Bipolar 2 From Inside and Out

Posts tagged ‘support systems’

Distance Psychotherapy: Is It for You?

By Alice / adobestock.com

I will make a confession: I have never used distance therapy, except for when I couldn’t drive to my therapist’s office, my husband wasn’t available to drive me there, or when I had the last-minute I-just-can’t-go-today feelings or I’m having-a-crisis feelings. This was in the days before teleconferencing, texting, and other long-distance forms of therapy, so occasionally my therapist would agree to do a telephone session, which I appreciated greatly. In general, they didn’t last as long as the standard psychotherapy 50-minute hour, but at times they were lifesavers.

Now, when everything seems to be online, and especially during pandemic lockdown, quarantine, or simply fears of going outside, tele-psychotherapy seems to be becoming a thing. Many services are now available via the internet, smartphones, and whatever way you pursue your online life.

I’ve been looking at these services, not because I need one now, but because I want to know what’s available in case I ever should. The APA (American Psychological Association) provides a lot of helpful information on the subject. Their site has provided a list of pluses and minuses regarding telehealth for psychology. They note: “With the current research and with the current technology, mobile apps and text messaging are best used as complementary to in-person psychotherapy…Research does show that some technological tools can help when used in conjunction with in-office therapy,” though “There are cases in which Web-conferencing or therapy via telephone does seem to be a viable option on its own for some people.”

Inc.com provides a helpful list of the pros and cons of online therapy. Some positive aspects are that:

  • People in rural areas or those with transportation difficulties may have easier access.
  • Most online therapy services cost less than face-to-face treatment.
  • Scheduling is more convenient for many people.
  • Individuals with anxiety, especially social anxiety, are more likely to reach out to an online therapist.

among the negatives are:

  • Without being able to interact face-to-face, therapists miss out on body language and other cues that can help them arrive at an appropriate diagnosis.
  • Technological issues can become a barrier. Dropped calls, frozen videos, and trouble accessing chats aren’t conducive to treatment.
  • Some people who advertise themselves as online therapists might not be licensed mental health treatment providers.

Despite the concerns, research consistently shows that online treatment can be very effective for many mental health issues. Here are the results of a few studies:

  • 2014 study published in the Journal of Affective Disorders found that online treatment was just as effective as face-to-face treatment for depression.
  • 2018 study published in the Journal of Psychological Disorders found that online cognitive behavioral therapy is, “effective, acceptable and practical health care.” The study found the online cognitive behavioral therapy was equally as effective as face-to-face treatment for major depression, panic disorder, social anxiety disorder, and generalized anxiety disorder.
  • 2014 study published in Behaviour Research and Therapy found that online cognitive behavioral therapy was effective in treating anxiety disorders. Treatment was cost-effective and the positive improvements were sustained at the one-year follow-up.
  • A recent review of studies published in the journal World Psychiatry compared people who received CBT treatment online with those who received it in person.  The two settings were shown to be equally effective.

One possible pitfall, warns APA, is that “online therapy or web therapy services are often not covered or reimbursable by most insurance providers. If you plan to be reimbursed, check with your insurance company first. Otherwise, prepare to pay for the full cost yourself.” The services I explored charge about $35 to $80 per week for unlimited messaging and one live session per week. MDLive provides a psychiatrist at $284 for the first visit and $108 afterward. (They have lower rates for seeing a therapist rather than a psychiatrist, and do accept insurance.)

Business Insider, in its article on the subject, dealt specifically with a service infelicitously known as Woebot. Unlike the other services, Woebot is a “chatbot” that substitutes artificial intelligence and natural language processing for a real, live therapist. It uses cognitive behavioral therapy. Their website claims that Woebot “is the delivery mechanism for a suite of clinically-validated therapy programs that address many of today’s mental health challenges, from generalized anxiety and depression to specific conditions like postpartum depression, adult and adolescent depression, and substance abuse.” Like a non-directive therapist, it asks probing questions and responds to questions and answers from the user. For now, it is free to users, though they seem to be exploring a paying model.

