Bipolar 2 From Inside and Out

Posts tagged ‘my experiences’

Body and Brain: Self-Image

I’m fat. I admit it. I haven’t been fat all my life, so this came as something of a surprise to me, but I’m dealing with it. I don’t know whether it’s my eating habits or my medication or some genetic thing that has caused me to gain weight, but there you have it. It could be any or all of those.

I’m not trying extreme diets or grueling workouts, though I admit that some exercise would be good for my mental condition as well as my body. I’m living with and acknowledging the fact that I am fat.

The thing is, when I think about myself, I don’t think of myself as fat. Perhaps I’m in denial about it. But I do know how much I weigh and that it’s over what I should, according to all the height vs. weight and BMI Index charts. And I don’t think of myself as thin. I just feel as though I’m still in my 30s and weigh what I weighed then, despite my body’s very clear rejection of those notions. I know I’m really in my 60s and have trouble getting up off the floor if I fall, in part because of what I weigh.

I’ve heard that everyone gets stuck in their head at a certain age and always remains that same age in their mind. It’s not quite like having an inner child of four or ten (or in my case, more like 15). I used to think I didn’t have an inner child until I remembered how much I still love chocolate milk, plush animals, and naps. And I do have that inner teen that wants to make up for all the things I missed when I was a depressed teen, like mad crushes and experimenting with fingernail polish and fake nails. But having an inner weight is different somehow. It’s like my brain and my body are clashing in some way.

At least I don’t have Body Dysmorphic Disorder. That’s when you see tiny, imperceptible flaws in yourself and magnify them until you think that’s all people see when they look at you. Technically, it’s not the same as anorexia because, in anorexia, you focus only on your weight even if you are thin. Anorexia is an eating disorder that you have as a reaction to your flawed perception of your body size. Dysmorphic Disorder is more about smaller perceived flaws such as balding or the size of your nose. (The Mayo Clinic does say that Body Dysmorphic Disorder can cause or be associated with eating disorders, low self-esteem, mood disorders, obsessive-compulsive disorder, and substance abuse. The DSM-5 does not classify Body Dysmorphia as an eating disorder. It’s confusing.)

One of the dangers of Body Dysmorphic Disorder is overuse of plastic surgery, which can be somewhat of an addiction in itself. Just watch a few episodes of the TV series Botched and you’ll see what I mean. There are always horror stories like the one in which a young man wanted to look like Michael Jackson and as a result of repeated surgery suffered the same health problems and conditions that the singer did.

If I had Body Dysmorphic Disorder instead of the ones that I do have, I might be undergoing multiple treatments of liposuction, “cool sculpting,” tummy tucks, gastric bypass, extreme fad diets, weight-loss pills, and other procedures. I don’t and won’t. I’m aware that those are only temporary fixes and leave you open to disappointment, infection, scarring, and other bad effects and complications that can be worse than your original condition and stay with you for life.

So, where does that leave me? Besides fat, I mean. I try to be body-positive about people who don’t conform to societal messages about weight, including myself. It’s a difficult thing to get over. The messages are relentless. I have found myself in the past thinking that fat is unappealing and in the present thinking that extreme thinness is dangerous. But that’s only in the abstract. Any number of men I’ve been attracted to have been anywhere from pudgy to fat, including my husband.

I realize that I may get a lot of pushback from people telling me of all the medical reasons I should lose weight. I’m not saying they’re wrong. I’m just saying that if I’m comfortable with being fat, they could at least be okay with my fatness as well. In other words, I already struggle with my mind. I don’t want to struggle with my body too.

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Why Can’t I Sleep? Why Can’t I Wake Up?

Image by fizkes

Often in the past, I went to bed at my usual time but woke up at 4:45 a.m. and couldn’t get back to sleep, no matter what. It was like I had a hamster on a wheel inside my brain.

Other nights I would go to bed early and couldn’t get to sleep for hours. I tried reading, but sometimes I read till 2:00 a.m. with no sleep in sight. (I know you’re not supposed to read when you want to get to sleep because it activates your brain, but it’s been my nighttime habit for decades. When I find that I am reading the same paragraph twice, I know it’s time to knock off and fire up the CPAP machine.)

Then again there are days when I feel the need to nap in the early afternoon. I try to resist, but if I give in, there are no refreshing catnaps for me. I’m down for two and a half hours typically. Then the whole sleep-wake cycle gets off course.

And when I’m in the middle of a depressive episode, I’ve been known to stay awake all night, obsessing and catastrophizing. There are also days I can’t get out of bed in the morning, or all day in some cases, though I don’t usually sleep well after them.

