Monthly Archives: September 2016

Writing for Relief

I don’t know about you, but there are times when I feel that going a week (or two, or three) between therapy sessions is far too long.

I don’t think it is because I have an extraordinary amount of drama in my life, but there are some subjects and issues I only really discuss with my therapist. I’ve found that there are things I’ve brought up with friends or family that really weren’t constructive because nobody could relate, so short of therapy (or group therapy) I have a vat in my brain where all those thoughts just kind of slosh around in holding until I have the opportunity to wash the tank out each week.

A full and sloshing vat of pent up confusion or sadness or anger or whatever is hardly ideal. It can get so full that things start to spill over into my daily life, and that’s not cool. Sometimes it can get so full the structural integrity of the vat can’t hold it all and it blows up in my face. Squishy thought fragments get all over the floor, everything gets warped… it’s a nightmare to clean up.

Lately I would say I’ve been exploring some rather complex issues and thoughts and they aren’t things that I can easily talk about with the people around me. Sometimes I feel like things are just too abstract to be able to talk about in a way that will make sense to people, and therapy really helps me take pieces of an idea and mold them into something coherent.

Words.

But, as I’ve pointed out, that isn’t always an option. Sometimes I need my brain to form words sooner rather than later, because once these bits are formed into pieces that I can understand they become solid. I can take them from the vat and file them wherever they need to be filed in my head.

I learned pretty early in my life that writing is one way I can form those bits into full words and ideas on my own without waiting for the vat to overflow.

In my youth having a journal was (pardon my nerdiness here) kind of like having my own personal horcrux. It was someplace I could turn those thought fragments into words and store them to save space in my mind. At the same time negative thoughts and imagery could live in the journal safely without having to constantly nag at me. Looking back at these journals has showed me that they were really a stream-of-consciousness word barf sort of situation, and that’s fine (now where did I put that basilisk fang?). They weren’t meant to be on the top of the New York Times bestsellers list. Writing that way helped me cope with the sheer volume of everything inside my head and allowed me to have a little more space to concentrate.

As I got older writing and journaling began to allow me to ask questions of myself and the world and brainstorm what they might mean or what the answers might be. It became a tool for me to organize my thoughts more than just dump them.

Things progressed even further when I began writing this blog and used the writing process here to take questions or ideas I had about mental health, put them into words, and then try to arrange those words in ways that made sense to other people. I’d say this not only satisfied my desire to understand things better, it has also meant working toward being able to communicate better in general around the topic of mental health.

Writing is incredible that way, it is a form of expression I really think I took for granted but didn’t realize for a long time how many ways it has helped me. Writing in journals, writing poetry, writing blogs, there are a lot of options to try depending on what you might hope to get out of it. Some of the biggest takeaways I’ve encountered are:

  • Organizing thoughts
  • Purging negative thoughts or ideas for relief
  • Expressing hidden emotions I may not express otherwise
  • Better understanding (of myself, my illnesses, my issues, my situation, etc.)
  • Seeing things from another perspective (great with writing prompts)
  • Taking the terror out of something I’m afraid of (by exploring what is so scary about it)
  • A place to practice “positive self talk” (letting myself know that I am awesome, I’m doing a good job at life, and I’ve got this handled)
  • An outlet for conveying difficult ideas to other people (blogging, for example)
  • A way to become familiar with words that go with my emotions, being familiar with this vocabulary has made it easier for me to express them in situations outside of writing.
  • Perspective on a past version of myself, seeing how far I’ve come (only if I’m willing to go back and read it)
  • A sense of relief and release should I feel inclined to write about something I’m holding onto and destroying the writing later (shredding, burning, etc.)
  • You never know, something you wrote could be comedic gold in 20 years (check out Mortified for some super amazing adults reading their teenage journals aloud, I love it)

I’m sure that is just the tip of the iceberg there.

I wanted to share this topic this week because I’ve been dealing with some difficult topics in my life that are hazy. They remind me a lot of when I first started trying to write about mental illness and I found I didn’t have the words to describe what it felt like, or how it worked in me. Back then I didn’t even know what my emotions were, I was so used to pushing them down that I couldn’t readily identify one from another.

