Bipolar 2 From Inside and Out

Posts tagged ‘mental illness’

Is Stigma a Problem? Is Systemic Breakdown?

Some people who have mental illnesses say that stigma is a problem. Others say that’s not the real problem – a lack of social or political action is. I say, why not combine the two?

Stigma Fighters (https://stigmafighters.com/) and other organizations such as the International Bipolar Foundation (ibpf.org/), the National Alliance on Mental Illness (NAMI) (https://www.nami.org/Get-Involved/Pledge-to-Be-StigmaFree), and even Facebook groups, promote the eradication of the stigma surrounding mental health issues. They say that mental illness is stigmatized in our society – some even deny that it exists – because people don’t understand it. This happens when churches say that mental illness is a sign of sin or refuse to welcome people with mental problems into their congregations or have any kind of outreach to them. It happens when a person is honest about having a mental illness and tells her boss or friends about it and receives negative feedback, incomprehension, or the back-away-slowly-and-don’t-make-eye-contact look.

People who believe that stigma is a problem say that stigma is one of the largest reasons that people refuse to seek treatment for their mental disorders. Being seen going into a psychiatric clinic, people finding out that the person sees a psychiatrist, and being ignored or discounted when talking about mental illness are seen as ways that stigma propagates.

People who believe that stigma is a problem promote education as the main solution. If more people understood what mental illness is and how many people suffer from it, they would be less likely to discriminate against those who have mental conditions. Stories about celebrities who have mental dysfunctions or whose relatives do are considered inspiring and helpful. Stars who speak out encourage others to seek treatment (though it’s increasingly true that public expressions of mental illness diagnoses are tied to specific online therapy businesses).

People who believe that political action is necessary also try to effect changes in people’s thinking, but, more importantly, support changes in the systems that are supposed to provide services to the mentally ill. These systems include schools where mental illness plays no part in the curriculum; lack of beds for psychiatric patients in hospitals; the response of police to calls regarding people with mental disturbances; the number of medical schools that provide no information to doctors; the lack of psychiatrists, especially in rural communities, which mean people must wait a long time for services or have no access to them at all; politicians who put mental health issues low on their list of priorities; law enforcement that reacts with deadly violence to calls involving persons with mental illnesses; and health insurance and EAP (Employee Assistance Programs) that treat mental illness differently than physical illness or even addictions. NAMI promotes grassroots activism as one facet of the appropriate response to such problems (https://www.nami.org/Advocacy/Advocate-for-Change).

People advocating for political change also see education as one partial solution to the problems caused or exacerbated by insurance companies, educators, medical schools, media, law enforcement personnel, correctional facilities, and politicians. Political action is seen as the right course to take to improve conditions. (Though it should be noted that people have sent books about the breakdown in societal responses to mental illness to politicians and receive only standardized, unhelpful “thank you” letters that are mostly signed and sent by staffers rather than the political figure.)

I say that education is the best response to both of these problems. Education of the general population about the realities of mental illness will lead to less stigma. Education of the voters, their representatives, and their local communities will help to lessen the inequities and difficulties that now abound.

This will not be easy. Education about the realities of mental illness is hard to convey to either citizens at large or politicians and others who have some degree of authority. Until it touches their own lives, people will largely be blind to the problems. Educational campaigns and the testimony of celebrities may help educate individuals. But politicians are likewise only affected by the aspects that touch their own lives, such as the public revelations by those like Kitty Dukakis (wife of former presidential candidate Michael Dukakis), who has been quite open about her mental difficulties and her ECT treatments (https://www.amazon.com/Shock-Healing-Power-Electroconvulsive-Therapy/dp/1583332839).

What I fear is that these individual occurrences will motivate only a small number of people enough to make a change in society as a whole. It’s easy enough to say, “Oh, Catherine Zeta-Jones has bipolar disorder. Too bad for her, but that doesn’t affect me” or “Someone in my family has a mental illness, but my constituents won’t support legislation to benefit the homeless mentally ill or to provide halfway houses in their neighborhoods. Better to spend my time and influence on stopping terrorism or drugs.”

But until or unless something changes, mental health will still be swept aside or ignored outright. People at large need to understand that just because mental illness hasn’t touched their lives so far, it still could in the future. Public officials and public servants need to believe that mental illness issues are vital to their communities and something that can be made better if only they have the courage and compassion to make the necessary changes.

Stigma-fighting or political action? Both are problems that need solving and education is at least part of the solution to both. And it appears that it’s up to us, those who have mental illnesses, to do the educating.

