Withdrawing, again

I did enjoy my friend’s visit, but I have been pretty withdrawn surrounding everything else. It started before she came.

I have four paid-for readings that I have not finished – they were due more than a week ago.

I have been avoiding Facebook because I don’t want to talk to anyone, especially the people I owe readings to.

I have been sleeping in late every morning (until today) and feeling like I haven’t accomplished anything.

I have been feeling emotionally paralyzed.

I’m not deeply depressed, but I’m not doing well, either.

Physically, I feel like a slug – getting fatter (again), losing fitness. My back is starting to hurt again when I stand for too long – never a good sign.

I’m trying to break through that. Yesterday I went swimming.

That showed me how out of shape I am.

The first time I jumped in, I could only do three laps before I was out of breath. I took a break and went in twice more for 4 laps each.

I usually do laps using a pretty gentle side stroke, so being out of breath at that freaks me out.

This morning I woke up early and went for a walk. Only 1.63 miles by MapMyRun, but at least it was something.

I’m hoping that a little physical activity will help turn around this dead mood. I don’t really care about fat as much as being able to do what I want to do without struggling.

I mentioned in another forum something that maybe I should talk about here.

Several years ago, my therapist thought that I should be fully disabled.

I fought against it – fought hard.

I was in a group of other bipolar people once or twice a month, all of whom were on disability except me.

At that time, I kept thinking that I wasn’t as bad off as they were. I was better than that.

Right now, I’m not so sure about that.

I’ve had 18 months to complete some paperwork, and I never work on it for more than 5 minutes at a time.

For 18 months.

Obviously, I’m resistant to finishing it.

Whether this is my fear of success or resistance to completion or something else, I don’t know.

At the moment, I don’t care.

I’m just wondering if maybe it wouldn’t be better to apply for disability.

It’s been suggested that this may be the depression talking, and that is so, but maybe my therapist was right.

That’s an idea that scares me. I don’t want that.

But when I try to look at things objectively. .  . the money and opportunities that I’ve missed out on because there are times when I can’t pick up the phone or deal with paperwork in a timely way, the time I waste doing NOTHING and feeling exhausted. . . .  Wouldn’t it be better to have a steady income from disability to make sure the basic necessities can be paid?

*Sometimes* I’m competent, efficient, on the ball, capable.

But it seems to me that those times are fewer and far between, and they last less and less time.

Several people are suggesting that I use my disability rating to get a federal job.

They don’t understand.

I’ve looked at that before.

I even had the VA Voc Rehab people pay a place to help me with a federal resume.

I never returned their calls or filled out the paperwork they sent me.

And right now, hearing people suggest that again is making me break out in tears.

It’s too complicated. I can’t handle it right now.

I can’t handle anything at all right now.

I think my shrink thinks I’m doing much, much better than I really am.

I’ve asked him to get me in with a new therapist (the old one transferred about 4-5 years ago). He wants me to attend “Wellness Classes” about nutrition and sleep and meditation and biofeedback and other things I could likely teach.

That’s not where I’m at. That’s not what I need.

So, I’m writing him a letter to try to get this across to him.

Mental Health: Drama, Crisis & Friends

In this one forum I’m on regularly, there’s currently a discussion going on about mental illness.

One person feels s/he can no longer be friends with someone who has stopped taking medication.

I can actually understand that part.

The medication changes a person’s personality on some levels.

When I look at my life, I currently have very few friends in my life that knew me before I was medicated. That is my fault. I let most of those old friendships fall away.

During the discussion, other people have brought up moments of drama and crises that people in their lives have caused or lived through. One in particular mentioned that she had a family member with bipolar, and she will no longer deal with someone who admits they have the disease – whether or not they are medicated – because of all the drama.

People with problems create drama in their lives. I’m sure you’ve seen it. I’ve seen it, in others and in myself.

No one likes to be pulled into someone else’s drama.

Except. . . . what is life if not dramatic?

If your life doesn’t have a little drama in it, what are you doing? How do you spend your time to avoid all drama?

