Tag Archives: anxiety

Starting a Mental Health Blog: Insights

I’ve put together a few tips of things I really wish I had known before starting this blog in hopes of providing a little useful information for anyone leaning toward starting their own.

I’ve been writing the bi[polar] curious blog now for five years and there have definitely been some big lessons I’ve had to learn along the way. I wanted to put together a list of a few of those lessons to share for anyone in the early stages of blogging or thinking about starting their own mental health blog. Of course, keep in mind that I’ve remained relatively unstable over the last five years because of the treatment resistant nature of my bipolar symptoms so you may find that your approach to navigating some of these issues may be a lot different than the way I’ve gone about dealing with them. Really I just thought there were several things I wish I had known ahead of time, things I could have coped with before starting this blog that might have helped me remain more stable through this process.

The spam is real.

WordPress does a pretty good job of helping filter out spam comments from real ones, but sometimes spam comments show up where they shouldn’t. Early on it would be a little heartbreaking to think I’d received a comment only to find that a robot was trying to sell male enhancement products on my page, and while most of these spam comments are harmless (just annoying to clear out when they happen) every so often I would get one that would throw me into a fit of paranoia because it would use a jumble of words nearing something rational and related to something I was experiencing (hello psychosis!). I’ve had many situations where I’ve had to sit down and remind myself that spam is just spam, it is meaningless, and it happens.

The comment commentary.

Five years ago I convinced myself that I would respond to every comment a real-life human posted on my blog. That seems like common courtesy, right? Of course, that was when I’d have a comment or two a week, and they were nice, fluffy sort of, “you did it!” comments. Unfortunately, negative comments are something that happen, and sometimes they are a product of someone failing to understand the point of a post, or not liking the content, and sometimes they can just be random, cruel turds someone left behind for no apparent reason. For a time I even had a commenter who liked to point out every spelling and grammatical error in every post. Negative comments happen, and it took some time for me to be able to take a step back from them and understand that they didn’t mean my blog sucked. They didn’t mean I sucked. They didn’t mean I wasn’t doing a good job, and choosing not to respond to them (because doing so would send me into a fit of panic) wasn’t the end of the world. In fact, these days I find I can’t respond to most comments because I simply don’t have time, and I’ve reached the point where I am ok with that, even if it means looking somewhat aloof or elusive.

The real trick here is having a plan for what to do when these negative comments occur, because living with an emotional disorder makes responding to something that pisses me off or is making me cry very difficult when it occurs in a conversation with someone I love, let alone a random stranger who can’t hear my tone in my comment and may not have understood me in the first place. Ultimately, creating some distance to keep from taking comments personally has been a really, really important process for me in terms of blogging.

Da emails.

Having contact information available on the blog was important to me because I envisioned helping people who needed it. I’ve had crisis intervention training in regard to speaking with people who are very suicidal, but I am by no means a doctor or therapist or any other number of licensed professionals who deal with that sort of thing on a regular basis. I hoped people would contact me if they had questions because I am a peer, and because emailing me might be a less-intimidating intermediary step between not seeking help and seeking it.

I set up an email account dedicatedly specifically for this blog because it was also important to me that people not have my immediate personal contact information. This was really important in helping keep a boundary between readers and solicitors and me, but sometimes it has been really hard to cope with emails from people in crisis, a constant barrage of emails from people wanting to post “guest posts” for my blog (with my blog name obviously copy and pasted into their email), and those asking me to promote their products or services on my blog. These last two categories were completely unexpected, and having to “act professional” when I’m actively in the middle of a depressive or manic episode has been outrageously challenging –especially when some companies have been pushy or rude about promoting their products.

One of the ways I have gotten around this has been to formulate my own “general response” email template. It hurt my soul a little bit at first to do it, but the more I noticed the emails I received being written in general terms and sent to hundreds of bloggers the more ok I felt with doing the same thing to reply to them. Obviously I haven’t relied on a template to reply to those in crisis or those with genuine questions, but I’ve always been the sort of person who has a hard time saying “no” and having a template to fall back on that does that for me in a polite but firm way has been extremely helpful.

Overall, the number of emails I receive on a daily basis can be overwhelming, given I have a condition that leaves me having a hard time just getting through the basics of taking care of myself at times. Knowing that would be an issue ahead of time would have really helped me out, and I think I wouldn’t have worried so much about saying no to people, especially those who offer to write “guest posts” for the blog. Honestly if you are interested in writing a guest post for a blog, I’d expect to see an email without typos. An email that talks about why you want to write, and potentially a link to something that you’ve already written. A blog is only as good as its content… and while there is nothing wrong with finding guest authors (in fact it is great if you’re out of town or need more content) I think it is worth finding ones who can write.

Keeping it regular.

When I started the bi[polar] curious blog I told myself I would write regularly. At first that meant five days a week. Then eventually three. Then eventually one. Did I get on my case about not being able to keep up with the pace I set for myself (when I was hypomanic, I might add)? You bet! But as I’ve continued on I’ve found that writing one good post has sometimes meant writing three or four that weren’t as good, and then a few drafts of the one I’m posting before I put it out there. I guess along the way I found that I favor quality over quantity (though the level of quality is surely negotiable) and I had to realize that my blogging habits really mimicked the patterns I saw in myself in the workplace. When I am depressed I don’t want to write. When I am manic I want to write constantly.

