The Switch

I’ve been flying high on a cloud made of hypomania the last couple weeks, so high I thought the wonderful feelings and extra energy might last forever.

Then, the switch happened.

A bipolar switch can easily be defined as the moment one mood or episode changes into another. The problem is that the way these switches happen is usually much less straight forward.

Realistically, there are times when folks (myself included) wake up one morning and things have changed. I would say this is the most polite way bipolar disorder can make a shift in mood, but for me that is very rarely the case.

There might also be times where the switch occurs sometime over the course of the day (or night). This seems to be the case most often when an episode is triggered by something, or when one has been holding everything back all day only to get home and have it all explode out in a flurry of emotion. To have your day thus interrupted is certainly inconvenient, and feeling your mood change from one extreme to the next can be uncomfortable, if not totally maddening.

The third (and my decidedly least favorite) option the switch can take is to playfully leap back and forth between moods for hours, days, even weeks before finally settling again on an opposing mood.

This was how my day went down Sunday (yesterday). It was as if my mood had been sent through some kind of cheese grater, switching six times between delightful hypomania and a horrible mixed state.

One minute I was intensely irritable, throwing things in the apartment, stomping around like a child and yelling at the dog, then I would be delightfully enjoying a burrito and moseying along in the Seattle sun. An hour or two later, more scowling, throwing, and stomping, followed by a casual, relaxed couple hours watching a movie.

Unfortunately, this isn’t entirely uncommon for me. There are times when it seems like my brain either wants to ease me into the next type of episode by giving me little hints of it at a time, or wants to “spice up” an episode by sprinkling in all kinds of unwanted turmoil. Either way, going from feeling elated to self-punishing and back to elated within a series of a few minutes can leave one feeling very confused at best, and certainly scared as to what might happen next.

I woke up this morning very alert. I had a dream last night about Las Vegas, which meant mostly waking up with a smile on my face (and you know, I’m not going to speculate why Las Vegas, in my dream, was populated solely by the Chinese) so I feel tentatively optimistic. The problem is that after a day like yesterday, I’m starting my week off very nervously.

After all, will today be a repeat of yesterday? Are my joyous recent days of hypomania over soon, or might I be lucky enough that yesterday’s mixed moments were a product of something fleeting like… hormones? Either way, I suppose being prepared at this point is half the battle, and after yesterday’s roller coaster I don’t expect to let the rest of this switch take me by surprise!

Finding a Primary Care Provider

Recently, more and more health insurance providers are moving toward a system where signing up for care means being assigned a primary care provider (general physician) until you choose to change that physician to someone else.

The trouble is (and I’ve found this on more than one occasion) many of the lists these primary care providers (or PCPs for short) are coming from are outdated. These lists on record often contain the names of physicians that no longer work for the hospitals and clinics found on the list, or they are no longer accepting new patients.

Yesterday I found myself in something of a pickle. My medicaid plan (signed up for near the end of the affordable care act enrollment time) assigned me a sub plan automatically (until I chose another) which also assigned me a primary care doctor that didn’t exist.

What’s worse is that when I tried to fix this (and pick another plan under medicaid) I found out it wouldn’t kick in until May, leaving me a window through April with a wonky plan and no doctor.

Fifteen minutes of tears and a panic attack later, I made an attempt to find a new primary care physician under the plan I was stuck with, only to have the plans’ customer service people assign me a second, non existent doctor. 

The point of this story, to me, is pretty clear. Relying on someone in a cubicle and a phone to choose my doctor for me is ridiculous. Trying to pick a doctor out of a list of names also seems ludicrous, after all… how do I even know which ones are good?

In a blog about mental health, you might be wondering just how important general physicians are anyway… but there are many reasons having a good primary care doctor can work in your favor.

Primary physicians can be the gateway to mental health treatment. I know several people who are prescribed mental health medications by a primary physician (though I’ve had terrible luck with that myself). On top of that, many insurance plans require a primary physician to refer (basically give you an “in” and a stamp of approval for mental health treatment to your insurance provider) you to mental health specialists before you can get treatment.

Primary physicians are often a gateway to all realms of physical health. If your insurance doesn’t require a referral for mental health services, it is much more common to require referrals to all other specialists, including anything from dermatology to neurology to allergy specialists. Doing what we can to help our minds is only half the battle, we need to be able to take care of our bodies as well. This might even include a primary physician helping counteract physical side effects of psychiatric medications, something that has been super important in my own search for better health!

