Bipolar 2 From Inside and Out

Posts tagged ‘mental illness’

My Brazen Hussy Phase

This is me in my Brazen Hussy phase, back in my college days. The piano player is a friend that I sometimes went places with. (We tried dating once, but it was a total bust.) We decided to recreate a saloon girl-type photo at the piano in the student union building. There was a lot of hooting and cheering as we got in position. I didn’t have a saloon-girl outfit, so I dressed Western instead. The vest was one my mother made for me out of various calico fabric scraps. I don’t remember just when or where I got the leather hat, but it went with me throughout college and beyond.

My Brazen Hussy phase was the first time that hypomania hit, except for the many times that it appeared as anxiety before I went to college, and after.

As many people do the first time they experience hypomania, especially the sexual kind, I rather enjoyed it. I flirted and dated, which I never did in high school. I joined a sorority and went to frat parties. I enjoyed my first kiss and then many more. I had a mad crush on a musician and eventually got to know him too. He was exciting and passionate and awakened something in me that never even seemed to exist before. When he broke up with me, I went into a deep downward spiral. I won’t say that was why I took a year off college, but I was confused about my future, and that surely didn’t help.

Back in my hometown for the next year, I got my hypomanic mojo back. I engaged in what I knew was a risky relationship with a coworker. I kept up with him for years and told him about my former life as a Brazen Hussy and about my depression. We went out during the former and he stuck with me through the latter. But he always said he wanted Brazen Hussy Jan rather than timid, depressed Jan.

I was back in Brazen Hussy mode when I met the man who would become my husband. We were with a couple of women who already knew him and greeted him with a kiss. “Don’t I get one too?” I asked boldly and got one. He kissed me again around the campfire and followed me around all weekend. I basked in the attention. It was exactly what I needed at the time.

Shortly thereafter, I moved back to my hometown. But we conducted a long-distance relationship until finally he moved out to be with me and, eventually, we married.

I won’t say I never went back into Brazen Hussy mode again. Hypomania still affected me. I still got mad crushes and flirted outrageously. Finally, however, I was diagnosed with bipolar and properly medicated. I won’t say the Brazen Hussy mode went away entirely, but episodes were fewer and further between and easier to understand.

I didn’t originally mean this post to be so confessional, but hypomania and hypersexuality are a very real part of bipolar disorder that I didn’t miss out on in my younger years. And that I sometimes miss in my later years. I know that not having those surges of intense feeling is better for me. Nowadays, however, when my bipolar disorder kicks up, it’s generally bipolar depression. I’m a lot more settled now and don’t have much room in life for hypomania. When I experience it now, it usually manifests as anxiety again or mild euphoria and overspending.

But I’d be lying if I said I didn’t miss my Brazen Hussy phase from time to time.

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Mental Health

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Support Group Spam

I belong to a number of Facebook support groups for mental illness issues such as anxiety, depression, and bipolar disorder. I’m even a co-moderator for one of them, Hope for Troubled Minds.

What’s troubling my mind right now is the scammers and spammers who try to take advantage of the group members.

There are the typical posts of course about how much they admire your comments and think your profile picture is very appealing. They’ve tried to friend you, but it hasn’t worked. Then they beg for an “add.” I know that as soon as I friend them, they’ll DM me with a wonderful opportunity. I find these posts annoying, but since I simply hide and block them when they happen to me, I don’t worry too much about them.

The ones that really bother me are those that are targeted to support group members specifically. Here’s one I’ve seen in various groups:

[Product] on Instagram helped me overcome Osteoporosis, fibromyalgia, autoimmune disease, LUPUS rheumatoid arthritis, ptsd, Chronic gastritis, chronic-pain, joint pain, muscles spasms, intense sweating, Raynaud’s Syndrome, inflammation, diagnosis, Fibromyalgia, skin-itching, ADHD, arthritis, spasms, swollen, blotchy hands, shingles, numbness, Anxiety, Autism, feet nerves, and flare-up permanently after taking various meds that didn’t work, look him up.

I suppose I should find it amusing that diagnosis, feet nerves, and flare-up are among the many disorders that the product is supposed to relieve. And the idea that any one product can alleviate PTSD, anxiety, and autism along with all the other listed conditions, is ludicrous.