What is it with all the sleep disturbances? Well, I have bipolar 2, so that may have something to do with it. An article published by the National Institutes of Health (NIH) says, “Sleep disturbance is a core symptom of bipolar disorder. The diagnostic criteria indicate that during manic episodes there may be a reduced need for sleep and during episodes of depression, insomnia or hypersomnia can be experienced nearly every day.” They also note that insomnia and hypersomnia are early warning signs, or “prodromes,” of a bipolar episode occurring. In fact, sleep disturbance is the number one prodrome for mania, and is recognized by approximately 80% of those suffering from it as an indication of an impending episode.

Webmd discusses a number of ways that bipolar disorder is associated with poor sleep: either insomnia or hypersomnia (over-sleeping); decreased need for sleep; a circadian rhythm sleep disorder; REM sleep abnormalities which can affect dreaming; and co-ocurring sleep apnea (around a third of people with bipolar also have sleep apnea, which is associated with excessive daytime sleepiness and fatigue). Bipolar meds have also been known to affect sleep-wake patterns, as well as co-occurring substance abuse disorders.

What are the consequences? Sleep deprivation has demonstrated detrimental effects on cognitive functioning, particularly in teens and young adults. This has been observed in performing psychomotor vigilance tasks, working memory tasks, and cognitive processing tasks. No wonder a series of sleepless nights can result in a foggy or fuzzy-headed feeling!

Unfortunately, the advice given for how to counter the effects of sleep disturbance in bipolar disorder is almost indistinguishable from the advice given to the general population, such as incrementally moving bedtime and waking time until the desired period of sleep is reached; and not using electronics such as computers, cellphones, and TVs near bedtime. Some preventives that have worked with bipolar patients have included bright light therapy in the morning and the use at bedtime of supplements containing the naturally occurring hormone melatonin that the body releases in response to darkness.

My own experiences with sleep deprivation and bipolar disorder have been a mixed bag. For many years before I was diagnosed, I was subject to the difficulties caused by shift work, either third or second shift. (When I was on second shift, we sometimes extended our sleepless periods by playing cards or midnight miniature golf after the shift was over.) Third-shift work made me too tired to drive safely, especially if I was also working first shift the next day, which sometimes happened. My husband pitched in and picked me up on those days. My friends knew never to call me before noon.

For a while I took a prescribed sleep aid, but sometime during the last year realized that as my sleep-wake cycle was regulating to a more “normal” pattern, and that the sleep I got without the meds was more refreshing and conducive to clear thought in the morning. So I quit taking it, with the approval of my psychiatrist. Even though I work at home and make my own hours, my work schedule has become predictable as well. Now I wake around 6:00 or 7:00 a.m., check my emails and timeline, have some breakfast and start my work (when I have some). I break for lunch, then resume work in the early afternoon. (And pray I don’t get any more work that day, as sometimes happens.)

As for getting to sleep, it’s usually not a problem (except when it is). Any more, I take my nighttime meds, read for about 30 minutes, and drift off to sleep normally. I usually only need a nap if extra work requires that I stay up late in the evening or get up very early in the morning.

So, does “Sleep, that knits up the ravelled sleave of care,” as Shakespeare described it, exist for people with bipolar disorder? I’d say, not for everyone, but when it does, it’s always welcome. We all have our various sorts of “ravelled sleaves” that need tending to.

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What If My Symptoms Come Back?

It’s inevitable. Once you’ve dealt with a mental illness, you’re afraid it will come roaring back, even if you’ve been stable for a long time. You wonder if your medications will stop working. You dread “breakthrough” episodes that will put you back in the same awful space you thought you had escaped from. You have flashbacks or dreams that take you to places you thought you had left far behind. You imagine you hear someone call your name and wonder if it’s a symptom. Sometimes, something you never thought of as a trigger will catch you by surprise and send you right back to the dark place, the anxious place, the out-of-control place.

Those fears are not unwarranted. All of those things could happen. For many people, they do. For most, the thoughts pop up at odd moments, even when you’re doing well. They’re unpredictable. That’s part of what makes them so scary – the knowledge that you have no control over these thoughts of recurrence.

It certainly happens to me. I obsess over my own thoughts. I fear dropping back into depression. I wonder if I’m exhibiting hypomanic behavior without realizing it. I overanalyze nearly every feeling I have if it has the slightest hint of a symptom of bipolar about it.

That’s when it’s good to have a strong support system – a person or persons you can talk to and check in with. Someone who recognizes your baseline behavior and when you start to depart from it. Someone who understands your disorder and what the symptoms might be.

