Bipolar 2 From Inside and Out

Posts tagged ‘my experiences’

When You Don’t Want to Live, but You Don’t Want to Die

“I hope I don’t wake up tomorrow morning.”

That is the classic thought of someone suffering from passive suicidal ideation. It’s not really a desire to die by suicide. It’s just a way of expressing how much it hurts to be you.

It’s not active suicidal ideation, the kind where you make an actual plan to kill yourself, even if you never put it into practice. It’s passive, meaning that you’d like to be dead but don’t intend on doing anything about it. It’s like asking the universe to take over and do it for you.

I’ve certainly had passive suicidal thoughts. Once I was very stressed and depressed while coming home from a business conference. I clearly remember thinking, “Maybe the plane will go down and keep me from having to deal with all this.” I certainly had no plan to rush the cockpit with a box cutter or anything like that. I just wanted my pain to be over. I wanted the choice taken out of my hands.

Another time I was at a business meeting in a swanky hotel that had rooms surrounding the lobby on numerous floors. I remember being on the 16th floor, looking down at the atrium beneath with what felt like idle curiosity. Would it annoy the hotel more, I wondered, if I landed on the carpeted area, necessitating a thorough cleaning or total replacement? Or would they be more upset if I landed on the marble floor portion of the lobby, making a bigger mess and potentially chipping the surface? (And was it just a coincidence that business meetings made me contemplate my mortality or did they just come packed with a lot of stressful triggers?)

At neither time was I actively suicidal. I’ve been there once too, and this was completely different. When I was suicidal, I had actual plans and plenty of means to carry out any one of them. I’m not going to discuss what those plans were. (The difficulty of choosing among them may have been what kept me from actually doing it. By then my depression had lifted just enough for me to get help.)

It was easy enough later to make jokes about the passively suicidal occasions and most people took them as exactly that – jokes. It was even plausible that they were jokes. I used to talk about jumping out a window, adding that it wouldn’t work because I lived in a basement. It was only much later that I thought about it and realized that I needed help even on those occasions. After all, isn’t pain the source of much humor and the downfall of many comedians?

Passive suicidal ideation is asking yourself “what if?” What if my troubles were over? What if my pain was gone? What if all I had to do to accomplish this was to let that bus hit me instead of stepping out of the way?

The important thing to remember is that someone passively suicidal is in great psychological pain and wants not to feel that way anymore. In that respect, it’s similar to cutting or other self-harm. And like those acts, it doesn’t end the pain at all. It may be a temporary escape valve, but it’s not a solution.

Passive suicidal ideation is certainly a bad thing and an excellent reason to see your psychiatrist or therapist as soon as possible. If you hear a friend or loved one talking this way, encourage them as strongly as possible to seek help. Let a professional decide if the person has passive suicidal ideation or active suicidal ideation. It is entirely possible that passive suicidal ideation will lead to the more active kind and even to death if it is not dealt with.

The One Pill I’m Embarrassed About Taking

I know that there are lots of people – and not just the bipolar ones – who don’t like taking medication and especially don’t like needing to take them. It’s a reminder of their illness, I guess, or a dependence on a chemical answer when we’ve been told for so long, “Just say no to drugs” and indoctrinated by DARE. The only thing they leave out is that some drugs are good for you – the prescribed ones that allow you to live and function.

I don’t mind my psychotropic medications. In fact, in many ways I love them. They are the things that keep me relatively stable, on a mostly even keel, and make sure that none of my mood swings lasts more than a couple of days. I loathe pill shaming and consider it just one more kind of stigma that attaches to mental illness (and other chronic illnesses).

But there is one medication I take every day that gives me pause. It is my sleeping pill. My psychiatrist prescribes them and I take one every night, along with my other nighttime pills. In about 20 minutes to an hour, I’m asleep, and I stay asleep usually until 8:00 a.m. or so. It means I get about eight or nine hours of uninterrupted sleep per night.

I do need that sleep. I’m not one of those people who can function on four or five hours of sleep, the way tech geniuses and high-powered execs claim they can. If I don’t get my eight hours – and sometimes even if I do – I take naps during the day. Not just naps: mega-naps. My brain and body sneer at 20-minute catnaps. If I’m going to sleep, they say, it must be an hour at a minimum. Two is even better.