Yes, these people are important, but when being assigned phantom PCPs, how do we find good doctors accepting new clients who also take my insurance??

My advice is not to start too small. Start by looking for locations that generally accept your insurance. You can do this by doing a search online at your insurance provider’s website (usually, you might have to google the addresses you find to see the actual locations), or you can call your insurance customer service line (though I’m warning you, this can be a huge headache). Something that worked for me was calling the office of my phantom PCP (via a number on my new insurance card) and finding out there were several (real) doctors there that do take my insurance.

I find that if you need to choose between calling insurance people or calling clinics, you will often get much more help from the clinic receptionists. As long as you try to remain calm and friendly, they can usually point you in the right direction.

We have several hospital systems in Seattle, so finding out what hospital system takes the health insurance in question can also help you find primary care doctors and specialists in your area. I called my usual hospital (who didn’t take my new insurance) but found out another hospital down the road who does. 

Don’t underestimate the knowledge of friends, family, or co-workers who have the same insurance as you. If you know someone on your plan who claims they have a great doctor, ask for their information! This rings true for not only primary care doctors, but psychiatrists, therapists, and any other specialist you might be interested in seeing.

Once you’ve found out if a location (or if doctors at a given location) take your insurance, you can call and ask the receptionist if anyone is accepting new clients. I’ve met some really wonderful receptionists who have even gone so far as to give me brief descriptions of the available doctors dispositions!

Writing down the name of the doctor (with correct spelling), the phone number of the location, and the address is important. Once you have this information, you can go back to the insurance website or customer service line and request a change of primary care physician.

This last step is IMPORTANT, because if you don’t follow through with the choice that you’ve made your insurance company can potentially deny your claim (aka not pay for it) if the doctor you see doesn’t match the doctor listed in their database.

Some insurance companies will allow you to change this information on their website, while others have an automated phone system. On occasion you might need to speak to a customer service representative (who may also put you on hold to call the clinic you just talked to and verify the information). In any case, once you have finished the process you can expect to receive a new ID card in the mail with your new (and correct) PCP information listed.

I realize this is a lot of information, and I know nobody likes insurance nonsense, but finding and selecting a primary care physician before attempting to interact with insurance representatives can save you a lot of hassle. I know it would have saved me a panic attack, and three hours of yesterday’s morning!

Hypomanics Just Want to Have Fun

I’ve been hypomanic, but I didn’t realize to what extent exactly. Yes, there has been hilarious dancing, yes I have been walking up to strangers on the street and talking to them, and yes, my anxiety around spending money has been lifted and I casually bought a pair of shorts.

When I got into my therapist’s office yesterday (our relationship renewed by medicaid’s promise to give me 33 free sessions) I said,

“Well, I’ve been having trouble sleeping and I’ve been running all over the city for two days straight, but things don’t seem too intense.”

I shrugged and wrote off my symptoms. After all, I wasn’t experiencing any agitation (or even racing thoughts), and things hadn’t reached the point of mania (where people couldn’t understand what I was saying anymore) so things seemed fine.

After about fifteen minutes of talking and filling out some paperwork my therapist looked at me and said,

“I realize this may be coming out of left field, but you’re speaking rapidly, using much more exaggerated hand gestures than usual, and your volume is just short of yelling.”

I was shocked, not that she said that to me… but that I hadn’t any idea that I was doing any of these things.

To be fair, two years ago I couldn’t pinpoint manic symptoms in myself short of starting a fight with a pharmacist or believing I was a werewolf. It seems so much easier to pinpoint symptoms of depression or mixed episodes, because they feel unpleasant. How difficult is it to notice I am experiencing something or doing something that feels great?

When it comes to hypomania, I can recognize insomnia, or a lack of hunger, or high waves of energy, even giddiness and elation. Less straightforward is the part where this becomes funneled through me and introduces itself to other people’s lives.

I don’t really know how to pinpoint symptoms like rapid speech and exaggerated hand gestures, short of someone pointing them out to me. Even then, my therapist asked if he pointing these things out made me want to change my behavior. At the time, sitting there, I said no.

As much as I am afraid of coming off wild and intensely, I know this period also lends itself to a certain hilarity that I can’t embrace quite the same way at other times. It becomes easier to tell jokes, easier to laugh at jokes, and easier to take conversational risks.

I know this can ball itself up and transform into mania (or even a mixed state) but it seems as though the acting excitedly itself isn’t an issue. Just because I am paying close attention, monitoring my sleep and eating to try to keep things wrangled in doesn’t mean I can’t have a little fun.