I’m fortunate to have a support system in place, though it consists of only two or three people at this point – my therapist, my husband, and to some degree my prescribing psychiatrist. I see my psychiatrist only four times per year for med checks, but I can tell him when I think I’m experiencing symptoms and ask whether he thinks it’s something that warrants a change in meds.

I see my therapist approximately once a month, and she has a better handle on intrusive thoughts and whether they are irrational or not. She provides a “sanity check” for me. Most of the time, she reassures me that they’re normal (or nearly so). Sometimes, she tells me if I should bring them up with my psychiatrist the next time I see him. Mostly, she listens, which is what I think a good therapist does.

The mainstay of my support system, however, is my husband. He understands bipolar disorder from years of living with me and living through my mood swings. He knows my baseline level of behavior and when I begin to depart from it. For example, he can recognize when I am starting to get hypomanic and suggest to me that I might be beginning an episode. Or, if I feel like I might be getting manicky, I can ask him if he sees the symptoms in me or not. If I’m having delusions that other cars are swerving into my lane, he can suggest I take an anti-anxiety med.

Four former members of my support system are no longer there, two because they recognized my symptoms increasing and were not able to deal with them, and two lost to death. Even though my husband and my mental health providers help keep me on an even keel, I do miss the additional input. I need reassurance when I am doing well and help when I begin to veer off course.

This month, however, I am doing better. I just postponed my therapist appointment because I have no pressing issues that need addressing this month. May it stay that way.

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Baby Steps Toward Healing

Once I attended a weekend photography workshop. One of my photos received praise as being innovative and interesting, one based on a technique I had seen a friend use. The rest of my photos missed the mark. I was frustrated by my lack of progress. The instructor reassured me, advising me that I should take (or was taking) “baby steps.” That photo provided a brief glimpse of what I could do if I kept at it.

My therapist has also reminded me of this numerous times. And she’s been right. Almost all the progress I’ve made in dealing with being bipolar has been gradual and incremental.

The baby steps process was long and arduous, lasting for years. The first step was taking Prozac, which helped me for a while, then didn’t. Most of the progress I’ve made with medication has been in tiny, discrete steps. My prescribing psychiatrists have never done anything quickly, which is in one way a blessing and in another a torment. They would try me on one drug, then wait to see the results, then try a different dose or a different drug altogether. Lather, rinse, repeat until progress at last occurred.

Progress in therapy has likewise been gradual over the years. First there were therapists who diagnosed me with depression, which was certainly true, though not the whole picture. And they helped, or at least a number of them did over the years. I learned a lot about depression in general and how it applied to me in particular. I also learned about relationships, and those insights helped my marriage.

Finally, I was given an accurate diagnosis of bipolar disorder 2 with anxiety. That was where the steps toward reaching some resolution regarding my medication really started. That was also when I started working with the therapist who reminded me about baby steps.

Although I had made steps toward healing in the past, I had taken a deep and protracted plunge into depression before I started going to her. Several years of it had left me immobilized, despairing. At my lowest point, I described myself as “pathetic.” There were going to be a lot of baby steps needed to get me out of that miserable place.

So we went to work. I liked the kind of therapy she practiced – non-directional, non-judgmental. (I had had problems with therapists who weren’t like that in the past. Needless to say, I made no progress with them. In fact, I even took steps backward.) There was a long way to go.

Dr. B. frequently reminded me of the importance of baby steps and, eventually, how far those steps had taken me. I learned coping mechanisms. I learned new ways of thinking. I learned to accept myself with the reality of my bipolar disorder, but without the constant misery. And, by the time my proper medications had kicked in, we were making some even bigger steps. But all my progress was built on a foundation of many, many baby steps along the way.

I think all therapy consists of a lot of little steps. I don’t know anyone who has had a great revelation that instantly moved them further along with their healing. I only got glimpses of what my situation could be like if I persisted. And along the way, I regressed at times, needing to re-learn the lessons I had been exposed to and re-taking the steps I had already accomplished. Progress is like that – two steps forward and one step back – especially with a disorder as cyclical as bipolar.

Anyway, I still go to therapy and still take baby steps toward whatever my future holds. I realize it will take a long time – probably the rest of my life – but I’m dedicated to the process.

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Grief and Depression

A number of years ago, I saw a TV show in which the main character was grieving the death of a friend. The other characters decided that he was grieving for too long and concocted a plan to distract him from his grief.

I was pissed off. What the man needed was time, not distraction. And how long he took to process his grief was not up to his friends. Grief takes as long as it takes, and it’s a different amount of time for different people.

Mostly we think of the death of a person when we think about grief. But that’s not the only occasion when grief comes to us. The death of a friendship can bring grief. I have lost friends to circumstances other than death, and I still miss them and find myself thinking, “Oh, Kim would like that,” or “I need to talk this over with Hal,” then remember that they’re no longer in my life. I do grieve the loss of those relationships, the ones I know will never be mended.

