Bipolar 2 From Inside and Out

Posts tagged ‘my experiences’

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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Traveling – and Planning – While Bipolar

Traveling is often a challenge for people who have bipolar disorder. Some people can’t do it at all or can’t even leave their houses, which I certainly sympathize with. I really do. There have been times in my life when I could travel and times when I could not, because of my mental state.

Right now, I’m able to. I’m taking advantage of this to go with my husband to Ireland for ten days. We started planning this trip last fall, which has, of course, given me plenty of time to overthink everything – but not to reconsider. I think this will be one of the best things we have ever done together, apart from getting married.

If everything (and by everything I mean Facebook) works right, this post will appear while I’m overseas. I didn’t want to just skip a week in my blog, so I’m trying out the feature that lets you schedule posts ahead of time. I worry that it won’t work, which in the greater scheme of things wouldn’t really be so bad. Just more overthinking.

In addition to overthinking, I am over-scheduling and over-packing. I have been bothering our travel agent with questions about driver’s licenses and phone service. I have made reservations for eight different scenic places and interesting events. (I think they require reservations because of COVID, because they don’t want too many people to show up for tours at the same time.) I have a list of things I need to do before we leave. Every time I cross one thing off, I add another at the bottom. I used to be able to pack for a long weekend for both of us with only one tote bag, but those days are long gone. My list of what I will need to have with me threatens to spill over my luggage allowance.

In the past when I’ve traveled, I’ve had some success with giving myself permission to feel the way I feel – to take a day off from activities if I feel low, for example. This time, what with all the pre-booking, I may not be as inclined to do that. We do have days scheduled with less driving around and I have noted times when we can simply explore local pubs and restaurants. We’re even bringing along a card game in case we feel too useless to leave our bed-and-breakfast.

I have no guarantees that my mood swings will abate while I’m gone, of course. Making sure all my meds are refilled and packed is top on my to-do list. That’s much more important than packing a card game. I can see myself getting cranky about getting to the various locations in time for our reservations, but I’ve been fairly stable lately, so I hope I don’t tip over into something worse than grumpiness. At least my husband will be there to help me laugh and decompress.

I think that time to decompress is necessary while traveling. It may have been my hypomania that told me to make reservations for every occasion. And I hope the looming shadow of my bipolar disorder doesn’t sabotage the whole thing. This vacation is very important for us, which probably means I have too much invested in it, and I don’t mean just monetarily. It’s most likely the last time we’ll ever be able to travel abroad, so I want to make the most of it.

I just hope that making the most of it doesn’t send me tipping over the edge into depression or hypomania. I’m never good psychologically with financial affairs or not knowing what’s going to happen. I’ve seen those tendencies in myself increase with time. I hope that this vacation is what I need to shake me loose from some of those feelings. I hope that I will look back on it, after this bit of writing becomes public, and realize that I have proved my relative stability by being able to go through what is intended to be a magical time. But I guess expecting magic is too big an expectation to put on a vacation.

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Of All the Things I’ve Lost…

The quotation from Mark Twain goes, “Of all the things I have lost, I miss my mind the most.” It’s a little annoying, at the least, when people repeat it. Those of us with psychiatric diagnoses don’t actually lose our minds, but we do lose a lot of other things along the way.

Friends

I’ve certainly lost friends because of my bipolar disorder. I can think of two in particular who were very dear friends, but cut off all contact with me when I was at the depths of my depression and they feared I was suicidal. I reached out to them a few times and even sent them a copy of both my books, but got minimal response. I still miss them, though they now live in another state and it’s unlikely that we’ll ever see each other again, even in social settings we all used to frequent.

Jobs

Twice I lost jobs largely because of my bipolar disorder. The first time, I had been isolating a lot, keeping the door to my office closed and barely interacting with any of the other employees. While an open door wasn’t technically a requirement of the job, I was the only editor who habitually hid behind a closed one, and it wasn’t taken well. I’m afraid I got a reputation as being difficult and uncommunicative. Finally, after several incidents where my emotions ran away with me, I was let go.

The second time was at the job I had directly after that job ended. At first, I did all right in the department where I was assigned. Then my boss left and the department was disbanded. I was transferred to another editing group, and there my difficulties began. The people there misunderstood my attempts at humor. My boss didn’t understand bipolar disorder and when she asked, “What does that mean?” I was caught off-guard and made a brief, unhelpful remark to the effect of “Sometimes I have good days and sometimes I have bad days.” I could see her thinking, “What makes you different than anyone else?”

Finally, I was put on probation, the only time in my entire career when that ever happened to me. I decided to leave before they could fire me. Then I went into a period of hypomania about not having to work there anymore and starting a freelance career, which did not turn out as well as I had hoped.

Intellectual abilities

I know a lot of people worry that when they have a disorder such as bipolar, or even when they take medication for it, they will lose some of their brainpower. I never felt that way, but looking back I can see that the disorder also disordered my thinking. Moods of despair and exhilaration interfered with my cognitive functions. In addition to the general dulling of feelings during depression, I also lost the ability to concentrate enough to read, formerly one of my primary and best-loved activities. Even as I mourned the loss of my reading, I was simply unable to pick up a book and follow its contents. I took to watching mindless TV shows instead – really bad ones.

