Tag Archives: mental health

Recognizing Positive Forces: Barbara Ballard

The last couple months I’ve been thinking about my high school English teacher Barbara Ballard’s retirement this week. I went to a small public high school in the town of Coupeville on Whidbey Island and she has been a fixture there for quite some time now.

I’ve always been the sort of person to have a brain like a dry sponge. It is often ready and willing to soak in anything and everything given to it which really was difficult to deal with in high school. Most of the teachers didn’t know what to do with me because I tended to be ahead of the curve in terms of their curriculum. I mostly hung out and made art, soaking up whatever new bits of new information I could get my hands on.

That changed my junior and senior year of high school when I began taking Ms. Ballard’s English classes. They were the first classes where I truly felt challenged (apart from never quite being able to get a positive score on the V-sit in P.E.), and even though I didn’t give much mind at the time to any writing skill I may have had it felt wonderful to have something other than sports I could pour my competitive spirit into (even if I was only competing with myself).

Though I didn’t recognize how honing my writing by continuously running the gauntlet in her class might help me in the future I’ve had the last few years to contemplate it. After all, finding myself in a position where living with treatment resistant bipolar disorder has kept me from being able to work a traditional 9-5 job I’ve had a lot of time at home to try to figure out an alternative that would allow for feeling even a sliver of purpose or fulfilment, and it seems I’ve found that again through the writing Ms. Ballard helped me build a foundation in.

In a way this realization has not been unlike when Dorothy finds she had the power to get home all along in the Wizard of Oz. After all, the first time my bipolar symptoms reared their ugly head was in my junior year of high school. Amidst the paranoia and psychosis, the intense mixed episode where I’d find myself feeling both amped up and tragically devastated at the same time I was enrolled in Ms. Ballard’s English class. When it came to the point where I needed to be hospitalized in order for me to get the treatment I required my mother told me that she spoke with my teachers about it to get my assignments worked out.

At 17 the idea that my teachers were aware of such an intense experience I was having, one that I desperately wanted to hide at first, was terrifying. Especially when it came to those teachers (well, there was only one really) who were demanding great work: Ms. Ballard.

I was too young and inexperienced with mental illness at the time to be able to recognize how well Ms. Ballard handled the information and how seamlessly she accommodated my situation in class. Once or twice she allowed me alternative reading from the rest of the class when she thought the content might not mesh well with my situation, and if she eased up on her critiques at all it didn’t keep me from trying as hard as I had before. She never made me beg or try to explain myself and she never acted condescendingly toward me (something many other adults were doing at the time). She simply allowed an unspoken understanding to sit between us and in doing so I felt comfortable enough to go on to complete a University of Washington English course in her class for college credit my senior year.

Like I said, I had little expectations for what writing could do for me at the time, but the treatment I received from Ms. Ballard at a very delicate time in my life left me with an enormous respect for her.

It has only been in the last few years that I’ve merged the skill of writing I’d gained with my experiences with mental illness to create a platform to help other people understand what it is like to live with mental illness and why it is important to be fluid and supportive in how we handle situations with other people. In my mind we could all take a lesson from Barbara Ballard because it seems she’s at the head of the class.

Thanks for providing an atmosphere where I could succeed and congratulations on your retirement!

 

 

 

 

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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!”

 

Antidepressant Turnover

You may have read (here: Back in the (Rx) Saddle Again) that I have been experiencing a significant enough decline into depression to warrant attempting an antidepressant again. Being home with my boyfriend who has a broken shoulder on a daily basis has been quite exhausting, and despite my typically treatment-resistant symptoms (and negative reactions to new medications in the past) I have a new psychiatrist who seems hell-bent on un-wedging me from my latest foray in desperation.

Her latest idea was to start me on 12.5 mg of Zoloft (sertraline). Previously I tried 100 mg of Zoloft and started to vibrate out of my own skin with manic energy so we were hopeful that a tiny dosage might be enough to nudge me out of the black abys without launching me sky-high like some kind of slingshot of euphoric destiny.

As much as I find myself feeling like an emotionally unstable lab rat I admit, I’ve always been interested in science and how the body works. I’ve spent the last six years documenting my symptoms several times a day to try to help me understand where they are coming from and what helps me negate them. This has led to a complicated system of notes I sometimes see my boyfriend trying to read but tends only to result in a lot of head-scratching on his part. That said, even though my doctor has recommendations for my health and what might help, I have worked hard to pay close attention to the process for every medication we’ve tried, even those that were meant to help curb side effects and several that haven’t been related to psychiatry at all.