One can even grieve the loss of a beloved pet. There are those who say, “It’s just an animal. You can get another one.” But that’s not the case. I had my cat Louise for over 20 years from the time she was a tiny bit of fluff to when she took her last breath resting on my lap. I have since gotten – and loved – other cats, but none can truly replace my beloved companion. I grieved for her and still do. My grief is less intense and not always with me now, but I can’t say it’s gone, not the way Louise is gone. I still dream about her and find myself calling our other cats by her name.

Even the loss of a possession can trigger grief. “Oh, it’s just a thing that you can replace,” you may hear. But think about a wedding ring that was given 40 years ago. Yes, we replaced it, but it had been the repository of that long-ago wedding day and all the years since. A new band of gold didn’t have the emotional weight that the original carried.

Among the worst of all losses is the death of a dream. Poet Langston Hughes said it with these simple words:

Hold fast to dreams 
For if dreams die
Life is a broken-winged bird
That cannot fly.

Hold fast to dreams
For when dreams go
Life is a barren field
Frozen with snow.

So why am I writing this for a blog on mental health? Because grief is also a mental health issue. Grief and depression are not the same thing, though one can easily bleed over into the other. Like grief, depression has no timeline. Like depression, grief can ambush you suddenly, when you are least expecting it. You will get through it, or learn to bear it, and you will do so in your own time, or with help.

Both grief and depression evoke feelings of hopelessness, numbness, and loneliness. And both are eased somewhat by the loving presence of friends and family. While it’s true that no one who has not lost a child, for example, can know the exact shade of grief and eternity of pain that brings, anyone who has experienced a different form of loss and grief can be there to hold your hand, provide a shoulder to rest against, cry with you. That doesn’t make it better, except that it kind of does. Being alone in your grief is itself another kind of grief. But you don’t have to be. There are grief counselors, just as there are therapists for mood disorders, and they can help you process the memories you bear with you and the pain you feel on every birthday or holiday.

As with mental illness, no one should tell you that grief is something you have to get over or that you should be over it in a certain amount of time or that you’re expressing your grief in the wrong way. We all experience grief at some point in our lives, but the exact boundaries of it differ from person to person. Those boundaries need to be respected.

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Not Breathing Affects Our Mental Health

My husband and I both have sleep apnea. We also both have depression, or at least he does and I have bipolar disorder with a pretty hefty depressive bent.

Sleep apnea is a medical condition in which a person stops breathing multiple times a night. The body responds to this by resuming breathing after a second or two, but sleep disruption has already occurred. For my husband, this occurs up to 60 times a night, while it happens to me more like six times. (Technically, my version is called “hypopnea” (hypo+pnea – low+breath; apnea, a+pnea – no+breath.))

The body depends on breathing, of course, for oxygen, but it also depends on sleep – which is disrupted in sleep apnea – for proper functioning. REM sleep, for example, is vital for dreaming, which has multiple beneficial effects on the body and mind. REM sleep has been known to be altered in depression, and studies have suggested that it is involved in modulating mood symptoms, including psychological distress in general.

One of the more observable symptoms of sleep apnea is loud and prolonged snoring, which both my husband and I have suffered from. While I was traveling with my mother, she even requested that I let her go to sleep first since my snoring kept her awake.

But what does sleep apnea actually do to the sufferer’s brain? Surely lack of oxygen to the brain has some effect.

Indeed it does.

According to research conducted at UCLA, “gasping during the night that characterizes obstructive sleep apnea can damage the brain in ways that lead to high blood pressure, depression, memory loss, and anxiety.”

Sleep apnea has been associated with difficulty concentrating, memory problems, poor decision-making, depression, and stress. Psych Central reports that untreated sleep apnea increases the chance of anxiety by over three and a half times; depression, by more than three times; severe psychological distress, by not quite three times; and suicidal thoughts, by more than two and a half times. Sleep apnea has also been associated with PTSD. The Journal of Clinical Sleep Medicine recommends that “in individuals with [obstructive sleep apnea] and psychiatric illness, treatment of both disorders should be considered for optimal treatment outcomes.”

Studies suggest that sleep apnea is linked with changes in at least two neurotransmitters in the brain (GABA and glutamate) that combine and coordinate signals that help regulate emotions, thinking, and some physical functions. Researchers plan to investigate whether treatments for sleep apnea will help these brain chemical levels return to normal.

