Bipolar 2 From Inside and Out

Posts tagged ‘my experiences’

No Longer Trapped

Recently, I wrote a post on how I was trapped in my house because of a lack of transportation. It wasn’t just because it’s too people-y out there in the world, though I have to admit that may have been a factor. Other factors have been that I’ve been simply too comfortable in my study, which contains nearly everything I need for my psychological and physical needs. And the bathroom is nearby.

Then, too, I have physical limitations these days. I had my left knee replaced last year and tore a muscle in my thigh afterward. My right knee is still bone-on-bone, however, and needs to be replaced, too. I also broke my right foot in two places. I can’t climb stairs yet, so I have a ramp at the front door that I have to use a wheelchair for. And I’m living on the first floor of the house. Because of the wheelchair/ramp situation, I still need Dan’s help to get out of and into the house.

So, difficulties persist, but soon I will have options. I’m getting a new (to me) used car. It’s a cream-colored Mercury Milan with only 40,000 miles on it, and it’s just been to a mechanic to check its soundness.

Logistics Are Difficult

The major problem is that Dan and I have to fly to Florida to pick it up. Having it shipped 850 miles is just too expensive. So, we have to fly down and then drive the car back. We considered having Dan fly down and drive back alone, but he didn’t want to leave me on my own for three days in case I have an emergency, minor or major. (He also doesn’t want to drive back on his own, and wants me to help with the driving and keeping him awake.)

That means we have arrangements to make, which are complicated by my infirmities. Getting to the airport is something that everyone has to do—Lyft or Uber. I’ll ask for mobility assistance (wheelchair) at all the airports because, while I usually use a walker at home and am taking it with me, I don’t move very fast with it or stand in line for long.

One thing I’m afraid of is that, since we’re flying on a small jet, we may have to board it on the tarmac with a set of stairs rather than via a jetway from the terminal. There’s no way I can make it up a set of stairs with my walker. The airline says they don’t know how we’ll board until the day of. They also say that someone will help me, but they don’t say how.

I do have a special walker for use with stairs, but I haven’t been able to put it together yet. And it’s simply impractical to take a stair walker and a regular walker on the trip.

Psychological Effects

As you may have gathered, I’m having anxiety about the trip. This is not unusual for me. I often have travel anxiety. But the uncertainty of the airline arrangements is making it worse. Driving back is anxiety-producing as well. I haven’t driven in well over a year, especially not in a large car. Driving in the rain or at night is also nearly impossible for me. We plan to stop at a hotel on the way back, so maybe I won’t have to drive at night.

I also have plenty of anxiety about how I will use the car once we get it home. Say I go out to lunch with a friend. I haven’t been brave enough to walk down the ramp with my walker. That means I’ll have to return the ramp and learn to use the stair walker, but carry my regular walker with me. Or maybe I’ll be able to use a cane by then. I’ll have to call my ortho and ask.

Anyway, getting a car of my own at last is a good thing, but everything that goes with it is confusing and anxiety-producing. Getting it will mean facing some of my fears and developing workarounds. Using it once it’s here will require some more.

All in all, though, I count this development as a plus and offer many, many thanks to my mother-in-law, who is making this all possible.

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Mental Health

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Self-Care Definitions

It used to be that when you said “self-care,” you were talking about spa days, shopping sprees, mani-pedis, indulgent desserts, or wine tasting. Or, as Marge Simpson so eloquently put it while ensconced in a bubble bath, “a banana fudge sundae! With whipped cream! And some chocolate chip cheesecake! And a bottle of tequila!”

Pretty quickly, that definition of self-care was recognized as a bougie, upscale fantasy available only to a wealthy person. Not to say that it isn’t relaxing or restorative, but it’s clearly not for the majority of those overwhelmed, traumatized, or otherwise suffering psychologically. They need something more than a beauty regimen and a spending spree.

A Better Definition

The next definition of self-care adds up to basic physical health and hygiene. You know, all the things you’re supposed to do to lead a healthy life: eat right, hydrate, get enough sleep, take showers daily, walk daily. And the things we’re supposed to do for mental health and hygiene: get outdoors, reach out to friends and family, take your meds, exercise, go to therapy, journal, practice affirmations.