I guess it helps that I am interested, but much of my documentation has come out of necessity. Living with a mental illness has been super hard to get a grasp on and for many years I didn’t know exactly what was coming from bipolar disorder or anxiety and what was me. My rigorous note taking was what allowed me to show something like physical evidence that my doctors could contemplate to diagnose me in the first place, and beyond that it has been necessary because having treatment resistant symptoms (and often unusual side effects) has made it hard to know if something is helping or potentially hurting me overall. I have enough experience with physicians at this point to know that they are much more likely to believe what I tell them when I can present it in a formal and organized way. Rationality doesn’t hurt either, but sometimes that is hard to come by.

On a personal level, these notes have been totally invaluable when it comes to situations like trying Zoloft again a couple weeks ago, not just because they are something I can show my doctor but because living with a mind that can have trouble judging reality from fiction can make it difficult to believe in myself and the conclusions I am drawing at any given time. Having something tangible I can go back to so I know that I’m making important decisions (like whether to start or stop a medication) based on my experience and understanding of my situation and not a psychotic delusion has made me more confident about understanding my own health than I feel about any other aspect of my life.

As helpful as that can be, it can undermine me as well. Being confident about how I have assessed the results about any medication I’ve tried tends to leave me on the defensive with some doctors and I can come off as hostile or difficult to work with. When faced with the wrong doctor, one who tries to push their own agenda rather than listen to my point of view, I know I can become volatile. That’s why having the right doctor has been equally as important to me as the note taking.

So everything I’ve said about note taking was to get to this: the last two times I tried a new medication each one was a repeat of something I tried many years earlier. 5-15 years earlier. It is the oddest thing because I would almost swear that I’ve become even more sensitive to medications and develop more side effects than I did a few years ago. I don’t know if that is possible, but that’s the way the data seems to lean.

Ultimately this time around 12.5 mg of Zoloft had more adverse effects for me than the original 100 mg did. Yes, last time I was manic, but this time I waded through several days of intense dizziness, nausea, and GI upset only to be blindsided by 8 straight days of severe headaches in a row.

By the time I reached the seventh and eighth day my irritability was rising exponentially, to the point of being more reactive and depressed from the pain than I was before I started the Zoloft in the first place. I didn’t want to gamble the pain continuing(or even worsening) over the weekend since both my boyfriend and dog are relying solely on me for their care and I was already irritable to the point of arguing with every commercial that was coming on tv.

I called my psychiatrist’s office and the nurse suggested the headaches were a product of allergies (due to the intense tree pollen bloom this year) but if I really felt sure I should stop the medication over the weekend and call on Monday to report any changes.

I went with my own gut and stopped the Zoloft and within 24 hours I felt totally fine physically. The 8 day headache was gone, as were the other issues -all except the irritability that took more time to reduce itself. I admit, I did a little jig -both because the headache was gone and because I was happy I had made the right decision.

All too often it seems that doctors are more than willing to force me into a position of feeling much worse before I can begin to feel better, and while I understand the concept of waiting out side effects long enough for them to dissipate, in my particular situation of treatment-resistance it has never once paid off. Either the side effects become debilitating to the point of requiring a trip to the ER or hospitalization or I manage to get through the side effects after several weeks or months of struggle (like with lithium) and find I receive no beneficial effect from the medication.

Thursday I will be meeting with my psychiatrist to go over the notes I took from the trial and I’ll see what advice she has for me next, if any. Writing about the situation in this forum allows me the space to really think about the situation and try to understand it without feeling overwhelmed or sad or angry. I guess I am just ready and willing to accept that this is how things are for me, and even though I would say that is some serious progress I still hope to find whatever it is that will allow me to move toward wellness -or at least the best approximation I can afford.

 

 

 

 

Back in the (Rx) Saddle Again

Living with treatment resistant bipolar disorder can be really frustrating, not just for me but also for those around me. With symptoms that have responded atypically (either worsening or not resolving and accompanied by outrageous side effects) to the traditional route of pharmaceuticals normally used to treat bipolar disorder I have to shift all of my focus onto using skills to help keep me calm and rational.

