Bipolar 2 From Inside and Out

Posts tagged ‘self-care’

Permission to Be Depressed

Depression can be so riddled with guilt. Why am I not able to fake being okay? Why do I isolate when what I need is interaction?

Sometimes what I need is to give myself permission to be depressed. I have bipolar disorder 2, with a heavy depression component. It has overwhelmed me many times. I have fought against it, given in to it, tried to make compromises with it, tried to ignore it – almost any reaction you can imagine. Then I learned how to give myself permission to be depressed.

This is not quite the same as giving in to depression. It involves acknowledging that I am depressed and allowing myself to feel the feelings that I have. Of course, I don’t give myself permission to be permanently depressed. In a way, it’s more like giving myself permission to practice self-care and not to force myself to smile and bull my way past the depression. I recognize that I am depressed and do what I need to do to get through it. That may be staying in bed. It may be crying. It may be wallowing in sad music. These are things that I’m likely to do anyway when I’m depressed, but giving myself permission to do them is surprisingly freeing.

I used this technique probably for the first time when my husband and I went on a “barefoot” cruise vacation. It was something we both enjoyed and both want to do again someday.

But I knew from the beginning that depression might overtake me – probably would, at that time in my life – even while I was doing something enjoyable. Naturally, I didn’t want the depression to ruin the whole vacation, so I decided to give myself permission to do what I needed to do to cope with those feelings.

Most often, that involved retreating to my bunk for a nap. This enabled me to get away from other people when I was feeling overwhelmed and unable to socialize. Sure, I missed some of the onboard and shore activities, but I wouldn’t have enjoyed them anyway while in the metaphorical fog and darkness. I enjoyed what I could, then let myself not do what I didn’t feel up to doing. I didn’t try to make my husband stay with me and miss all the fun. There wasn’t anything he could do for me anyway. If the other passengers thought it was odd – and they did – they barely mentioned it to me. My husband told them I was tired. Seasickness was also a believable excuse.

In a way, having bipolar depression at that level is like having the flu. I feel bogged down and logy, inclined to cocoon, rest, and stay away from other people. I realize this is not always possible, but if it is, I can allow myself to do it. Fortunately, this spell of depression wasn’t so bad that it completely incapacitated me as it has at other times in my life. I was still able to feel enjoyment at some times, though not at others.

At other times, I’ve had to give myself permission to have anxiety. If a situation makes me anxious, I acknowledge that I am nervous, and do what I need to do. I can’t “think away” my anxiety, but sometimes I can get myself out of the situation at least temporarily. I do not have to sit and be anxious while people around me argue or shout at each other, one of my anxiety triggers. When I recognize how I’m feeling (which takes practice) and give myself permission to feel the way I feel, I’m better able to come up with coping mechanisms, such as leaving the room to get some fresh air or making myself a cup of tea.

You may notice that when I give myself permission to be depressed or anxious, part of my solution involves avoiding other people. That’s sometimes a hard thing to do. Isolation can certainly make depression worse, but it can sometimes also be necessary if pushing through, trying to smile, mingle, and socialize will make the depression worse in the end. And I have learned that if I try to do that, the depression comes along with me. Once a friend told me that it was like having a separate person with me, a person called Misery. Better to give myself permission to stay home and give myself some self-care.

What I can’t do is give myself permission to stay depressed or anxious. Giving myself permission is a very limited-time offer. It doesn’t work for those really lingering, midnight-dark depressions that last for weeks or months on end. Those, I have to fight. And while I’m depressed, I don’t give up on meds or therapy. Those are necessary to alleviate the depression instead of resigning myself to feeling it.

When Self-Care Seems Impossible

It seems the days when I most need self-care are also the days when I’m least able to accomplish it. I mean, when I can’t even get out of bed, I’m not likely to have the wherewithal to perform any kind of self-care regimen.

I’m not talking here about the take-yourself-to-the-spa type of self-care, either. That’s beyond my means and my capacity. What I’m thinking about are the most basic needs that must be met – meds, food, sleep, and the like. But there are sometimes things that prevent me from accomplishing even these.

Part of the reason, of course, has to do with lack of spoons. It takes energy to shower and dress, make a meal, go to appointments, and all the other tasks that should actually make me feel better. According to Spoon Theory, we wake up with an unknown amount of spoons every day and must choose how to spend them. Some days I wake up with only a few or even zero.

