My Experience Only. YMMV.

You know when you feel sure that other people are talking about you? You notice them whispering, or looking at you, or studiously not looking at you, and you think, what are they saying about me?

Two smiling friends sharing secret in coffee talkPsychologists call those feelings “ideas of reference.” (If you alter your behavior because of the supposed scrutiny, they’re known as “delusions of reference.”) Ideas of reference are often associated with paranoia. However, if you ask clinically depressed or bipolar people, you will find that many of them have them as well.

I know I have. It’s hard not to. You already feel that you’re not really normal (whatever that means) and you’re afraid that it shows. If people can see that you’re not like everyone else, they’re bound to be talking about it. Never mind that your difference is a mental one; you’re sure that everyone can tell just by looking at you that you’re crazy.

In actual fact, the people you think are talking about you usually aren’t – until you go over to them and defensively berate them or accuse them of doing so. Then you can be sure they will be talking about you after you leave.

Except perhaps in junior high school, most people in everyday life do not spend their time discussing how odd the people around them are. (Except for those people who take pictures of others at Walmart and then post them on the internet.) But the average person is too involved in his or her own daily life to give more than a passing glance to a stranger. The people you see whispering behind their hands are most likely developing their own secrets or gossiping about someone you don’t even know.

Even if the people are talking about you, ask yourself – so what? Do their opinions really matter? I know that you want to say yes, they do. But in the larger scheme of things, they don’t. Your life will not change in the slightest if they are saying they don’t like your haircut or that they heard you bite your nails. Malicious gossip and social bullying are separate matters. But again, you don’t really know that these people are saying anything that’s actually harmful.

Perhaps you feel it’s more significant if the people you think are talking about you are family members, coworkers, or friends. They may really be talking about you. The point is, even if they are, you have no idea what they’re saying. Most of the time they speak in low tones so as not to upset you, never realizing that that upsets you more. Tell yourself they could be planning a surprise party or talking about Aunt Edna’s affair with a younger man. Not everything is about you.

Ideas of reference may be a factor in imposter syndrome – the feeling that you are not really successful, competent, or talented, but are just faking it, and that everyone around you can tell. Or perhaps your ideas of reference are like intrusive thoughts – sudden, distressing notions that pop into your head, seemingly without cause or warning. These can be anything at all, from “I wonder if my passport has expired” to “Who would miss me if I died?” to “Those people are talking about me.”

What can you do if you have ideas of reference? Resist the urge to ask if the people are really talking about you. That will only make things awkward and worse. Ignore them if you can. (This is not the same as the bad old non-advice about ignoring bullies. You know when a bully targets you. With ideas of reference, you never really know if your fears are true.) Since you didn’t actually hear what the people said, you can realistically assume they were talking about someone or something else entirely. Imagine that one is telling the other that her slip is showing. (Do people still wear slips? I know they don’t wear pantyhose anymore.)

If you feel you must react, use a minimal response such as the good ol’ side-eye, which is sufficiently ambiguous that the person (who may also have ideas of reference) can assume it’s directed at someone else.

Another suggestion I’ve heard is to work with your therapist on issues of self-esteem and self-concept, or to try cognitive behavioral therapy. Some medications may help too. Still, if you feel you can manage it, I think the best idea is to tell yourself “So what?” and move on.

There are triggers and then there are trigger warnings. They’re two different things. Here’s a look at which is which.

Triggers are things that set off your symptoms. They are usually fairly common, everyday things that don’t seem to affect others negatively, but that set off a reaction of anxiety or depression in you.

Acute stressI have bipolar 2 with anxiety. As such, I have spells of depression and anxiety that hit for no discernable reason – endogenous, meaning “from the inside.” They have no specific triggers except my own brain biochemistry. I don’t know how long they’ll last, and most of the time I don’t know what will relieve them, except self-care, meds, and the passage of time.

Obviously, since these feelings have no particular triggers, writing about them usually doesn’t need a trigger warning.