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COVID News and Mental Health

Many people have been blaming COVID for depression and other mental health problems. They have said that quarantining and uncertainty have raised the level of anxiety in the general population, and quarantining has caused depression. These increased levels may be – probably are – accurately reported, but I don’t think they necessarily indicate an increase in the incidence of mental illness in our society.

The depression and anxiety that people are feeling are, I believe, natural and expected reactions to the pandemic conditions that prevail. I’m not trying to minimize these experiences, but most people have never experienced clinical depression or anxiety and so don’t understand the nature of the actual illnesses. What depression and anxiety the pandemic has caused is likely to clear up when (if) the pandemic does. This is situational depression and anxiety.

This is not to say that people experiencing pandemic-related depression and anxiety don’t need help. Of course they do. “Talk therapy” may do them a lot of good, and there has been an upswing in the number of online and virtual counseling services available. Whether these people need antidepressants and anti-anxiety meds is a question I’m not able to answer. My best guess is that they don’t, at least not long-term courses of drug treatment, as their symptoms are probably not indicative of mental illness. Short-term anti-anxiety meds may do some good.

I do think that the pandemic and the reactions to it have been triggering for many people who do have mental health conditions. People with OCD who are germophobic saw their most extreme fears become reality. People who have Seasonal Affective Disorder may have suffered more from lack of sunlight during the stay-at-home orders and quarantines.

Many people are in extreme denial, believing that the pandemic is a hoax and refusing to take any steps to prevent its spread. Is this a symptom of mental illness? I don’t see how threatening officials and doctors who promote pandemic precautions is a sign of mental health, but are the people who do this delusional or are they merely at one extreme end of the anxiety spectrum?

I understand that people’s perceptions of reality differ, but it annoys me when people deny mine, which currently is made up of snot and phlegm, as well as depression and anxiety. We can have these academic debates, but for my husband and me, at least, the pandemic has pushed us from believing that it is “out there” to realizing that it’s in here, in the most literal and alarming sense.

My husband has tested positive for COVID, and I have a terrible sore throat and cough, so I likely have it too. We’re resting and taking Coricidin until we hear from our doctors what to do. A dear friend has sent us a pulse oximeter, with instructions to get more help if our O-sats fall below 90.

All this is messing with my head. I was entering a depressive phase anyway. Now I’m not sure if it was due to my bipolar disorder or my immune system crapping out. (Just FYI, my husband and I are both triple-vaxxed. He probably got the virus at work and undoubtedly passed it on to me. I can’t imagine I would test negative now.)

I don’t think our illness is life-threatening, though honestly, it could be. You never know with COVID. And now, that’s part of my reality.

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Reminders for New Year’s (and Beyond)

I’m not big on New Year’s resolutions. I can barely plan my day, let alone the whole year. And I’m also not big on making commitments I know I can’t or won’t keep.

Instead, I remind myself of certain behaviors I think I (maybe) can accomplish and refer to the list as often as needed. Here are a few suggestions that may be appropriate reminders for you as well.

You don’t have to drink alcohol at New Year’s Eve parties. Or ever, really. No one should try to pressure you into doing this, but if they do, simply saying, “No thanks,” should be enough. If the person is really pushy, you may have to ask, “Do you have soda or fruit juice?” You are not required to explain why you don’t want to drink alcohol, and you may want to forego attending parties that do not have such non-alcoholic alternatives in the future. You don’t have to attend parties at all, and “No, I can’t make it” is a perfectly reasonable response to an invitation. Or “Maybe next year.”

You don’t have to make New Year’s resolutions per se. You can have New Year’s intentions, small goals you don’t have to announce to the world at large and that you don’t have to beat yourself up over if you don’t fulfill them. Instead of resolving to jog every day, intend to get out of doors once a week, even if it’s only to walk to the mailbox and back. Baby steps, after all.

I hate to use the word “should,” but you should keep track of your medications, reorder them if they’re getting low, and see your prescribing physician if the scripts are about to run out. That’s just common sense that’s necessary for your mental health, not a resolution. These days, you may even be able to arrange to have meds delivered.

Try to engage in a hobby once in a while. Say, once a month. It honestly doesn’t matter what the hobby is. Read a book, or even a short story or magazine article. Knit or crochet. Repot a plant. Water a plant. Do a crossword puzzle. Bake your favorite cookies, then eat them all yourself if you want to.

Keep comfort objects nearby. These can be anything that soothes you. A music playlist. A stuffed animal. A scented candle. A cozy blanket or sweater. A favorite warm beverage like cocoa or green tea. Don’t be embarrassed about using them to ground yourself. Most neurotypical people won’t even notice if you’re wearing a favorite sweater or have a scented candle lit.

