My Experience Only. YMMV.

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 (http://wp.me/p4e9Hv-7Z), 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 (http://www.vocativ.com/culture/junk-science/).

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.

 

Every article you see about self-care for bipolar disorder will tell you, Get enough rest or Get enough sleep.

Sleep is that golden chain that ties health and our bodies together.  – Thomas Dekker

But what did Thomas Dekker know? For many of us, proper, beneficial sleeping is easier said than done.

Neon light owlEven with my prescribed Ambien and Ativan, I’ve done the wide-awake-at-3:00-don’t-get-to-sleep-till-5:30 thing. And the unsettled-from-nightmares-afraid-to-go-to-sleep thing. (Also the just-one-more-chapter thing, but that’s my own fault.)

Then the next day I have to take a mega-nap (http://wp.me/p4e9wS-iO), which leads to guess what? More insomnia.

But this coin has another side as well. There are days when all I do is sleep. A full night plus (at least 10 hours), then a mega-nap, then right back to bed after dinner.

I don’t think I was awake for much of my childhood. I did a lot of napping. This might have been a defensive measure against encroaching depression. – Michael Ian Black

I know that part of my problem is my husband’s work schedule – third shift – and wanting to be awake at least at some of the same times that he is.

Another part of the problem is my medication. If I wake at 8:30 (yeah, I work at home) and take my meds, I’m down for the count again until at least 10:30. Or 11:00. Or even noon. I hope my clients think that I run errands in the morning or work on my projects with chat, IM, and phone turned off so as not to be disturbed.

And then there is my meal schedule, which is just as erratic as my sleep schedule. Most days I try to eat at least one good, full, hearty meal (another self-care recommendation, though they usually advise more than one meal). But after I eat – especially a hefty meal – I get postprandial torpor, the technical term for why you fall asleep on Thanksgiving after eating all that turkey. (And you thought it was the tryptophan.) And there comes another nap.

The repose of sleep refreshes only the body. It rarely sets the soul at rest. The repose of the night does not belong to us. It is not the possession of our being. Sleep opens within us an inn for phantoms. In the morning we must sweep out the shadows.  – Gaston Bachelard

But recently, it’s been the not-able-to-sleep thing. There’s a Tarot card that symbolizes the feeling – the 9 of Swords. In the Rider-Waite deck, the image is of a person sitting up in bed, hiding her face, with nine parallel swords floating in the background. I always refer to it as The Dark Night of the Soul. (The 6 of Cups usually means something like Childhood Memories, but for me it means “See Your Therapist.”)

(Note: I had a rather irregular introduction to the Tarot deck, and for me it acts sort of like a Thematic Apperception Test. I apologize to those of you I have just offended in one way or another.)

Sleep is when all the unsorted stuff comes flying out as from a dustbin upset in a high wind. – William Golding

Anyway, a recent event caused me a fair amount of trauma that I had to suppress at the time, and it came out immediately as bloody horrible nightmares the next time I slept. I haven’t had any more of those since, but I suspect they’re still lurking at the back of my brain.

That we are not much sicker and much madder than we are is due exclusively to that most blessed and blessing of all natural graces, sleep. – Aldous Huxley

I guess what I mean by all this is that sleep as self-care is wonderful, if it cooperates. But there are so many things that can go wrong and screw it all up – grief, guilt, depression, sorrow, anxiety, fear, loneliness, restlessness, obsessive thoughts, worries. It doesn’t feel like something that I have much control over.

The Therapeutic Hug

People Group Teamwork Holding Logo. 3D Rendering illustration

Big Group Hug

The common wisdom is that a person needs four hugs a day for survival, eight for maintenance, and twelve for growth. I doubt that this is confirmed by any scientific studies and I doubt that it is true. If it were, there would be millions of people on Earth who would not survive.

I would be one of them. Despite being married to one of the two truly world-class huggers I’ve met in my life, I do not get my four-a-day. And certainly not twelve. Assuming eight hours a day for sleep and eight hours a day for work, that would leave eight hours to work in twelve hugs. That’s one and a half hugs per hour, and I suspect half a hug just won’t do.

In fact, I know it won’t. Scientific research has been done on the 20-second hug. It releases oxytocin, a pleasure and bonding chemical in the brain. Half a hug would need to be 40 seconds long to do the proper amount of good, and young lovers and newlyweds tend to be the only people who give hugs of that duration.

Then there’s the question of what constitutes a hug. For greatest oxytocin effect, I would recommend the full body hug – toe to toe, torso to torso, heads on shoulders, arms tightly squeezing. But you probably can’t give that particular hug when you run into an acquaintance in the supermarket, especially not 20 seconds worth, without blocking the aisles.