One of the things we pride ourselves on in the bipolar community is that ability to produce in elevated periods, and I found that instead of posting everything I wrote in those periods all at once I could use a little tool in wordpress called the scheduler to pick a date and time in the future to unveil a post I’d already finished. I’ve had many people comment on the relative regularity of my blog and the answer is not rigorous training or pushing through my periods of depression, it pretty much has everything to do with the scheduler. I write as many posts as I can when I feel inspired, then set dates for them to be posted.

Best shortcut ever.

Everyone can see it.

There is something very freeing about being anonymous and writing about a topic like mental health and there are certainly some good reasons to go that route. My goal with this blog has been to be more open, to take some of that “scary” away from mental health, and to help both people I know and don’t know understand what living with mental illness is like.

Ok, so creating a blog and telling everyone I know about it was absolutely terrifying. When it happened I felt quite ill honestly, and though I didn’t vomit profusely it took a while for me to get used to the idea of people I know reading the things I was writing. Even after five years I’ll hear someone say something about this blog to me or a friend and feel wildly embarrassed as I realize that they have been reading it, but that’s ok. Ultimately the people I know have responded quite well, given some of the things I’ve written about.

The flip side of that coin is that if your email address is linked to your blog or if you real name is associated with it people you know (and potentially ones you don’t want to read your blog) can still find it. Social Security (if you’re applying for SSDI) can certainly find it (they found mine in a heartbeat) and they really tried hard to use it against me in my hearing.

In many ways, even if you blog anonymously, it is important to remember that the things we write, like the things we say, have weight. Writing something privately is much different than writing something others can read, our words effect other people and they effect ourselves, so taking responsibility for those words (whether you are writing anonymously or not) is something that will ultimately benefit you in the long run. Choosing to post things while in a crisis situation may be helpful if you feel unable to reach out to your support network (your doctors, therapist, psychiatrist, friends, family, support group) however be prepared to expect that in the mental health community these sorts of crisis posts are taken very seriously. Many of us have lost friends to suicide and find ourselves quite despairing when someone leaves a trail of suicidal breadcrumbs without any way for us to help. Trust me, talking to someone in person is much more highly recommended, and when in doubt reaching out to an organization like the crisis clinic (like this one: 1-800-273-TALK) is much more likely to provide support in the moment when you need it.

I guess I’m just saying, please do not rely on the mental health blogging community for all of your mental health support needs. Connecting to other bloggers and feeling a sense of community is great, but it is no substitute for having a real-life support system in daily and crisis situations. Having someone you can reach out to in times of crisis who can respond immediately is very, very important.

Initial uncertainty.

There was a lot of uncertainty when I started. A lot of obsessing over how many followers I had and over how many comments I had. I didn’t know how to come up with ideas for posts so I started brainstorming odd lists everywhere. I didn’t know what I wanted my blog to be, I just knew I wanted to write something. That’s normal.

Maybe you have a plan or no plan at all, and maybe you’ll find that you love blogging or maybe you’ll hate it. Maybe you’ll find that you don’t care as much as you thought you did, or maybe you’ll find that a blog is a stepping stone to something else. Ultimately there are many ways it could go but you’ll never know unless you give it a shot.

There are certainly a lot of positive things that have come out of this blog for me but most of that reflection will come in next week’s post (and some was already discussed in last week’s post as well). In the meantime, I would say that if you’ve considered writing or look to connect with others through writing, or even just want to get to know yourself better blogging can be a really helpful way to do those things!

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.

Bright or Blight

There is something strange about being old enough to see fashion recycling itself. I have a degree in fashion design, so I have been finding myself acutely aware of the fact that people half my age are now wearing reissued platform sandals and overalls.

I’m thirty and despite growing up on an island a few hours from Seattle I missed grunge. I don’t remember the kids in my school having many options in terms of fashion, my high school wasn’t awash with much style diversity. A lot of us wore whatever odd second hand clothes we could come by, and even those that seemed to linger on the fringes of the social structure typically didn’t make it all the way into the realm of “goth”.

I was infatuated with punk rock and found myself seeking out skinny jeans before they became a staple. I listened heavily to the Clash as a teenager and, bored with the social norms I had grown accustomed to every day, began dying my hair in bright, new, interesting colors.

20160812_130730.jpg

Me at the Denver Art Museum in 2003, Photo by Michael Putlack

 

That was a lot for a small rural town to handle at the time and every day I was greeted politely by someone telling me I didn’t belong. To be fair, they usually said, “you ought to be living in the city!” but no matter how it was phrased, I knew that we agreed on something: I didn’t quite fit where I was.

Experiencing the budding effects of bipolar disorder and psychosis in my teens made it hard for me to see a place for myself among my peers and as funny as it might sound, dying my hair orange (or blue, or pink, or green) was one of the only ways I felt like I could express that. Trying to avoid how different I felt, how much I felt like I didn’t fit in only acted as fuel for my depression and a little hair dye went a long way in helping me accept those differences and realize that being myself was something worth doing.

