Category Archives: Mixed

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.

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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.

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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.

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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?”

 

Swapping Big Moves for Little Moves

Let’s face it, living with bipolar disorder has had a huge influence on the way I make decisions. It hasn’t been all bad, I admit the impulsivity I tend to feel has left a trail of both exciting fun memories in my wake as well as some cringe-worthy ones, but I’ve spent a lot of time considering impulsivity and the ways it has both helped and harmed me.

Instead, today I want to specifically discuss making big moves.

For a long time I believed that I only made impulsive big, life altering decisions when I found myself experiencing hypomania and mania. This was evident when I dropped out of college, for example, at age 19. The idea of living aimlessly in the Colorado sprawl seemed like a wonderful idea, and it was great… for a while.

Likewise mixed episodes have lent themselves to impulsive big moves as well. Spur of the moment breakups would be an example, running away from home. Usually these kinds of big decisions have been fueled by the need to escape something (rather than make a positive change in my life) and the results have tended to be regrettable when I returned to rationality.

Recently I’ve been thinking a lot more about how that overwhelming impulsive urge influences depression, because for most of my life I would say I didn’t think it did. I mean, is sitting down and watching a full season of Ru Paul’s Drag Race because I’m too tired and depressed to do anything else a big impulsive move? Yeah… I didn’t think so.

Lately I’ve been seeing it a bit different. Maybe it is the nature of the depression I face, maybe it is a little mixed and coming with a small paper cup full of mania to act as a dipping sauce. Whatever the reason I’ve been able to hone in on this feeling, this urge to make a big move, and somewhere inside of me there is this spark that says,

If you make a big, sudden change in your life this depression with disappear.

To be fair, I’ve been doing this all along. In my younger years I found myself in some kind of Job-Hopping Phenomenon loop that I tried my best to grasp but couldn’t understand.

I would start a new job, be doing fine, and then start sinking into deep depression. The answer always seemed to involve quitting and starting a new job, where my hypomania would take over and I would feel great for a while until… you guessed it… wash, rinse, repeat.

For the most part I always chalked this job-switching thing to be coming from a place of reason though, not emotion. I told myself, “well, maybe this isn’t the right job for me,” and I’d launch myself out into the world feeling a sense of purpose every time I tried to find a new one. It kind of acted as a really inefficient, W2 swamping sort of band aid.

I didn’t connect the dots between these actions and that general bipolar big move urge until this month. I’ve been declining into depression for almost two months now, swiftly and severely enough for my psychiatrist to be on red alert (more on that next time). Honestly I think what I am experiencing may be a depression-heavy mixed episode because I’ve found myself in several swirling pools of psychosis where I seem to find myself in another place.

While I’m there everything is turned on its head, the only consistent element is that I feel overwhelmingly compelled to make a big move!

Sometimes the urge is to run away and start a new life, or get a job, or demolish my relationships with people… but every time the haze wears off I’ve been thankful to find I haven’t done any of those things.

With my manic and mixed episodes I feel like I have had the opportunity to practice not making those big moves I find myself gravitating toward. I’ve tried to remind myself of how horribly wrong they tend to go sometimes, and how what I am experiencing at the time is typically in the minority of how I feel otherwise.

The last few years my treatment resistant symptoms have left me experiencing severe depression without much alleviation, so much so that the only thing I could do was binge watch Ru Paul’s Drag Race. I feel like that might be what is causing me to hesitate when I fall into those whirlpools that try to bully me into mixing things up, because now I know that even when I do nothing at all I can make it out the other side.

In the grand scheme of things, I often picture bipolar disorder as a set of scales. I used to chuck whatever blocks I could find at them knowing that if one landed, they would flip my emotional state into the opposite direction and I could slide from depression into mania almost immediately. This crude method was effective short-term, but didn’t set up any kind of system for long-term stability.

The last few years I have been learning to scale down those moves when the urges hit. Instead of running away, maybe I’ll take a shower. Instead of getting a job, I assign myself to take out the garbage every Monday and see if I can consistently do it. Instead of destroying my relationships I turn on the Xbox and funnel my aggression into some kind of PvP deathmatch.

Instead of chucking those big blocks at the scales it is more like I am adding single grains of rice. While there is a kind of tension that comes from refusing the big move beast the satisfaction of an impulsive remix, I’m finally understanding that I can come closer to making those scales balanced by making little moves than I ever did with the big ones.

