Bipolar 2 From Inside and Out

Posts tagged ‘mutual support’

Inspiration and Mental Illness

high angle view of pencils on table

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I was manicky this week and it affected my blog writing. I had a post all ready to go this morning, but last night I thought about it and realized it was crap. It meandered, without focus. The ideas were confused. It sucked. So I got up this morning to write something different instead.

Many of you may recognize this aspect of mania or hypomania. You do something that you think is fantastic  while in the grip of mania and when you come down, you can’t see what you ever saw in it. Or you begin an ambitious project that you work on and work on but never can complete.

I was toying with the idea of “inspiration porn” – the sort of post or story or TV show that holds someone up as an ideal, usually because they’ve lost a bunch of weight and gotten themselves into shape, or have an illness or disability and managed to do – whatever – again. Think “The Biggest Loser.” Or amputees who’ve learned to eat with their feet. It’s put out there for entertainment and to make everyone feel good that whoever it is conquered whatever it was. It takes a regular person out of the context of their lives and reduces them to their condition. And the subtext is that if this brave person can become able to do or be whatever again, so can everyone else with the same problem.

It happened to a friend of mine who was at a gym on a treadmill. A woman came up to her and said how inspiring it was to see her working so hard to lose all that weight. “Excuse me?” was my friend’s reaction. She was doing it for herself, not for anyone else, and especially not to inspire some random stranger.

The thing is, there really isn’t any mental health inspiration porn. For one thing, it would make lousy TV. Oh, they’d get advertisers – all those purveyors of psychotropics that clog the airwaves. But who would watch a depressed person finally getting out of bed and taking a shower, unless she had a coach yelling at her?

Inspiration for those of us with mental health problems takes other forms. Celebrities who speak about their struggles with mental illness are one. They are inspiring because they break the taboo about talking about mental illness in public and because they have done so to help other people.

Then there are the superstars of mental health inspiration. Carrie Fisher, Glenn Close, and Jenny Lawson, to name a few. These are people who focus light on the difficulties and struggles of mental illness. Their communications don’t stop with the announcement that they have a condition and encouraging people to get treatment, though those are also good things. But the real inspirations are those who open their lives, take others with them through the journey of symptoms, treatments, relapses, small triumphs, and bigger successes. They speak and keep speaking and keep speaking their message. They don’t make the process sound easy, because it isn’t. And they speak with authenticity and authority because we know they’ve been there.

They do inspire us because they are honest and open, and they clearly care about helping others in the same proverbial boat.

We lost a true inspiration when we lost Mama Carrie. No one will ever really take her place. But you can tell that she was an inspiration by the many people whose life she touched and how they remember her. If someday they make a movie of her life, I hope it features not only her personal struggles, but all that she did for others. Her speaking and continuing to speak despite – or because – of her ongoing struggles.

We can carry on her work by doing the same, by shedding the stigma, by talking to others, even family and friends. Recently a friend “came out” to me that she takes an antidepressant and an anti-anxiety med (the same ones I take). I was proud of her, but I didn’t make a big deal of it. But I was impressed and pleased that she was able and willing to share even that much. She was saying that she was part of our tribe.

As Jenny Lawson reminds us, in this we are alone together. And that’s inspiring. 

Talking to Ourselves

people woman relaxation girl

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Recently on Facebook I asked how many of my friends knew the meaning of the semicolon – other than as a mark of punctuation. About two-thirds of those who responded did. The rest either didn’t or had some vague idea but no real knowledge. But I’m pretty vocal about mental health issues and a fair number of my friends have similar problems and difficulties, so that two-thirds figure is likely not representative of the population at large.

Yet I see increasing numbers of t-shirts, bracelets, and other paraphernalia adorned with semicolons and sometimes colorful butterflies or the word “warriors.” But nowhere does it say what the semicolon stands for. For those of you who don’t know, the semicolon marks that place in a sentence where a writer could have stopped, but chose to go on. As such, it has become a symbol for suicide prevention and mental health awareness.

I have a semicolon tattoo myself. I don’t regret getting it. It reminds me, as the saying goes, that my story isn’t over. But when I got it, I also hoped it would be a tool for education – that I could explain to those who saw it and asked what the symbol meant.