*

Living in Seattle the last ten years and working in the fashion industry in particular has meant seeing all kinds of trends come and go, both in style and in my own life. Some seasons I am happy about some cute boots and sweaters, some seasons I am happy with where I fit in the world. Other seasons everything in stores is mustard yellow (which is crap for my complexion), other seasons I find myself hating Seattle. The city has been tumultuous that way, and every March I tell myself I can’t stand anothe Seattle winter… but here I am.

I gave up the neon colored hair almost nine years ago. It was hard to keep up as a broke student and then, even working in fashion, it wasn’t something that was exactly welcomed when the economic crisis hit in 2008. Making my departure from the fashion realm didn’t pave the way for brilliantly colored hair either, there were no studies I could point to that suggested pink hair might sell more condos.

Somewhere in the interim I slipped back down into depression first, and then found myself with post traumatic stress disorder after a slough of unwelcome male attention. It seemed to be something that was all around me, coming from bosses and strangers and people I couldn’t seem to get away from. I found myself wanting to fold myself up like a tiny note and hide in a crack somewhere. I was having so many panic attacks that I had to wear sunglasses on the bus in an effort to hide the fact that I was crying most of the time.

So even when it began, when the citizens of Seattle began showing up more and more with brightly colored hair, it wasn’t something I could celebrate. I was too busy hiding to be willing to put a neon sign on my head, too busy wanting to be invisible.

That hesitation followed me for several years. I felt too afraid of the police, too afraid of anyone noticing how agitated I might be at any moment, how aggressive I might seem without realizing it, how manic I might be acting to feel like drawing attention to myself. I obliterated my wardrobe in an effort to remain unseen, packing anything noteworthy up in boxes or giving it to charity. I became an expert at blending in, even when I found myself so overcome by my symptoms of bipolar disorder, PTSD, & psychosis I was only really blending in with the rampant population of those living with mental illness on the streets in Seattle.

I told this to my therapist a few weeks ago and she seemed confused by the idea that I didn’t want to be seen, she kept asking why I would be afraid of people looking at me and if I was always afraid of attention from other people. Instead of try to explain how much anonymity has eased my anxiety about a local police force with a poor track record regarding those with mental illness and the expanse of men who have always seemed to believe that I owe them something simply for existing I revised my statement to say that so many people are dying their hair “just because” that it didn’t feel punk rock anymore.

Gross, I feel gross for saying that. At this point doing something because it is in fashion is not enough to motivate me, but not doing something just because everyone else is doing it is something I find equally disturbing. I don’t want trends or what people want or expect to play into the decisions I make about what I wear or how I look or the confidence I feel in myself. I want the freedom to look however I want, and even though chipping away at my own anxiety is what will eventually help me tear through all of that (though hypomania seems to work too) it is important to me to work toward doing what I want, regardless of any other opinion.

You know, when the idea came up of changing my hair again I really wrestled with it. I had so many excuses not to, I didn’t want to relive the past (heck, I’d already done every color), I didn’t want to spend the money, I didn’t like the idea of people looking at me… but ultimately I had nothing to lose (well, except hair and mine grows so fast it would only be a travesty for a month or two). Without remembering the sense of peace it gave me the first time around, the confidence, the comfort, I had a hypomanic sort of upswing a few weeks ago and just let it happen.

It’s true the fashion police in my head were in an uproar (“you’re just trying to recapture your youth!” they cried furiously) but something funny happened that I didn’t expect. I didn’t revert to a past version of myself, I just found her in one of the deep recesses of my mind reading John Irving. I tapped into her sense of levity and found that I feel more like myself than I have in several years. That might sound goofy, the idea that orange hair could produce such an outcome, but I find that I’m remembering what it was like back before I felt the need to hide all the time.

Whatever I thought might happen when people looked at me, well it hasn’t. Heads haven’t exploded, I haven’t had strangers trying to talk to me every five minutes, and I haven’t been approached by dozens of creepy stalker suitors because even though my hair is different, that isn’t the key. I am different too. I am older, yes, but also wiser. It has been important for me to realize that I don’t need to hide from unwanted attention, I am strong enough and capable enough to deal with it when it comes, even if there are times I don’t feel that way.

 

 

 

Putting Myself Out There

Despite how busy summer has been I have found myself doing very few of the things I wanted to do. I’m fully aware that feeling helplessness doesn’t look good on me, so I decided to try a few things outside my comfort zone in an effort to feel more in control of my own life and to pep up a potentially dangerous sense of boredom.

For better or worse, my sense of curiosity has always been able to steer me into the mindset of, “well let’s try _____ and see what happens!” Sometimes the results have been wonderful and sometimes they have been devastating, so when I went to work trying to decide what new thing to try I wanted to be a little conscientious of that fact. Ideally trying something new and maintaining whatever scrap of emotional and mental stability I have is the goal, but knowing that living with treatment resistant symptoms of bipolar disorder means that any little detail could potentially rock my brain-boat is challenging. I have often found myself opting to do nothing at all because doing anything is potentially risky (in terms of creating instability in my mental health) but, tired of doing nothing, I decided the reward was potentially worth the risk.

I have been described as having an “overactive imagination” and more than one therapist has told me that when things are perfectly fine my mind has a tendency to imagine problems that aren’t really there… these days I would consider this description to be something like a cute version of saying, “psychosis”. For a time I thought this might lend itself well to writing fiction, but back in 2007 when I tried my hand at writing a novel I found that I lost track of where the novel ended and reality began. The problems in the story became the problems of real life, and I abruptly vowed never to venture down that path again.