Other telehealth counseling services include:

Amwell

Betterhelp

Brightside (depression and anxiety, not bipolar or mania)

Online-Therapy.com

ReGain (couples therapy)

Talkspace

teencounseling (will consult with parents)

If you decide to try online therapy, it’s best to compare services and determine what services they offer, at what price, and what the credentials of their therapists are. If you have already tried it, I would be glad to know the results. Feel free to comment.

 

 

A Letter From the Future to Bipolar Me

by sosiukin via adobestock.com

Dear Me:

You’re 13 years old now, and there are a few things you should know.

You have bipolar disorder. No one knows this, not even you. But a lot of people notice that you act “weird” at times. You have decided to embrace your weirdness, which is fine, but what you really need is psychological help. And medication.

Don’t pass up any chance to get that help. Your high school will recommend to your parents that you get counseling. When your parents leave the choice up to you, take it. It will not go on your permanent record, and you will still get into a college. A very good college, in fact.

I know that at times you sit alone and cry. Other times you laugh at things no one else finds funny. This is not just “weirdness.” This is a mood disorder, called bipolar disorder, type 2. Your mood swings will make it difficult for you to make and keep friends. Keep trying. The friends you will find are worth it and will stand by you when you really need them. You will not be alone in dealing with this.

Your choice to go to college out of state will be a good one. There you will have a variety of experiences that will make you grow in unexpected ways. Your mood disorder will go to college with you, though. Leaving Ohio will not mean you will leave bipolar disorder behind. You will still feel the mood swings, and most of them will be depression.

It’s a good idea to take that year off between freshman and sophomore year. I know it will feel scary, but at that point you will be in no shape to carry on with academics. Instead, you will get a job which, while not great, will introduce you to more new people and new ways of life. At least one of those people will stick with you till you are old and gray.

Returning to school will be a good decision. Your parents will support you in that decision. They won’t object to your year off, because they know you will go back. It still won’t be easy, but you will have a core group of friends that accept you, even though you are different from them.

Your bipolar disorder will follow you back to college. It will make you miss some opportunities and choose others that will not be good for your mental health. You will be unhappy most of the time, but you will find that music helps you through it.

Try not to self-harm. I know you will feel numb and want to feel something else, but cutting yourself is a bad decision and will not help. You will carry those scars forever.

When you meet Rex, though, you will be encountering a problem too big for you to handle, and the relationship will leave you scarred as well. It would be best if you were to steer clear of him altogether. But then again, you will find some true friends in his circle, and it would be a shame to miss them. Try your best to hold yourself together, remember what I said about self-harm, and don’t give up on who you are. You are not your disorder, and you will get through this, despite everything.

I know you never gave a thought to marrying, but you will meet a man and in a few years you will marry him. This, I assure you, is a good decision. He will stick by you no matter what and help you find help.

Going into the building that says “South Community Mental Health” will be a good decision. Whatever you will be feeling at this point – most likely misery – it’s not mentally healthy. This will be the place where you will start to climb out of the hole you have found yourself in.

At last, a doctor will tell you that you have bipolar disorder – most often depression, but also anxiety. He will work with you to find a combination of medications that will help you. When that happens, you will become reacquainted with your brain and relearn how to function in the world at large. Your brain will function in a new way, one with fewer out-of-control feelings. You will experience life more fully and be glad of your new outlook.

It won’t be quick, and it won’t be easy, but you will have therapists, and friends, and work, and love, all of which will help see you through. You will have bipolar disorder all your life, but it will not be your life, though it seems that way now.

Reach out for help whenever and wherever you find it. Cherish your friends. Keep trying, even when you want to give up. Better times are on the way.

I promise.

