Bipolar 2 From Inside and Out

Posts tagged ‘psychotherapy’

Do I Have PTSD?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

 

The Biggest Gaslighter

The subject of gaslighting is big these days. Everyone from your ex to the president is called a gaslighter. But what is gaslighting, really, and who is the biggest gaslighter of them all?

I’ve written quite a bit about gaslighting and here are the basics: Gaslighting is a form of emotional abuse. The gaslighter denies the other person’s perception of reality. The gaslighter tries (and often succeeds) in making the other person feel that she or he is crazy. Gaslighting is very difficult to escape from. Healing from the effects of gaslighting can take a long time, even years.

By those standards, I maintain that bipolar disorder, or maybe mental illness in general, is the biggest gaslighter of all. Think about it.

Bipolar disorder is basically your own mind inflicting emotional abuse on itself. It denies your reality and substitutes its own. It makes you think you are “crazy.” It is very difficult to escape from. And healing from it can take years.

First, let’s consider bipolar disorder as emotional self-abuse. Bipolar disorder uses your own brain to make you miserable. It takes control of your emotions and often your behaviors, and uses them in a destructive manner. Emotional abuse inflicts a conditional called “learned helplessness” on a person. The abuser turns positive and loving just often enough to keep the victim hooked – to keep the victim believing that the abuse is really his or her own fault. Bipolar disorder can relent just enough to let you think you are over it or gives you enough euphoria to make you think that your life is just dandy. These are lies, of course.

That’s the other thing that bipolar disorder does – tells you lies. Bipolar depression tells you that you are worthless, hopeless, and pathetic; that nothing you do is right; and that nothing you can do can change that. It’s a big suckhole for all your emotions, but especially good feelings. And those are lies. You are not worthless. You do many things well. You can escape depression’s clutches. Depression – your brain – tries to substitute an alternate reality for your own.

Bipolar mania lies too. It tells you that you are delighted and delightful, able to accomplish anything and indulge in any behavior without consequence. It lifts you up to a realm of unreality. Again, this is your brain telling you lies, ones that can adversely affect your health, your relationships, your finances, and more. And these lies you want to believe, because they are so seductive and at first feel so good.

These lies are denials of reality. No person is as worthless as depression makes them feel. No one is as invincible as mania says you are. Taking these lies seriously can cause profound damage.

And make no mistake, bipolar disorder makes you think you’re crazy, or at least ask yourself if you are. The out-of-control emotions, the out-of-control behavior, the mood swings, the despair, the euphoria feel crazy. You know your emotions aren’t under your own control and you don’t know what to do about it.

But just as there is healing from gaslighting, there is healing from bipolar disorder. The first thing to do in either case is to remove yourself from the situation. For gaslighting, that can mean breaking up with a partner or even moving away. Breaking up with bipolar disorder is even harder. It likely means starting medication and therapy.

With gaslighting, there can be a tendency to go back, to think that it really wasn’t all that bad. And there were undoubtedly things that drew you to the gaslighter in the first place, plus the intermittent reinforcement of loving apologies that make you deny your own perceptions of reality. And with bipolar disorder, the work of healing is so difficult that you may want to stop doing it – skip your therapist appointments, stop taking your meds, retreat to your emotional cycles, which at least are familiar.

But both gaslighting and bipolar disorder don’t have to steal your entire life. You can get away from the gaslighter. You can find healing from bipolar disorder. At the very least, you can improve your life and not have to ask yourself all the time: Is this real? Am I crazy? Getting treatment for bipolar disorder can break the hold it has on your life, disrupt the cycles that have you feeling perpetually out of balance.

But there’s the big difference between bipolar and gaslighting. You have to run away from gaslighting; you can’t change it. You can’t run away from bipolar disorder.  You have to face it and do the work to find remission and healing.

Growing May Take a While

I saw a meme the other day that said, “Grow through what you go through.” I thought to myself, “This is going to take a while.”

Now, I’m not saying that the meme promotes a bad idea. I just mean that it’s not as easy as the meme makes it sound. Memes are like that. They encapsulate a difficult and painful process into a succinct platitude that never captures the reality of what it purports to express.

It is certainly possible to grow because of bad experiences that you have gone through, and I have surely done this. But it hasn’t been quick or easy. Not that it is for anyone, but especially not for people with serious mental illnesses.

Bipolar disorder, and bipolar depression in particular, often leads one to recall and obsess about the very things one would most like to forget. (Of course, this happens with unipolar depression, too.) It’s like having a recorder in your head that replays the most painful, embarrassing, humiliating, or devastating events in your life. And there is no “off” button or even a “pause.”

Getting through something is not the same as getting over something. And growing through something is something else again. It takes as long as it takes. There is no way to rush it or to speed it up.