All those actions and activities can help your mental health, it’s true. But they work best if you’re already fairly stable. There have been times in my life when all I could do was eat Cocoa Puffs and take my meds. When you can’t even get out of bed, telling you to get out of bed isn’t likely to work. It can even make you feel worse because you know you should do those things, someone’s telling you to do those things, and you’re so deep in the hole that you can’t do those things. Then you beat yourself up for that.

The Self-Care Box

I think that when it comes to self-care, you should start small. When you do begin to see a ray of light, take note of the things around you: comfort objects, things that have distracted you and pulled you out of your misery for even an hour or two in the past. Surrounding yourself with these items or knowing where to find them is, to me, a valid form of self-care.

I’ve seen recommendations that you prepare a self-care shoebox containing the things that soothe your five senses: ones that you can touch, taste, hear, see, or smell. That’s a good idea, but the things that soothe me don’t fit in a box, especially my blue blanket, my cat (just try to put a cat in a box not of his own choosing), a DVD player, and discs of The Mikado, The Pirates of Penzance, and The Three (and Four) Musketeers. I could probably fit a bag of ginger snaps in a self-care sensory box.

Instead, I just make sure I know where these things are. They’re all in my study (except sometimes the cat), which is, in effect, a large sensory box itself. My husband knows my self-care regimen and steps in as needed to provide the items I don’t have. And, after I’ve restored myself a bit, he’ll try to coax me out of the house with the promise of lunch at a favorite restaurant. Or even Waffle House, which is very close by and doesn’t require much effort, like getting out of sweatpants and into a skirt.

If you don’t have a study, keep your comfort objects in one room of your house: bedroom, living room, basement, rec room, or wherever. The important thing is to know where to find them when you need them.

Today’s Self-Care

I do journal, or at least I write in my blogs and post them weekly. When I’m overwhelmed, my schedule keeps me tied to the world. I know I have to have something written by Sunday at 10:00 a.m. It motivates me to get out of bed and kick my brain into gear. It’s less random than journaling, which can easily fall by the wayside. And if I’m still depressed, anxious, or overwhelmed, I can write about that. Thanks to my bipolar disorder, I have a ready supply of topics.

Right now, today, I have my blue blanket and my word processing program. The cat is in the doorway and likely to curl up on my comfy chair or my lap and sleep. I have a bag of ginger snaps on my desk and more nutritious things like fruit within easy reach. I’ve taken my morning pills, which live in a bag that hangs on the doorknob near my bed. I’m set for the day. I don’t need cheesecake or tequila.

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Mental Health

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Ambient Abuse: A Sigh and a Glare

I was a feminist, at least as I understood it at the time. I scoffed at the boys in high school who referred to the ERA as the Equal Restrooms Amendment. I went to a college that I chose for myself. I signed the loan for my first car. I read Men, Women, and Rape, The Burning Bed, Women and Madness, The Feminine Mystique, Sisterhood Is Powerful, and Ms. magazine.

I knew about domestic violence and swore that if an intimate partner ever battered me, I would not tolerate it for a minute. Either he or I would be gone. No second chances. One blow, and that was it.

So how did I end my college years involved with a man who never hit me but made my life miserable—more miserable than it was already with my undiagnosed and untreated bipolar disorder?

Chalk it up to the fact that my feminist education was incomplete. I had never heard of verbal abuse, emotional abuse, or gaslighting. I didn’t know how to respond to them when they happened to me. I didn’t even know at the time that they were happening to me. It took more years, more reading, and more talking about it, not to mention therapy, before I understood.

What Is Ambient Abuse?

Until this week, I had never heard of “ambient abuse.” Often described as an aspect of gaslighting, ambient abuse creates a toxic environment in subtle ways. Even the person living in such an environment cannot see what is happening, and their friends and family can’t either. It’s blamed on the victim for “being too sensitive,” “imagining things,” or “overreacting.”