It’s not like I want to go back to the days before the sleeping pills, either. I do still remember the long nights of fear and sorrow, the fits of crying, the panicky sensation of not being able to breathe. The endless mental replay of every stupid thing I’ve ever done. The anticipation of the disasters the next day would bring. The hopelessness and the helplessness and the loneliness. The feeling that I was the only being awake, maybe in the world. If a single little pill can save me from all that, I should be glad to take it.

Why, then, does it bother me?

Perhaps it’s because it doesn’t feel necessary in the way my psychotropics do. They are prescribed for my bipolar condition and somehow make the difference in how my neurotransmitters operate. The sleeping pill feels like a different category of drugs.

Or perhaps it is because sleeping pills are often a drug of abuse and even suicide. My psychiatrist trusts me with them, though, and has for years. Plus, my anti-anxiety med is also often abused and I feel no guilt about taking that.

Maybe it’s because a sleeping pill feels in some way like a luxury. I don’t think it does anything specific for my bipolar disorder – except that sleepless nights are certainly associated with depression and my middle-of-the-night anxiety as well.

I hate to think it, but maybe the pill-shamers have gotten to me. I take such a cocktail of assorted psychotropics that it’s perhaps natural I should ask myself every now and then if I’m overmedicated (my doctor doesn’t seem to think so) and whether I could do without any of the drugs. The sleeping pill is the only one that might be in that category.

But no. I don’t want to go back to the nights of distress, despair, and devastation. I don’t want to wake my husband up as I gasp for breath and need him to stroke my hair until I fall asleep. And I surely don’t want to go through those bad feelings all alone in the night while he works the third shift.

All in all, I think the sleeping pill is a good thing for me and that I shouldn’t try to give it up. I just wish I didn’t feel so ambivalent about it.

 

 

The Fire and the Window

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When Anthony Bourdain died by suicide and I told someone the news, he asked me, “Why?”

I was taken aback. “What do you mean, ‘why’?” I replied.

“You know,” he said. “Did he have money trouble? Break up with his girlfriend? Have some disease?”

That’s a common reaction to suicide and it’s uninformed. Real-life stressors can contribute to suicide, but they are almost never the whole story. People die by suicide when the pain of living seems greater than the pain of dying.

Gregory House, the misanthropic, genius title character of House, M.D., once said, “Living in misery sucks marginally less than dying in it.” People who kill themselves don’t believe that. They believe the opposite.

The best metaphor I ever heard for suicide was the plight of people in the World Trade Center’s upper floors on 9/11. There were the flames. There was the window. And that was the choice. Suicide happens when a person sees only two alternatives and both are equally horrible, or nearly so.

The bullied child does not take her own life because she was bullied. She was in pain, for a variety of reasons that included bullying. It was a factor, but it wasn’t the reason. She was hurt. She was isolated. She was depressed. She couldn’t believe that things would improve. She wanted the pain to stop. She believed she faced the choice between the fire and the window.

The politician who dies by suicide in the face of a major scandal does not kill himself because of the potential scandal. He dies because he sees his choices limited to shame, humiliation, despair, and ridicule. He believes that what happens to him will be as bad as dying. He is caught between what he sees as the fire and the window.

Mental illness can make it difficult to see that there are other choices. The distortions of thinking associated with serious mental illness can make us see only the fire and the window.

The one time that suicidal ideation got the better of me and I was close to making the choice, my thinking was just that twisted. I was faced with a choice that seemed to me would ruin someone I loved. I thought that I could not live with either choice. One was the fire and the other the window.

My thinking, of course, was severely distorted by my mental disorder. The thing that I thought might rain destruction on the other person was much smaller than I believed. There were ways out of the dilemma other than dropping a dime or killing myself. If we continue the metaphor, the fire was not that big, or that implacable, or that inevitable, but I couldn’t see that. In the end, I hung on long enough for my thinking to clear and for me to see other options.

I don’t actually know what was going on in the minds of the souls who were trapped in the Twin Towers. I don’t mean to lessen the horror of their deaths or wound their families by speaking of suicide this way. The reality of their choice is so far distant from the choices that other people who consider suicide face.

