RealMental

I’m posting this from an airport terminal in Little Rock, where our flight to Orlando has been canceled because we’re fogged in. I can’t access the post I had prepared for today, so I thought I’d pop in and just ask for some feedback.

One of the challenges of keeping things on an even keel for us is STRESS MANAGEMENT. So, events like this can really put us into a tailspin. Alex does great during the crisis, but sometimes, after the fact, when the immediate distress is over, it kind of catches up to him and bowls him over, and we get what we just refer to as a “crash.” So right now, I’m hoping to avoid that. He’s already been pushed into what I’d consider a pre-hypomanic state by all the frenetic activity of the last 24 hours, and these new complications are just prolonging that, which is not good. The number one thing that is difficult for us but so important is the ability to remain FLEXIBLE. And my husband is a planner, so while he absolutely “takes care of business,” rolling with the punches when things get shaken up takes a lot out of him.

So, what are some stress management techniques that y’all have found to be successful, particularly as relates to managing a mental illness and preventing potentially stressful situations from throwing you all off-kilter?

We have a stressful situation coming up, and I worry. I’m already seeing signs that I recognize…they could go away as quickly as they came, or they could get worse. I won’t know until it happens. I am on eggshells, unable to figure out the “right” thing to do or say, just trying not to crack the surface I tread. I don’t know how to respond to thought processes that are, to me, foreign. Nothing terrible is happening, indeed, nothing bad is even happening. But I have that ache all over my insides, like the ache you get in your eyes when you’re straining to see in total darkness, the tightwire tension of trying to be perfectly still and silent so that you can hear what might–or might not–be coming up behind you.

You’re welcome.  And, I’m sorry.  But I think I’m doing just that.

After a visit to the psychiatrist in which I described my symptoms (regular physical symptoms of  panic/anxiety with no underlying emotional connection or distress) and he responded by refilling my Xanax prescription, and dismissed the idea of checking my hormone levels, I went back to the OB/GYN/Reproductive Endocrinologist who performed my hysterectomy last year.  I described the same symptoms to him, and he nodded throughout, and said that, while he wasn’t prepared to say that I do not need psychiatric care, all of my symptoms fit the profile of someone suffering surgical menopause without enough estrogen replacement.  And my bloodwork confirmed that my estrogen level was low-ish, so we increased the dosage of my estrogen patch.

Ten days later, I feel on my way to being a new woman.  It is supposed to take three weeks for the effects of the dosage increase to be fully realized, but already, the 5 hours a day I was spending in a cold sweat, feeling panicky and unable to leave the house is down to a matter of minutes.   And what is bugging me right now is the idea that I have, perhaps, had hormone-imbalance problems for most of my adult life, and no one to recognize them as such, and treat them accordingly.

Knowing that many mental illnesses are triggered and/or exacerbated by hormonal events such as puberty, childbirth, and menopause, why is this not factored into diagnoses more often?   It’s not just women–men are affected as well.  My own husband seems to have experienced the first symptoms of bipolar disorder just after hitting puberty.  But with women, I have the feeling that it just gets…overlooked more often.  I mean, the very word “hysterectomy” pretty much indicates the medical community’s attitude toward things female, doesn’t it?  That woman is unbalanced, moody, highly emotional, downright erratic…hysterical.  By removing her reproductive organs, the part of her that’s female, we can make her sane.  Whatever.  I’m not crafting a very good explanation of what I’m getting at here, but I think you understand.   Hello, AMA?  It’s almost 2008.  Can we have a NEW WORD to replace “hysterectomy,” please?  Ugh.  And by going on a rant about this, HEY, I’ve just proven them right, haven’t I?

At least they can’t say I’m “PMSing” any more.

How about the rest of you, ladies?  What is your experience with the relationship between hormonal fluctuations and your mental/emotional state, particularly as regards diagnosed, medicated mental illness?  Are hormone levels checked regularly as part of your treatment regimen?  Is your “femaleness” even considered…or worse, is your mental state “written off,” even in part, due to gender and the perceived instability/emotional weakness of women?

Do you ever get the feeling that a doctor is listening to your symptoms, and wondering if it’s just “that time of the month?”

Act Today! Presidential Vetoes Threaten Funding for Mental Illness Research and Services

November 15, 2007

Help Override the President’s Veto of Funding for Mental Illness Research and Services

As early as today, the House of Representatives is expected to vote on a motion to override President Bush’s veto of the FY 2008 Labor-HHS Appropriations bill (HR 3043). This bill includes the budgets for the National Institute of Mental Health (NIMH) and the Substance Abuse and Mental Health Services Administration (SAMHSA) – with increases totaling $40 million for FY 2008 for mental illness research and services.

Act Now!