You can connect with people online. This counts as interacting with people. Say happy birthday. Forward a funny meme. You don’t have to make it specific to your condition, but there are plenty of people on Facebook, for example, who have bipolar disorder or PTSD or an autoimmune disorder. You don’t even have to interact with them. You can join a group, then just sit back and see what others post there.

Avoid triggers, if you can. That judgmental aunt. Your creepy cousin. Your boastful neighbor. Again, you have the right to say no and not explain why. (It’s the not explaining that’s the hardest.) Don’t watch movies that you find upsetting, whether it’s Die Hard or Rudolph the Red-Nosed Reindeer (which many people don’t like because of the implicit bullying).

Write about how you feel, if you want to. It could be a mood journal, a regular journal, a letter that you will never mail, a poem. Don’t feel that you have to show it to anyone. Tear it up afterward, if you want to.

You don’t have to face the new year as a whole. If you must have resolutions, resolve to get through the next week or even the next day.

Make an appointment with your therapist. Many therapists are offering tele-visits these days, so it’s easier than ever just to touch base or to work through a problem, a trigger, or feeling overwhelmed.

In other words, do whatever you can to get you through the next day, week, month, or season. The year will take care of itself, whether you make resolutions or not.

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Schizophrenia: Nature and Nurture

Think about the devastation that a case of schizophrenia can cause a family. Then multiply that times six.

If you want a book that explores such a situation, look no further than Hidden Valley Road: Inside the Mind of an American Family by Robert Kolker. It’s the true story of a middle-class family with 12 children, six of whom became schizophrenic. The children included ten boys and two girls; neither of the girls developed schizophrenia, so that’s a full 60% of the boys who did.

The story begins in the 1950s, when at least there were hospital beds as well as halfway houses for psychiatric patients. The matriarch, Mimi Glavin, however, preferred to care for her boys at home as much as she could. This was, of course, disruptive to the rest of the family. And the patterns were perhaps obscured by the fact that four of the boys and the two girls never developed the disorder. One of the girls was sent to live with a rich friend, and the other managed to be admitted to a boarding school. These were irregular family arrangements, intended to get the girls out of harm’s way, though they certainly harbored resentment at what they saw as abandonment.

The 50s and 60s were the era of what the mental health community called the “schizophrenigenic” mother. Back then, schizophrenia was thought to be caused by the mother, who was either too cold and distant or too controlling. Take your pick. It was the mother’s fault. It was also the era when Thorazine was the best (or only) treatment that could be given for the disorder.

The boys, many of whom were talented athletically or musically, presented with schizophrenia, as you would expect, during their late teen or early adult years. Chief among the delusions affecting Donald, the oldest son, were religious ones. The younger ones also heard voices. One committed a murder-suicide, and another sexually abused his younger sisters. Violence among the brothers was common. Overlooked in all this was that Don Galvin, the father, had suffered a mysterious hospitalization while on duty in the service, which was classified as depression.

Psychiatrists and other researchers were at that time conducting twin studies to examine whether twins were equally likely to develop schizophrenia or not. The Galvin family was a treasure trove.

Still, the family couldn’t resolve the nature-nurture debate. Were the six boys affected by defective genes? Or was their illness because they had all been raised in the same household? DNA study was in its infancy. Most of the family agreed to interviews and blood studies, though they proved not to be much help.

Of course, the children, when they began to have children themselves, were afraid that the family affliction would be passed down to them. One of the young women put her child in therapy at a young age, hoping to spot incipient signs of psychosis. This choice did possibly more harm than good, as the young boy never developed any symptoms and resented the unnecessary therapy.

The heroines of this story were, of course, Mimi – who cared for all her children as best she could, and her husband after he had a stroke in later life – and Lindsay, the youngest child. The care for her schizophrenic brothers was her purview – monitoring their health, their medications, their hospitalizations, and their money, as well as caring for her mother, who became incapacitated in old age. The mentally healthy brothers and the older sister largely detached from the family and went about living their own lives.

Why read this book? It delves into how schizophrenia can affect not just a person, but a whole (and large) family. It illuminates the struggles the family had to deal with in caring for the brothers who had mental illness. It records how treatments for and research about schizophrenia over the years worked and didn’t. And it’s a well-written book on top of that. I could easily have read it in a couple of days, but I stretched it out over weeks to savor and contemplate.

