RealMental

The problem of mental illness is its invisibility– no wheelchair, no boils, no external signal that proves the existence of the condition.  Like a pain syndrome, or a dormant allergy, mental illness exists to the beholder only to the extent that they are willing to behold it—to believe it exists.  The other part of the problem with mental illness is its very mentalness—meaning that mental illness manifests itself it through words and deeds.  Trying to explain what’s going on in your head, to someone who’s not inside with you, makes no sense– literally.  There’s an underlying assumption that our thoughts and actions are under our control—such that the products of our thoughts, our words, our deeds, are intended.  From the beholder’s end, the crazy person had to have meant what she said, what she did, because why else would she have done it, unless she was trying to be cruel/mean/whatever? 

“Because I am crazy” ends up sounding like a lame excuse, but it’s true–  unless you are inside the crazy person’s head, you can’t understand that there is a lack of control, a lack of connection between what you intended, and what manifests itself externally.  When the crazy person is expressing thoughts, and acting on thoughts and feelings that are what she felt and meant at the moment, but which are based on a misperception of reality—psychosis, delusion, disassociation—how to explain it away when the episode is past, and say “I meant it, but it wasn’t real?”  How to explain that your lies, your accusations, your hurtful behavior, were based on an unreal paranoid perception, or an anger so overwhelming that the whole world is colored red—but again, that it wasn’t real, you didn’t mean it in the sense of intending to hurt, now that the episode is past?  Add into it the denial, the shame, the fear that we feel when we realize it’s happening again,  and we lie about what were are thinking, what we are feeling before the episode really begins, because we know you won’t understand.  It’s easier to pretend like your feelings and thoughts are connected to your words and deeds, and to not try to express, to in fact suppress, the swirl of emotions, the cycling thoughts, than to try to make you explain what you can’t.  Which can only lead to more explanations of words and deeds to untangle when the world is right side up again.  There’s an enormous leap of faith, of trust, that the outside observer is being asked to take—to believe what the crazy person is saying, afterward, even though the crazy person sometimes can’t trust their own mind.

I wish there were a flash animation online to show how increasing and decreasing hormone levels affect the map of the brain—your insight and memory, speech centers, emotions.  Likewise with neurotransmitters, the electrical impulses that misfire when the crazy brain isn’t working properly.  The analogy of serotonin to insulin works a little bit, and I’ve tried likening the misfiring impulses of the brain to a downed, live electrical line—who would go near it?  No one.  But the crazy person can sometimes lack the low blood sugar signals or the caution tape of the downed wire—making the “I can’t explain what you won’t understand” into a problem of “I can’t warn you about what I lack the insight to perceive.”  Therapy can help, but it can take years to identify the warning signals, to become self-vigilant enough to seek help at the critical point.  It’s better if you believe, and you watch with me, and you tell me I’m getting crazy again.  That is, if I am lucky enough not to have ruined our relationship last time.

I am a classic Adult Child. I need to please everybody, and my self-worth is measured by my ability to make everybody happy/calm/sober/sane. Between my alcoholic dad and my depressed nonfunctional mom, I was the adult of the family. I spent a lot of time being quiet, being good, being busy, being helpful growing up, but it didn’t make a dent in my parents’ behavior. All it did was make me wonder why they didn’t love me enough to see how hard I was working to make them happy– which then, of course, made me both more depressed and more determined to be better, smarter, nicer, more. (And really, really, angry. But it took me years to figure that part out.) I tried to take care of my younger brother, and mothered/smothered him right into resentment, which is only now beginning to heal. I tried to take care of my mother, but those attempts bounced off the teflon shield of her narcissism. And I tried to please my dad– though this, in part, was “rewarded,” and kept me coming back for more.