Another piece of spam along similar lines says:

Truly, natural remedies do work. If they didn’t, we wouldn’t have used them for thousands of years. And, pharmaceutical companies wouldn’t be studying plants, taking extracts of them, and patenting them as lupus drugs.this is not a claim or lies I was totally relieved from pains of lupus disease and CFS by [Person]. His remedy is surely the best. I suggest you try him out if you are having any health challenges and also get cured too, give him a try

This piece of spam is less hyperbolic than the previous one, but it still appeals to people seeking relief from difficult-to-treat conditions. But why post it in a support group that deals with mental illness? It doesn’t address them directly. Perhaps the poster thinks that, since SMI is not thoroughly understood, people who live with it are desperate for any treatment, however unlikely or unconventional.

It’s easier for me to understand how the next bit of spam might appeal to the distraught and lonely people who find that SMI has shattered their most significant relationships. But again, it offers false hope of a “love spell” and the opportunity to become a millionaire.

My appreciation goes to [Person] for restoring back my relationship with his powerful love spell to bring my boyfriend back and also for setting my son free from Courtcase and helping a friend whom I recommend with money spell that made her a proud millionaire are you having any issues that needs urgent attention kindly contact

Finally, we have one that might actually appeal to someone who’s been in an emotionally abusive relationship.

Living with a narcissist can be very difficult due to the gaslighting and lies. If you are interested in obtaining a basic analysis of what your partner does in secret, there is a resource called [product] can provide you with access to text messages, call logs, emails, games, and social media activity (including deleted messages) send a direct message

Never mind that it’s the gaslighter who is more likely to use apps like this to keep track of their victim and isolate them from friends and family.

When I see posts like these, I report them to the group admins. What they do about them, I don’t know. I do know that I haven’t seen people trying to post similar spam in the group that I co-moderate. Unless a person is well-known to us, they must submit a message before it’s posted. So far, no one has proposed a spam post to our group. Occasionally something a bit off-topic, but that’s about it.

I think the spammers intend to prey on people they see as weak and vulnerable. And while there are people who post about their trials and tribulations with brain illnesses, they’re far from weak and vulnerable. You have to be strong and determined to live with them.

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The King Baby and the Narcissist

Almost everyone knows a grown-up in their life who has to be right all the time, has to be catered to, and blames everyone else for failures or unpleasant events.

That person is a King Baby. (Not to be sexist. There is also a Queen Baby.) It’s someone who never grew up, at least not emotionally. King Baby expects everyone to love him, take care of him, and solve all his problems for him.

Reference.com says that a King Baby: “is typically selfish, rejects criticism, complains, is obsessed with money and belongings and doesn’t feel like rules should apply to him. In short, he is someone who refuses to mature.” Tom Cunningham wrote the book (well, the 28-page pamphlet) on King Baby Syndrome in 1986. It’s still available from Hazelden, which is good because King Babies haven’t gone away, nor are they likely to.

King Babies view the world as their plaything and other people as someone whose only function is to meet their needs. Physically they are adults, but emotionally they are still infants. Typical King Baby remarks are, “That’s not fair,” “This is what I want,” “That’s not how I do it,” “Do this for me,” and “I’m the best at everything.”

Needless to say, King Babies are very trying to be around.

I learned about King Baby syndrome from my husband. Not that he has King Baby syndrome. But he used to work as a counselor with various therapy groups. One thing he told me was that when someone was trying to pull King Baby shit, one of the others might call him on it by saying, “Wah!”

King Baby goes by other names as well. Probably best known is Peter Pan, from an 80s pop psych book, The Peter Pan Syndrome. Years before that hit the bookshelves, though, writer Aldous Huxley produced a novel called Island, which talks about “dangerous delinquents” and “power-loving troublemakers” who are “Peter Pans.” In addition, he said, they are “boys who can’t read, won’t learn, don’t get on with anyone, and finally turn to the more violent forms of delinquency.” Huxley cited Adolf Hitler as an example.