Pets cause drama, making changes to your life causes drama, being married or being a parent has it’s own drama, getting ahead is dramatic, LOVE is dramatic, EVERYTHING in life has drama.

So, when someone says, “I can’t deal with the X’s drama any more,” what they mean is, “X never learns from his/her mistakes,” or, “X’s stuff is too exhausting to deal with,” or, “X’s problems end up hurting me.”

All of these are legitimate reasons to minimize contact with someone – you have to protect your own mental health.

But I guess the term “drama” used in this way annoys me, much the same way people calling things “bipolar” or “schizophrenic” because they are mercurial. Or the latest one with every armchair shrink diagnosing people as having Asperger’s. *eyeroll* And yes, I know I’ve been guilty of that.

It’s true that I tend to create crises, over and over.

I know it, and I’m working on it.

But it seems as though I perform better in a crisis, at least I get much more done. I don’t know why, and I don’t like it. It is very stressful, I don’t like it and a large part of what I’ve been working on this year has been trying to stop doing this.

I haven’t been completely successful, but I think I’m making some progress.

It’s also true that being my friend can be exhausting.

I know it.

That’s one reason I withdraw during hard times. I don’t WANT to draw everyone else into the pit with me.

What’s my point today?

I don’t know.

I guess I’m beating a dead drum of wanting people to be precise when they speak. Or to be more understanding of mental illness. Or something.

I’m tired of my own drama, too, and want it to end. Maybe the friend that was referenced above feels the same way?

Mental Health: How society treats Mental Illness

I started writing this on April 19, around the time of the Boston Marathon bombing.

I don’t want to think about a lot of the stuff that’s gone on this week, on the large scale (Boston, Texas, Waterton, etc) and on a personal one (Monterrey and tires – I’ll relate it soon).

And then I read this:

And that really didn’t make anything better.

For some reason, it reminded me of one of the (actually very few) negative reactions I’ve had when I disclosed my Bipolar.

I was in school, pretty early on, maybe my second semester at the university, so 2005? 2006? I was in a history class. The teacher was very strict on counting attendance as part of the grade. I was struggling with a bout of depression. One of my classmates, a young woman, was struggling with debilitating migraines.

We were commiserating about this and I talked about being bipolar. I also talked about about my daughter who was in third or fourth grade at the time.

The young woman said, “They haven’t taken her away?” or maybe it was, “Why haven’t they taken her away?”

I was shocked, stunned.

I’m ill, so “they” should take her away from me? More importantly, “they” should take me away from her?

My response to the young woman was, “Why should they take her away? She’s clean, fed, bright, does well in school, has clothes, etc.”

I wasn’t taking care of myself very well at that point, but SHE was taken care of. That’s where the majority of my energy went.

I don’t know if that reaction is better or worse than some of the other reactions I’ve had. The best is when someone starts to relate about about someone in their lives that has the illness or another big psych issue.

But others are like, “Aren’t we all a little bipolar?” I loved the nurse that tried to tell me to get off my meds and everything would be fine, that was good. There’s a great list of “things to not say” here.

Not sure I have a real point today, except I’m fairly frustrated at the way we as a society treat mental illness.

This came up for me again recently.

The new Diagnostic and Statistical Manual of Psychiatric Disorders, version V, came out this month.

The director of the National Institute of Mental Health, Thomas Insel,  “rejected” the new version as not scientific enough.

 Indeed, symptom-based diagnosis, once common in other areas of medicine, has been largely replaced in the past half century as we have understood that symptoms alone rarely indicate the best choice of treatment. Patients with mental disorders deserve better.

 I agree that we need better ways of determining mental illness.

Wouldn’t it be great to point to a blood test or a brain scan to say, “THIS is what’s wrong”?

But those tests don’t exist yet. There is research going on, but it’s not yet at a level where we can do that.

NIMH does not deal directly with patients, they fund research, so this won’t affect patients directly.