The term “ambient abuse” was introduced by Dr. Sam Vaknin, a narcissistic personality disorder expert. He explained it as a situation in which an abuser creates a hostile environment that fills their partner with fear, anxiety, and hypervigilance—without committing any obvious physical acts of violence. Dr. Christine Louis de Canonville, another expert on narcissistic abuse, describes ambient abuse as “psychological terrorism.” It creates a state of threat for the victim without ever directly threatening them.

Among the tactics used to foster this invisible ambient abuse are a sigh, a facial expression of contempt, the silent treatment, or eye rolls. The toxic atmosphere is created without saying a word or raising a hand.

In other words, it was something I was not prepared for.

My Experience With Ambient Abuse

In my case, it was a combination of the sigh and the glare. Delivered together, they told me without words that I had done something wrong, misjudged something, said something stupid, behaved inappropriately, or otherwise transgressed. I cooked dinner, but I didn’t stay to eat it because I left for a scheduled guitar lesson. I ate a sandwich without offering him a bite. I wanted to close the bathroom door while I was using the toilet. I wanted to listen to my favorite music, not his, while ironing. Little things? Certainly. But added up day after day and reinforced with the sigh and the glare, they added up to a technique designed to keep me in line.

People who haven’t lived with ambient abuse can’t understand the cumulative effects. But to the person who does live with it, ambient abuse can trigger stress. When it continues, the person affected lives in a state of hypervigilance, unable to ever relax. And along with that come the natural bodily and psychological consequences of stress: headaches, stomach aches, changes in eating habits, tight muscles, inadequate sleep, poor concentration, and even long-term health problems. I had several of those symptoms, plus the twitching muscles and stabbing pain that exacerbated my TMJ problem.

Breaking Free

There were plenty of other, more obvious reasons to leave, but getting away from ambient abuse was certainly a factor. I applied for a job in my home state and packed up and left on a day when he was at work. I was across the state line before he got home.

The man who became my husband knows enough that he realizes that the sigh-and-glare trigger me. So we found a way to make fun of it. If I make an error, I say, “Are you going to sigh and glare at me?” He then huffs and blows and puts on his “mean face,” with furrowed brows and squinting eyes.

Then we both snort and laugh.

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A Bipolar Breakup

A recent issue of BP magazine had an article on surviving a breakup as a person with bipolar disorder. It noted that “a split can trigger manic or depressive episodes.” It also noted that “there’s typically a period of destabilizing upheaval as the newly single adjust to life on their own, perhaps in different surroundings.”

I can vouch for the mood episodes and destabilizing upheaval. My senior year in college, I experienced a breakup that was not just destabilizing but devastating. At the time, I was not diagnosed, but it’s now clear that I was in the grip of a major depressive episode, between not having any idea what would happen to me after college and the train wreck that was the relationship.

The article also described how to maintain stability, avoid dangerous rebounds, and prioritize self-care when a relationship ends. They advised readers to avoid rebound relationships, not stop their medication, see or seek a mental health professional, avoid isolation by using their social support network, take their time, and allow themselves to heal.

This is no doubt good advice, but it’s easier said than done. I wasn’t able to put all of it into practice. I had no mental health professional (and wasn’t ready to look for one), and was unmedicated, unless you count the benzo I was given for my TMJ problem and the wine our neighbors poured for me.

As for rebound relationships, I met the man I would eventually marry the weekend before I left where I was living to return to my home state. But it’s hard to call it a rebound relationship, as for over a year, we saw each other only twice, but simply corresponded. So I guess you could say I took my time.

However, one year wasn’t all I needed to heal. Neither the flashbacks and nightmares nor the crying were finished in that time. I had to repair my relationship with my parents. I had to realize that I needed psychiatric help and begin that journey. I had to rebuild my social support system and find the wherewithal to interact with them.

When you consider everything, it took more than a decade. By the time my “rebound” guy and I got married, I was still not healed. He had to cope with my distress as I tried to shake off the memories. He tried to understand my longstanding depression (but really couldn’t until he experienced a depression of his own). The people in my support system soon realized that I would back out of plans, often at the last minute, and that if I did show up, I could be preoccupied and uncommunicative.