Call your House member today, at 800-965-4298 or 877-210-5351! Urge them to support the motion to override the President’s veto of the Labor-HHS Appropriations bill. Remind your House member that HR 3043 includes:

Click here to view additional background information on the House-Senate agreement on the FY 2008 Labor-HHS spending bill.

Well, you probably don’t think of them when you’re not the person most directly affected, anyway. This post is going to be short and sweet, but I think it’s important. Mostly because I myself am guilty of what I’m going to try to explain here. And what I understand of this, I understand because of the patient, thoughtful, and painstaking explanation of it to me by my bipolar husband, Alex.

Alex has Bipolar 1 Disorder, and nothing about it is fun. Unmedicated, his hypomanic phases are short preludes to pretty horrific and lengthy manias. He’s never had any symptoms of psychosis, but the extremes of his cycling are pretty severe. Fortunately (ironic as that term is in this context), he has tremendous insight into his own illness, and total dedication to treating it and staying on top of the often chaotic ebb and flow.

You would think that having his illness managed as well as he does would make everything just hunky-dory most of the time, wouldn’t you? Well, most people would, and DO. And that’s kind of the problem. There is a catch-22 here that most people would never even consider, and that is this: Even when you are open and transparently honest about your illness, as Alex is–everyone in our lives, from family to workplace to church to friends, knows about it–there’s a hitch. Because even with all proper treatment, bipolar disorder is prone to “breakthrough” manias and depressions, and that can cause disruptions in daily life, with work, family, friends, etc. Sometimes BIG disruptions, like not being able to get out of bed for a few–or several–days, or not being able to concentrate, or just feeling…”off,” and anxious to the point of distraction.

And therein lies the rub. When you’re “doing well,” especially the longer you’re “doing well,” then the more people expect you to ALWAYS be doing well. The reaction that comes from a crash of any kind is surprised, disappointed, even shocked. It’s as if every single time you have a good stretch, people seem to expect, if not totally on a conscious level, that you are “cured.” And sometimes, compassion, or the impression of compassion, anyway, can seem reduced, and people can seem impatient for you to “get it together” and “get back on track.” Very few people understand about breakthrough manias or depressions, and most seem to think that once you start taking medication, it’s going to work forever, so if you’re having problems again, it must be due to some personal weakness or omission. And even though I know that it’s a perfectly reasonable question from a clinical standpoint, given the low rate of compliance and insight among bipolar patients, when Alex and I get an emergency appointment with the psychiatrist because things are going awry, and the first thing he asks is, “Are you taking your medications?” I get pissed off.

I could ramble on about this for a while, but my point, for those of you who may be reading, who have significant others, family members, friends, who deal with mental illness and who try hard to keep things on an even keel, is…well, when there’s a blip on the radar, a wobble of the boat, or whatever other metaphor you want to use to indicate a break in the desired pattern of behavior: Try to remember that there IS an illness there, and that just because things were managed for a while doesn’t mean they always will be. Try not to be impatient with your loved one, because I assure you that he or she doesn’t want to be “off” any more than you want them to be. Give whatever support you can in getting things back on track, but give it with a compassionate spirit. If you have a compassionate friend who REALLY understands, then vent if you need to, but don’t vent to those who aren’t “in the loop,” because you’re only doing damage to their perception of someone you love.

People who are trying hard to maintain, and having a good percentage of success at it, shouldn’t have to think, sometimes, that it might be easier if they were just sick to the point of being totally disabled all the time, so that everyone else’s expectations would be lowered. And here’s where the tightrope-walk of a significant other comes in, because at the same time, you don’t want to live your life as if you expect things to go awry at any moment–or to project that feeling onto your loved one.

Nothing about this is easy, but one thing is sure. It’s a joint effort.

You know, I ain’t right. And I don’t really know where first to turn to try and find out why not. All I know for sure is that the last several years (let’s review: Got married, new husband went into full-blown manic episodes, no one knew what was going on, but he was disappearing for days on end, engaging in substance abuse, and emptying our bank account. Then I got pregnant, and Husband went floridly manic again, got hospitalized against his will, was released to rehab, got ninny psychiatrist who totally mismanaged his treatment for bipolar disorder, stayed a month in a rehab facility then moved into an apartment, because I could not have him come home just then. Later, he moved back home, we had our beautiful daughter, and before you could say “relapse,” he disappeared when she was just 4 days old. Manic episodes continued until spring when he finally went off the deep end and wound up forcibly hospitalized again, this time landing in a GOOD psychiatric facility and securing a GOOD doctor who prescribed a GOOD treatment and had him participate in a GOOD outpatient rehab program, the result of which has been sobriety and relative stability with NO manic episodes since May of 2004) have been hard, emotionally, and then the last three years (let’s review: My father suddenly and tragically died, ripping a hole out of my very heart and changing the fabric of WHO I AM, I miraculously got pregnant for the second time, and then seven weeks later lost that precious baby to a miscarriage…grief compounded by grief) have been…tragic, desperate, and then this past year since the hysterectomy has just been bizarre. I’ve dealt with depression and anxiety, grief over the definitive end of my childbearing potential, which seem to come and go whimsically, and catch me off-guard. I took one anti-depressant after another over these years, and suffered side effects galore without ever really feeling significantly better. Anti-anxiety meds (read: benzos) helped me through some tough spots, and then I’d go several months without any before needing them again.