The book rings with authenticity, as interviews with all of the family and records of their therapy and hospitalizations were made available to the writer. It resonates with pain, frustration, pity, courage, illness, relapses, and desperation. It is truly the best chronicle of schizophrenia I have read. I can’t recommend it highly enough.

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The Time I Was (Sort of) Hospitalized

When I was a teenager, being hospitalized for mental illness was a big joke. The local facility was located on a street called Wayne Ave. Wayne Ave., despite whatever else was located there (a pizza restaurant, I think), was shorthand for “crazy.” (This was no doubt an annoyance to people who actually lived on Wayne Ave., of which there were many. Now the former mental facility is a Hospice.) I knew by then that I was mentally unbalanced, but it never occurred to me that I would end up in Wayne Ave. It was an address used only to tease other kids, which was uncomfortable enough.

By the time I got to college, I was aware that I was in trouble, mentally. I had turned down the offer to see the school district psychologist in high school, delusionally afraid that it would show up in my permanent record and prevent me from getting into a good (or any) university.

I did, however, get into a very good university. (No idea if they took my lack of mental health treatment into consideration.) But by this time I was really suffering mentally and emotionally. I tried at least one therapy group, but was able to breeze through it without making any notable progress, thanks to my ability to “act normal” for an hour at a time.

Still, I figured it was just a matter of time until my mental disorders manifested themselves sufficiently to be generally noticed. Maybe even noticed enough to be diagnosed. And I was waxing delusional. I felt sure that at some point in my life I would be hospitalized for my illness. I just wanted to make it through college and work at a paying job for at least two years, if I could, in hopes of getting Social Security. (I said I was delusional.)

Along the way, though, I was (sort of) hospitalized for mental illness. I say “sort of,” because I went to the university clinic, a small facility with about a dozen beds, most of them used for students with flu and the like. (There was a sort of witticism going around campus: It’s a short trip from Willard Straight (the student union building) to Willard State (the nearest psychiatric facility). Again, going to a psychiatric facility was considered a joke.)

I was nearing the end of a disastrous relationship, self-injuring, self-medicating, and vaguely suicidal. I checked in to the campus clinic. I don’t remember much of it, my brain obviously not working too well at the time. I had to tell them I wasn’t really suicidal, or else they would have called my parents, which I definitely didn’t want.

I do remember a nurse who would look in on me as I lay in bed crying. I don’t remember what if any treatment they prescribed. In my memory, mostly they just let me cry.

One very peculiar thing happened, though. The man of the disastrous relationship “checked me out” for an evening (much as you would check out a library book) to go to a dinner with someone in editing or publishing that he thought might help me get that coveted job after college. I don’t remember the dinner being a hit, and of course no job ever came from it. Then I was checked back into the clinic for a few more days of crying. I don’t remember how long I stayed or why I was finally released. It was altogether a peculiar experience, and the gaps in my memory have swallowed most of it.

I don’t think it actually helped me at all, other than to confirm to me that I was indeed ill, with some kind of mental disorder, and to reinforce my delusions. It also, I think, hastened the dissolution of that relationship, which proved to be a good thing in the long run. Was it all a ploy by the boyfriend to establish that I was the “sick one” for the purposes of couples counseling, which I had convinced him to try at one point? I’ll never know.

But since that time, I have never been hospitalized for my bipolar disorder. I have been properly diagnosed and treated. I now take psychotropic meds faithfully and see a therapist. I have been working for decades (except during a major depressive episode, when I learned how hard indeed it is to get Social Security for a psychiatric disability).

I suspect my hospitalization was far from typical. After all, it was dozens of years ago and not in a dedicated mental hospital or ward. I can’t say whether it helped me or not. But it’s an experience I never want to repeat – and, at last, something I never expect to endure again.

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What God Gives You

There are two expressions, common in “inspirational” memes, posters, and the like, that rub me the wrong way.

One is “What doesn’t kill me makes me stronger.” I addressed that one in a post (https://bipolarme.blog/2014/11/10/suffering-and-train-wrecks/) roughly seven years ago, and now I’m ready to tackle the other.

“God doesn’t give you more than you can handle.”

Let’s take a look at the premise. It implies that God gives us all our trials and troubles. Already, I have problems with that. Perhaps God is love and the devil gives us trials and troubles. Perhaps neither God nor the devil is involved, and life gives us trials and troubles. Perhaps even we give ourselves trials and troubles. It strikes me that these are equally valid propositions, though many people favor one or another.

At the heart of it, though, is the fact that there are trials and troubles in our lives, whoever or whatever gives them to us, and we must handle them. Wherever they come from, they will not be more than we can handle, the saying states.