The good news is that I finally did heal. My husband and I now have a strong relationship unclouded by the specter of that failed one.

So, what would I advise someone to do in the aftermath of a bipolar breakup?

First of all, take the time you need to heal, and don’t worry if it doesn’t happen quickly. The death of a relationship engenders grief. And as with the death of a person you cared about, grief takes as long as it takes. There is no official timeline or cut-off point. I’m not saying you should dwell on a past relationship, but that there are many facets to such a breakup, and you may have to heal from one after another. You can’t rush it, so don’t try. Unresolved memories and grief can pop up again when you least expect them.

Next, while you’re taking your time to heal, also take the time to do the work. Find a therapist or psychiatrist and go to your appointments faithfully. If they give advice (they may not), take it. If they give you homework, do it. If they say something that resonates with you, think deeply about it. See where it fits into your life and your situation. If it doesn’t seem to do so, discuss it further in a later session.

Finally, don’t overlook “glimmers.” These fleeting reminders of the things that remain good in your world are worth treasuring. What they are will be personal to you. The sight of a blue jay flying past your window or hummingbirds fighting over a feeder. The smell of cinnamon rolls baking. The sound of a song you love being played over the sound system of a restaurant you visit. The cuddly warmth of a blanket or a hug. The taste of your favorite kind of chocolate. Use all your senses to identify the presence of things that bring you, if not joy, at least a smile.

Give it time. You will get over that relationship.

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Lifelong Meds?

I was in my 20s when I started taking Prozac. Now I’m nearing 70 and still taking SSRIs, though the names have changed over the years.

When I was first diagnosed with depression (which was before I was diagnosed with bipolar 2 and anxiety), I understood it to be a lifelong condition. When my diagnosis changed, I still thought of it as a lifelong disorder requiring lifelong treatment. So far, that has proved to be true. I have been on antidepressants ever since and fully expect to stay on them forever, or at least until a cure is at last found.

Recently, however, the New York Times published an article that examined whether the received wisdom was still true. Did someone, once prescribed antidepressants, whether for depression, OCD, PTSD, or another mental illness, have to continue taking them for the rest of their life? The article noted that the FDA’s approval of the drugs was based on trials that lasted only a few months. Other “in-depth” studies lasted two years or fewer. The Times also noted, “Current clinical guidelines do not specify the optimal amount of time they should be taken for.”

Many people stop taking antidepressants on their own, based on side effects and a dislike of them, the fact that the drugs seem to stop working (either fairly quickly or over the long term), or simply because they dislike taking pills. According to the Times, however, “The answer depends on your symptoms, diagnosis, response to the medication, side effects, and other factors—all things to discuss with a medical professional.” In other words, cold turkey isn’t the way to go. With psychotropic drugs such as benzos, it’s positively dangerous, and quitting antidepressants brings the risk of falling back into the depression you and your doctor were trying to alleviate. Tapering off the drug with the help of your prescribing physician is recommended.

And about those side effects—some disappear over time as the body gets used to the medication, but others, particularly annoying ones like weight gain, sexual dysfunction, and possibly increased heart symptoms, linger. A doctor can prescribe a different drug in hopes that the side effects will not be so severe, but they may only be similar or worse. Patients generally don’t like tinkering with their medication and having to wait weeks until the effects appear and the side effects disappear. It’s a tedious and discouraging prospect.

What do the clinical guidelines say? Experts say that antidepressants, once they work, should be taken for four to nine months. Any quicker than that, relapse may occur. To maintain the positive effects, they should be taken for two to four years. Taking them for longer periods is sometimes advised, depending on how long the depression lasted and whether the patient has had several depressive episodes. Long-term use depends on whether the illness has continued for a long time and whether the depression is very severe, causing hospital stays and a loss of the ability to perform daily functions.

All in all, says Dr. Paul Nestadt, the medical director of the Center for Suicide Prevention at the Johns Hopkins Bloomberg School of Public Health, “I’m still of the opinion that, in people who have real depression, the benefits outweigh the risk.”

