Bipolar 2 From Inside and Out

Posts tagged ‘mental illness’

I’m Not Brave – I’m Stubborn

Don’t forget! March 30 is World Bipolar Day!

Kopf durch die Wand

One of my friends, who is overweight, recently told me that when she was at the gym on the treadmill, a stranger came over to her and told her she was “an inspiration.”

My friend felt insulted. She was working out for herself and for her health, not to inspire anyone else or to be taken as a symbol of I-don’t-know-what – perseverance? attitude? effort? hope?

I feel sort of the same way when people say that because I am open and public with my bipolar disorder that I am “brave.”

I’m not doing this because I’m brave. I’m doing it because I’m stubborn.

I am who and what I am, and I’m willing to reveal a lot of it because, frankly, I can’t hide it and don’t want to. I’m not average or typical. Not normal, mentally or emotionally.

I’ve always had a love-hate relationship with the concept of “normal.” Desperately wanting to appear normal, but knowing viscerally that I am not. Wondering what it’s like, but knowing that I’ll never know. Wondering what it even means, or what it means that I’m not. I haven’t found answers yet, and at this point I don’t think I’m going to. It’s probably a waste of my time to try.

So, if I’m outside the “norm,” which I am, I may as well admit it. And since writing is what I do, I write about it. I’m not doing this because I’m “brave,” I’m doing this because on some level I have to. I’m stubborn.

I’m stubborn enough these days to have made a sort of peace with the concept of “normal,” even though I still don’t understand it.

I’m stubborn enough to acknowledge my difference and give it its proper name – bipolar disorder.

I’m stubborn enough not to care when I say that and some people flinch or back away.

I’m stubborn enough to reveal things that embarrass me because they are part of me and part of what I’ve lived and lived through.

I’m stubborn enough to get tattoos proclaiming my status as “mentally ill” and using them to open conversations and educate others.

I have not come to embrace my stubbornness easily. I’ve tried to fake “normal” and hide my differences. I’ve gone to my shrink and just referred to “doctor appointments.” I’ve made Prozac jokes even though I was taking it at the time. (For this I am truly sorry, as I later learned that one of those jokes made another person afraid to admit that she took Prozac too.)

I’m not trying to be an “inspiration.” I’m not trying to prove anything to anyone else. I’m doing what I have to do for me. If someone else finds some good in it, that’s fine. But that’s not why I do it.

I am bipolar.

I am a writer.

I am stubborn.

Taken together, you get this blog.

Bipolar Me.

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Mental Health

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What Is Sanity?

And who is sane?

Negatives Positives Computer Keys Showing Plus And Minus Alternatives Analysis And Decisions
These are questions you don’t hear much anymore, at least outside of judicial proceedings. Even there, the phrase “guilty but mentally ill” is gaining currency. “Not guilty by reason of insanity” made people think a criminal was getting away with something. And indeed, the “insanity defense” has been misused.

We’re much more comfortable talking about health and illness, concepts we all understand, than about seemingly fixed states like sanity and insanity. They sound so final. At least illness can be treated; health can improve.

Before the deluge of psychiatric labels and the DSM, how to tell if a person was sane or insane was a vital question. The insane were put away – in an asylum if they were poor or kept discreetly out of sight at home if they were wealthy.

But were all the people in asylums insane? And what kind of treatment did they receive? Investigative journalist Nellie Bly determined to find out. Her 1887 exposé Ten Days in a Madhouse was a muckraking revelation.

Bly feigned amnesia and delusional fears, was reported to the police by her landlady, and declared incurably insane.

While she was at the Women’s Lunatic Asylum on Blackwell’s Island, she experienced cold, hunger, brutality, and no diagnosis or treatment. Several of the other inmates were, like Bly, sane by any modern standard, but poor, friendless and alone. The newspaper she worked for arranged to have Bly released, but the other women remained to be beaten, choked, starved, humiliated, not treated and driven insane if they weren’t already.

Bly’s ordeal and testimony did prompt a grand jury to recommend an increase in funding of $850,000 – quite a large sum in those days – for the Department of Charities and Corrections, which oversaw asylums. (It is ironic to note that the word “asylum” originally meant a place of protection, safety, or shelter.) But it mainly went for better physical conditions – warmer clothes, edible food, more and better-trained nurses – rather than actual diagnosis and treatment of the women’s “insanity.”

The question of who is sane and how you can tell was revisited in 1973 by psychologist David Rosenhan. A professor at Stanford University, he devised a simple experiment. He sent eight volunteers, including both women and men, to psychiatric hospitals. Each person complained of hearing a voice saying three words – and no other symptoms.