King Baby syndrome is not an actual psychological diagnosis. It is not covered in the DSM. But the DSM does include Narcissistic Personality Disorder, which sounds remarkably like a King Baby:

  • exaggeration of accomplishments
  • saying they have done things they haven’t really done
  • acting or feeling more important than others
  • believing they are special and unique
  • having a need to be admired all the time
  • expecting to be treated differently, with more status than others
  • exploiting others to get what they want or need
  • pretending concern towards others or lacking empathy
  • being jealous and competitive with others
  • thinking that others are jealous of them
  • acting arrogant and superior

Narcissistic Personality Disorder is, of course, an official diagnosis in the DSM. King Baby is only someone you perceive as narcissistic but who hasn’t gone through the process that leads to a diagnosis. I’d hesitate to call someone a narcissist who hasn’t even talked to a psychologist or psychiatrist. But I have no problem labeling someone a King Baby.

So what do you do with a King Baby? My advice is to avoid them if possible. You can, like the people in my husband’s therapy groups, call the person out for their behavior, though it’s not likely to do any good. Often it’s best just to cut the King Baby out of your life. If you do, though, expect anger, blaming, and recriminations.

If you do have to live with a King Baby, perhaps the best thing you can do is to recognize the behavior when you see it happening and not fall into the trap of trying to meet the King Baby’s every need. This won’t make any difference in the King Baby’s behavior, of course. You’ll have to deal with pouting, sulking, poor-me talk, and even retaliation.

Because just as vampires never grow older, King Babies never grow up. They can’t and they won’t.

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Breach of Confidentiality

One of the things that people who see a therapist dread is a breach of confidentiality. Fortunately, it almost never happens. Therapists have client-therapist confidentiality that forbids it. It’s like the seal of the confessional for priests.

There’s an exception, however, and that’s the Tarasoff warning. Here’s how it came to be.

Way back in 1969, a young woman named Tatiana Tarasoff, a student at the University of California, Berkeley, was murdered. The killer was Prosenjit Poddar, also a student at the university. They knew each other and had gone on several dates. Unfortunately, as happens way too often, the couple had differing opinions on where the relationship should go.

Poddar became obsessed with Tarasoff. She was no longer interested. So he began stalking her. He had an emotional crisis and began seeing a therapist at the university medical center.

So far, it’s a pretty typical story of a relationship, a breakup, and an extreme emotional reaction. However, it soon became much more than that.

One day, Poddar admitted to his therapist that he wanted to kill Tarasoff. (He didn’t refer to her by name, but her identity was clear). The therapist said that, if Poddar kept issuing death threats, he would have to be hospitalized. Poddar stopped coming to therapy.

The therapist was left with a dilemma as to what he should do next.

The therapist and his supervisor decided to write a letter to campus police regarding the death threats. The police interviewed Poddar in the room he shared with Tarasoff’s brother. When Poddar denied everything and said he would stay away from Tatiana, the investigation was halted. The supervisor instructed the therapist to destroy all his case notes.

Of course, Poddar continued stalking Tarasoff and confronted her. When she tried to run away, he stabbed her with the knife he was carrying, killing her. He was arrested, tried, and convicted of first-degree murder (though he had tried to plea-bargain down to manslaughter). He served five years and was deported to his native India.

Tarasoff’s parents sued the university and the therapists on the grounds that they should have warned their daughter about the death threats. The therapists countered with the client-therapist confidentiality argument and won. Later, however, the case was retried and this time, in 1976, the Tarasoffs prevailed.

Since then, over half of US states have enacted “Tarasoff laws.” Others leave the decision up to the therapist. And Maine, North Carolina, North Dakota, and Nevada have specifically ruled that Tarasoff laws don’t apply there. The laws are still controversial. For one thing, the university therapists did call the campus police. For another, it leaves the burden of deciding whether a threat is credible solely on the therapist. And it left it up to the therapist whether to breach confidentiality. And there have been debates on whether Tarasoff warnings should be given regarding threats of physical violence that fall short of murder.

So, what’s a therapist to do? Warn clients that if they make threats, they’ll be reported? That can have the effect of causing the client to leave therapy. Guess—and it really is a guess—whether a threat is real or perhaps a fantasy? Err on the side of caution? Give priority to the confidentiality requirement? Risk a malpractice lawsuit brought by the client if the therapist does report the potential threat? A wrongful death suit for not acting in time?

Which prevails: the duty to warn a potential victim or the duty to preserve confidentiality? And is it a duty to warn or a duty to protect? (These distinctions have been made in some places.) We’ve become used to the phrase “harm to self or others” when it comes to involuntary treatment. But this question goes further. What does a therapist owe to a specific individual who may be killed? Sectioning the client? Reporting the threat to the police? Directly warning the potential victim?

