Bipolar 2 From Inside and Out

Posts tagged ‘my experiences’

Was My Family Dysfunctional?

Clockwise from left: my father, my sister, my mother, and me

Leo Tolstoy said, “All happy families are alike; each unhappy family is unhappy in its own way.” Nowadays, we don’t talk about happy and unhappy families. We talk about functional and dysfunctional ones.

If you ask, most people will say that all families are dysfunctional. They differ only in the degree of dysfunction and the ways that dysfunction presents.

But is that true? Is there really no such thing as a functional family?

First, we need to look at some definitions.

What Is a Dysfunctional Family?

According to certain stats, 70% to 80% of families are dysfunctional. But what does that mean?

Fortunately, the term “broken home” has been retired, and single-parent families are no longer considered automatically dysfunctional. In fact, a dysfunctional family can result in a separation or divorce that makes the remaining family structure much more functional.

In addition to dysfunctional families, we talk of “toxic” families, “traumatic” families, and “estranged” families. (There’s obviously considerable overlap.)

But are those the only kinds of dysfunctional families?

A 2024 article by Kaytee Gillis in Psychology Today says, “Having one or two unhealthy behaviors crop up occasionally is usually not cause for concern. Traumatic dysfunction involves patterns of behavior that are harmful and pervasive, such as emotional or physical abuse, neglect, or extreme manipulation that occurs over a long period of time. This type of dysfunction creates an environment of fear, instability, and ongoing emotional pain, leading to significant psychological scars and lasting trauma that likely impacts you today.”

In a 2023 article, also in Psychology Today, Gillis identified five different kinds of dysfunctional families.

• The family that believes they have no problems because they project them all onto other people.

• The family that worries about what others think of them and carefully controls appearances.

• The family with one “scapegoat” member who is blamed for any and all problems.

• The unpredictable family that changes based on traumas like mental illness, addiction, or abuse. (This is what most people think of when they consider dysfunctional families.)

• The family that faces challenges from extreme conditions such as generational poverty or violence.

Nidra Nittle, in VeryWellMind, lists three kinds of dysfunctional families:

• The emotionally unavailable family.

• The family of addicts and enablers.

• High-conflict and abusive families.

Soulaima Gourani, writing in Forbes, says “subtle issues such as the inability to give unconditional love, … and poor boundaries contribute to dysfunction. Regardless of what the cause is, the outcome is the same. An unhealthy emotional connection can lead to the breakdown of the family unit and residual shame.” She adds, “I believe strongly that the concept of family is up for discussion. We can define family for ourselves and break the cycle of dysfunction. How we do this depends on our resolve to make a different choice.” Many people these days are creating new family structures that they hope will be less dysfunctional than the ones they grew up in. “Chosen family” is edging out “blood kin” as a preferred family pattern.

Was My Family Dysfunctional?

I didn’t grow up in a ’50s television family, though my parents took the roles of breadwinner and homemaker. They never had loud arguments or violent behavior. We had an alcoholic uncle and a “bad girl” cousin, but neither of them lived with us, so we weren’t exposed to their behavior much. My parents weren’t very outgoing, but my father did have some friends in the neighborhood and at his work. He was part of the gun culture, but deeply law-abiding and a stickler for safety. My mother was quiet but creative, exchanging crochet patterns with friends around the world. She also had a strength that most people never noticed. And we had at least one “chosen” family member, a friend of mine whose parents were divorced and who became an acknowledged sister to me.

All of that says that we were pretty darned functional. I can’t identify us as any one of Gillis’s five types or Nittles’s three types of dysfunctional families. But there was mental illness in the family (mine, undiagnosed at the time), which no one had any idea how to cope with, and some devastating health problems that directly or indirectly affected us all (cancers and a heart attack). My sister and I are now estranged (by my choice), so that likely indicates some dysfunction somewhere. I’m not in touch with uncles, aunts, or cousins either, and have surrounded myself with people I have chosen to be close to.

Put all that together, and I’m probably the closest thing my family had to a dysfunctional member. The family structure seems to have been as functional as anyone’s ever is.

All in all, I’ll take it.

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mental health

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When Journaling Doesn’t Work

If there’s one thing people tell you to do when you have a mental health issue, it’s to start a journal. They may not call it that. They may say it’s a place to write affirmations, or things you’re grateful for, or aspirations. But what they really mean is a journal, a written record of what’s going on inside you.

But sometimes that doesn’t work. You may not be in touch with your inner feelings yet enough to know what your dreams mean or whether you need to explore your inner child’s trauma. It may simply be too soon.

Writing isn’t a bad idea, though. It just may be a mistake to call it a journal or to try to make it a way to explore your inner life. But there are other things you can do while you’re waiting until journaling is right for you.