All this time I’ve been writing nonfiction instead, and while I’ve enjoyed writing for this blog the past five years I feel like I am constantly moving toward the point where I wont have anything more to say without being redundant. I’ve been learning a lot about myself and writing in the process (and I don’t expect to stop any time soon) but part of me has wondered if I could write about something else. Anything else, really. I admit there are times where I don’t want to think about my own mental health. I want the freedom to think of other things, of other problems, and for the love of Pete, to talk about something other than myself.

With a little experimentation I found that while writing fiction that takes place in a modern setting (like my writing in 2007) is too close to my own life for me to separate myself from it, writing about situations on other planets or in places I’ve never actually been seems to create enough distance to keep my mind from getting the two confused. It seems that following an odd story down a rabbit hole makes perfect use of my (previously useless) problem-generating brain because stories need conflicts to be interesting.

Writing any fiction at all certainly took me out of my comfort zone, but in the past few weeks I decided to take things one step further and I joined a local writing group. Frankly just getting out of my apartment to meet with them was a huge step and even though I was anxious as heck to make my first appearance I did my best to remind myself that they’re strangers, so who cares if they like me anyway?

It turns out they are all quirky, imaginative, and intelligent individuals and just passively listening to them share about the different projects they are writing was both interesting and encouraging. Within an hour or two I found myself holding conversations with people casually and I left knowing that I wanted to go back again.

Of course, I put it off a little. Since it is a critique group I knew that at some point I would have to share something I had written, and when I’m working on something I’m typically very private about it until the final version is completed. Even though I don’t like sharing something unfinished because of how vulnerable it makes me feel, I have had a lot of questions that I knew would probably be answered if I just powered through my anxiety and shared my work.

So the thing I did this week to step out of my comfort zone was to read something I had written in front of a group of people and listen to their feedback. I had a knot in my stomach all day leading up to the group and every five minutes I could feel myself changing my mind, thinking, “well… I’ll print these read along pages and bring them, but I don’t have to read them.” Then, “well… I will tell the moderator I have something to read, but maybe they wont get to me before the group ends.”

Finally, that night at the group after an hour and a half the moderator asked me, “do you want to go next?”

I knew that if I left without reading I would feel twice as anxious the next time around and I knew I couldn’t handle a double dose of anxiety driven irritable gut another day. I had already gone through 5 or 6 tums and it seemed there was little to do but press on.

I decided to take a leap of faith and even though it was wildly uncomfortable, even though my hands were shaking and my ribs were contracting as I powered through a panic attack while I read, I reached the last page in a triumphant (and slightly dissociative) stupor.

I never used to have problems reading aloud, not when I was in school. I gave so many presentations, so many speeches (even publicly at the state fair) that I never expected to feel so overwhelmed when speaking publicly. I know my anxiety is much worse these days, but I also think that the unfinished nature of my story and the effort I had put into it were huge in informing how nervous I was.

I also know that my Achilles heel is judgement. I’ve never taken criticism particularly well, never felt good about the idea of being examined and torn apart. I feel like I can say that I generally feel good about who I am, but there has always been the fear of judgement present in some form in my life. Fear of God’s judgement as a child, fear around the judgement from my peers in school, fear around critiques in college, and fear around the scrutiny of Social Security and the government as a disabled adult.

By the time I stumbled into the critique portion of the reading I had catastrophized the whole situation so much that it inevitably went much better than I expected. Some of my concerns were confirmed, some new issues were brought to my attention, but for the most part everyone seemed excited about what I had written, which acted as a cork in my odorous anxiety bottle.

My boyfriend, sweet as he is, went to work right away when I got home to remind me that I don’t need to take any of the advice I was given. I don’t need to change anything I wrote if I don’t want to. I know he has continuously witnessed the way other people’s opinions have acted like quicksand for me in the past. The defiantly obsessive portion of my brain loves to latch on to those statements without letting go, and I immediately found myself wrestling with them as they echoed (ironically) in my mind, “redundant, redundant, redundant…”

The difference now comes from the knowledge that has come from my DBT group. I know that when I’m closed in with the garbled echoes of disappointment or disapproval or judgement I can open the windows in my brain-house and let that stuff escape. I don’t have to be hosting the equivalent of a mental dinner party six years from now and set an extra place setting for “redundant” because it’ll be long gone. That’s the hope, anyway.

Having said that, I don’t know if I will read my writing aloud again any time soon. I need time to practice letting go of these comments, time to sort them out of the “terribly important, don’t stop thinking about this,” pile into the, “backlog” bin. If I can manage it without much incident I expect to have another go, because having the opportunity to practice letting go of, “this sentence is redundant,” is infinitely easier to me than having to let go of considerably more cruel and pointless scrutiny. Anything I can do to help myself learn and grow is good, but anything that also helps me learn to be less reactive and less prone to destabilization is a serious win.