The other obstacle I’ve noticed that inhibits my self-care is my occasional inability to plan. Yes, I can make sure I eat at least one meal a day, but on some days only if I have gone to the grocery store earlier in the week and bought at least a box of Cocoa Puffs and some bottled water to keep by my bed. Not much of a meal, I know. It’s the bare minimum I can do, but sometimes all I can manage.

Taking my meds is the only part of self-care that is an essential that I don’t do without. I usually have that bottle of water right next to my bottles of pills, but even if I don’t, back in college I learned to swallow pills with only spit. But again, this takes a little planning – calling in prescriptions and getting to the pharmacy to pick them up.

On days when I have slightly more spoons, I have to plan and prepare for the days when I don’t have enough for proper self-care. Even the planning and preparing use up spoons.

But there are also days when I can manage a little self-care. On those days, if the spoons are low, but not completely nonexistent, I take shortcuts. I wash up in the sink instead of showering. I put a piece of salami between two pieces of bread and call it a meal. I put on clean pajamas and underwear instead of getting all the way dressed. I use mouthwash instead of brushing my teeth. I pet the cat instead of calling friends.

And I call it good enough.

Admittedly, those are some low standards for self-care. It would be nice if I could do more – and on some days I can. But on many days, the obstacles seem overwhelming. Inertia takes over and entropy sets in. I know it’s not good for me and can slow my recovery from spoon deficit spending, but that’s just the way depression is sometimes. It sucks you down into a hole that’s hard to climb out of when it’s at its worst.

But, thanks to the aforementioned meds and the minimal self-care I’m able to do, I know that one day I’ll be out of the hole and able to work on some proper self-care. Even plan for the next time that self-care seems impossible.

Emotional and Mental Work

I am weary to my bones and to my soul. As the spoonies say, I’m so out of spoons I can’t eat soup.
Physically, I haven’t done that much to wear myself out. A little light housecleaning. Running some errands. Answering emails and making phone calls. No heavy lifting, unless you count the time I had to help my husband push the washer back into place.
No, the heavy lifting I have been doing is emotional and mental. Make no mistake, that is work and it is exhausting. I am responding to a physical and emotional crisis that happened almost exactly a month ago. After the disaster (a tornado destroyed our house), my husband has done almost all of the physical heavy lifting.
The mental work is stuff that I’m easily capable of doing on a good day: dealing with bureaucracy, organizing the trivia of paperwork and daily life, paying bills, etc. Now, however, there is so much of it to deal with that I am falling behind. I haven’t kept up with sorting our receipts. I haven’t returned the phone call about the hole the cable guy made in the wall. I haven’t even listened to the voice mail about it. I haven’t responded to a friend’s request to look over an official letter she is writing.
The emotional work is entirely different. My husband is dealing with issues of grief, loss, and anger regarding the loss of our house and our possessions. Somewhere inside, I must be having similar feelings, but his are closer to the surface and he is able to express them more.
And I am having some difficulty dealing with this. First of all, angry men distress me, even if I’m not the object of their anger. It’s a throwback to other times and other relationships, a button that was pushed and has stayed mostly stuck in that position. Dan is doing his best to accommodate this quirk, trying to keep his voice down and his conversation rational when we speak of it. But I hear him when he is alone in his study, bellowing or wailing in emotional pain about something I do not fully understand.
My husband and I are operating from different places, with differing agendas, regarding the loss of our house and belongings. He invests his memories and emotions in things much more than I do. I look at what can be replaced and he looks at the irreplaceable – artifacts from his trips to Africa and Israel, for example. Those can’t even have a price put on them and there is no way to replace them. His grandfather’s diamond ring could be physically replaced, but not the sentimental value he attaches to it.
I do understand this, though not at the gut level he does. I do (or did) have possessions that meant a lot to me – a guitar, paintings a friend did, some carvings in semi-precious stones, some photos, of course (though some are stored on my computer, which survived). And I think the salvage company did a poor job of inventorying what they had to throw away and keeping what was small but important, letting us participate in the process. But my anger doesn’t extend to revenge fantasies.
All these feelings, both expressed and unresolved, are sapping my strength and my energy. I have gone back to my therapist for reminders of my coping mechanisms and validation on what I have been able to do – and to have a safe space to vent when all of this does begin to spill over.
And now I have decided to go back to work, on a reduced schedule at least. I don’t know if this is a good idea or a bad one, but it seems a necessary one. Perhaps it will provide a missing piece of familiarity in my life, something to anchor me. Perhaps a different kind of work will distract me from what I have been dealing with.
I know there’s still a lot of emotional and mental labor to do, but with help from my husband and my therapist, I believe I will get through it, especially if I pay some attention to self-care: taking my meds regularly, sleeping and eating regularly, taking breaks when I need them, taking comfort in our cats, and trying to eat the elephant one bite at a time.
This is one of the biggest elephants I can remember, though.