 

Providing an Outlet

Even since childhood I have often equated pain (emotional or otherwise) to be like electricity. Failing to provide an outlet for that force once it has entered my system generally results in short circuiting; an explosion of force down an unintended pathway as it tries to escape.

This morning I leaned in to kiss my partner goodbye as he left for work and stubbed my toe. You know the feeling you get when you know something gruesome has occurred to part of your body (in this case: a toenail) without looking -you can just feel it? Well, as pain started shooting through my foot I knew I wasn’t ready to look down and look at the damage quite yet. Even so, my first impression was to scream out in pain… but with my boyfriend standing less than 12 inches from my face (and it being 7 am in a crowded apartment building) I decided to hold it in.

Big mistake.

That energy that should have been released out my mouth shot down my throat to the next available thing; my arm. I immediately punched the wall (twice, apparently the first time wasn’t quite enough to allow all of that energy to escape) and winced as he left, attempting to walk off the pain in my foot.

While my big toenail is split (right in time for sandal weather, drats!) it wasn’t until my hand started to swell up from punching the wall that I realized that maybe I should have just screamed. Denying myself a natural outlet for letting that energy out certainly backfired, and my attempt to help my boyfriend and neighbors by keeping my seemingly inevitable screaming at bay ultimately hurt me in the end.

In my experience, the turmoil experienced in mental health isn’t much different. Providing myself with an outlet while depressed usually means verbalizing or writing through what is bothering me, while my manic outlets tend to be more physical; cleaning/exercising/and creative based projects. It took me many years to realize that, like punching the wall because of my big toe, failing to give myself an outlet for that energy trapped inside has often led me to explosive behavior, and outlets that have been seriously more damaging than what might have occurred if I had just followed my natural instinct.

I’ve done several training workshops about how to mitigate suicidality in crisis situations for other people, and I was shocked when each technique boiled down one core idea; confront the person about feeling suicidal, and then talk about why they feel that way with them.

Certainly I was expecting black hawk helicopters and swat teams and maybe a little magic to be involved, but ultimately providing an outlet for the person to express those feelings verbally in a nonjudgmental atmosphere proved that allowing some of that energy to escape was usually enough to disarm the threat of imminent suicide and get the person to some kind of treatment.

I would say that usually in my most dire moments I find myself at a loss for how to get that energy out. The fog associated with depression or mania might make it seem impossible, or unnecessary, and I might feel trapped in the moment, unsure of where to focus that energy without hurting myself or other people.

And obviously… I’m not perfect at it. After 15 years of considering this idea I still find myself punching walls occasionally or throwing my phone or rushing to my therapist feeling like a ticking time bomb because I’ve become certain that any words or actions on my part will destroy whoever I’m around (not true, as it turns out, but it still feels that way sometimes).

One thing I’ve done to help myself along though is to make a list for each of my intense mood states of good, useful, positive, harmless outlets that can help me get whatever energy I’m feeling out in a safe and satisfying way. Any time I think of something new, I add it, and that way when I am in the throes of a depressive fog, or so revved up on manic sunshine, or so irritable and agitated I don’t want to leave my room I have a little something to jog my memory.

Otherwise I might wind up punching the wall all the time and I’d never get my deposit back.

And an Epiphany in a Tree

I can say with some certainty that November and December have become my least favorite times of the year. For a long time I thought the stagnant months of February and March were worse (as they hold the record for the majority of my psychiatric hospitalizations) but it seems that every big blow-out started with a seed of intense stress in November and December.

Last week was really rough. Our dog Luna has been having seizures that our local vet has been having a hard time getting under control, and combined with the stresses and pressures of the holidays I started to crack very quickly. It started with really intense insomnia, and waking up psychotic around 4 or 5 am each morning for three days in a row. By the third day I had put on boots and a coat and walked to the grocery store outside in the dark in an attempt to outrun the vibrating energy in my body as I was filled with unprompted rage, and then the walk back tipped the scales in the other direction. Uncontrollable crying.

