Mental health care is complicated and irritating to maintain. And just like every other kind of health there is no magic pill. If you sprain your ankle and they tell you to take anti-inflammatories it will do no good unless you also rest the dang thing. Heart attacks mean "lifestyle changes" as well as possible pharmaceuticals. In general, whatever pill you are popping, there really needs to be some accompanying activity on your part.
I used to think that I was immune to psychology. That counseling and therapy would just bounce right off me. Because I know all the crap that they are going to tell me. Eat better. Exercise more. Get a good night's sleep. Don't feel terrible about things that are actually not terrible.
This last one is the hardest. Okay, so I'm not really doing the other ones either. Not without an outside expert telling me that I need to keep doing these things over and over again. It cannot be a friend or (heaven forfend!) a family member giving me the same advice. It doesn't have the same weight. (Sorry, folks. No offense.)
There is the same expert phenomenon in academia. Perhaps the best, most expert person on a given topic lives right next door. But if you fly someone in from across the country, people pay more attention. (We are really not very smart as a species sometimes.)
I have had to admit (again and again) that I am not, in fact, immune to psychologists.
And this is not remarkable. First off, I am not trained as a psychologist. So just because I feel that I have been counseled to within an inch of my life (although mostly as an adolescent and young adult) does not mean that I have the same expertise.
Also, even if I did have that expertise, it's not likely that I would have the distance to practice psychotherapy on myself.
And this is another unremarkable thing. In addition to pills not being magical (U&#@(*^^!!!), it is true that even the experts cannot (at least not effectively) operate on themselves. Or even close family members.
We are too close.
If I had the distance from myself to do an adequate job of psychoanalyzing me that would be a whole different problem.
Apologies for not posting. It is not, as you might fear, because I have been obsessively beading (or anything else). I have actually been quite good (since going off the Lithium) at engaging in a variety of activities.
I'll say more later.
Computer battery about to die.
When I was first diagnosed with bipolar disorder, one of the things that I was most afraid of was that treatment would "cure" my creativity. I worried that the things I liked most about myself might be symptoms of my illness. That my quick brain would be sluggish (although it hardly felt quick during the Depressive phases).
Because this is the story that is passed around: that there is a certain madness to creative people. Artists and the like. And that when their madness is treated, they lose their art. They lose their vision. They cannot create like they used to. How long has there been this story? It has been passed from generation to generation. Great artists are mad. They require their madness to be great.
And if this is true for the great artists-- that without illness they will go from being great to merely "pretty good," then what about the rest of us? If we are not great, then are we doomed to go from okay to "ugh?"
Well, I think I go straight to "ugh" during both the top of the roller coaster and the bottom. Manic or Depressed I am equally NOT creative. Not myself.
I am happy to report that I do not feel that treatment is curing me of my creativity. I am fortunate that I do not have severe bipolar disorder and the medications that I am taking have relatively few side effects. (450mg bupropion to stave off Depression, 200mg lamotrigine to act as a mood stabilzer).
I know what it feels like to be on the wrong medications (for me it was venlafaxine and lithium). And I am very thankful that I have a Psych NP to work with me on making sure that I am on the correct doses of the correct medications.
Now that I am weeks away from my last venlafaxine and I've been off the lithium for a while as well-- I'm getting back to feeling normal. And not the boring normal that I am afraid of. Just normal for me.
4yo: Do you like lions or ladybugs?
4yo: but lions eat you!
me: okay. I like ladybugs.
4yo: so, would you like lion meatballs on your spaghetti?
took my meds all the time
acupuncture (shen leng bai zhu shian herbs)
one friend each week to boss me around in my house for decluttering purposes
whole family clean-up once a day
finding a good shape for the weeks of summer
Or something like that
permission to do the things I like to do
so long as the things that need to get done also happen
Lex I: Corpus omne perseverare in statu...