 

Coping with Coping

Of all the things I’ve read and researched and talked about in terms of coping with mental illness I don’t think I’ve ever quite been prepared for the notion of coping with what comes next. Having poured my full attention (alright, we’ll say about 75%) into how to cope with living with treatment resistant bipolar disorder I’ve found which strategies have been helpful for me (DBT, ongoing therapy, group therapy, limited drugs and herbal remedies) and which haven’t (CBT, psychiatric medications -though my doctor is now trying a new approach which I’ll discuss later on, and the old fashioned I’m-going-to-stuff-all-my-feelings-down-and-ignore-them trick, to name a few).

In the time I have spent with the majority of my focus on mental health related topics (about 5-6 years) I often found myself growing in helpful ways, but then sort of falling behind every time I had a major episode. I would say that in that time I very rarely felt like I was able to get ahead of the curve when it came to my mood swings or anxiety and even when I was able to rebuild my own sense of self and self-worth from the ashes of a major depressive or psychotic funk my treatment resistant symptoms had a habit of pulling the rug out from under me all over again, requiring me to start at square one.

While I don’t like the idea of calling myself self-absorbed or self-involved, living this way (without continuously going full ass-over-tea-kettle) has meant spending a LOT of time crawling my way out of the dark corners of my mind with nothing but a spoon and a flashlight, or untangling myself from the intrusive thoughts that pop up, or needing to ask people to help me by doing things that seem strange to them, to say the least, in order to keep from constantly triggering me. I’m fully aware that this sort of living probably doesn’t look good to those on the outside looking in, and having to spend so much time focusing on my own issues has meant having a hard time with personal relationships (wait, when is your birthday again?) and generally seeming like a distant asshole.

That life, though, that sort of living and coping with the constant need to pay attention to every little detail inside myself in order to keep from being overwhelmed by it, that is honestly where I have built a (we’ll say -though not exactly) comfortable existence for many years. This is the world I know, the world that is 75% me dealing with my own mental health issues and having 25% of my time and energy and interest left over for things like relationships with other people, doing housework, leaving my apartment, having a job, and being creative. Showering. Playing with my dog. Discerning which banana has reached peak ripeness. Important things. If you consider it, 25% of my time isn’t a lot to try and do all of those things and I’ve had to cut out a lot of them, especially since that 25% has encompassed when I’m feeling at my best. In a full blown episode I might have only 5% of my brain available for all of those things, so obviously taking advantage of every resource available to me to try and increase that number has been my main priority.

Alright, so if that is a general approximation of how things have been the past 5 years, what does it look like when the numbers begin to change?

Even without a medication to help stabilize me my doctors and I are beginning to realize that I am more stable when not subject to a constant barrage of new medications to try. My system is simply too sensitive to keep playing medication wheel of fortune on repeat, but given the proper amount of down time to sweat out all those side effects I can function better without them (go figure). It isn’t the difference between being totally stable and in crisis, more like 25%-30% stable or in crisis. I’m not suddenly a rocket scientist or anything, but every little bit helps.

After that important discovery, DBT (dialectical behavioral therapy) coming into my life has made a huge impact. Again, not cured or totally stabilized by any means but I’m learning to cope more effectively. Instead of having to crawl through the dark recesses of my mind with a flashlight and a spoon it’s like I’m learning where all of the light switches are. When I’m getting tangled in obsessive or anxious thoughts I’m learning that the less I struggle, the less hold they seem to keep on me (like that plant in Harry Potter, oh, you know the one). With all of the things I am learning, I am definitely making changes in my life that are allowing me to go beyond having that limited 25% external focus.

But here’s the kicker. I’ve found that working on coping with my mental health issues isn’t enough. No, there is actually a subplot here where I am rapidly discovering that having time to focus more on the world around me, and particularly the people in that world, has meant having to learn a whole new set of skills to cope with the clarity that my newfound perception is affording me!

Being in a position to improve my own mental health has made it difficult for me to watch the people in my life who may not be coping with their own situations very well… and I may not have noticed how frequently many of them were struggling until I was able to look away from my own problems enough to see it. In a sense, I’m having to find ways of coping with the realizations and discoveries brought on by my initial coping and it feels like the most bizarre twist life has thrown me in a while (and I’ve had psychotic episodes so that’s really saying something).

Somehow… being more self aware has led to me needing to spend less time being self aware, and all that extra focus I’ve been able to put on the people around me because of it has made me see things I really didn’t notice before. The most maddening part of all of it is discovering that most people aren’t even aware these issues exist, or are quick to deny them, or cope in ways I know are wildly self deprecating and dangerous.

In that way, the coping that has been afforded me through DBT really started out as all hearts and stars (and horseshoes, clovers and blue moons… pots of gold and rainbows, and the red balloons!) but I’ve concluded that with the knowledge I’ve gained I inadvertently stumbled upon a double edged sword. I never asked to be able to use this strange, newfound mental health x-ray vision on others… I only wanted to use it on myself! Damn.

I’m doing the only thing I can do (or at least, what I can do and keep the relationships) and try to practice being nonjudgmental and accepting and all of that exceptionally difficult stuff, but there seems to be a natural shuffle where many aspects of my life (including my different relationships) are currently up for reevaluation because I’m seeing everything in a whole new light. I want a healthy life that will help reinforce the positive strategies I have been learning because without the aid of medication, they’re one of the only tools I’ve really got. At the same time we’re all human and I can respect the fact that no matter where I go or who I meet, the vulnerable flaws of humanity are not escapable.