Love, me (older and maybe wiser)

Bipolar Conversation

This morning a podcast called Bi-Polar Girl was uploaded, and I was the interviewee. (You can find it on Apple, Amazon, and other podcast sources.) Here’s a look at what was like.

  • Prepping. Before we recorded the podcast, my anxiety kicked in, and I tried to overprepare. I bombarded the hosts with emails asking what I should be prepared to talk about or what questions they were going to ask me. Basically, they told me we were going to “wing it” and have me tell my story.
  • History. The thing we talked about most was when I started showing signs of bipolar and when I was diagnosed. I explained that I was showing signs of it as early as my high school years, how I decided to seek treatment after college, and how I was mistakenly diagnosed with major depression for years before receiving the proper diagnosis and medication.
  • Meds. We discussed medication in some detail – pill-shaming, how every person reacts to meds differently (so it’s useless to “recommend” a particular drug to friends or support group members). We talked about the side effects of various medications, including the fact that the most-feared one seems to be weight gain. One particular point of discussion was how many people are afraid that taking medications to treat their disorder will stunt their creativity or turn them into “zombies.” Snowflake (one of the hosts) and I agreed that our creativity and ability to work were actually improved while on medication, because it enabled us to focus and do more creative work.
  • Family. We also talked about the fact that I have no children and my reasons for that. (We also introduced some of our pets during the Zoom call, or they introduced themselves. Just try to keep an animal out of a Zoom call.) I shared that I felt it would be unfair to a child to have a nonfunctional mother, that I was afraid of going off antidepressants while pregnant, and postpartum depression afterward. Snowflake shared her story of medications, potential side effects, pregnancy, and postpartum depression.
  • My publications. I talked about my blog and my books, Bipolar Me and Bipolar Us. In particular, we discussed gaslighting, which features in my second book, and how people with bipolar are more susceptible to it. Both Snowflake and I shared how we had encountered gaslighters in our own lives.
  • Groups. Chacoman, the other host, questioned me about whether I was involved in any local or regional support groups, and I had to admit that I’m not. Now, during the pandemic, group meetings are problematic at best, but I don’t react well to groups at any time, due to my anxiety (which is how my hypomania manifests). In my case, outreach is limited to my blogs and books, and membership in online support groups.
  • Miscellaneous. We got off topic a number of times. I don’t want to make it sound like the interview was all serious or grim. We also talked about our pets, positive relationships, college memories, and even politics.
  • Plans. I talked about how my next book will be a mystery, with a bipolar main character, and received positive feedback on the idea.

All in all, it was a good experience, worth overcoming my anxiety for. I had only participated in a podcast once before, a not-altogether-successful interview about my first book with an interviewer who had obviously not read it and was more interested in whether any of my family members were also creative. (It was supposed to be a podcast about first-time authors.)

This was not the same sort of thing at all. I told my story, as the hosts had recommended, and we had a genuine, far-ranging conversation about not just my own experiences with bipolar disorder, but with how others cope with it as well. Actually, I learned a lot about myself, from how much my anxiety – and especially social anxiety – still affect me, to how much my teen years illustrated my journey into depression.

So, here’s a big thank you to Snowflake and Chacoman for the opportunity to share with them and their audience. I would absolutely do it again. It helped me step out of my comfort zone and, I hope, will help the listeners as well. It’s a form of outreach that I had never considered, but one that I found valuable – and just plain fun!

 

 

The Demise of a Bipolar Support Group

By Artur / adobestock.com

Funny, but I thought support groups were supposed to be supportive. Recently, though, I ran into one that was anything but.

I won’t name the group, since some people may still get something out of it, but as far as I could see, it was a group of over 5,000 people out of control. Many posts were off-topic, sexually-oriented, political, and even abusive. Of course, many people never contributed at all, so I don’t know whether they approved, ignored, or simply watched from the sidelines.

I have my own opinions about bipolar support groups – they should be focused on bipolar disorder, its symptoms, treatments, and lifestyles. Within that large umbrella, there are lots of topics to be covered.