I Hate My Job, But I Don’t Hate My Life

The other day I found myself thinking, “I hate my job. I hate my life.” But then I stopped. The truth was that I do hate my job, but I don’t hate my life.

There have been times when the two thoughts absolutely went together. I well remember getting up in the morning and thinking, “Now I have to go to the bad place where they make me unhappy.” Unfortunately, the thought would color my whole day. Instead of unwinding after a rotten day – or a whole series of them – I brooded about what came before and dreaded what would come the next day. I was caught in a loop of bad thoughts and they wouldn’t let me go, or enjoy, or relax. My life seemed to stretch out into an unending series of more of the same.

Of course, that was when I was deep in bipolar depression, improperly medicated, and unaware of self-care. Oh, the job was indeed pretty terrible. I was an editor, a writer, and a proofreader, tasks and occupations I normally enjoy. There’s something wonderful about taking something mediocre and making it good, or even taking something bad and making it better. Once or twice I even got compliments on the job I was doing.

But at that time, when I hated it, the job was a misery. A reorganization had put the editorial department under the marketing department, which had been true in fact for a long time but was now formally acknowledged, with a resulting new chain of command. Anything I wrote was essentially a puff piece for some advertiser. Three senior editors were fighting over my time and attention, each determined that I should work on their project first and foremost.

I wasn’t quite ready for a major breakdown, but I was close. I hated both my job and my life.

Now I have a tedious and basically unfulfilling job. I transcribe audios of boring business meetings and lawyer consultations, relieved only by the occasional podcast. On top of that, I’m a really crappy typist, so it takes me hours to do a job that others could zoom through. Add in foreign accents and mumblers, and you get a job that brings me no joy, but only a modest paycheck.

But for some reason it also suits me. I work four days a week, at home in my pajamas. No one is looking over my shoulder. If I make my deadlines (and I do), I can expect fairly steady work, except during the holiday season. I earn enough to supplement my social security without going over their limit on extra income.

I also have medications that stabilize me and a much better knowledge of self-care. Working at home for only one boss is part of that. So is taking meal breaks whenever I want them and spending that time with my husband. Eating nutritious meals. Letting myself say, “I hate it! I hate it!” after a particularly trying assignment. Reading a book before I go to bed. Snuggling with the kitties. Allowing all these things to seep beneath my skin and feed my soul.

I don’t belong to the regular-massage-and-decadent-chocolates school of self-care. Maybe I’m a simple soul, but I prefer the everyday comforts that make my life not a misery and help me appreciate what I can of my situation. Not that I’ve got anything against either massages or chocolate. But to me, they are special indulgences rather than a part of my daily self-care.

In the end, medication and self-care are what keep me going, hating my job, but not my life.

Bipolar Disorder: Mood and Food

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FDA looks to ban trans fats. Exceptions made if consumed while depressed, anxious, or without anything better to do.

The Daily Show

If that were true, I could eat all the trans fats I wanted, because my bipolar 2 often leaves me depressed and/or anxious.

In fact, my friend Leslie, who is my partner in depression, invented the perfect snack for depressive times: a ruffled potato chip dipped in cream cheese with an M&M on top. My husband starts to worry about me when I ask him to get those ingredients at the store.

But there’s a reason for our peculiar snack. Leslie and I are simply self-medicating.

“Blood sugar and carbohydrate intake are very important to the brain,” according to Everyday Health. “Your brain runs on glucose and depends on carbohydrates to supply the energy it needs. Carbohydrate intake also prompts the production and release of important neurotransmitters, such as serotonin, which creates a feeling of calm and well-being and reduces depression. So people with bipolar disorder may be indulging in a form of self-medication when they eat sugary snacks during depressive lows or manic highs.”