Unfortunately, no one has asked.

I’d hate to think that the semicolon has become like a secret handshake that identifies members of our tribe to one another, but leaves out the rest of the world. As stigma-fighting symbols go, it doesn’t seem terribly effective.

The political conversation has become so fraught that no one talks to anyone who doesn’t believe in the same things. And I’m afraid that, like them, we’re largely talking to ourselves.

Self-talk is important – definitely something we should pay attention to and work on improving. But if we really want to fight stigma, we need to talk to other people about it.

I see a fair number of stigma-fighting memes and discussions, but unfortunately, most of them take place in mental health support groups, where the message is not as much needed as in the larger world outside our band of the mentally ill.

Of course, there are organizations such as NAMI, Bipolar Awareness – Stop the Stigma, and Stigma Fighters that dedicate effort to reducing stigma. And they are doing a good, necessary thing.

But what about the rest of us? What can we do to break out of our shells and involve the rest of the world in our cause?

One thing is to question other people’s assumptions when we see or hear them. When you read a post that calls the weather bipolar, answer it. Explain why that’s not a good comparison – that it trivializes a very real problem that millions of people face every day. And when someone assumes that a mass shooter or other terrorist must be mentally ill (or “off his meds”), remind them that those with mental illness are more often the victims of violence that they are the perpetrators of it.

Will people get the message, or will they just dismiss you as “politically correct” or a “social justice warrior”? Personally, I can think of worse names to be called, and many of us have been called them. But just as “retarded” and “gay” are no longer acceptable as synonyms for “weird” or “stupid,” we should try our best to make “crazy” and “mental” and “psycho” and that annoying little twirl of the finger by the temple no longer acceptable as shorthand for behavior that one doesn’t understand. (I still haven’t figured out how “dumb” and “lame,” both ableist language, have managed to skate by.)

What I’m saying is that to fight stigma we need to engage with the world outside. We need to explain why certain uses of language are hurtful and what the truth is about the many people who are affected by mental illness.

I’ve had to smack a few friends on the nose with a rolled-up newspaper when they get it wrong and I try to put my two cents into other discussions that are portraying the mentally ill insensitively. I think about what I’m going to say and even practice it before I speak or press send. (Sounding well-informed and reasonable is the way I want to express my message.) I post my blog entries to “public” as well as to friends and support groups. Sometimes I even talk to my family about stigma.

As a group, we need to do a whole lot better at not hiding from stigma but confronting it wherever we see it. We can live with stigma or we can fight it.

Reaching Out and Reaching In

A lot has been said in recent days about reaching out when you’re in trouble psychologically. And that’s always a good idea. Reach out to your friends, your family, your therapist, your psychiatrist, your church or synagogue or temple.

hands people friends communication

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Unfortunately, not everyone has those resources. And sometimes when you reach out to them, they do not reach back to you or even respond in hurtful ways.

Sometimes – many times – you’re just not able to reach out. That’s true of me, anyway. When major depression hits me like a truck, I get immobilized. Uncommunicative. Isolated. I usually have the wherewithal to get to my therapist, if my husband drives me, but not much more.

My family and friends can tell when I’m in trouble. And they do reach out, even when I don’t reach back.

My mother always knew when I hit a particularly bad spot because she could recognize it in my voice – it lacked animation, even if I was talking about something I loved. Not that I talked much or felt much. Depression can damp down all your feelings sometimes. You don’t cry, you don’t feel sad. You feel nothing. And it shows to someone who knows how to look and listen.

This is called “flat affect” by psychiatrists. The person’s face, voice, mannerisms do not reflect emotions, sometimes not even anxiety or despair. And sometimes people adopt a flat affect so as not to betray their inner turmoil. (It can still leak out around the eyes, even to relative strangers. And I don’t mean crying.)

My husband knows I’m depressed when I turn monosyllabic. Ordinarily, I enjoy talking to my husband about anything and nothing – things we’ve read or heard, what’s happening at work (his, mostly), funny things the cats did, and so forth. But when I stop responding and communicating, or respond only with “yeah,” “nah,” and “meh” sorts of answers, or don’t laugh or at least groan at his jokes, he knows I’m headed downward.

