Bipolar 2 From Inside and Out

Posts tagged ‘my experiences’

Self-Care and the Power of Routine

When a lot of people hear the word “routine,” they think “rut.” My opinion, though, is that routine and rut are completely different. A rut is what you get into when you have nothing else in your life but work and chores, while routine is something that provides structure to your day. Of course, a routine can become a rut, if it’s not flexible enough to make room for variety somewhere.

What I think routines are particularly good for is self-care.

Let’s consider how you develop a routine. The business concept of “time-blocking” will help.

Time-blocking is a method of scheduling that relies on dividing your day into blocks of time (duh!) for each of your tasks or activities. A businessperson might have time blocks reserved for “planning meeting,” “business lunch,” and “create spreadsheet.” They estimate how long each will take and adjust the time blocks accordingly. If their time estimates are off, they revise for the next day or week.

One of the principles of time blocking is grouping similar tasks together. For example, one might have a single time block for making phone calls or answering emails. Another one is to leave some blocks empty so they can be used for tasks that you may not have completed or blocks that had to be shifted because of having to put out fires.

You can do time-blocking on a daily or weekly paper calendar, but business books recommend using scheduling software. I like the idea of using an erasable board that you can put up on your refrigerator or in another convenient place.

How does this relate to self-care? Well, it’s a good idea to make self-care part of your routine, and time-blocking is one way to develop that routine.

The first things to schedule are good habits that help you manage your disorder. For me, these are medication, food, and sleep. I take my meds as soon as I wake up and on my way to bed. I don’t consider that a time block, more like a habit, something to check off on a mental list.

I usually wake around 7:00, unless I have a work assignment that needs to be turned in early in the morning. I usually go to bed around 9:00. I need lots of sleep.

I have a time block for lunch at 12:00 and for dinner at 6:30. I make sure to have food on hand that is easy to prepare for lunch – cheese and crackers, soup, applesauce, and so on. My husband makes dinner because he wants to make sure that I eat at least one complete meal every day.

The other important time block for me to schedule is work. I’m a gig worker, so my assignments can vary. Generally, though, I work until about 11:00 in the morning and till 4:00 or 5:00 in the afternoon. I try to make working a habit, too. It keeps me from falling too far behind if I have a day when I’m simply not able to face getting out of bed and working.

You may have noticed that there are gaps in my schedule of time blocks. These are when I fit in self-care. In the morning, I have time for checking my email and Facebook. Why are these self-care? They’re the ways I keep in touch with friends and acquaintances – the outside world in general.

In the afternoon, between work and dinner, I watch some TV, usually cooking shows, which I find comforting. After dinner, I have time with my husband to see a movie or binge-watch a favorite series. When I take my meds and go to bed, I read for about half an hour. All these are part of my self-care. A person needs to set aside time for relaxation, which is a vital part of self-care.

Sometimes, I have to set aside a time block for something else. If I have to go out somewhere, I usually schedule an hour before I have to leave. It sometimes takes me that long to shower, dress, put my hair up, and make sure I have everything I need in my purse. I know that, so that’s why I leave an hour for it. Then there’s time for whatever errand it is, or maybe lunch out on my husband’s day off.

That’s my daily schedule of time blocks. I also have a weekly set of time blocks. I try to have a first draft of my blogs done on Thursday, finish them and tag them by Friday, proofread on Saturday, and post on Sunday. This is something that’s not quite work, because I don’t get paid for it. It’s something I do for myself and I get satisfaction from it, so I think of it as a self-care activity.

I also use my Google calendar to keep track of things that need to be done monthly – bills, recycling, doctor appointments for me and my husband, deadlines for my gig work, and so on. That’s self-care too, because I suffer an unhealthy amount of stress if our finances get out of control. Reducing stress is part of keeping me on a steady course. I could use the weekly or daily functions, but those are tasks I’m used to after getting into the habit for so long.

I prefer having these times and tasks in a reasonably consistent schedule, with some room for adjustments. Routine helps me get done what I need to do and enables me to schedule self-care too, rather than leaving it to last.

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What’s Really Scary

It’s very nearly Halloween and there are lots of scary things out there, from costumes to movies. But here’s what I find scary.

