Monthly Archives: February 2015

Like Black and White

The effect bipolar disorder has on my life is never quite as apparent as it is when I see two distinct periods book-ended together.

The way things have been for the last four years I generally have found myself in a “stable” headspace for a week (maybe two if I’ve been really good) each year. During these periods it feels like slipping back through time, and the sounds of birds and expansive sky are not blacked out by a wall of noise and fear in my head.

I admit (though somewhat embarrassingly) that it is has been pretty common for me to begin to believe I am free of it. That life will go on with birds chirping and the sun shining and everything I have experienced will fade like a bad dream.

The truth is that in my life, those stable moments have been both the bearer of exceptional hope and the product of immeasurable fear. Hope that I could once again live my life feeling relaxed and calm… but fear that the rug will be swept out from under me at any moment.

So this is what I mean by two distinct periods book-ended together. Sometimes the clarity I find comes from experiencing mania and depression back to back, but overall the moments I am able to truly see the difference between a stable, rational me and what I experience the other 95% of the time are when the chirping birds and blue sky are suddenly drowned out by the inescapable noise and dampening via my brain.

This has been my situation the last two weeks. Though I have done my best to “avoid stress” it isn’t possible for me to avoid my health problems and the surgery I need to help correct them. With this news came the curtain, and with the curtain has come a very interesting view of how dramatically different my brain works when cycling vs. not.

At any rate, I just wanted to mention that I may be absent from this blog for a few weeks while I get surgery and heal up. I need to focus on coaxing my brain through this emotional maze with as much cheese as I can get my hands on.

Advertisements

Giving Someone With Bipolar Disorder Bad News Safely

I’ve had a number of people tell me lately that they don’t feel comfortable telling me bad news. The idea that people close to me are hiding serious issues from me because they are afraid of triggering my bipolar disorder is extremely frustrating; while I appreciate that people are trying to be wary of my feelings, the plan almost always backfires. Hearing bad news and that the people closest to me have been hiding it makes for an even bigger mood implosion.

The best I can do is try to convey that I realize I have trouble processing bad news, but the manner in which that news is passed on to me has a huge impact on my reaction.

When frightening or serious news is dropped in my lap suddenly (without warning) it can feel significantly more shocking; likewise if the conversation ends moments later (and I haven’t been able to ask any questions or begin to wrap my head around the news) I often find myself trapped in emotional quicksand. The more I struggle to understand on my own, the faster I sink into depression, anxiety, and irritability.

Through my experiences I have devised some tips to help ease some of the emotional reaction in situations regarding passing-on upsetting news. Personally, these things have all lent themselves to a much more safe emotional environment and a quicker recovery from intense bipolar emotional reactions.

1. Be up-front that the news might be distressing.

Letting someone know that a conversation is going to take a serious turn (instead of taking the turn suddenly) can make serious news much less jarring. There is something to be said about being able to prepare oneself mentally before receiving bad or serious news, and part of what contributes to a bad emotional reaction in my case has often been feeling blindsided and totally unprepared to hear something jarring.

Having said that, I have found even very broad, general statements like, “I have something serious to tell you,” or “can we have a serious talk?” are effective in this arena. If I know I might be at risk of having an emotional reaction, I can do a better job of containing myself than if the news is just dropped on me suddenly.

2. Bookend the bad news.

The best way I have found to receive (and give) potentially upsetting news is to bookend the serious subject matter with more lighthearted information. Starting the conversation in a casual way to ease the tension before launching into serious content can help folks feel less anxious about the upcoming serious bit. Probably more importantly (to me anyway) is ending the conversation with something more light-hearted to bring the mood back to the present can help with avoiding being caught up completely in the emotion of the serious bit.

Often hearing bad news can put us in a situation where we feel attacked or fearful, even unsafe. Being able to laugh at a bad joke or talk about a cute puppy really helps nullify that feeling of fear that can be the beginning of a big emotional spiral. In my life, being able to sidestep that fear makes for a totally different reaction to bad news and I am able to focus on counteracting my shock more than having to counteract my fear.

3. Make it a dialogue.

One of the things that really feeds into my fear when I get bad news is being unable to get answers the questions I have about what has happened/is happening. I do not want my mind uncontrollably fantasizing about all of the questions I have (and it will) so being able to ask questions and get answers that I understand makes a big difference in how my reaction will unfold. If we don’t have time to have a dialogue about the topic (and not just be subject to a monologue) then the timing probably isn’t appropriate.

4. Consider timing.

A couple days ago I received some bad news about 15 minutes before I was about to go to bed. Needless to say, I didn’t sleep that night.

Likewise, stress can be a big factor in how reactive my bipolar disorder is in any given situation. Laying some bad news on me when I am already agitated or stressed will yield worse results than providing the same information when I am relatively stable or calm. Again, even in an unstable situation, following tips 1-3 can pave the way for a better reaction.