All – all – were admitted and diagnosed, most of them as schizophrenic. Afterward, the “pseudopatients”  reported to their doctors and nurses that they no longer heard the voices and were sane. They remained in the psychiatric wards for an average of 19 days, beating Nellie Bly’s experience by nine days. They were required to take antipsychotic drugs as a condition of their release.

Rosenhan’s report, “On being sane in insane places,” created quite a stir. Indignant hospital administrators claimed that their staff were actually quite adept at identifying fakes and challenged Rosenhan to repeat the experiment.

This time hospital personnel were on their guard. They identified over 40 people as being “pseudopatients” who were faking mental illness. Rosenhan, however, had sent no volunteer pseudopatients this time. It was a dismal showing for the psychiatric community.

Times have changed, of course. Few people are confined in locked wards for life. Diagnosis is, if not yet a science, less of a guessing game, backed up by the DSM and assorted checklists of symptoms. And insurance companies hold the keys to psychiatric units as much as medical personnel do.

Still, the fundamental questions remain. Are neurotics sane and psychotics insane? I have bipolar 2. Am I mentally ill? I would have to say I am, since my condition will require treatment, barring any dramatic scientific advances, for the rest of my life. And my illness does affect my ability to function “normally.” Yet I think that few would consider me insane (unless I were suddenly to start shooting people in a public place, of course).

Speaking freely about mental illness and mental health is, presumably, supposed to make such disorders more understandable, less fearsome, less stigmatized. I suspect, however, that there are those who would rather we remained out of sight – if not locked away in asylums, then restrained in the virtual straitjackets of strong psychotropic medication.

And while group homes and other sorts of assisted living situations are now more available (though not nearly as accessible as the need for them would require), the general public prefers that such facilities, along with halfway houses for addicts and parolees, be constructed “NIMBY” – Not In My Back Yard.

Out of sight, out of mind.

Maybe the conversations surrounding such issues are reducing the stigma of mental illness, or insanity, or whatever you choose to call it, but I’m dubious about the level of success. There’s still a long way to go.

 

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Mental Health

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Is Bipolar Disorder an “Invisible Illness”?

Empty Chairs Laid Out For Meeting

Yes and no.

First, a little on the concept of invisible illnesses. These are the sorts of afflictions that are not apparent on first looking at a person – conditions such as fibromyalgia, chronic fatigue syndrome, celiac and Crohn’s diseases, diabetes, epilepsy, lupus, Lyme disease, and many others.

Disabled-world.com says, “Many people living with a hidden physical disability or mental challenge are still able to be active in their hobbies, work and be active in sports. On the other hand, some struggle just to get through their day at work and some cannot work at all.”

Most mental disorders are invisible illnesses by that definition. There isn’t a sign around our necks that proclaims “Bipolar,” “Social Anxiety Disorder,” “PTSD,” “Depression,” or even “Schizophrenia.”  The word “Crazy” isn’t tattooed on our foreheads. Our mere appearance doesn’t give away our “secret.”

We have a lot of the same problems that people with other invisible illnesses have. Spoon theory, for example. For bipolar people, simply taking a shower requires so many spoons that we seldom go out. (I count myself among that number.) People who don’t know or understand Spoon Theory often don’t understand why we don’t accept their invitations or cancel at the last minute, or simply don’t show up. You lose a fair number of friends that way.

On the other hand, a mental disorder is not always invisible. People can see us burst into tears for no apparent reason, or go into the bathroom at a party and never come out. They can see our shaking hands, confused looks, and depressed expressions. They can hear our awkward attempts to socialize “appropriately.” They may not know what is wrong, but they can often tell something is.

When we realize this is happening, there are various strategies we try. We can leave the situation – entirely or partially (my go-to is to leave the room on the pretext of needing to make a cup of tea). We can try to brush it off or laugh it off (“Sorry. My nerves are bad today” or “I don’t know why I said that. Must be a brain-fart”). We can try the half-truth/half-joke (“Oops. Guess my meds just haven’t kicked in yet”). We can ignore whatever is happening and hope everyone else does too.

Or we can own it. “I have social anxiety disorder and need to be in a less crowded space than the mall.” “I won’t be able to go to the carnival with you because my PTSD is triggered by loud noises.” “I may come to your party if my bipolar disorder will let me.”

We can also address the subject when there isn’t a situation looming. During a phone conversation or an IM chat, we can let the other person know that we have a mental disorder – an invisible illness. It doesn’t have to be dramatic and dire. Casually may be the best way to handle it. “I know you’re wondering why I didn’t go to the movies with you last week.” “When I saw my doctor yesterday we talked about my physical health and my mental health too.” “You know that character on that show that has PTSD? I have that too, but it’s not exactly like on the show.”

If that sounds risky, you’re right. It can be. There will be people who still don’t get it. People who “don’t believe in” mental illness. People who try to brush it off. People who offer the latest vitamins or super foods or Eastern philosophy as the cure-all.

