Tag Archives: Bipolar

Thyroid Hormone for Depression

I mentioned recently that my psychiatrist has decided to change directions in how we try to treat the mood swings I have emanating from treatment resistant bipolar disorder (type 1).

In the past six years I have actively tried several benzodiazepines (like clonazepam, or lorazepam) , antipsychotics (risperidone, ziprasidone, olanzipine to name a few), mood stabilizers (lamotrigine, oxcarbazepine, gabapentin & more), and antidepressants (sertraline, fluoxetine, bupropion, etc.) but have always experienced either:

  • worsening symptoms
  • side effects severe enough to warrant stopping the medications
  • or tolerable side effects with no response from my symptoms.

The only psychiatric medication I’ve been able to keep taking regularly is Lithium, and while there is some debate on whether it is helping I’ve been taking it for long enough that I am having no side effects so the consensus is usually just to keep taking it.

Starting any of these new medications has typically made my mood swings worse (more frequent and more severe) so it has been a bumpy ride. After my new(est) psychiatrist got a good look at this happening she decided it is probably useless at this point to keep trying in these same classes of drugs I’ve had problems with. Needless to say, this was both a relief (hooray for no more psychiatric drug barrages!) and a little disheartening (alright then, now what?) but after all I’ve been through I’m more than willing to break away from this cycle and try something new.

Like anyone who finds themselves chained to the great lithium beast I have to go get my blood checked every few months to monitor the level of lithium in my blood. During these times I often also undergo other tests to check things like kidney and thyroid functioning.

Apparently my thyroid level doesn’t appear to be outside the range of “normal”, but my doctors have found that for me a tiny change can make a huge difference (as seen with my reactions to most drugs). My psychiatrist also told me that sometimes thyroid medications can be used to treat resistant depression, so our next route is to give liothyronine (cytomel) a shot and see what happens.

I always get a little nervous when I’m given a new drug to try and my doctor asked if I thought it would be better to start it when I am feeling more stable or unstable. That has always been a tricky question for me because if there are significant side effects a drug can easily take me from stability to a place of being unstable, and having less stability I tend to want to take advantage of those times as much as possible. At the same time if side effects occur when I am already very unstable I am less likely to cope in a healthy way so I told her don’t think there is a right answer here.

Ultimately, I’ve had the flu for the last week so as soon as I feel better physically I’ll start the liothyronine regardless of what my mood decides to do. This one comes with all kinds of obnoxious directions (take on an empty stomach at least 30 minutes prior to eating, no antacids for at least four hours after taking it, can’t be taken at the same time as vitamin or mineral supplements -sheesh!) so I need to do some work shifting all of my medications into a system that will allow me to follow those rules.

As scary as it can feel not knowing what will happen, I always feel some element of hope that this time might be different. If I didn’t feel that I’m sure I would have given up ages ago. It might be that I’m just stubborn or absurdly optimistic at times too, but it is easy to gamble when I feel like I don’t have much to lose and there is potential for increadible gain.

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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.

 

 

PokéMania

I remember waking up early on a Saturday morning before my parents were awake to play Duck Hunt on the NES as a child. I wouldn’t call that my introduction gaming induced mania, but it certainly had me hooked on gaming.

By the time I was a teenager and my mood had begun to destabilize (even though I didn’t know it was bipolar disorder at the time) I found that the power I felt beating my teenage boyfriend at Mario Kart 64 on vs. mode 82 times in a row was obviously feeding something, and I didn’t quite know what it was or how to stop it -but then again I didn’t want to. It felt incredible.

By the time Everquest was in full throttle in the early 2000’s I was able to limp our computer and dial-up to a place where I could play it, and I discovered some very important things.

  1. I didn’t want to stop. Not to pee, not to eat, not to shower. Heaven forbid any of my family members needed to make a phone call, that was outrageous.
  2. The main reason I didn’t want to stop was because of how miserably depressed I felt in my daily life, and when I played Everquest I found myself feeling like a million dollars.
  3. Constantly choosing the sleepless mania of gaming and feeling good also seemed to have negative consequences in all other aspects of my life, but for a while I was feeling far too great to care.