The only sure thing is that my moods and anxiety/panic attacks always corresponded with something going on externally. You know, like lying awake at 4:00 AM wondering where my husband was, or lying awake sobbing for my lost child, or lying awake crying into my pillow because I NEED MY DADDY BACK. In other words, if things were going okay, I was fine. But somewhere along the line, especially since Dad died, something had gone KABLOOEY with the coping mechanisms that had served me for the first 35 years of my life. I have a hard time wrapping my mind around this, that some external event(s) could occur that could trigger a weakness, a malfunction, in my brain.

One day this spring, while I was discussing this with a wonderful friend–a friend who just happens to have been, for the last few years, a MUCH better friend to me than I’ve been to her, or to anyone else–who happens to be a doctor of pharmacy, not to mention having much personal experience with clinical depression and the meds that go along with it. I listed to her all the anti-depressants I’d tried, told her how none of them had worked, and asked her, “What (meaning what drug) can I try next?” She looked at me, and after just a moment’s consideration, said, “You know, Belinda, even though you’re depressed, you may not have an actual chemical imbalance. I mean, you’ve been through some pretty horrible, awful stuff, just year after year recently, and you have every right to feel despondent without it meaning that your brain is all wonky…like mine.” And then she laughed. And I saw a light. And I loved her like she was part of me, because she got it. And then she told me the hard part.

She said, “Sometimes, you can’t even live life ‘one day at a time.’ Sometimes, you have to live it in 30-minute increments. You can do almost anything for half an hour, no matter how badly you don’t want to. So on days when I just want to stay in bed with the blinds drawn, I make a deal with myself to go out to the barn and groom one horse. By the time that’s done, I might look over at YOUR horse” (she’s been keeping Misha for me for way longer than I meant for her to) “and decide that his mane needs detangling, so I brush Misha’s mane. Then I might want to clip his bridle path, and before you know it, I’ve spent half the day out in the sunshine, DOING something, instead of wallowing.”

Just when I had decided that Kerri was the most brilliant, insightful woman on the face of the planet, she confessed to having developed this coping mechanism after hearing a version of it in the film, “About A Boy.” She said, “Yep. 10 years of therapy and I finally learn something useful from a Hugh Grant monologue in a movie. Not the book–the MOVIE.”

She IS brilliant, my friend, and she’s definitely onto something. I can’t help but think that, since no AD has helped me feel better–not really–that whatever is wrong with my brain, it’s not something that an AD can “fix.” I’ve been off the most recent AD, Wellbutrin, since early March, with no noticeable effect at all. I don’t feel better, I don’t feel worse. Just the same. The anxiety symptoms have abated (I’m not having falling-down panic-attacks in Wal-Mart any more), but are still present to some degree, in proportion to what’s going on in my life. Every once in a while, I suddenly get HOT all over, start sweating from head to toe, my nose runs like a faucet, my heart pounds, and I just need to be HOME.

Something is particularly difficult about mornings, about just getting out the door. Once I’m out, I’m pretty good for a few hours, but my calm seems to have a shelf-life, and I need to get back home in the afternoon. I like to plan things pretty far in advance, but I have trouble committing to things in advance. Anti-anxiety meds help. I’m not wild about how they make me feel, i.e. slightly dopey, but I do use them when I need them.

And then there’s the hormone angle, which I don’t even know for sure how to approach. Something has GOT to be going on there, since the weirdness has escalated by, um, a bunch, since my hysterectomy last fall. When I first came out of surgery, on estrogen deprivation, I literally felt, for the first and only time in my life, that I had lost my mind. It’s like nothing I can describe–the misery, despair, agony, anxiety–the certainty that it’s never going to be better, ever. After a couple of weeks, I was able to start estrogen replacement therapy, and it was like a miracle…at least to a point. It made the extreme crazy go away, but like I said at the beginning of this post, I still ain’t quite right. But then, I’ve never had the dosage checked or adjusted, so there’s a thought…

And I can’t help but think that a large part of what keeps me “down” and anxious is the disarray of my lifestyle–I keep Bella clean, fed, loved, dressed well, entertained, cared for…and that’s almost (but not quite) the limit of my motivation…and THAT is my motivation for this effort. I don’t know yet if it will work, but I know that to have peace and calm, I must first have order. I need it, Bella needs it, Alex needs it. And I need to provide it. I’m on my way, I hope…the house is still a mess, but I’ve done certain chores more regularly this week, and my family has had a hot, homemade, nutritious meal on the table every night this week, with NO takeout. That’s got to be a start. And Alex, bless his ever-loving-heart, cleaned the living room today, which lifted my mood unbelievably.