But you’ll also find people who say, “Oh, my brother-in-law has that too” or “Okay. But I’m still your friend” or “What can I do to help?”

So those are the choices, basically.

Take a chance. Or stay invisible.

Neither choice is right or wrong for everyone. Mental illness is very personal.

You decide.

 

 

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Mental Health

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Support and Non-Support Groups

My family has never been big on support groups. When my father had multiple myeloma (which killed him after 15 years), he turned down any opportunities he was given to join cancer support groups with names like Make Today Count. He preferred to go it alone. He was stubborn.

So am I.

I have actually been to support groups for mental illness once or twice, but they were never a success or, I guess, just never right for me.

The first one was when I was in college. That one was a bust because I wasn’t really ready to address my problems and because I had the ability to appear “normal” for an hour at a time while sitting cross-legged on the floor. I couldn’t do that now. (The floor-sitting part.)

The second time was after I saw a brochure for a group called High Flyers and Low Landers, which met in the church I was going to at the time. (I don’t think the organization still exists. The church is still there.)

It was a very odd experience. Everyone had a book, many with needlepoint covers. It was their bible, though not the Bible, which I know many people needlepoint covers for, or at least did back then.

The meetings consisted of a little ritual. One person read a passage from the book. Then each person in the circle had to tell an event that happened to them in the past week. The recital had to be in a specific format: what happened, what symptoms the person experienced (dry mouth, racing thoughts – there was a list), how the person would have handled it before reading the book, and how the person did handle it. There was much quoting of the book and certain specific phrases that everyone had to use.

Some of the quotations were helpful, or at least true. (People do things that annoy us, not to annoy us.) But as I recall, those were the only sorts of comments the people in the circle were allowed to make. Not “How did that work out?” or “What did your mother do next?” or “I hate when people get passive-aggressive.”

It was just too weird and formulaic for me, so I never went back. (As I was leaving, I offered someone a mint. Everyone laughed and said, “Dry mouth!”)

Since I don’t seem to do so well in actual support groups, I recently thought I would check out some virtual ones. I’m not going to name the groups I joined or where I found them, because all of them stressed privacy and confidentiality.

What I found was both support and non-support.

Some of the groups were associated with national organizations or publications, and they pretty much stuck to sharing articles about scientific research or political news about mental illness, along with lists of resources, hotlines, and the like.

So far, so good.

Other groups were more like traditional support groups, with members asking questions or relating accounts of what had happened or how they felt. There were administrators who tried to keep the members to more or less stick to the topic and rules of the group (give trigger warnings, no suicide threats, or whatever).

Some of the groups were peaceful. People asked standard questions (Who’s on this med? Should I take something else too?) and received fairly standard answers (Worked for me. Didn’t work for me. Ask your doctor.) People related similar events and how they handled them, or asked for more specifics so they could understand the situation better. People posted assorted uplifting memes and affirmations.

Then there was the other sort. People did not know how to use trigger warnings or simply didn’t bother. Others shared people’s posts without removing identifying information. Some posted truly vulgar jokes that had nothing whatsoever to do with bipolar disorder. Negativity overflowed. Arguments raged. (Some of the topics were “Bipolar is not an excuse for bad behavior” and “Don’t buy into the drug companies’ propaganda by taking meds.”) There was the online equivalent of name-calling and shouting. People reported other people to the admins. People accused people of reporting people to the admins.

The administrators did try to keep a handle on these groups, but couldn’t always, most likely because they were busy with their own lives and issues and difficulties.

It got so bad that I took to lurking instead of participating. Every week or so I would go back to take a peek and check on the drama llamas. Mostly they were still running around spitting. I think I had helpful things to add to the discussions and times when I needed help with feelings, but I just couldn’t trust enough to jump back in. I know other people left these groups for similar reasons, and some were blocked or banned or given warnings about their behavior.

In general, I have this to say about online support groups. You’d do well to sit back and watch their interactions before you try participating on anything but a “Congratulations! You got a job!” level. If the group seems truly helpful – supportive – then dive in. You may be able to give and receive help.

But non-support is exhausting. And I’m too stubborn to put up with it.

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Mental Health

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The Teen in my Head

There is someone else living inside my brain.

I don’t have Dissociative Identity Disorder (DID, formerly called Multiple Personalities). I just have another me who pipes up from time to time. And, man, can she be annoying!

She’s 14 years old, and she doesn’t have a name. I don’t know when I acquired her, but I do know when she acts up.

She’s the one who frets when a friend doesn’t answer my IM. When he does, she squees, “He noticed me! He noticed me!” She’s the one who wants to buy ridiculous, useless – but amusing – things. She makes me eat that extra chocolate cookie, then frets about getting fat and pimply. She’s the one who is hooked on all the stupid clicky Internet games.