Not that self-medication is good for us. Bipolar people are more likely to have type 2 diabetes than the rest of the population. Three times more likely. One of the risk factors for type 2 diabetes is excessive weight and we all know and bitch about the weight gain from our assorted meds. Prescribing ourselves the Ben & Jerry’s treatment is not going to help, even though it may feel like it at the time.

So what are we supposed to be eating to help stabilize our moods? Of course, people will recommend turmeric, cider vinegar, or the latest “superfood.”  But every serious list I saw looked like this:

  • complex carbohydrates, especially fruits, vegetables, and whole grains
  • protein in the form of lean meats, poultry, fish, and low-fat dairy
  • omega-fatty acids from fatty fish (such as salmon), walnuts, and flaxseeds

In other words, exactly the kind of diet that is recommended to everyone for general good health! I think this comes under the heading of self-care, which is not always easy to do. Especially when I’m so depressed I can’t even manage a microwave cup of mac-n-cheese, or when my husband brings home a rack of ribs that he bought on sale.

But if I am stable enough to shop and cook and eat properly, those recommended foods may be good for my mood disorder as well as my body. According to bipolar.newlifeoutlook.com, eating protein “promotes serotonin and improved moods.” They also note that researchers in Italy say “increased consumption of omega fatty acids helps reduce depressive episodes and decreases the risk for suicide in patients with bipolar.” So apparently fish is brain food after all.

The other common suggestion in this realm of self-care is to keep a food journal, or I guess in this case a food and mood journal, to keep track of what you’re eating and how it affects your moods. If you’re the journalling sort, by all means, give this a try. As for me, I blog rather than journal and I know you don’t want to see a lot of “ate salmon, felt energized; ate chips with cream cheese and M&Ms, felt sad.”

The fact that food and mood are related is just one more example of how the brain and the body are intertwined, interdependent. It gives us a clue about the kinds of self-care that may do the most to help us stabilize our moods. And it gives us a chance to take more control, if we can, of our mental as well as physical health.

Exhaustion as an Antidote for Panic

Wednesday afternoon my husband called his doctor complaining of chest pain and was instructed to go immediately to the ER. Actually, he had had the chest pain off and on for several days but he A) attributed it to Taco Bell, B) is good at denial, and C) is stubborn.

So off to the ER we went. We were tucked into Bay 22 and after a time, a nurse drew my husband’s blood. While we were waiting for results, we watched The Big Sleep on the room’s TV, possibly not the best choice at that particular time. We were there from 4:30 to 10:00, when they reported that Dan’s cardiac enzymes were a “little high.” I left shortly thereafter and Dan was admitted.

Although in the past ER visits with my parents caused massive anxiety which then caused a variety of physical symptoms, this time I did not panic. I was too exhausted. I even had a little trouble driving home. The streets in our plat seemed the wrong length or something and I wasn’t absolutely sure where to turn. When I got home I fed and watered the cats and then collapsed. Sleeping, not weeping.

The next morning I had to get up and finish a work project, then go to see Dan for a few hours, then back home to more work. Again, an early collapse. Still no panic.

Today (Friday) I am writing this post after finishing the work project and while waiting to hear that Dan’s angiogram is done so that I can go and see him. Again, I am not panicking. Numb, maybe, and tired, but not anxious.

I used to hate not knowing. Waiting for the proverbial other shoe to drop was torture. I am given to catastrophizing at the least provocation. But now, when there is an event that lends itself easily to catastrophizing I find I’m not. I have decided to postpone panicking until I truly have something to panic about.

At the moment Dan is fairly comfortable, in a very good hospital with attentive staff and even therapy dogs. There is nothing that I can do except visit him and call him.  I figure that when he calls with the results of the angio and info on whether they gave him a stent, I can panic then if required. Say, if he has to have bypass surgery.

But I’m disinclined to panic until or unless they tell me that’s the case.

And … I just got a phone call from his doctor. Dan had multiple artery blockages and required four stents, but no bypass surgery for now. I’m relieved, of course, but my main feeling is still one of exhaustion. Maybe I’ve been worrying in the back of my brain at a subconscious level and that has added to my exhaustion. Maybe when this is all over I’ll let loose and have a good cry, when he’s back home.