I’d love to hear from anyone who’s been through, or is going through anything similar, especially from the hysterectomy angle. Or not. Just whatever. Can you just have bad things happen to you and suffer a shift in actual brain function? (Yes, these are questions for my shrink, but my next appointment’s a couple weeks off. Humor me.)

Adapted and significantly augmented from a nearly simultaneous post at www.ninjapoodles.com

I can remember screaming that once, long ago. I was just a kid, and had been talked into getting on “The Spider” at a county fair up in north-central rural Arkansas, by some long-forgotten friend. Some of you may know this ride as “The Octopus,” or another name. What it is, is a kind of a jacked-up version of the Tilt-A-Whirl, with long “arms,” and the cars set on an angle. The arms move up and down, individually, from the base of the machine, spinning around the base simultaneously. While this is going on, each individual CAR is also free to spin at will, which it does, at a crazy pace. Good gosh, I was sick after just a few moments. I can vividly recall screaming at the ride operator to PLEASE stop the machine–and it seemed like a perfectly reasonable request to my 10-year-old brain. They could stop the ride, let me off, and resume the thing for all those fortunate, iron-gutted riders who wished to continue. But the thing was, I needed OFF, and I needed off NOW, before I slung vomit over all and sundry and ruined everybody’s day. I even remember timing my shrieked pleas for mercy so that I was doing the bulk of my screaming precisely as my car swooped down over the ride operator’s head.But that carny was either hard of hearing, uncaring, or just plain MEAN, because he didn’t stop the ride, and I had to, somehow, find within myself the literal intestinal fortitude to tough it out until the ride was over. I still don’t completely understand how, but I did it. And I never, ever, EVER got on an Octopus/Spider/Hellmachine ever again. Although, go figure, I grew up LOVING “The Zipper.” Hardly matters, because ever since my big surgery in the summer of 2000, I can’t even ride the stupid Tilt-A-Whirl any more without getting woozy, and EVERYONE knows that the Tilt-A-Whirl is a BABY ride. Anyway.

My life is feeling a little like that Octopus-ride at the moment. And while I don’t really want to get off and abandon the ride, I’d like to just slow it down a bit, please. Just for a while, so I can catch my breath, and maybe hand off my cotton candy to someone on the ground so it doesn’t wind up spiderwebbed all over me (this is another reference to an ACTUAL childhood carnival experience, when my little sister and myself brilliantly carried cotton-candy onto a Tilt-A-Whirl, with hilariously embarrassing results) in the meantime.

Seriously: I’m not worried about anything superficial, like my metaphorical hair getting messed up–I just don’t want to explode metaphorical stomach contents all over the whole metaphorical world. Wait–the world is real, isn’t it? But you get my meaning. It’s just too much, too fast, too up-and-down, too back-and-forth, and with ENTIRELY too much spinning, one axis mounted upon another, mounted upon yet another…and it seems like some cosmic, metaphorical carny is adding to the base, for yet MORE spinning potential, each and every day, just to see how much I can take. It’s like a NASA stress-test, and I’m the rocket. What, I’m mixing metaphors now? Sue me.

I can’t remember who was with me on the day of that fateful Spider ride, way back when. It can’t have been my sister–she’d have been too short to get on. But whoever it was, whatever young peer, I do remember them more or less talking me through that nightmare ride that seemed it would never end. The way it worked was through distraction, pure and simple. Whoever that wise young friend was (MAN, I wish I could remember, and could thank them), he/she kept my attention focused on his/her voice, and gave me a metaphorical life-preserver to cling to until the vertiginous nightmare was over.

I say all that in the “now” to say this for posterity: Isabella is my life-preserver. It seems that I can’t possibly be tossed about enough that a rousing rendition, complete with hiney-shucking choreography, of “Grey Squirrel, Grey Squirrel, shake your bushy tail…” can’t bring things zooming right back into focus, and still the ground beneath my feet. Her sweet smile, her hugs and kisses, her mere existence is like BEDROCK. I want her to know, when she’s looking back in years hence on these pages, why I did this, wrote these things down. I want her to know that she did this for me, even before she was born. She makes it matter, she makes it right, and she makes me stay on the ride and weather the dizziness.

I guess she made me a “mommyblogger.” Among other things, all of which are vast improvements over anything I was before she came along.

Today’s post was brought to you by the word “metaphorical.”

Originally published at www.ninjapoodles.com