SSRIs (selective serotonin reuptake inhibitors) such as fluoxetine and sertraline (Prozac and Zoloft) are thought to be valuable in treating sleep apnea. One study indicated that SSRIs may be a good treatment option for [sleep apnea], particularly for those [patients] with epilepsy. Another study showed a link between “having sleep apnea and increased odds of having a mental health issue” or symptoms such as anxiety or thoughts of suicide.

Treatments for sleep apnea include dental appliances to be worn while sleeping, lifestyle changes, and even surgeries. These treatments sometimes address snoring directly, but not the underlying mechanism. The more effective treatment is “positive air pressure,” delivered by CPAP machines.

CPAPs use positive air pressure to keep the sleeper’s airway from collapsing, which is what impedes their breathing and jolts thie brains into resuming it. They consist of a unit that generates air pressure, a hose and mask to deliver it, and assorted straps to keep the hose in place throughout the night. The masks can be ones that cover the entire nose and mouth or cannulas that are simply placed in the nostrils. There are also cushions on the masks or available separately that reduce discomfort as well as waking up with “mask face.” Many people find the masks uncomfortable to wear all night, but others use them not only at night but also for naps. Unlike a ventilator, the CPAP doesn’t breathe for a person. It allows them to breathe more effectively on their own.

Diagnosing sleep apnea requires a “sleep study” ordered by a doctor. Assorted leads are attached to the subject, who then spends all night sleeping (or trying to). Breathing rate, heart rate, oxygen saturation, and other parameters are measured and a record is kept of the number of times the subject stops breathing during the night. This is sent to the doctor, who can then prescribe a CPAP unit and mask.

Dan and I both use CPAP machines. They are a bit inconvenient, especially when we travel and have to take power cords so we both can use them at the same time (and power converters when we travel abroad). When it comes to packing, the machines are a bit bulky and somewhat heavy. Still, we take them with us religiously.

Has sleep apnea treatment improved our mental health? It’s hard to tell, especially since we’re both taking SSRIs anyway. I know correlation isn’t causation, but our depression and bipolar have certainly eased up since we started getting treatment and our sleep cycles have become more regular. But if all it does is stop the snoring, that’s still a win for us.

So, if you snore a lot and have mental health issues, you might want to be tested for sleep apnea and treated if you do. Like chicken soup, it can’t hurt and might help.

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Self Image: Who Do I Think I Am?

Self-image is a problem shared by millions of people every day. Take women, for example. They are bombarded by relentless messages that they are too fat (or too thin); too plain; with inadequately full, shiny hair; or with un-perky, non-voluptuous breasts. (Men face messages too about their lack of muscles, excess paunch, thinning hair, or short stature – but nothing like the volume (in both senses) that women receive.)

Self-image is also a big problem for people – both women and men – who live with mental illness. It’s not always physical self-image. Sometimes we get messages about how we should think and feel from all the ads on TV and in magazines and on the internet that feature happy people interacting joyfully with their friends and families. The subliminal message is that if your life isn’t like that, the advertisers’ products will make it so that it is.

Of course, nowadays there are also ads that feature depressed or bipolar people, but they end the same way. Get online help or psychotropic meds and you’ll turn into one of those happy, joyful people living life to the fullest. For many of us, that’s not the way it is. There are treatment-resistant disorders, for example, and complex problems like OCD, PTSD, and schizophrenia that aren’t mentioned at all. (PTSD is sometimes addressed in the context of veterans helping one another, which is good, but the ads for this usually offer moral and financial support, rather than a more trauma-conscious solution.)

I’ve been through my own battles with self-image, and not all of them related to things I saw in the mirror. When I was a child, I endured bullying that made me feel unworthy and unable to fit in. As a teen, I saw myself as plain and unlovable. I even doubted my parents’ abundant love, thinking they loved me only because, as I was their daughter, they had to. Later, my self-image consisted of being a depressed person. That’s who I was and all I could see of myself.

When I was working, I saw myself as an imposter. I had a “respectable business lady disguise” that I could put on when desperately needed, but I knew it wasn’t accurate. Then, when I lost my job, I saw myself as a failure.

Still later, after my most severe breakdown, I defined myself as my husband’s “sick, crazy, crippled wife.” I know those are terms we’re not supposed to use, but that’s what my brain was telling me. (The “crippled” part was because I had mobility issues that necessitated two operations on my back, and thereafter used a cane.) I used it as an excuse not to go places, see people, or do things. Actually, my husband used it as an excuse too, though he didn’t phrase it that way. (Now he doesn’t.)

In short, my self-image was someone who was broken – and not “in the best way possible,” as Jenny Lawson says.

Years of therapy and medication have largely gotten me to the point where my negative self-images are no longer constantly haunting me. They still rear their ugly heads on occasion, but now they aren’t all-pervasive. My husband helps too. He says, based on photos, that I was cute when I was in high school and he would have dated me. (I still have my doubts about that.)