But that’s kind of the point. People who die by suicide don’t see any other way out. If they seem to be responding to what most people see as survivable hurts or solvable problems, people say they can’t understand how someone that rich, that successful, that beloved, that full of potential could have not seen that help was only a reach away.

The person who dies by suicide doesn’t see the hand reaching out. Only the fire and the window.

 

If you are considering suicide, call the National Suicide Hotline: 1-800-273-8255.

The Appropriate Committee

 

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When I was a teenager, my life was spent resenting the Appropriate Committee. I always ran afoul of them.

It seemed there was some nebulous group, invisibly judging us and deciding whether what we did, or wore, or how we acted was appropriate or not.

Part of the Appropriate Committee was, of course, the adult world. Teenagers were supposed to be polite and respectful and not talk or play music too loudly. To do otherwise would be inappropriate.

The social milieu was also part of the Appropriate Committee. How we monitored one another to make sure our pants weren’t too short, or that we didn’t wear ankle socks, or that we didn’t stay in the Girl Scouts past Brownies. The punishment was derision.

Of course being bipolar didn’t help. Both adult and junior versions of the Appropriate Committee took note of my mood swings – my loud, inappropriate laughter; my extreme, inappropriate crying; my extended, inappropriate isolation.

I tried to defy the Appropriate Committee. I laughed at them, thought they were stupid, and vowed not to let them run my life. They did anyway, of course. They were all-powerful and I had not yet gained the wherewithal not to care. It was like a pervasive, invasive form of bullying: Everything I did or said was wrong. The rules changed capriciously. I was punished with disapproval, mocking, and the wrong kind of laughter.

And they broke me. At times I tried desperately to fit in, to live up to expectations, to suppress my differences. At other times, when the effort became simply too much, I let my natural weirdness float to the surface and looked for the few other like-minded individuals that could tolerate that. Depression set in and, rarely, hypomania. I still dressed “wrong.” I still laughed at the wrong things, and too loudly. I still isolated and wept.

I thought that when I grew to adulthood, I would no longer be subject to the censure of the Appropriate Committee, Of course, that was completely delusional. I learned that the Appropriate Committee for Adults was a powerful force. It is particularly insidious in the business world, where it judges not just your appearance, but even seemingly minor matters such as where and how you eat lunch (with the “cool kids,” of course) and how you spend your breaks (cigarettes OK, crossword puzzles not). There’s still the problem of being laughed at in meetings and needing to go into the restroom to cry.

I finally realized that the Appropriate Committee exists in part to perpetuate stigma. So many of the behaviors of people with mental illness defy societal norms. It’s the Committee that insists we fit in, no matter what we’re feeling. It’s the reason that neurodivergent people are so reluctant to admit their differences in public and try their best to “play through the pain,” something that isn’t good for them, or for athletes either, really.

I’ve had enough of the Appropriate Committee over the years. Now that I’m properly diagnosed and medicated and relatively stable, I could undoubtedly fit in better than at any time previously in my life. But I dress how I like, even if it’s pajamas. I play my music as loud as I want and laugh or cry along with it if I feel like it. I embrace my weirdness, my differences, and seek out like-minded weird friends who are also living in defiance of the Committee.

Maybe the Appropriate Committee is needed for some places and times and people, like theater audiences or church services. Maybe. But for the mentally ill the Committee is hurtful, and stigmatizing, and unrealistic. We can strive to overcome our differences and sometimes we need to. But sometimes it’s better just to embrace weirdness, differentness, and our membership in the group of the neurodivergent.

And when I despair, I remind myself of songwriter Steve Goodman’s lyric: “I may not be normal, but nobody is.” And I let it blast.

The Golden Glow and the Spoons

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Hypomania is as insidious as it is enjoyable.

I remember when I quit my 9–5 office job to go freelance. I remember when I made the decision. I had gotten my first bad review, ever, shortly after disclosing my bipolar disorder to my new boss.

I remember driving around shortly thereafter, running errands in the middle of the day. I felt the warm, golden glow that goes with either happiness or hypomania. I could wake when I pleased and work when I pleased. I could run those errands when I wanted. I could take my mother to her doctor’s appointments whenever I needed to. I could make and go to my own appointments as necessary.