My number one fear is the return of my bipolar symptoms, especially the depression. I’ve been mostly stable for years now, with only occasional and relatively mild symptoms when I relapse. But I still remember what it was like and I don’t want to go back there. The misery and the hopelessness. The numbness and the pain. The lack of joy, or contentment or, for that matter, even blankness.

Hypomania isn’t as scary, though I know it can and does recur from time to time. I don’t have a history of extreme symptoms and, with my husband’s help, I’m able to navigate the ones that do occur.

I can handle it if I get mild “breakthrough” symptoms when I encounter triggers. I have coping mechanisms in place, including simply waiting for them to pass, because I know they will. That trust in my resiliency – and my medications – has grown over the years.

Still, there’s always the thought in the back of my mind that the efficacy of my meds could wane. I could crash again. There’s no guarantee.

Then there’s the fear that I could develop a batch of new symptoms, triggered by God only knows what. I know that some people with bipolar disorder have hallucinations, hearing or seeing things that aren’t there. One friend of mine has heard voices for years, and another one is visited at times by an imaginary animal. (He doesn’t mind it; he says it’s always been pleasant.) Again, not likely, but then again, my brain has already been proven to be glitchy.

Of course, I do find other things scary. I am terrified of bees, wasps, ticks – anything that impinges on my dermal boundaries. I’ve been stung once and suffered no symptoms beyond the usual, but it did nothing to allay my fears. In fact, I took beekeeping in college, hoping that I would get over the fear. That didn’t work either. I still freeze, shake, scream, cover my head, or run. It’s a phobia, though not a crippling one. It doesn’t bother me enough to try eradicating it via therapy. Besides, if the beekeeping class didn’t help with desensitization, I’m not sure what would.

But there are less personal fears that I have too.

Some are societal problems. Stigma regarding serious mental illness still exists. And although people increasingly seem to be concerned about “mental health,” it turns out what they really mean is usually substance abuse or crime. Initiatives and funding tend to focus on those problems, sometimes to the exclusion of actual brain illnesses – except maybe schizophrenia, and then only as it relates to violence or homelessness. Of course, those are real problems, but there are a lot more people who need to be helped that aren’t getting attention, funding, or treatment.

Speaking of treatment, that’s another subject that’s frightening. It just isn’t available in many locations. I don’t know what the situation is regarding available beds in my geographic area, but I doubt there are many, given national trends and the complete lack of an inpatient ward at the hospital nearest me. If I did experience more extreme symptoms, I’m not altogether sure I could get good, prompt treatment.

Finding a psychiatrist or a therapist can also be difficult, bordering on impossible. When Dr. R., my longtime psychiatrist, retired, I tried to find a new one. I called the doctors he recommended, but none had openings. I turned to my primary care physician, who at least agreed to continue my psychotropics until I could find a psychiatrist. Six months later, I got in to see someone. And that was only for med checks. I had slightly better luck finding a therapist, but it was by no stretch of the imagination a breeze. Fortunately, both have managed to avoid retiring.

Call me a pessimist (okay, I’m a pessimist), but I also fear that things aren’t going to get much better anytime soon.

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On My Own

Earlier this month, my husband went away for 11 days to visit his 96-year-old mother, leaving me at home to fend for myself. I didn’t object to his going (though that hasn’t always been the case on other occasions). But it left us both concerned about how I was going to manage without him for nearly two weeks.

My husband helps me with most of my self-care needs. I guess I shouldn’t even call it self-care because he does so much of it. He makes sure I eat regularly, shops for food, and usually prepares dinner. He recognizes when I’m overwhelmed and gives me a hug. He helps me get ready if I have to go out. He does most of the physical chores. (I do the ones involving a computer, like correspondence, bill-paying, and scheduling appointments.) He calls me twice a day to make sure I haven’t fallen and been unable to get up. If I don’t answer the phone, he rushes home on his break to help me. I really don’t know what I would do without him.

For 11 days, though, I was going to have to. We hadn’t been apart this long for years.

Since one of my major self-care problems is forgetting to eat or not having the energy to make myself something to eat, he stocked up with all the things I like that were easy to fix and eat: juice, cola, ginger ale, yogurt, cans of soup, whole wheat bread, bologna and salami, assorted kinds of cheese, applesauce, and those little frozen meals for useless people like me. There were muffins and frozen waffles for breakfast, peanut butter and mac-n-cheese and spaghetti for lunch and dinner, and even jello and pudding for dessert. Everything that needed heating was microwaveable.