Likewise I’ve found myself opening all kinds of old boxes in my brain only to find that there are things that are still very relevant. They may not pertain to mental health, but they are things that, like my emotions, I’ve been cramming in boxes and throwing in deep storage for the past 30 years. As I’ve delved into all of this I’ve also started feeling some depression, I’ve felt confused and overwhelmed and quite a lot like I don’t believe I can handle it.

That’s the thing though, isn’t it? Mental illness isn’t going to wait for me to clean out the freezer and the garage before it rushes in to greet me, at least, not with the kind I have. Having treatment resistant Bipolar Disorder means having to multitask sometimes, even when what is in front of me doesn’t seem to have any baring on my illness specifically. Of course, I am more than willing to admit that the prospect of repressing any important memory or issue is probably depressing to anyone, but with my diagnosis I can pretty much anticipate that reaction in a very certain way.

One of the ways I’ve been coping with this has been to write. I’ve been writing non-stop for the past three weeks and then had to ease up the past few days because my hands were swollen from typing (which has meant not being able to play xbox either, rough!). Writing has become a place where I feel comfortable with my thoughts and feelings, and it is great because I don’t always feel that in social situations.

I would attribute writing (though I am self-soothing, getting outside, eating regularly, all that jazz) to the relatively level amount of depression I’ve been having. Yeah, it isn’t ideal… but being able to write enough to keep this vat from overflowing (ugh, and I just stained the new hardwoods too!) has helped keep me more rational and able to deal with the depression as it comes and has seemed to keep the depression from becoming totally consuming.

Whether I am writing something private or public it is comforting to know that I have complete control over what goes on the page, but the best feeling is to allow myself to step over the line of control, to allow myself to write anything and everything I feel. It can be an act of rebellion, it can be profound, it can be silly, it can be unidentifiable. In the end it doesn’t matter to me because it is the act that defines it, not the finished product.

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Total Eclipse of the Gut

For many years now I’ve been avoiding my gut instincts. Maybe avoiding is the wrong word, I’ve been wary of them and I haven’t been implementing them when they come up. I guess that is probably one definition of avoiding, but for whatever reason it feels important to me to add that part about feeling wary.

I’ve been thinking of my gut feelings as the product of an inner-office anonymous comments box and I’m the poor sap who has to sift through the comments that have been left there.

“This is a place to leave comments,” the box says, “ideas, and suggestions on how to make the office run more smoothly. They will be reviewed by management in the consciousness department.”

Of course, I haven’t been able to take the program very seriously when many of the comments have read things like:

Absolutely trust that guy who is inviting you inside his house and says there is free taco bell inside.

or

Can we please collect more roadkill? The IT department won’t even notice the smell.

or

Make Fridays “casual werewolf” day.

In the beginning I followed through with most of the suggestions in the box only to realize there are one or two A-holes in the office (damn you Psychosis! Mania! And don’t think I don’t see you sneaking around over there too Depression!) who keep leaving these bizarre notes they expect me to follow through on.

Without a filter to keep the odd comments from the important ones the results historically turned out poorly.

But that’s always the story, isn’t it? One or two bad apples ruining it for everyone. As the manager of the office inside my brain I’ve had to stop allowing comments from within myself simply to keep from doing some totally stupid and irrational things. The trouble is… all of the good, useful comments have also been discarded in the process.

In the meantime I’ve worked to try to improve the comments program. It has been temping every time someone has told me “just trust your gut” I feel like I ought to give it a second chance, despite constantly winding up in situations where I’ve taken away all of the pairs of scissors and staplers in the office during a busy week or deprived my employees of contact with the outside world for days until they go on strike and say, “you know, we really aren’t getting any work done at this rate.”

As someone who wants to manage this office well I’ve taken it upon myself to try to find answers. To research and test through trial and error what I could do to keep the team running. I’ve scoured the anonymous comments with handwriting analysis in hopes of being able to pull Psychosis’ notes from the rest (and the rest of those who love to throw a wrench into things) with no luck. I even hired on a new employee (Rationalization) to help manage the comments department but ultimately it didn’t seem to make much difference. Before long Rationalization seemed willing to justify why casual-werewolf-Fridays would be great and I had to halt the project over again.