My friends have been sending me and him thoughts and prayers, hugs, light, and even good juju. They have also been reminding me to take care of myself, to remember to eat and sleep and I’ve been doing that at least on some kind of level. A bowl of cereal now, cheese sticks as a bedtime snack, a visit to the Waffle House when I’m too tired to make a meal. And eight hours of sleep a night. I can’t say the sleep has been dreamless or restful. I wake up still exhausted but at least my body is taken care of in a reasonable manner.

So there you have it. A potentially dire situation happened but I did not panic. Was it postponing the catastrophizing that helped? The exhaustion? I don’t know, but whatever coping mechanism it was, I’m glad it kicked in.

Dan has done so much for me through the years. I’m glad I will have an opportunity to pay him back even if only a fraction as much.

Realistic Self-Care

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I hate articles about self-care for mental illness such as the one I saw recently that said:

…[W]ays I practice self-care include swimming and Pilates, getting regular massages, spending time with friends and family, since staying connected is an essential part of emotional health at every age, watching TV, and seeing movies. I also love going for walks, especially near Santa Monica beach, and reading or listening to books.

If I could do all those things, I wouldn’t need self-care! When I’m depressed or anxious, I cannot make myself swim or exercise, or even get out of bed and shower at times, which lets out going to the movies and spending time with friends, too. I can maybe read a book or listen to a podcast if I’m not too twitchy and if my attention span and concentration will cooperate. And I can sit on the sofa and watch TV, but that feels like uselessness, not self-care.

Plus, guess what? A lot of those activities cost money.  Massages, movies, exercise classes (for which you need exercise clothes), and swimming (for which you need a swimsuit) would all require “shopping therapy,” which I loathe IRL and can’t afford online.

I personally would love a massage, but that’s not self-care for everyone. As Emily Roberts points out in “Self-Care for Mental Health: Find Ways That Work for You”:

The myth of a massage as an essential self-care activity – or anything that makes you more anxious – isn’t helpful for your mental health. I didn’t listen to my body the first time I booked a massage and guess what? It was so triggering to my body I couldn’t even finish it….I started to cry and couldn’t compose myself 10 minutes into the appointment. I was embarrassed and confused. I thought, “This stuff works for all the people in the magazines. What is wrong with me?”

I decided that booking an extra appointment with my therapist and having a date with my best friend was more helpful as self-care for my mental health than pushing myself to practice self-care in the way the media was telling me to.

One person’s mani-pedi can be another’s nightmare. I much prefer small ideas for self-care rather than big expeditions or splurges. For me, comfort food is one form of self-care. It has to be something I can make easily, though, like frozen mashed potatoes, mac-n-cheese, or French bread pizzas. (The microwave is my friend.)

Of course, these comforts require a little planning when I’m not overwhelmed to the point that I need self-care to restore me. I must think ahead, during those times when I’m able to go to the store, to bring home the foods that are easy to make yet soothing.

Another self-care technique I came across is definitely more my speed. Caiti Gearsbeck, in “Make Your Own Mental Health Self Care Kit” offers a simple, DIY alternative. She recommends filling a shoebox or other box with soothing things that appeal to all five senses, plus a few activities. Here are a few of her examples:

Sight: photos, cards, and letters

Smell: essential oils or candles

Taste: chocolate or tea

Sound: meditation CD or an mp3 player with a playlist

Touch: soft cloth or stuffed animal, stress ball or fidget cube

Activities: coloring books and pencils, a journal, a favorite movie

She adds: Whatever works for you!

For me, that box would contain photos, Irish Spring soap, oolong tea, an mp3 player, a stuffed animal (I have lots to choose from), and a CD of The Mikado. I’d need a cat in the box, too. But given the nature of cats, there would probably be one in there anyway, whether I wanted it or not. All of that is stuff I have around the house, unless I’m out of Irish Spring or oolong. Add a quiet room like the bedroom or my study and I’m all set. At least until I can afford a massage.

 

References

https://blogs.psychcentral.com/millennial/2017/10/make-your-own-mental-health-self-care-kit/

https://www.jwi.org/articles/mental-health-and-self-care

https://www.healthyplace.com/blogs/buildingselfesteem/2018/5/self-care-for-mental-health-find-ways-that-work-for-you

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