I stop communicating other ways, too. I don’t post on Facebook or only pass along the occasional pass-along. I skip commenting on posts regarding things I usually care about. I spend hours alone reading, if my sometimes-dubious powers of concentration let me. Or I sleep, and nap, then sleep some more. I certainly don’t leave the house or even make plans to go out. I don’t call friends. I isolate. I don’t reach out, like the memes say I’m supposed to.

I am fortunate to have friends that do reach out to me. John would lend me books, talk about them with me, and listen if I needed to vent. Peggy would call and invite me to visit, even when she knew I wasn’t leaving the house. Pete sometimes IM’s every day just to check in and JB assures me that when he IM’s and I don’t feel like chatting that’s still okay. Robbin calls me and tells me all about her life even when I can’t talk about mine, then says, “Let me know when you surface.” If she doesn’t hear from me for awhile, she calls again and reminds me that I can call her too. (She can also “read” my voice and knows when there’s some topic I’m avoiding.) My husband offers a hug or kisses me on the head. My mother prayed for me. I am fortunate indeed to have had people like these around me when I really need them.

Reaching out to others is good. So is reaching in to the suffering. Best is a combination of both. But that takes work and not everyone is able to do it.

If you can reach out, reach out.

If you can reach in, reach in.

If you’re lucky, you’ll meet in the middle, where hope lives.

 

Books About Bipolar and Other Fun Topics

I love reading. Always have – except for the period when a major depressive episode stole it from me –https://wp.me/p4e9Hv-qp. I’m never more than two feet away from a book or, at this point in my life, an ereader. Reading is how I explore the world.

So naturally, in trying to better understand my disorder, I read about it. And because I’m interested in psychology in general, in addition to books about bipolar disorder, I read about other mental illnesses as well.

Let me share some of my reading with you.

For sheer delight as well as profound insights, try Jenny Lawson’s Furiously Happy: A Funny Book About Horrible Things. Amid the hilarious stories of life in her other-than-typical family are insights into depression and social anxiety, along with a manifesto of defiance – the will to be, well, furiously happy.

The other easily approachable book is Allie Brosh’s Hyperbole and a Half: Unfortunate Situations, Flawed Coping Mechanisms, Mayhem, and Other Things That Happened. What started as a humorous blog grew into a book (with quirky illustrations) featuring two chapters in particular, “Adventures in Depression” and “Depression Part Two,” which are about as good as writing about depression gets. A second book, Solutions and Other Problems, was scheduled but has been postponed indefinitely.

And while we’re on the subject of funny books about mental illness, there’s Surviving Mental Illness Through Humor, an anthology edited by Jessica Azar and Alyson Herzig.

Perhaps the best-known book in the field of bipolar disorder is An Unquiet Mind: A Memoir of Moods and Madness, by Kay Redfield Jamison. In it, Jamison deals openly and honestly with bipolar disorder, particularly with mania and psychosis, along the road to becoming a doctor herself. She has also written Robert Lowell, Setting the River on Fire: A Study of Genius, Mania, and Character, about the famous modern poet, but I haven’t read it yet, so I can’t comment.

Birth of a New Brain: Healing from Postpartum Bipolar Disorder, by Dyane Harwood, is another recent book that I haven’t read yet, either. But I know Harwood’s writing and expect it to be a stand-out, as well as the only book I know of on that particular topic.

Other books on bipolar disorder include Lost Marbles: Insights into My Life with Depression & Bipolar by Natasha Tracy.

For books about depression, the definitive work is The Noonday Demon: An Atlas of Depression, by Andrew Solomon. A thorough examination of depression, including the author’s own, it is practically a reference book on the topic, though much less dry than that makes it sound.

Darkness Visible: A Memoir of Madness, by William Styron, is another classic on depression that I really ought to read, but haven’t yet because I’m not that fond of Styron’s writing. (Sophie’s Choice is his best-known work.)

For mania, I recommend Just Like Someone Without Mental Illness Only More So: A Memoir, by Mark Vonnegut, M.D. The son of Kurt Vonnegut, Jr., the author deals less with his celebrity father, instead focusing on his saving-the-world-style mania during his pursuit of an M.D. degree.