With exogenous depression and anxiety – those that come from the outside – there are more often triggers. After a while a person learns what those triggers are and how to avoid them.

Two of my triggers for anxiety are sudden loud noises and loud voices, which means that I will never in my life be able to work in or even visit a Chuck E. Cheese restaurant. Avoiding Chuck E. Cheese is one of my coping mechanisms.

Another is gesturing to let my husband know that his voice is getting loud when he gets angry about politics, for example. Or leaving the room on the pretext of getting a cup of tea when a group of people begin arguing.

My husband knows about these triggers and also helps me in coping with them. He warns me if there is likely to be a loud noise, such as hammering or using a power tool when working on a project. When there is a sudden noise, he reassures me afterward – “It’s okay, honey. I just dropped a plate.”

If I write about my personal triggers (which, of course, I just did), there is likely no need to post a trigger warning. The reader is not actually hearing the loud, sudden noise or the quarreling voices. Even if the reader has the same triggers, he or she is merely reading about them, not hearing them in real life.

The other kind of trigger is very different. It is something that causes a person to have an acute reaction to or flashback of a trauma – rape, sexual abuse, self-harm, suicidal thoughts or attempts, etc. At their worst, reading or hearing accounts of these types of incidents can cause a person to re-experience the trauma. The account triggers a painful memory, which can easily lead to a panic attack or even a total meltdown.

The trigger warning was invented to let a person know that a particularly sensitive subject is about to be discussed and the person may want to skip reading it or wait until she or he is in a safe space before doing so. It’s a little like putting ratings on movies or TV shows so that viewers can choose the level of sex, violence, or profanity they are willing to experience.

A trigger warning is just that – a warning that difficult content is coming – provided so that a person can choose when or whether to read it. To use the earlier example, I do not need a trigger warning at the beginning of an account of a visit to Chuck E. Cheese. I do need one for an account of self-harm.

A trigger warning is not an excuse to avoid a reading assignment or class work. It is not an attempt by a “special snowflake” to sanitize the world. It is a courtesy – a signal – intended to prevent people from experiencing crippling reactions to content that produces only mild discomfort or even no reaction in others. Using a trigger warning when none is needed dilutes the value of the serious, severe kind of trigger warning. I strongly advise against using trigger warnings too freely.

(P.S. There may be triggers for hypomania and mania as well, but I’m not familiar with them. If you are, please tell us about them in the Comments section.)

A while back I wrote a post called “Another Word for Stigma” (http://wp.me/p4e9Hv-oz), which was about the new-to-me term “sanism” and how it set up a dichotomy between the sane and the insane. While sanism may have been intended to reframe the discussion about mental health issues, I said, “We already know that stigma exists surrounding mental illness. We don’t really need the word ‘sanism’ to redefine it. Or to pit us against one another.”

When applied to mental illness, “ableism” is another word that subtly reinforces stigma. It implies that, unlike the neurotypical population, those of us with mental disorders are differently abled, mentally challenged, or – dare I say it – disabled.

Many of us – including me – have applied for disability and many – including me – have been turned down. Despite that, many of us live with varying levels of ability and disability, which are nearly impossible to see and therefore to prove.

When I applied for disability, I was in the depths of what would once have been called a nervous breakdown. I had mental deficits, emotional instability, trouble performing the skills of daily life, inability to hold a job – certainly at the level that I formerly had, or possibly not at all. My thoughts were disordered. My life was disordered. I got by only with the help of a caregiver – my husband. If that’s not at least partial disability, I don’t know what is.

By the time my claim was denied and my disability lawyer was prepping me for a hearing, however, I was, if not well, at least better. I had found part-time work that I could do at home, which provided as much income as disability would have. At his suggestion, I dropped my claim. Perhaps I shouldn’t have, because the lack of medical benefits has been a constant difficulty.