So, continuing to take antidepressants is really up to me and my doctor. At this point in my life, I see my doctor quarterly for a med check. We sometimes tinker with the dosages, based on my symptoms at the time, but for the most part, we stick with what has been working. As the saying goes, “If it ain’t broke, don’t fix it.” And since it ain’t broke, I’m content to keep taking my antidepressant (and other medications) for the foreseeable future.

Note: This post is not medical advice and should not be taken as such. Discuss medical questions with your physician, especially before stopping a medication.

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What’s the Future of Ketamine Treatment?

You’ve likely heard about the use of ketamine and other psychedelic drugs in the treatment of SMI. Many people have found it helpful for alleviating—though not curing—treatment-resistant depression and PTSD. Ketamine, long used as a surgical anesthetic, is given for mental health purposes via IV or injection as an off-label use or as an FDA-approved nasal spray, under the supervision of a doctor.

It’s that supervision of a doctor that’s proving to be a problem, now in Texas and perhaps in other states soon.

On December 3rd of this year, MindSite News Daily published a story about ketamine being under fire in Texas.

The state of Texas has permitted clinics to administer ketamine if they’re under the supervision of a licensed physician, such as an anesthesiologist—though not always one onsite. The off-site doctor sometimes has nurse practitioners, paramedics, or physicians’ assistants perform the actual procedure at the clinic. It’s a form of telemedicine. But a change in the rules, influenced by the Texas Medical Board and the Texas Society of Anesthesiologists, might mean that Texas clinics will have to have a doctor physically present.

It’s true that ketamine has been known to produce trance-like hallucinations or, in some cases, even heart failure. And it may interact with other medications like benzos that a patient may be taking. In non-medical circles, ketamine is known as a “party drug” referred to as “Special K.” And, naturally, no physician is usually present at these parties.

But when used correctly under the supervision of a professional, ketamine may result in a trance-like state that can even alleviate suicidal thoughts. Until now, Texas has been a leader in using psychedelics such as ketamine and exploring psilocybin or ibogaine to treat PTSD or MDD in particular. The number of veterans living in Texas makes this procedure especially needed.

I experienced ketamine recently, as an anesthetic after I broke my ankle in two places. The doctors seemed a little wary about giving it to me, given all my other meds. But they discussed it with me and I decided that it was better than being put all the way out.

Ketamine is definitely a psychedelic. When the drug hit, I began seeing everything as a series of see-through squares, like the kind of glass they use for bathroom windows, except they stretched and moved. It reminded me of the movie Minecraft, where everything is made of blocks. My husband watched as the doctor manipulated my foot in unpleasant ways. What I felt wasn’t pain—more of a stretching sensation that made me groan a bit. (My husband said that I cried out, but it didn’t seem like that to me.) That was probably when they hit me with another dose. Gradually, I came down, and the squares resolved themselves into emergency room curtains and assorted medical gear and people. Then I was trundled off to the operating room for more traditional anesthesia so they could put in some pins and plates.

All in all, it altered my perceptions for a short time, but at no time did I feel euphoric. It did its job in regard to pain, but had no lingering psychological effects that I could see. But then, the doses I received were calibrated for a specific purpose, which had nothing to do with my mental difficulties.

Would I have tried ketamine treatment for the medication-resistant depression I once had? I might have—at least if I had experienced its pain-relieving qualities. Having grown up in the 1960s, I was wary of psychedelics and their reported effects and dangers. Then again, I was ready to try ECT until another medication, added to what I was already taking, finally proved effective.

Then again, the off-label use is not likely to be approved by insurance, and I don’t have the kind of money a course of treatment would require. The nasal spray is a relatively new method of administration and is generally covered by insurance. So it’s highly unlikely that I would ever have agreed to ketamine treatment for my SMI, at least until a broken ankle introduced me to it.

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Staying Home

This is our house, and it’s pretty great. When I first saw it, I thought it looked like it had just grown up out of the earth. The main bedroom is large, and there are two smaller bedrooms that have become studies, one each for my husband and me. A great room. A deck. Over and under double ovens. Over and under space-saving washer and dryer. All electric. Over an acre of land, mostly woods, with lots of flowers in the front yard. Quiet cul-de-sac. A modern, new hospital practically within walking distance. A mall and other stores nearby. Close to my husband’s work, my doctor and PT, restaurants, and assorted other amenities.

