My Experience Only. YMMV.

Archive for the ‘Mental Health’ Category

The Lone Wolf Strikes Again

It is gun control, or the lack thereof.

It is Hollywood.

It is religion, or the lack thereof.

It is radical Islam.

It is a conspiracy.

It is a “false flag” operation.

It is substance abuse.

It is toxic masculinity.

It is hatred.

It is anger management issues.

It is evil.

It is desire for fame.

There are plenty of suggestions for what causes events like the Las Vegas shooting. The one that amused me most is that men do not have close friends and don’t play enough (despite the prevalence of golf, tennis, softball, bowling, basketball, and a lot of other recreational sports). But the go-to explanation, once race and religion have faded into the background, is mental illness.

This time around the shooter is a white male belonging to no terrorist cell or cause, so he gets called a “lone wolf.” (Do I hear that resonate as a symbol of pride and freedom? Don’t rebels and renegades of all stripes identify themselves with lone wolves? Aren’t lone-wolf types celebrated in movies and TV shows and novels and video games? It’s certainly a “nicer” epithet than “terrorist.”)

And since Stephen Paddock was on one anti-anxiety medication, a (very loose) case is being made for mental illness. Again. Despite the fact that he was never diagnosed, treated, hospitalized, or gave any other indication of mental illness. Unless you count shooting hundreds of people.

Certainly a person who did what he did would be tested for mental illness after he committed such a horror, had he not killed himself. But before the fact? Was he mentally ill – a “known” hazard?

He was quiet, a loner. (Aren’t they always?) He may have had financial problems related to gambling. He took a benzo.

Think of all the quiet men you know that have financial problems, perhaps even addictions such as gambling. How many of them have stockpiled guns and shot hundreds of people? Hell, my husband is a loner with financial problems, takes an antidepressant, and has access to guns. Why hasn’t he?

Because these men – millions of them – do not become mass shooters as a rule. And when one does, well, he must have been crazy.

You and I know the statistics. One in four people will experience some form of mental disturbance in their lifetimes. Yet 25 percent of us do not become mass killers. The unfortunate fact is that there is no way to predict who is going to. Even after the fact, there is no way to say, “We should have known,” because so many people fit the criteria.

It’s a complex problem, difficult or impossible to untangle. Just as one cannot say that cyberbullying was definitely what caused a suicide, there are myriad factors at work in violence, and blaming just one “obvious” cause does not explain or help. Look at Columbine. Harris and Klebold may (or may not) have been bullied. But they also lacked supervision, had trouble with the law, and had access to guns and explosives. Can any one of those factors be viewed in isolation from the others?

There are some voices that have started to question the automatic link between mental illness and violence. Julie Beck wrote a fine article for the Atlantic (https://www.theatlantic.com/health/archive/2016/06/untangling-gun-violence-from-mental-illness/485906/?utm_source=fbb), which I hope will be widely read and influence many people. I’ve written about the problem too, small contribution though it may be (http://wp.me/p4e9Hv-6A).

Beck calls the easy leap from mass killing to mental illness “a consistent and dangerous narrative.” She points out that “[o]nly 4 percent of the violence—not just gun violence, but any kind—in the United States is attributable to schizophrenia, bipolar disorder, or depression (the three most-cited mental illnesses in conjunction with violence).  In other words, 96 percent of the violence in America has nothing to do with mental illness.”

And, she says, “Other research shows that reading stories about mass shootings by people with mental illnesses makes people feel more negatively toward the mentally ill. This only heightens stigma, which could lead to more people going untreated.”

That’s a second horror, not as sensational or sensationalized as mass killings, but a chilling one nonetheless. None of our anti-stigma campaigns speaks as loudly as gunfire.

Ten Opinions That May Offend Someone

Recently I noticed that I have been reluctant to offend people, particularly on Facebook. I keep my opinions to myself, especially on social and political matters, and dread being “unfriended” or starting (or continuing) a “flame war.”

This is not just a matter that relates to my bipolar disorder, though it is certainly that too. I have written a number of times about how having bipolar disorder and the behaviors it has brought out in me have cost me friends, even ones that I thought were “forever-friends.” These losses have affected me greatly, at times pushing my anxiety and depression buttons nearly as far as they can go.

Just as I have toned down my comments on subjects such as liberal vs. conservative issues, I have also let pass by posts in bipolar support groups and mental health memes on people’s general Facebook timelines that I’ve disagreed with. Oh, when I see a particularly incorrect or egregiously stigmatizing remark, I’ve been known to smack the person on the nose with a rolled-up newspaper, but often in a soft, “In my experience, you may not be correct” manner.