So, am I disabled? I would have to say, partly. I still cannot hold a full-time job – certainly not without accommodations – and my caregiver (still my husband) has to help me with many of the tasks of daily living.

The notion of requiring accommodations leads us to the subject of discrimination. Employers are required by federal law to provide “reasonable accommodations” to persons with disabilities, according to the Americans with Disabilities Act (ADA), for conditions including “a physical or mental impairment that substantially limits one or more major life activities,” and also to “a person who has a history or record of such an impairment, or a person who is perceived by others as having such an impairment. The ADA does not specifically name all of the impairments that are covered.”

“Reasonable accommodations” are not defined for mental disabilities, but examples of accommodations for other conditions include modifying work schedules, as well as leave flexibility and unpaid leave. But just try telling a prospective employer (as you are entitled to do) that you will need flexible hours to accommodate appointments, panic attacks, or other phenomena; or asking someone you work for to give you unpaid leave for a hospitalization. I think you know the result as well as I do.

One problem is that these forms of discrimination – which is what they are – are damnably hard to prove, as onerous and unlikely as being classified disabled in the first place. Yet the protections against these forms of discrimination are defined by law. But how many of us have the wherewithal to challenge them, prove our cases, and get by while waiting for the results of a lawsuit?

Even the act of asking for an accommodation opens us to yet another instance of stigma, and the outcome depends on the individual knowledge and understanding of an employer, when it should follow the law. We approach employers and prospective employers hat in hand, asking for – but not expecting – to get the treatment that is legally, rightfully ours.

In these days of rampant discrimination against people of any number of races, religions, national or ethnic origins, sexual orientations, and disabling conditions, our voices may not be the first to be heard. But we, the neurodivergent, the mentally ill, the emotionally disabled, the psychiatric patients, and our caregivers and loved ones deserve to be free from the effects of ableism, discrimination, and stigma.

Let’s speak up, keep educating about our issues, and support each other in banishing stigma, ending discrimination, and putting ableists on notice that we will not shut up until our rights are acknowledged.

 

As a Muse, Depression Sucks

Pencil tied in a knot on a white backgroundRecently, someone commented that I didn’t write like I was depressed, even though I actually was at the time I wrote.

This week I am even more depressed, so I thought I’d give you a look inside my head as I try to write while depressed and/or anxious.

::typing:: “Donald Trump Is Not a Monster. He may be a liar, a bully, and a misogynist who is uninformed, egotistical, and thin-skinned, but he is not a monster. Monsters are mythical. They are what we invented to be The Other. To say a person – Timothy McVeigh, Ted Bundy, Donald Trump – is a monster is to say that they are Other: not human beings. In reality, they are all human beings, who may have done monstrous things. But they are motivated by the same things as all humans: greed, fear, hate, sex, fame…”

::thinking:: No. That stinks. Half the people who read my Et Cetera, etc. blog will hate me because I said Donald Trump is not a monster and the other half will hate me because I compared him to Timothy McVeigh and Ted Bundy. I’ll offend everyone at once. Maybe I could write “How to Offend Everyone at Once.” No, that’s a terrible idea. My goal is not to offend.

::still thinking:: Why am I so afraid of offending anyone? Is it because when I’m depressed, my self-esteem is super-low and I can’t afford to lose any more friends? Is it because I’m female and was raised to be a people-pleaser? Then why haven’t I pleased more people? Is it because I don’t want to be called a “special snowflake”?

::still thinking:: My knee hurts.

::still thinking:: Maybe I should write something about education. What, though? The education issue everyone is talking about is Betsy DeVos. I only know about her what others have written. Writing about her would be useless and boring. Crap. It’s already Friday and I don’t have anything. I’m not going to have a thing to post this week.

::still thinking:: What’s another go-to topic? Books. I just re-read The Handmaid’s Tale and that’s totally relevant.

::typing:: “The Handmaid’s Tale: A Tale for Our Times”

::thinking:: No.

