Bipolar 2 From Inside and Out

Posts tagged ‘my experiences’

Permission to Be Depressed

Depression can be so riddled with guilt. Why am I not able to fake being okay? Why do I isolate when what I need is interaction?

Sometimes what I need is to give myself permission to be depressed. I have bipolar disorder 2, with a heavy depression component. It has overwhelmed me many times. I have fought against it, given in to it, tried to make compromises with it, tried to ignore it – almost any reaction you can imagine. Then I learned how to give myself permission to be depressed.

This is not quite the same as giving in to depression. It involves acknowledging that I am depressed and allowing myself to feel the feelings that I have. Of course, I don’t give myself permission to be permanently depressed. In a way, it’s more like giving myself permission to practice self-care and not to force myself to smile and bull my way past the depression. I recognize that I am depressed and do what I need to do to get through it. That may be staying in bed. It may be crying. It may be wallowing in sad music. These are things that I’m likely to do anyway when I’m depressed, but giving myself permission to do them is surprisingly freeing.

I used this technique probably for the first time when my husband and I went on a “barefoot” cruise vacation. It was something we both enjoyed and both want to do again someday.

But I knew from the beginning that depression might overtake me – probably would, at that time in my life – even while I was doing something enjoyable. Naturally, I didn’t want the depression to ruin the whole vacation, so I decided to give myself permission to do what I needed to do to cope with those feelings.

Most often, that involved retreating to my bunk for a nap. This enabled me to get away from other people when I was feeling overwhelmed and unable to socialize. Sure, I missed some of the onboard and shore activities, but I wouldn’t have enjoyed them anyway while in the metaphorical fog and darkness. I enjoyed what I could, then let myself not do what I didn’t feel up to doing. I didn’t try to make my husband stay with me and miss all the fun. There wasn’t anything he could do for me anyway. If the other passengers thought it was odd – and they did – they barely mentioned it to me. My husband told them I was tired. Seasickness was also a believable excuse.

In a way, having bipolar depression at that level is like having the flu. I feel bogged down and logy, inclined to cocoon, rest, and stay away from other people. I realize this is not always possible, but if it is, I can allow myself to do it. Fortunately, this spell of depression wasn’t so bad that it completely incapacitated me as it has at other times in my life. I was still able to feel enjoyment at some times, though not at others.

At other times, I’ve had to give myself permission to have anxiety. If a situation makes me anxious, I acknowledge that I am nervous, and do what I need to do. I can’t “think away” my anxiety, but sometimes I can get myself out of the situation at least temporarily. I do not have to sit and be anxious while people around me argue or shout at each other, one of my anxiety triggers. When I recognize how I’m feeling (which takes practice) and give myself permission to feel the way I feel, I’m better able to come up with coping mechanisms, such as leaving the room to get some fresh air or making myself a cup of tea.

You may notice that when I give myself permission to be depressed or anxious, part of my solution involves avoiding other people. That’s sometimes a hard thing to do. Isolation can certainly make depression worse, but it can sometimes also be necessary if pushing through, trying to smile, mingle, and socialize will make the depression worse in the end. And I have learned that if I try to do that, the depression comes along with me. Once a friend told me that it was like having a separate person with me, a person called Misery. Better to give myself permission to stay home and give myself some self-care.

What I can’t do is give myself permission to stay depressed or anxious. Giving myself permission is a very limited-time offer. It doesn’t work for those really lingering, midnight-dark depressions that last for weeks or months on end. Those, I have to fight. And while I’m depressed, I don’t give up on meds or therapy. Those are necessary to alleviate the depression instead of resigning myself to feeling it.

In Remission

My bipolar disorder is in remission. I know I’m not cured. There is currently no cure for bipolar. But I’ve reached a point where I’m stable enough that I don’t expect a crash or a buzz to descend on me at just any old time.

I still get moods, of course. They’re just not severe or long-lasting enough to be symptomatic. Yesterday, for example, I spent several hours wrestling with phone trees and people who wouldn’t switch me to a supervisor when all I was trying to do was straighten out a couple of bills that contained errors. Afterwards, I felt frustrated, cranky, and a bit sad. But those were normal emotions, based on what I had just gone through. After a nap I felt better, and dinner blew out the remaining cobwebs. Napping is definitely better than staying in bed the entire next day.

Of course, I didn’t achieve remission alone. It took years of doctor visits, therapy, and medications to reach this state. I am particularly grateful for mood levelers. For me, they actually do what they’re intended to do. They keep my moods within an acceptable range, or at least one that’s acceptable to me.