It’s an awful lot to place on the shoulders of a therapist: determine the reality of a threat, make a prediction about future violent behavior, and determine an appropriate response. Weighing patient confidentiality and harm or death to another is a huge burden. But in the interests of there never being another Tarasoff-style murder, I’m coming down on the side of the duty to warn.

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The Overwhelming Problem

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

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

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

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

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

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

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

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

He agreed.

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

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

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

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Side Effects: TD and Stevens-Johnson

We all hate side effects. They go from bad to worse to horrible. (A popular meme says that people wish they had side effects like multiple orgasms. Alas, no one’s invented a drug with that side effect yet.)

In my journey through the process of settling on reasonably effective medications, I’ve experienced a number of side effects, including violent nightmares, paranoia, and feeling numb all over. I switched to other meds, but really, those weren’t so bad.

Two of the worst side effects are Tardive Dyskinesia (TD) and Stevens-Johnson Syndrome.

TD, according to Penn Medicine, is “stereotypical involuntary movements of the tongue, neck, and facial muscles, truncal musculature, and limbs.” These movements “can range from slight tremor to uncontrollable movement of the entire body,” explains NIH. Basically, these movements often consist of facial movements like grimacing, sucking, sticking out the tongue, rapid blinking, and chewing motions. The bodily movements can include ones of the arms, legs, and pelvis, from tapping your feet or fingers to rocking the pelvis, swaying, and uncontrolled movements while walking.” (One description of it was “waddling.”)

The medications that can bring on TD include antipsychotics such as Haldol, Risperdal, Abilify, and Seroquel; antidepressants including (but not limited to) Sinequan, Elavil, and Prozac; antiseizure medications such as Lamictal and Dilantin; and, of course, lithium, particularly if taken along with other medications. (I’m currently taking meds in three of these categories and have in the past taken others, though never lithium. I’ve never experienced TD.)

You may have seen commercials on TV with information on treatments for TD. Although they’re designed to prevent a particularly troubling side-effect, they have side effects of their own. A list of these includes depression, suicidal thoughts, mood symptoms, heart abnormalities, allergic reactions, dizziness, weight gain, loss of balance or falls, stomach pains, frequent urination, and constipation. Oh, and there’s one more—uncontrollable body movements that may become permanent. That’s right. The anti-TD meds can cause exactly the symptom they’re supposed to alleviate. Sounds like a good deal to me. Admittedly, the incidence of these side effects is likely less than the incidence of TD from lithium, but would you be willing to roll the dice? Maybe you would, if there’s a chance it could protect you from TD. It’s up to the individual. Me? I’m not sure.

Another undesirable side effect is Stevens-Johnson Syndrome. It’s a condition that at first causes a skin rash that isn’t really itchy and often first appears around the nose and mouth or other mucous membranes. Unless you get immediate treatment, the rash can spread and turn into blisters and painful sores. It can develop into toxic epidermal necrolysis (TEN), a condition in which skin all over the body peels off. It’s potentially fatal. In 80% of cases, a psychotropic medication is the cause. (My psychiatrist prescribed me an antipsychotic particularly associated with the disorder and told me, “Don’t look it up on the internet. It’s gross.” Of course, I did look it up, and he was right. It is gross.)

I’ve had my bouts with side effects over the years. In every case, my doctor listened to me, weaned me off the drug that was causing the problem and titrated me up on a different one until we finally found a regimen that works. I’m fortunate that none of the side effects have been TD, Stevens-Johnson, or TEN. And I’m profoundly thankful.

The only advice I can give is to be mindful of the potential side effects of the drugs you take. On TV commercials, they run through them so rapidly and print them in such small type that they’re difficult to notice. But they matter. It’s your physical health as well as your mental health that’s at stake. If that means you need to do research on the internet, do it. I know there’s a danger that you’ll expect the side effects you read about but, in my opinion, it’s a trade-off worth making, especially with all the new drugs on the market and the potential severity of the side effects you’re facing.

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Is It Bipolar or BPD?

When I first started looking at the literature regarding SMI, I became confused by the abbreviation BPD. At first, I thought it was a typo or an alternative for Bipolar Disorder. Of course, I found out that it wasn’t—BPD stood for Borderline Personality Disorder.

