RealMental

I was at dinner last night over at my father’s house, and a friend of his was also in attendance. This friend is a well-intentioned person, but he never shuts up, he talks out of his ass, and he never listens. He’s irritating as all get out, and I often feel badly about not being able to really engage much with him in conversation, but he’s just too much stimulation for my misfiring neurotransmitters.

I forgot how we got on the subject, but at some point during dinner, he started going on about how he was sure that most depression diagnoses these days were over-medicalized and over-medicated, and that most of it was stuff that people “just had to deal with” as part of one’s life experiences. That simple proposition? It’s possible. There are probably some people who don’t need antidepressants, and just need some cognitive/behavioral therapy to learn some coping skills or change their conduct. But I tend to give people the benefit of the doubt. Whatever works, really. If medication gets you through a hard spot? Go for it.

But of course, it didn’t stop there. He started going on about how all mental illnesses were so subjectively diagnosed, and that a lot of things could be just gotten over. He started talking about how he would just talk himself out of funks as a teen, or make a change of scenery– as if his experiences settled the question. My dad tried to push him off with a subtle “what the hell are you talking about?” but that didn’t work. He continued, acting as if his personal experiences were sufficient empirical evidence to solve the human condition. That, and the experiences of one or two people he’d known. At that point, he started questioning biochemical and hormonal imbalances, which got my brother, the pharmaceutical researcher, into the fray. My brother was trying to explain the science of the SSRI’s, the dopamine inhibitors, the MAOIs, the typical and atypical antipsychotics. I chimed in with facts about how the brain electricity is sufficiently different in bipolars and schizophrenics to be detectable on MRI. You can see it, I said.

Neither my brother’s objective expertise nor my own hard-won knowledge could cause this person to admit his lack of foundation, set aside his skepticism, or admit he needed to learn more before issuing blanket statements. I shut the argument down, finally, by saying “I don’t care what you say, lithium rocks.” Everyone else laughed, he finally realized he needed to shut up, and we moved the conversation to another topic.

As we were driving home, my husband asked me if I was upset by this man’s know-nothing bloviating. I told him I was and I wasn’t, in part because I knew he didn’t mean any personal harm, and in part because I was so used to this dolt’s utterances on any topic that I knew there was no use in really engaging with him about it, because he’d continue as he always did until something happened personally to him to change his mind. What I am more upset by is the general reductionist attitude that far too many live by—“if it’s never happened to me or anyone I know, then I don’t believe it.”

There are more things in heaven and earth, Horatio, than are dreamt of in your philosophy.

The problem with this attitude is not just the impact on the people around them who do have different experiences—although that’s bad enough, since it affects the way they vote, the way they educate their children, and the way they affect the general level of human happiness. Denying someone else’s experience just because it’s never happened to you is reckless cruelty of the highest order. The insistence on personal experience not only connotes a lack of imagination and empathy– it also connotes a lack of preparation.

When these blinders-on pragmatists are faced with something never dreamt of in their philosophy, they deny it, ignore it, misname it, suppress it, and otherwise completely fall apart. Having never experienced real depression, or mania, or delusion, there is shame, fear, anxiety—because their unwillingness to be curious about and open to other experiences than their own impairs their ability to deal with something new when it comes along. It draws the process out longer than it needs to be— all us believers end up having to take care of them in the meantime, and then listen to them preach to the choir when they do come around to their real condition.

There’s a Buddhist principle called “beginner’s mind.” Essentially, the idea is that you should always be open and accepting of new ideas, new possibilities—to close your mind, and consider yourself an expert, is to fail to be open to all the experiences life can show you—if you’re willing to look for them. I try to practice beginner’s mind, and it’s hard, because it means I have to re-think previous opinions, and even discard things I thought I believed. The temptation to be a never-believer is thus understandable—it’s much easier. But I’d rather be open, and uncomfortable, and evolving, than closed, negating, and nullifying.

What would you rather be? A blue sky, or a black hole?

I was talking to my therapist about various things during our last session, and one of them was how much better I feel for having started writing again.  She knows that I blog and that I keep my journal.  I’m not sure if she reads my personal blog or this one– I suppose telling her about them keeps me honest.  I was also showing her a poetry series that I was working on, since some of it had to do with other things we were talking about.  She handed my journal back to me and said something simple but perspective-altering– “what a relief to recover something you used to do for pleasure.”

When I think of how many pink cloth diaries and wire-bound notebooks and scratch pads I used to fill with bad poetry, stories, rantings to myself, and every other musing, prosaic and poetic when I was an adolescent and teen… all I can say is I did it because I enjoyed it.  It gave me relief.  I wasn’t sharing what I wrote (and it was before the internet, anyway) or expecting criticism– I just wrote for my Self.  And I just . . . stopped, lost that part of myself with my first really bad depression in college.  I didn’t recover my writing in any consistent fashion until after my diagnosis in 2005.