As always, I’m working to find the balance between these things, even if the ride has been wholly unexpected.

 

 

How DBT is Changing the Game

I have been celebrating all week because as of last Thursday I have officially completed all of the sections in the DBT workbook and group. Apart from high-fiving myself (alright, so that’s just a clap really) for seeing this through I’ve been reflecting on how DBT (Dialectical Behavioral Therapy) has been a game changer in a life largely structured around living with treatment resistant bipolar disorder.

Before I can offer up a delightful before and after like some kind of mental and behavioral makeover I have to say that I feel lucky just for getting into a DBT program here in Seattle. I am on Medicaid and the waitlist for people receiving public mental health services here in Seattle means it takes typically months and in some cases years to get into a group. In the time it took me to get in I tried all sorts of treatments and even went to two consultations for ECT (electro-convulsive therapy). Obviously it seemed like DBT was a popular option, but after having a hard time with other types of therapy (like CBT, cognitive behavioral therapy, as an example) I couldn’t be more pleased with discovering why DBT has gained so much popularity and why I had to wait in the first place.

Me

Just so you know where I’m coming from on this I think it might be helpful to tell you a little bit about what I experience.

I have treatment resistant bipolar disorder which means there haven’t been any medications that have been able to help stabilize my ongoing mood swings or prevent new ones from happening. My mood swings range from several intense swings in a day (which can range all the way from euphoria to suicidal depression and back again in a matter of minutes) to long intense episodes that can last months at a time. I experience mania, depression, agitated and sometimes hostile mixed episodes, suicidality, homicidality, and psychosis.

Needless to say… that has been a bit of a handful both for me and for other people to deal with. I can be unpredictable around other people which means they don’t typically know if I will be excited or devastated or aggressive from one moment to the next and I’ve had too many issues with homicidality, suicidality, and psychosis at work to keep a job for the last several years to boot.

The things I have felt needed the most immediate addressing have been things like:

  • feeling strong urges of violence toward myself or others
  • feeling unable to communicate with my boyfriend or others during intense episodes
  • losing relationships and jobs because of my emotional reactivity
  • constantly relinquishing my own self-respect in attempts to make others happy and avoid confrontation or the potential triggering of more episodes
  • isolating myself due to constant fear and paranoia that someone might hurt me or I might hurt someone else
  • negative thoughts I could not seem to stop or make quieter

In addition I have experienced very intense anxiety since I was old enough to remember. This has typically caused problems like:

  • worrying to the point of causing physical illness
  • believing horrible, sometimes life-ending events are about to unfold at any minute
  • fear and panic overwhelming enough to keep me from having a driver’s license (at age 30)
  • attempts to control other people’s actions to keep their unpredictability from making me more anxious (I wouldn’t recommend it…)
  • constant obsessive thoughts that I felt powerless to stop that also often keep me from sleeping
  • Ongoing panic attacks

Sometimes I can pass as a typical stable adult to others because I am intelligent (might as well toot my own horn there but people often point that out as a reason I can be high-functioning at times) and periods of hypomania tend to dissolve the anxiety I feel when they are occurring. Unfortunately as I have gotten older my episodes have gotten progressively worse and those periods of “normalcy” have been few and far between.

Before DBT

The ways in which I have coped with these issues have definitely evolved over the last 15 years. I’ve gone through my fair share of harmful coping strategies (self-harm, alcohol, binge eating) but I have also gone through a long line of coping methods that may not have been directly harmful but weren’t exactly effective either.

Ineffective coping strategies are usually those I’ve come up with and then discarded after a period of trial and error. Without much direction (both from my doctors and therapists previous to DBT – with exception to CBT) I kind of just came up with ideas I thought would work and tried them… I’d like to chalk this up to the scientific method but it may have been equally spurred by a constant feeling of desperation. Sometimes the methods would work for a while and then I would begin to get exhausted because they took all of my focus and effort to maintain. Things like:

  • seeking approval from other people when I was depressed
  • reaching out to every person I knew in times of crisis instead of just people I could trust (resulting in sometimes landing myself in dangerous situations)
  • constantly fighting the obsessive or negative thoughts by arguing with them
  • keeping myself in a state of constant distraction so it wouldn’t get quiet enough for me to hear negative or obsessive thoughts
  • never being alone because then I would be alone with the obsessive or negative thoughts
  • changing jobs frequently in an attempt to find one that “made me happy”.

Obviously I found a few things that worked, even if I didn’t know it at the time. Writing, art, playing music, playing video games… all seemed to make things feel easier, just not enough for me to base all of my activity on them. After all, how was playing the piano going to help me maintain friendships? How could I work retail and be drawing at the same time?

When it came to CBT I could get behind the idea of doing activities like journaling but the idea there was that there was a thought that was ultimately prompting my emotion and behavior. I found many of the activities soothing for a time, but even after I managed to figure out what negative thoughts were prompting my emotions or behaviors I couldn’t find anyone who could tell me how to change those negative thoughts (or stop from obsessing) in a way I could understand and it frustrated me.

I was disheartened when therapists would simply say, “you just stop obsessing.” or “you just accept the situation,” and when I asked how one does those things (as I couldn’t seem to make them happen voluntarily) nobody could answer with anything more than a statement a golf caddy could have given me. It seemed to go against the whole idea of working toward having better mental health, after all… if I could stop obsessing or just suddenly accept a situation I wouldn’t need to ask how to do it.