What I’m getting at is that a person’s self-image can and does change over time. I think I am more accurate now in thinking I am no longer cute, except maybe when I smile; still mobility-challenged but not so self-conscious about it; and, I would have to say, a “recovering” bipolar person.

We’re getting to the point where we don’t all or always think that what we see in the mirror reflects our worth or our true self. We’re learning not to believe our own or others’ negative messages about our appearance – though there is certainly still a long way to go.

What I’m not sure of is that we’re making much headway on redefining our self-images regarding our mental health or lack thereof. Despite all the positive affirmations we see and hear in so many memes and elsewhere, do they really sink in and change our thinking? Or is the only way to do that bound up in time, treatment, and the support of our family and friends? I’m just glad that it is possible to change, whatever the mechanism. My life is much more settled and happier now that I no longer see or define myself as I once did. That’s something I want to hang on to.

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Boundaries and Cookies

What are boundaries and why is it important to have them?

Boundaries are limits in a relationship that your friends, partners (and relatives) need to observe. They can be simple or complicated. They can address different aspects of a relationship – social, emotional, or physical, for example. And there can be different levels of boundaries that you set.

In the kink community, boundaries are set before a consensual relationship starts. The different levels are “hard no,” “yes,” and “maybe.” It’s easy to understand what hard no and yes mean – that the person simply will not perform certain acts or gives voluntary consent to them. The maybe category is a bit trickier. These are acts that the person is willing to consider or try, but hasn’t definitely either agreed to or ruled out. That’s why partners have “safe words” or other signals that indicate when a maybe isn’t working for them and they need to slow down or stop.

Boundaries are useful in nonsexual relationships too, and again have categories like hard no, maybe, and yes. For example, in romantic relationships I have a hard no against physical abuse, and I communicate that to all my partners. If one of them hits, slaps, or otherwise gets physically violent with me, that’s the end of the relationship. No explanations, no excuses, no second chances. I’m out of there. I’ve made my husband aware of this boundary and he respects it. He’s never crossed that boundary.

Unfortunately, at the time I established that boundary about physical abuse, I didn’t know about the concepts of verbal abuse and emotional abuse. In one significant relationship, I put up with these for quite some time. Verbal abuse and emotional abuse are two of the tactics of gaslighting. I put up with those for far too long before I was able to say, “I’m out of here.”

Dan once described boundaries to me using the metaphor of cookies. Suppose someone offers you a cookie and says, “Here’s a delicious chocolate chip cookie I made just for you. Yum, yum. Try it.” Only when you do try it do you discover that the cookie isn’t a chocolate chip cookie at all. Instead, it’s a shit cookie – something you definitely don’t want to eat. You set up a boundary about shit cookies. Just because someone offers you a shit cookie, you don’t have to eat it. And you really don’t have to say, “Yum, yum. This is delicious!”

What kinds of shit cookies are you likely to encounter? They can be insults. You don’t have to believe them. They can be other kinds of distressing – talking about you behind your back, for instance. You don’t have to respond or explain. Or they can be actions such as the aforementioned gaslighting, sandbagging, or saying one thing and then undercutting it with actions. You don’t have to put up with those. Refuse to eat the shit cookies. They are all bad for your mental health.

There are less drastic boundaries that you may have to set as well. If you have a friend who always calls you and vents at length about their problems but never listens to your problems or your advice regarding their problems, you might set a boundary: “You can call me with problems, just not after 9:00 p.m.” or you could set an unspoken limit that you will only listen to the friend for half an hour at a time. After that, you end the conversation and get off the phone. Perhaps you establish a signal that you have reached your limit: “My eyes just glazed over.” Your friend may even pick up on the signal: “Your eyes just glazed over, didn’t they?”

Or you might have a partner that has unreasonable expectations. Such a limit might be that you will be involved in disciplining the children, but you won’t do it all yourself. It could even be a seemingly silly one. I refused to iron my husband’s shirts because I felt resentful when he treated me like a laundress. He came to understand what I meant. And we worked out a solution: wash-and-wear shirts. Those I would gladly purchase. Problem solved.

Sometimes, however, there are people in your life who go beyond simple boundary breaking. They refuse to acknowledge any boundaries that you may have. People who hurt another family member, for instance, or who expect you to solve all their problems – not just asks for help, but insists on it and gets offended when you try to establish that boundary. It’s best to cut toxic people out of your life entirely.

But what if it’s a member of your own family who’s toxic? That makes the situation more difficult. You might cut off contact with the person, but have to see them at family reunions or holiday occasions. The toxic person might go behind your back and tell their side of the story to the rest of the family.