And after a little depression, don’t we all deserve a little fun?

Journalist Comes Out About Having Mental Illness

I want to share an article that I found interesting, it is a post written by Mark Joyella, a journalist and former television reporter who has just recently come out about having a mental illness to help fight the stigma that surrounds it.

His article, Screw Stigma. I’m Coming Out takes us on a journey through his fear of being identified as a mental health consumer to a place where he feels comfortable sharing his OCD diagnosis.

For someone in the public eye, I found this article to be extremely thoughtful and well written, as well as reflective. I think his journey can be related to anyone who has questioned their own diagnosis or felt self conscious about the idea of having a mental illness, not just for folks who have an OCD diagnosis.

In any case, I suggest checking it out… and for Mark Joyella, a big high five – thank you for being brave enough to come forward about your experiences!

Learning to Say “No”

For a long time I had trouble saying no. I think it had to do with the notion that people would like me more if I gave them what they wanted combined with an intense terror and anxiety about what would happen if I were to say “no”.

Realistically, there were many years where I just did what everyone around me wanted me to do. I relied on everyone else to make up my own mind for me.

Go on a special diet? Ok.

Hang out with an emotionally abusive friend? Ok.

Watch my boyfriend spend our anniversary hanging out with his friends? Sure.

I don’t think it is that I didn’t have any of my own opinions, I was just afraid of what would happen if I expressed them.

After all, if I told my boyfriend he was being a dick, wouldn’t he break up with me?

And if I told that emotionally abusive friend I didn’t want to hang out, wouldn’t she verbally attack me until I gave in anyway?

And if I went against a doctor’s orders, would I be blacklisted from their office or… well… die?

That might sound a little extreme, but fear can take you to many odd, irrational places.

The breakthrough came when I met with an art therapist named Sandy who told me I could say no. There was something about someone I respected giving me permission to say no and stand up for myself that gave me a nudge in the right direction.

I slowly switched tactics, saying “no” when I could muster the strength to do so by adding an explanation in my response. My intense anxiety dictated that the explanation always be true. That way I wouldn’t feel “caught in a lie” if the other person tried to call me out, and I would feel better defending my original response.

The explanations I gave felt necessary. Part of me didn’t believe that if I just said no, people would take it at face value. There were so many people in my past who would poke a prod if there were any air of mystery around what I was doing, so I let them know immediately.

To be honest, this system was a great stepping stone for me, but something about constantly explaining myself to others made me feel vulnerable and like I was looking for their approval. It wasn’t until my latest therapist that I heard a thought that would change everything.

“You don’t have to give any explanation, you can always just say no.”

I laughed at that, it boggled my mind at the time. I couldn’t really believe anyone could say no without being completely trampled by the person they were saying it to. I’m sure part of that comes from a life with so many people who have trampled me, and the unyielding urge to remain as un-trampled as possible.

Still, about a month ago I found myself sitting on the floor with my phone. A friend had asked if I wanted to hang out and I was racking my brain, searching for a reason for not doing so that would sound good. I wanted to have a reason for saying no that wouldn’t offend them, something that would still make them feel important… but without lying. I was having trouble coming up with the words.

After thirty minutes of rolling around on the carpet contemplating the situation a lightbulb went off in my head. I could just say, “no”.

So I did.

A few minutes later I got the response, “ok, no problem.” And that was it.

I leapt up and danced around the apartment as Corey rolled his eyes at me. “I just said ‘no’ with no explanation!” I shouted as I wiggled around the living room, throwing my hands in the air.

He didn’t see the significance, but it was the first time I’d ever just said no.

Maybe this change is fueled partially by my age, as I feel more and more comfortable asking for the things I want and being ok with my own preferences. At the same time, it has taken me years to cut the people out of my life who make me feel small and insignificant and replace them with people who respect me and the things I have to say. Doing so has given me an environment where saying what is on my mind has little chance of emotional backlash, and though it still feels terrifying (at times) expressing my needs I am coming to realize that there is no point being afraid of the ghosts of a precarious past that has long passed.

Cosmic Weight

My anxiety has been through the roof the last few days, to the point where it feels like giant fingers are wrapped around me in a constant, slow squeeze. I keep breathing in as deeply as I can to fight the feeling of constriction, but I am left still, minutes later, out of breath.

