My Experience Only. YMMV.

The 5 Stages of Depression

One of my depression triggers has been well and truly tripped and I am experiencing the long plunge downward. It’s been quite a while since this has happened, but oh, how well I remember it.cracked egg conceptual image for birth

In the classical Five Stages of Grieving, depression is the fourth, right before acceptance. For me, in the Five (or however many) stages of depression, the first stage is (duh) depression. I guess the next four would be immobility, numbness, despair, and Total Meltdown.

Right now I would have to say that I am somewhere between depression and immobility. I got out of bed for a few hours today, and I am writing this. I managed to get a big project done before this bout of depression hit, which was a Good Thing. I also now have a good supply of meds on hand, which is, I think, an Even Better Thing.

The Best Thing is that I have Dan, my husband. He just made sure I got a hot meal and is now giving me space and alone time, which is what I need more than attempts at engagement. And a cat just licked my face, which would be comforting if he hadn’t just been licking his butt.

As Jenny Lawson says, depression lies. Right now it’s telling me I’m useless, helpless, guilty, and ashamed. I hope that at least some of these are lies, though at the moment they’re what my brain is telling me is true. Then add in a large helping of catastrophizing, which at the moment is more likely to happen than not. I can’t see a way out.

Since I’ve been through this process before, I know the things that will help (at least a little) and those that won’t. I’ll try to keep my brain engaged enough to continue writing, and I’ll try to intersperse the doom and gloom with some ideas I made notes on before all this hit. I feel a responsibility to this blog and its readers to keep the thing going as best I can.

Based on my estimate, this episode is likely to last a minimum of two months. Maybe this time I can stop the slide before Total Meltdown. Wish me luck.

Which Way Is Out?

What do you get when you take two people, three doctors, eleven prescriptions, two pharmacies and an insurance company?

No, wait – I’m not finished.

THEN add another person, two banks, a credit card company, a missing check and a disputed charge.

Mix in bipolar disorder, clinical depression, and several months of previous stress.

Anxiety DisorderWhat you get, first of all, is something that rhymes with buster-cluck, and then a dangerous situation: Two people under pressure, neither of whom can function well enough to find any solutions.

There is enormous inertia. You make a few calls, get a few responses. Fine, you think. That’s taken care of. Except days later, it isn’t. There are new overdraft notices, rapidly dwindling supplies of psychotropics, and occasional fits of tears.

So you take another swing at it. More phone calls. More revolving phone trees. More dropped calls. More suggestions that you really need to get someone else to call someone other else to resolve it and here’s a handy 1-800 number that takes you to a department that never heard of you, your problem, or the company you’re dealing with.

Yes, they all agree. It’s important that you don’t run out of your psychotropics. It would sure be nice if there were enough money in the account to pay the premium for the crappy insurance. It’s a mystery why no one has any record of the complaint you asked them to file.

Another day. Another no check. Another no drug delivery. By now we’re getting into mixed states: immobilizing depression and nail-biting, catastrophizing anxiety.

You look for possible work-arounds. Maybe the local pharmacy can sell you enough pills to tide you over. But, oopsie! Your bank balance just went from -$53 to -$82. And the insurance won’t pay for drugs at the local pharmacy any more – only through mail order. Which brings us back to D’oh!

This is not hypothetical. This is happening.

What do we do now?

Well, we split up the tasks. I work on the drugs and insurance end, while my husband works on the banking problem. We both hover over the mailbox, waiting for the check.

We take turns. Both of us having a meltdown at the same time is not pretty. I’ve seen it. Trust me on this.

We do all we can do and then stop. For the moment anyway. When the pitch of my voice starts rising to dog whistle range and I start sniffling and tearing up, I know I’m just moments away from becoming incoherent, which may demonstrate the need for the psychotropics, but is not actually any help in getting them.

We try to take care of ourselves. Dan can sleep (I can’t), so he does. He buys my comfort foods (fried rice, mashed potatoes). I decide that this may not be the best time to be reading a new, fast-paced zombie apocalypse thriller and switch to a familiar old standby character study with no crises worse than deciding when to have a child (not a small thing, but on the scale of introspection to pulse-pounding, pretty low).