Even if you know what the abbreviation means, it’s easy enough to get confused between the two. In fact, bipolar is often misdiagnosed for borderline, or vice versa. There are some similarities between the two disorders as well. Both involve mood swings. Both can cause reckless behavior. Both can be associated with childhood trauma. And both can lead to suicidal ideation or completed suicide. They’re both very serious diagnoses.

Johns Hopkins says that Borderline Personality Disorder “may also be called emotionally unstable personality disorder. People with BPD have unstable moods and can act recklessly. They also have a hard time managing their emotions. If you have BPD, you may have problems with daily tasks, obligations, and life events. You may have trouble keeping jobs and relationships.”

Sounds familiar, doesn’t it? The same could be said of bipolar disorder. So what’s the difference between the two?

VeryWellMind says the difference lies in the fact that “People with bipolar disorder tend to experience mania and depression, while people with BPD experience intense emotional pain and feelings of emptiness, desperation, anger, hopelessness, and loneliness. In BPD, mood changes are often more short-lived. They may last for only a few hours at a time.”

Not to get picky about it, but as a person with bipolar, I’ve experienced intense emotional pain and feelings of emptiness, desperation, hopelessness, and loneliness while in the throes of a major depressive episode. (Not so much anger.) They did, however, last for months rather than a few hours at a time.

People with BPD can also experience dissociation and paranoia, and reckless behavior. They tend to have intense, unstable relationships. Dissociation is sometimes also seen in manic episodes of bipolar disorder and reckless behavior is a symptom of bipolar mania as well. Bipolar disorder can cause difficulty with relationships too. In between mood episodes, the person with bipolar can achieve stability, while that’s less likely for BPD.

So it seems that BPD might be seen as “bipolar on fast-forward.” The short time span of BPD episodes is one of the major differences between the two conditions. (It’s been described as “pervasive instability.”) But since the two sets of symptoms overlap, even clinicians sometimes mistake one for the other. BPD appears to have a strong genetic component; the cause of bipolar is thought to be a combination of brain functions, genetics, and early trauma.

When it comes to treatment, there are more options for bipolar than BPD. With BPD, medication is generally limited to symptomatic relief, such as with antianxiety agents. Dialectic behavioral therapy is the treatment of choice, along with psychotherapy. There are dozens of medications available for bipolar, as we know from TV commercials if nothing else.

It’s important to note that the two diagnoses can coexist. When they both affect a person, which is possible, they can be even more difficult to diagnose and treat. It’s easy to see how that can happen. Mood swings, reckless behavior, and potential dissociation can be effects of either one. Seeing a person only once a week, as many therapists do, can make it difficult to track the symptoms and see the patterns. And if the person sees a therapist or psychiatrist less often than that, the difficulty is compounded. Symptomatic relief may seem sufficient at first, but long-term is no solution.

Am I satisfied with my bipolar diagnosis? I’d have to say I am. While I despise the long-lasting mood swings, those are now largely controlled on medication. My destructive relationships haven’t been quick but have still been intense, and now I’ve achieved stability in that too. All things considered, I’ll stick with what I’ve got—not that I have a choice in the matter. If I had been afflicted with BPD, I hope I would have done as well.

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The Power of Awe

My husband asked me if I wanted to watch this movie, Operation: Arctic Cure. He knows I love stories about people who face hardship. Sometimes they triumph. Sometimes they fail. But they’re always out there trying. Dan also knows that I like stories of Arctic adventure—mountain climbers, exploration ships, races to the pole, and the like. So he figured the movie would be perfect for me. And it was.

It was a documentary telling the story of a handful of people cross-country skiing across Baffin Island, Canada, to reach Mount Thor, pictured above. What made this expedition different was that the participants were all people who had been injured in the wars in Afghanistan and Iraq. Most were soldiers, but one was a news correspondent who had been caught in an IED explosion and suffered traumatic brain injury (TBI). The other people on the expedition also had TBI or amputated limbs. And PTSD.

The people who conceived the expedition were hoping that the experience would somehow help them alleviate the PTSD. The teamwork, the effort, the hardships for a cause were all hoped to be therapeutic.