The evidence of our eyes, and perhaps our own lives, says that this simply isn’t true. Plenty of people encounter (or have given to them) more than they can handle. Think of the homeless mentally ill. Are they able to handle what they’ve been given? The woman with her third miscarriage? The veteran with catastrophic injuries? Sure, some of them face their conditions bravely, but others don’t, and they’ll never make the news as “inspiration porn,” the uplifting stories of people who can and have overcome their afflictions, which is predominantly what we hear about in the media.

The fact remains that some people do receive more troubles than they can handle. There are serious mental illnesses that have no treatment. There are injuries and horrors that leave a person scarred inside and out. There are troubles that are so bad they contribute to death by suicide. In these and other cases, someone or something (or simply life itself) has given certain people more than they can handle.

The premise behind the saying, however, is that God never gives YOU more than YOU can handle. What I’ve said doesn’t mean there is no hope – only that it might come from a source you don’t expect. That might be the same God who ostensibly gave you those trials. It might mean another person, or a group of people, or a society can help you with what you need to make it through.

It’s not necessary to leave it all up to God to solve these problems. And it may be that we cannot rescue ourselves. But perhaps we can be that person, or one of those people, who can help someone whose troubles are more than they can handle by themselves.

I won’t argue whether it is because of the grace of God that other people help. But the original saying, in all its simplicity, is too simplistic. I believe that troubles and trials come to us from somewhere in the world, not from God, and people in the world are ultimately the ones who can help us handle them.

I’m not trying to deny the actions of God in the world. I’m saying that we must do our part to solve these problems too. Donate to a good cause. Volunteer to help. Listen to someone who’s hurting. Even just buy a box of cookies from a Girl Scout. Let’s make that “you” an “us.” God (or life) never gives us more than we can handle – together. (Note: Don’t even get me started on “God helps those who help themselves.” That’s not even in the Bible. Go ahead and look. I’ll wait.)

And why is this post in a blog on mental illness? Because that’s one of the things that some people can handle and others can’t, whether it was God or genetics or brain chemicals or trauma that gave it to them.

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Bipolar Questions and Answers

Have you heard of Quora? It’s like a crowd-sourced online question and answer center, where anyone can ask questions on practically any topic and request an answer from a specific person, or leave it up to whoever wants to answer.

I’ve used it myself for answers to questions about Ireland and about gardening. But since my Quora “credential” says that I have bipolar disorder and have written two books on the subject, I get questions about bipolar (and other mental health topics), usually several a day. Some I can’t answer. Some have already been answered. But I answer a couple every day. I consider it part of my goal of spreading information about mental health wherever and whenever I can.

Here are some of the types of questions I’ve been asked and how I answered them. Maybe they’ll help some of my readers as well.

What is the best medication to take for bipolar?

This one is the question most commonly asked, and it is easy to answer. I don’t know which medication is right for you. Only you and your psychiatrist can figure that out, basically through trial and error. It may take a while to settle on a med or combination of meds will work for you with the maximum effects and the fewest side effects.

I am thinking of quitting my meds, as I don’t feel I need them anymore or am having bad side effects.

DO NOT DO THIS. There are dangers in going cold turkey, not the least of which is withdrawal symptoms. Work with your psychiatrist. She/he can help you decide whether it’s a good idea to quit a medication. If going off a med is a reasonable idea, your psychiatrist will help you do it safely, most likely tapering off on the med you are on and possibly ramping up on a med that works better or has more tolerable side effects.

Besides, meds for bipolar are supposed to make you feel better – but it’s not a one-time thing. You have to keep taking them to keep feeling “better.” And if you go off a med and then decide to go back on it, it may not work as well.

Would bipolar disorder be eradicated if everyone came from a loving, stable home?

Sadly, no. While bipolar disorder may have a genetic component and may run in families, it can affect any person in any family. I had the most stable, loving family you can imagine, and here I am with bipolar 2.

What causes bipolar disorder?

The jury’s still out on that. Some people will tell you the cause is genetic. Others will say it is caused by deficiencies or overproduction of chemicals and receptors in the brain. Still others will say that trauma, especially childhood trauma, can cause bipolar disorder. Personally, I don’t know for sure, but I suspect it could be any one of them, or any combination of the three.

How do I help a family member with bipolar disorder?

First, you may be able to help them manage their disorder. In the early stages, you can perhaps help them find a psychiatrist, drive them to appointments, pick up their medication, and so forth. Be supportive. Tell the person that you love them and hope they feel better soon. (They may not respond to you at the time, but later they will remember who stood by them and helped them.)