Last week there was a death in my family. Not a fun prospect, considering my family is quite small to begin with. The shock I felt was compounded by the fact that my grandpa was someone who I remember always smiling and laughing, always a welcome sight in a rather emotionally tumultuous family.

I can’t help but wonder if the last two days of depression and intense anxiety I’ve had are a slow response to losing someone. Sometimes it can be so hard to tell what feelings go with what situation (or if they are correlated with any at all) but it seems to be pretty common for me to have delayed reactions, emotionally.

All I know is that the realm of bad news has been pretty intense for me this year and (as I stated the last two months) really cosmos, you can stop any time now.

At any rate, I am hoping spending some time outside in the sunshine today will help lift the spirits a bit and will give me a little relief from otherwise crushing anxiety!

Confronting Delusions

The older I get, the more acutely I’m aware that my mind creates fictional situations and relationships all on its own. Once I started paying more attention to this process, I realized that this issue seems to come from my mind jumping to conclusions after stumbling upon something my mind considers to be a clue.

Here is a very simplified example.

I call my boyfriend.

Clue: he doesn’t answer.

Delusion: he is dead.

I’ve gotten better at spotting these irrational conclusions in simple situations (like the one above) but in the cases of hardcore delusions (like the one 16 months ago where I was certain my boss was trying to get me fired and sabotage the company we worked for) my delusions are made of a series of clues, usually all taken out of context, coupled with subsequent bad-conclusion-jumping.

It seems that in these situations, anything I read, anything that comes up in conversation, as well as physical clues (mail, clothing, you name it) all begin working together in a web of total fiction. The more clues I stumble upon that seem to lend themselves to my theory only make a stronger case for the delusion, and makes it more difficult for me to break the spell.

Generally, when I begin having delusions like this, I tend to make things much more complicated by talking to different people about it. I might easily find myself talking about the clues or suspected theory to friends, family, or my therapist even… and though one would think this might help (and it does occasionally) most often people take what I have to say at face value. Usually if I believe it, it isn’t totally unreasonable to suspect the people I tell will believe it as well.

There have been a few situations where I was contested about what I mentioned, but it wasn’t enough to “break the spell” until almost a month later. No, realistically what I’ve learned is that it is best to go straight to the source.

I had a delusion almost a year ago now that one of my friends was having an affair with another friend of mine. In that situation I knew I couldn’t completely trust myself and the conclusion I had come to, so I did the only thing I could… I confronted one of them and asked about it.

NOW, confronting someone you have a delusion about in an attempt to find the truth has been one of the most uncomfortable things I’ve ever had to do. In some cases it has actually been a bit rewarding (not having to continue obsessing over the delusion anymore is nice) but generally, you need to know that it really puts people off.

I’ve only done this sort of thing with people who are pretty close to me, people who already know about my (somewhat questionable) mental health. Even then, starting the conversation with something like, “so, I have a question for you, and I don’t want you to get upset because it is going to sound totally crazy -but that is only because I think I may be delusional. I just need to know what is real and what isn’t!”

Yes, people get offended. Or distraught. Or very silent.

(I guess this is starting to sound less and less like a good idea, but I swear it can be very helpful!)

The thing is, the way my brain functions, I need to be able to walk up to someone I trust and ask if something happened, or didn’t. If something exists, or it doesn’t. If they saw or heard something or if there was only silence a moment ago.

There are so many layers of things going on in my mind that sometimes I need to be able to ask if I’m the only one experiencing something, or if everyone else saw/heard/knows it too.

Though mildly concerning to the people I’ve asked of this before, the result on my end has been extremely helpful. By going straight to the person I’m having delusions about and asking them about the situation I am essentially bypassing days, week, maybe even months of delusional thoughts and “clues” that riddle my brain with no real point (apart from distraction), as well as averting potential crises (like setting a huge HR investigation in motion).

I’ve also had to consider what this does to my reputation. After all, it isn’t particularly common for people to be sharing their delusions (let alone confronting people about them) and it probably looks a little… weird. Since I embrace the fact that I’m a bit of an oddball, it doesn’t bother me much at all.

I guess the best advice I can give is to tread carefully.

No. Wait.

The best advice I can give is to have one person in your life that you can trust and be honest with who will tell you (gently) that you have no idea what you’re talking about. If you can find more than one, consider yourself very lucky!

Sometimes it is better to go straight to the source when it comes to delusions. If you can risk talking to the person about the delusional situation you could ultimately save yourself a lot of time and trouble down the road.