I’ve heard the theory that everyone has a mental age that they get stuck at. No matter how old they get, they always picture themselves at that age. Mine is somewhere between 28 and 34. So how did I end up with a 14-year-old?

My theory about her existence is that she is there to try to do what I never did when I was 14 – all the regular teen-age angst and frivolous stuff: mad crushes and pouting, self-obsession and discovering her sexuality, in-jokes with BFFs and trying out fingernail polish.

When I was actually 14, I did none of that. I was in a prolonged downward mood swing, made worse by puberty and the horrors of junior high school. I wrote depressing poetry and read French existentialists. If they had had hipsters back then, I suppose I would have been one.

When I feel her popping up in the back of my skull, most of the time I have to put her in a box and sit on the lid. It’s scary to let her take over. She’s rapid-cycling, impulsive, and worst of all, unmedicated. (I don’t know why my meds don’t affect her, but there you are, they don’t.)

Once in a while I let her out of the box. I let her enjoy some mad crushes (as long as she doesn’t do anything about them). I let her buy things that cost $20 or less. I let her talk me into fake fingernails (once!). I let her have some of the fun that I never had at that age.

The thing is, I don’t know if this is just a me thing, a female thing, or a bipolar thing.

I know I’m not completely alone in having a teen ride-along. I do know a man with DID who has an alter that is a teen girl. I could tell when she was out because she giggles a lot and buys junk food. A friend of mine who has suffered from depression also has a 14-year-old in her head. She has given her teen a name – Innie Me. Hers behaves a lot like mine.

I also don’t know whether having a teen living in my head is a good thing or a bad thing. It could be good, because it does give me access to the feelings and experiences I never had as an actual teen. My teen is better than I am at having fun.

On the other hand, I know it would be a bad thing if I let her have her way all the time. She needs that box and I need to sit on the lid. The trick is knowing when and how and for how long to let her out.

On an episode of Scrubs, one character remarks that no matter how old a woman gets, she always has an insecure 14-year-old inside her. I suppose that men have similar phenomena. Most people are said to have an inner child (although I think they are usually younger than 14). I think my husband’s inner child is usually about seven.

Certainly my teen is insecure. There’s no question about that. But she’s also enthusiastic, engaged, and energetic, as well as moody, dramatic, and confused. I think she may be related to the hypomanic part of myself, although I’m also sure some of my fits of apparently reasonless weeping have been her acting up.

My therapist knows about my 14-year-old. We have discussed her and her behavior and her moods several times. Dr. B. has never expressed surprise or shock or puzzlement at the idea. She does think it’s good that I’m learning to sit on the box lid when I need to. We’ve talked less about when it’s a good time to let her out. That’s something I still need to work on.

I guess I’ll have to learn to live with my 14-year-old, because I don’t think she’s going away anytime soon. And I don’t think I really want her to.

 

 

 

 

 

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Mental Health

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Bipolar Basics for the Newly Diagnosed

If you have recently been diagnosed as bipolar, there are a few basics you should know. You’ll likely find them out on your own, but it might take a while.

So, here are some tips.