You can also help by helping the person practice self-care. Provide an environment that contains the things that comfort and help ground them – comfort food, soothing objects such as blankets or pillows, favorite scents, or even stuffed animals. Encourage them to bathe or shower and facilitate that: Have clean towels available and clean clothes or pajamas ready to wear. Make sure there is soap and shampoo handy.

For persons in the manic phase of the illness, you can accompany them when they go out, try to help keep them centered on projects at home, try to help them when it comes to overspending or other reckless behavior. Again, remind them that you love them and will be there for them now and when they feel better.

How do I deal with a narcissistic, bipolar boss?

You can’t know that your boss really has a personality disorder or a mood disorder unless you have read their medical files, which is illegal. They may have narcissistic traits or change their mind frequently (which is not the same as having bipolar disorder). You basically have two choices: Put up with it or quit. You will not be able to change your boss’s behavior.

I’m afraid my parents will find out I have bipolar disorder.

If you are underage, you can probably not hide it from them. It’s not a good idea to delay treatment until you are of legal age, though. You can ask your family practice physician to recommend a good psychotherapist or psychiatrist. You can ask your school counselor to help you find help. There are telephone and text hotlines. The best bet may be to talk to your family about it, in a quiet, low-stress environment and explain what bipolar disorder is and why you believe you have it. Their responses may surprise you.

Will I be bipolar for the rest of my life?

Unfortunately, the answer is yes. Bipolar disorder is not a disease like cancer that can in some cases be cured. It’s more like diabetes or asthma, in that you will have to live with it, cope with it, and have treatment for it, most likely for the rest of your life.

But it’s not a thing to be feared. If you have the proper support, such as therapy and sometimes medications, you can live a fulfilling, “normal” life, and accomplish many if not all your goals. I have bipolar disorder and have completed grad school; have a loving, stable marriage; own my own home; and do paid work. You are not tied to a future of despair or fears or bad effects.

Keep trying.

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Why CBT Isn’t for Me

It’s been suggested more than once that CBT, or Cognitive Behavioral Therapy, might help me with some of my problems, including “depression, anxiety disorders, marital problems, and severe mental illness” (bipolar disorder, in my case), according to the American Psychological Association (APA). And I understand that it’s helped a lot of people, including some in my position, with some of the same problems I have. If it works for you, that’s great. I’m not saying that no one should ever use it or that it’s a rotten form of therapy.

I, however, dislike the premise of CBT and have never felt comfortable trying it. Here’s why.

One of the basic tenets of CBT is that the client’s thinking is faulty and the therapist helps the client to discover how and where. Then they work together to pinpoint the faulty thinking and replace it with healthy behaviors, or at least less destructive ones.

Again, according to the APA, “CBT treatment usually involves efforts to change thinking patterns” and examine “what is going on in the person’s current life, rather than what has led up to their difficulties.”

When I first got into therapy with the counselor who has helped me the most, what I needed was not someone to convince me that my thoughts were faulty. I had worked hard to reclaim my memories, validate them, and recognize that they really were damaging events. I would resist any attempt to undo that work by invalidating those memories, and my attempts to understand them, as “faulty.”

Despite all the times it has betrayed me, I think my brain is the most powerful weapon I have in moving forward, but that does not include denying the past or brushing it aside in favor of what the APA calls “learning to recognize one’s distortions in thinking that are creating problems, and then to reevaluate them in light of reality.” Evaluating the memories and the thinking associated with them is a large part of what has helped me most, but calling them “distortions” would not be helpful. I needed to reclaim those memories and understand the feelings, accept them for what they were and how they changed my life, and then go on to rebuilding a new life – not one free from those memories and feelings, but one that validates them as part of my lived experience.

The methods used in CBT discomfort me as well. The idea of “homework assignments” and role-playing my future interactions does not appeal to me. I have gotten on much better with good ol’ talk therapy (and medications) than I believe I could with body relaxation and mind-calming techniques.

My problem largely involves confronting my memories and not denying them or downplaying them, but learning how to live despite having them in my past. It does me no good to deny a train-wreck as “faulty thinking” or to dismiss it as part of my past. Owning it as part of my past and realizing what it did to me is much more helpful. Validating my feelings and reclaiming my memories, then moving beyond them, is what I need. My therapist has helped me do that, without ever once suggesting that my thought patterns are faulty. We’ve worked on coping skills, sure – but never based on the premise that my past doesn’t affect my present or future.