Enjoyment

Just as I no longer found joy in reading, I no longer found other activities enjoyable or interesting as well. I used to love cooking, especially with my husband, but when depressed, I could barely microwave a cup of mac-n-cheese. I loved good conversation with friends, but I barely talked to anyone and ignored friends’ overtures. I enormously enjoyed traveling, but couldn’t summon the energy even for a day trip.

Confidence

I used to be able to do all kinds of things by myself – attend business conventions (and science fiction conventions) and write articles for publication, for example. When I was suffering the most from bipolar disorder, I could do none of these things. When I went to conventions, I needed a bolt hole and spent as much time as I could in my room. At that point, I couldn’t write about my condition or even send emails to friends. One of my friends said, when I was considering ECT, “Write about it! That’s what you do!” But it wasn’t what I did anymore. Putting pen to paper – or words on a screen – was not even a possibility. I asked someone else if she would write about it instead.

Things I haven’t lost

Of course, most of these things came back to me once I was properly diagnosed and medicated. I now read every night, write my blogs every week, travel here and abroad, and make friends that I keep in touch with. I discovered that some of my friends had stuck by me, even when I was in the depths. I still can’t work in an office, but I have found work I can do from home. I enjoy travel again. And if I’m a little slower to get a joke or find a word, it doesn’t bother me so much. I know my brain is just fine, except for occasional glitches.

Losing all those things made me realize just how good my life is now that I am back to being myself. I have my mind back, if it was ever lost at all.

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Hypomanic, Anxious, and Overextended

My hypomania and my anxiety are fighting each other. Here’s what happened to start the quarrel.

There wasn’t much work for me over the holidays and into February. The transcription company that I freelance for didn’t have many assignments to give out, and, being part-time, I was low on the list to get them. Plus, one of the company’s biggest clients was leaving. And my husband and I got COVID, so it was impossible for him and difficult for me to work.

The job at the transcription company isn’t great. I make a few hundred dollars a month, which is a good supplement to my Social Security and my husband’s pay. I’m really a crappy typist, though, so it takes me longer to finish assignments than it does for most people. I work only four days a week, but it feels like full-time.

But, with the job likely to go away entirely, my anxiety was triggered. I figured it was time to look for a new part-time gig, maybe one that wouldn’t be as taxing.

I started my job search and eventually found a company that was hiring remote online tutors, which seemed perfect for me. My bipolar disorder makes it difficult for me to work in an office, especially in a 9-to-5 job. I’ve done it in the past, but don’t think I could anymore.

Then good news came – the transcription job wasn’t going away after all. A new client had signed on (though the work hasn’t started to come in yet, so I have no idea what the pattern of assignments will be).

I didn’t want to give up on the tutoring job. (I haven’t started yet, as they are still processing my paperwork.) I figured I might be able to do both, tutoring on the three days per week that I wasn’t transcribing, or in the mornings between assignments. The tutoring gig requires only five hours per week, though you can take on more.

Then I got a lead on a job editing, which is my real love when it comes to work. And I began to wonder whether I could do that in addition to both the tutoring job and the typing job.

Of course, that’s hypomania talking. I don’t get hypomania very often and when I do, I have a hard time recognizing it. My husband sometimes notices it before I do and gently reminds me when he sees me starting to go overboard. “You’d be awfully busy,” he said, looking dubious. It made me stop and think. For one thing, it made me think that it might not have been a good idea to buy the new computer that the tutoring job would require. For another, my time off with him is precious, and I wouldn’t like losing that.

The typing job is supposed to get rolling again, but I like it the least, as it isn’t a good use of my real skill set. But I’ve been doing it for several years now, so I’m kind of used to it. The prospect of having no extra money coming in scares me, though, enough that I am really considering getting that second part-time job. That’s my anxiety talking as well as my hypomania.

Realistically, I ought to just stay with the job I have and hope that the new client works out. Now that that is a possibility, maybe I should give up the idea of more work. But the uncertainty that I’ve recently experienced tells me that I ought to have another way to jump, just in case.

Which will win – my anxiety, my hypomania, or my husband’s common sense? I really want that editing job . . . .

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mental health

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Going Off (Some) Meds

I regularly tell people not to go off their meds without consulting their psychiatrist. I yell at them, in all caps. It’s not just a bad idea, it can result in withdrawal and even lessening the meds’ effectiveness if you do go back on them. Yet recently, I went off two psych meds without my psychiatrist’s prior approval.

Here’s what happened.

My husband and I recently had COVID – probably the Delta or Omicron Variant, as we have both been triple-vaxxed. That is to say, my husband tested positive for COVID and I have close contact with him, plus I had the same symptoms that he did.