Other books that I can recommend include:

  • My Lobotomy, by Howard Dully, a memoir of a boy who was lobotomized for no particular reason other than the fact that his stepmother hated him, and the difficulties he encountered in and out of institutions.
  • Ten Days in a Mad-House, by Nellie Bly, early undercover journalism at its finest. (I wrote about her experiences in one of my earlier posts: https://wp.me/p4e9Hv-hG.)
  •  Shrinks: The Untold Story of Psychiatry, by Jeffrey A. Lieberman, a history of the development of the field from the buried memories days to the biological understanding of today.
  • The Man With the Electrified Brain: Adventures in Madness, by Simon Winchester (who also wrote The Professor and the Madman, about the making of the Oxford English Dictionary). Despite the title, this is not about electroshock treatment, but rather dissociative states.
  • Rebooting My Brain: How a Freak Aneurysm Reframed My Life, by Maria Ross; and My Life Deleted: A Memoir, by Scott Bolzan. These books, about a cerebral accident and amnesia, respectively, don’t speak directly to bipolar disorder, but I found them interesting as accounts of rebuilding one’s life after a significant mental condition.

And for an opposing point of view, if you must, there’s Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America, by Robert Whitaker. Once you’ve read the title, you pretty much know how the book’s going to go; I don’t recommend this anti-psychiatry screed.

What books do you recommend? Which have helped you?

Twelve-Step Groups for Bipolar?

Why are there no 12-Step groups for persons with bipolar disorder?

There are a number of support groups, both online and in local areas – and even a Facebook page called Bipolar Anonymous (https://www.facebook.com/bipolaranonymous38/) – though it’s not a 12-Step group and seems to consist mostly of posted memes of encouragement. They describe themselves as:

a group page for people who suffer from a Mental Illness, or are having a rough time of things, to seek out people with like problems, for support and a place to vent.

My short answer is that a 12-Step program would not work for bipolar disorder.

It’s not that people with bipolar don’t need AA. Some do. As James McManamy says at Health Central (https://www.healthcentral.com/article/bipolar-and-alcoholism-is-aa-the-only-game-in-town):

One-half of those with bipolar experience alcoholism at some stage in their lives, far more than the general population. Four in ten experience other substance use issues. This extra burden comes at a huge personal and family and social cost. As if bipolar weren’t bad enough, already.

However, at many 12-Step meetings, according to David Oliver (http://www.bipolarcentral.com/articles/articles-644-1-Ailcoholics-Anonymous-and-Bipolar-Disorder.html), alcoholism is the only condition discussed at meetings. Bipolar disorder is considered an “outside issue.” However, he also notes that for those with a dual diagnosis:

Part of the program of Alcoholics Anonymous is to get a “sponsor.” A sponsor is a person who will help the member through the 12 steps of the program, to help them stay sober, and to help them deal with the issues surrounding their alcoholism.

Hopefully, the member with bipolar disorder can find a sponsor who is sensitive to the fact that bipolar disorder is one of the issues that does, in fact, affect their sobriety.

Another facet of AA that can be applicable to those with bipolar disorder is Reinhold Niebuhr’s Serenity Prayer: God, grant me the serenity to accept the things I cannot change, Courage to change the things I can, And wisdom to know the difference.

But as to the 12 Steps themselves, only a few are likely to be helpful to bipolar sufferers, and several apply not at all. Let’s take a look at a few:

  • We admitted we were powerless over alcohol – that our lives had become unmanageable.
  • Came to believe that a Power greater than ourselves could restore us to sanity.

These, the first two steps, are problematic if you replace alcohol with bipolar. We are not powerless over bipolar. There are treatments, involving therapy and/or medication, that give us power to manage how bipolar affects us. And that Higher Power so essential to AA – often expressed as “God as we understand Him” – will not restore us to sanity, through prayer may help us get through the difficult times associated with the disorder. (https://wp.me/p4e9Hv-B6)

On the other hand, a few of the 12 Steps may be relevant:

  • Made a list of all persons we had harmed, and became willing to make amends to them all.
  • Made direct amends to such people wherever possible, except when to do so would injure them or others.

