing with trauma. Thinking the way you feel is the only way to feel will severely impede healing.

If it sounds like I am trying to remind myself of all these things, well, I am. We lost our home in a tornado, and my husband and I were dealing with mental difficulties before that happened. I feel that I must be on alert now for any signs that our relationship is cracking. But it’s not just my problem. The disaster, and the mental disorders, and the relationship are things that we share. They have led to a tangle of emotions and reactions that aren’t predictable or rational or even helpful.

We know the basic things we need to do – take our meds, practice self-care (and help each other do so as well), talk when necessary and be alone when that is what’s needed. We have to keep our eyes on what’s important: our mental health and getting through these difficult times intact both personally and as a couple. And we need to see the humor where there is any. But this isn’t the ordinary sort of disagreement that lasts a day or a week. It’s something we’ll be working on long-term.

Wish us luck.

When Will My Breakdown Happen?

For those of you who follow this blog, this is another chapter in the saga of our experience with the Memorial Day tornado, which destroyed our house. My husband, who lives with depression, and I have been coping very well so far.

I saw my psychiatrist on Saturday. During the session, I mentioned that I hadn’t had a breakdown yet, but that I knew it was coming. “I hope not,” he replied.

Frankly, I think he’s being unrealistic. I keep saying it will come when we are settled in a living space, which we now are (a rental house) and when I don’t have to deal with insurance, housing, furniture, landlords, finances, utilities, and the thousand-and-one things that I’ve been in charge of dealing with. (Dan has been in charge of the more physical stuff, like salvage at our dearly lamented former house. He’s better at that and I’m better at working the phones and the computer.)

I think my brain will want to decompress with a crying jag and a couple of days in bed, at the very least. I plan to start work again next Monday, so it will likely happen during this next week. I know you can’t schedule these things, but I hope that’s the way it works out.

Dan is already at the ragged edge. He went back to work a couple of weeks ago, though physical health problems interfered with that somewhat. On Saturday he slept the whole day, having worked all night without sleep, owing to our moving out of the hotel and into the house in just a couple of hours. His emotions are also closer to the surface, too. He’s expressed anger at the salvage people and a need to cry when he sees what’s left of the house and our belongings.

Much as I dislike having breakdowns, or mini-melt-downs, or whatever you call them, I think sometimes they are both necessary and inevitable. When a bipolar brain gets too clogged up with the effort of coping during especially trying circumstances, it seems only natural that when the stress lets up even a little, that brain will need to let out all the feelings that have been suppressed while dealing with the crisis.

Bottling up your feelings is generally not a good idea, but sometimes you just have to in order to keep going. But like a shaken bottle of soda, the pressure builds up and there has to be a way to release it. The metaphoric bottle may simply explode, spraying shrapnel and its contents over everyone and everything within reach. This is not pretty, but it is understandable.

Keeping your feelings suppressed too long – putting them in a box and sitting on the lid – is not healthy, either. If you don’t allow yourself to feel the emotions and deal with them, they may fester and spring out of the box at the most inopportune time. Or you may turn off your emotions entirely and not be able to feel anything – including relief and satisfaction, in addition to the distress, anger, and/or despair that are in that box. A lot of us, including me, have done this for years in the course of our disorder. Feeling nothing but numbness can seem appealing if the alternative is chaos and pain.

So, in a way, I am hoping that I do have a bit of a breakdown, in a safe space where I can rage, weep, isolate, and grieve what we have lost. I don’t think I’ll be quite whole again until I have gone through the emotions that I’ve been putting off.

This week I’ve made an appointment with my psychotherapist, whom I stopped seeing about a year ago. I hope that she will be able to help me process the process, as it were. I think it’s definitely time for a “check-up from the neck up.” Maybe in her office, I will find that safe space and begin to feel the feelings that I know are hiding somewhere deep inside me.

 

Helping Someone Else

My husband used to work in a community correctional facilityessentially a jail. The residents were considered nonviolent offenders technically on parole for mostly drug crimes, but things could still get interesting. Mostly he didn’t talk about his work because he would try to dismiss it from his mind every day as he went by a certain overpass on his way home from work.

One day, though, I was bitching in disbelief about something that had happened at my work – another editor had put his table of contents in random order instead of numerical. I was appalled by the stupidity of that.

There I was ranting about it. Then my husband said, “Boy, that’s tough. All I did today was break up a fight and spot a guy who might have a septic wound. But you – the table of contents out of numerical order? Wow!” That put me in my place.

My husband was someone who helped other people. For years after he left the job, people would come up to him when he was out and about, and reminisce with him. They’d tell him about how well they were doing, how they were clean and sober, how they had jobs, how they had improved their lives. They always said thank you to my husband.

This morning when I woke up and checked my email, I found something I wasn’t expecting. There, nestled in amongst the spam, was a response to a post that I wrote back in January, about passive suicidal ideation (https://wp.me/p4e9Hv-Me).

In the reply, the person told of having thought about suicide but not acting on it. The response ended, “I’ll follow your advice and seek professional help.”