There are also conflicts within the bipolar world that I have strong opinions about but have not jumped into, for fear of offending someone. And I have to ask myself, what would be the consequences of offending someone in such a discussion?

Yes, I might be unfriended. More likely I would be ignored. Or (virtually) yelled at. In other words, if I offend someone with my opinions, they may in turn offend me with their opinions. And while that’s not a productive state of affairs, it’s hardly the end of the world. In an ideal world, I might cause someone to question or consider or engage in fruitful discussion. Not likely, but possible.

So, if I am trying to overcome my fear of offending people with my positions on guns, abortion, health care, climate change and the like, what am I to do about my opinions regarding bipolar disorder and mental health in general?

Well, first of all, I can state where I’m coming from: straight, white, female, married, childless, bipolar type 2, 60 years old, diagnosed for years and on any number of medications for years as well. Not much controversial there. That’s just facts about me and hard to deny.

But here are some things I believe that I know are sometimes subject to differences of opinion. And for what it’s worth, here’s my take on them.

  1. Psychotropic medications are good things. Yes, they can be overprescribed or improperly prescribed, but when dispensed and used correctly, they help.
  2. The Scientologists are way off base. Mental illness exists, and so do treatments for it.
  3. “Natural” or “holistic” treatments for mental illness are not enough to replace medication and talk therapy.
  4. Sunshine, exercise, and positive affirmations are good things, but also are not enough to replace medication and talk therapy. They do good for a number of people, less for others, and not much at all for some.
  5. We’ve got to change the popular dialogue about mental illness and violence. We must not let it go unchallenged. For that matter, we must change the popular dialogue about mental health in general.
  6. While it’s a good thing if those with mental illness take their medications properly, it is absolutely their right to refuse treatment.
  7. Health care (and insurance plans) should cover mental health care at the same levels as physical health. (Okay, that one’s not really controversial among the mental health community.)
  8. Emergency responders including police should all receive training in dealing with mental health issues, but they probably won’t.
  9. Most people don’t/won’t/can’t understand mental illness until it touches their own life in some way, and maybe not even then.
  10. Education about mental health issues should begin in grade school.

There. If you disagree with any of those statements or feel that I am an idiot for stating them, so be it.

Oh, and while we’re at it, persons with a mental health diagnosis should not automatically be prevented from owning guns, but people with domestic violence convictions should be.

My Love-Hate Relationship With Hypomania

Most of my time on the bipolar 2 spectrum has been spent on the depressive side. Lately, however, I’ve been trying to acknowledge my hypomanic side as well.

This has been difficult to do. My psychiatrist told me that my hypomania generally comes out sideways, as anxiety, and I’ve certainly had my share of that. One of the earliest I remember, from my teens, was when I had panic attacks in the cereal aisle at the grocery. I attributed it to the bright, loud colors that bombarded my senses and, if my later reaction to Chuck E. Cheese’s is any indication, that may have been accurate. My doctor at the time, however, thought it was an ordinary panic attack that I just happened to have while in the cereal aisle, and the two became linked in my mind. Of course, this was before I was diagnosed bipolar, so who really knows?

I also used to have the panicky kind of hypomania when my husband was driving the car, particularly on the highway. I still maintain that panic while on the highway is not completely unwarranted (compared, say, with the cereal aisle). It is, after all, a dangerous place.

The first time I can remember having the swooping, soaring type of hypomania was when I worked at a publishing company. A young woman came through and asked me about how to get published. Pressured speech? I babbled, I burbled. I spouted advice. I sprayed out ideas. I rejoiced in my own success while encouraging her in hers. I had no idea if she really had the talent or the drive necessary, but by the time I finished twittering at her, she had caught my spark and resolved to go right home and put my advice into practice. I have no idea, to this day, whether she succeeded. But at least, in that case, my hypomania was inspirational.

I used to say, when I was diagnosed unipolar depressed, that I wished I were bipolar, because then I might get something done. (I will pause here while you all laugh.) But the truth is, hypomania pushes me to take on challenges that I can only sometimes accomplish. Once I agreed to interview an old Chinese lady and write something based on her experiences. After the interview, which was fascinating but overwhelming, I was unable to write. It was one of the few times I took on an assignment I couldn’t finish.

More recently I took on an assignment to write 13 children’s stories of 2500 to 3000 words each, with very specific deadlines. Although I’ve met all the dates so far, I wonder whether hypomania has fooled me again. All I can hope is that this is one of those times when it has pushed me into doing something difficult, but will help me maintain until I get through it.