The swings were intense, on the brink of hospitalization-worthy. After having the ten-minutes-of-rage, ten-minutes-of-despair, ten-minutes of clarity, (wash, rinse, repeat) for a couple hours Corey and I decided it would be best to start the day with my emergency antipsychotic (Risperidone). 15 hours of sleep later I was a little more evened out, but it was a very serious sign to relax and take things more slowly. The last thing I wanted was to spend the holidays (and the new Star Wars premier) in the hospital.

One of the biggest difficulties I have at this time of year is that all of the progress my various family members have made regarding understanding my illness seems to evaporate (I am chalking it up to holiday stress, I don’t think they mean to do it) and things seem to reset to a time where I had little to no control over what I was doing or where I was spending my time.

It is often very hard for me to communicate my needs when it comes to managing bipolar disorder, but the problem always seems to grow exponentially around the holidays. It can feel really frustrating (to say the least) when my actions attempting to keep myself safe and sane start being ignored or demeaned when my needs start being categorized as selfish wants or irrelevant to the success of a holiday gathering.

I come from a long line of people who are much more quick to accommodate others than accommodate ourselves, and I think my Grandma said it best to me when she told me recently, “I always put my family’s needs before my own.” While this is something I have admired about us (lending itself to being giving and compassionate) one of the most difficult aspects of my life up to this point has been watching the people I love not taking care of themselves and feeling helpless to do anything about it.

At times it seems like my desire to take better care of myself is seen as an insult to my family when it has nothing to do with any of them. That is why I have had a whole series of Christmases where I made plans, and then always disrupted them at the last minute to do whatever whichever family member wants. These are people that really matter to me, and the shame and guilt I end of up feeling about not letting them control me is usually enough for me to give in. I don’t want to disappoint them, and I find myself traveling back to being a teenager or a kid who would rather just forgo helping myself and hide that I ever needed anything at all to keep from feeling vulnerable and like a disappointment.

Obviously that is a big part of what got me into this mess in the first place. Not taking care of myself when I really needed it has made my bipolar symptoms much bigger and stronger over time, and now that I am finally at that point where I am (making a good attempt at) managing my symptoms with a lot of help from my friends, things seem to be improving -albeit slowly.

Yesterday after a significant struggle through some knee deep inner turmoil I had a lightbulb go off. After the episode of this last week and all of the family conversations I had it was clear that taking care of myself has finally outweighed pleasing my family.

Like I said, I love them and I want them to be happy, but this doesn’t have to do with me being selfish, or my own happiness, or trying to punish them for not accommodating me, or just not wanting to be around them. This is about my health. My sanity.  My brain is a pretty integral part of my daily living, so it’d be better if I gave it a hand here, you know?

Putting my family first doesn’t keep me from having bipolar episodes. It doesn’t help me cope with stress. It doesn’t let me live the life that I want to live because I am not living through them, I am living through me. It took me many years to learn that I could not take care of them when they were failing to take care of themselves, but taking care of me is the one thing I can do.

My needs are important and they can’t be ignored any longer. I am thirty years old now, and it is crystal clear that nobody is going to take care of me but me. That means I need to step up and do it all the way, not just a little bit here and there.

This doesn’t mean I am becoming a hermit, it simply means that what I want is going to have to agree with what is appropriate for my health before I do it, and the execution will involve a firm “no” (gasp!!) from time to time.

I’ve spent ten years trying to execute this plan and failed every time before now, but I am finally able to see that the old way… well it isn’t working. While I recognize that this is always easier said than done I can feel that guilt and shame window closing. I am tired of being ruled by my emotions, because emotions can be manipulated. I want my life to be about the things that are important to me, and while my family is important I am finally recognizing just how important my health is to me too.

Finding Psychosis in Unlikely Places

Lately things have been up, up, up! A rather profound and relatively welcome change from my typical morose malaise dragging down even the most cheerful of moments. Things seemed to be going perfectly well when I hit a bit of a speed bump last week and started noticing my slightly-elevated hypomania (and general stability) being peppered with hysteria riddled buckshot.

Right now in the DBT (Dialectical Behavioral Therapy) group I am in we are learning about a skill called check the facts which involves taking time out to look at the big picture and discern if my reaction to events (or if my interpretation) might be colored by unwise reasoning (like jumping to conclusions).

I felt like I had a pretty good grasp on the skill and practiced it multiple times before that speed bump I was talking about last week. In these periods of agitation and intense depression-laced moments (lasting a couple hours at a time) I could no longer find “the facts”. It seemed like my ability to step back was totally negated, adding fear and panic to my already disoriented state.