Even doing everything I have encountered; things like meditation, dialectical behavioral therapy skills, living openly about my illness and asking for help when I can, paying close attention to my diet, sleep, and exercise, -that bipolar spark in my brain remains elusive and unchecked. Under the right conditions, my big mood shifts can happen in whatever direction they choose and I find myself along for the ride.

Lately I’ve been seeing that frustration growing in my healthcare team. In the last two months I’ve been taking a significant shift into depression, enough that both my therapist and new psychiatrist (of about 6 months) have become edgy. My therapist let slip that, “well you would think something should be helping by now!” and my psychiatrist sat, horror-stricken, when I replied to her question about what we should do about my depression with, “well the past few years nothing has worked so we typically watch and wait, requiring hospitalization as necessary until the episode ends.”

Unacceptable!

Maybe so, but it is my life. As much as I dislike being subject to frequent mood swings and psychosis I have reached the point of feeling some form of acceptance over my situation. I can’t throw a fit (though sometimes I do) every time a new treatment option doesn’t go my way, but the slightly pissy attitudes of my healthcare team the past few weeks has initiated something of a domino effect kicking people into gear.

On one hand, it feels nice to know that my psychiatrist feels inspired to do everything she can to try to help me. On the other, after a constant barrage of negative outcomes from medication after medication the past few years I am pretty familiar with how it can feel to be a guinea pig. I’m not saying I am opposed to new options, quite the opposite. I want to keep trying, I want to move toward a life that is stable and more functional, I just need to find a balance where I can do that and not have to be pulled along in the wake of each drug that’s had a negative effect without being able to take a break. When psychiatrists take me on it can be easy for them to look at me as a sort of challenge and they feel eager to throw everything at me they can think of right away without giving me time to recover. It has tended to make me both more physically and mentally sick while this is occurring, so it is important that I can balance pursuing new treatment options and living some of the life I am working to improve.

After how hard it was cycling through medications the last go around (2010-2015) I have been floating around using my cognitive skills and sitting tight taking Lithium that isn’t helping. I have actually been doing better without the barrage of new drugs constantly eroding my mental and physical health, so I have just kind of been waiting for the right doctor, or something new to come on the market, or for things to get rough enough to push me back into feeling willing to roll the dice again.

I wouldn’t normally consider my current state of depression severe enough to make me desperate enough to move back into that place of uncertainty, but last week my boyfriend was gone for 8 days and I was really concerned about being home alone that whole time and having the added stress of taking care of our sick dog on my own.

My new psychiatrist is focusing on making tiny changes in medications (hoping that my big reactions to regular doses might be mitigated by tiny doses) and trying things that have a low chance for making my overall health worse.

We started with a huge increase in my fish oil consumption, up to 2400 mg daily of highly concentrated oil (with a bunch of other specific properties I can’t quite recall). I couldn’t tell if it was helping while my boyfriend was out of town, but I didn’t feel worse, so for depression that was causing me to steadily deteriorate that may have been enough to give me a more level playing field last week.

If the fish oil was helping keep me from sliding further into depression, the plan went to hell a little bit when my boyfriend came home from his trip with a broken shoulder. The immediate jump in stress level left me plummeting and I was frantic this week trying to take care of him, and the sick dog, AND me.

I found myself in a situation where I can’t really afford to be screaming at my neighbors or paranoid out of my mind at the grocery store so I called my psychiatrist and agreed to try an antidepressant again.

I tried Zoloft a few years ago in a similar situation and was manic within a couple days. My boyfriend found me feeling high out of my mind in our apartment jumping around uncontrollably and he thankfully had the frame of mind to point out to me that I was acting a little strange.

Naturally, the idea of taking an antidepressant isn’t one I’m too keen on (I’ve had several mixed or manic reactions over the years to them) but I find my psychiatrist’s theory about trying the tiniest little bit to be intriguing, mostly because I’ve had the same thought myself and anytime I’ve brought it up to a doctor before (or my sensitivities to medications) they always just prescribed a regular dose anyway.

Yesterday I tried 1/8 the dosage of Zoloft as I did the first time around. 12.5 mg, half of a 25 mg pill that is so small I keep losing them. I was able to sleep (which is a good sign) so I expect to keep this up and see if anything happens.