The only thing you can do in those circumstances is not to eat the shit cookies. Establish your boundaries and remain firm with them.

You’ll get a lot of pushback from other family members and even your friends. “But they’re family!” they’ll cry. “Family comes first, before everything else.” But that’s a trap. Family may be very important to you, but at some point you have to establish that ultimate boundary in order to protect yourself and your mental and emotional health.

Toxicity can eat away at your soul. It can destroy whatever good or even tolerable relationship you had with that person. It’s not worth it to try to understand a toxic person or to give them fourth and fifth and fifteenth and fiftieth chances to change. At some point, you have to draw the line and recognize that nothing you say or do will ever change that person. It’s not reasonable to expect you to change your feelings or your actions to accommodate them.

Setting boundaries and sticking to them – sometimes it’s the only way you can live with others or, more importantly, with yourself, at least in terms of your mental health. It takes practice and determination. But in the end, you’ll be mentally healthier. And you won’t experience the lingering taste of shit cookies.

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Remote Work and Mental Health

Nowadays, many workplaces have a toxic culture or at least a dysfunctional one. They demand – not just expect – more from their employees than any human being should have to, or be willing to, give. Sixty-hour weeks. Twelve-hour days. Giving up weekends and holidays. They treat employees as fungible things that can be easily replaced and regularly are, especially if they don’t live up to the brutal “standards” that are supposedly required by the free market.

Toxic workplaces are also full of toxic people. Bullying of employees and coworkers is common. Gaslighting even happens, more regularly than we’d like to admit. Required conformity and enforced corporate “team-building” parties and picnics suck the meaning out of workplace enjoyment. Exhortations that the workplace is a “family” and then behaving in ways that belie this are rampant – false, harmful, and destructive.

Corporate practices aren’t human-friendly, much less family-friendly. Flexible working hours, job-sharing, onsite childcare, remote work, part-time work, and extended sick and other types of leave are largely reserved for only the highest echelons or never even considered for any workers. Health and disability insurance are nonexistent or ultra-expensive for workers because of the monetary costs to the company. Discussions about the stress caused by work end in suggestions to try yoga. Employee Assistance Programs (EAPs), if they exist, provide some therapy, but only with a provider of the company’s choosing and usually only for six weeks or so.

Then along comes the COVID pandemic. Suddenly, corporations and other, smaller businesses were faced with the difficulties of staffing during lockdowns and quarantines. All of a sudden, workers weren’t so available or so desperate. Owners had to scramble to hire enough workers to keep the wheels turning. Some businesses were forced to raise wages. Others had to rethink corporate travel to cut costs.

And some turned to remote work. Not all could, of course. Some jobs simply can’t be done from home. Construction workers, wait staff, airline attendants, and countless others were simply let go or put on furlough, many of them without even partial pay. But many jobs, particularly office jobs, were the sorts that could be done from home, on the phone or via computer. And that proved beneficial both for the affected companies and for the mental health of their workers. Bosses suddenly realized that work-from-home even improved the bottom line, reducing overhead. It soon became clear that home-workers were able to be as or even more productive when not being constantly interrupted by mandatory meetings and other useless exercises.

How did telecommuting affect workers’ mental health? First, remote workers were spared from many aspects of toxic workplaces. Micromanaging became largely unfeasible.

This certainly helped improve their working conditions and stress. So did getting respectably dressed only from the waist up, especially for those of us with limited spoons. Being able to step away from the computer for a half-hour or more to do something about chores or even hobbies provided a welcome break. Lunches could now be taken whenever you were hungry and last more than 30 minutes. Even spending more time with pets reduced stress and provided emotional support that’s next to impossible in most workplaces.

Many of the stresses that so exacerbate mental health conditions were at least lessened. People were more comfortable in their own homes, with comfort objects and self-care items more readily available. Those with a greater need for alone time suddenly had more of it. If they found that they could work better or more productively part-time at home, it was a benefit for the companies as well.

Of course, not all bosses took to this new way of working. Once they figured out that employees could be more productive when working at home, some of them upped output requirements. They could insist that employees remain logged in during standard working hours, making flex-time less doable. Or they started requiring more output from those telecommuting, or scheduling Skype meetings that cut into employees’ time.

I work at home, remotely, and have for a number of years. I do so because I have been fortunate enough to find jobs that pay (though not a lot), jobs that match my skill set, jobs that aren’t 9-5, and jobs that are conducive to working around my days of depression and hypomania. I’ve considered going back to work in an office from time to time when funds were low, but not enough to actively pursue it. Truth to tell, I don’t think I’ll ever be able to do that again, and not just because I like working in my pajamas. (For those who are curious, I’m doing transcription and ghostwriting at the moment. They provide a supplement to Social Security and allow me time to work on my blogs.)