I have always had a hard time identifying psychosis when it is happening, or at least identifying it before it has altered my psyche in a profound way. Typically the only way I have been able to pinpoint it in the past was after the fact, faced with a trail of breadcrumbs leading in several opposing directions at once.

Granted, I have experienced a few situations where the psychosis I was experiencing was something that seemed pretty easy to point out at the time. The overwhelming need I had to live with gypsies and time I thought I had become a werewolf are definitely two examples, but both occurred many years ago. Since then things have changed, and the psychosis I experience now is almost exclusively tied to fear, not euphoria or grandeur.

The fears are almost always something that could happen. Typically not things that are likely, but possible in the realm of actual life events. My boss trying to undermine me at work was a pretty infamous episode I had, but this time it was a little closer to home and my fear revolved around my boyfriend and an impending doom of our relationship.

In my mind, my boyfriend was trying to push me away to the point where I would become fed up with him and break up. Though this is not even remotely based in reality I was certain it was happening (but only for 1-2 hours 3-4 times a day) and I became terrified to speak to him. Unfortunately not speaking to him only fed into the awkward feeling I was having, making the whole thing seem more real.

For me, psychosis is typically like a real asshole lawyer. It builds a case based on tiny clues that are generally considered meaningless in our everyday lives, and when there are big pieces missing to corroborate the story, it makes them up. I’ll often find myself with memories of saying or hearing things that never actually happened, despite feeling very much like they have.

Trying to reason with someone who isn’t playing by the rules (psychosis) became relatively meaningless in my experience this last week. I felt overwhelmed by mass confusion because trying to check the facts led to so many contradictory facts that I didn’t know who or what to believe.

And that’s when my boyfriend found me.

I tried to explain why I was upset (without knowing at that point that I was even experiencing psychosis). It didn’t seem like him to be vindictive or evil, after all our relationship had always been like a slow, lazy river as opposed to the Niagara Falls of my last relationship. I blamed him for a long list of things that apparently never happened, and when trying to express my confusion I suddenly started laughing. Yep. That’s when I figured it out, the contradictory breadcrumbs were coming from many different directions and were made of several individually delicious but totally different and clashing baked goods.

[insert emergency antipsychotic here]

Things have been fine since, and while these sorts of episodes always lead me to feeling rather embarrassed and apologetic I was very lucky that I had some help in pinpointing this situation early. Being able to celebrate my birthday over the weekend without any added psychosis was huge.

Corey reminded me that this sort of thing tends to crop up for me when I am starting to get stressed. It was a good reminder to pay attention this holiday season and do my best to remain relaxed. I never want to come off as being a “Scrooge” but finding a way to celebrate the holidays without totally losing control of myself can be a big challenge. High-five to my man for being smart and compassionate!

On a final note, I am in the market for a new psychiatrist. This last one has made some comments that were more harmful than helpful, so this week I hope to switch to the next doctor on deck. Stay tuned!

“Mixed” Messages – A Firefly in a Swarm of Bees

My bipolar symptoms the last week or so have largely been mixed. Mixed episodes have often been the ones landing critical blows on my relationship, and having one over the first weekend in three that I’ve been able to spend with my boyfriend was… well, I think the word frustrating works on both ends.

While I’ve had mixed episodes that blended pieces of mania and depression into a clear goal (annihilation of myself and everyone around me), more often my mixed episodes are an odd, muddled mixture of many distinct (and sometimes opposite) feelings occurring at the same time. As it was over the weekend, I was able to feel excitement, anger, profound sadness, desire, disappointment, and completely calm (as a very rough example) all at once.

Internally it feels like walking into a party and having a conversation with several guests at once, I am reacting to each simultaneously.

You can imagine how much of a problem this poses when trying to have a conversation with someone externally on top of that. Even just having a conversations about sandwiches, this touches the “completely calm” internal feeling I am having (so I feel like I am calm whilst having the conversation) but all of my other reactions (excitement, anger, profound sadness, desire, and disappointment) are showing through randomly through my facial expressions, my body language, and the inflection of my voice.

All of the intense emotions I am feeling in a mixed episode are spinning on a roulette wheel, presenting themselves continuously without any rhyme or reason. Naturally, this confuses the crap out of people.