    1. Being bipolar isn’t necessarily a tragedy. It’s a chronic illness. At times it’s better, at others, worse. It’s not a death sentence and it’s treatable. You can still live a reasonably full and satisfying life.
    2. You need help. To live with bipolar disorder, you need a support system. Unfortunately, your friends and family may not be all that supportive. Fortunately, there are online support groups. But the most important parts of your support system, at least at first, are your psychiatrist and your psychotherapist. I recommend having one of each – psychiatrist for medication, therapist for talk or cognitive behavioral therapy, or whatever works for you.
    3. You will most likely need medication. And the odds are good that you will need it for the rest of your life. Don’t panic. After all, diabetics need insulin, usually for life. You may hate taking pills, you may hate the idea that you are dependent on them, you may hate the fact that they remind you of your brain’s difficulty functioning. But realize that meds will make your brain’s functioning less difficult. They are worth the hassle.
    4. Everyone is different. Everyone’s symptoms are slightly different. Everyone’s medications are slightly different. Everyone’s reactions to their medications are slightly different. A support group can help you with general information, but they cannot tell you what is ultimately best for you. Your particular symptoms and your unique version of bipolar disorder may well require different medications, in different amounts, than your friends. And you may have different reactions to them. Some pills have no effect at all on one person and are life-savers for another.
    5. Getting better takes time. Once you have your diagnosis and your medication, don’t expect to feel better quickly. Most medications for bipolar disorder take a while to build up in the body. Six weeks is not unheard of. Then your doctor may assess how well the medication is working, and change the dose or even the medication itself. Then you may go through another six weeks of waiting for the new dose or drug to take effect. Each case of bipolar disorder requires a medication regimen tailored specifically to the individual, and that often takes some doing.
    6. There are several different types of bipolar disorder. The two main types are called type 1 and type 2. Type 1 is the classical bipolar disorder, which used to be called manic-depressive illness. Type 2, a more recently identified version of the disorder, often manifests as mostly depression, possibly with hypomania, a less severe version of the ups that accompany bipolar 1. Other forms of bipolar disorder are rapid cycling, in which one’s mood states alter quickly, even within a few hours. Another version of bipolar disorder is called mixed states. Mixed states occur when a person experiences both extremes of emotion at the same time – for instance, depression and irritability, or fatigue despite racing thoughts.
    7. The odds are that you already know someone with bipolar disorder, or at least some kind of mood disorder. One in four Americans will have a psychiatric or emotional illness at some time during their lives. Because we don’t talk about it, though, no one may ever know. Especially when the disorder is treated properly, a person with bipolar illness can maintain function in society and choose whether or not to share the diagnosis with friends and coworkers. Many people choose not to because of the stigma surrounding mental illness. It’s a valid choice, but it cuts the bipolar person off from possible support and understanding from others who may share the disorder.
    8. Relationships can be difficult but not impossible. Relationships are difficult for everyone. People with bipolar disorder have relationships that are difficult too. The disorder may make the relationships even more difficult, especially when the family member or loved one or even close friend does not understand the symptoms, the medication, the mood swings, the anxiety or fatigue, or all the other facets of bipolar. The best cure for this is education. However, it may not be possible for a relationship to survive bipolar disorder, just as a relationship may not survive trauma, grief, addiction, infertility, incompatibility, meddling relatives, infidelity, parenting, or a host of other conditions. It may be better to look at all the circumstances surrounding a troubled relationship rather than automatically blaming bipolar disorder for difficulties.
    9. Learn all you can. Because bipolar disorder is so little understood by the public, because it manifests differently in nearly every case, because a person can be actively suffering or in remission, because a person may have any of the different types of bipolar disorder, because everyone is different – the need to educate yourself and probably those around you is essential. The more you know, the less you’ll panic when a symptom you haven’t experienced before suddenly hits. Rely on reputable sources. Medical, psychiatric, or psychological websites are usually the best. Support groups can offer much information, but the people in a support group may not be any more well-informed than you are. And there are lots of people selling “miracle cures” that can lure a person away from needed medication and other services.
    10. Keep trying. It’s hard. It’s frustrating. It’s difficult. It’s painful. It’s confusing. But bipolar disorder is something you can live with, and even something you can rise above. The secret is to keep trying. Keep seeking out therapy and friends who support you. Keep taking your medication, even if you don’t want to. (Stopping your medication without advice from your doctor can be dangerous, so don’t try that.) Be stubborn. When you feel like giving up, tell yourself that maybe things will get a little better in the morning. Hang in there. You may not realize it, but there are people who need you in the world, who need you to be functioning and happy, who need you to keep fighting the disorder.

Do you have any other tips for the newly diagnosed? Please share them in the Comments section.

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I Chose Fat Over Misery

I was a skinny kid who grew a lot less skinny.

Do my bipolar meds have something to do with that?

Probably.

Do I care?

No.

I’ve noticed a lot of people with bipolar disorder panicking over the topic of weight gain. “I know I need meds, but I’m afraid of weight gain.” “What meds can I take that don’t cause weight gain?” “I tried X med but I quit because of the weight gain.”

It’s true that mental health and physical health are linked – what affects one may affect the other. And it’s true that medications have side effects, among which may be weight gain.

What I don’t get is why some people are so afraid of weight gain that they would sacrifice their mental health to avoid it.

Actually, I do sort of get it. There are ads everywhere that promote thinness – even to the point of illness – as the ideal for both feminine and masculine. There is a “War on Obesity” and plenty of people who will tell you that your body mass index is the most important number that identifies you. There are fat people jokes and gags that could not be told about any other group, be it race, sex, ethnicity, or religion. Plenty of comedians have made a good living making fun of fat – even their own. On TV, the fat character is never the hero.

Now back to the skinny, scrawny, bony kid I was. Undiagnosed and untreated. Aware that there was something wrong with me, but no idea what.

I had mini-meltdowns and major meltdowns. I had anxious twitches. I burst into tears when certain songs came on the radio – and not necessarily sad ones. “Take Me Home, Country Roads” tore me up. “I Am a Rock” could leave me sobbing. I took walks in the rain till I was soaked to the skin. I would laugh out loud for no reason that anyone else could see.

I was a mess. But a thin one.