There’s never a good time for these cosmic pile-ups to happen, but now is unusually bad. The last few months have brought assorted financial and medical troubles (the two being related, of course), plus the death of three elderly pets within a couple of weeks of each other. Dan is dealing with the fact that the house he grew up in is up for sale. I haven’t been getting as much work as usual. Soon, I will have to look into expanding my client base.

After I get the drugs. And after they start to work. Whenever that is.

Sorry I don’t have anything encouraging or amusing or informative to share this week. That’s just the way it is sometimes. And now is one of those times.


In 1994, writer Abigail Padgett published Child of Silence, the first in a series of mysteries featuring Bo Bradley, a child protection advocacy investigator – who just happens to have bipolar disorder (or manic depression, as it was more commonly called back then). The series continued through four more books – Strawgirl, Turtle Baby, Moonbird Boy, and The Dollmaker’s Daughter. (All are still available as ebooks.)

abigailpadgettcRecently, I had the opportunity to ask Padgett some questions about her books, her heroine, and the state of mental health care today.

Is there anything you would change about Bo Bradley, given the advances made in understanding bipolar disorder and medication for it?

Not really. There are some new meds and public understanding is better, but the experience of people who live with real, clinical mood disorders is still fraught, dangerous and revelatory.

Bipolar disorder is better understood by the general public now than it was 20 years ago – to an extent. But the general public, including me, cannot ever actually “get” what a manic or depressive or psychotic episode feels like. The best that can be hoped for is an acute public interest and support. Movies, especially like Touched With Fire, are enormously helpful.

What do you think of Stigma Fighters, the Semicolon Project and celebrity awareness campaigns? Are they having much effect?

Hard to say anything about effects without any data, but . . .  I think focusing on the big corporate/cultural atrocities is really important. Examples are a two-page NYC menswear ad in which the front page said, “If you’re paying $50 for this shirt . . .,” turn to reverse of page, “then you should be wearing this one”  (photo of a straitjacket).  The store, Daffy’s, actually got an award for that ad! Then there was John Deere’s “schizophrenic tractor” and a tire company here in CA that did a horrible TV ad showing a man in a straitjacket in a padded cell trying to eat a cake with no hands. years ago I worked with Jean Arnold and Nora Weinerth for the National Stigma Clearinghouse (, which is still active. The idea was to go after major companies who ridiculed  psychiatric illnesses, diagnoses, doctors, or anything associated with mental illness.

Stigma Fighters seems to be a venue for supportive communication and that’s good, but it doesn’t have much effect outside itself.  And I love the Semicolon Project idea!  A good image is worth a million words in terms of broad impact, and I hope that one can organize and grow into a significant movement.

Celebrities? Any day that a celeb states publicly that s/he is living with a psychiatric disorder is a good day. Americans adore and identify with celebs. (Not good for either Americans or the celebs, but nonetheless the way it is.)

What one change would you most like to see in the mental health care system?

One?  Have to go with funding. Funding for psych research; for psych hospital care for as long as it takes, not just a week or two; for clean, professionally staffed respite centers in every town; for attractive, professionally staffed halfway houses; for arts programs, job training, theater tickets – you know, the world?

Is it time for another Bo Bradley novel?

Another Bo, The Stork Boy, is over half finished. Bo and [her partner] Andrew are in France, where she can’t even read a menu but nonetheless gets involved in a murder. Of course the #1 suspect is mentally ill. Bo to the rescue!

Is there anything else you would like to say about your work, bipolar disorder, or anything else?

Vote for Hillary.  The alternative is inconceivable.

The Scientific Tease

Fun doctor

I know the headlines and accompanying news stories are supposed to give us hope: New Treatments for Mentally Ill, Scientific Advances for PTSD Suffers, How Research Is Finding Causes – and Possible Cures – for Bipolar Disorder, Brain Science May Explain OCD.