Did toxic work environments cause mental illness? Probably not, though they have pushed some people closer to the edge and others past the breaking point. It’s hard to work in corporate culture with any kind of mental disorder (except possibly narcissism). For these people, remote working is a blessing. COVID has been devastating, but one of its side effects has been to improve working conditions for millions of people – and especially those living with mental illnesses.

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Anxious in Ireland

So not us.

Over the last couple of months, I’ve written about the anxiety I’ve been having regarding our vacation in Ireland. There’s been the overplanning, overscheduling, overspending, and the trying to make sure that everything went perfectly (like that was going to happen). I had anxiety about whether I would pack too much or too little, whether I could sleep on the plane, whether I could find things to eat comfortably (after recovering from dental surgery). Anxiety about whether I could find help with my mobility challenges in the airports and at my destinations. Anxiety about driving on the left. Et endless cetera.

As my therapist noted when I spoke to her after my return, it was good I took my anti-anxiety meds with me. (I made sure to pack them, even though I haven’t been taking them every day since consulting with my prescribing psychiatrist. I packed all my other psychotropics too, of course. I also carried my sleeping aid, which I’ve also stopped taking regularly, for the plane flights, but didn’t need it.)

Many of the anxieties I encountered in Ireland did indeed have to do with driving. I tried driving the rental car once, but I was too nervous to continue that. My husband ended up doing all the driving and I navigated. After some bad experiences with the GPS unit that the car rental company provided, we switched to using Google Maps on my phone, both of which fortunately worked in Ireland. I was in charge of transmitting the directions to Dan and trying to translate kilometers into miles for him.

One of the first difficulties we had before we defaulted to Google Maps was when we were heading to our first bed-and-breakfast reservation (the accommodations were arranged in advance by the travel company, so I didn’t have to have anxiety about where we were going to sleep each night). The GPS took us on a series of narrow, stony roads that ended up with us running off the one lane and into a ditch. After the initial shock and the realization that we couldn’t simply rock the car out of it, though, I wasn’t really all that anxious, perhaps because it was late at night and I was emotionally as well as physically exhausted.

I had a flashlight in my purse (something I almost always carry). My husband took it and set off on foot to find help, while I waited with the car. In about half an hour he returned with a local couple of lovely, helpful people, who drove us and our luggage to the b-n-b (which was actually quite nearby). They also came back in the morning to pull the car out of the ditch and pulled out a minor dent for us, and they accepted a modest amount of Euros for all their help. All things considered, it could have been much worse. I fell into bed that night and slept soundly.

During the whole trip, I never got really used to the driving situation. Dan noticed that I was making humming noises as we drove and bracing my hand on the dashboard (or the roof) at times. He called this “vibrating” and gently reminded me that I had the anti-anxiety meds with me. Eventually, I got used to taking them every morning before we began our day’s wanderings. My vibration was particularly noticeable when we passed another car or when I thought we were swerving too close to the edges of the road (the ditch situation made this seem all too plausible). Parking in cities – and indeed simply trying to navigate in them – also triggered my anxiety.

Then there were the godawful problems with our flights and our finances. Back in December, the airline had changed our flight out but never notified us about it, so we showed up at the airport four hours after our flight left. I spent several hours on the phone with the airline, our bank, and our credit card company trying to make arrangements for the first flight out the next day and the money to pay for it (since we were considered no-shows). Fortunately, I went into task-oriented mode (which I am sometimes capable of) and shuffled money and flights around before I collapsed. We did miss our scheduled first day in Ireland, though.

Getting a flight back was even worse. There was a problem with our COVID certification (we needed an antigen test, not just a triple-vax card) and later flights were booked solid. In the end, we had to spend two days in a Dublin airport hotel while trying to make arrangements with a dying phone and no charging cable. Dan came through there too when I was at the end of my proverbial rope (or in this case cable) and managed somehow to get a replacement. But by then we were out of money and I had to ask friends and family to PayPal us money for the extra nights in the hotel. It was all quite nerve-fraying and close to panic-inducing.

We’re back home now and I have settled down quite a bit, though I’m still dealing with financial repercussions, which have always been one of my major anxiety triggers. But I’m not taking the anti-anxiety pills daily anymore. And, as always, Dan is helping me.

The good news is that, throughout and despite all this, we managed to have a great time in Ireland. Sure, I had anxiety – and quite a bit of it – but I was still able to enjoy the country, the scenery, the food, the activities, and the wonderful people. We’re already talking about saving to go back.

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