It’s relatively recently that doctors and scientists have explored the connection between psychotropic medications and weight gain. Some have speculated that people who are depressed don’t eat much. Then, when their meds kick in and they feel better, their appetites return. In my case, I ate more when depressed and less when anxious. By the end of my undergraduate years, I was drinking banana milkshakes so my parents wouldn’t worry about how thin I was when they saw me at graduation.

Slowly, I got better with therapy and meds. Slowly, I gained weight. At first I didn’t notice. Then I did. I tried prescription diet pills and Lean Cuisine, which worked – for a while. But eventually, as is true of most dieters, I started piling the pounds back on. If one of my psychotropics was to blame, I couldn’t pinpoint which one, what with going on and off so many different ones and the cocktail of several I ended up with.

But as I got better and gained weight, I also started making friends, going on dates, finding lovers, and eventually meeting the man I would marry. Some of them were overweight, too. But that wasn’t what mattered most to them – or to me. Oh, I suppose there were people who were turned off by my well-padded physique. Maybe some of them were marvelous people, and maybe I would have enjoyed their company if they could have seen past the weight.

But the fact is, I now have plenty of close friends who just don’t give a damn about weight. Sometimes one of us will need to lose weight for a specific health reason like diabetes, and the rest of us will offer encouragement. But for the most part, we are who we are and love each other that way.

Given the choice – and I do have the choice – I will take the psychotropics that keep me reasonably stable and happy and productive. And yes, overweight. I remember the misery, the despair and pain, and no matter how I look, I don’t ever want to go back there. Self-esteem, for me at least, is better if it comes from the inside out, not the other way around.

The bottom line?

I’ve been skinny. I’ve been fat. Either way, I’m still me.

 

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Dental Health and Mental Health

I still remember one of my earliest episodes of panic, which happened in a dentist’s waiting room. As I said in the uncomfortable chair, surrounded by Highlights for Children magazines that I had already read, I felt dread moving up my body from my toes. It crept up my legs into my hips and on into my abdomen. I was convinced that when the feeling of terror reached my heart, I would die. I was called into the doctor’s office before that happened.

This is a memory I have shared with only one other person before now. Just thinking about it still brings back a visceral body memory of fear.

It really bothers me that some people think that good teeth are a sign of moral superiority. Some other people, like me, are simply born with bad teeth, or at least weak, cavity-prone little tooth buds embedded in our infantile gums. Brush as diligently as we might, we are never going to have pristine white teeth like the people on TV.

While my dental phobia can possibly be attributed to the general pool of my anxiety triggers, there were also some outside factors that contributed to it.

My parents were never good role models for dental health, as my mother had gotten dentures at age 16 and my father chewed tobacco.

There were also bad experiences with blame-and-shame dentists and hygienists, one of whom scraped a bit of tartar off my teeth, stuck it in my face, and asked, “If I put that on a piece of bread, would you eat it?”

I used to loathe the public school practice of making us chew little purple tablets to see how clean our teeth really were. My teeth were – and still are – considerably crooked, so it was difficult for me to brush in a manner that wouldn’t leave glaring purple spots all over my mouth.

My teeth have only gotten crookeder, since my parents were not able to afford orthodontia for me. When and where they grew up, braces were a luxury for the well-to-do; rural children like they were simply did without. By the time my sister and I came along we lived in the suburbs, but braces had never become a priority for my parents compared, say, to eyeglasses, which were deemed essential.

My last and most recent experience with a dentist was a number of years ago. I don’t remember what prompted me to go, but I did tell the dentist about my phobia and he was very considerate. (I always look for a dentist whose advertising says, “We Cater to Cowards.”)

He did my exam and treatment in the kiddy room with the bright, nonthreatening murals of cowboys and western scenes on the walls. Just the x-rays and routine cleaning proved alarming enough to trigger one of my worst stress reactions – diarrhea. When it came time for the actual procedures the dentist brought in a traveling anesthesiologist so that I could be knocked out rather than conscious and terrified. My husband was there for driving, moral support, and decisions that needed to be made while I was out cold.

I have not been back to the dentist since. However, it’s becoming increasingly obvious that I need to. My teeth ache. My fillings have fallen out. One tooth is broken. Because of that, my teeth are moving in directions they were never supposed to. And that makes my dental bridge (acquired at the aforementioned last experience) fit poorly. I look like the stereotypical Willie Nelson fan. (I am a Willie Nelson fan, but I don’t care to reinforce the popular image.)

This week I was trying to convince myself to call a dentist just for a consultation. I still haven’t managed to do that. Just saying the word “dentist” gave me a spasm in my chest. Maybe I’ll be able to make the call during this coming week.

The only person in the world who is a worst dental-phobe than I am is my sister. She too had childhood dental issues. Once she even bit a dentist and he slapped her. Needless to say, that experience did not improve her attitude toward dental care.