But the reality is that those headlines are teasers. Once you read the story, you realize how little is new, how far from reality the science is, and how long it will be until the supposed cures make any difference.

I’ve written on the subject before (, and included a link to a short video that explains the scientific process, from original study up to the time when a new drug or treatment hits the market (

But drugs aren’t all the scientific world is offering for people with bipolar and other mental disorders. There are transcranial stimulators, magnets, fMRI, and other technologies that hold promise for at least understanding our illnesses and, in some cases, treating them. Studies of the human brain, DNA, epigenetics, neurotransmitters, precursor chemicals, and more are touted as ways to unravel the mysteries of why some people get mental illnesses and some don’t; why some medications work for some people and not for others; and how the medications that actually do work do what they do.

If you are buoyed by the hope these scientific articles and the advances they hold out, you may envision a world in which parents can tell when a baby is liable to depression and watch for early signs; a troubled teen can be diagnosed with bipolar 1, 2, or psychotic bipolar; which particular “cocktail” of drugs is the best fit for an individual; how a small machine can send signals to the brain that will ease the symptoms of, well, anything.

Unfortunately, that’s not true. Oh, there is scientific research going on – although there would be more if funding for mental health issues were taken more seriously. But not all that research will result in effective, practical treatments for mental illness – more closely targeted drugs, new understandings of various psychological models, new methods of diagnosis. A breakthrough, when it comes, may even be discovered as an unexpected side effect of something else entirely.

Besides, can you imagine these wonder drugs and diagnostic tools, and nanobot treatments (or whatever) making it to the vast majority of the mentally ill? Will psychologists be able to send clients to get an fMRI to pinpoint problems, and will the insurance pay for that? How would you convince a homeless schizophrenic to place his head in that clanking machine, hold still for half an hour, and answer question? How long will it take the FDA to study and approve a new drug, and will it cost $12,000 or more per year? And will insurance coverage even be available because it’s still considered “experimental”?

Frankly, I can’t see most of these heralded miracle treatments making their way down to the community mental health center level anytime soon, even once they’ve been developed, tested, proven, and put on the market. Like so much of medicine, I fear psychiatric advances will be available only to the rich or those with platinum-level insurance. And although one in four Americans will experience some form of mental illness in their lifetimes – and millions more friends, relatives, caregivers, and loved ones will be affected by it as well, psychiatric topics don’t draw government or university funding or charitable support the way other conditions like HIV, breast cancer, and heart disease do.

So forgive me if I see those uplifting headlines and think, “Pfft. More pie in the sky.” I do think progress is being made and will continue to be made, but I doubt whether it will be soon enough, or tested enough, or cheap enough, or available enough to benefit me. You younger folks, now – you may still reap the benefits of these remarkable advances. But in the meantime, while you’re waiting for that magic pill or Star Trek device, keep on taking the meds you’ve been prescribed, and talking to your psychotherapist, and building a support system, and taking care of yourself.

For now, let’s work with what we’ve got.

Owning My Bullying

bullying, written on vintage metal texture

I have written many times before this on the subject of bullying – and now I have to admit that I have been a bully too.

Bullying is often seen in stereotypical terms as a larger kid extorting money from a smaller, weaker one, or torturing someone in the locker room with “swirlies” and other indignities. But there are many kinds of bullying. There is physical bullying – the kind most people thing of. There is ostracism or social bullying – the stereotype of which is the clique of mean girls or arrogant jocks. There are racist bullying, ethnic bullying, socioeconomic bullying, ableist bullying, sexual bullying, and just about any other type you can name.

Nowadays, one of the most vicious types of bullying, with the most harmful and longest-lasting effects, is cyberbullying. The tools of connection are being used to separate, exclude, and destroy reputations and even lives.

None of those is the kind of bully I was.

I was an intellectual bully. And since I realized that – only recently – I am ashamed.

I am not ashamed of my intelligence or my educational accomplishments. Those were the products of nature and nurture that I had little control over. It was what I did with those advantages that is shameful.