Too many people fear mood levelers, I think. Level moods sound boring – as though there are no variations, just a blank, straight line. That simply isn’t so. Mood levelers have pushed the spikes that used to go wild in either direction to a less extreme range. If you think of mood as an EEG, mood levelers prevent the lines from going off the charts, settling them to fluctuate within a middle range that most non-bipolar people have naturally.

I think the term “mood leveler” scares some people. They seem to think that such a drug would make them perfectly level, robotic, unchanging. They fear that any spark of personality or creativity would be lost.

That’s not the case. Instead, with level moods – and especially for depression-prone bipolars – a person has much more ability to explore his or her creative side.  I know that’s true for me. Now that my moods are stable and level, I’m able to get more writing done, but also to tell whether the work is good or needs serious revising before I post it.

My doctor recently increased the dosage of one of my medications, a mood leveler, because I was having trouble with hypomania that wouldn’t let me sleep. And it worked. I am now getting seven to eight hours of sleep each night and have enough energy to at least face the day, if not always to conquer it.

Don’t think mine has been a case of spontaneous remission. I’m not sure I believe that’s possible with bipolar disorder. It’s taken a lot of years and a lot of work to get to where I am today. For example, it took literally years for assorted doctors and me to find a combination of chemicals, a cocktail of psychotropics, that would work for me. And during all that time, it was as if I was not medicated at all. Only the right combo of drugs and dosages would unlock my brain and level my moods.

So, here I am, in remission – and I love it. My moods aren’t blunted, they’re leveled. I am not as fearful now that my extreme moods may return and wreak havoc on my life. Oh, I still have some symptoms and side effects that remind me I’m not cured. But now I know that remission is possible, with work, with luck, and with the right mood levelers.

Nothing to See Here

Many people with SMI are afraid that it shows, that other people can see automatically that there is something wrong with them. They feel as though they stand out in a crowd. Everyone notices them, and probably talks about them.

I have the opposite problem. My bipolar depression makes me feel invisible. It’s not just that SMI is often an invisible illness. It’s that I myself seem to become invisible. I think of myself as a particularly ineffectual ghost, frightening no one and unable to affect anything in my environment. Some people call this dissociation.

At first, I made the best of it. I’m especially invisible when I’m out in public and reading a book. So I found that if I was at a business convention and wanted to remain invisible, my best strategy was to sit alone at a table and read a book. Only once did a man approach me while I was so engaged. No one else ever did.

Apparently, though, I don’t need a book to disappear. Maybe it’s anxiety that makes me keep quiet when people around me are discussing something interesting. Maybe it’s my instinct not to be noticed so I won’t be subject to derision or worse. Either way, I can’t seem to catch anyone’s eye or add my bit to the conversation. I blend into the crowd, even if it’s only a crowd of three or four.

It’s almost like there’s some aura around me when I’m out in public that says, “Don’t notice me,” like Harry Potter’s cloak of invisibility. I do not use my invisibility for pranks or mischief, though. I don’t use it intentionally at all (except for using a book, as I mentioned).

Why do I think this invisibility is part and parcel of my bipolar disorder? It could be imposter syndrome at work. I feel so unworthy that I don’t want anyone to see me for what I am. Or it might be the anxiety component of my hypomania that keeps me from presenting myself more assertively. Or maybe people can see that I have a troubled mind and simply look away.

I am slowly learning to make myself seen and heard. I find that calling people by name makes it easier for them to see me. It seems to signal them that there’s another person in the vicinity. And once I even set up an occasion where I would be the center of attention, speaking about my bipolar disorder at a signing for my book.

I also use my writing to make myself “visible.” This blog (and my other one) and my books give me a presence, though not a physical one, even at a distance. When I see likes and follows and sales, I know that someone has noticed me, or at least discovered that I exist.

I sometimes think that going out in public more – practicing being visible – might help. But actually, that’s when I feel the most overlooked, the most unseen and unheard. The most lost.

Perhaps what I need is to go out and meet a specific person, someone who expects to see me. Then I could be guaranteed of one person who would see me.

But it has been suggested to me that I may not want to be seen at all – that I would prefer to fade into the background, not put myself forward and disappear from the stresses of being seen. Perhaps that is true, or at least once was.