It’s difficult to describe what I felt then. Mostly, it was gratitude that my writing had helped someone, combined with not a little surprise at receiving a response at all. Sometimes writing is like shouting down a well. You never really know if anyone even hears you or if you’ve made a difference. Most of the time when I write this blog, I have no idea how the posts will affect my readers, if at all. But this time I knew – at least if the person followed through – that I had actually helped someone.

When I started Bipolar Me, it was to share my experiences with bipolar disorder and my thoughts on mental illness and mental health. If my writing resonated with someone, good. But I wasn’t writing with the intention of being inspiring, or helping people solve problems, or being a “good example.” I’m not a professional and the kind of advice I give (when I do) is largely commonsense – don’t stop taking your meds, seek professional help, thank your caregivers, and so on.

I’m not going to break my arm patting myself on the back here. There are lots of people who do the work of caring for the desperate and hurting every day. I am privileged to know some of them and to have even been helped by some. There are people like Sarah Fader and Gabe Howard who are advocates and activists for the mentally ill, who go out on a limb to do something to help the whole mental health community.

But today, for just a moment, I felt that I had really touched someone, really helped. It was a good feeling.

So there it is. I started this blog for self-centered reasons, to chronicle my own struggles and occasional victories. If it helped anyone, fine. If not, I still had stories to share. But now I find that having helped someone else has made a difference – in the other person, in me, in the world. Now I believe that my blog and my book could do more of that.

Bipolar Moonshine

Honestly, the things they ask on Quora these days! Quora, for those of you not familiar with it, is a website that allows people to ask questions for “experts” to answer. Somehow, I have become one of the people that others come to with questions about bipolar disorder. (Also the Ivy League, but that’s another story.)

Some of the questions are serious, but others are less so. “If you could stay hypomanic all the time, why wouldn’t you?” “How can I get my bipolar dad to stay on his diabetes meds?” I actually had an answer for that: You can’t. And bipolar has nothing to do with it. 

I’ve answered a few of the questions if I had the time or if a good answer hadn’t already been given. Many of the answers are written by doctors, who can do a much better job than I.

Recently, however, I saw a question that I thought it wouldn’t take a medical degree to answer:

“Is bipolar disorder causally linked to lunar cycles?”

Impressed that the writer knew the difference between “causally” and “casually,” I responded:

“No. The cause, as far as we know, is a glitch in the brain between the synapses. There may also be a genetic or hereditary component. But nothing to do with the moon.”

To my surprise, I received a reply. The writer, while asserting that he or she was also bipolar, said that my response was “no answer at all” and incorrect. Acknowledging the genetic component I mentioned, the author then proceeded to enlighten me with an “unpublished hypothesis.” (He or she also claimed to be “a bipolar scientist,” though not a neurophysiologist.)

The argument was based on several points.

  • Sexual reproduction is always in response to lunar cycles.
  • This is based on gravity, illumination, and diurnal and lunar cycles/high tides.
  • Bipolar disorder is a disruption of sleep.
  • It first manifests at or near puberty, with the onset of hormonal cycles.
  • Something about teenagers having a different sleep cycle than adults, staying up later to reproduce while the parents sleep. (I can’t say I understood this part.)
  • During the full moon, hospitals and police report increases in both people out late at night and odd behaviors and emergencies.
  • Anecdotally, the writer noticed “elevated and depressed moods not necessarily linked to lunar cycles, but not necessarily independent of them either,” noting that “periods of mania occur during full and nearly full/new moon.”

The writer’s hypothesis, if I follow it correctly, is that bipolar disorder involves sleep-hormonal cycles related to the full moon, which evolved in the days before artificial lighting. This apparently gave a reproductive advantage of being awake at night because bipolar disrupts the sleep cycle. This is noted to be “an obvious evolutionary reproductive strategy.” There was more, but that was enough for me. (The writer admitted that statistics to prove any of this did not exist or had to be derived from “Bayesian statistical methods,” which one source I looked at called “a measure of the strength of your belief regarding the true situation.”)

So, where to start? First, if the writer thought he or she already knew the answer, why write in with the question? Obviously, to seek validation or to promote a theory (or to make me look like a fool).

I could answer each point individually. (I’m not a neurophysiologist either, but I do have some experience with rhetoric and logic. And bipolar.) But let’s just take a few.

Not all animals’ reproductive cycles are based on the moon, and neither are humans’. Women have menstrual cycles at all times of the month, and men don’t. (And what about bipolar men?)

Bipolar disorder can certainly cause a disruption of sleep, but is not caused by it. That is too simple an explanation for a complex disorder.

We’ll just skip that one about teenagers reproducing while parents sleep. Its connection with bipolar disorder is slim at best.

That one about the full moon is most likely anecdotal, as reported by police and emergency room workers, but no statistics (other than perhaps Bayesian ones) seem to bear this out. And the moon is full, nearly full, or new for more than half the month. Let’s also disregard the fact that bipolar cycles are seldom exactly a month in length. I had a depressive crisis that lasted several years.

Many causes have been theorized for bipolar disorder, from gut bacteria to early trauma to brain wiring. At the moment, as far as I know, the jury is still debating. Perhaps all of these are components of the cause, though I favor brain wiring as the principal cause. But given the actual science, I’m betting that the moon isn’t the answer.

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