Other variations of hugs that may be less effective are the side-by-side one-shoulder squeeze (and the multi-person variant, the Big Group Hug), the manly back-thumping, and the A-frame hug (standing a distance apart and leaning in for a hug from the shoulders up). Then there are the virtual hug, usually written ((hug)), with the number of parens indicating the length/intensity of the hug, and the proxy hug, in which you delegate a person to pass along a hug when you’re not able to be there. None of these seem really conducive to the 20-second, made-for-thriving hug.

But, on some level, we know that hugs are therapeutic. Oxytocin or whatever, they make us feel better. Lots of hugging goes on at support and 12-step groups, and people who go to those daily might indeed make their recommended quota.

I go to private psychotherapy, however. I’ve never hugged my therapist, and am not even sure whether it’s appropriate for therapist and client to hug. It would be awkward to ask, “Can I have a hug?” only to hear, “No. That’s unethical.” But I suppose it depends on the therapist and the client and how each feels about the subject. I know sex is unethical, but hugs may be a gray area. Perhaps someone can enlighten me.

Of course, there are people who do not like to – or are afraid to – touch other people. Think Sheldon Cooper on The Big Bang Theory. People who are aware of and skilled in responding to others’ body language may be able to see the little (or, let’s face it, large) cringe when one person sees another moving forward with open arms. If the non-hugger is quick enough, he or she can quickly stick out a hand for a hearty handshake, or the potential hugger will abort the hug and retreat to a friendly tap on the shoulder.

But there are people who will swoop in and envelop you in an unwanted embrace and maybe even air kisses with smacking noises. I suspect these would be more likely to shut down oxytocin entirely, and possibly release adrenaline instead in a fight-or-flight response.

As with sex, the safest route is to ask for consent – “Can I have a hug?” – and take no – “I’d rather not” – for an answer, without taking offense or pressuring – “Aw, c’mon” – and making things even more awkward.

Still, the best advice I can give is to be proactive about hugging. Say, “I need a hug” when you do. Ask “Do you need/want a hug?” when a person you know seems to be in distress.

Avoid hugging strangers, though. That hardly ever helps. At least wait until you’ve been properly introduced.

 

 

Helpless Woman Holding RopeAnymore, I don’t very often have days when I can’t get out of bed, but this week I had one. It doesn’t matter now what caused it, but I am feeling the lingering aftereffects. Today I had no choice but to get out of bed, and I thought as long as I’m up, I might as well blog.

(Actually I can blog in bed too, since my tablet will take dictation, but it’s not optimal.)

I had been headed for bed-bound all week – the slowly creeping whelms; the feeling of being nibbled to death by mice; the recent trauma of two pets’ deaths; a game I couldn’t win, couldn’t break even, and couldn’t get out of. Expected relief came three days too late.

Aside from not eating, not getting out of bed meets many of my needs – quiet, rest, naps, not having to fight off the numbness and care about anything. And yes, there’s some feeling sorry for myself in there too. I won’t try to deny it. Staying in bed is a big messy wad of self-pity, anhedonia, lack of energy, trying to stave off thoughts, and generally not being able to give a shit about anything. It is more than sadness. It is as J.K. Rowling described the Dementors: You feel as if you will never be happy again. In other words, there’s nothing worth getting out of bed for.

When I was searching for images to go with this post, I entered “end of rope.” I guess I expected to see cute kittens dangling and inspirational quotes like “Hang on Baby, Friday’s Coming!”

Instead, what I found were endless images of nooses. Nooses by themselves or with people in them. Overturned chairs under nooses. Photos, illustrations, every conceivable image of nooses. According to the visual imagination of illustrators and photographers, “end of one’s rope” means suicide. There were some images of frayed or broken ropes, but the nooses were in the lead by at least four to one. (There were also a few nautical pictures with coiled ropes, but they weren’t statistically significant.)

That’s not what I mean by “end of my rope” – not dangling kittens OR nooses. Staying in bed all day, being unable to function, is a long, long way from suicide. Indeed, I find it a mechanism that staves off thoughts of nooses. Staying in bed admits of the possibility that tomorrow, or maybe the next day, I will have the wherewithal to drag myself out of that bed. Or that something will force me out of the bed and I will have to respond, as it happened today.

Hence the title of this piece. I have not reached the end of my rope – certainly not to find a dangling noose at the end of it. I have not reached the end of my hope, because I believe that some day (I hope soon) I will be out of the bed (at least as far as the sofa, and then who knows?). But when I stay in bed all day, I have reached the end of my cope.

This is not exactly the same as reaching the end of my spoons, because I don’t use up any spoons by lying in bed. And I don’t really know, or perhaps don’t believe, that I will have a new supply the next day.

I expect that some people will beat me up for being so useless as to give up for even a day, to be unable even to try. I know I’m beating myself up over it too. But today I am out of bed, for at least part of the day, and I am writing. That means there’s at least an inch of rope left. An inch of cope.

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