I used my smarts and my vocabulary to squash other students.

It may have started as a defense against the bullying I received – physical and social and whatever else. Intelligence seemed like the only weapon I had, and I wielded it as one. I was taking revenge in the only way I knew how. And that is something I should never have done.

I may not have intended it that way, but every snarky remark, every intellectual put-down, every sesquipedalian word flung back at my bullies carried a message. I was telling them that they were stupid and inferior, and that I was smarter  – better – than they were.

If that’s not bullying, I don’t know what is. And I’m sure it caused damage to egos and self-esteem, as well as perpetuating the cycle of be-bullied-and-bully that leaves countless perpetrators and victims in its wake.

Later in life, as my bipolar disorder deepened, I turned the bullying inward. I made self-deprecating remarks, snarked at myself, even made fun of myself for being overeducated and pedantic. I thought I had to do these thing to myself before someone else did them to me. It was at once a measure of my profoundly low self-esteem and a way to lower it even further.

In essence, I was bullying myself. And I’ve known other people who have done likewise. (For what it’s worth, I’ve since learned that it can be profoundly irritating to listen to a person tear himself or herself down this way.)

Intellectual bullying is a hard habit to break. The words, the ideas, the sarcasm are there for the using. The consequence, of course, is driving people away, sometimes without even realizing it. I have done this and seen it only when looking back at the potential or actual friends lost, the coworkers who thought I was a jerk, the people I’ve hurt.

I’ve been trying to break myself of the habit. Oddly, the Internet helps. It is, as has been noted, true that there are few ways to convey tone of voice in chat or email. There is no sarcasm font. But there are ways to let the recipient know that you do not mean a message literally or unkindly. You can place <snerk> after a remark or a  :P emoji or a sticker that demonstrates you mean well. I’ve even seen people use <sarcasm on> and <sarcasm off> around their messages to make them clearer.

But mostly, I try to guard my speech. I have to install a little censor (or sensor) that says, “Ooh! That’s funny! But is it insulting?” before I make a remark.

I’d rather pause for a second and look like a doof than go back to being a bully.

Running Out of Drugs

Isolated Empty Pill BottlesRunning out of your medications is scary.

I know. It’s happened to me several times in the last few months.

Sometimes it was a matter of supply. My usual pharmacy ran out of Ambien and wasn’t going to get any more until after the weekend. Fortunately, they recommended a mom-an-pop pharmacy (yes, such things do still exist) just down the street and helped me transfer my prescription there.

Another time the problem was the prescription. I ran out of Ativan, but when I called in for a refill, I was told that it wasn’t time for one. When I looked at the bottle more closely, I discovered that they had given me 60 pills, as if I were taking two a day, instead of the three a day actually prescribed. (I was changing doctors about that time and there was miscommunication.)

Yet another time, it was money. I ran out of Abilify (actually aripiprazole – all my scrips are generic) and was told that even with insurance, it would cost me $800 because of the out-of-pocket required minimum. I spent a couple of days arguing with the insurance company, researching solutions online, and making sure a local pharmacy would take the coupon I found, which lowered the price to under $200. (I also had to stand in line while they called the coupon people and the insurance company to see how to enter it all in their system.)

And of course there are the everyday screw-ups. My husband forgot to pick up my scrips, or forgot which pharmacy they were at, or didn’t hear me say that I was completely out, or the pharmacy didn’t open until 10:00, or they had my pills in two different bags and they only gave us one. There are lots of ways it can happen.

Once I even took my entire supply on a weekend getaway and left them in a drawer in the bed-and-breakfast. I know. Stupid.

Most of the time running out of drugs isn’t a crisis. It just feels like one.

Of course, there are exceptions. It is a crisis if you run out of certain anti-anxiety drugs and you don’t get any for several days. You can have withdrawal – actual, physical as well as psychological withdrawal. I’ve heard that benzo withdrawal can be as bad as opiates. That’s one reason it’s important to replace your meds as soon as possible.