::typing:: “Written Thirty Years Ago and Still Relevant”

::thinking:: No. Hardly anyone reads my book posts anyway. How can I have been doing this for three years and not have more followers? Is that why I write? Ego gratification. I’m a sad, sad person who needs external validation instead of interior satisfaction.

::still thinking:: My husband doesn’t even read my posts half the time, even if I mention him. Maybe I could write about bipolar disorder and sex. No, I’d have to do too much research and I’m running out of time. Besides, with my luck, my husband would read that one and not want our sex life all over the Internet.

::still thinking:: My knee still hurts. How long have I been sitting at this stupid computer?

::typing:: “I Hear Voices” – I’ve been meaning to write that one.

::thinking:: No. I don’t hear voices like psychotics hear voices. All I hear are Pete Seeger singing pizza commercials or a men’s chorus or an NPR broadcast that I can’t quite make out. That’s boring. My life is boring. Besides, I’d have to do too much research and I’m running out of time.

::still thinking:: I could look up some quotes about bipolar and say whether I agree with them or not. More research again. Besides, who cares whether I agree with them or not?

::still thinking:: Maybe I could re-post one of my old posts. Wouldn’t that be cheating? If I can’t some up with something by tomorrow, I may have to. But that’s like admitting failure. Like I can’t write. Maybe I can’t write anymore. Maybe I’ve already written everything I know.

::still thinking:: Maybe I could write about not writing. Too boring? Too meta? Don’t people hate stream-of-consciousness? Especially stream-of-depressed-consciousness. It’s so bloody depressing. I’m so bloody depressed.

::typing:: Recently, someone commented that I didn’t write like I was depressed, even though I actually was at the time I wrote…

::thinking:: Now how am I going to illustrate this?

Last month I wrote about how bipolar disorder had cost me – well, not the ability – but the capacity to read (http://wp.me/p4e9Hv-qp). I am intensely thankful that the concentration, focus, and motivation to read have returned as my healing has progressed.

But there are some other things that are missing from my life that I wish desperately that I could get back. Or wish I had never lost in the first place. (Depression is very much with me right now, so forgive me if I dwell in the past with my failures a bit.)

First are friends. I’ve written about this before too (http://wp.me/p4e9Hv-2W), but the subject was brought home to me recently when I received a fuck-off letter from a former friend I was trying to reach out to, in hopes of reestablishing the relationship. One of her main reasons for cutting me off was that every time we went out, she felt it was “her and me and my misery.”

She did acknowledge that at times our friendship had been burdened by her misery too, but evidently that either didn’t count as much, or else mine lasted too long. (If it was too long for her, it was even longer for me.) I am very disappointed that, now that my “black dog” is smaller and on a leash, she found other reasons not to associate with me. To make it more ironic, she has been a therapist and now teaches psychology.

I also miss having a steady paycheck. My last 9-5 office job was over ten years ago, and since then my mental state has not allowed me to get and keep another such position. The security of knowing how much money I would have every month allowed me to plan.

And to travel. I really miss traveling. Admittedly, part of my inability to travel now is determined by my physical health. But my anxiety would make it just that much more difficult. Now I can barely get away for a weekend, and even then I must carefully monitor my moods, limit my activities, track my eating and sleeping, and avoid crowds.

One of my deepest regrets is that when I was undiagnosed and untreated, I couldn’t fulfill my potential. I attended an Ivy League university, but I can’t say I got out of it what I could or should have. I feel now that I skated by, impeded by many depressive spells, lack of focus and concentration, and confusion. I even took a year off to get my head together, but since that didn’t include getting help for my bipolar disorder, its value was questionable.

Lest this seem like nothing but whining (which my depression is telling is what it is), there are also some things that bipolar disorder has taken from me that I don’t miss at all.