I almost never leave my wonderful house.

Oh, I go out to doctor’s and PT appointments. My husband can occasionally get me to go out to have a meal. And I get out for other reasons from time to time.

But not often.

We have only one working car, and Dan needs it for work. He works in a big grocery/home goods store and does what shopping I can’t do online. I work from home, doing ghostwriting and editing, and take care of our financial matters online, too. I keep track of all our appointments and subscriptions. Anything that can be done on the phone or computer, I do. I’m not completely useless.

However, I stay home most of the time, living in pajamas or sweats. I know there are people with agoraphobia, movement disabilities, depression, and other conditions that keep them from going outside.

That’s not me. There’s no mental or physical reason I can’t leave the house, though there are limitations on how long I can stand and how far I can walk. These are (I hope) temporary. I do have an anxiety disorder, which may contribute to staying home, but back in the day, I used to travel domestically and abroad, sometimes with my mother or husband, or by myself.

There are excuses I use for not going out. Too much walking. Bad weather—heat, rain, snow, or cold. Fear of falling. My husband’s hours at work. Not having a car I can use when he’s at work. Errands that require only one person to do, such as getting the car’s oil changed.

Back in the day, Dan had a cat that was so chill he could ride in a car without causing a ruckus. When I didn’t want to run errands with him, Dan would scoop up the cat and say, “C’mon, Matches. You’re coming with me.” And off they’d go. I wasn’t properly treated for bipolar back then and had many profound depressive episodes. I knew this maneuver was directed at me, but I didn’t care.

If I do have to go out, we try to make it an occasion—having a meal out before or after PT, for example, if we have the money. I’ve been to a couple of special movies shown on the big screen, with dinner before or after. Visiting a friend in the nursing home and bringing her a gift or treat. But if I don’t have to go out, I simply don’t. And if I do go out, it had better be within five miles of our house.

So, the choices for why I stay home: I still have depressive spells that immobilize me; I still have anxiety that makes braving the world outside seem treacherous; I’m content to let Dan do everything that needs to be done elsewhere; or I simply prefer not to leave the cozy place where I have everything I need.

I would like to travel again, though. But that won’t happen until my purely physical problems are resolved. Until then, I’ll do the best I can inside four walls of safety.

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Love, Hate, and Mania

Mania, or in my case hypomania, is easy to love. It creates a buzz that carries you along, although you’re not always sure where to. Ordinary things become extraordinary, and extraordinary things become magical. I love mania. It can be fizzy, like champagne.

I hate mania, too. When it leaves, it leaves a hole behind. It leaves depression that’s like a nasty hangover. And many times, it can leave consequences. Sometimes dangerous. Sometimes shameful. Always unexpected.

I’m in the grip of hypomania right now. I recently got through a series of medical difficulties. Now, I’m back home, and not dependent on nurses and aides to bring me meals and wipe my ass. It’s glorious. And I’m celebrating by enjoying a burst of benevolence. It’s holiday time, and I’m back to my computer with a debit card and a desire to shop. That gives me an excuse, if not a reason.

I’m buying gifts for Dan and a few friends. I’ve bought so many for Dan that, now that the packages have started arriving, even I am a bit embarrassed. Fortunately, he has a birthday in April, and I can save some of the gifts for that.

In the past, Dan had the advantage. He could follow me around and watch what I oohed and aahed over, then sneak back and get it for me. But I am buying exclusively online now because I rarely go out. Dan doesn’t know how to buy online. I’ve offered to show him, but all the financial stuff goes to me, so I’d know where he bought stuff and how much he spent on it. This leaves only the store where he works to buy gifts. And he says he doesn’t know what to get me anymore, as I spend most of the day in pajamas and don’t wear earrings at home, so clothes and jewelry are pretty much out.

Anyway, I’m definitely manicky. I can tell. And I’m definitely spending more than I should. Fortunately, I just got paid for a freelance job I did, more than I usually get, so I haven’t gotten us into financial trouble, though it was a close thing. The check came just in time.