One avenue you can try is other forms of writing. Don’t even think about your difficulties and how to solve them. You can get to that later, probably with the help of a therapist. For now, just write poetry. About anything. Your cat. The tree outside your window. The guy you just met at a party. Literally anything. Don’t try to be deep. Don’t try to write something meaningful, something for the ages.

Just put words on paper. Lord knows, they don’t have to rhyme. And don’t show it to anyone. The idea isn’t to impress anyone with your innate poetic talent. It’s just to get used to the idea of putting words on paper. Sure, it will feel weird at first (especially if you do try to make it rhyme). You don’t have to set any kind of goal like writing a poem every day or even every week. Just every once in a while, sit down at your computer (or, if you must, sit with a legal pad under a lilac bush) and write a poem. Or revise one you wrote the week before.

If you feel so inclined, try setting your poem to music. Strum that old guitar you haven’t dug out in months, or noodle around on GarageBand. Don’t make it a chore. Try it, just for the heck of it. Or you can decide to scrap the poems and just play around with music. There’s nothing that says you have to write poetry. What you’re doing doesn’t have to involve words at all.

Or, if none of that appeals to you, pick up a pencil and doodle, the way you do when you’re on infinity hold on the phone. Start with boxes and squiggles. If one of them starts to look like a pirate chest, go for it. See if your doodle turns into that, or something else. Draw a cartoon face. Then draw a setting for it. Is this your pirate? Is it a bartender? Is it an astronaut? Or take an empty candy wrapper and tape it to a sheet of paper. What can you make of it? Is it the body of a bird? Does it remind you of a ballet dancer’s costume? Does it begin to look like the tree outside your window? Just keep doodling.

The point of all this is not to create Great Art or to spur Great Revelations about your inner life. The point is simply to let yourself play—with words, with sounds, with sketches. Or pottery. Or katas. Just get used to the idea of letting something inside you come out. It doesn’t have to be important and meaningful. If it’s meant to be, that will come later.

I tried to start a journal once. It was pathetic. I recorded my daily activities, which at the time consisted largely of deciding whether to get out of bed that day. I recorded what I felt (depressed). Each page, each day, was the same. It was boring and no help at all. I was a dud at journaling.

Instead, I started this blog. In it, I was free to write about myself, but also about what I saw and heard in the world around me—what other people thought about mental illness and whether I agreed with them. Things I’d heard in the news and how the stories made me feel—outraged or comforted or confused.

It wasn’t journaling. I learned a lot from it, though (primarily that journaling wasn’t for me). No affirmations. No dream analysis. Over the years, though, it’s given structure to my week and a place to say things that aren’t necessarily profound. To ask questions and grope for answers.

Go thou and do likewise. Or go thou and do something else. The medium doesn’t matter.

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What Is Intimacy?

The first thing you probably think of when I say “intimacy” is “sex.” That’s natural. Most people do. Sex is a particular kind of intimacy, but it’s not the only one. Others can be just as intoxicating, fascinating, and compelling. They can be a great way to bond with another person and provide fulfillment.

You may think that treatment for mental illness will take intimacy away from you. I’m here to tell you that you can still have intimacy with another person. It may or may not be sexual intimacy, but it’s valuable all the same.

Intimacy is a bond between two people. While it can be caused by sexual attraction, we all know how quickly a sexual bond can fade or disintegrate. Sometimes, a couple can have another form of intimacy once sexual intimacy is no longer possible. And, of course, there are couples who can maintain sexual intimacy until quite late in life.

Another way you can bond in a kind of intimacy is through shared trauma. As the saying goes, shared pain is halved and shared joy is doubled. The trauma doesn’t have to be a natural disaster, though that can certainly bond people who show kindness to each other. Once, I was sitting next to a man at a concert when a song touched a deep nerve and made him dissolve in tears. I reached for him and held him until the song was over. That started a deep friendship that has lasted for decades.

I’ve also found that shared symptoms can lead to a kind of intimacy. If both of you find your legs twitch when you’re not paying strict attention to stopping them, if you’re taking the same medications or have the same adverse reactions to them, or if you’ve both been gaslighted, you can find yourself exclaiming, “Hey! You too!” It helps to know that you’re not alone in your pain.

Humor, especially dark humor, is another way of sharing intimacy. It’s that shared joy principle. One way that’s worked for me and others is to use quotations from funny movies or songs—Young Frankenstein, Monty Python and the Holy Grail, Buckaroo Banzai, and Weird Al Yankovic are among my go-tos. Puns. Bad jokes. A good, shared belly laugh is a powerful bonding experience. It can lead to endless conversations that reveal lots about another person.

