My Experience Only. YMMV.

Bipolar Travel Tips

photo by Dan Reily

Last week I blogged about “Running Away From Home” (aka the geographical cure) https://wp.me/p4e9Hv-F9. This week I want to talk about actual travel – for business or pleasure. Travel was one of my greatest joys and one of the things I’ve missed most since bipolar stole so many parts of my life. I am delighted to be able to say that I am beginning to reclaim it.

I know that many people aren’t able to travel at all because of their bipolar disorder, but for those who can, here are some tips to make it easier.

The basic thing to remember while traveling is this: self-care. You may find it hard to do while on the road, but it is essential to keeping yourself functional. Just give yourself permission to do the things you have to do. And find ways to avoid the things that trigger you.

Business Travel

Business travel is the most difficult, and something I’m no longer able to do at all. Oh, I can drive an hour for a half-day training session, but I want to be back in my own house and bed when it’s over with. But the kind I used to do – four to seven days, with coworkers (sometimes in shared hotel rooms), and especially with booth duty – are simply beyond me. There’s no time or space for self-care.

If you must travel on business, however, I recommend bringing along a comfort object (https://wp.me/p4e9wS-k9) such as a small plush animal, a favorite pillow, or toiletries that have a soothing scent like lavender. Fuzzy slippers may have to do as a comfort object if you have to share a room. It’s also a good idea to bring along portable snacks such as nuts or raisins in your purse or briefcase, as regular meal schedules are often thrown off by meetings and other events.

“Me” time is hard to arrange, but do try. One trick that works for me is to find an unused function space and sit there with a pad of notepaper. Zone out. Then if anyone comes looking for you, claim you were just consolidating your notes.

Visiting Relatives

Avoiding arguments is one of the particular challenges of visiting relatives – particularly in-laws.

On one of the first visits I made to my in-laws’ house, I noticed that they shouted a lot. When that happened, I would go into the kitchen and make myself a cup of tea. That’s a strategy I have often used. It’s also a grounding method I can use when things are spinning out of control. When everything around me is chaos, the simple, familiar, soothing action of heating a pan of soup or a teakettle can bring me closer to stability. Whether I really want soup or tea is not the question.

My husband noticed that I kept skipping out to the kitchen and asked why I kept making tea. “Because you’re all shouting at each other,” I replied.

“No, we’re not,” he said.

“Listen to yourselves.”

Just then an argument broke out over where to go to get some sandwiches. “You take the 422 to Souderton, then turn…” “Nah, you follow Cowpath Road then cut over to the 309. That’s shorter.” “But there’s more stoplights!” With each comment, the volume grew. Dan and I went out and got the sandwiches and when we got back, the family members were still arguing about the best way to go. Dan had to admit that I had a point. He just couldn’t hear it until I shifted his perspective.

Another technique you may find helpful when hit with nosy questions from relatives is the “Boring Baroque Response,” described here – https://wp.me/p4e9wS-cY.

Leisure Travel

My friend Robbin says that when you travel, the only things you really need to have in your carry-on are your meds and some clean underwear. Anything else you can buy when you get there if your luggage doesn’t manage to arrive when you do. It’s also good to talk to your pharmacist beforehand and make sure you have enough meds for the scheduled length of the trip. (Do not do what I did and take your entire supply of meds and then leave them at the bed-and-breakfast.)

Once I went to DisneyWorld https://wp.me/p4e9Hv-2K. (Okay, twice, but the first time was epic.) Surviving it was an exercise in self-care. The things I learned there are applicable to almost any travel situation.

It helps if you go with a person or people who understand your disorder and your needs. When you’ve exhausted yourself, it’s good to have someone who can think of options – “Of course, we can go back to the hotel now, if you want, or we could sit in this café and have a cold beverage while you rest your feet for a while.”

The point is, you don’t have to go on what a friend calls the Bataan Fun March – you don’t have to ride every ride, see every scenic overlook, visit every church or castle. Give yourself permission to take a nap or read a book or lounge around the pool, if that’s what you need to do. (If you’re on a guided tour and want to skip an event, let the tour guide know, so the head count doesn’t come out wrong after an event or stop.)

Finances tend to prevent the kind of leisure travel I used to do, but at least now if I can ever afford it, I can also survive it.

 

Running Away From Home

photo by Karen Cox

When I was a teenager, I lived in Ohio, and all I wanted to do was leave. The suburb I lived in was homogenous and boring. The surrounding area had little to interest me. I was miserable. When it came time to select a college, the first thing I ruled out was anything in the state of Ohio.

It did not occur to me then that the reason I was miserable was not the state of Ohio, but bipolar disorder. And of course I took that with me to college.

When I returned to Ohio and began living in a suburb very near the one I grew up in, my friends were astonished. “I thought you hated Ohio,” they said. “I never expected you’d come back here to live.”

What I had been seeking was a “geographical cure” for a problem I didn’t know I had. I thought could outdistance it, outrun it, make a new life for myself somewhere better.