She is also ultra sensitive to (or afraid of) pain and quite terrified of needles. Even as an adult, she has been known to scream so loudly and lengthily that she has cleared an entire dentist’s waiting room. (She then sent the dentist a Halloween card that screamed when you opened it.)

Still, I am a grown up. I need to do this. I cannot convincingly tell myself that waiting will improve the situation. I just have to pick a day for my appointment when my husband is available to take me and I have had my prescription for Ativan recently refilled. And some Immodium on hand.

Wish me luck.

 

ETA: I now have an appointment with a dentist for some serious work, and with a traveling anesthesiologist for IV sedation. I tried to get the doc to prescribe roofies, but some guys have no sense of humor…

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Mental Health

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Does “Natural” Treatment Work for Depression?

Not for everyone. Not all of the time.

Angel Chang recently posted on LittleThings.com “The 10 best natural ways to treat depression.” (See http://www.aol.com/article/2015/11/06/the-10-best-natural-ways-to-treat-depression/21260290/?ncid=txtlnkusaolp00001357) While she does acknowledge that “clinical depression is triggered from within, and very often need[s] medical attention” and “it’s imperative to consult your physician if you notice an abrupt change in your mood, feelings, or sense of well-being,” her article is about “easy” ways to treat depression yourself.

Unfortunately, her tips are not very helpful for me and many others who suffer from clinical bipolar or unipolar depression. Here’s how I respond to them.

Meditate. This is both nearly impossible when you have racing thoughts and a way to sink even lower if you can’t clear your mind of negative thoughts, which is one of the hallmarks of depression. And if you’re manic, even sitting still in one place for any length of time can be a challenge. After you’re stabilized on medication – go for it.

Eat Foods With Vitamin B. It may be true that vitamin B has been linked to neurotransmitters that we need more of, but preparing them is not realistic when I’m in the Pit of Despair. I try to imagine myself preparing a meal of fish, Swiss cheese, spinach, and eggs, and I just can’t. Or shopping for them, for that matter. I might be able to scramble an egg in the microwave, but that’s about it. (I wrote about food and depression recently: http://wp.me/p4e9Hv-db.) I do take a multivitamin along with my bedtime psychotropics, so I guess I can follow this advice a bit.

Set goals. Chang recommends starting with “small, daily goals.” When in full-blown depression, mine are about as small as you can get. Get out of bed. Make it through the day without crying. Take my meds. Poof! Out of spoons! The expert Chang quotes gives an example of a goal to work up to as washing the dishes every other day. To me, that implies a series of goals: Gather up dishes. Find soap. Fill sink. Wash a dish. Put in drainer. Repeat. My tip: Wash the spoons first!

Sleep on a schedule. Going to bed at the same time every night may be do-able, but getting up at the same time isn’t possible for me, which is one of the reasons I can’t hold a regular job. An alarm clock awakening me before my body is ready leaves me groggy and unfit to work. And there’s no guarantee that I’ll actually sleep during those scheduled hours, even with Ambien. Chang advises not taking naps, but I seldom make it through the day without one, even if I have slept eight (or nine or ten) hours. In fact, I love naps and consider them therapeutic, for me at least. Naps are my friends.

Get out of your rut. Structure is the only thing that keeps some of us going. And if we could find joy in a painting class, a museum, or making a new friend, as Chang suggests, we probably wouldn’t be depressed in the first place. J. K. Rowling described the Dementors in the Harry Potter books: “Get too near a Dementor and every good feeling, every happy memory will be sucked out of you. … You will be left with nothing but the worst experiences of your life.” She has stated that they are metaphors for depression. With every good feeling sucked out of you, you can’t see anything but the rut. I am told that for some people, Cognitive Behavioral Therapy (CBT) lessens the tendency to keep traveling in the rut. But “easy” and “natural”? I don’t know.

Talk. Chang is advocating talking with trusted loved ones, which is good as far as it goes. What it ignores is that friends and loved ones are not universally understanding of depression or supportive in dealing with it. She never suggests talking with a therapist or doctor. I don’t know why that’s less “natural” than talking with someone who has no training. Except you have to pay them (or your insurance does), but painting or language classes or art supplies aren’t free either.

Exercise. This is a classic antidote for depression, and I understand that it works for many people some of the time. But I would put this under the same heading as setting goals. I know it would be good for me, but motivation is hard to come by and immobilization thwarts me. But I wish I could take this advice. I looked into water aerobics, but there’s not a feasible program in my area.

Responsibilities. “Because you might feel down,” the article states, “you may also want to withdraw from your daily activities in life and your responsibilities at home or at work.” Yepper. “Try staying involved as much as possible in the causes you care deeply about, and take on new daily responsibilities. These can be as simple as volunteering at your local food pantry, or going back to work part-time.” Big nope. See getting out of your rut, above. For the clinically depressed, working even part-time is unimaginable, with responsibilities of the crushing sort.