Some couples who have explored these alternative kinds of intimacy find they can live without traditional sex or can find sexual fulfillment solo. Those are valid choices, too. Even people who have sex with a partner can use sex toys and other aids from time to time. They’re easily available on the internet, so you don’t even have to go to a potentially embarrassing sex shop.

Of course, you might point out that these kinds of intimacy require meeting people, and going out may be something that frightens you. Fortunately, technology provides answers. With telephones, computers, and the internet, you don’t have to be in the same room with another person to develop intimacy. You can even turn off your computer’s camera so your new friend won’t see you. I’ve corresponded with a kindred soul via old-fashioned snail mail. And it’s something you can work on with your therapist if non-sexual intimacy is your goal.

If sexual intimacy is what you want, however, you can start with these techniques and work up to the big event. Having a solid foundation for touch, foreplay, and sex will make the process go more smoothly. Leaping into a sexual relationship without exploring other kinds of intimacy can leave you open to disappointment, a mismatch of sexual styles, and a devastating ending. Taking your time and finding a partner who doesn’t pressure you for sex will help you achieve sexual fulfillment when you are truly ready for it.

Intimacy with sex? That’s another topic for another week.

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mental health

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Off My Meds, But Not by Choice

I’ve been off my meds for about a week now, and it’s really getting to me.

I didn’t go off them on purpose. It was an accident. I tried to get back on them as soon as I could. But I kept encountering roadblocks.

It happened like this. My husband and I flew down to Florida to pick up a car that his mother was giving us. We drove it home to Ohio, stopping at a nice hotel in northern Georgia. When we got home, I discovered that the bag I keep my pills in was gone.

Replacement Pills

Let me start by saying that yes, I am an idiot. I had simply taken the bag of pills and put it in our travel duffel. I know I should have one of those pill caddies so I could divide up my meds and take with me only as many as I need. But I didn’t, so when the bag disappeared, so did my entire supply for the month. I had to start replacing them.

My non-psychotropics were no problem. I simply went on my PCP’s patient portal, explained what happened, and requested new prescriptions. The doctor’s office sent them promptly to my pharmacy. I called the pharmacy to let them know what was going on. They sounded like it was no big deal. They did say that, as I was basically asking for a refill before it was time for one, my insurance company likely wouldn’t pick up the tab. That was fine. All my scripts were generics, and the pharmacy had a discount card that they applied to the costs, so it wasn’t a big financial hit. The next day, I had my physical medication needs restocked. No big hassle.

The psychotropics, not so much.

Hassles

We arrived home and discovered that the bag of prescriptions was missing late on Friday. I called the hotel we stayed at to ask whether the bag had been found. They said they would check with housekeeping the next morning. It actually took until Monday for them to determine that no, housekeeping denied all knowledge of the bag of pill bottles.

I called our pharmacy Saturday morning to find out what the process would be to refill them. I had a hunch it wouldn’t be as straightforward as the other prescriptions had been. I was right.

I would have to see my doctor to get new prescriptions ordered. They worked me in on Tuesday, the first day he was in the office. I was also told that I would need to make a police report. Two of my prescriptions were for controlled substances, an anti-anxiety med and a sleep aid. I naively thought those were the only two I’d have trouble refilling.

I tried to picture myself calling the police four states away, saying that I most likely left my medications in the hotel room, and could they please investigate. Maybe police departments are used to this kind of thing, but even if they do it all the time, I assumed that the wheels of justice would grind slowly, and they wouldn’t make it a priority. Not when it was likely a case of stupidity, not a crime.

I went to the doctor’s office on Tuesday. He listened to my story, agreed that I should have a pill caddy, and sent new prescriptions to the pharmacy over the computer. I saw him do it. I thought that would be the end of it.

Phone Tag

That was not the end of it. When I called the pharmacy to see when my meds would be ready, I was told that they couldn’t fill the prescriptions because it was too soon. I explained again about the missing bag of prescriptions and was told that I had to get new prescriptions and file a police report. I told them that I had seen the doctor just that morning and had watched him send the new prescriptions. And that the doctor had not told me I had to file a police report under these circumstances.

The pharmacy told me that the doctor had to verbally authorize filling the prescriptions early. Fine. I thought that the pharmacy would reach out to the doctor’s office, as they do when there are no refills on a prescription. But no. The doctor’s office would have to call them. By that time, the doctor’s office was closed, and Dr. G. wouldn’t be back in until Thursday.

Wednesday was spent alternately making calls to the pharmacy and the doctor’s office. The pharmacy said that speaking to the medical assistant would be good enough. But, of course, again, they didn’t mention that the office would have to call them. I spent the day trying to get the two entities to talk to each other. Each time I called the pharmacy, I spoke to a different person who had no notes on what had gone before and started all over about it being too early to refill and needing a police report. Each time I called the doctor’s office, I was told they had spoken to the pharmacy or had just left for the day.