While I was searching for a solution I wasn’t expecting things to get worse. One of my employees, Sexuality, began leaving notes in the comment box in an effort to make the break-room more LGBT friendly. I discarded all of those comments with the suspicion that they may have come from Psychosis playing a prank. Denying all of the comments meant denying the legitimate ones too, and before long Sexuality was upset and launching a full scale mutiny, bringing all of her closest co-workers on board. Depression wailed, Energy dropped dramatically and wouldn’t come out from under their desk, and Self-Worth made a very rude gesture at me during my 3 pm coffee break.

When Intimacy made a request to work harder on relationships in an effort to feel more connected I ignored it. I was certain it was Psychosis again, and even though I hadn’t seen them in weeks I thought for sure it was some game of misdirection. Pretty soon Anger snapped after a paper jam and ripped the feeder tray off the unit and Productivity simply stood up and said, “I can’t work in an environment like this, I’m going home.”

I watched chaos erupt from my cubicle and that’s when my phone rang.

“Yes, Department of Consciousness here,” I answered.

“This is HR,” a voice said. “It has come to our attention that you’ve denied a request to make the breakroom more LGBT friendly and I’m afraid Sexuality has come to us to file a complaint.”

Sexuality filed that comment?!?” I asked astounded, “Are you sure it wasn’t Psychosis?

“Sarah, Psychosis hasn’t been in in weeks, hasn’t even booted up to work remotely, there hasn’t been a need. I’m afraid the issue at hand is bordering on discrimination at this point so it needs to be addressed immediately. If you can’t take care of it, we’ll find someone who can.” The voice said.

“Of course!” my mind reeled, horror struck that I had ignored something so important. “Right away!”

“Good day.” The voice added.

“Wait!” I quickly cried upon realizing I’d never encountered anyone from HR, “Who is this?” But all I heard with a click followed by a dial tone.

 *

I’ve gone through years of therapy trying to figure out how to discern which piece of my internal dialogue to listen to, how to pinpoint the difference between when my gut says something to me and when it is mental illness pushing me in a specific direction.

Ultimately I reached the point where I felt the need to scrutinize everything that ran through my head before making any decisions. It didn’t keep me from having manic episodes, or depressive episodes, or psychotic episodes or doing wildly irrational things. All it did was create a backlog of personal issues that built up and began contributing to my anger and depression and paving strange avenues that I’d find myself trying to take to solve those issues when I was psychotic or manic. In some ways it seems as though Psychosis was trying to help me, attempting to take back doors to solve issues I wasn’t solving directly.

That is part of what has made everything so blurry. I was so worked up and emotional about some issues when I was psychotic (or depressed or manic) I couldn’t see how important the same issues were to me when I wasn’t. I simply didn’t feel the same level of intensity about them when I was feeling stable, even though they still mattered.

All this time I’ve considered psychosis to be like a bubble, like I could discard anything that happened within the bubble in which the episode took place and discount any aspect as being useful or informative (though usually a good story later). The psychosis bubbles that arose eclipsed my gut instincts entirely, or at least discounting anything within those bubbles often also meant discounting real and important instincts. Really, the more time I take to understand the issues I’ve been avoiding, the more it seems that my episodes have acted more like a magnet drawn intensely to those same issues rather than provoke or direct me toward new useless ones.

I’m sure all that is confusing, and it is to me too. Even so, this has been a huge revelation for me because it means the eclipse is ending. I’m realizing that there is value in every comment in that comment box, even the ones I considered to be a joke.

“You mean, you’re listening to yourself again?” My therapist asked last week.

*

I imagined myself in that office, smeared with printer toner and covered in paper cuts climbing on top of my desk and waving my arms.

“Alright! Alright!” I shouted at them. “I’ve been a terrible manager, I can see that now. Ignoring you isn’t helping us get things done and the box,” I kicked the comments box off my desk onto the carpet littered with remnants from the three hole punch and paper clips, “screw the box. The box isn’t working! From now on we’ll have an open door policy and if you need something you can come directly to me. Even you Psychosis,” I added as a fit of giggles came from over one of the speaker phones.