CBT is also said (by NAMI, the National Alliance on Mental Illness) to be a short-term process (which I’m sure the insurance companies love) or one that can be carried out without a therapist guiding it. To me, this smacks of the “think away your troubles” idea. If I could have, I would have, without the help of long-term talk therapy.

My therapy has been a long and often painful process, but never one that attempts to make me think that my memories are invalid and that my progress will come by admitting that. Talk therapy is hard work, and I don’t believe there is any shortcut to mental health. Even now, after I have largely ceased therapy, I sometimes need a “booster shot” when my problems become overwhelming. Again, this comes from recognizing that my problems are real and that thinking them away rather than hard work is not the answer.

I am sure that people will tell me that I have misunderstood CBT, what it is all about, and how it is practiced. They may have many good experiences with it. But I don’t want to take a chance on a form of therapy that denies my reality and dismisses it as “unhelpful thoughts.” I need my reality heard and validated and examined. I need depth and breadth of therapy that recognizes my “train wrecks” and to what degree they have left me wounded. I need coping mechanisms that acknowledge my past as part of what going forward may mean.

I don’t trust CBT to do those things.

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Anxiety, Fear, Panic, and Phobias

I’ve heard it said that you know when you’re a problem drinker when your drinking causes you problems, whether of the emotional, legal, financial, or several other varieties.

Similarly, I think anxiety, fears, panic, and phobias are problems only when they cause you problems.

Let me unpack that a bit.

Phobias are considered to be a type of anxiety disorder or panic disorder. For example, social anxiety is sometimes defined as social phobia. Everyone has anxieties. Many people have at least one phobia. And most people can avoid these triggers with little or no effect on their daily lives. There are habits they can cultivate to avoid the things that make them anxious or phobic.

For instance, someone with acrophobia, a fear of high places, isn’t usually incapacitated by a stepladder, and can fairly easily avoid standing on cliff edges, rotating top-floor restaurants, and hotel rooms over the first or second floor. (When the anxiety/phobia extends to fear of flying, or aerophobia, the person can limit or eliminate air travel from their lives, usually without much difficulty.)

Crippling phobias, however, are generally classed as mental illnesses. My panic around bees (apiphobia) does not rise to that level; I would call it an anxiety reaction or a panic attack, not a phobia. It usually only manifests as bodily stiffening, tremors, and immobility, and pleas for anyone in the area to shoo away the offending insect. (I once took a beekeeping class to try to get over my phobia. Big mistake. Didn’t work.)

Agoraphobia (fear of unfamiliar environments or ones where you feel out of control), however, can be socially and psychologically crippling. The Mayo Clinic says that agoraphobia “can severely limit your ability to socialize, work, attend important events and even manage the details of daily life, such as running errands.” (Technology has made these constrictions less onerous, what with doorstep delivery and Skype.)

Anxieties as a symptom of mental illness are harder to define. While some anxieties have triggers, others simply don’t. “Free-floating” anxiety comes on unexpectedly, like the depressions and manias of bipolar disorder. This doesn’t mean that the anxiety isn’t real. It certainly is. It just means that the anxiety has no identifiable cause such as high places or bees. It is simply (or not so simply) a panic attack, which the Cleveland Clinic says is “sudden, unreasonable feelings of fear and anxiety that cause physical symptoms like a racing heart, fast breathing, and sweating. Some people become so fearful of these attacks that they develop panic disorder, a type of anxiety disorder.” They add, “Every year, up to 11% of Americans experience a panic attack. Approximately 2% to 3% of them go on to develop panic disorder.”

Sometimes I have anxiety that is attributable to triggers, such as financial difficulties, which are relatively easy for other people to understand. Who wouldn’t be anxious when the bank account is dry and a bill is due?

Other times, free-floating anxiety or panic simply descends on me, with nothing that triggers it. It’s an awful feeling, like waiting for the other shoe to drop when there has been no first shoe. Like a cloud hovering around me with the potential for lightning bolts at any time.

The thing is, I don’t know how to get rid of my anxieties, fears, or phobias. There are desensitization procedures that are supposed to work by getting one used to the trigger gradually. (I think that was my idea behind taking the beekeeping class. One of them, anyway.) There are antianxiety medications, including antidepressants and benzos, designed to take the edge off, if not remove the anxiety. (I take antianxiety medications. I’m still afraid of bees. Not that it affects my daily life much, but I’m never likely to visit that island off Croatia that’s covered with lavender.) For phobias, Cognitive Behavioral Therapy (CBT), as well as exposure therapy, has been recommended. This is usually a short-term procedure, according to the Mayo Clinic. But I have an aversion to CBT.