Oddly, one of them is a 9-5 office job. While I do miss the steady paycheck, I absolutely don’t miss the things that came with it. Now, doing freelance work, I can fit my work around the things I need to do (like seeing my therapist) and the things I have to do (like slowing down when depression hits). I don’t have to get up at the same time every day and dress appropriately (if at all) and try to fit in and socialize with my co-workers. That was never easy for me and became nearly impossible after my big meltdown.

And, as much as I miss travel, I don’t miss business travel. Again, being “on” all the time, for days at a time, with no time or place to decompress, would be impossible now. Since we usually had to share hotel rooms, there wasn’t even a chance for any alone time, which I need a fair amount of. I could never get the hang of “team eating” either.

Finally, I don’t miss the boyfriend who took an already broken me and broke me worse. (I wrote about him in my post about gaslighting http://wp.me/p4e9Hv-pm.) My self-esteem was not great before the relationship, but afterward it went into negative numbers. Self-harm, self-medication, self-doubt, and negative self-talk were what I had instead. But Rex didn’t do it alone. He had my bipolar disorder there to reinforce his words and actions. And to not let me see what was happening.

Bipolar disorder is a balancing act, in more ways than one. It takes away good things from our lives. But my therapist reminds me that it also gives an opportunity – as I rebuild my life, I can choose which pieces I want to reclaim and which I want to discard. And the parts I can rebuild are what I should concentrate on.

And I will, once this spell of depression releases me.

 

 

 

 

 

 

 

Why pay $250 an hour just to talk to someone?

That was my sister’s reaction when I said I was going to start seeing a therapist. This is my answer.

Mental health symbolWell, Lucy, while a psychiatrist doesn’t cost 5 cents anymore, therapy can be had for a lot less than $250. There are community mental health centers with sliding fee scales – which is what I was going to then. There is insurance, for now at least. I’ve even known psychotherapists who would accept less than their usual fee for long-time patients in temporarily dire straits.

And I’m not paying to talk to just “someone.” A therapist usually has at least an M.A., and sometimes a Ph.D. Psychiatrists have an M.D. or D.O. They have years of training, more years of experience, and colleagues they can consult if your problem is particularly challenging or out of their area of expertise. You can also find peer counselors, religious counselors, and proponents of every variety of therapy or treatment you can name, from neuro-linguistic programming to electroconvulsive therapy.

Now, as I reflect on my clueless sister, I’ve started thinking about all the things that therapy has done for me.

Diagnosis. When I first started going, back in the 80s, I could only afford one of those community mental health centers with the sliding fee scale. (At the time, I paid $5 per session.) There I was diagnosed with depression. The primary treatment they offered was “talk therapy,” but I had years and years of mental difficulties to talk about. Later, when I was seeing a psychiatrist, I was re-diagnosed with bipolar 2 and anxiety disorder. Suddenly, my past became a lot clearer, even if my present was still messed up.

Medication. There has been a lot of it over the years. I started, as so many did, with Prozac, which had a noticeable effect on my depression. It was like the difference between watching a black-and-white TV that got only one channel that showed only tampon commercials, compared to a wide-screen color TV that got hundreds of cable channels. The meds I’m on right now keep me functional, at least enough to make a living and be creative.

Perspective. When I first started going to my current therapist, the word I used most often to describe myself was “pathetic.” I no longer call myself that. Dr. B. helped me view parts of my past in a different light and helped me develop techniques and strategies to deal with the problems I was facing at the time. Now she keeps me on track, reminding me that I have the tools to cope with many of my recurring problems. And she reminds me how far I’ve come since my “pathetic” days.

Couples counseling. When we married, I was still smack in the middle of clinical depression. (My husband had problems too, but I don’t want to talk about them here, except to say that a codependent and a depressive living together can never decide where to go for lunch. And that was the least of our difficulties.) Several times since then, we have had to turn to counselors to work on problems related to sex, money, and just plain living and communicating together.