So. I’ve loved buying presents. I hate that I almost overdrew the bank account. I’m happy that I was saved by a check. I hate that the shower of presents may embarrass Dan, who won’t be able to reciprocate in a like manner.

Manic and hypomanic episodes are like that. A buzz and then self-doubt. A thrill and then regret.

I used to wish that I had mania too, instead of just depression. My theory was that if I were manic, I would get more accomplished. But I once knew a woman who had bipolar 1, rather than 2, so her manic episodes were more extreme. And her plans crashed and burned around her. She would start a project, tear it up, and redo it, even more than once. Her sense of humor was extreme and not really funny. (Once she mimed swallowing a whole bottle of pills.)

After that, I no longer wanted to be manic. But, as it happens, when my depression stabilized, my hypomania had more room to express itself. I haven’t indulged in the more dangerous behaviors, like drinking and driving. But this month, I can’t deny that I have hypomania.

I’m getting better at telling when it’s going to happen. Once I’m in the episode, I know. I feel the buzz. I notice the bank account dwindling.

Dan notices when I’m getting manicky, too. I can usually tell him that I feel it coming on and check it out with him. But this time, secrecy was part and parcel (literally) of it. Once it was getting beyond my control, I told him. Not about almost overdrawing our account, though. Once there was money back in the bank account, it didn’t seem necessary.

I’m not quite over this episode. I’m cooled down enough to rein in the buying. Just a couple more small presents for friends. I swear. It’s progress, anyway.

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Time Out

It’s been a while since you’ve heard from me, and I wanted to explain. I’ve been in and out of the hospital.

No, not the mental hospital. All this was purely physical. Well, it had certain effects on my mental health, but the reasons for my multiple stays were due to my body, not my brain or emotions.

It all started back in April, when I had my left knee replaced. This was a long-anticipated thing, necessitated by the fact that my knee was “bone on bone” (the doctor’s words) and the fact that the steroid shots were no longer working.

I will admit to having possibly unwarranted fears that I would wake up from anesthesia with mental deficits. I was assured that this had never happened. (I assume they meant while having a knee replacement, not ever. It has to have happened ever.) So I sucked it up and went under the knife, as the saying goes.

The operation went well. The aftermath, not so much. Time in the hospital, learning how to use a transfer board and walker. So far, so good. But when I went home, it turned out that I wasn’t healed sufficiently to be on my own. I fell. And kept falling. After one fall resulted in a pretty bloody shin, I was advised to go back to the hospital to make sure the artificial knee was still in its proper place. I then went to a post-acute care facility (nursing home), where it turned out I had an infection on my still-not-entirely-closed scar. I stayed and got PT.

Back home. No more falling (thanks, PT). But three days later, my leg swelled up from my toes to above my knee. I called the nurse hotline, and they advised me to go back to the hospital, where they determined that the fluid was not building up in my heart, as feared. Back to the rehab. I practiced walking and got to the point where I could (sort of) climb stairs.

Back home. Then I fell in my study and broke both sides of my ankle. Back to the hospital (fentanyl in the ambulance, ketamine anesthesia while they set it, and general anesthesia while they put in metal pins and plates). Back to the rehab, leg swathed in bandages and not allowed to put weight on it. (Ever tried standing while putting no weight on one foot? Don’t.) PT became interesting. The only way I could use a walker was with a knee sling, which is, at the least, awkward.

Finally, I got a boot and was able to put some weight on the foot. PT went better from then on, and after a while, they took the boot off and allowed me to put full weight on the foot. Eventually, I came home.

While I was at the rehab, I didn’t take my laptop. In addition to the fact that I was on pain meds and muscle relaxants for a lot of the time, I worried that my electronics would be stolen. So, no writing.

Now I’m at home, having outpatient PT, and I walked 250 steps with the walker yesterday.

But this blog is about my bipolar disorder. So, here’s what happened to my moods.