“I’m sorry I went behind your back,” Sexuality said to me as the last of the internal raging died down and we began cleaning up.

“I don’t blame you,” I replied, dumping the old comments box into the trash. “I guess I was so wrapped up in working on communicating to the outside world that I forgot the importance of communication here.”

*

“Um, yes,” I replied to my therapist, blinking for a moment. “I am listening, and I expect I have a hell of a lot to say.”

 

Big Picture Mood Charting

I’m sure those of you that have been reading a while know that I am a big mood-charting enthusiast and for those of you who haven’t, well, I get a real thrill from any kind of chart or graph in general. Don’t even get me started on those that can convey something as mysterious as the inner workings of living with bipolar disorder… that’s my jam.

I’ve spent a lot of time messing around with different charts and graphs as a result and ultimately I’ve found that there is one type of mood chart in particular that has been very helpful in providing a big-picture look at how my symptoms operate. I call it the “color band mood chart” and it is a way to visualize what types of episodes I have and when they have taken place over a period of time.

I’ve spent some time sharing about this type of charting before (here) but I wanted to revisit the topic because with nearly five years of data now on my chart it becomes very easy to see the comings and goings of my episodes. I live with mood swings that can occur over a long period of time (months) but also swings that can happen several times in a day so this method of charting is really useful for seeing my episode length and severity of symptoms in a single glance.

20160908_105507

This type of charting is done on graph paper and the key above denotes how the element of time is displayed in the chart. I have opted to leave out any mood swings taking up less than 3 hours in a day (even though they are often present) to chart the moods that encompass the longest period of time each day. I also limit the mood swings represented in a single block to 3, any more than that and I typically just consider it a “mixed episode” day.

20160908_105446

The key above shows what each colored box represents. Green areas are periods of stability. Blue represents depression, but darker blue signifies more severe depression (generally with some symptoms of suicidality). Yellow denotes hypomania with red representing full mania. Brown represents mixed symptoms and black represents more severe mixed symptoms (usually with psychosis or suicidality).

The chart below begins in 2011 and I’ve been compiling data every day (with the exception of a short period in June, 2011) since. Looking back and looking at the chart below I can certainly say that 2011 and 2014 were both pretty hard years for me and both required psychiatric hospitalizations. There have been other times I may have benefitted from hospitalization that I only really recognize by looking back at the chart as well.

20160908_105349

Sarah’s Color-Band Mood Chart showing bipolar episode length and severity  from 2011-2016

 

If you have been reading the past few months you might remember I had a pretty severe mixed episode in June and part of July and if you look here at the bottom of the chart you can see the dark shapes that represent that period as I fluttered between depressive, mixed, and elevated symptoms.

The information on these two pieces of graph paper have been huge in helping me convey my symptoms to my doctor and also to avoid undergoing treatment that isn’t potentially helpful to my own personal brand of bipolar disorder (as not all types of treatment are useful for all types of bipolar symptoms). I began the chart because I really wanted to find the patterns in how my episodes work, but as you can see there is really much more to my illness than experiencing symptoms at a specific time of year or alternating back and forth between depression and mania specifically. The chart has also been great for seeing how the medications I have tried have effected me and since my symptoms are treatment resistant it has been really important to have this tool to convey the way many medications have triggered (or worsened) episodes for me (like during the past few months) instead of quelled them.

It has been encouraging too to see episodes that were initially big chunks of depression or hypomania become smaller fractured chunks. Even without a medication to stabilize me everything I’ve learned about how to cope with the mood swings themselves has helped me bounce back out of them at times instead of staying locked in. Even though there are times I find there is little I can do to shake my way out of an episode, the smaller daily mood swings are something I’ve learned to cope with somewhat more effectively.

Just something fun to share and maybe some inspiration for those of you living with mood swings (bipolar or unipolar too). Being able to quantify the periods I am having problems has made living with my illness much easier to accept and try to treat.

For more information on mood charting (including other charting methods and tips) you can read “why chart?” as well as a number of other posts from Chart Week like “Personalizing Mood Chart Rating Scales or  “What else can I chart?”