None of this helps me have healthy relationships. I am the best, most caring, most sympathetic friend ever, until you don’t reciprocate in a perceived hour of need, when I, exhausted, heart-hurt, depressed and angry, will lash out at you in a sobbing, choking, waterfall of grief and accusation. I am the ideal employee, until the father-figure mentor falls short of my expectations in some way, at which point I will cease to give a shit and start self-sabotaging. I work myself into the grave, then get exhausted, manic/depressed, and start messing stuff up, all the while lacking perspective because I was trying to be perfect and denying that I was falling short. I’m the best boss– always available to help you sort a situation out, giving credit where credit is due, and being truly constructive with my criticism– until I fall apart and am utterly unavailable to you. And I am a pretty good wife, mothering, cleaning up, nudging along, until I get pissed off at whatever it is that I’m annoyed by, because isn’t it enough that I work, and do the shopping, and do the cooking, and do the family organizing, do I have to do everything? All of these traps are hard to avoid, and keeping out of them is as much work as remembering to take my pills every day. That’s why practicing the fine art of Letting Go has been so crucial to keeping my sanity.

Before I met the Better Half, long before my bipolar II diagnosis, it would be safe to say that I was a Serious Person, well on my way to being a Bitter Bitch. I was a prime candidate for a Sense of Humor Transplant. But the Better Half made me laugh, makes me laugh, helped me rediscover my laugh and my sense of humor. And the joy that he brings me every day allows me to lighten up, to realize that my house doesn’t have to be perfect, to let the dishes sit another day, and to air my grievances in a way that will not win me Battleaxe of the Year. It’s still a struggle– decades of being a Control Freak are not easy to let go, and a little bit of perfectionism is OK. But maintaining the balance? Oof. Letting go of getting it right, and just practicing, even if I never make perfect– that’s what’s needed.

Republished from BipolarLawyerCook.

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.

“If you want something badly enough, you can make it happen.” It’s not true, at least when it comes to memory. There’s always some inconvenient truth-teller, correcting the re-written version of the past that you’ve authored. I’ve wondered often if you’re in denial, or if you really believe it. Are you that insecure? That fragile? That crazy? Re-framing is one thing, but painting over the canvas doesn’t change what’s underneath.

You tell us we are lying, that it was never like we say. You tell us that we are ungrateful. And it’s not true. We are grateful, because despite all the rest, we made it out of childhood as OK as anyone can reasonably expect. And we know that you believed that you loved us. Intent counts for something, even if what it’s always been about is your narcissism and self-absorption, your need to be seen as a “good person”.

But you’re the one who’s lying. You’re lying to yourself because you don’t want to know that you should have done more, tried harder, stopped looking inward and acted to do what you could for us, rather than spent all the years feeling sorry for yourself. And telling us it’s the truth won’t work. And now you’re lying about other things, because you like the mania, and you feel every bit of the self you imagine yourself to be. You’re denying that your behavior is manic, because if you admit that you are, then the feeling of worth isn’t real, and you have to re-paint the canvas again.

I feel sorry for you in some ways, because it must be exhausting, needing to re-write everything to define yourself in your favored purple prose. I feel sorry for you for not being able to admit your mistakes, much less learn from them. But you can’t make me admit that what happened didn’t, and you can’t make me tell you lies that will make you feel better. My canvas is worn in places, scarred in others, but the entire work is there for me to understand, and the total picture teaches me something new every time I look at it.

(Sunday morning, East Coast Time)

As I traded phone calls back and forth with my brother (here), my aunt (there), and my mother (there), I reflected on the fact that this is just too damned hard right now. And, that maybe I precipitated her mania? by not just keeping my damned mouth shut during her visit. By the time I talked to her this past Thursday, she was excitedly complaining to me about the internal inconsistencies in The Golden Compass series, which I’d lent her to read on the plane flight home. Something about how Lyra already knew how to do her hair in the first book, so why was she learning all over again in the second? Hoo-whee.

When I talked to her on Friday night, she was excited to tell me about how she’d finally been able to get out some thoughts about a theology based on the Holy Spirit, and not on God the Father or Christ the Son. From a lecture she gave 30 years ago, back when she was teaching at divinity school. “And I was considered quite one of the more brilliant up-and-coming feminist theologians.” Nah, obsession with the past and inflated ego are not signs of mania.