I’ve always let peter out things I really enjoyed when I entered a bad depression.  As depression’s lead blanket would descend, causing me to lose my joy in life, and as my insecurities would foster a deeper depression, I would become convinced I didn’t deserve happiness, and would withdraw from life.  I would withdraw from, or even sabotage friendships.  I would stay in my dark bedroom all day.  I would let the phone ring and ring and ring.  And I would let the thoughts circle around, in ever-tightening spirals in my mind, until it was impossible to break out of the vortex until my brain chemistry righted itself.  But now, I know more about the whys and hows of my depression, and am slowly getting better about seeing the black cloud on the horizon.  I know now that if I allow myself to back away from all the things I enjoy, then it’ll be worse than if I just grit my teeth and at least go through the motions. The activity itself is therapeutic.  So now, I resolve to do the things I used to do for pleasure, whether I feel like it or not.  I think that “practice makes perfect” has especial meaning when depression is keeping you pinned to your bed.

Write every day, for the release, for getting the circling thoughts out of my head.  Get out in the sunshine every day, because the secret to bipolars is that we are all part plant and part cat, and need sunshine to stay sane.  Meditate every day and do yoga three times a week, so I can let go of some of the circling thoughts that don’t really require writing out.  Call a far-away friend once a week, and ask them about what’s going on with them.  Have lunch or dinner with a friend at least once, preferably twice a week, because I have good friends, who care, who make me laugh, who deserve my attention.  And try not to forget the things I like to do for fun, because the only thing better than the relief of recovering that joy is never really having lost it.

NAMI sent a questionnaire to presidential candidates, asking them their positions on mental health issues, including access to care for the poor, and these are their responses so far. Thanks to Emily at On Call for Life for the link.

Cross posted at BipolarLawyerCook.

I don’t have the answer to this question, but it’s one that everyone faces at one point or another in their relationships with the toxic people in their lives. I’ve been contemplating it on a number of fronts– toxic friends, toxic employment, toxic family, but it’s the last that’s the hardest, at least for me. The crazier my mother gets, the more I question what relationship I can safely have with her.

“Family” is a loaded, loaded word. The family to whom you are born may be less than ideal, and you haven’t got a choice in the cards that nature deals you in the long game of family– genetics, personalities, economic circumstances, and psychological pathologies. With friends and employment, there is always an element of choice, even if it’s a selection between a rock and a hard place. But in a family, the lack of choice is constraining. I, at least, feel like I have to try to make things work. The social belief that we owe our families our lifelong involvement and devotion, repaying the debts of our infancy and childhood to our elders is one that deserves examining.

As someone coming from an essentially middle-class background in a western civilization, I’m not equipped to opine on other cultures’ notion of a lifelong debt to family, nor am I even sure about whether that’s the best way to characterize it. But in our culture, I do believe there’s a breaking point. There are circumstances that are so horrific that we can all agree that someone has the “right,” if not in fact the self-obligation, to cut themselves off from their toxic family. But when do the circumstances suffice in our own lives? And when deciding if your family (or certain family members) are too toxic to continue to be borne, is it “fair” to make your decision based on your own reaction to their behavior, compared with the “objective” assessment of their toxic behavior?

It’s a question I’ve struggled with for years. I’ve been in therapy off and on, and at different points in my life, different behaviors have been wounding. As I get older, I’ve come to peace with the fact that it simply isn’t personal, and that the behavior is due to the mental illness and personality disorder from which she suffers. Too, I’ve mellowed as I’ve aged, and gotten a sense of tolerance if not humor about some of the craziness. But even with all that work, some of it is just too much– it hurts, every single time, and nothing I say or do to be self-protective, including standing up for myself, will change the behavior. But it doesn’t just only hurt– the stress she creates by failing/refusing/being incapable of getting appropriate medication, psychiatric treatment, and therapy pushes me down toward my depression end on the spectrum. First anger, then indignation, then self-pity, then sobbing self-pity, then apathy and wishful thinking and ignoring the problem, pushing it off onto my brother and aunt. At the same time, who better than I to help monitor her moods, get her the help she needs? I’ve already learned that she will never, never, never, change anything about her own life– her narcissism and martyr complex will see to that. But does my “responsibility” to her as a daughter to try to make her elderly stage of life livable obviate my need to take care of myself, to live my own life, to stay healthy for the husband I chose, who doesn’t engage in behaviors that literally drive me nuts?

Distancing has worked for me in the past (I don’t think she’s noticed), and more is in order. I also have decided that “plain talk” of actions and consequences is in order, whether or not she’s capable of understanding or acting on such, because she does have the capacity of being a lucid and functional person. Babying her accomplishes nothing, and is destructive to my own sanity. But the breaking point? I haven’t decided if I’ve reached that yet.