 

Redefining My Urges

Trigger Warning: topic includes some discussion on self-harm, suicidal, and homicidal urges.

Lately I’ve been trying to do a better job of understanding the urges I feel and how they fit with my symptoms. Living with treatment resistant bipolar disorder has meant that even though I find myself having the sorts of urges everyone else seems to (though as human beings we all seem quite reluctant to talk about urges) I also experience urges brought on by my illness. On top of that, my ability to respond to these urges can be quite compromised based on what my symptoms are doing as well… but let’s back up for a second.

Urges are impulses. Strong desires. They are those feelings inside of us that scream out to “just do it” in certain situations. Sometimes my urges come only in the form of a feeling like gravity taking over and I act on them without thinking, sometimes they’re accompanied with thoughts that can encourage or discourage following an urge.

To break it down, here’s an example of a relatively healthy urge I have. A simple craving.

Urge: make eggs.
Thought: I do like to eat eggs.
Action: made eggs.

You can substitute chocolate in for eggs, chocolate is good. Or you could substitute tea, in which case the urge and actions become blurrier for me because I have dietary restrictions. In that situation having a chai tea latte, for example, becomes something I shouldn’t do. I will get sick if I have dairy, so the urge has a negative consequence –it becomes unhealthy.

Urge: drink a chai tea!
Thought: holy yum batman, but this will make me sick (Reminder: I can’t have milk or caffeine).
Action: urge denied, drank juice.

Even though drinking a chai tea is unhealthy for me, there are times when I am run down or worn out where the negative consequences of drinking one sort of fade out. In that kind of situation I find my thoughts work against me.

Urge: for pumpkin spice’s sake, drink a chai tea!
Thought: It is fall, I do like chai, and even if I get disgustingly bloaty and gassy and can’t leave my house for two days I don’t have any plans anyway.
Action: 20 minutes of sweet, sweet chai tea action, 48 hours of intestinal horror.

Finally, there are those situations where thinking doesn’t even come into play (I swear, I have a point here). If someone put the chai tea in my hand and told me to drink it, the impulse becomes much easier to carry out.

Urge: drink this chai tea in your hand!
Action: yes, thanks.

Alright, so this seems perfectly reasonable to understand when I am thinking about something mundane but delicious, like breakfast… but these same scenarios are true for most types of urges I encounter. As human beings, we come up against a lot of kinds of urges, but the ones I want to look at more specifically are the negative urges, the ones that we know will have (or are likely to have) negative consequences. Things like lying, cheating, stealing, violence, sexual attraction to inappropriate parties, overeating, overuse of drugs or alcohol, self-harm, and suicide (to name just a few).

Most of the things I’ve listed are not things people talk openly about despite how commonly we find ourselves feeling urges to do negative things. I’m sure there are people who excel at shooting down these urges, but I don’t think it is very clear cut. If my chai tea was now an act of violence (let’s say slapping someone in the face who had done something inappropriate), even a totally rational person might not deny the urge after several drinks.

Urge: that bitch just threw a drink in your face! Slap her!
Thought: I’m the bigger person here… she looks ridiculous, I can let it lie.
Action: deny urge, stand around dripping.

(But after several drinks, or a bad day, or after something particularly offensive like groping your partner…)

Urge: oh no she didn’t, slap her!
Action: slapping.

I’d say that, more than anything else, is why I don’t drink anymore. My mind, for whatever reason, seems fully capable of jumping from urge to action without being intoxicated.

Anyway, last example. Living with treatment resistant bipolar disorder has often meant living with suicidal urges on a regular basis, and this is one aspect of my illness that I think people understand least. You see, these urges are something I can typically rationalize away.

Urge: you should kill yourself.
Thought: I might not feel good right now but I’ll bounce back. Plus that sounds like a lot of work. Plus what about my dog? Plus I think people might get upset.
Action: still alive, despite lack of chai tea lattes.

But, as I mentioned with my chai example above, if I find myself in a position where extreme stress or a particularly long depressive episode has eroded my ability to think clearly, the urge becomes harder to contradict.