Now I think I would prefer to be seen, flaws and all. If someone cannot tolerate the sight of me, a mentally disordered person, or glances over me as if I did not exist, I think I shall insist on being seen. I will use my voice, my (admittedly glitchy) brain, and my human physicality to assert that I exist, that I matter, that I have something to say.

And in social situations I will try to assert myself (if politely) to join the public discourse and add my two cents, whether the subject is mental illness or the latest bestseller.

I exist. I deserve to be seen. I will not remain invisible.

Hypomania, Shopping, and Sleep

I hate shopping. Loathe it. Grocery shopping. Clothes shopping. Shoe shopping. Practically the only thing left for me is online shopping, and that can be treacherous – and not because I can so easily spend too much money.

Online shopping can push me over into hypomania. So can thinking about online shopping.

Recently, our house was destroyed by a tornado. We lost everything. And we have to replace everything. (Fortunately, our insurance company is paying for most of the lost items, as well as rebuilding the house.)

When I first got the inventory of things that needed replacing, I was too overwhelmed to do much about it. A window-shopping trip to La-Z-Boy left me bereft of spoons, as shopping always does. So I turned to the internet.

Do you have any idea how many companies are willing to sell me chairs, sofas, rugs, computer desks, jewelry armoires, electric fireplaces, and even walking sticks (to mention but a few items)? Lots. Lots and lots. Now I even get messages from many of them on my email and Facebook feed.

I have spent literally hours browsing online. And then I try to sleep. It’s an instant case of “Hamster Brain,” as my friends and I call it. I can’t sleep, even with my prescribed sleep aid and prescribed benzo. My mind starts whirling and my thoughts start racing.

Hypomania takes over. Oh, I don’t run to my computer and start ordering stuff. I’m keeping hands off my PayPal account, for the most part. But I lie in bed, eyes closed, trying to picture every purchase in what will be its new setting. I compare various color schemes for each room in the house, then change them each night – gold, brown, and cinnamon for my study? Blue and green with coral for the living room? And, oh, God, what about the bathrooms and the kitchen? I even arrange the furniture in my head – which wall will the computer desk go against? What will go beside the chairs? Tea cart? End table? Should we have a corner breakfast nook or a proper dinette set?

And how do I explain to my husband what my visions are? I can’t even decide between boho and country comfy. I can’t even define for him what I mean by boho. How do I keep him from sprinkling the house with 50s pieces (now called mid-century)? How can I integrate his treasures without spoiling my visions?

Most nights now I am up until 2:30 at least, which is when I take the benzo. When I wake, though, the hypomania is not over. It’s back to the computer with a new thing to search for, adding item after item to my favorites lists, comparing prices. I spend hours doing this. I email pictures back and forth with my husband as he gets caught up in my frenzy. This afternoon I spent several hours online buying replacements for books that were ruined. Tonight may be another case of no sleep till who-knows-when.

I’d like to stop, or at least slow down. Realistically, I don’t have to do anything now. I certainly don’t have to order or even browse choices. The house will not be rebuilt until at least the spring and we have no place to store any purchases until then. It’s silly to make decisions now, when between now and then thousands more choices will become available.

If I keep going at the pace I’m at now, I will be supremely sleep-deprived by the time I actually need to make purchases. And between now and then I see myself with a copy of the floor plans, making little cut-outs of different-sized furniture and trying them out for size and fit like those sliding puzzles we used to do as kids.

I see my pdoc this weekend and I’m going to ask him what to do about the hypomania and the lack of sleep. I get hypomania so seldom and it usually goes away so quickly. It’s impossible to think about it continuing at this level and going on for months.

Of course, it’s too simple for someone to tell me to calm down, not to think about it until the time comes. This is hypomania. That’s exactly what I can’t do. Once again, my brain is in control and running riot. And it won’t shut up, not even when I really need it to.

Did Bipolar Disorder Lose Me Jobs?

I lost two jobs, one that I had held for 17 years, because of my bipolar disorder. I only realized this comparatively recently. In both cases, I readily admit that my work had gone downhill, but at the time (at least for the first job), it never occurred to me that bipolar disorder was the reason for my dismissal.

I was working at a publishing company as an editor, having worked my way up from editorial assistant. I had been the editor of two different magazines, assistant editor for a couple of others, and writer and proofreader for them all. (It was a very small company.)

As time went on, though, I became less and less reliable. I edited my magazines, but I had trouble dealing with people. I had particular trouble with an art director who didn’t like my cover choices (despite the fact that several of them had won awards), humiliated me in a staff meeting because of it, and reminded everyone about it later. She was toxic, sure, but I was unable to deal with the situation or even stand up for myself.