NIMH is apparently going to use their own criteria called Research Domain Criteria. NAMI (National Alliance on Mental Illness) on the other hand has a more rational approach, along the lines of my feeling – It’s not perfect, but it’s what we have right now.

While we are better than mental hospitals of 50 years ago, we still have a long way to go treating mental illness, and those who suffer with it so that it’s on parity with “physical” illnesses.

Mental Health Month: Bipolar – the Manic Side

Depression and the depressed side of bipolar get a lot of attention, in the media and in society. Many people know someone that has battled depression at some point in their lives.

Most people don’t know anything about the manic side. They are told that it is the “up” side of bipolar, the creative side. And it is.

But it is also can be just as destructive as the depressed side.

Symptoms of mania include three or more of the following (when not caused by drugs):

  • inflated self-esteem or grandiosity
  • decreased need for sleep (such as feeling rested after only 3-4 hours of sleep)
  • more talkative than usual or pressure to keep talking
  • flight of ideas or subjective experience that thoughts are racing
  • distractibility (attention too easily drawn to unimportant or irrelevant external stimuli)
  • increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation.
  • excessive involvement in pleasurable activities that have a high potential for painful consequences (such as unrestrained buying sprees, sexual indiscretions, or foolish business investments)
Full mania can also lead to psychosis and hallucinations. Hypomania (“little” mania) of the bipolar II has all the same symptoms, but lack psychosis and supposedly aren’t severe enough to interfere with daily life.
A couple of years ago, on another internet forum, someone postulated that he would simply love to have bipolar instead of unipolar depression, because at least then there is an upside.
We had quite the argument where I was trying to explain that “upside” really wasn’t. I don’t know if I was successful. 
It seems as though an increase in “goal-directed activity” should be a good thing, and it can be, to a point. The creative people with bipolar tend to create in this state. But, there’s a passage in An Unquiet Mind where Kay Redfield Jamison describes mania:

“There is a particular kind of pain, elation, loneliness, and terror involved in this kind of madness. When you’re high it’s tremendous. The ideas and feelings are fast and frequent like shooting stars, and you follow them until you find better and brighter ones. Shyness goes, the right words and gestures are suddenly there, the power to captivate others a felt certainty. There are interests found in uninteresting people. Sensuality is pervasive and the desire to seduce and be seduced irresistible. Feelings of ease, intensity, power, well-being, financial omnipotence, and euphoria pervade one’s marrow. But, somewhere, this changes. The fast ideas are far too fast, and there are far too many; overwhelming confusion replaces clarity. Memory goes. Humor and absorption on friends’ faces are replaced by fear and concern. Everything previously moving with the grain is now against– you are irritable, angry, frightened, uncontrollable, and enmeshed totally in the blackest caves of the mind. You never knew those caves were there. It will never end, for madness carves its own reality.” 

photo from Unprofound.com
This is what my thoughts feel like at times –
going by so fast I can’t capture one –
blurs out everything

When I look back at certain periods of my life, I can clearly see now that I was manic then.

In particular, my promiscuity screams loud and clear about being hypomanic. I know I lost a couple of good guys because of it, but for the most part, I didn’t see my one night stands as people. I assumed that men were always out for sex and I took advantage of that. Having to explain to a perfectly nice guy that you really were only using him for sex is not the most fun thing in the world. So I started sleeping with guys I didn’t like. Now, how fucked up is THAT? I haven’t dated at all since my diagnoses in Dec. 1999, so I’m certainly over that. 😛

But some other symptoms. . .

In 1991, I received about $4000 worth of back pay. It was the most money I’ve ever had at one time, and I almost couldn’t wrap my brain around having that much. In the next few weeks, I managed to spend $7000. I know SOME of what I spent it on: a stereo, a small tv, VCR, some CDs, some clothes, rented a car, luggage. Other than that? Not a clue. And now I was in debt, having written bad checks to the Exchange and to the US Government. It lead to me losing a prime assignment in the military.