“Why is it, that whenever I finally have a breakthrough in the creative process, you people think I am crazy?” Well, let’s see, the giggling every minute or so might have tipped me off. And . . . “whenever?” This is only her second manic episode. She was very irritable with me during the three phone calls we had, and was refusing to go to the hospital over the weekend. She was sure she wasn’t manic. “This is different.” Telling her that sure, creativity and happiness are nice, but these were precursors to delusion and confusion, like last time, and that you have to stop it before it starts, or it’s longer and worse, wasn’t getting me anywhere. So the third time I spoke with her, after she told me “I did NOT agree to go tomorrow, I will NOT go anywhere until MONDAY, when the doctor’s office is open again,” I just started sobbing, and begging her to please go to the hospital on Saturday, because I am three thousand miles away, and as angry as I am at her, I want her to be OK, and I just can’t handle her breaking down right now, in the middle of my own issues.

Well, when I put it that way, and appealed to her self-image as a caring mother, it was a different story. She went, the doctor and she and my aunt met, the doctor told her he thought that she was on the verge again, she grumpily accepted the ‘scrip, and then she and my aunt went out for Thai, according to my aunt, who called from the restaurant while Mom was in the bathroom. I’ve got to call her in a few hours to try and convince her to fill the prescription, and take it before she goes to see the shrink tomorrow, so that he can “prove to you that I am fine.”

(Later Sunday afternoon)
Well, that didn’t go well. She told me the doctor gave her the medications “just in case,” got increasingly more agitated, and then hung up on me after telling me that she didn’t understand why we all hate her. She then called my aunt, told her that she hated her for telling me “lies” about what had happened with the doctor, and hung up on her.

I then spoke with the covering psychiatrist, who seems a saint. I told him what’d happened and he agreed with my take, and told me he and the shrink at the hospital yesterday had rx’d Abilify, but we’re at that point where she’s not yet hospitalizable, so there’s not a lot I can do from Boston.

I don’t want to go to California. My brother’s going to try to call her in an hour and see how she’s doing.

(Early Sunday evening)
She’s been calling my aunt, yelling at her, and hanging up. My brother then called her, talked her down, and got her to agree she’s going to see the shrink tomorrow. (I’d told him the covering’d told me they were open tomorrow and she could come in whenever.)

She then called me to tell me she was sorry she’d yelled at me, but that she was still mad at my aunt, and that we were all still wrong. I said, “Good, I hope I am. Give Dr. X my cell number so he can call me and tell me so while you’re there.” “That’s a good idea!” she says.

I don’t want to go to California. I don’t want to look for documents to establish our relationship, so that I can start guardianship or commitment or representative payee proceedings. I want her absence to make my heart grow fonder.

The good news is that I have my new new official theme song. “Because I’m Awesome” by The Dollyrots. That’s my new motherfucking theme song: You’re stronger, faster and can spell. Yes, thanks, but I would use a serial comma after that penultimate item. And that sentence isn’t parallel. But whatever. It’s rock.

Anyhow, I especially like the little bratty spoken part at the end, which sounds exactly like me when I’m unmedicated. And hey guess what? Not medicated. And guess what? Not enjoying this. I called the doctor and discovered–here’s more good news–that I had an appointment today. I thought it was last week and I missed it. Then I realized that I had no fucking idea what day it was today.

I seriously had the following exchange at the office:

OTHER GUY: Hey, were you here on Friday?

ME: I have no idea.

The weekend was like trying to stand up in a squall, topped off by the unexpected arrival of a totally random four-year-old who came over and stayed for six hours on Saturday. He was with his dad, who was doing some work for my neighbor, next door. And I guess he needed some kind of supervision and it takes a village and all that, but sometimes the kids in the village need to stay out of the hut of the Crazy Lady until she gets her Depakote.

Incredibly, I found in the doctor’s waiting room a woman who was more fucked up than I was. She was having some difficulty affording her mental health care, and it was a really bad scene. The receptionist had her on the phone with some kind of agency. The doctor wanted her to come back in three weeks (anything above monthly is a big deal in our practice), but she couldn’t afford to. That’s how people slip through and get lost.

I stopped her as she was leaving. I told her I didn’t want to get up in her business, but I gave her a $20 because that’s what I had. Use it for whatever. She took it and looked at it like she was going to have to figure out what it was. Then she gave it back.

I go back in two weeks.

Originally published at Baldo.

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.