To me, it is legitimate to have “getting to know you” posts – Where are you from? What is your favorite comfort food? What kind of music do you like? Such posts and responses enable people to reach out and make connections, to realize that there are people in the world who experience life in the same way that they do – or in different, equally valid ways.

Similarly, it is understandable that people post about their symptoms – Do you ever wake up angry? Do you often get hypersexuality as a symptom? What do you do about it? Is there anything that alleviates your feelings of being alone? These posts encourage people to share commonalities and suggest ways to deal with them.

I can even see some good in comparing medications, though I don’t much like them. Has anyone tried Vraylar? Do you have much weight gain with Abilify? As far as I can see, the only answers to such questions are: Ask your physician or pharmacist. Medications affect everyone differently. Yes, I have, but your mileage may vary. The only truly useful things I can think of to say are: Don’t stop taking your medication without a doctor’s help, and If you get a rash, especially around your mouth and nose, see your doctor immediately. But if it gives comfort to know that someone else has the same reactions you do, that may indeed be helpful.

What this particular support group got into, however, was way off-topic remarks, sexual solicitations, stalker-like behavior, politics, name-calling, and general nastiness. It seemed like some of the participants went out of their way to be offensive. One poster asked, “Do you know what ‘tea-bagging’ is?” A few others got into a, shall we say, heated discussion about Black Lives Matter and Blue Lives Matter that involved calling each other not just racist, but “cunt” and “fucking POS.” Yet another complained about the cursing appearing in such posts and was met with a long list of responses, all of which said, “Fuck you.”

Part of the problem seemed to be inexperienced or overwhelmed moderators. They did not take down the most offensive posts. They did not try to steer the discussion in productive directions. Admittedly, moderating a support group is not an easy thing to do, and dealing with a group that experiences symptoms such as anger, despair, hypersexuality, sensitivity, and irrational thinking, as well as the normal responses of outrage, insult, offense, anger, retribution, and hurt, is that much more complicated.

Perhaps the majority of the 5,000 group members don’t mind such interactions, but there were more than a few who did, and said so. Some quit the group or went off to start their own. Others decided to stay around for a while to see if things got better.

I am torn. I hate the group the way some members are currently behaving. I hope that more administrators/moderators can get the group back on track to something that is truly a support group. But my time, attention, and patience are limited. Unless I see some changes – and soon – I’m outa there. I may not be missed, but neither will I miss them.

When My Carer Needs Care

By Farknot Architect / adobestock.com

My husband is the mainstay of my support system and, in large part, my caregiver. I cannot count the things he has done for me and does for me every day. We’ve been married for over 35 years and during that time he has helped me through daily life, major depression, anxiety attacks, loneliness, irrational thoughts, school, therapy. He makes sure I practice self-care and cares for me as needed.

Recently, though, he needed my help and care. The other day he experienced distressing eye-related symptoms – a large “floater” (dark spot) in his vision and unexpected flashes of light. What could I do about it? First, I answered his request to get a flashlight and look in his eye, but I saw nothing.

Next I arranged an appointment for him at our eye doctor. Dan used to be terrible at admitting when he needed medical treatment, but since a heart scare he’s been much more amenable to seeing a doctor. That particular evening, he was scared and cranky, and made up excuses. He left his phone in the car. That’s okay. I had mine right there. He didn’t know the number. That’s okay. I have it programmed into my phone. I waited on hold. “Forget it,” he said. “Never mind,” I replied. “I’ve got nothing else to do.” He said he didn’t see the floater any more. I pointed out that his eyes were closed. I got through to the doctor and made him an appointment for the next day.

Naturally, I drove him to the appointment, as they would have to dilate his eyes. Then, afterward, I drove him on several other errands (including an appointment with a different doctor) and made sure he ate lunch. I canceled one of the errands and put off others when I saw how tired and nervous he was getting. I took him home and tucked him in bed. (The floater turned out to be nothing truly alarming, just an effect of his aging eyes. He named it “Freddie the Free-Floater.”)