Beyond that I often felt like I had mood swings that seemed to happen totally independently of what I was thinking or doing. I could be at Disneyland on a roller coaster and suddenly find myself depressed, but none of my therapists or any of my hospital workers were willing to consider or explain why that might be happening. Most of them told me I didn’t know what I was talking about which I could watch transform my curiosity into livid rage.

Needless to say, I started DBT feeling skeptical after my time with CBT but what I found was a language I could understand.

Dialectical Behavioral Therapy

I think it is import to point out that in my situation (one where every previous treatment option has failed) I have been desperate for any kind of help with my mental health for some time which means I found myself in the DBT group both ready and eager to learn as much as possible and practice the techniques. I needed relief from my symptoms and without anything that could provide that previously I was ready to throw my whole self into the class and take it very seriously. Being willing to dive in to the class helped me push through the frustrating or difficult parts I faced in the beginning.

I encountered the material in a structured weekly class with homework each week and I think in my case that structure really helped hold me accountable to practice the skills and do the reading. The previous week’s homework was reviewed each week so I needed to finish it. Being in a group also allowed us to compare ideas on what different ideas meant and discuss which coping strategies worked best for each of us.

The sections discussed were:

  • Mindfulness
    • basically how to live in the moment instead of being distracted by internal thoughts as well as how to enjoy each moment fully
  • Emotion Regulation
    • how emotions work, what goes in to working to keep them balanced, and how to change an emotion
  • Interpersonal Effectiveness
    • maintaining relationships and how to have positive social interactions
  • Distress Tolerance
    • tools for crisis situations

The thing I found most effective about the material is that it suggests that the best strategy for living a balanced life is to operate using both emotion and reason. Each section goes on to describe strategies that work to help you create that balance by bringing in whatever is missing (usually for me it is the reason element) into the situation.

While there were some aspects of the workbook I had already figured out on my own through the trial and error I mentioned earlier this style of workbook offers many different kinds of strategies and basically you keep what you like and leave what’s left. I really respected that idea because I was able to tailor my own set of skills based on my needs and everyone else in the group was able to do the same. In that regard I can see where DBT’s popularity comes from because it is accessible to a wide audience.

After DBT

The important thing to understand about DBT is that I still have mood swings. I still feel suicidal urges, I still feel most of the things I felt before. The group wasn’t a magic cure for those feelings and urges, but it helped me understand how to negate or change them in healthy and manageable ways. More than that, I’ve been equipped with an arsenal of coping skills that work for me, and that is HUGE.

The mood swings may not be gone but being able to bring reason and logic to the table when they happen tends to mean less reactivity on my part. Less reactivity means it is easier to maintain relationships. Being friendlier to people means I feel less paranoid about potential reactions to my reactions. It all starts to trickle down through all these channels because everything is connected.

The only hard part here is that it only works as long as I use these skills. That might seem like a no-brainer, but mood swings can sweep me up sometimes and I find myself swirling around with no idea of how long I’ve been there. Anxiety can leave me worrying so much that I forget to let myself rest or use the skills that might provide some relief. Yes, it takes a lot of effort, but I’m doing my best to be as diligent as I can because even though this may require more energy than if I’d found a medication that worked straight away DBT has led me to the first glimpse of relative functioning in years.

Even though I only started this class six months ago I can see changes. Three or four situations happened just over this last weekend where I found myself thinking, “wow, this really would have ruined the whole weekend before, but I seem to be able to accept and to move past these situations much more quickly now.”

I had a neighbor who kept parking in our building’s guest parking spot in an attempt to dodge paying for a spot. It went on for months, and even though I had to remind myself every time I saw it that it would be better to accept the situation (and not leave rude or threatening letters on his windshield) and to be effective than to make enemies with my neighbors I did it. They moved away and I did a celebratory dance because I was able to keep myself from being a total A-hole.

I’ve also found it very useful to distance myself from my own thoughts and remind myself that just because I’ve thought it doesn’t make it true, it doesn’t mean I will act on them, or that they will happen. I’ve got several ways of weeding out bad ideas now before I find myself doing them, which means creating a sense of self-trust and self-respect where I didn’t have one before.

While DBT has made things easier (less effort for better results) the more stress I am experiencing the less reliable the system is for me. If I am too distracted or upset to complete the skills things simply operate… well, as normal. In some respect that means I’m working to weed out stress before it’ll swamp me now, trying to be proactive about avoiding avoiding things. There are some situations though, like Corey’s broken arm, that came with an intense whirlwind of stress I couldn’t dodge and as a result I quickly slipped right back into a state of crisis. I’m still working on climbing my way out of it but each day gets a little easier.

Finally, apart from being immediately useful to me, I really respect the DBT program because it provided content that wasn’t given to me in a condescending way but made sure to fully explain why each part was important. DBT fits my personal values, and makes room for those with values that are different from my own.

The obvious take away here is that there is some serious potential for more DBT groups in the Seattle area, and I wouldn’t be surprised if that was a trend across the country.