Urge: you really should kill yourself.
Thought: you’ve been pushing that nonstop for months, and I’m sure there is a reason I have resisted that urge in the past even if I can’t quite remember it now. I’d better call someone.
Action: call my therapist, she acts as a rational brain for me when mine isn’t working.

Then there are situations that I call “level 3” suicidality, and that is when hospitalization becomes required because the urge has consumed any ability to contradict with thought.

Urge: kill yourself.
Action: jaywalk, check into the ER.

I know it isn’t a pretty topic, I’m sure that is why it goes unmentioned most of the time. Just the fact that I spent so many years not knowing where the urges I felt were coming from or that they did not mean immediate suicide, or violence, or self-harm, that I still had a choice as to whether I would act on them or not, was exceptionally confusing and wildly detrimental to my sense of self-worth. On top of that, not knowing what kind of situations (alcohol, mania/mixed episodes, high stress) led me to jump from an urge to an action without thinking made it really hard for me to stop acting on the urges I felt.

Being unable to separate the urges I felt from the totality of who I thought I was meant years of trying to punish myself for urges I could not control in an effort to curb them because I assumed that “getting better” meant not having those horrible feelings anymore. Besides, urges that provide harmful consequences are not generally seen as normal in our communities despite how often people experience them because the topic is typically taboo. Needless to say, when I was sixteen and experiencing psychosis with homicidal urges I immediately assumed I was a terrible person who probably didn’t deserve to live, given the fact that I wanted so desperately to hurt other people. Even though I worked hard to deny those urges I still felt wildly ashamed for having those urges in the first place.

I still catch myself sometimes, telling myself that the urges I feel to self-harm or commit suicide mean I am something less that others, that it doesn’t matter how many worms on the sidewalk I frantically save from being walked on because overall I’m a terrible person.

But that simply isn’t true. (And I’m sure the worms do appreciate it in their own way.)

I can’t judge myself based on the urges I feel because doing so is like judging an entire library because one book doesn’t seem to get shelved properly on a regular basis. To discredit the entire system and collection because of one book seems absurd, especially once I’ve learned that there are many creative solutions for where to keep that book in the catalog.

As I’ve gotten older I’ve started to understand that everyone feels urges and that urges are outside of our control. We might not all feel the same ones, but I’m sure we’ve all felt an urge now and again we have felt ashamed of. Being able to take a step back from that shame has meant feeling better about myself and even though I don’t expect those urges to go away anymore, I just try to focus on the way I view the urge and how I choose to act when it comes up.

…and if I slip up and drink a chai tea now and again, I’m only human.

Alternative Mental Healthcare for Severely Psychotic

An article came out this month in the New York Times about an organization called the Hearing Voices Network. The Goal of the Hearing Voices Network is to create support groups where the symptoms of those with psychotic symptoms like hearing voices and having hallucinations are explored to understand where the voices or visions might be coming from and find ways to cope with them mentally and emotionally.

I’m not doing the article or network itself much justice so I would definitely recommend reading about this alternative form of therapy here (at the New York Times Article) or here (at the Hearing Voices Network homepage).

Without going into too much detail I wanted to mention that this topic stood out to me because in a way it reminded me of the type of therapy I have been undergoing with DBT (though certainly not the same thing). The similarity in my mind comes from my experiences the last six months having to address my internal dialogue, generally stop abusing it and being afraid of it, and allow myself to learn where these thoughts and feelings are coming from so that I can cope with them in a healthy way.

Having treatment resistant symptoms of bipolar 1 (which can include psychosis at times) has rendered other types of treatment (like psychiatric medications) useless for me up to this point so my experiences with talk therapy and particularly a group that could help me address those aspects of my illness has been paramount to helping me cope and feel more comfortable in my own skin. I’m excited to see that an exploratory type of alternative therapy like this is being offered to those with severe psychosis because the more types of treatments available mean the more people that will potentially be able to improve.

Of course, both websites mention that this type of therapy isn’t right for everyone, but as someone who has experienced what mental illness is like living as an outlier, having options of things to try before falling into the hopelessness that all else has failed is potentially making a life-saving difference.