Every body persists in its state of being. An object at rest tends to stay at rest. An object in motion tends to stay in motion. To change these states requires an external force-- a force of great magnitude. A force that is strong enough to swim against the tide, to slip the bonds of earth, to stop boulders in their hillside tumbling, to prevent the wind from slipping through your fingers. So when thoughts are heavy-- weighted down-- there is no inclination to rise. And when opposite, spiraling (outward, upward, inward, downward), there is no call to stop. (STOP!) And here is the challenge: to somehow recognize the state in which your body persists and fight against it. Day after day. To accept this as your fate is to keep company with Sisyphus in his mad endeavor.
Lex II: Mutationem motus proportionalem...
Force is equal to mass times acceleration. So things can hit you hard if they are very big. Or very fast. An elephant may flatten you even if it sits upon you very slowly. And it isn't the size of the bullet that makes it deadly, but its velocity. The big things you expect to struggle with: loss of job, death in the family, natural disaster, tragic events. The surprise is in the small, sudden changes (good or bad) that can do quite a bit of damage if given sufficient acceleration.
Lex III: Actioni contrariam semper et æqualem...
For every action there is an equal and opposite reaction. Whenever I am functioning at what I think is my peak (but is in no way sustainable) I can look forward to a descent into very little functioning whatsoever. Time in company with many people requires time removed from all people. Great industry must fall into great sloth. Quick succession of fantastic ideas is only a hint that soon all thoughts will become sluggish. And forgetful. But somehow the descent into depression never seems to indicate a natural rise. This is the law that makes all things seem impossible.
What is the threshold between hypomania and mania? (a refresher course for me)
the individual's experience
Both mania an hypomania have 3 or more of the following characteristics persistent and pervasive:
1. Inflated self-esteem or grandiosity
2. Decreased need for sleep (e.g. feels rested after only three hours of sleep)
3. More talkative than usual or pressure to keep talking
4. Flight of ideas or subjective experience that thoughts are racing
5. Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)
6. Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation
7. Excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g. engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)
In hypomania, these things tend to not interfere substantially with life or work and usually do not require hospitalization. Also, there are no psychotic features associated with hypomania.
With mania, there is marked impairment at the workplace and/or social functioning. Hospitalization may be required and there are psychotic features.
So it seems to me that there is some fuzzy space on the continuum. Severe hypomania and mild mania are kissin' cousins, right?
I don't know that my latest mood episode could be considered truly manic. It's possible that the other people in my life disagree. Don't know. OFP asked what Spouse thought of "all of this." But as Spouse's mother helpfully pointed out, he has been dealing with "all of this" for more than two decades.
The only difference is now we are more aware of my quirky behaviors. And if they becoming obsessively present to the exclusion of... well everything else, then it seems like something is not quite right.
I have joked that I need a PCA. Someone to remind me when to get up, eat meals, start an activity, stop an activity, and keep track of time on a macro and a micro level. Not that I really want someone micromanaging me to that degree. But some imposed external structure seems to be key for me. Yuck.
Lithium is the go-to drug for manic episodes-- particularly acute mania in patients with bipolar I. But it doesn't work for everyone. And it did not work for me. Of course, I was not in an acute stage of mania. I was just in a persistent state of spiraling anxiety.
Since I am super late with this post and it is not even remotely as daily as I'd like my posts to be... I can say that I feel better now, off lithium, than I have felt in some time. With the 20/20 hindsight, I think it would have been prudent to try more non-pharmaceutical ways of handling the mania before jumping on the lithium bandwagon.
That said, it's possible, I suppose, that the small, brief lithium in my system did a fine job of curbing the oncoming mania and now I am on a more even keel. Let's go for that.
Here is what to remember: bipolar meds have a stabilizing effect. They do not eliminate issues with depression and manic behavior. I am reminding myself of this.
Also, very very tired of trying to tease out which things are related to the illness, which are related to medication, and which are related to my temperament. Which is intense and emotional and perfectionistic and goal-oriented. And pharmaceuticals cannot treat temperament. Which is why the cognitive therapy is an important piece, I suppose.
It was very tired out today. I slept in. I took a nap. I will likely go to bed in a timely fashion tonight as well. I had an appointment with the OFP this morning. It was good. I fell into my recently usual crying spell on the way to her office. Which pissed me off. When I filled out the PHQ9 that is supposed to tell if I am depressed or not and i always come out with a 4 today I was a 9. But it didn't feel Depressed. It felt Anxious and Horrible. Jittery and sad. Incapacitated and angry. Blarg.