Thursday, I had been unmedicated for a week. I wasn’t sleeping more than three hours a night, and my anxiety was working overtime. I was mentally dizzy from all the runarounds and explanations. I couldn’t remember whom I had talked to last or what I’d told them. I didn’t have enough executive function to write everything down, with a timeline and names. My voice as I spoke to the various parties was rising in pitch and lowering in coherence.

At last, I called late Thursday afternoon, and my prescriptions were ready. But only the controlled substances. The mood stabilizer and SSRI hadn’t been filled. It was too soon, I was told. Oh, they were new prescriptions? Had I filed a police report?

I’m going online right now and ordering a pill caddy.

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mental health

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Was My Ex a Narcissist? Maybe Not

I know I’ve said my ex was a narcissist. His pleasures and interests were the only ones that counted. If I said that I liked something, like a certain style of music or kind of food, he said, “Eat shit. Fifty million flies can’t be wrong.” He talked about how important his honor was. He invented something that I would collect, just so he could pre-select gifts for every occasion. To quote the song “My Baby Thinks He’s a Train,” “He dragged me ’round just like an old caboose.”

But was he a true narcissist or simply a self-centered asshole?

Well, he was never diagnosed as a narcissist. The only time he saw a therapist was when we went for couples counseling. He aligned himself with the therapist. He made it seem like I was the crazy one, and he was only there to help me because he loved me so much. (That was gaslighting, not narcissism.)

And that’s an important point. Only a psychiatrist can diagnose a true narcissist: someone who has narcissistic personality disorder.

What’s Narcissistic Personality Disorder?

The Diagnostic and Statistical Manual-V (DSM) has a list of criteria that add up to Narcissistic Personality Disorder. There may be changes in the DSM-VI, currently being written, but for now, in order to be diagnosed, a person has to exhibit:

A pervasive pattern of grandiosity, need for admiration, and lack of empathy, as well as five or more of the following behaviors or traits:

grandiose sense of accomplishment

My ex: Check. Always had to be the smartest person in the room, though he never completed his doctorate. Thought his middle name, Albert, was a reference to Einstein.

preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love

My ex: Probably not. Content with a public service government job; bounced from relationship to relationship.

believes that he or she is “special” and unique and can only be understood by or should associate with other special or high-status people (or institutions)

My ex: Pretty much. Only associated with neighbors who could do something for him; felt others had lower status.

requires excessive admiration

My ex: Check. Wanted to be known as the smartest, funniest, most talented, skillful, and well-loved.

a sense of entitlement

My ex: Not sure. Regarding sex, intimacy, and attention, yes. In other ways, not so much.

interpersonally exploitative

My ex: Big check. Put people in “can’t-win” situations.

unwilling to recognize or identify with the feelings and needs of others

My ex: Check. See above.

envious of others or believes that others are envious of him

My ex: Not really, or didn’t say so.

arrogant, haughty behaviors and attitudes

My ex: Check. Corrected others’ pronunciation; got to define “quality” for others.

Explanations

By those criteria, my ex might qualify as being among the 1% or 2% of people who have a Narcissistic Personality Disorder—if diagnosed as such by a psychiatrist, not through the lens of only one person—me—who is not truly qualified to assess him. I can’t truly say that he had the Narcissistic Personality Disorder, only that he exhibited some narcissistic traits when I was with him.

There’s a possibility that we were simply incompatible, or that I exhibited unhealthy traits too, or that he was fine in relationships with others, or that he was simply a selfish asshole and nothing worse. If you were to believe social media, 30% to 40% of bad relationships were caused by a narcissistic partner.

There are different degrees of bad behavior. A person can be a gaslighter without being a clinical narcissist. They can be abusive. They can be cold and unforgiving. They can behave so badly that you think of them as abusive or narcissistic. None of those are good things. But calling someone a narcissist is giving them what is essentially a meaningless label, or at least one that says, “I suffered when I was with them.”

So, I did suffer. My ex treated me and others badly. But as for his being a real-life Narcissist, the jury remains out.

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mental health

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No Longer Trapped

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

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

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

Logistics Are Difficult

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

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

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

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

Psychological Effects

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

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

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

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

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mental health

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Self-Care Definitions

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

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

A Better Definition

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

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

The Self-Care Box

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

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

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

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

Today’s Self-Care

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

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

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mental health

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Ambient Abuse: A Sigh and a Glare

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

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

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

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

What Is Ambient Abuse?

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

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

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

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

My Experience With Ambient Abuse

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

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

Breaking Free

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

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

Then we both snort and laugh.

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A Bipolar Breakup

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

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

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

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

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

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

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

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

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

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

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

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

Give it time. You will get over that relationship.

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Lifelong Meds?

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

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

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

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

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

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

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

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

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

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