Group therapy. Actually, though I’ve attended group therapy a few times, what I’ve learned from it is that it’s not for me. I do appreciate the fact that it’s there if I should need or want it, and that my therapist can recommend a group if she or he is going to be away for a while. Perhaps I just haven’t found the right group yet, although the support communities I’ve found online may serve part of the same purpose.

In short, therapy has given me my life, my sanity, my coping skills, my emotional strength, and my creativity back. And I can definitely say that professional therapy has been worth more than 5 cents, or whatever insights my sister could have offered.

 

I know all about how it feels to have depression. For dozens of years, that was my diagnosis and my daily companion – unipolar depression.

In the last dozen years or so, however, I have had to come to grips with the idea that I am actually bipolar – bipolar type 2, specifically. And that I sometimes have hypomania.

It was quite a revelation.

I didn’t believe I had ever felt manic in my life. I couldn’t recall feeling anything but miserable, despondent, and worthless. Although objectively, I was doing well in school and in college, had a few friends, and was never suicidal, in fact I was a depressive mess. Later, as I learned more about mania, I was able to identify some manic – or at least hypomanic episodes that had occurred during that time, but that I had never noticed when they were happening.

When I was hypomanic, I thought I was just feeling what everyone else described as “normal” – happy, able to enjoy activities, functioning pretty well. They didn’t last long, but I didn’t realize how very tenuous and brittle those good feelings were – how they could be shattered by the slightest bump, plunging me back into the old familiar depression. It was even more depressing to think that I couldn’t even do feeling good right.

I struggled along under these circumstances for years, until at last one-half of my problem was diagnosed – the depression half, of course. It certainly was the most noticeable half, the most troubling, and the most disruptive of the problems that plagued me.

My doctor prescribed Prozac and I remember it working pretty well at first – at least when it kicked in after about six weeks of taking it. I can remember feelings of calm, contentment, and enjoyment. It changed my life, and probably saved it. Prozac didn’t alleviate all my problems, but it did let me glimpse a world in which they were not the only things that existed. It’s not too extreme to say that I rejoiced.

But, unknown to me (and my doctor), I was not purely unipolar at that time – or ever. What was happening to the lurking hypomania during while the depression was being treated? Did it disappear? Did the Prozac take care of it too?

No. With the depression more or less at bay, hypomania found new outlets to express itself – as anxiety, for example. I had a spell of being alarmed in the cereal aisles of grocery stores. There was a time (not yet completely gone) when I thought other drivers were swerving into my lane, even when I was a passenger. (That one alarmed my husband too, when I would fling out my arms and gasp or cower, shaking in my seat, at the thought that a crash was imminent.)

My psychiatrist later explained to me that these were manifestations of hypomania that came out sideways, as anxiety instead of euphoria, ambition, desire, exaltation, and assorted addictive or destructive behavior. Trust me to have the less-fun alternative. (Although somewhat less life-wrecking.)

Since that revelation, I have tried to harness my hypomania and use my power for good. I channel my hypomanic binges into writing, for example. I can’t say that it’s always good writing, but at least I get words on the screen that I can fix up later. I usually have several projects – paying and non-paying (like this blog) going at the same time, so I can switch among them as needed. That may be hypomania too.

Sometimes I can even use my hypomanic fits to enjoy myself – have a pleasant lunch out, read a book, do a puzzle, have a conversation with my husband or another friend. Of course, these activities do not always fit in well with my hypomania. At times, instead of simply enjoying these activities and sensations, I am too twitchy and nervous to relax and enjoy them.

I must admit that two of my strategies for controlling my hypomanic spells are naps and anti-anxiety pills, not necessarily in that order. But at least I am getting better at identifying when the anxiety, which I used to think of as free-floating, is actually a form of hypomania. Then a combination of hot tea, silence, cat-petting, reading, and Ativan can bring me back to some kind of stasis.

If not, I just have to accept that I’m having a hypomanic episode and try to stay away from things I can buy using my PayPal account.

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