Reading Belinda’s thought-provoking post about forced commitment and medication, and the thoughtful comments people have since made, caused me to think a little bit more about how medication, while a lifesaver when appropriately prescribed, is only the first step.  Once you’ve gotten past the big ifs of a proper diagnosis and a proper prescription, you’ve got to be willing to use the equilibrium that the meds bring you to eradicate the mindset that meds are a “cure,” rather than merely a means toward maintenance and repair.  It’s my personal opinion that even the mentally ill person whose “only” life trauma is the toll of the disease itself has serious mental work to do, adapting to the concept of being “mentally ill,” redefining their sense of self around the diagnosis, and adapting to the medical and emotional features of their long term diagnosis.  The grief, regret, relief, anger and confusion that come with a proper diagnosis can’t be overstated, and it’s not something to be gone through without the aid of a therapist.  Too, medications don’t work forever– even once you’ve hit on a good combination, it may not work indefinitely– and being able to identify that your mood is changing despite being good about your meds is crucial.

From my own experience, I’ve built up a variety of coping skills to deal with my anxiety, depression, and need to people-please that are very unhealthy and counterproductive as I approach the worst end of my depressive spectrum, and it’s hard for me to recognize, when I am in the midst of a depressive phase, what I am doing.  But once I’ve recovered some stability, I can use that solid ground as a base to look back from the corner I’ve worked myself into this time.  I can look back and try to figure out when I first started the most recent downslide, and see if there were any causes.  I can then try and map out what I did and didn’t do during that period, identify whether anyone tried to warn me (and if they didn’t, possibly why not), and look at what coping mechanisms came into play, and what resulted.

There are lots of good books on the subject of eradicating bad mental habits out there, but I think a good therapist is really key.  (The subject of finding a good therapist, with whom you can work, is a whole post unto itself.)  Working with friends or family to identify your “bad behaviors,” your mood cycles, your triggers, just won’t be complete, because they’re not objective, and inclined to either overlook unhealthy or exaggerate healthy behaviors.  While friends and family can be the best first defense against a recurrent episode, and have the concrete experience of your past episodes to guide them, you need these folks to be focused on the micro level, not the macro/meta level.  A therapist outside your circle, however, is objective, has training, and is someone in whom you can confide and to whom you must be accountable.

Support groups outside your circle can also be therapeutic– because they don’t know you, and take you at face value when you take part, there’s an objectivity there that allows a freedom of expression you might not have with friends or family.  Hearing others say they’ve gone through something similar, and come out on the other end, is tremendously encouraging.  And knowing that someone else understands the swirl inside your own head lends credibility to their advice and encouragement that a “normal” source doesn’t have.

The most important thing to be gained from therapy is a firm sense of your self, knowing what you need and what you don’t need.  Personally, I’ve never joined a bipolar support group because the way my bipolar has manifested itself has been primarily anxiety and depression, and the course of my illness was and is usually very different from that of others in the groups I’ve tried.  Having never been frankly manic, psychotic, or delusional, much less hospitalized, I knew I didn’t “need” what these groups are offering.  But depression and anxiety sufferers?  I crave their company, search regularly for a group that meets after the end of the business day, eagerly read posts by others suffering from the same symptoms– because in hearing their stories, I learn something new about myself.  And by collecting these tidbits, I can hope that the next episode won’t be as long, as bad, as deep, because the work that I’ve done will allow me to see that it’s coming, and know that it’s arrived.  The meds provide the viewpoint, but I’ve still got to be willing and able to look around me– the therapy allows the rest.

Nauseous
Dizzy
Too many smells
Sweaty
All backed up
Got the runs
Spaced out
Shaky hands
Shaky legs
Shaky handwriting
Thirsty, always thirsty

Sleep
Laugh
Smile
Write
Think
Do
Feel
Nightmares are gone
Tears have dried
Rage subsides
Calmness resumes

Life returns.

There is an article re-affirming the existence of Seasonal Affective Disorder in the NYT today, and discussing the various treatments, including a new one called Negative Air Ionization. I don’t own a lightbox or dawn simulator, but I do use a humidifier and full-spectrum spot lighting. Bipolars tend to suffer from SAD a lot, and I am cat-like in my ability to lie in the sun and soak up the light. I’ve actually noticed an uptick in my mood this last week at home, because I’ve been able to work in my lovely sunny living room.

There are lots of folks who haven’t had SAD who don’t think it’s real, but it is all too real for those who feel it settle on their shoulders like a lead apron as soon as the light starts getting dim.  It seems so strange that we’d respond to light so drastically, that one’s mood can wax and wane with the sun, that one can respond like a plant to a bit of sunlight, and droop in its absence– but there it is, and to have it scientifically proven is something, at least.