After that blew up in my face I went years without playing another substantial game, I swore off of anything more rigorous than Wii bowling or Zelda. I hadn’t really displayed the ability to make good choices when engrossed in a fantasy world (particularly a social one) so I figured it would be best to let it lie.

But then, as an adult, I started dating a gamer. I started out trying to be careful, but before long I was being swept up by the Xbox 360 and then the Xbox One, feeling overwhelmingly tempted to stay up until 3 am because, well, everyone else was.

I wish I could say that the release of Pokémon Go this week didn’t rattle me, but the original debut of Pokémon landed right in the age-range sweet spot for my sister and I the first time around. We played the games, we watched the show, and our binder full of cards probably weighed a metric ton.

I knew it might be a slippery slope for me, but I had an easy out. With a windows phone I couldn’t download the Pokémon Go app, and my brand loyalty to Microsoft started out feeling like a blessing until I was sucked down into a vortex of depression. After two days of not being able to play the game everyone else around me seemed to be playing I felt miserable, and the safety of going without this game somehow transformed into a wretched despair over missing something potentially profound.

That night I couldn’t sleep, I could hardly eat breakfast, and as soon as the clock struck nine I was out the door headed to the mall. Before I had time to think, before I had time to react, really, I’d signed up for a brand new phone and spent the next eight hours setting it up so I could play Pokémon Go.

In hindsight it is hard to say if manically buying a new phone to play a Pokémon game is more or less embarrassing than last week’s manic interlude (after all, catching socially acceptable pretend creatures is probably less alienating to people on the street than collecting the dead corpses of real ones) but after the jolting, humming, rush of ecstasy subsided a day or two later I’ve been able to be a little more objective.

After spending the last five years getting to know my brand of bipolar disorder intimately and getting a grip on some of the things that trigger it for me I think I’m able to do a better job of regulating something I know can amp me up if I’m not careful. I intend to follow all of the rules I’ve set for myself playing any videogames in order to avoid issues with triggering hypomania and mania, things like:

  • No games after 10 pm (11 at the latest on weekends). Part of the reason games can trigger mania for me is that I lose track of time, and without having a set time in place for me to detach myself from the games and work on winding down before bedtime I wont be able to sleep. I’ve found that anything after 11 (and I try to be safe and stick to 10 pm) only makes me more alert and is huge for triggering insomnia for me. Guess what? Insomnia breeds mania!
  • Play at set times. I like to have a routine, to have structure in my day to make me feel less useless (since I’m just at home alone most days). My boyfriend and I play Xbox in the evening after dinner before we watch tv and I try to limit my Xbox time to that window (even if I am not always successful). Likewise I’m trying to limit Pokémon time to specific times of day (lunch time, walking home from an appointment (not to it or I’m likely to lose track of time), waiting for the bus, etc).
  • Limit my interaction with others. Ok, this might sound odd, but if I am starting to feel amped up and then I begin talking to other players who are equally amped up, I can easily become hypomanic or manic. Being aware of my mood state before interacting with people online or in person has been really important to help me understand how much I should interact and when to just be silent.
  • Food Food Food Food. I need to eat, and I need to eat more than candy and chocolate. I have to keep eating on my regular schedule, and not settle for eating a few handfulls of stale fruit loops becuase I am not willing to walk away from a game. If I don’t eat my mood gets all out of whack, and it doesn’t always mean a date with hypomania but that is one of the (less sucky) outcomes that could occur. Limiting caffeine is also huge, it has also triggered hypomania for me in the past as well as insomnia if I have any too late in the day.

As the case has been with everything lately, I’m working hard to try and find a sense of balance in as many areas of my life as possible. I want to be able to enjoy the things I want to enjoy (like catching them Pokémons) while remaining as stable as I can. It can be a tough nut to crack, but I’m hopeful that a little extra effort I can do it.