Since we didn’t need expensive and rare treatments or hospital stays and ventilators, we relied on over-the-counter medication to treat the symptoms, which included sore throat, coughing, fever, congestion, and fatigue. We recovered in a couple of weeks to a month and my husband is back to his job, where he regularly interacts with numbers of people. I work at home, so I didn’t have that problem. I just needed to take some time off when I felt truly crappy.

When we read the directions on the OTC symptom-relief pills, however, there was a warning that said not to take anti-anxiety agents or sleep aids with them. My regular routine has been to take a sleeping aid at bedtime and an anti-anxiety pill in the morning and at bedtime, with an extra dose allowed if I have an anxiety attack during the day. I have been taking both of the meds literally for years and have never had any problems with them. (I won’t say what any of the medications are, since everyone has different reactions to different medications, and my reactions, while fairly typical, won’t hold true for everyone.)

Perhaps out of an excess of caution, I decided not to take the anti-anxiety and sleeping meds while on the OTC ones. When I quit taking them, though, I was worried that I might experience some of the ill effects that were possible.

Throughout the course of my bout of COVID, I didn’t notice any withdrawal symptoms, excess anxiety, or difficulty sleeping as I feared I might. In fact, I slept better than usual and had fewer attacks of anxiety. So I decided that I would try going off the two meds for a while, even after I felt better. It was about six weeks until my next med check with my psychiatrist.

Of course, when my med check came around, I told my psychiatrist what I had done and why. I thought he might react badly when I said that I did this on my own, without his advice and consent.

Instead, he seemed thrilled.

“Good for you,” he said. “You’ve stopped taking the two addictive ones, too.”

I had known those drugs were potentially addictive, which was why I was watching for withdrawal symptoms. I took the lack of these as signs that, though the drugs were addictive, I was not addicted. (My psychiatrist has to regularly have an analysis done to show whether his patients have a high risk of abusing psych meds or taking more than needed. My score was 0%.)

It felt good to have my psychiatrist validate that I had done a good thing and not a bad one. But even more, it felt good to be taking fewer pills each day. I’ve never minded having to take pills or felt ashamed of taking them, but it was still significant to me that I had lowered my medication schedule to just the ones that had beneficial psychotropic effects, such as antidepressants and mood stabilizers. I was delighted to find that I didn’t need as many pills as I had once thought.

All in all, my experiment was a success, but I was lucky, and my experience is not medical advice. I don’t recommend it to anyone else. Consult your prescribing physician before you cut back on or stop any medication. I MEAN IT!

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How I Learned I’m Not “Pathetic”

When I first went to my therapist, I often described my life and myself as “pathetic.” Slowly, as I made progress, I stopped doing that. It was a revelation that took some time to sink in. Here are some of the things my therapist said and did to help me overcome this harmful description of myself and my bipolar disorder.

Refusing to accept my description. This may seem like an obvious thing, but it had real meaning for me. I had been majorly depressed for approximately three years and bipolar as long as I could remember. I couldn’t do anything – get out of bed, shower, feed myself or the cats, or perform the tasks of daily living. (My husband picked up the slack. Thank God for him.) My therapist never said in so many words, “You’re not pathetic” or “Your thinking is wrong.” She just patiently spent the time with me and gave me tools I could use to get better.

You’d think I would take this as denying my perception of reality, which I ordinarily hate when anyone tries it. But this time, I welcomed it. It was nice at that point to have someone denying my perception because Dr. B.’s perception was so much more appealing than mine. It gave me something to shoot for – a time when I would no longer feel that “pathetic” was an apt description. She also let me cry it out, which I often did when I was feeling particularly pathetic.

Baby steps. (Also known as “Eat the elephant one bite at a time.”) My healing was slow, thousands of baby steps of accomplishing more and more. Because my therapist never gave up, neither did I. Baby steps take you only so far at a time – after all, they’re tiny. But over time, they add up to a measurable distance. As I slowly moved away from my “pathetic” label, I also moved away from feeling pathetic. Eventually, I was able to eat, if not the whole elephant, at least a larger portion of it through slow but steady progress.

Not that I didn’t sometimes backslide. Whenever I hit another depressive episode, my feeling of pathetic-ness came roaring back. It was only as I learned that some other feeling was possible that I was able to catch a glimpse of a time when pathetic might no longer describe me.

Saying, “Look how far you’ve come.” This is something that my therapist kept reminding me. Dr. B. noted that I was becoming able to get out of bed to come to her office. She would bring up the tools that I had acquired or developed to help myself leave the bad old days largely in the past. She would also point out that I not only remembered those tools, I was using them.

Sticking with me. Dr. B. was also there when I backslid. A couple of times I had made so much progress that I thought I was able to go it alone. But, sooner or later, I would need a “booster shot” of work with her to remind me of the things that I really already knew. When I was feeling too low to make it into the office, we would have phone sessions. When COVID hit and in-person visits became even more difficult or impossible to arrange, we began having videoconference sessions. Slowly, I worked up from every week to once every two weeks to once every three weeks – and am now meeting with her only once a month.

And, let me tell you, it feels great not to feel pathetic anymore.


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