Imagine I told you, “oh yes, a sandwich for lunch sounds great,” and even though that is what I meant verbatim, I am crossing my arms, stomping on the floor, or throwing my hands in the air when I said it. Or maybe I am crying uncontrollably but singing and dancing.

Or maybe I can’t decide, because I both love and hate sandwiches at that very moment?

Corey (my boyfriend) has known for a long time that I have a really hard time with making decisions when I am having episodes, but it wasn’t until I explained this scenario of mixed messages to him this weekend that he began to realize that my indecision doesn’t come from disinterest (at least not during a mixed episode) but from way too many interests vying for the decision to be made on their behalf.

Sometimes making a decision while being bombarded by all of these emotions simultaneously is like trying to catch a firefly while being stung by a swarm of bees. It is even more perilous knowing that reaching out and grabbing the wrong insect might mean exposing a volatile emotion or putting myself or others in a situation where conflict arises, damaging myself or my relationships.

“That must be really confusing,” Corey replied. “Especially not being able to always distinguish what you want.”

Sometimes “what I want” is the option that is the least harmful to myself and those around me, but honestly it can be hard to tell which insect buzzing around me is going to be friendly or harmful. Other times I try to draw from cues from people around me. Being able to ask someone else what to have for lunch helps me forgo getting stung by that swarm of bees as all of them are vying for my attention.

Ultimately, in a mixed episode it isn’t uncommon for me to want everything and nothing. To love everyone and despise them. To want to laugh and cry and scream all at the same time. It feels like being pulled in every direction at once, but also like implosion is desperately imminent. Sometimes it takes all of my effort just to hold it in, and other times… I can’t.

It has been very confusing trying to understand all of this (and I have experienced it firsthand for many years now), but tying to convey it to someone who doesn’t experience it can be even more confusing. I do think, though, that taking the time to try to explain my motivations to Corey regarding my mixed episodes helped both of us understand better… and in the long run I am hoping better understanding will set us both toward better coping.

The Many Faces of Psychosis

My attempts at writing lately have not been particularly fruitful, but I have finally gotten some sleep. Unfortunately, the sleep was also accompanied by several intense conversations with my health care team pointing to ongoing psychosis the past few weeks (at least).

When it comes to psychosis I find myself in something of a pickle. I have not been able to tolerate taking an antipsychotic on a daily basis (because of intense side effects like ultra-rapid weight gain and feeling so fatigued and exhausted I can barely move) so my psychiatrist allows me to take it only in times I am experiencing psychosis. It definitely isn’t the sort of thing I would generally expect is a good idea, however my rapid cycling paired with my inability to tolerate the drugs for more than a few days at a time make it more useful than, say, nothing at all. Many times it seems like one or two days are enough to kick the legs out from under the psychosis before my mood cycles away from it.

The biggest hurdle in this method for me has been being able to identify when the psychosis is present on my own. With a good team looking out for me (my boyfriend included) it becomes easier… but even after meeting this “character” (psychosis) on and off for at least the last 50% of my life I have a hard time picking it out of a crowd.

Meeting psychosis when physically ill or on various medications has left memories that were already too fuzzy around the edges to be able to account for an accurate depiction.

Meeting psychosis when manic has been like stumbling upon a huge party where the music and lights are easily drowning out the words and the intentions of the faces I see around me.

Meeting psychosis when in a mixed episode has been like crawling into a crime novel where I don’t know who I can trust, and psychosis might look just as innocent or guilty as anyone else I stumble upon… leaving me with no distinguishing features.

Finally, meeting psychosis when I feel (or think I feel) stable has been the most confusing thing of all. The encounter is totally unexpected, and I find myself quickly trying to write the ensuing conversations and situations off as simple irrational fear or rapid mood swings happening too fast for me to put a defining stamp on them.

The best indicator I have of psychosis is when pieces of my life, pieces of stories don’t line up the way they ought to. When the memories I have don’t correspond with the half dozen other people who were there at the time. When my boyfriend seems to have me caught in a “lie” but as far as I know, I’ve only spoken the truth.

At any rate, I expect to spend the rest of the day on the couch due to the exhaustion I feel from the rispiridone today, but if that is what is necessary to aid in alleviating the confusion, I am ready to do it.