Few would deny that bipolar disorder has often been a factor that affected our relationships with others. We can certainly acknowledge that we have hurt others as well as ourselves while in the grip of mania and/or depression, and we can offer or try to make amends.

But, overall, it seems that 12-Step programs are not for us.

What is there to suggest instead? Here are two places to look:

  • Therapist-led support groups in your area
  • Depression and Bipolar Support Alliance (DBSA), which offers online and in-person peer support groups or chapters http://www.dbsalliance.org/site/PageServer?pagename=home

DBSA has a page that helps you locate support groups in your area. Unfortunately, there are none within a reasonable distance of where I live.

However, I could always start one. And so could you.

Also, I invite you to write any number of steps that would be appropriate for a support group along the AA model.

Gaslighting and Bipolar Disorder: A Follow-Up

Over a year ago, I wrote about gaslighting and bipolar disorder (https://wp.me/p4e9Hv-pm). In my post I said:

[W]hat does gaslighting have to do with bipolar disorder? Someone who is in the depressive phase of bipolar – especially one who is undiagnosed – is especially susceptible to gaslighting. The very nature of depression leaves a person wondering, “Am I insane?” To have another person reinforcing that only strengthens the idea.

Since then, gaslighting has become a hot topic, appearing all over the Web, so I thought I’d write about it again.

The essence of gaslighting is that someone denies your reality and substitutes his own. (Gaslighters are mostly – though not exclusively – men.)

What I believe is driving the interest in gaslighting is the “#MeToo” movement. Women everywhere are speaking up about incidents of sexual harassment, sexual abuse, sexual assault, and even rape that they had not spoken of before. Or that they had spoken of but not been believed.

In many of these cases, gaslighting was involved. The women say, “This happened.” The men say, “It was a joke/flirting/a compliment/not that big a deal/consensual.” Until now men have denied the women’s perception of abusive reality and substituted their own innocent explanation. And, for the most part, the men’s reality has been accepted. Again and again.

Some of the high and mighty have recently been brought low by revelations of misconduct. The more we hear, the more it seems that men who achieve prominence in any field see women and especially their bodies as just another perk – like a company car or a key to the executive washroom. An audience for a dick pic. A pussy to grab.

Those are the cases that make the news. But the problem goes all the way down to the least prestigious situations. Any male in a position of power over a woman has the opportunity to exploit that relationship. Many are decent men and don’t. But many – from your local McDonald’s manager to the city bus driver to the head janitor – do. That’s millions of men and millions of women, the gaslighters and the gaslit.

Again, why discuss this in a bipolar blog? Because the very nature of our disorder makes us a little unsure of reality anyway. Perhaps this is mania and my boss is complimenting me because I really am sexually appealing. Perhaps this is depression and I deserve the degrading thing that just happened to me. Perhaps this is somewhere in between and I can’t guess what’s what.

A person unsure of her emotions is more likely to take the “bait” that the gaslighter dangles. A person unsure of her reality is more likely to accept someone else’s definition of it.

The #MeToo movement is empowering. It allows women to bring into the light the shameful things that have been hidden away. And it gives the bipolar person a more objective standard against which to measure reality. “That happened to me too! I was right that it was inappropriate!” “I saw that happen to my friend. Next time I’ll be strong enough to speak up!” “I see what’s happening. I’ll teach my daughter not to put up with that behavior. And my son not to do it.”

And it says to the bipolar person, “You have an objective reality outside your moods. You can trust your perceptions on these matters. You too have a right to live without these insults, these aggressions, this gaslighting. You can trust your feelings when you perceive that someone has stepped over that line.”

We have bipolar disorder. We are not the disorder. And it does not rule every aspect of our lives. When we perceive a situation as unprofessional, harmful, insulting, degrading, we can say so – and deserve to be believed. Just because we have a mental disorder does not make us any less worthy of decent, respectful treatment by the men in our lives, whether they be boyfriends, husbands, fathers, employers, or supervisors.

We have enough problems in our lives. We shouldn’t have to deal with gaslighting too.