Take grief, to choose an example that most people with and without mental disorders are familiar with. I saw a TV show once in which various characters were concerned that the hero had not “gotten over” the death of a friend as quickly as they thought he should. I remember thinking, “That’s stupid. There’s no arbitrary limit on how long a person should grieve.” I know that in days past, a mourning period of a year was customary, with restrictions on dress and activities. That’s stupid too. It may take a few months or a year or the rest of your life, depending on how close you were to the deceased and the circumstances of her or his death.

Deaths don’t have to be physical, either. The death of a relationship can be just as soul-searing, as traumatic, as a literal death. It’s still a loss and one that you may have put your whole heart and soul into.

Of course, it’s great if you can grow through the experience. It’s possible to acquire a new depth of spirit when you go through something traumatic. You can emerge stronger and more resilient and more compassionate because of the experience. I think that’s what the meme was talking about.

But if the trauma – the death or separation or other experience – is fraught with pain as well as grief, then growing through it can be even harder and take even longer. A son whose abusive mother dies has feelings that can hardly be expressed, a jumble of emotions that’s almost impossible to articulate, much less grow through. The end of a relationship with a gaslighter may evoke relief as well as grief, conflicting emotions that can impede growth. These and other situations can call up memories and feelings that one wants to escape, not dwell on. But processing them seems perhaps the only way of growing through them.

That process cannot be rushed. It may take years of bad dreams and flashbacks – at least it did for me – as well, perhaps, as a period of therapy that, like grief, takes as long as it takes to make progress in growing through whatever happened. From outside the situation, it may seem like the person is wallowing in the pain or grief. But on the inside, the process of growing may be occurring at a rate that you can’t see or understand.

In other words, if a person has been through a trauma, don’t expect him or her to “get over it” on what you think is a proper timescale. Some plants, like dandelions, grow incredibly rapidly. Others, like oaks, grow incredibly slowly. For each, it takes as long as it takes.

 

Men, Women, and Mental Health

My husband is no stranger to situational depression. He experienced it when his father died, when a beloved pet passed unexpectedly, and when his job turned suddenly more stressful and meaningless.

But he didn’t understand clinical, chronic depression. “What would it be like if those feelings lasted for months at a time, or even years?” I asked. He said he couldn’t even picture it. “That’s the way my life is,” I explained. Then he lost his job, and after a brief period of relief from the stress, he finally experienced depression that lasted more than two weeks – two years, in fact, during which he was unable to work.

He did not seek help for it until his best friend and I both proactively encouraged (i.e., nagged) him to do something about it. He’s been on an SSRI ever since and has occasionally seen a psychologist.

Lately, there has been a movement to educate men about mental illness and mental health. Primary among its goals is to help men understand that mental illness is a thing that can affect them and that there is no shame in asking for help.

Certainly, the statistics bear out that the majority of mental health consumers are women. Psychology Today reports: “Research suggests that women are about 40% more likely than men to develop depression. They’re twice as likely to develop PTSD, with about 10% of women developing the condition after a traumatic event, compared to just 4% of men. It’s easy to write off this epidemic of mental illness among women as the result of hormonal issues and genetic gender differences, or even to argue that women are simply more ’emotional’ than men. The truth, though, is that psychiatrists aren’t really sure why mental illness is more common among women.” Perhaps the answer is that seeking treatment for mental illness is more common in women.

Prevention magazine says that there are four mental health conditions that affect women more than men: depression, anxiety, PTSD, and eating disorders. That PTSD is twice as common in women may surprise you, though the stats about eating disorders are not likely to. The fact is that, although few women experience the traumas that soldiers do, they are much more likely to experience other sorts of trauma, such as rape, which can also lead to PTSD.

But men experience societal and psychological barriers to getting help when they need it. Among the excuses you hear are these:

  • I don’t really need help.
  • I can handle this myself.
  • I don’t want to appear weak.
  • I might lose my job if anyone finds out.

In other words, a lot of bullshit that boils down to “I’m a man and mental illness is not manly. Asking for help is not manly. Talking about emotional problems is not manly. Taking medication for a personal problem is not manly. Not being able to deal with my problems, especially emotional problems, is not manly. Therefore I have no mental problems and don’t need treatment for them because I’m a man.”

Or, looked at another way, the campaigns against stigma around mental illness have been less than effective for most men. Now the attention to that problem, which is surely needed, is beginning to be heard and, one hopes, acted upon.

Still, it’s important to remember that mental illness is not just a men’s problem or a women’s problem. It is a human problem, affecting both genders (and all ages and races) if not equally, then without discriminating.