Dan has done almost exactly the same for me, many times. I could usually make my own appointments, but he encouraged me to do so. He has driven me to appointments countless times. He makes sure I eat. When I run out of spoons, he cancels or postpones errands, or even runs them for me. He reminds me when I need to have a lie-down or to sleep or to shower.

It was unusual for me to be the caregiver in this situation, and at times difficult, but I didn’t begrudge it. How could I possibly?

Of course, later in the day, I had a crisis and a mini-meltdown of my own, and there was Dan, ready to be with me, talk me through it, and make sure I didn’t skip a meal.

I know this is what marriage is supposed to be – partners helping each other through their individual and mutual times of difficulty. I also know that mental illness can put a terrible strain on a relationship. I admit that I am very needy at times, and was even more so at other times in my life.

But this time I got to be the strong one and take care of his needs before my own. And I was pleased and proud to be able to do that. Often there’s little enough that I can do for him, except offer him encouragement and remind him that I love him and appreciate him and all he does for me. If he asks for something he needs, I try to make sure he gets it (except for the $900 woodchipper, I mean). And I do what I can that benefits both of us – working to bring in money, paying the bills, doing computer research, handling phone calls, reminding him of appointments when I can – mostly stuff that involves computers and phones and recordkeeping and occasionally knowing where missing stuff is. And reassuring him when he gets trapped in the depression that he also suffers from that I love him and that he is strong and good and that he needs to take care of himself, and that if he can’t, I will try and do my best.

I Don’t Need a “Pep Talk”

MarekPhotoDesign.com/adobestock.com

Here’s the thing. Many people, when you mention a problem, feel obliged to help you fix it or fix it for you. When the problem is related to mental illness, though, that can be counterproductive.

The fact is, most serious mental illness can’t be fixed, at least not by a friend or loved one. To try is to invite frustration on the part of the fixer and worse feelings on the part of the fixee.

Some of the worst help we are offered are pep talks, which are meant to be encouraging. Smile more. Keep trying. Other people have it worse. Everyone goes through this.

No, says my stubbornly glitchy brain. Everyone does not go through a major depressive episode. And when I’m having one is not the time I can concentrate on what constitutes “worse.” I can try all I want, but my bipolar disorder isn’t going to just go away. And smiling when I’m ready to cry is a suggestion that denies my perception of reality and encourages me to lie about my feelings.

You can see much of this kind of advice on Facebook, for example. There are always memes that exhort you to look on the sunny side, have a positive mental attitude, or choose to be happy. But it’s easy enough to scroll by them.

These pep talks hurt more when they’re offered in person by someone you know or even love, especially when that person knows you have a mental disorder. You can’t just scroll by someone you love telling you that, in effect, it’s your own fault that you don’t get better.

I know these sentiments are kindly meant (except for the ones that blame you for your own condition). But the reality is that we can’t cure ourselves of SMI by smiling, or jogging, or thinking happy thoughts, or eating turmeric. We can’t cure ourselves at all.

But we can make things better, through therapy and medication, and yes, through some things that are not cures themselves but adjuncts to healing – physical activity, engagement, mindfulness, self-care, and the like. Who knows? Maybe even turmeric.

So, if pep talks don’t work, what can you do instead? What might actually help your friend or loved one? Here are a few suggestions.

Treat the person with mental illness the way you would treat a person with any other illness. I’m not suggesting sympathy cards are appropriate, but a phone call or text message saying you care is usually welcome.

Listen without judgment. Don’t offer advice. If the person opens up to you, respect that. Don’t minimize the problems. If the person doesn’t respond, wait a while and try again.

None of that will “fix” the person, but you know what? Neither will a pep talk. My brain, for one, is simply unable to process them, digs in its metaphoric heels, and says, “Oh, yeah?”