There were other humiliations that I tolerated because I didn’t have the wherewithal to quit. When, during the financial crisis, salaries were cut by 20%, mine was cut by 40%, which to me meant that I was twice as useless as, say, a salesperson.

I stayed, but I isolated myself. My office had a door and I used it, the only person in the company to do so. I knew that people thought this was odd behavior, but by that point, I didn’t care. I was let go with no explanation given.

Yes, the company was a toxic environment and no, I didn’t deal with it well. But the situations I put up with exacerbated my bipolar disorder until I was headed for the crash. When I was on the upswing I was able to do my assignments and, I like to think, do them well. But when things went bad, I was prey to the voices that told me I was no good. Losing the job proved that to me.

The next job I went to was editing textbooks. My supervisor knew me and knew that I had bipolar disorder. The fact that she understood helped me keep on an even keel for a while. I developed little techniques to stave off difficulties. But some of my coping mechanisms were unacceptable. (Apparently, it’s okay to have a cigarette break but not a crossword puzzle break.)

Then my supervisor left. I said to her, “I’m going to miss you,” and she replied, “I know.” Prophetic words. I was open with my new supervisor about having bipolar disorder and was quite taken aback when she asked, “What does that mean?” Unprepared to give a proper explanation, I blinked and replied simply, “It means I’ll have good days and bad days.”

From that point on, my performance and their satisfaction with me fell, until I received a bad review, the first one I had ever had. Before the six-month probation period was up, I left of my own accord, determined to make it as a freelancer.

There were personal circumstances at the time, including my disorder, that made me less capable. I became responsible for my mother’s health and finances. I could easily miss half a day of work just getting her to her various appointments. That no doubt affected many of my job functions, particularly my attendance and my ability to concentrate. My major breakdown began not long after I left that job.

The thing is, in 2008, the Americans with Disabilities Act (ADA) added bipolar disorder as a covered condition. Employers were (and as of this writing still are) required to provide “reasonable accommodations” to affected individuals. Examples of reasonable accommodations include job restructuring, part-time or modified work schedules, and “a change or adjustment to a job or work environment.”

To receive accommodations under the ADA, an employee must disclose their bipolar disorder (which I did, at least at the second job) and request accommodations (which I didn’t do, other than offering to work from home).

The EEOC (2009) has a publication called “Psychiatric Disabilities and the ADA,” which is available online at http://www.eeoc.gov/policy/docs/psych.html. Among their recommendations to help a bipolar employee continue to function in the work environment – maintain stamina and concentration; stay organized and meet deadlines; work with supervisors; and handle stress, emotions, and attendance issues – are these:

  • Allow flexible scheduling
  • Allow for time off for counseling
  • Allow work from home during part of the day or week
  • Provide space enclosures or private office
  • Allow telephone calls during work hours to doctors and others for needed support
  • Provide flexible leave for health problems
  • Allow the employee to make up time missed
  • Maintain open channels of communications between the employee and the new and old supervisor in order to ensure an effective transition

I know there are those who would consider such accommodations “coddling.” And I wouldn’t have needed them all, or all of them at the same time. But even an understanding of my closed door and my need to work at home would have helped.

Do I Have PTSD?

Once a therapist I was considering going to put down on my form that I was suffering from PTSD. She based this on the fact that I was having nightmares and flashbacks to the toxic relationship that I counted as a significant part of my past.

It was rubbish, I thought. I had never been in the Vietnam or Iraq war. And her idea of my trauma was that I supposedly had been coerced by an older man into doing sexual things that, had I been in my right mind, I would have objected to.

I chose a different therapist, who was bemused, to say the least, at that therapist’s notes. I had had a relationship with an older man and done sexual things that were not precisely the plainest vanilla, but I had surely not been coerced into them. (The gaslighting was a separate issue, one I did not recognize at the time.)

I still have the dreams of being back in his house, and I am occasionally triggered by things that remind me of the relationship, especially when I am depressed or otherwise vulnerable, but by and large, I don’t think that I have PTSD based on that.

Then, recently, I was hit with a more physical trauma. I survived a tornado that destroyed the house I was living in, taking the roof off the second floor where I was sleeping. I have also had nightmares about that and anxiety whenever there are storms and lightning. So, do I have PTSD now?