 

 

Mental Illness: Poverty and Privilege

Mental illness is not just an American problem. In fact, it’s a problem around the world, and perhaps much more acute in other nations, especially those plagued by poverty.

There’s no way to know for sure, but many – perhaps most – of the world’s mentally ill are undiagnosed, untreated, ignored. Because what do you do when you live where there’s no psychiatrist? No therapist. No medication. No help.

Your family may support you, shelter you, or shun you, depending on their financial and emotional resources and those of the community. But for many people, there is simply nothing.

Psychiatrist Vikram Patel, one of Time magazine’s 100 Most Influential People for 2015, is working to change that.

As a recent profile in Discover magazine put it, Patel and others like him have set out to prove “that mental illnesses, like bipolar disease, schizophrenia, and depression are medical issues, not character weaknesses. They take a major toll on the world’s health, and addressing them is a necessity, not a luxury.”

In 2003, Patel wrote a handbook, Where There Is No Psychiatrist: A Mental Health Care Manual, to be used by health workers and volunteers in poverty-stricken communities in Africa and Asia. A new edition, co-written with Charlotte Hanlon, is due out at the end of this month.

Patel, in his first job out of med school, in Harare, Zimbabwe, says he learned that there wasn’t even a word for “depression” in the local language, though it afflicted 25% of people at a local primary care clinic. There was little study of diagnosis and treatment in “underserved areas.”

Later epidemiologists learned to their surprise that mental illnesses were among the top ten causes of disability around the world – more than heart disease, cancer, malaria, and lung disease. Their report was not enough to spur investment in worldwide mental health.

Patel developed the model of lay counselors – local people who know the local culture – guiding people with depression, schizophrenia, and other illnesses through interventions including talk therapy and group counseling. By 2016, the World Health Organization (WHO) admitted that every dollar invested in psychological treatment in developing countries paid off fourfold in productivity because of the number of people able to return to work.

One objection voiced about Patel’s model is that the real problem is poverty, not depression or other mental illness. The argument goes that the misery of being poor, not a psychiatric illness, leads to symptoms and that Westerners are exporting their notions of mental health to the rest of the world, backed up by Big Pharma. Patel responds, “Telling people that they’re not depressed, they’re just poor, is saying you can only be depressed if you’re rich … I certainly think there’s been a transformation in the awareness of mental illnesses as genuine causes of human suffering for rich and poor alike.”

Of course the problem of underserved mentally ill people is not exclusive to impoverished nations. There are pockets in American society where the mentally ill live in the midst of privilege, but with the resources of the Third World – the homeless mentally ill, institutionalized elders, the incarcerated, the misdiagnosed, those in rural areas far from mental health resources, the underaged, the people whose families don’t understand, or don’t care, or can’t help, or won’t.

I don’t know whether Patel’s model of community self-help can work for those populations as well as they do internationally. This is not the self-help of the 1970s and 80s, when shelves in bookstores overflowed with volumes promising to cure anything from depression to toxic relationships. It would be shameful if the rich received one standard of care for mental health problems, while the poor had to make do with DIY solutions, or none.

But, really, isn’t that what we’ve got now?

 

Surviving College While Bipolar

I had two goes at college, and they were very different from each other, based on the state of my bipolar disorder at the time.

The first time I went to college, for my undergraduate degree, I was undiagnosed and unmedicated – except for self-medication. I was away from home for the first time – that was my first goal when choosing a college, being after a “geographical cure.” I ended up in the Ivy League, a scholarship student and a fish out of water. And profoundly depressed.

I did manage to hit the ground hiking, as the university sponsored backpacking trips led by juniors and seniors for entering students. We used to joke that it was meant to lose a few along the way, but really it was for orientation. Campfire chats about college life and the like.

On that hike through the Adirondacks, I met Caren, Roberta, and Cyndi, who instantly became my best friends and were my support system throughout the five years I spent there.

Yes, five, though only four of them were really at the university. After my first year, I took a year off. My depression had gotten so bad that I was given to sitting on the floor in the hallway, staring at a poster for hours at a time instead of sleeping. During my year away, I worked a dreary but educational job as an evening shift cashier at a restaurant. When I returned, I had a new major and the same old depression.