While I’ve never spent to that extent again, I do sometimes still. . .  lose track of how much I’ve spent. I have bought some “fun” things (books, yarn, etc) before paying bills. When I’m thinking clearly, I don’t do that; I can budget damn well. But at times, my judgment is off.

Talking. Gods, the talking.

Recently, C told me that one of the parents at TKD commented that I tell everybody everything (i.e. too much) about my life.

The thing is, I know I do it. I know people don’t want to hear this shit. But I can’t STOP. If I’m feeling social, I talk and talk and talk and talk. I take over conversations. I get the “teacher voice” and sound like an authority on everything. Hell, I think I AM an authority on everything.

And I can hear myself doing it.

And I can’t stop.

I talk so fast people don’t understand what I’m saying. I have been somewhat successful in consciously slowing down my speech at times, but if I don’t concentrate very hard, I lose that. And LOUD. My voice will carry across a room.

That may seem like a small thing, talking too much. But it can be socially devastating. Who wants to be around the loudmouth that takes over all the conversations and/or makes them all about her? Who wants to be around the parent who does that?

I’m not like that all the time, but when I’m not, social interactions are . . .  difficult. For one thing, I’m embarrassed about how I act when hypo-manic. I’ve become more and more withdrawn over the years.

There was a day last week where I was awake for approximately 41 hours. I dozed for about 10-15 minutes at a time at various times, but never really reached sleep. And it took medication to get me to sleep even after that. By the time I took the meds, I could not concentrate on anything for more than 2-3 minutes. I felt. .  . floaty, disconnected from my body, light-headed. Luckily, I have medication to do this (with my doctor’s knowledge and blessing). If I was still unaware that this is a danger sign or didn’t have the medication, it could have lead to some bad stuff.

Oh, my home would probably be a little cleaner, and maybe I would have a few more things written, but one thing about mania that I think doesn’t get enough press is irritability.

I have a very short fuse when manic. C is good about pointing out to me, “Why are you shouting at me?” when I don’t even realize I’m shouting. I can be very grumpy while at the same time feeling free enough to do whatever the hell I please.

It’s a love/hate relationship with the mania. I *do* get more accomplished. I do start things when in this phase. I get a lot of great ideas. This is also the time when I say, “Fuck it!” and take chances, do new things, go places I’ve never been and so on.

It can be fun. But it can also be just as destructive as the depressive side.

Mental Health Month: Bipolar’s Darkest Side

May is Mental Health Awareness Month . . . . .

Trigger warning – this post talks about suicide and suicide rates. For some merely talking about the topic can be triggering.

A couple of weeks ago, I came across this video of an interview with Stephen Fry (a British actor, if you are unfamiliar; and if you are unfamiliar look up Fry & Laurie, a comedy sketch show where he teamed up with Hugh Laurie of House long ago). He has been diagnosed with cyclothymia. Cyclothymia is technically a separate diagnosis from bipolar; the Mayo Clinic describes it as, “Cyclothymia causes emotional ups and down, but they’re not as extreme as in bipolar type 1 or 2”. Stephen himself calls it the most mild form of bipolar. They are certainly closely related mood disorders.

In the video, he calls Bipolar a “morbid” disease and then qualifies it as “morbid in the medical sense – it kills people.” (He has a lot of other good things to say, too, like the part about it being like the weather and the story of the guy who stood in front of a lorry (truck)).

And it does, in the sense that the suicide rate among those with bipolar is higher than in the general population.

2000 study indicates that 25-50% of those diagnosed with some form of bipolar attempt the act – up to HALF of people with some form of bipolar attempt suicide. About 10-15% of people diagnosed Bipolar I commit suicide (others suggest as high as 20%). A 2007 study indicates that the rate in patients with bipolar II may be even higher.

“. . . the rate of prior suicide attempt is higher in biplar II patients, and bipoloar II disorder is overrepresented in depressed suicide victims. Among patients with different clinical manifestations of major mood disorders (unipolar major depression, bipolar  and bipolar II disorder), bipolar patients in general and bipolar II subjects in particular carry the highest risk of suicide.”