So, what are some things you can say instead of giving a pep talk? Try these.

I’m here for you.

You can always call me.

I’m sorry you’re hurting.

Tell me if you need anything.

Do you need distraction?

Do you need to be alone for a while?

Do you need to talk?

What can I do for you? (The answer may be, “nothing,” but at least you cared enough to ask.)

If you are also suffering from SMI, there is even more you can do. You can say, “I understand how you feel,” and mean it. You can recommend a therapist. You can congratulate the person on any accomplishment, the kind that wouldn’t seem like an accomplishment to anyone else.

In general, stay away from platitudes, feel-good sentiments, and quick fixes – unless you know that the person responds well to that kind of encouragement. They’re too easy to say and too hard to follow through on. Save them for people who are simply having a bad day, not someone who has mental illness.

Do I Need Advice or Do I Need to Vent?

COK House / adobestock.com

Sometimes we need advice. But sometimes we just need to vent. This is true of all people but especially true of people with mental illness.

Venting is the act of getting something off your chest. It may come explosively if it has built up for a while. There may be one final incident, however tiny, that sets you off. All you really want is to feel heard, that someone acknowledges your distress and understands it. All you really need is a sympathetic ear and maybe a pat on the shoulder.

Venting acts as a safety valve. It allows you to “let off steam” that might otherwise build up pressure until it comes out violently, or at least excessively.

Why do I say this is particularly true of people with mental illness? So often we have feelings we can’t articulate, thoughts we don’t understand, or events that trigger us in both large and small ways. It’s natural to want to keep all these things inside. We’re taught to do that – not to “let the crazy show,” to keep all those messy thoughts and feelings to ourselves. Eventually, we get to the point where we think that no one will understand anyway, so there’s no point in giving voice to these feelings.

Then, when we do finally vent, inevitably someone says we’re overreacting. Because, you know, crazy.

If I’m venting, the wrong thing to do is to give me advice. Unless I specifically ask for advice, that is. But even well-meaning advice can easily go wrong. People who do not suffer from psychiatric conditions often offer advice regarding what works for them when they feel a certain way. And yes, a walk in the fresh air and sunshine can certainly be uplifting. But when I’m too depressed to get out of bed, it can be an impossibility. It can even make me feel worse about myself.

To me, suggestions for possible remedies for my disorder are even worse. It’s taken me and my assorted doctors years to assemble the right medications at the right dosages to tame my bipolar disorder down to something livable. When someone tries to tout the latest remedy they heard about – Pilates, elderberries, juice cleanse, probiotics, or whatever – it feels to me like “pill-shaming,” like I’m being blamed because none of my meds will “fix” me thoroughly enough. Add the fact that these suggestions come from questionable sources – laypersons or bogus “studies” – and I’m likely to dig in my heels and feel offended.

At times, though, I do need advice. When I do, I usually get it from my therapist, someone else who shares my disorder, or an old friend who has been there for me on my journey. Sometimes I need a reality check – am I just catastrophizing or is it really true that something bad might be happening? Sometimes I need help dealing with a specific person – what can I say to my sister to help her understand my condition? Sometimes I need a reminder that I really ought to make an appointment with my therapist and get a “check-up from the neck up.”

And it should be understood that advice is just that – a suggestion that I am free to take or leave. Even my therapist, who usually gives very good advice when I ask her, sometimes suggests techniques or approaches that just don’t work for me. And even she knows that sometimes I just need to vent, to feel the feelings of sorrow or hurt or rage and let them out in a safe place. To quote Jimmy Buffet, “It cleans me out and then I can go on.”

The Importance of Alone Time

Alone time is a precious thing. But right now, with the self-isolation that accompanies the pandemic, many of us are experiencing too much “alone time.” But many of us need more.