Another inspiration for the trek was Dacher Keltner’s book Awe. In it, the researcher on emotions posited that encounters with the wonders of nature could have beneficial effects on the brain and body. These outcomes would be largely self-reported, of course, but were backed up by scientific data. The participants took their cortisol levels, a measure of stress hormones, before the trip and twice a day during it. They also had sensors that recorded the length and quality of their sleep. And they kept video diaries, with their faces computer-analyzed for symptoms of stress through eye movement and changes in facial expression.

They did indeed encounter hardships. The skiers pulled heavy loads of their gear behind them. There was the numbing cold, vicious winds that held up their travel, and one amputee whose prosthetic caused so much pain that for one day she couldn’t walk. One of the men pulled her along with his own pack so she could stay with the expedition until she was able to adjust her foot the next day. They talked, of course, sharing stories of their war experiences and their families. One participant came to realize that he hadn’t been in touch with people he knew during the war and that he needed to be.

Where did Keltner’s book fit in? It proposed that the experience of awe, perhaps best encountered in nature, had healing properties. The expedition certainly had those awe-some experiences. They were far enough north to see huge displays of the Northern Lights. They conquered milestones such as reaching the Arctic Circle. And they made it to the foot of Mount Thor, a rugged landscape that features the world’s highest vertical cliff.

But those were subjective experiences. Was there science to back up Keltner’s claim and to validate the emotions described by the participants?

The measures of cortisol provided interesting feedback. In normal individuals, cortisol levels start high in the morning and decline through the day, leaving the body ready for peaceful sleep at night. The participants started the journey with cortisol levels significantly lower than average and rapidly declining throughout the day. By the end of the trek, their cortisol levels approached normal. And their sleep quality and length improved as well. One participant had a 40% increase in his sleep stats.

The movie followed the injured warriors during their trek, but not afterward, so it’s unclear whether the gains lasted. But they evidently experienced something profound. They spoke of the clarity from being in nature and the feeling of being a part of the world around them.

Many books and articles on self-care recommend being out in nature. Most of them talk about the benefits of sunlight, motion, and exercise. Keltner’s book and the film suggest a broader effect. The feeling of awe, of being one with the natural world, could increase a person’s peace, happiness, and a deeper connection to other human beings.

It was pointed out that you don’t have to travel to extreme environments to experience this awe. It’s all around us, if only our eyes are opened to it.

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Self-Care and Social Care

We hear a lot about self-care these days. Much of the mainstream media seems to think that it means “shopping therapy,” indulgent desserts, spa days, and mani-pedis. Expensive things. Ones that you need to be able to leave the house to do. (Except for online shopping, of course.)

Businesses are also quick to suggest self-care for their workers who are experiencing stress. What they mean by self-care is to take up yoga or meditation—on your own time and your dime.

Real self-care may include yoga and meditation and even the judicious use of ice cream, but it’s much more than that, of course. Self-care begins with the things that we all know are good for both body and mind—exercise, healthful food, good sleep, and stress reduction. Other good habits often mentioned are a digital detox, mindfulness, journaling, gratitude, affirmations, prayer, fresh air and sunshine, and hobbies.

Those are good things, of course, but they are primarily solo things, or at least were while the pandemic had us cooped up. Now we can get out and about more easily, go jogging or hiking with a friend, invite people over for dinner, and generally add human companionship to our list of self-care techniques.

But maybe what we need is social care (also known as community care). It’s hard to define social care. One source I looked for mentioned advocacy. But that’s pretty much something we have to do for ourselves. There are organizations like NAMI, and they do a great job at advocacy, but there’s only so much they can do. There aren’t brain illness support groups the way there are for alcoholism, narcotics addiction, and other kinds of afflictions that require outside support. There aren’t Meals on Wheels-type services for people who can’t leave their homes because of crippling anxiety. (Of course, grocery stores deliver now, but it gets expensive.)

There are very few group homes for people with SMI who need to transition between the hospital and living alone. There are group homes (sober houses) for those with alcohol or other addictions and even prisoners on parole. Many people with psychological or psychiatric needs rely on family members as long as they are able. I know a woman who lives with her father because of her assorted diagnoses. We’re all worried about what will happen to her when her father, who’s not in good health, dies. Her mother, when she was alive, tried to get her into a group home, with no success.

For those who are able to leave the house on occasion, social networks are recommended as a form of self-care. And even for people who can’t go out, there are social media, email, and video chats, which can fill some of the gaps.