Still, despite my therapy and medications, I have to live with my anxiety and phobias. I’ve probably not reached the point where the anxiety causes me severe problems, like bankruptcy, though I have been known to overdraw my checking account on occasion and run my credit card up too high. These, of course, are signals that I may have a problem or am beginning to have one. It’s something to explore with my therapist, anyway. Maybe she can suggest ways I can deal with my anxieties before they turn into more significant problems.

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When Depression Doesn’t Go Away

Back in the day, I suffered from treatment-resistant depression. (This was likely due to the fact that what I had was actually bipolar 2, but never mind that for now.) My psychiatrist prescribed me medication after medication, but none of them worked, or at least not for long. We got into a seemingly endless spiral of trying one drug, adding another, weaning me off one drug and ramping up another, then another and another.

Some of them just plain didn’t work. Others had intolerable side effects, from vivid horrible nightmares to making me feel like I was about to jump out of my skin.

All this went on for certainly months – maybe years. (Memory problems were one of the many intolerable side effects.)

Eventually, my doctor reached the correct diagnosis, and then there were months of trying medications that were targeted for bipolar disorder instead of plain depression with anxiety. Again, nothing worked, or didn’t work adequately.

Nowadays, there are non-pharmaceutical methods of coping with treatment-resistant depression, including ECT (better known as electroshock), TMS (transcranial magnetic stimulation), and ketamine treatment.

I never had any of these treatments, since my psychiatrist and I finally worked out a drug combo that brought me back to balance, with only minor tweaks in dosage over the years. Nonetheless, I’ve become interested in the alternate means of dealing with treatment-resistant depression, and here’s what I now know. (If you want a patient’s own experience with ECT, TMS, and ketamine treatment, look up Kitty Dukakis or read some of the Bloggess’s posts.)

ECT, or electroconvulsive therapy, is what used to be known as shock treatment. For a long time it went the way of prefrontal lobotomy, stigmatized as a cruel and harmful procedure. The portrayal of ECT in Ken Kesey’s novel One Flew Over the Cuckoo’s Nest and then the movie of the same name were major influences in terrifying the general public, leading to a nearly complete disavowal of its use.

It’s making a comeback, though. The theory behind it is that electric stimulation of the brain will shock the brain back into normal functioning. The American Psychiatric Association notes that it is now performed under anesthesia, with medical personnel attending the procedure. They report improvement in 80% of patients.

(ECT is the alternative treatment that I was ready to try when none of the drugs prescribed for me proved effective. Then my doctor wanted to try one last drug, and that was the one that did the trick.)

TMS, or transcranial magnetic simulation, is described by the Mayo Clinic as “a noninvasive procedure that uses magnetic fields to stimulate nerve cells in the brain to improve symptoms of depression.” It’s also called rTMS, or Repetitive Transcranial Magnetic Stimulation, because more than one treatment is generally needed. The theory is that the magnetic pulses stimulate areas of the brain involved with mood control and depression. It doesn’t cause seizures or require anesthesia. The exact mechanism of how it works isn’t really understood, but that’s true of many other treatments for depression, including medications.

Harvard’s Health Blog reports that rTMS helps about 50% to 60% of people who did not respond to drug treatment “experience a clinically meaningful response.” They do note that treatments, “while encouraging, are not permanent,” which is true of many other forms of treatment.

Ketamine is the newest of the treatments for treatment-resistant depression. Ketamine was once known as a “party drug” called “Special K,” described by the DEA as “a short-acting anesthetic with hallucinogenic effects.” As a treatment for depression, however, it is thought to “enable brain connections to regrow,” according to scientists at Yale. The American Association of Nurse Anesthetists notes that ketamine “is not a first-line therapy for psychiatric disorders,” but then, neither are ECT and TMS.

Ketamine can be administered via nasal spray, but for psychiatric purposes (including to treat bipolar disorder and PTSD) it is often given as a series of infusions. An article in The Lancet says that “Ketamine is thought to act by blocking … receptors in the brain.” Another article by doctors at the National Institutes of Health comments that ketamine “has a robust and rapid effect on depression, which was seen immediately after the administration of ketamine and sustained at the end of 1 month.” Repeated treatments are generally necessary.

I don’t know about other patients and doctors, but after years of drug therapy not working, I was ready to give almost anything a try. ECT was next on the list, and the only likely alternative, as TMS and ketamine were not available at that time. I’m just glad that now patients and their doctors have more options when depression resists drug treatment and “talk therapy.” And I hope that even more alternatives become available for people with depression who are desperate to find a treatment that works for them.

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