5. Life happens.

Life is full of good news and bad news, that is just the way it goes. Unfortunately, living with bipolar disorder can make getting bad news extremely disruptive to our lives and our relationships, but pretending that bad news doesn’t exist doesn’t help us learn to cope with our reactive nature or practice living a full life.

Ultimately, I want to believe that the people in my life are genuine with me and open about their lives and their experiences. Honestly, in times where I could tell people close to me were holding back bad news it felt almost more maddening than if they had just been honest! Though this is an area that is very sensitive for many people with bipolar disorder, being gentle about the subject matter and being respectful to our situation when being open with us can mean a world of difference -not just for us, but also for our relationships.

Concluding Hormonal Treatment; Pushing the Bipolar Button

My second jaunt down Hormone Road this week ended relatively the same as the first (two-three weeks ago). By day six I was experiencing so much anhedonia I couldn’t eat or sleep. I had become completely engulfed in a tidal wave of pointlessness and self harm fantasies, so much so I could be seen walking up and down the street in the rain like a zombie, frowning for no real apparent reason.

Honestly, I pretty much expected this (since it already happened once two weeks ago) but I was holding on to some faint hope that I might be able to avoid surgery for the odd and still somewhat unknown abdominal problems I have developed. I’ve never had surgery (well, just a wisdom tooth extraction), and never even stitches, so the idea of anyone slicing me open (even a little slice) makes me exceedingly nervous.

Despite my inability to talk with the nurse over the phone in a polite or straightforward manner I am pretty proud of myself. She suggested I see the surgeon the same day I was calling to let her know about my reaction to the hormones, but somewhere in the back of my mind a little voice reminded me that I couldn’t figure out how to use the shower the day before (the same shower I have been using for the last six moths). If I couldn’t figure out how to make hot water come out of a tap (with only two options, left and right) it might not be the best idea for me to talk with a surgeon and make important decisions about the most invasive procedure I will have ever had up to this point. I told her it would be better to meet with him next week, and I am glad I did because it would be another 24 hours before I could smile for the first time in days.

One thing I have found relatively interesting from this whole hormonal excursion is that the first round (on a higher dosage of hormones; desogen) triggered an extremely agitated mixed state where I was depressed, but also very aggressive (not unlike my experiences triggered by corticosteroids). The second round (lower dosage, microgestin) provided a straight-up triggering of intense hopeless depression. Even after I stopped taking the drug (after waking up completely depressed) the depression worsened for 48 hours before the symptoms began to recede.

As usual, I feel compelled to point out that my body (for whatever reason) has become extremely sensitive to pretty much any and all medications I’ve tried, usually with some very poor results. Though it is probably not typical for people to have these sorts of reactions to hormones, it irks me somewhat that most bloggers and internet articles have now taken the stance that hormones never cause mood issues. Of course, this was also the stance of the first nurse who ever gave me hormonal birth control (when I was 18) -which promptly landed me in a psychiatric facility because of a sudden intense mixed episode.

Do hormones cause people to have mood problems? Maybe not most people, but I believe that anyone making broad sweeping generalizations about how safe and effective a treatment is (hormones never cause mood problems, vitamin supplements never cause side effects) are usually trying to sell you something. The truth is that even though hormones might not cause mood problems in most people, nobody ever mentioned them potentially triggering episodes for people who already have abnormally behaving moods.

Frankly, going into this second round of hormones I guessed (with probably 90% certainty) that I would not be able to tolerate them. This guess was not based on anything I read on the internet, but based on my own experience with hormonal treatments I previously encountered (prior hospitalizations, prior depression triggered by hormones, etc.). Having tried a multitude of medications in the past few years (and finding myself reacting to them in unusual ways) has taught me that the best thing anyone can do when starting a new kind of treatment is pay attention. Get to know what is typical for you; a typical headache, a typical bipolar episode, even your typical aches and pains. Without knowing how my body and mind normally act, it becomes incredibly confusing and maddening trying to discern side effects from the normal mood cycles I experience.

And most of all? Don’t forget about your doctor. If something is feeling off, or if I feel much more miserable more quickly than I normally would (like this week)… that’s when it is time to say something. I know that I tend to get incredibly anxious about contacting my doctors after starting a new treatment because I don’t want to appear to be a hypochondriac, but working with people I trust has meant that they also trust my judgment, and I know they want the best for me.

As frightening as surgery sounds to me, after 7-8 months of extreme pain I am ready for this issue to be addressed… and if hormones are not going to be the way to do that, I am ready to take whatever steps I need to in order to improve this situation. Though I can rule out episodes triggered by hormonal therapies at this point, the pain I have been experiencing is significant enough to trigger episodes as well. In the end, all of the healthcare I have been seeking is ultimately tied to improving my mental health as well, less pain -> less stress/distress -> more sleep -> more stable mood. I am hoping that if I can get my body to a relatively happy place, my mind might follow suit.