The Bees Knees

Though I do have mania that occurs on its own it has always attacked me more like a lightning bolt. It hits rapidly and jolts me into some kind of dream world before disappearing as quick as it came on.

When I have manic symptoms for an extended period of time they are almost always mixed episodes where depression intermingles with the lightning long enough to keep it grounded. In those cases the result tends to be more like ongoing electrocution, quite unpleasant really.

Of course, that is only naturally occurring mania. For someone who has spent five years cycling through medications to try to find one that helps out with my treatment resistant bipolar disorder, you can be sure I am no stranger to medication induced mania too.

Generally speaking, pairing an antidepressant with a depressed person can send that depression packing… but when you give an antidepressant to me (and to many people with bipolar disorder) my depression suddenly busts through its shirt like the incredible hulk and screams, “I’m the King of the world!” before doing a keg stand.

For whatever reason my body takes this phenomenon one step further. I can have mania induced by many different kinds of medications, anything from nasal sprays to opiate painkillers to antipsychotics.

I was reminded of this fact in full force over the holiday weekend while I was trying my hand at taking Geodon again. I slipped into mania without even realizing it, being far too wrapped up in my new life plan to become a ventriloquist to sleep and then crawling around in the bike lane of Seattle streets collecting several dozen dead bees that had gotten too much sap on their wings to fly, dying along the streets and sidewalks.

The funny thing in these situations is when I can actively think about what I’m doing and how it must look to all of the people walking past me but feel powerless to stop it, and then I go on to notice that I am totally comfortable with that powerlessness so I might as well just enjoy the ride.

It wasn’t until I realized that I hadn’t paid any of our bills, our rent, and hadn’t renewed our lease on time that I began to think that I might need to stop taking Geodon. Even then, I didn’t feel completely sure… thank goodness it was also giving me periodic headaches and stomach cramping or I might have let it carry on a few more days.

As expected, within forty eight hours of discontinuing it I was rapidly sliding down into depression. I had strained one of my quads at some point -probably when I was picking up all those bees, I can’t typically feel pain during mania so it is hard to say- and had to spend two days resting because I couldn’t walk!

It’s funny to me how even with medication induced mania I feel some sense of shame after it’s over. Like maybe I could have done something to stop myself, or recognize it earlier, or whatever. Of course my doctors and therapist have all told me that I shouldn’t be embarrassed because it wasn’t my fault… but there is something difficult for me about resigning to the fact that sometimes I really don’t have control over myself.

Needless to say, I haven’t been posting as regularly as I would like but now that I’ve experienced the worst mixed episode I’ve had in at least five years, the most intense period of mania I’ve had in five years, subsequent intense depression, and psychosis (a story for another day) in the span of about two months I’d say I’m doing pretty well, all things considered.

 

 

 

 

Self Identity & Mental Health – Pride Edition

Pride weekend is a pretty big deal in Seattle and while I tend to avoid events like parades (too much standing still with too many people for me to feel comfortable) I found myself on Capitol Hill twice during the celebration. I enjoyed having the opportunity to see all kinds of different people milling around smiling and laughing, and the attitudes of the multitude allowed me the briefest window where my self-consciousness could melt away.

Pride was, in a roundabout way, what led to a conversation where I was asked how important I think it is for us as human beings to be able to categorize ourselves in different ways. Even though I’ve only just started becoming familiar with the particulars of gender when it comes to self identity I couldn’t help but point out that this is a topic of conversation that comes up in regard to mental illness pretty frequently too.

In those instances the question is usually about diagnosing mental illness and if trying to fit our symptoms -which can vary widely even within an illness- into one category or another is more helpful or harmful in the long run. Even though opinions vary greatly on this topic I’ve found that the majority tend to see reaching a diagnosis as something helpful and can appreciate it as a tool to better understand their symptoms and how to live with them. For me being diagnosed with bipolar disorder felt more like a relief than anything else, even despite finding my symptoms don’t line up with the majority of those with the disorder.