But social services are thin on the ground, at least near me. I live in a suburb near two medium-sized cities. Most of the services available are for the mentally disabled, physically disabled, seniors, and some respite care for caregivers. People with SMI get a list of the crisis numbers. And, of course, psychiatric beds are limited and even psychiatrists have months-long waiting lists.

I know funds are limited and that the other groups need care, too. But social care is needed for those with SMI, too. We’re dependent on tax dollars, which are hard to come by.

It’s worth noting that the National Health Service in the UK has many more programs accessible to those with SMI at little or no cost. Of course, those are functions of socialized medicine, which is not likely to be enacted in the US anytime soon.

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Mental Health

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Is It Narcissism or Gaslighting?

We know that narcissism and gaslighting both lend themselves to abusive treatment, but they are actually two different things. They’re both extremely destructive. They both have serious negative effects on the people around them. And people who are victims of narcissistic abuse or gaslighting face similar problems in determining what to do about it. Let’s take a deeper dive.

Narcissism is a psychiatric condition—a personality disorder—that’s included in the DSM and has been recognized for years. The DSM says that NPD involves “a pervasive pattern of grandiosity (in fantasy or behavior), a constant need for admiration, and a lack of empathy, beginning by early adulthood and present in a variety of contexts.” Diagnostic criteria include a need for excessive admiration, a sense of entitlement, interpersonally exploitive behavior, a lack of empathy, a belief that others are envious of them, and arrogant and haughty behaviors or attitudes. Narcissism is a personality trait, while clinically, Narcissistic Personality Disorder is a psychiatric condition.

(I will not now be discussing politics. Diagnosis-at-a-distance is not valid or desirable. Diagnosis can only be made by a mental health professional who has actually spoken to the person in question.)

Gaslighting, on the other hand, is a form of psychological manipulation that narcissistic abusers sometimes use to control another person by making them doubt their own reality and sanity. But people other than narcissists use gaslighting as well. They could simply have narcissistic tendencies but not be diagnosable or diagnosed with NPD.

In other words, narcissism focuses on a sense of grandiosity and superiority, while gaslighting focuses on the way one person manipulates another in an abusive manner.

Gaslighting gets its name from a movie that showed a husband who tried to convince his wife that she was insane, for personal gain. The term has entered the non-psychiatric discourse and is used very loosely to mean any kind of abusive tactics rather than the specific one of causing another person to doubt their own reality.

Gaslighting can be one tactic that people with NPD use when they do abuse others, but there are a number of other toxic behaviors they demonstrate as well. Someone engaging in narcissistic abuse can use a variety of techniques to emotionally manipulate another person. They may belittle and demean their victim, isolate them from friends and family, and use intermittent reinforcement (in which they sometimes praise and show love for the victim, then take any opportunity to insult and blame them).

A gaslighter denies the victim’s perception of reality. They may explain their abusive behavior as “just a joke.” They may deny that their victim’s memory of an incident is true. They create a sense of cognitive dissonance in which the victim’s lived experience is at odds with what the abuser says really happened. There is obviously a great deal of overlap between gaslighting and narcissistic abuse.

The effects of narcissistic abuse or gaslighting can be severe. Victims can feel low self-esteem, internalize the abuse and believe they are to blame for it or brought it on themselves, feel alienation from friends and family, have difficulty trusting others, be unable to make decisions, and not feel able to maintain a sense of self. They frequently stay with the abuser, unable to recognize what is happening. They may feel they can change the abuser. They can’t.

The best way to counteract the harmful effects of narcissistic abuse or gaslighting is to get away from it. Admittedly, this is difficult to do. The victim may have been conditioned to believe that the abuser loves them and not want to give up on the relationship. Even if the victim does leave, it may take a long time and most likely therapy for them to realize what actually happened and define it as abuse.

Setting boundaries can help, though an abuser is not likely to respect them. Seeking support from friends, family, a psychologist, or group therapy may well be necessary. Couples counseling is not likely to help. The abuser may not admit that they need help. Education can be empowering. Once you learn about the dynamics and techniques of abuse or gaslighting, you’re less likely to be susceptible to them.

But the best thing to do is not to get involved with a narcissist or a gaslighter in the first place. It’s a situation that’s a lot easier to get into than to get out of. Watch for red flags, then keep your distance. They may seem attractive at first, but they’re trouble waiting to happen.

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