It is important to get men the mental and emotional help they need, in a timelier and more comprehensive fashion.  I would have liked to see my husband be willing to recognize when he needed to get help and to get it without being pushed. But it would be wrong to push the needs of women aside to accomplish this. This is a societal problem, and while right now spreading the word to men is particularly important, our goal should be to make sure that all people are aware of the prevalence of mental illness, the fact that it can happen to them, and that there are places to get help. That message, at least, is not gender-specific.

Big Box Mental Health

photo by rawpixel.com from Pexels

According to an article published on the blogsite She Knows, “a Boston-based company that manages mental health care for 40 million people, has opened a small clinic in a Walmart location in Carrollton, Texas, and has plans to expand the program in other retail locations throughout the country.”

And I don’t know whether to vomit or applaud.

Walmart’s ubiquity is one point in its favor. They’re everywhere. And for some people, whether they love or despise Walmart, it’s the only choice they have for groceries, household goods, or much of anything else. Those areas are also likely to be underserved by the mental health system, such as it is.

And sparse as the options offered by the Walmart walk-in clinics is – treatment for anxiety, depression, grief, relationship issues, and stress management – it’s more than a lot of people have access to now. The trial site is said to be staffed with one licensed clinical social worker, has a sliding fee scale for those with no insurance, and will soon be approved for Medicaid reimbursement (it is hoped). There will even be remote Skype therapy services if necessary.

All that is good, as far as it goes. But does it go far enough? Will people be able to get more than a pat on the head and a pep talk as they do their weekly or monthly shopping? How will the walk-in clinic handle referrals for people with serious mental illness or a need for psychotropic medication, something that clinical social workers can’t provide? How many people can get help from a single professional? How good is internet therapy? And what percentage of Walmart shoppers have access to the internet?

The walk-in clinics are touted as reducing stigma around mental health issues. After all, the thought is, getting your mental health services at Walmart will become as natural as getting a haircut or an eye exam there. Well, maybe. On the other hand, how many people are willing to have their friends and neighbors see them publically, sitting in the waiting room or ducking surreptitiously through the door? It seems to me it might perpetuate stigma, rather than lessening it.

Besides, Walmart is hardly a bastion of high-quality goods and services. Will the mental health services be second-rate as well? It could be that even second-rate care is better than no care at all. But it’s surely not enough to deal with issues that require long-term therapy with actual treatment plans; scheduled repeat visits; building a relationship with a particular therapist; access to medications; and all the other aspects of more effective treatment, especially considering complicated disorders like bipolar, OCD, or anorexia.

I fully admit that I hate Walmart – the way they have driven out local Mom and Pop stores, for example, and the way they treat their employees. But I have many choices of where to shop near where I live, and access to both therapists and psychiatrists, and insurance that covers my appointments and medications. If I weren’t looking through the lens of privilege, I might see things a lot differently.

So for now, I guess my attitude is to wait and see. One test location does not a Walmart Psych Empire make. Perhaps it will succeed; perhaps not. Perhaps it will become the Great Clips of the psychotherapy world.

But while I’m waiting, I’m hot holding my breath.

 

When Your Therapist Tells You What to Do

The classic examples of non-directive therapists are Sigmund Freud and his disciples, who legendarily sat at the head of their couches and made comments like, “Hmm,” “Tell me about your dreams,” and “How do you feel about your mother?”

Freudian psychiatry is, thankfully, now out of vogue. But there are still therapists who believe that their job is to listen, not to instruct.

On the other hand, there are more directive therapists who assign homework. This can be anything from “Listen to this podcast on mindfulness” to “Write a letter to your ex telling him/her what you truly feel.” They probably won’t tell you to kick the bum to the curb, but if you decide to do so they’ll help you prepare for it.

But, although I am far from a Freudian and shy away from those who are (not many these days), I prefer non-directive therapists. I am not averse to doing a little homework or having a therapist ask me in a session to vocalize what I would like to tell a person or even to write a list of the coping mechanisms I’ve developed. My preferred dynamic, however, is to give-and-take with the therapist and then go home to contemplate what was said and how I feel about it.

I have had therapists who have given me homework and I can’t say they were wrong to do so. Sometimes writing something down or throwing teacups against the basement wall (or whatever helps you get your anger out) is a good thing.

My most recent therapist was a combination of the two. She mostly listened while I rambled on about what was happening in my life or what had happened in my past. Then she suggested ways that I could think about the events or pointed out coping mechanisms that I had developed or suggested ways I could put those coping mechanisms to use.

All in all, I felt that our sessions were mostly non-directive. She did suggest that I listen to a podcast on mindfulness, but she never quizzed me on whether I did and only listened when I told her what I got from it. She never told me that I should delve deeper into mindfulness or listen to more podcasts. She left that up to me, if I thought it might be helpful.

I understand that some therapists, particularly those that work in community mental health facilities, are required to file treatment plans and I can see where giving homework can flesh one out more than “talk about feelings.”