I often eat in my study, where there is a little tray table, so we devised a strategy for getting to and from the refrigerators. The time when I trip and fall most often is when I’m carrying several items and lose my balance. He came up with the idea that I should carry my food items in a plastic grocery bag to and from my room. We have hundreds of those bags. And it worked. I didn’t fall once. I don’t know why we didn’t think of that before.

He still called me every day, though of course there was nothing he could do for me if I fell. In fact, he called me much more often than twice a day, just to talk. We found the thing we miss most when we’re away from each other is simply shared conversation.

I developed a little routine to see me through the days. In the morning, I would have breakfast and watch a cooking show till I was awake and alert enough to start my day. Then I would do my work in the mid-morning until lunch. After lunch, more writing. After dinner, music or TV, or more work, if I had an especially pressing assignment. Go to bed early. Lather, rinse, repeat. Repetitive, certainly, but it seemed to work.

So, what did I learn from this exercise? Well, first of all, I found out that 11 days on my own is a doable thing – if we anticipate difficulties and prep for them. That I am able to continue my daily rhythms and keep up with my work, eating, and sleeping. That I experienced no recurrence of my bipolar symptoms even though my usual environment had changed. (I had been worried about depression or anxiety setting in.) That the loss of my husband’s presence wasn’t crippling. That we managed to retain our important connection despite the physical distance between us.

That photo with this post isn’t entirely accurate, though. I didn’t meet my own needs completely on my own. My continuing self-care still required my husband’s help. But once the systems were in place, I managed. On my own.

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Three Days in the Life

What’s it like to have bipolar type 2? Here’s a look at three typical days.

It’s a day when I’m depressed. I wake up late and try to decide whether to get out of bed. I do so in order to take my meds, since I have to go to the bathroom anyway. If I have anticipated this depression, I will have left a box of Cocoa Puffs by my bedside, and these constitute my breakfast.

If I stay in bed all day, I am bored, because I can’t even focus enough to read. Everything I try to read means nothing to me. If I get up, I spend a large part of the day on the sofa, watching horrible reality shows that remind me that there are other people with crappy lives too. I skip lunch. I forget that I have an iPod with thousands of songs on it. I skip therapy appointments because I’m unable to get up and dressed and drive there. I feel numb and useless and pathetic. My brain reinforces this belief.

In the evening, I cry. I weep. I sob. Snot runs from my nose. I have circling thoughts about every stupid, embarrassing thing I’ve ever done. I try to wait till my husband’s asleep so he won’t hear me crying. I wake in the middle of the night, still crying.

I have anxiety attacks too, particularly when I’m in bed at night. I wake gasping. My husband holds me and strokes my hair until I fall asleep again. It’s really all he can do for me.

My psychiatrist and I keep trying different meds, but none of them does more than take the edge off a little. I still can’t function.

There is nothing I can do to change any of this. I can’t cheer up. I can’t even see a time when I won’t feel this way. This goes on every day for months. For years, even. I’d hope for an end to this, but I have given up on hope.

______________________________________________________

It’s a day when I’m hypomanic. I wake up early, not exactly refreshed, but with a more-than-usual alertness. I take my meds, then go downstairs and have a muffin and a container of yogurt for breakfast.

I go to my computer and start writing. I may have an assignment – typing or ghostwriting – or I may just work on new blog posts. The momentum of writing stays with me and presses me to keep going. I write lots, but badly. Maybe I forge ahead and write another blog post or volunteer for more typing. I forget that I need lunch.

I jump around from project to project. I scroll and scroll through Facebook. I check my email every few minutes. I go to clothing websites and order underwear and pajamas and blouses. I look at jewelry, too. I check my bank account at least four times.

I don’t read, because nothing holds my attention. I watch competition shows because of the excitement. I try to listen to music, but I can’t finish one song without flipping to another.

I may notice that I’m hypomanic and try to control it. This goes on for a week or so. I hope it ends soon.