So, it seems, most of my hypomania is related to work (except for the cereal thing and the driving thing). I occasionally get the urge to spend money, but since we don’t have much money, it’s not too hard to fight that one off. Plus, we don’t have a credit card. We learned that lesson years ago.

What to make of all this? I now know that hypomania is part of my psychological makeup. I now know that I have to watch out for unwarranted spending (enabled by my husband, who has that tendency too). I now know that hypomania can push me into work that may overwhelm me. I now know that it can still come out as anxiety and panic, which can have unwanted effects on my everyday life. For those reasons I hate it.

Hypomania can also push me past what I think I can do to what I learn I actually can do. It can let me feel the buzz, the blast of joy that depression so long denied me. And for that I love it.

Mostly, though, I have to be wary of hypomania. It could dump me in either direction, and I won’t know which it is until it’s already happening.

Surviving College While Bipolar

I had two goes at college, and they were very different from each other, based on the state of my bipolar disorder at the time.

The first time I went to college, for my undergraduate degree, I was undiagnosed and unmedicated – except for self-medication. I was away from home for the first time – that was my first goal when choosing a college, being after a “geographical cure.” I ended up in the Ivy League, a scholarship student and a fish out of water. And profoundly depressed.

I did manage to hit the ground hiking, as the university sponsored backpacking trips led by juniors and seniors for entering students. We used to joke that it was meant to lose a few along the way, but really it was for orientation. Campfire chats about college life and the like.

On that hike through the Adirondacks, I met Caren, Roberta, and Cyndi, who instantly became my best friends and were my support system throughout the five years I spent there.

Yes, five, though only four of them were really at the university. After my first year, I took a year off. My depression had gotten so bad that I was given to sitting on the floor in the hallway, staring at a poster for hours at a time instead of sleeping. During my year away, I worked a dreary but educational job as an evening shift cashier at a restaurant. When I returned, I had a new major and the same old depression.

Oh, I did have fits of hypomania. I joined a sorority during one, though I deactivated later in a depressive downturn. And I went through the ups and downs exacerbated by several failed romances, including one total trainwreck.

The only help I got, aside from the support of my friends, was one brief therapy group at the campus mental health center and a brief stay at the university clinic, because of some suicidal ideation that my friends recognized.

Needless to say, I came out in no better mental shape than I went in, but I did manage to snag a B.A. degree. Now I feel that I missed a lot of opportunities along the way. It was just another occasion when I felt that my lack of mental health got in the way of what could have been a more productive time, as a well as a happier one. When I left college I was still almost as ill-prepared to function as when I went in.

By the next time I gave college a try, I was, if not mentally healthy, at least mentally healthier. And being back in the town I had been so eager to leave, I had a larger support system, now including a therapist, parents, close friends, and a husband. This time I had help.

I was still a mess, but less of one. With my depression lifting, I was able to teach introductory courses and manage my own course load. I remember my first semester teaching as a blaze of hypomania as I adored the subject and thought I was sweeping all the students along with my enthusiasm. Then one of the students gave me a bad review and I plunged again, never to recover that soaring sensation. I plodded through the next three semesters of teaching.

This time I came out with an M.A. and better job prospects. The day after I graduated I was working as a temporary editorial assistant, a job I kept for 17 years, moving up to editor along the way.

What did my experiences with college teach me (aside from modern poetry and how to swallow aspirin without water)?

  1. Making it through college is possible when you’re unmedicated and have minimal support, but I don’t recommend it.
  2.  Even with diagnosis, medication, and support, it’s still not easy. You know how hard it is to get out of bed and take a shower some days? Now think about going to a class on top of that, where your work will be critiqued. Taking a year off was one of the best things I ever did.
  3. Being bipolar isn’t your only identity, though it looms large in your life. I was also a student, a teacher, a friend, a daughter, a wife, a poet, a cashier, and so many other things. I may not have enjoyed them as I should, gotten as much from them as I could, but they were as much a part of me as bipolar was.

I can’t see myself at this point going back to college and getting a Ph.D. Which is not to say I’ve never considered it. But I like to think that, were I to try, this time I would have a better chance of getting through, sanity intact, with something more to show for it than a piece of paper to hang on the wall. This time, I tell myself, I wouldn’t let Bipolar Me take the experience away from Me.

Andrew Tate Doesn’t Get to Define Depression

“Depression isn’t real. You feel sad, you move on. You will always be depressed if your life is depressing. Change it.”