Best of all, I felt as though I had enough spoons to do all this. I was able to keep up with the work and the errands and the appointments and, hey, if I got tired I could take a nap in the middle of the day.

But.

Eventually the glow wore off and the spoons ran out. Hypomania dumped me back into the depression I was oh-so-familiar with. I had more work to do and less energy to do it. My mother’s problems increased and I had to take over her finances as well as my own. I was teetering on the edge of a major depression, and then I fell off that cliff.

Anymore I don’t trust hypomania. First of all, I can’t distinguish it from actual happiness, competence, or satisfaction. I always question its sincerity and watch out of the corner of my eye for the coming crash. In other words, when I’m happy I can’t even enjoy happiness without reservation.

One way I keep track of my hypomania is by being aware of the number of spoons I have. If I’m flying on a hypomanic cloud, I feel replete with spoons. It never occurs to me that I will run out. When I’m experiencing garden-variety happiness, I still suffer at some point from lack of spoons. No matter how many pleasing things are scheduled for the day, I know deep inside that I cannot simply dive into all that bounty. My joy is measured out, as the poet said, in coffee spoons or in this case metaphoric spoons which I always visualize as small white plastic ones.

Stability for me does not mean that I can ignore my supply of spoons, either. I may be on an even keel, able to do most of what I want, but inevitably the spoon depletion hits, sooner or later. There is simply no more that I can do, much as I want to. And if I force myself past that point, I will surely pay for it in exhaustion, irritability, or isolation.

Spoons, therefore, run my life. If I am too happy, I have to watch for incipient spoon depletion.  If I am level, I know that I must still keep track of the spoons I use. And if I am low, my spoons can disappear altogether, to the familiar point of not being able to get out of bed.

I think the trap of hypomania is the worst of all. On a high like that I can lose track of my spoons – even forget that they are necessary. Fortunately, I don’t get the full-blown version of mania. I fear I would squander spoons recklessly, leaving me a terrible absence of any.

Spoons are a useful way to explain the energy demands of chronic and/or mental illnesses. My husband and I speak spoonie shorthand. But I wish I could experience that golden glow, that haze of happiness, that feeling of floating, without having to keep one eye on the spoon-meter.

 

Bipolar Sex: Drought and Abundance

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Here’s something bipolar people talk about amongst themselves but not so much with the world outside: sex.

The two poles of bipolar, depression and mania, govern a person’s appetite for sex. A lot of other factors determine whether the sex will be any good, or good for the participants.

Of course the above is true for neurotypical people as well. Moods and emotions – things in the brain – have as much or more to do with sex than stuff in the body. Thinking about sex and wanting sex, for example, start in the brain and without them, nothing else is likely to happen anywhere else.

The depression side of bipolar sex is easy enough to map out. After all, some of the hallmarks of depression are numbness, inability to enjoy things that once gave pleasure, and a tendency to isolate. It’s hard to get your motor revving with all that going on.

Still, the depressed person may want to have sex, or at least want to want to. That’s the way it’s been with me. When I’m in a thoroughly depressed state, sex doesn’t even cross my mind. When I’m not quite as depressed, I think I might like to have sex but don’t have the energy for it. And when I’m relatively stable, there’s the meds.

It’s well known that medications for bipolar disorder can kill the sex drive and in men the ability to get or maintain an erection. Some drugs supposedly have less effect on sexuality, but I’ve never found the magic combination. Or the supposed sex-friendly drug has had side effects I can’t tolerate.

So if bipolar depression is largely a big zero for bipolar sex, how about mania?

Overactive sex drive combined with a lack of impulse control can lead to sexual excess. The tendency to minimize risk-taking behaviors means that some of that sex can be detrimental to one’s health, relationships, and self-esteem. Riding that wave is exhilarating, but then, inevitably, comes the crash and the need to pick up the pieces.

Full disclosure here: Since I have bipolar 2 and my hypomania tends to turn sideways and come out as anxiety, I don’t experience that manic sex high. On the whole, I think I am grateful for this. Sex has never been such an important part of my life that I would risk everything for it.