A lot of psychotropic medications build up to a therapeutic level in your bloodstream, so a day or two without them probably won’t even be noticeable. When you start taking them again, your levels will even out.

But even if the med you run out of is one that you can easily tolerate a day or two without, you may have some psychological effects. When I run out of a prescription, even for a short time, I become twitchy and agitated – my hypomania kicks in and comes out as anxiety, the way it usually does for me. I fear crashing back into that deadly unmedicated space where all is misery and despair. Intellectually, I know that likely won’t happen. But it sure feels like it will. This is one way my none-too-stable mind plays tricks on me.

It’s like the opposite of the placebo effect – believing that a medication will help you and experiencing gains even if the pill is fake. In this version, I believe that not taking the pill will cause relapse, even though it actually won’t.

Whatever else you feel or do, DO NOT use missing a couple of pills as an opportunity to go off your meds entirely. This is another lie your brain can tell: “You’re doing fine without it. Why keep taking it?” It may not be right away, but you will feel the effects of not taking your meds, and then there you are, back in the Pit of Despair or rocketing to the skies. It won’t be pretty.

For me and a lot of others like me, the key to effective medication is consistency. Once you find the right “cocktail,” stick with it. But if you run out, don’t panic. Keep Calm & Get a Refill.

We all know it’s a bad idea to stuff your feelings, especially if you then pile food or alcohol on top of them.

The thing is, sometimes you need to suppress a feeling, for just a little while, in order to get through a difficult situation. When that happens, I put my feelings in a box.Cardboard box with the zipper isolated on white background

Here’s an example. My father was dying, and had only days to live. We all knew it. My mother, who didn’t drive, asked me to take her shopping for something to wear at his funeral. “Do you mind if I don’t wear black?” she asked. “If you don’t mind that I do,” I replied.

It was my first encounter with a close family death, and I had to get through this awful, wrenching shopping trip. I had to keep my composure so that my mother could keep her composure. I had to steer her away from a flowered dress, which would have been fine for church, to a navy suit and a lighter blue top, which would be suitable for a funeral but not so somber that she couldn’t wear it for anything else. All while my father lay in the hospital, dying painfully of bone cancer.

My feelings were complicated and I absolutely could not afford to feel them at that time. I had to stuff them in a box and close the lid on them until my mother’s needs had been met. Then I could let them out, in a time and place where it was safe to, in the presence of a person I could trust with those feelings.

When such circumstances arise – and they will, in one form or another – I recommend using a box, one in which the feelings will be out of sight for a while. A box is small; only a few feelings will fit in it. If you think the feelings are going to leak out, you can sit on the lid. Then, when it has served its purpose, you can rip the box open (or gently lift the lid) and feel the feelings. Cry. Rage. Grieve. That’s the important part.

You have to experience the grief or fear or even the crushing weight of guilt in order to come through it and heal.

But why put feelings in a box instead of something stronger? Who wants to feel those negative emotions anyway? Aren’t we better off without them? Shouldn’t you just build a wall around them to keep them from breaking out?

We’ve all tried it. It works for a while. But a couple of consequences go with the practice. First, all of your feelings get trapped behind that wall – the good as well as the bad. When you find yourself disconnected from all your feelings, life is a gray blur. In your depression or anxiety or fear or rage, you may not have had many good feelings. But when you build that wall, you cut off even the possibility of having them.

Second, you’re only postponing the pain. The wall will leak sometimes; your unpleasant feelings will come out some way – in your dreams, around your eyes, in sudden spurts, or trickling back into your everyday life. Worse, the wall may shatter – fail altogether, releasing all those feelings in an unstoppable torrent, only stronger and more concentrated from having been confined. They overwhelm both you and anyone in the vicinity. It’s not pretty. And it’s destructive – to you, your mental health, your healing, your employment, your relationships – to every aspect of your life.

If feelings are behind a wall, you may be able to tell yourself they don’t exist. But if you stuff them in a handy box, you can choose the time and place to open it – and yourself – back up.


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