In terms of self-identity I’ve always been curious as to how other people live their lives and what we have in common, but for as long as I can remember I have struggled with the idea of who I am. Trying to find commonalities has felt exhausting at times because I’ve had a hard time locking down what my values are, what I want my life to be, and who I am.

Issues of gender and sexuality have definitely played into that. Discovering that I might not be attracted to the same people my friends were was both alienating and isolating. Not being able to really understand why I feel uncomfortable when people address me differently than I imagine myself has been frustrating because being unable to explain this strange off-putting feeling to myself has meant being unable to explain it to anyone else too.

Self identity in that sense has had a huge impact on how I act, how I interact with other people, but also on my mental health. Feeling estranged from people I can relate to has often meant feeling depressed and isolated. Being unable to pinpoint and communicate where a lot of those thoughts and feelings are coming from and, even more, feeling the need to constantly explain myself has fueled a lot of the anger I have toward myself and other people.

While issues with gender and my sexuality have fueled issues like depression and low self-esteem I have found that living with mental illness itself, in my case treatment resistant bipolar disorder and anxiety, has played a huge role in keeping me from being able to pinpoint who I am and what I want out of life. Mood swings make a habit of constantly changing my motives and desires, so getting a grasp on what is underneath has often felt like digging a hole in the sand at the beach that is constantly being refilled by each wave that rolls in.

After six months of DBT (dialectical behavioral therapy) I’ve got a new-found appreciation for the fact that having a real understanding of ourselves and what we want in life is how we are able to find ways to make ourselves happy and move toward our goals. What can we expect if we don’t know how to make ourselves happy? Where do we go if we’re not moving toward the lives we want?

Without categorizing our needs in other ways, like the diagnosis of mental illness, how can we expect to move toward improving our symptoms? Without understanding our needs and being able to communicate those needs in a way other people and healthcare providers can understand, how can we address them?

I can understand how categorizing the elements in our lives can seem limiting to some people, but throughout history mass communication has been based on shared common knowledge. That might come from our language, or our understanding of science and theories at the time, or things we’ve learned from our friends and family (among others). Being able to communicate what we need in a way that other people can understand is a huge part of being able to be successful in both feeling acceptance from other people and moving toward what we want, and while sometimes that communication comes at the price of having to simplify things to help people understand, the understanding and acceptance is the ultimate goal.

Granted, there are big differences between something like identifying gender identity or sexual preference, and identifying a mental illness. I think it is important to remind people that our sexual preference and gender identity are inherent to who we are and to express those things comes from a lot of personal reflection and understanding of ourselves.

Conversely, most people in the mental health camp consider mental illness to be just that, an illness. I would be remiss if I didn’t say there aren’t people that disagree, but to most the symptoms of anxiety, depression, bipolar disorder, and schizophrenia, among others, are things that are keeping us from being happy and living the lives we want to.

If you consider it though, identifying mental illness is one way we are all able to be true to ourselves and to act in a way that will bring us a better understanding of ourselves and how to move toward living the lives we want. We seek treatment to try to get back to the sense of self we understand and feel that we have lost.

What is the expression and self discovery that comes with coming out, or expressing a change in gender identity but an act in the same direction? Taking steps to understand and communicate our identity is another way in which people can reaffirm their sense of self and actively move toward finding happiness and living the lives they want to live.

In both situations we fight to protect our sense of self and our identities, and though it might initially feel like an act of self-preservation both the LGBTQ and mental health communities know the value of protecting our inner-self and see that being true to ourselves, whatever that means for us, will make us happier in the long run.

I know that I’ve felt the effects of ignoring my most inner sense of self, and that whether that came from hiding who I truly felt I was or denying myself help from the constant attack on it that came with my mental illness I like to think that each day I know myself a little better. I understand myself a little better. I can keep moving in the direction of supporting who I am and what I want because I know that I am the only person who can do that for myself –and I deserve it.

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!”