Now, before you jump all over me, let me say that I never said that. It’s a tweet from Andrew Tate, kickboxing champion and former star of “Big Brother UK.” It caused quite a stir in the Twitterverse and was immediately challenged by, among others, J.K. Rowling and Patton Oswalt.

Obviously, there are a few things wrong with Tate’s opinions. First, the notion that depression isn’t real. To quote Hemingway, “Isn’t it pretty to think so?”

The millions of us with major depressive disorder and bipolar depression would love it if our disorder weren’t real; if we could just move on. If we could only change our lives. Kick depression out of our heads, as we should be able to, according to the kickboxer.

And Tate threw more fuel on the fire. He tweeted “MY DEPRESSION INBOX. Is hilarious. Full of crybabys. . . .”

Admittedly, many depressed people cry. But that doesn’t make us crybabies. Babies stop crying when their needs are met. People in the throes of depression don’t really know if their need for it to stop – their need for, if not happiness, at least not-despair – ever will.

When I first became clinically depressed I was a child and knew nothing about clinical depression. But I knew I was profoundly depressed. And I knew that if I waited long enough, that depression would lift. Being undiagnosed and unmedicated, I had no idea when I would come out of depression. All I could do was wait for it to happen.

Now older and wiser (and diagnosed and medicated), I know some things I can do to shorten that time until the depression lifts. I can practice self-care. I can call my therapist. I can turn to my husband. Now I know – really know and understand – that my depression isn’t forever, even if my disorder is.

And I know that, if I have to, I can push through depression instead of waiting for it to ease up on its own. Meeting my self-imposed blogging deadlines is one way I do that. Paying the mortgage and power bill is another. In some way those are both life-affirming activities, or at least statements that I am still connected to the world – however fragilely – and that I want and need to come out of the depression and get on with my real life.

It’s ridiculous to say “move on” or “change it.” Depression comes and goes when it wills. All we can do is endure it and keep pushing back until it gives the tiniest toehold. Then take that tiny purchase and push some more. It’s the hardest thing in the world when depression has sapped your energy, but believe me, there is more inside you somewhere. It may just take a long while to find it and to recognize it. We can no more change our depression than we can our souls. We can push back against it.

So screw you, Andrew Tate.

And screw you, depression.

 

 

Shortchanged: Bipolar Disorder and Money

I don’t know any rich people with bipolar, aside from the celebrities who struggle with it and go public. There may be some out there – there must be, statistically – but I don’t know any of them. I’m relatively well off – home, car, most bills paid, work – but even I live paycheck to paycheck. And have lived no-paycheck-to-no-paycheck in the past.

Let’s face it, having bipolar is expensive. And not conducive to making money. Here are some of the hurdles that I’ve noticed.

Insurance. The biggie. Right now I have insurance and, thanks to the Affordable Care Act (Obamacare), it covers mental health conditions. My previous insurance, which was more expensive, and crappier, and came through my husband’s employment, did too, but not nearly as well.

So, I’m covered, but not all my doctors take my brand of insurance. Some of them will accept reduced fees (if you ask) or have a special self-pay rate. But even that doesn’t always help much. My previous psychiatrist charged me $95 and my current one $75 – and those are just for 15-minute med checks, not full 50-minute sessions. My therapist accepted $30 per for that, so I was lucky, but had no official insurance document stating that she had to give me that rate.

Medication. The other biggie. I am currently on four or five psychotropic medications, depending on how you count (and no, you don’t need to know what they are: http://wp.me/p4e9Hv-u1). One of them – you can probably guess which one – cost $800 per month when it was first prescribed to me. I got a coupon from GoodRx.com that brought it down to around $200 per month which was, if not exactly reasonable, more doable. Finally, a generic came out and the ACA kicked in, and I get the drug for $45 per month now. That would have seemed high at one time, but now sounds comparatively reasonable. But if you’re on a fixed income, watch out. Fixed income and no insurance, you’re screwed.

SSDI. Which brings us to the topic of Disability, the “safety net” that’s supposed to catch those of us who are so disabled by our mental (or physical) conditions that we’re unable to work. Good luck getting it. Most people who apply are rejected, sometimes more than once. Practically speaking, you need a lawyer to navigate the shoals for you, and one who works on contingency at that. The hoops and red tape are massive. If you’ve got depression, to pick just one example, cutting through and jumping through may be beyond your capabilities. You’d think they planned it that way, just to cut down on the number of claims they have to pay.