In the meantime I’ll be here doing the best I can.

Swapping Big Moves for Little Moves

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

Mental State Dual Citizenship

Psychosis has often made it really hard for me to keep things straight, and even in my younger years I put a lot of effort into trying to separate depressive or manic periods and thinking from those where I am more stable. Before I was really able to pinpoint when I was experiencing mania or depression, one of the ways I did this was to consider these situations almost another version of reality.

Trust me, the idea of reality gets rather skewed while experiencing psychosis and though I’ve been on the hunt for ways to gauge whether the reality I’m experiencing makes sense with the reality of the people around me it can be frustrating (and impossible at times) to try to truly gauge the two.

So, as I mentioned, one of my first lines of defense has often been to think of my psychosis ridden bipolar disorder as something of a dual citizenship. That means I am a resident of two worlds; one world everyone else knows and sees on a regular basis, and another where (much like Alice’s wonderland) things can get a little weird.

It might sound a little funny, and while this other reality I live in from time to time doesn’t have talking playing cards or freaky cats (that would be something) I do often find myself dealing with life seeming to have a much different pace, the truths of the reality are often a far cry from what I’m used to, and even my motivations and dreams seem very different than in my regular day to day life.

Yesterday, for example, I spent about half the day living regularly. I washed some dishes, watched Ru Paul’s Drag Race, and talked to my Grandma on the phone.

The other half of my day was spent in depression land, a different sort of reality where (pace) no matter what I did, I couldn’t seem to catch up with what needed to get done. The (truths) I faced in this place seemed to be that my relationship was totally unstable and deteriorating before my very eyes, leading my (motivations) to demand I make sudden and dramatic efforts to curb the situation.

After several hours I found myself back in regular life, the reality of depression land having vanished and been replaced with (pace) feeling on top of things. (Truths) My boyfriend cares about me, he even brought me home some chocolates. (Motivations) For the love of pete, don’t make any sudden moves!

It seems like the last few depressive episodes I’ve had I find myself plopped down right in the middle of where I left off, which is rather maddening and definitely confusing as heck. A bit like waking up from a bad dream only to fall asleep and find myself right in the middle of it again!

Mania land is a little different for me, less like I feel overburdened by the information around me and more like everything starts to fade away like one of those Bugs Bunny cartoons where he keeps screwing with Daffy by drawing him into some kind of weird half plant half platypus and the setting becomes little more than a blank sheet of paper.

The (pace) often feels like I am so ahead of the game that spending six more hours writing isn’t a big deal. The (truths) usually suggest I’ve been worrying far too much lately, leading my (motivations) to urge me to brush off all forms of responsibility or concern. Hijinks ensue.

Mixed land, well, it’s a place I try to avoid at most costs but unfortunately I’m quite familiar with it. Everything about the (pace) there usually feels much too slow, like I am ready to run a marathon but I’m trapped in a vat of peanut butter; too much energy and no way to expel it. The (truths) that seep in tend to be based on suspicion, that people are hiding things from me or are up to no good (heh), leading my (motivation) to either have a meltdown at them or try to sleuth my way to the truth in some kind of jacked-up Film Noir version of reality.

Sometimes describing my mental and emotional states as places helps people understand how jarring it is to be sitting around one minute, minding my own business, and then suddenly be thrust into another odder, often less productive version of my life. I can be sitting pretty one second and in depression land, or mania land, or mixed land without warning; sometimes it takes me some time to even recognize something has changed. After all, the people around me go on with their lives and their own reality as if nothing has changed, and if I’m having a good day they may not notice that anything has changed on my end, even though I’m somewhere else.

Ultimately, time has shown me that I am probably not actually trapped in some outrageous form of reality manipulation by warping me to suspiciously similar copies of my life and that this dual citizenship is actually coming from within me, not externally. Still… I can’t say for certain that there isn’t some kind of brain gnome in my noggin who happens to keep forgetting to turn the basement light off or something, leading me to hear a high pitched whine where there wasn’t one before.

In all seriousness though, mental health is a tricky thing to understand, even for those of us who experience mental illness every day. Having said that, thank nuggets it is therapy day today.

 

Providing an Outlet

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

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

Big mistake.

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

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

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

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

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

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

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

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

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