Oh, I did have fits of hypomania. I joined a sorority during one, though I deactivated later in a depressive downturn. And I went through the ups and downs exacerbated by several failed romances, including one total trainwreck.

The only help I got, aside from the support of my friends, was one brief therapy group at the campus mental health center and a brief stay at the university clinic, because of some suicidal ideation that my friends recognized.

Needless to say, I came out in no better mental shape than I went in, but I did manage to snag a B.A. degree. Now I feel that I missed a lot of opportunities along the way. It was just another occasion when I felt that my lack of mental health got in the way of what could have been a more productive time, as a well as a happier one. When I left college I was still almost as ill-prepared to function as when I went in.

By the next time I gave college a try, I was, if not mentally healthy, at least mentally healthier. And being back in the town I had been so eager to leave, I had a larger support system, now including a therapist, parents, close friends, and a husband. This time I had help.

I was still a mess, but less of one. With my depression lifting, I was able to teach introductory courses and manage my own course load. I remember my first semester teaching as a blaze of hypomania as I adored the subject and thought I was sweeping all the students along with my enthusiasm. Then one of the students gave me a bad review and I plunged again, never to recover that soaring sensation. I plodded through the next three semesters of teaching.

This time I came out with an M.A. and better job prospects. The day after I graduated I was working as a temporary editorial assistant, a job I kept for 17 years, moving up to editor along the way.

What did my experiences with college teach me (aside from modern poetry and how to swallow aspirin without water)?

  1. Making it through college is possible when you’re unmedicated and have minimal support, but I don’t recommend it.
  2.  Even with diagnosis, medication, and support, it’s still not easy. You know how hard it is to get out of bed and take a shower some days? Now think about going to a class on top of that, where your work will be critiqued. Taking a year off was one of the best things I ever did.
  3. Being bipolar isn’t your only identity, though it looms large in your life. I was also a student, a teacher, a friend, a daughter, a wife, a poet, a cashier, and so many other things. I may not have enjoyed them as I should, gotten as much from them as I could, but they were as much a part of me as bipolar was.

I can’t see myself at this point going back to college and getting a Ph.D. Which is not to say I’ve never considered it. But I like to think that, were I to try, this time I would have a better chance of getting through, sanity intact, with something more to show for it than a piece of paper to hang on the wall. This time, I tell myself, I wouldn’t let Bipolar Me take the experience away from Me.

Self-Care and Human Needs

Self-care is one of the hot topics these days in the world of bipolar disorder and the people who live with it. Self-care can be as basic as remembering to eat or as complicated as knowing and avoiding your triggers.

Back in 1943, psychologist Abraham Maslow created what he called a “hierarchy of needs” – a series of stages that human beings must go through on the way to the ultimate goal of “self-actualization.” With few changes, the concept, usually illustrated as a pyramid, has continued to influence the study of human motivation and developmental psychology.

So what does self-care have to do with the hierarchy of needs?

The most basic needs of human life form the base of the pyramid. These are called “physiological needs” and are essentially what a person needs to stay alive: air, water, food, shelter, sleep, clothing. Without meeting these needs, a person cannot move up to the next level of the hierarchy.

A large part of self-care is devoted to meeting these very basic, fundamental needs. Air is usually not a problem but shelter and clothing can be, for those bipolar persons who are homeless – and there are more than a few. Many of us are just one financial reverse – loss of income, insurance, options – from being homeless.

The most common advice for self-care is to pay attention to these base-level needs: Remember to eat. Stay hydrated. Get enough sleep. At times, it’s a real struggle just to meet these self-care needs. Add “get exercise” to the list and it can suddenly be overwhelming. People with bipolar or major depressive disorder often need help accomplishing them. That’s as high as we get on the pyramid.

The second step of the pyramid, which people need to work on after they’ve met the requirements of the first step is called “safety needs”: personal security, employment, resources, and health. Again, the needs on this step may seem insurmountable, and may – probably will – require help to achieve.