Once, though, I did experience what you might call a hypomanic sex drive. It smoldered for a long time, requited but unconsummated, until the right set of circumstances presented themselves. It was a restlessness, an obsessive thought, a longing for connection, rather than an ungovernable rush of need. It gave me, perhaps, a glimpse of what it might be like to be manic and sexually stimulated. But I’ll never really know.

I do know that I am glad I had the experience, whatever it was. I’m glad it was safe sex.  I’m glad it didn’t destroy relationships. But just to feel that desire again, even if only for a brief time, even with the anxiety it provoked – and there was lots – it was a kind of affirmation that my body and brain are still connected in some vital way.

Most of the time I limp along with only thoughts of sex too fleeting to act upon. And maybe this is not the best way to live, but I have made my peace with it. And once in a great while, every now and then, I still am reminded that I can have a sexual existence.

Even though I have bipolar.

Of course, as always, your mileage may vary.

What Kids Should Learn About Mental Health

The stigma and the misinformation surrounding mental illness are staggering.

How many adults believe that depression is “just being sad”? That the weather can be “bipolar”? That you can call yourself OCD because you’re a little too organized? That suicide threats are never acted on? That mentally ill people are dangerous? That prayer, or sunshine, or positive thinking will cure all mental disorders?

We can’t do much about educating and informing the adult population that all those beliefs are false. But we can avoid raising another generation that buys in to these misconceptions – if we start now with mental health education in schools.

Whenever someone proposes this idea, there are common objections. You want kindergartners to learn about schizophrenia. You’ll have impressionable kids thinking they have every disorder you teach about. Discussing suicide will give teens ideas.

Again, those are misconceptions. Mental health education in schools could look like this:

In kindergarten and grades 1-2, part of the health curriculum should be a unit about understanding emotions and how to deal with them. This is already being done when teachers tell kids to “use your words” or “use your indoor voice.” But more could be done in the area of teaching children how they can keep from letting anger, sadness, frustration, and other emotions cause them difficulties. Yes, this may involve techniques that resemble meditation and yes, these may be controversial, but the outcomes will be beneficial.

I also think that young children ought to be taught about autism, though it’s not strictly speaking a mental illness. They will certainly meet autistic children in their classes at this age. Helping them understand the condition at their age level will, one can hope, lead to more inclusion and less bullying of kids who are “different.”

Older elementary children can learn about mental illness in their science or health classes. This should be a unit that covers the basic facts: that mental illness is like physical illness in some ways, that treatment is available, that mental or emotional disorders will affect one in four Americans in their lifetimes, and that mentally ill persons are not generally dangerous.

Middle schoolers can be taught some more specifics: the names and symptoms of some of the most common disorders, the kinds of treatments available, famous people who have succeeded in spite of mental disorders and ordinary people who live fulfilling lives despite them. Speakers from local mental health centers or the school guidance counselor would be helpful.

The topics of self-harm and suicide should be brought up at the middle school level. It is sad but true that children in the middle school age range are affected by both – if not directly, by knowing a classmate who is. And suicide is the third leading cause of death for children ages 10-14. Learning the facts may help students who need help find it before it is too late.

In high school, the focus can shift to human psychology; more detail about serious psychological conditions; and the possibility of careers in mental health treatment, nursing, or advocacy. Topics of self-harm and suicide should be covered in greater detail, with discussions of how suicide affects the families and loved ones of those who die by suicide, how to recognize possible signs that a person is thinking about suicide or self-harm, and what does and doesn’t work when a person shows those signs.

The details of mental health education in schools still need to be worked out. These suggestions come from my experience as a person with bipolar disorder, who began showing symptoms while I was a child. Organizations such as NAMI (National Alliance on Mental Illness) and NIMH (National Institute of Mental Health) provide resources that can help in understanding the need for mental health education among school-aged children.

Understanding mental health is as important for schoolchildren as understanding physical health. Why should one get all the attention and the other virtually none? Mental health education that begins early can help children and their families in ways that will resonate far into the future.

Most adults have little to no understanding of the realities of mental illness. It doesn’t have to be the same for the next generation.

This is a post I published almost exactly a year ago on my other blog, janetcobur.wordpress.com. I thought I would share it here as well, and have more to say about it next week.

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