Unwind and relax. If your depression comes with anxiety like mine, this idea is a non-starter. Unless you count drinking as relaxation, though it isn’t the best idea if you’re on meds.

Stay off caffeine. Okay, I can pretty much do this one, except for one cup of coffee or a caffeinated soda to get me started in the morning.

“Did you learn something new about how to naturally treat symptoms of depression?” the article ends. Not really. Well, except for the B vitamins. We’ve all heard these kinds of advice before. They’re good tips for situational or reactive depression, but largely not feasible for the chronically, clinically, biochemically depressed. In a way they add up to the much-hated “Just stop it. You must want to be depressed or else you’d be doing all these great things.”

But try them if you can, perhaps in addition to medical treatments. Maybe some of the ones that won’t work for me will for you. In the meantime, get help. See your therapist and/or psychiatrist. Keep taking those meds. Those may not be “easy, natural” ways to treat depression, but if they work, isn’t that the larger point?

P.S. Do NOT Google “CBT.” Spell out “Cognitive Behavioral Therapy.” Trust me on this one.

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Is My Cat Bipolar?

It sure seems like it. She lies around all day, barely moving. Then at any given time she races through the house pursuing nothing at all. Afterward she lies back down, immobilized again. It looks an awful lot like rapid cycling.

I’m not going to get into the debate here of whether animals have emotions or humans are simply anthropomorphizing. Of course animals have emotions, and act on them. Our cat Maggie could snub you so you really knew you’d been snubbed. Another cat, Shaker, was mortally offended if you stuck a whisker on the top of her head and made “beep beep” noises. Our dog Bridget has deep anxiety around strangers, both human and canine. She has been known to wet herself, or my husband’s shoe. Polar bears can experience boredom. I have it on good authority that sheep can hold a grudge.

But can animals experience mental illness? Recently the BBC examined the question in an article by Shreya Dasgupta.(http://www.bbc.com/earth/story/20150909-many-animals-can-become-mentally-ill)

The article is long and rather technical, citing genetic studies I’m not capable of summarizing and using words like “telomere.” But the Beeb’s resounding answer to the question is yes. Not only can animals feel emotion, they can suffer from mental disorders. The report says:

To our eyes, many animals seem to suffer from forms of mental illness. Whether they are pets, or animals kept in ill-managed zoos and circuses, they can become excessively sad, anxious, or even traumatised….There is growing evidence that many animals can suffer from mental health disorders similar to those seen in humans.

It was decades ago that I first heard about polar bears on Prozac, due to their pacing obsessively or swimming repetitively back and forth. (I did wonder how the vets calculated the dosage – by body weight or brain size.) Of course, rather than psychotropics, what the bears really needed was more appropriate-sized enclosures.

Stress and social deprivation seem to be two of the factors that can bring on mental illness – particularly depression or PTSD – in animals. Dogs that serve in combat zones have been known to have trouble adjusting to civilian life. And the death of an animal’s relative or beloved human companion has been anecdotally linked to profound grief and even death.

The BBC notes that all the evidence we have for animal mental illness comes from pets, captive animals, and research specimens:

That probably reflects our own preferences for certain animals. “It’s the animals that we find very charismatic, like elephants or chimpanzees, or animals that we share our homes with, like dogs,” that command our attention, says animal behaviour expert Marc Bekoff.

But do wild animals really suffer from mental disorders? It’s practically impossible to tell.

For one thing, wild animals cannot bare their souls to therapists. For many reclusive wild animals, we know so little of what is normal behavior that we would be hard pressed to identify abnormal responses to environmental stressors.

Still, the experts say, even invertebrates like octopi and honeybees seem to suffer from, if not what we would call mental illness, at least maladaptive reactions to trauma.

Severe psychiatric illnesses like schizophrenia seem to go with higher intelligence. (Octopi are actually quite smart.) But again, how can you tell whether a dolphin is hallucinating? It may be that animals with extreme mental illness are weeded out by evolution, as their erratic behavior may lead to early death and loss of the ability to pass on their genes.

Is this true for humans as well? Are mental illness and intelligence correlated? As yet, there is little consensus. Sometimes the debate boils down to chicken-and-egg levels. Do people with lower intelligence experience more depressed because they are unable to accomplish what they want to do? Or does depression make it more unlikely that they will accomplish what they wish for? (Most of the studies seem to relate to depression.)

As the BBC report says, “Mental disorders seem to be the price animals pay for their intelligence. The same genes that made us smart also predisposed us to madness. There’s nothing shameful in that.”

Except, of course, that in humans there is stigma. Cats, now – they can get away with acting as crazy as they want. We’ll just call it adorbz and post it on YouTube.

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