Alone time has been important to me as I have struggled with bipolar disorder. I have a loving, supportive husband who is there when I need him to be. But even he knows that sometimes what I need is to be left alone.

Sometimes the world is too much with us, and we long to escape – read a book, hide under the blankets, just sit in the corner and think. At times like that, interacting with another person can feel like an intrusion, an annoyance, unwelcome. Alone time can allow you to catch your breath, calm yourself, practice mindfulness, or simply be alone with your feelings.

Of course, getting alone time is not always easy, especially now when we may be cooped up with our nearest and dearest, with no respite in sight. In my opinion, these are the times when a bit of alone time is even more necessary. Even with people you love, being with them 24 hours a day, every day, will begin to wear on you all. Stress builds and you may be triggered by noise, conflict, or other stimuli.

I’m lucky. That supportive husband knows, if his other efforts at drawing me out (offering me food, or a movie, or music) have failed, the greatest gift he can give me is alone time. He’ll even ask me if I need alone time, in case I don’t realize that is exactly what I do need.

I’m also lucky that there is a dedicated space in my house that is perfect for alone time – my study. It has a computer, music, comfort objects, games, favorite pictures, and more. It even has a comfy chair so that I can just sit and think if that is what I need to do. I know that I come at this topic from a place of privilege.

Making mental and physical space for alone time is harder when you have a roommate or a family that doesn’t understand the concept of alone time. The TV may be blaring, the washer clanking, the kids yelling, the spouse being needy. There may be someone in every room of the house, making noise or demanding your attention. Sometimes you can’t even be alone in the bathroom. You want everything to stop, just for a while.

In situations like that, you may have to ask for alone time. First, realize that it’s a reasonable request. Suggest ways to make it happen – I need to be alone in the basement (garage, kitchen, yard, whatever) for a while. Don’t disturb me unless someone’s bleeding or something’s on fire. Offer to return the favor. If you’re feeling pent up, chances are someone else in the house is too.

Of course, too much of a good thing is not necessarily a good thing. Even though I need a fair amount of alone time, too much can leave me stuck inside my own head, not always a comfortable place to be. I can brood, catastrophize, feel lonely or bored, give in to depression. It helps if I can recognize when alone time is turning toxic like that. When I’ve had enough alone time, I can choose to leave that behind and rejoin the world in a better frame of mind.

As far as I can see, alone time is vital for every person, even the very gregarious. It allows us to let go and drop our metaphoric masks. But alone time is particularly necessary for those with mental illness. The ability to be alone with oneself can be a powerful step in understanding and healing. And whether time alone is the norm or the exception now, people’s mental health suffers. Connection is what we hear most about – virtual meetings, video chats, texts, and calls – but alone time is vital too. Treasure it when you get some. 

Asking for What You Need

I saw a post on a bipolar Facebook page that asked what coping mechanisms people used. There were the usual responses about self-care, which is certainly a fine coping mechanism. But it’s far from the only one.

I’ve learned any number of coping mechanisms over my years in psychotherapy. There’s “looking at how far I’ve come.” There’s “leaving the room when my anxiety gets too bad.” And there’s always one of my favorites: “petting the cat.”

But the answer I put down was “asking for what I need.”

It’s a good coping mechanism because no one can read minds. No one else knows what I need. And, short of them guessing and hoping to hit on the right thing, the only thing I can really do is ask.

I can ask my therapist whether we can work on my anxiety today. I can ask my friend to check in on me daily for a while. I can ask my husband for a hug, or alone time, or some distraction.

Of course, I don’t always know what it is that I need at any given time. At times like that, I can simply ask for things that might help or have helped in the past, like the aforementioned hug or alone time. My husband has been with me for so long and is so familiar with my bipolar disorder that he knows a number of things that are likely to help, and he can suggest them. If all else fails, he suggests I go to bed, or read, or listen to music, all things which can calm or center me. Sometimes he simply puts on my favorite movie, to help draw me out.