I tried hard and managed to stay mostly positive, like those TV commercials where people hold a little smiley face card in front of their faces. I faked this by slapping on a perky affect and making my voice rise in pitch when I say, “Yes, I’d love to go to PT.” “Yes, a shower sounds great.” “Can I try 15 minutes on the stationary bike today?” or “Next, I’d like to learn how to stand and pivot. Is that something I’d be able to do now?”

I did this especially for the PT folks, who took my willingness to try as a sign of progress. But there were times when I realized how impaired I actually was, and I felt depression. My husband has been very supportive, but he’s also pressuring me to get to where I can climb stairs again and walk up and down the wheelchair ramp we had installed. I can’t walk the ramp or the stairs with my walker, so doing that would mean I’d have to use a cane, which I do have but haven’t used in months. I need to have better balance and more stamina before I can even try that.

But I can write. So I am.

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Mental Health

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What Won’t Work

Actor/comedian Stephen Fry discovered at age 37 that he “had a diagnosis that explains the massive highs and miserable lows I’ve lived with all my life.” It was, of course, bipolar disorder. In documentaries, podcasts, and books, he has talked very openly about his condition, spreading the word about stigma and the necessity of getting help.

Fry once said, “You can’t reason yourself back into cheerfulness any more than you can reason yourself into an extra six inches of height.” And he’s right. If one could, I would have done so. With years of debate behind me and an extensive knowledge of rhetorical fallacies, I can argue nearly any proposition into the ground. I should have been able to reason my way out of depression.

But no.

Fry was right. There’s no way to reason cheerfulness into your life. Emotions are not so easily controllable, especially if you have bipolar disorder or another mental illness.

Nor can you reason yourself into having thicker skin. Throughout my youth, I was described as “too sensitive.” I was genuinely puzzled. I had no idea how to make my skin thicker (and it was never explained to me how such a thing could be done). It took a long time and many life lessons and mistakes to make any progress at all.

There are other things that won’t make you mentally well, either. Expecting the first medication you try to be the cure is unrealistic. It can take a long time (in my case, years) before a medication or even a combination of medications will ease your suffering. And if you can’t work out a medication regimen that works, other treatments such as ECT, TMS, EMDR, or ketamine therapy are not guaranteed to work, or at least not completely. If you go into those kinds of therapy expecting a complete cure, you may be disappointed.

Trying to wait it out or tough it out is likewise ineffective. Again, this is a strategy I have tried. I used to believe that my depressive episodes would abate if only I waited through them until they went away naturally. Eventually, my mood might improve slightly, but that was due to another mood cycle kicking in. Naturally, depression was still there, waiting for me to fall back into it.

I know this may be controversial to say, but religion won’t cure mental illness, either. Having a supportive religious community around you can be an asset—if you happen to find a church, synagogue, mosque, or other community that treats people with mental illness in a caring way. Prayer and sacred music can be a great adjunct to other treatments, but by themselves, they’re not a cure.

Exercise and yoga are not cures. They are also great adjuncts to other treatments. They can increase your number of spoons—if you have enough spoons to do them. But if someone with bipolar disorder or depression can’t manage to get out of bed, how are they going to avail themselves of the benefits?

Likewise nature. It’s a great way to lift your spirits to walk among spring flowers or autumn leaves or to plant a vegetable garden. But again, you have to be at a certain level of recovery to be able to do these things.

Changes in your physical circumstances may lighten your mood for a while, but they aren’t a cure. My mother used to believe that if only I got a better job, my depression would lift. And it did, but only for a little while. It certainly didn’t cure me. There were plenty of things about the job and about my brain that brought the depression roaring back.

So, what are we left with? Therapy and meds, and other medical treatments such as ECT, TMS, and maybe ketamine or other novel medications. One can hope that science will discover better ways, like fMRI, that can determine which treatments will be more effective. But it’s far from clear how soon that will be and when they will be available to the average person.

So, when is your reason an asset? When you’re deciding which treatment and which adjuncts are right (or possible) for you. For example, I had to think long and hard—and do extensive research—on whether I should try ECT.

I’m not a doctor, and Your Mileage May Vary, but for now, all I can recommend is to keep on keeping on with what we know can work. There’s no guarantee that these options will work, at least not for everyone. But they’re the best options we have.

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