Mental illnesses are particularly difficult to get SSDI for. They’re “invisible illnesses,” not like blindness or paraplegia that one can’t help but notice. When and if you do get approved, the monthly payment is meager and fixed (see above), unless there is a cost-of-living raise which, given the current economy and political leadership, is increasingly unlikely.

Bipolarity. Then there’s the disease itself. Anyone with mania can probably tell you about the sometimes-ruinous spending sprees that accompany racing moods. Hell, I only get hypomania and I’ve got five custom-made dresses in my closet that I’ve never worn and now can’t because of weight gain from my psychotropics.

You’d think depression would not have much effect on your spending. But it does have a profound effect on your income. People with bipolar depression who can work part-time or from home are lucky. Others not so much. There was a period of several years when I was unable to work at all, and we ran through our savings and retirement accounts rapidly. My husband could still work, but one income quickly became insufficient to meet the bills. (Fortunately, my bipolar depression lifted enough that I’m now able to do part-time, at-home, freelance gigs, which are about as unstable as I am.)

Retirement. No IRAs left. No savings. That means Social Security, delayed as long as possible, and the aforementioned fixed income. Basically, I can never retire. I can’t afford to.

Frankly, I can’t see any of this changing anyways soon. Money trouble is just one of those things that you have to deal with along with your mental disorder. And there’s nothing like stress to make your symptoms worse.

Are Political Extremists Mentally Ill?

Yes.

Well, some of them are. Given that one in four of Americans experiences a mental or emotional disorder at some time during their lives, 25% of any given group either are, have been, or will be affected by mental problems. Politicians. Girl Scout leaders. Chefs. Whoever.

Of late, though, it seems that political extremists – and politicians, of course – are being singled out for accusations of mental illness. And as for terrorists, they are in common understanding all mentally ill, so anyone you label as a terrorist is automatically insane. But we’re far from agreeing who is and is not a terrorist. (Antifa? Greenpeace? The NRA? The DAR?)

Admittedly, some of the extremists’ actions and statements seem “crazy,” but let’s stick to the more technically correct “mentally ill.”

Except it isn’t technically correct in most cases.

A lot of people seem paranoid these days. Everyone on the “other” side is out to get them, destroy America, or at least scare the pants off us. Conspiracy theories abound. And nearly all of them are crazy. (I wrote about this a short while ago: http://wp.me/p4e9wS-AH).

But “paranoid” is a clinical term in psychology, and it has a specific meaning: Paranoid Personality Disorder is a psychiatric condition, manifested by, among other things, “generally unfounded beliefs, as well as … habits of blame and distrust, [which] might interfere with their ability to form close relationships,” as WebMD says.

Those traits your political or social opponents may have, but most of them don’t also:

  • Read hidden meanings in the innocent remarks or casual looks of others
  • Perceive attacks on their character that are not apparent to others; they generally react with anger and are quick to retaliate
  • Have recurrent suspicions, without reason, that their spouses or lovers are being unfaithful

Diagnosis at a distance is dangerous, as well as bogus. The fact is that none of us (except perhaps psychiatrists) can diagnose a person as paranoid or any other variety of mentally ill without having met the person and performing detailed interviews and tests (I’ve written about this too: http://wp.me/p4e9Hv-6F).

This is also true of public figures. We can say that Donald Trump, to choose an example not entirely at random, has narcissistic traits; or is a narcissist in the garden-variety, non-technical meaning of the word; but we cannot say that he has Narcissistic Personality Disorder, an actual clinical diagnosis. We may think he’s crazy, but we can’t say whether he’s mentally ill.

Public readiness to label people, both acquaintances and public figures, with loose pseudo-psychiatric terms raises a number of problems, particularly stigma.

Labeling is a convenient way to dismiss a person who disagrees with you without listening to what he or she has to say, or considering the possible validity of an argument or even a statement of fact. If we apply a label, we make an assumption about a person that may or may not be true.

Stigma comes with the label mentally ill. People with diagnosed mental disorders are too often assumed to be violent, out-of-control, homicidal (or suicidal) maniacs – and therefore not worth listening to. In fact, many people with mental illnesses have no impairment in their cognitive function. It profoundly devalues them to dismiss them from political and social topics of conversation.

So, bottom line. “Those” people may be crazies, may act crazy, talk crazy, believe crazy things, but it is not accurate or helpful to call them crazies. Neither is it helpful to label someone who has never been diagnosed or has never been open about a diagnosis as mentally ill.

I just think that how we talk about people affects how we treat them. And that matters.

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