People with bipolar II tend to spend more time in a depressed state. Some researchers even suggest that major depressive disorder and episodes are really on a spectrum of bipolar II.

And there is data that the clear majority of people who attempt suicide are in the grips of a depressive episode (78-89%), about 11-20% attempt during a “dysphoric manic” state, that is a mixed state. A mixed state can be either “dysphoric mania” or “agitated depression”.

I know, for me, when deeply depressed, I may think about it, but I don’t have the energy to actually DO anything. For me, a mixed state is much more dangerous. Having the energy and agitation of mania and the thought patterns of depression? Very dangerous.

So, what can you do to help someone? I guess I often assume that everyone has been exposed to information on avoiding suicide and/or other mental health issues, so it feels repetitive to me to post it yet again. But maybe someone reading this might need the info so. . . .

Warning Signs of Suicide

  • Talking about it. When someone is talking about suicide, they aren’t just being melodramatic, they are asking for help. When someone jokes about it, too. I used to make statements such as, “Maybe I should take myself out of everyone else’s misery.” (It was apparently a little subtle for most people to pick up on – but at the time, I was pretty serious.)
  • Gathering stuff that will help them do it, the examples given by the Mayo Clinic include stockpiling pills or buying a weapon.
  • Withdrawing from social contact.
  • Mood swings (which, you know, for a rapidly cycling bipolar would be ALL THE TIME)
  • Preoccupation with death
  • Feeling trapped and hopeless
  • Increasing use of alcohol and/or drugs (also known as self-medicated)
  • Changing eating and/or sleeping patterns.
  • Risky and self-destructive behavior.
  • Giving away treasured belongings and/or “setting affairs in order”.
  • Personality changes and/or being severely agitated or anxious.
The problem is, some people don’t show anything at all. They keep their feelings and thoughts to themselves. Those are the most dangerous, of course.
If you feel this way, if this is you, the best thing is to reach out for help.
Problem is, for me, that’s the time when it’s most difficult to ask for help.
There are hotlines you can call, family/friends and medical professionals you can reach out to for help.
In the U.S.:
Veterans Crisis Line: 800-273-8255 (press 1)
There’s a list of other numbers here.
If you love someone who is showing signs, you can also contact the above places for ideas on how to get the person help.
Stephen Fry’s The Secret Life of the Manic Depressive – Part 1, Part 2

Some books on Mental Illness

In keeping with Mental Illness Awareness Week, here are some books and a blog that have information for the lay person about various illnesses.

Kay Redfield Jamison’s An Unquiet Mind is considered a definitive work on Bipolar (which she still calls manic-depressive illness). The author is a psychologist who also has the disorder. I read this shortly after I was diagnosed, and I feel like maybe I should read it again now, since my perspective may have changed. 

The Center Cannot Hold: My Journey Through Madness by Elyn R. Saks is on my list of books to read (no, I haven’t read it yet). Saks is a law professor who has schizophrenia.

Let’s Pretend This Never Happened by Jenny Lawson (a.k.a The Bloggess) is a very funny (and fast) read. While it isn’t about mental illness directly, Ms. Lawson suffers from depression and severe social anxiety, which made doing a book tour and other related things very difficult. And if you aren’t familiar with The Bloggess, check out her blog. Some things to make sure you don’t miss:

Beyonce the 6 foot metal chicken
Wil Wheaton collating paper
The video ad for the book (featuring several big name stars)
The traveling red dress revisited (and read all the links)
A confession about depression and self-harm (insert trigger warning here)

I’ll post more tomorrow.

Mental Health Awareness Week

October 7-13 is national Mental Health Awareness Week, according to the National Alliance on Mental Health.

I sometimes casually mention being depressed or having volatile moods or taking medication, but I thought I’d take this opportunity to talk about it more in-depth.

I have bipolar 2 disorder.

One of the best places to find out about the differences between “classic” manic/depressive bipolar (or bipolar 1) and bipolar 2 is PsychEducation.org. The author of that page is a researcher in the field and an advocate for helping people with bipolar 2.