As for me, when seeking treatment for mental illness has often meant taking one step forward and two steps back I am really glad to have had a chance to work through this program because in many ways it is changing my life for the better. Having the opportunity to change my negative behaviors while learning how to take the reigns back from mental illness has given me the footing to be able to respond with, shove off, I’m queen of the mountain now!”

 

DBT; Subscribing to the System

I’ve now been through three quarters of the DBT (Dialectical Behavioral Therapy) program and I have started my final chapter; Interpersonal Effectiveness.

That means I’ve been through Emotion Regulation, Distress Tolerance, and Mindfulness. I’d say I entered this program feeling rather skeptical (I hated CBT – Cognitive Behavioral Therapy, and generally disagreed with several of their claims about how the brain works) and while I didn’t know anything about DBT before, I quickly found myself sinking into a system of techniques that only added to my current ones without taking anything (useful) away.

As it turns out, I’ve been “practicing” several DBT techniques for a long time, things like distracting myself through immediately unsolvable emotional crises, or using changes in body temperature to calm myself or bring myself out of a slow depressive stupor. For the most part, I would say at least three quarters of what I’ve learned has been useful in some way -including new ideas, like working not to suppress negative emotions but to sooth myself through them instead. Overall I would say the subject matter has been presented in a very organized way which I really appreciate, and now, 75% of the way through the program, I feel a bit like this system is something I can really subscribe to.

I am really slow to jump on bandwagons, I tend to be too curious about what makes them tick to be able to adapt to them well. I like when I can see results quickly and know why they are happening, I like efficiency, and organization, and have a hard time putting all my chips into something I don’t understand.

So… what’s the problem, right? Up to this point, things with DBT have gone swimmingly! The trouble is that last week we started on Interpersonal Effectiveness. Communication and relationships with others are by far my Achilles heel, so at first I was really excited to get to this section.

The group was instructed to go through a series of statements and pick out which ones were myths and which were facts. I wasn’t born yesterday, the page was clearly headed, “Myths in the Way of Relationship and Self-Respect Effectiveness” and “Myths in the Way of Objectives Effectiveness” (fancy talk for convoluted thinking that keeps people from asking for what they want, saying no, and generally maintaining healthy relationships). So they’re all myths (you tricky teachers you!). I sat feeling quite superior at this realization.

But then, then I started to read them. Confusion began to rise as I chewed on my lip and skimmed through both blocks of text. I admit, I glanced over at the papers of my peers who had checked two or three of the boxes as things that rang true to them, but after everything was said and done I’d checked off at least half of the entirety.

“These are myths,” said my brain. “So why do we (brain and I) believe they are true?”

I sat there, confounded, rationalizing some of the statements.

“Well, I mean ‘everybody lies’ may not be an absolute truth, because… well… maybe some people don’t. I find that hard to believe, but in 6 billion people there might be a few who never lie, so I can accept that as a myth that feels true.”

“How about number 21? ‘Revenge will feel so good it will be worth any negative consequences.’ Well… that one usually feels true but having some experience in the revenge arena I can tell you it doesn’t always feel spectacular, so I can accept that as a myth that feels true.”

When the teacher called on me I joked my way through my response, did a small song and dance, and handed the imaginary baton to someone else. I was still quite disturbed at the discrepancy between the sort of general beliefs that had got me to that point and the fact that they were labeled myths on the page in front of me. It was like someone had told me my green shirt was actually called “orange” and I’d been wrong all along in believing “green” existed.

More seriously than the ones I described were others I could not seem to contradict. Statements like:

“I shouldn’t have to ask (or say no), other people should know what I want (and do it).”

“They should have known that their behavior would hurt my feelings; I shouldn’t have to tell them.”

“Other people should like and approve of me.”

“I should be willing to sacrifice my own needs for others.”

These were all things I could hold in one hand and look at saying, “perhaps this isn’t true,” but in general, when I got down to it, they were all ideas that have shaped the way I interact with others.

I left class last week thoroughly wigged out. My first reaction was to throw DBT under the bus and conclude it didn’t know what it was talking about. I couldn’t understand it, and so I had little ability to trust in it. At the same time (as I mentioned), Interpersonal Effectiveness is definitely the thing I struggle with the most so it seemed more reasonable to assume I am the issue in this situation.

I brought it up in therapy at the beginning of this week and my therapist (one of the teachers of the DBT group) told me to “think of it as an opportunity”. There have been so many areas of my life that I have been willing to experiment on, trying over a dozen new psychiatric medications, trying new techniques to help with mood swings, or falling asleep, or my general health. However, with all of this kind of experimentation I only lost a day, a week, my mental or physical stability for a brief period.

It takes an extraordinary amount of effort on my end to maintain an even vague sort of relationship with another person, so these relationships are extremely precious to me. Frankly, in many ways I am terrified of experimenting with them, it seems that the risk of losing a friend by suddenly behaving differently is more significant to me than losing a day to depression, or a week to hugely swollen lymph nodes. This notion that only bars my better judgement; I know I need to improve at communicating.

I took a French class at a local college in high school and almost failed the class. I had been a straight A student up to that point, but for some reason the very act of having to speak aloud, speak strange sounds and arrangements of words I didn’t fully understand, well it freaked me out. Being able to communicate in a way other than I’m used to is something I aim to learn, but, like French, don’t be too surprised if there is a lot of hacking and gagging involved before I get it right.