I think getting off the lithium will be a good idea. It certainly did not seem to help. And in many ways seemed to make things worse. But this means that I will not have any medications in place to help deal with the manic side of the equation. And let me stress again that I am not extreme either in the Depression or the mania. For which I am extremely grateful.
It looks like lamotrigine is known to be decent for preventing recurrent depressive episodes, but is not great at addressing the manic side of things except maybe preventing or delaying the mania. In general it is known as a maintenance drug and not one used to treat a current mood episode. And I think I am in a mood episode. Mild mania. Crap.
So the OFP reminded me of the non-drug things that I need to be doing to treat/prevent manic crap:
exercise, sleep, healthy eating... all the boring and unsexy stuff like that.
Here is my assignment
Mostly the non-medicinal ways to prevent mania focus on reducing chaos and promoting routine.
Here is my secondary assignment
took meds: 450mg bupropion, 200mg lamotrigine
saw the OFP
played with the daughter (hide and seek and LEGO)
K is for knackered
When I worked as a counselor one summer I was asked to teach the juggling class. So I arranged a space and made sure that we had materials we needed: silk scarves, beanbags, pins and hacky-sacks. I made sure we had a space to practice. I recruited campers to sign up. Only I didn't know how to juggle. But I worked with a junior counselor who juggled just fine. And so I was able to wrangle children and help him come up with lessons. And I even learned enough that I could juggle three scarves as they floated through the air in front of me. Anything heavier moved too fast and I lost the pattern and everything fell to the ground. And I could juggle one ball. No more. And not well. (Hand-eye coordination has never been my thing.)
And I feel like that now. That there are too many balls in the air and I can really only handle scarves. And I can only reasonably do the pattern for three and someone keeps adding more balls to the pattern: four, five six... They go by so quickly I can't see them, can't catch them. And I don't know which ones to let go or even how I would go about doing that without dropping everything. But with so many things to do, so much coming at me that is out of my control, I have no chance to slow things down and just practice.
And as a parent my life will always be like this-- scrambling to teach lessons in something that I cannot do.
(back-dated post due to above-mentioned incapacitation)
Sometimes I think that I don't have bipolar.
That the way I experience the world is typical.
It seems likely that people who do not have a mood disorder
Do not have uncontrollable crying for an entire day
Triggered by a dead caterpillar
(metaphorically representing failure as a parent)
And these same people probably do not
Cry for the duration of an acupuncture appointment
Lying still in the darkness with tears rolling into their ears
And the only thing that stops the crying jag:
Listening to (but not watching) violent shows
Stitching tiny glass beads into deerskin
With a glover's needle
And a thimble made from masking tape
Unable to stop
The choices: shut out the world or dissolve into tears
This day (yesterday) was one of the worst. Could not cope with anything. Not even minor things.
So I did these things:
called the OFP and left a message that I needed to see her sooner rather than later (she scheduled me for Saturday).
called psych np
me: I'm really weepy *sniff*
psych NP: Still? That's not good. It started with the lithium, didn't it.
me: I don't know. Maybe. Yes.
psych NP: You need to stop the lithium. Take one pill today, one pill tomorrow and then done.
Equatorial actions: made some calls. that's all.
All the things I should have done got off the bus on the last day of school and followed me home.
Panicky and shaky over nothing and everything.
Most of my anxiety is focused on a small green caterpillar in a jar on the daughter's dresser. Whether it will die because I misidentified it. Gave it the wrong food. I am starving it. Its imminent demise the first great tragedy of the summer.
I am shaky and tired and cannot sleep. I feel like I am doing backwards somersaults inside my head. And everything I have done, everything I will do is somehow assuredly wrong.
I should have spent time out of doors. I should have danced. I should have phoned a friend.
Instead I sat for hours on end beading Van Gogh's starry night into a piece of deerskin.
And it is too late now to get adequate sleep this night.
Once you realize these things
It is always too late.
Today not so much interested in connections. Hiding (I mean resting) in dark room with air conditioning running.
Quaker, teacher, parent,