Perhaps there is something I’m missing. Perhaps at different stages of therapy, directive psychological interaction is more beneficial. Perhaps my particular problems lend themselves more to non-directive therapy. Perhaps I just have an aversion to being told what to do, especially where it concerns my memories and my feelings.

Of course, everyone has the option not to do the homework. This can be seen as resisting treatment, or disagreeing with the treatment approach, or simply lacking the wherewithal to carry it out. Sometimes it may be more helpful when the therapist sacrifices part of the session to doing the assignment there instead of leaving it to be done at home. In this case, the therapist is being really directive, though of course the client always has the choice not to do the assignment. It’s much harder, though, when the therapist is sitting there waiting for you to make a list of your dreams, your feelings, or your interactions with your mother, or to bash an empty chair with a pool noodle.

What it comes down to, basically, is therapeutic philosophy and therapeutic style. And a client is not bound to pursue whatever style of therapy that is favored. Although it is sometimes difficult to realize, a client has the option to request or to seek a therapist whose therapeutic style matches what the client feels is most helpful.

Remember, your therapist works for you, not the other way around. If you need a more or less directive therapist, it is your right to seek one out. Therapy has been known to stall and a different approach or philosophy may be just what you need.

 

Healing From Gaslighting

Apparently, gaslighting has become the new “thing” in pop psych circles. We see article after article warning of the dangers of gaslighting and how to spot a gaslighter. I have written a few such articles myself:

Who’s Crazy Now? A Guide to Gaslighting (https://wp.me/p4e9Hv-pm)

Gaslighting and Bipolar Disorder (https://wp.me/p4e9Hv-C2)

When Men Aren’t the Gaslighters (https://wp.me/p4e9Hv-Cu)

Is it time for another? I think so. Now that more people know about gaslighting, they need to know how to heal after the experience, as they would after any kind of emotional abuse.

Because that’s what gaslighting is – emotional abuse. But it’s a specific kind of emotional abuse. In gaslighting, one person in a relationship (romantic or familial) denies the other’s perception of reality and works to convince the gaslightee that he or she is the crazy one in the relationship. As in other forms of emotional abuse, the gaslighter may try to isolate the victim from friends and relatives, give intermittent reinforcement (insincere apologies) that draw the victim back into the relationship, or denigrate the person with insults.

But the heart of gaslighting is that denial of the other person’s reality. The abuser says, in effect: You can’t trust your own feelings. My view of the world is accurate and yours isn’t. You’re crazy. (Of course, the gaslighter may also use the familiar techniques of emotional abuse as well: isolation, insults, projection, and belittling.) But gaslighting is unique because the perpetrator distorts a person’s world view, sense of self-worth, and belief in him- or herself.

Healing from gaslighting is not easy, but it can be done. Here is some advice from me, a person who was a victim of gaslighting but is now healing.

Get as far away from the gaslighter as you can. Yes, this may mean cutting off contact with a family member, if that’s who is doing the gaslighting. It may mean leaving town. It does mean making a sincere and lasting emotional break.

Do not maintain contact with the gaslighter. You may think that once you have broken free from the gaslighter, he or she can do no further harm. This is just an invitation to more emotional battering.

Name the abuse. Say to yourself – and possibly to a trusted person – this was gaslighting. I was emotionally abused and tricked into thinking I was crazy. My worldview was denied and my thoughts and emotions were said to be invalid.

Feel the feelings. It may be some time before you can admit to or even experience the emotions that gaslighting brings. Your first reaction may be relief (at least I’m out of that!), but there may be years of anger, frustration, fear, and rage lurking behind that. It may take work to surface those feelings and feel them and recognize that they are valid.

Get some help. This can be a therapist who specializes in treating victims of emotional abuse or it can be a supportive friend, family member, or religious counselor. It should be someone who can listen nonjudgmentally, validate your perceptions of reality, and sympathize with your situation.

Do not try to get revenge. This is just another way of reconnecting with your gaslighter. It gives the person another opportunity to “prove” that you are crazy.

Develop new relationships. It may seem like there is no one in your world who will understand and be supportive. For a while, you may not be able to trust enough to have another close friend or lover. You may have a lot of healing to do first. But remember that gaslighters are in the minority; most people don’t do that to people they profess to care about.

Give it time. It may take years to fully get over the experience. (I know it did for me.) Maybe don’t go directly into a rebound relationship. You need time and space to work through your feelings and rebuild your perception of reality.

Just know that gaslighting doesn’t have to be a way of life. It can end when you gather the strength to break away from it. You can heal and take back what you know to be true – that you are a person who is worthy of love. That your perceptions and feelings are valid. That you don’t have to live by someone else’s view of what is real. That you are not crazy.

 

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