But they are self-care needs too. Current society may not view them as such, but that’s because they tend not to struggle with them, at least not on the level of a person with a mental disorder. Individuals can sometimes help meet these needs, but more often government, community, or charitable organizations provide necessary help. Talking about self-care at this second level may seem like pie-in-the-sky to those who have not yet conquered the first. But truly, taking care of these needs is a form of self-care, enabling one to maintain the gains represented by achieving those of the first level.

The third level of human needs – and self-care – is called “love and belonging”: friendship, intimacy, family, sense of connectedness. Again, this is not usually thought of as a part of self-care. But it certainly is. Many of us – I include myself – lose friends, become estranged from family, fail at intimate relationships. There are other places to look for ways to practice self-care on this level, however.

Therapy groups and self-help groups can lead you to people who share your problems and may be able to help you in achieving self-care. (My husband met one of his dearest friends, who provided support, listening, understanding, and companionship, at a self-help group meeting.) If in-person meetings are not possible, social media such as Facebook, Twitter, and WordPress provide opportunities to meet some social self-care needs through various groups and online communities.

The top two levels of the pyramid are not as easy to think of as self-care, and not as easy to tackle. Level four is esteem: respect, self-esteem, status, recognition, strength, freedom. And five is self-actualization: to become the most that one can be. Realistically, these are not strictly speaking things that can be accomplished through self-care. Even neurotypical people may never complete step four, and there is reason to think that few people ever reach self-actualization. These are goals to strive for, but not guarantees.

Wherever you may currently be on the pyramid, the important thing to remember is that self-care will help you reach the next step; that each follows the one before; and that your bipolar life will improve with every step you achieve.

 

Caregivers Need Care Too

While there are professional caregivers, family members often provide care and support for those with bipolar disorder and other mental illnesses.

My husband of 35 years is my caregiver. He does a spectacular job – making sure I have my meds, taking me to my appointments, running the errands that I have no spoons to do, keeping the house quiet when I need to sleep, making sure I eat at least one nutritious meal a day.

It’s a lot. And there are things I can give him in return. Things he needs.

Appreciation. When my father was dying of cancer, my mother was his primary caregiver. One day she came to me, wanting me to tell her that she was doing a good job. She knew that she was. She just needed to hear it from someone else, someone who could tell her that her excellent care had been noticed and appreciated.

Appreciation – validation – is the thing that caregivers need most, to replenish themselves, to allow them to keep doing the things that are so vital for their charges. And it’s the easiest to give. When you’re in the depths of depression, it may be difficult to remember to say “thank you,” but it means a lot to your caregiver.

Now I’m mostly out of my depression (usually), and I say “thank you” a dozen times a day. And he always responds, “You’re welcome, friend.”

Alone time. Primary caregiving can be a full-time job. I know that one thing I need in the process of healing is alone time. Dan needs it too. He needs time off, even if that’s just time to retreat to his study and watch a movie or go outside and dig in the garden. I can always reach him if I really need him – for example, if I have a panic attack – via cell phone if nothing else. But, as the saying goes, you can’t pour from an empty vessel. That’s part of the reason that he’s able to give me so much of what I need.

Couples time. This doesn’t necessarily mean sex. It means time spent together, doing something other than dealing with mood swings and trauma. It’s a little gift we give each other. Sometimes I sit through a movie I don’t really care for, just to give him the gift of snuggling on the couch. He got me color-and-bake ceramic mugs that are great for creativity and distraction. One rainy afternoon we sat together and each colored one side of the mugs.

Life stuff. Dan does most of the chores and tasks of daily living, but I do what I’m able to. I earn money. I pay bills online and do most of the other computing, except what he does for leisure. I help with cooking to the extent I can – sous-chefing, finding recipes, breading or mixing or inventing dressings and sauces, making grocery lists. He can ask me for help too.

Sharing my spoons. When I do find myself with a few spare spoons – a little extra energy occasionally – I try not to be selfish with it. When I have spoons to spend, I like to shower and dress and go out for lunch. But the other day, I showered and dressed and went for a walk in the woods with Dan, something he’s been longing for. My spoons ran out pretty rapidly, but he appreciated that I made the effort and shared one of his delights. It was another gift that cost no money.

In other words, when you have a caregiver, don’t think it’s all one way. Your caregiver needs care too. Small or large, what you are able to give will be appreciated.

 

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