Closely tied to the mechanism of asking for what I need is the technique of negotiation. I may know what I want or need, but the other person may not be capable of providing it, or at least not right then. If a friend can’t take my phone call, I can suggest an alternative: Call me after 10:30 or sometime tomorrow. If I need distraction and my husband has to go to work, he can suggest that we go out to lunch the next day.

We’ve developed a shorthand for such situations. When the only thing I can do is say, “help,” he responds with, “help how?” If I can then come up with a suggestion, I do. A lot of the time he is able to provide what I need. But sometimes he just isn’t. Maybe he isn’t able to get me out of the house for lunch. So instead I say, “I need comfort food.” He usually says, “You can get that.” Or he may respond with what it is that he can do: “There’s cheese and crackers here. Will that do?”

Asking for help isn’t easy, and Lord knows negotiating for what you need isn’t either. Both take lots of practice. And there is always the possibility that another person simply cannot supply what you need. That’s where self-care comes in. I know down deep that a nap, or comfort food, or music may help me, and if no one else can provide them, I can usually do it myself.

Receiving help may not be easy, either. Asking for what you need can make you feel, well, needy. And receiving help from someone else may make you feel guilty or unworthy. But the fact is that you – all of us – need help at times and that learning how to ask for and accept help is a valuable skill. And a totally valid coping mechanism.

I’m Not Giving Up on You

Not you, Rachel, and not you, Paul.

Rachel, I know that your life has been shitty lately. I know that your health problems are overwhelming you and your depression is dragging you down to the deepest levels. I know your brother’s death by suicide still resonates with you and makes you think that there is an easy way to end your pain.

Paul, I know that your life has been full of drama and trauma lately. I know that the tasks of daily living get the better of you and the future keeps retreating further and further away. I know that you have barely any spoons each day and feel compelled to spend them on others instead of on yourself.

But I won’t give up on either one of you.

Rachel, I will take your calls even when I’m exhausted and listen while you vent. I will support you in every way I know how. I will honor and thank you for your generosity when I know that you could easily focus only on your troubles. I will maintain contact even when I am low on spoons.

Paul, I will keep sending you reminders that I am thinking of you and offering you solace and support. I will willingly accept that you are not able to reply just now. I will not take that as a reason to make a break with you. I will keep trying.

Rachel, you know you can say anything to me, for I have surely been there. You know that your suicidal ideation makes me uncomfortable, but I won’t ask you never to speak of it. I have had those thoughts myself and gotten through them. I know you can too. I see all the things that you do to reach out to others and extend your goodness to them. I empathize with your difficult family situation. I don’t know what to do about it, but I will acknowledge the pain that it gives you.

Paul, you know that I have listened to you in the past and will continue to do so, no matter what it is you have to say. I will not let my own anxiety and depression stand in the way of listening to yours. Please know that I understand what you’re going through more than I can say or have ever said.

Rachel, please know that I celebrate with you even the smallest achievements you make. When you are able to stand up for yourself against City Hall, I applaud you. When you investigate ways to make your living situation better, I will not judge you, though they may seem harsh or unacceptable to others.

Paul, please know that I wish only the best for you, even if I don’t always understand what it is that you need. I admire your continuing strength, even when I feel that it would be good if you could lay your burdens down for just a while. I acknowledge that I am not the person that can help you do this, much as I would like to.

The reason that I say these things is that I want you to know that there is someone who does truly understand and truly care. I have been where you are and have found my way out, at least a little. I remember the people – including you two – who have reached out to me even when I was not able to reach back. The very least I can do is to do the same for you.

When you are relieved of your burdens and can again see the light of day, I will be there to celebrate with you. I will not despair or think that you can never see that light.

I will not give up on you. I will not give up on any of my friends who are burdened with depression, anxiety, or some other difficulty. I will do what I can, because I must. There are people who have never given up on me. I know what that feels like, and I wish that same healing and help and health for you.

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