______________________________________________________________

It’s a day when I’m stable. I wake up after nine hours of sleep and take my meds. I have a bowl of oatmeal and a cup of tea for breakfast. I check my calendar and see what I have scheduled for the next few days, such as an appointment with my therapist or finishing my writing or typing assignment. I have peanut butter and fruit for lunch.

I do my work. I reread what I wrote when I was hypomanic and immediately start revising it – if I haven’t already submitted it. I take on new assignments and try to space them out so they’re not overwhelming. Sometimes I even succeed. I keep a calendar on my computer with dates of appointments for both me and my husband, when assignments are due and when bills need to be paid, and which week is recycling week.

I meet with my therapist once a month via video chat and see my psychiatrist four times a year for medication updates. The only time I miss one of those is when my car is at the mechanic.

I’m very close to “normal.” I hope this goes on forever.

This post first appeared on The Mighty.

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Murder and Delusions of Grandeur

Sometimes when I’m hypomanic, I write. I think that my writing is terrific. This does not always prove to be the case.

I wrote a murder mystery for literally years on and off. I put heart, soul, and sweat into it. I kept revising. I had a bulletin board with index cards of plot points that I moved around, trying to find the best sequence and flow. At last, one day I declared it finished.

I sent a query and a sample to over 100 agents and publishers. I waited. I kept a list of everyone I contacted about my novel, and I marked them off the list when they rejected me. None of them bit except the you-pay-us types that I had accidentally included and scorned. My prospect list was long, so this went on for months.

No doubt I was hypomanic when I decided the novel was done, and when I sent those queries. I wasn’t even deflated when I started getting rejections back. Out of 100 queries, I thought, surely there would be some takers. Maybe there would even be a bidding war for the publishing rights. I started doing research for the sequel and even started writing it.

As I waited, I basked in thoughts of success. I would be a guest at mystery conventions. I would do a book tour. I even imagined that I would receive the Edgar Award (mystery’s Oscar) for Best First Novel. I pictured myself receiving the email telling me that I was nominated and the phone call informing me that I had won.

Of course, I eventually came down when one of the rejections actually told me why my manuscript was being rejected and what was wrong with it. Faced with that reality, I had to admit that I had deluded myself. I had needed to rework the novel a lot more before submitting it. I had needed to workshop it with fellow writers, preferably those who knew something about mysteries. (I had sent the first few chapters to some volunteer beta readers, but they had made comments only on small details, not the structure, pacing, or characters.) I realized at last that I had submitted a manuscript that had a great prologue, but that everything after that needed serious work. Despite the time and effort I had put into it, it just wasn’t good enough. And that was the reality.

That was the longest spell of hypomania I’ve ever had – about a year. Of course, I was doing other things while I wrote and while I waited. I had some depression and some mixed states, but not about my mystery novel. I was exhilarated with that.

What I had were delusions of grandeur. I imagined the success without putting in enough work to achieve it. Despite the evidence of all the rejections, I persisted in believing that I had produced something wonderful and worthy. I anticipated plaudits and acknowledgment of my writing prowess and remarkable achievement. My hypomania was giving me messages that I was great, just as my depression had always given me messages that I was nothing. And I was deluded. I believed the hypomanic messages.

I have abandoned that manuscript and taken up other projects. I have also abandoned my research and writing for a sequel. I still have problems recognizing the actual merits of my writing, or lack thereof. I try to keep my expectations in check. I have some successes and some failures, though none nearly as monumental as the mystery. I live with my limitations instead of flying with my fantasies. Have I lowered my horizons? Well, yes. But I like to think that now, at least most of the time, I view the horizon where it really is.

I did love the exuberant feelings that I experienced. They gave my life a sense of meaning. If I learned anything from the experience, it was that I couldn’t, or at least shouldn’t, pin my sense of personal worth on something that isn’t real.

Of course, when I’m in the grip of hypomania, it’s hard to realize that.

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Body and Brain: Self-Image

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

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

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

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

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

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

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

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

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

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

Image by fizkes

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

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

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

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

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

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

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

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

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

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

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

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

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What If My Symptoms Come Back?

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

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

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

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

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

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

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

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

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

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Baby Steps Toward Healing

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

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

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

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

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

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

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

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

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

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

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Grief and Depression

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

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

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

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

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

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

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

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

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

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

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

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