The best visualization I’ve seen for defining mood disorders comes from the PsychEducation website. Dr. Phelps sees bipolar and mood disorders as a spectrum disorder (much like autism). While his opinion is not expressed in the DSM-IV (The Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association), his descriptions fit so well with my experience, I tend to go with it.

“Unipolar” refers to unipolar depression – clinical depression, major depression. Point A refers to people with depression who respond well to traditional medication. Point B is a point where:

 there is some sort of threshold where these approaches are no longer completely or continuously effective: either they don’t work at all, offer only partial relief, or help for a while then “stop working” (which may account for some or much of “Prozac poop-out”, now regarded as a “soft sign” of bipolar disorder, described below).  

 BP NOS is “bipolar not otherwise specified”. 

The main difference between bipolar 1 and bipolar 2 is the level of mania.

A person with bipolar 1 has had at least one fully manic episode. Mania is defined as:

manic episode is defined by a distinct period of persistently elevated, expansive, or irritable mood lasting at least one week (or less if hospitalization is required). The mood is also accompanied by additional symptoms, such as inflated self-esteem or grandiosity, a decreased need for sleep, pressured speech, flight of ideas, distractibility, increased involvement in goal-directed activities or psychomotor agitation, and excessive involvement in pleasurable and high-risk activities. from http://www.manicdepressive.org/dsm.html    

People with bipolar 2 have “hypomania” (aka “little” mania) with the elevated mood, grandiosity, pressured speech, flight of ideas, and many of the manic symptoms, but only lasting a few days (4-7) and  is “not severe enough to cause marked impairment in social or occupational functioning or to require hospitalization.”

Except that for me, it can cause problems. I’m too impulsive at work, or I can’t stop saying what I really think, which can get me into trouble with friends and bosses.

As I’m beginning to write this, on October 5 at about 1:30 a.m., I’m hypomanic. I’m doing all kinds of making plans and organizing. I downloaded multiple “blogging plan” pages and set up a binder. I bought new binders and other office supplies (that I WANT but don’t need and should be spending my money elsewhere). I’ve been reading blogs that have tips on making better blogs. Like, I swear, I read over 40 entries at Problogger tonight alone. I wrote posts for two of my other blogs, after almost a month of not writing at all.

It’s now the 5th at 6:30 a.m. I slept for about 4 hours and now I’m wide awake. I’ve opened about 15 tabs on Chrome looking for inspiration to start jotting down notes for my blogs, while watching a show on Hulu.

It’s really hard to hold onto a job when this happens. On the one hand, I’m more productive than ever, but on the other, I can’t concentrate on one thing for more than a couple of minutes. While I’m writing this, I’m thinking about the knitting I want to do, writing patterns, how to make my math blog better, how to get more money coming in, helping my daughter with a Greek costume for homecoming spirit week, and how the heck we’re going to finish making this dress she wants to make by tomorrow night (homecoming dance) and a few other things that keep escaping before I can get them written down.

While this state is much preferable to a state where I’m so depressed I can’t do ANYTHING for weeks or months at a time, it feels like I try to live my life in the brief few days of these hypomanic episodes, because I spend so much of my life depressed and unable to function.

According to the National Institute of Mental Health, about 2.6 percent of Americans have bipolar disorder – that’s about 5.7 million adults.

There’s a lot of us out there, and many are functioning well in society. You may know someone with this problem, but not even know it.

Because there is still a strong stigma about mental disorders, the person you know may never tell you. Like people with unipolar depression, they suffer in silence. But as we do more research on the brain with PET scans and the like and we begin to figure out how brain chemicals work, it becomes clear that there is a physical component to this and other “mental illnesses”.

For me, one of the things that is important about Mental Illness Awareness is about accepting that there should be no difference in how we treat “mental” illnesses and how we treat “physical” ones.

Do you know someone with a mental illness? Do YOU have a mental illness? How does it affect your/their ability to hold a job? To maintain relationships? To “have a life”?