Let’s see. For starters, mirecc.va.gov provides a “civilian checklist” of PTSD symptoms:

  • Avoid activities or situations because they remind you of a stressful experience from the past
  • Trouble remembering important parts of a stressful experience from the past
  • Loss of interest in things that you used to enjoy
  • Feeling distant or cut off from other people
  • Feeling emotionally numb or being unable to have loving feelings for those close to you
  • Feeling as if your future will somehow be cut short
  • Trouble falling or staying asleep
  • Feeling irritable or having angry outbursts
  • Having difficulty concentrating
  • Being “super alert” or watchful on guard
  • Feeling jumpy or easily startled

To begin with, many of the symptoms which I have are also indicative of depression, anxiety or bipolar disorder – loss of interest in enjoyable pursuits, sleep problems, difficulty concentrating. And I have noticed a few of the other signs – jumpiness and irritability, for example.

But, by and large, aside from the dreams and flashbacks, I have few symptoms that are attributable to PTSD but not to bipolar disorder.

I was talking with my therapist the other week and posed the question to her: Could I have PTSD?

“There are all kinds of trauma,” she said, “and all kinds of reactions to it.” I think what she meant was that I didn’t need to worry about having a specific label. I have been through traumatic events and I have had reactions to them. The reactions and symptoms may not rise to the level that constitutes clinical PTSD, but I have been affected by them nonetheless.

I don’t want to minimize the suffering of those who have been diagnosed with PTSD or those who are suffering from it without ever acquiring the label. I know that what I have experienced cannot compare to what some of them have experienced, and I can only hope it never does.

But still I think there are a lot of us out there who could count ourselves among the “walking wounded,” who have experienced physical or psychological traumas and still have adverse reactions to them. Call it borderline PTSD or some other type of stress disorder, if using the label PTSD seems arrogant or insensitive.

But know that there are other traumas besides war that can leave a person damaged, struggling to find themselves among the shards of a shattered world. We may not have lost a part of our physical selves, but the damage to our psyches can be just as real.

 

 

When Self-Care Seems Impossible

It seems the days when I most need self-care are also the days when I’m least able to accomplish it. I mean, when I can’t even get out of bed, I’m not likely to have the wherewithal to perform any kind of self-care regimen.

I’m not talking here about the take-yourself-to-the-spa type of self-care, either. That’s beyond my means and my capacity. What I’m thinking about are the most basic needs that must be met – meds, food, sleep, and the like. But there are sometimes things that prevent me from accomplishing even these.

Part of the reason, of course, has to do with lack of spoons. It takes energy to shower and dress, make a meal, go to appointments, and all the other tasks that should actually make me feel better. According to Spoon Theory, we wake up with an unknown amount of spoons every day and must choose how to spend them. Some days I wake up with only a few or even zero.

The other obstacle I’ve noticed that inhibits my self-care is my occasional inability to plan. Yes, I can make sure I eat at least one meal a day, but on some days only if I have gone to the grocery store earlier in the week and bought at least a box of Cocoa Puffs and some bottled water to keep by my bed. Not much of a meal, I know. It’s the bare minimum I can do, but sometimes all I can manage.

Taking my meds is the only part of self-care that is an essential that I don’t do without. I usually have that bottle of water right next to my bottles of pills, but even if I don’t, back in college I learned to swallow pills with only spit. But again, this takes a little planning – calling in prescriptions and getting to the pharmacy to pick them up.

On days when I have slightly more spoons, I have to plan and prepare for the days when I don’t have enough for proper self-care. Even the planning and preparing use up spoons.

But there are also days when I can manage a little self-care. On those days, if the spoons are low, but not completely nonexistent, I take shortcuts. I wash up in the sink instead of showering. I put a piece of salami between two pieces of bread and call it a meal. I put on clean pajamas and underwear instead of getting all the way dressed. I use mouthwash instead of brushing my teeth. I pet the cat instead of calling friends.

And I call it good enough.

Admittedly, those are some low standards for self-care. It would be nice if I could do more – and on some days I can. But on many days, the obstacles seem overwhelming. Inertia takes over and entropy sets in. I know it’s not good for me and can slow my recovery from spoon deficit spending, but that’s just the way depression is sometimes. It sucks you down into a hole that’s hard to climb out of when it’s at its worst.

But, thanks to the aforementioned meds and the minimal self-care I’m able to do, I know that one day I’ll be out of the hole and able to work on some proper self-care. Even plan for the next time that self-care seems impossible.

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