Believe me, it’s not possible; unless you are trying to leave an abusive relationship, moving somewhere else will do nothing for your underlying problem. Probably not even then.

The next time I had a chance to take the geographical cure – to move to Pennsylvania – I turned it down. I had by that time built up a support system in Ohio of family, friends, and doctors, and I couldn’t bear the thought of leaving them and trying to build a new support system in an unfamiliar place. (Eventually, my husband-to-be moved from Pennsylvania to Ohio, where we’ve lived ever since.)

But there are still times when I think about running away from this life. Often, I wish the Mothership would arrive and take me away to some interesting planet or galaxy.

But sometimes, when life just seems to be too much for me, I think of simplifying my life by starting over somewhere. It would be like being in the Witness Protection Plan, I always imagine. I’d live in a small, unimposing town somewhere. I would have a bookstore (maybe used books). I would live in a small apartment over the shop with one or two cats.

But alas, that wouldn’t work. Aside from the difficulties of moving, which I loathe, I would find myself in another place where I had no support system – no doctor to prescribe meds, no therapist to continue my progress with (I hate breaking in new doctors), no family or friends or husband. (I usually picture myself on my own, except for the cats.)

And life would be just as difficult, if on a smaller scale. I would still have days when I couldn’t get out of bed and open the store; weeks when I couldn’t bring myself to shower, driving away customers; times when the loneliness would become overwhelming. I would still have trouble with finances, health, isolation, shopping, business, et endless cetera. At least I would have a lot of books to read.

I would still have bipolar disorder. I might be able to replace some of what I would have to give up; it wouldn’t be easy or freeing. But sometimes I still like to imagine that it would be.

If my husband dies before I do, I may find myself in some form of such a solitary life and have to adjust to it, though I would most likely remain in my comfortable suburb, where I know a few people and have some great friends, and a psychiatrist and a therapist. I doubt I would again attempt a geographical cure unless forced by circumstances to relocate.

But I wouldn’t enjoy it, just as I wouldn’t really if I ran away from home now. The bipolar would just come with me, hopping into my suitcase before I even packed my underwear.

On Pain and/or Suffering

Recently, when I was reading Every Patient Tells a Story: Medical Mysteries and the Art of Diagnosis by Lisa Sanders, I came across this:

Eric Cassell, a physician who writes frequently about the moral dimensions of medicine, argues, in a now classic paper, that pain and suffering are very different. Pain, according to Cassell, is an affliction of the body. Suffering is an affliction of the self. Suffering, writes Cassell, is a specific state of distress that occurs when the intactness or integrity of the person is threatened or disrupted.

Later, when I was reading M Is for Malice, by Sue Grafton, I read this: “Pain was better than anxiety any day of the week and sweat was better than depression.”

The universe seemed to be telling me to focus my attention on pain and/or suffering.

Cassell (as quoted by Sanders), could have been (but probably wasn’t) talking about bipolar disorder when he defined suffering as “a specific state of distress that occurs when the intactness or integrity of the person is threatened or disrupted.” I certainly don’t feel intact or integrated while in the midst of a bipolar episode – either hypomanic or depressive. I suffer. My personhood is certainly threatened and disrupted.

It’s common to hear bipolar described this way: “I suffer from bipolar disorder.” I prefer to say “I live with bipolar disorder,” which I feel is more accurate. It’s always there, but I’m not always suffering. I live with it and it lives with me.

I think Cassell was wrong, though, about pain being a purely bodily sensation. I addressed the concept back in the early days of this blog. with a post called “Depression Hurts” (https://wp.me/p4e9Hv-6Z). In it I claimed that bipolar (or depression specifically) caused physical pain as well as emotional pain. I still maintain that one is as valid as the other and that they are virtually inseparable. The mind and the body not being entirely separate, or separable, you see. You get both for the price of one.

Grafton, on the other hand, through her character Kinsey Millhone, was talking about the physical act of running. We all know by now (or should) that exercise is recommended for those who have bipolar disorder or other mental/emotional conditions. But again, there is this idea that physical discomforts (pain and sweat) are better than emotional distress (anxiety and depression). She seems to be saying that pain is the antidote for suffering.

This can be dangerous territory. As someone who used to self-harm, I can easily see how one might think that pain is preferable to anxiety, or numbness, or dissociation – to suffering, that is. But in such cases, pain is really just another aspect of suffering, expressed in bodily terms. Again, the two are inextricably intertwined.

Personally, I would be delighted to avoid all four sensations – pain, anxiety, sweat, and depression. But I don’t think that’s possible, even with avoiding both exercise and self-harm. Sweat is the easiest to dispense with, thanks to modern toiletries, but there have been plenty of times when my anxiety has caused me to sweat. Think about being summoned to a tax audit, for instance, and you’ll see what I mean. Pain is unavoidable; no one goes through life without stepping on a nail or some such. Anxiety and depression occur at least occasionally in the neurotypical as well as the mentally disordered.

The human condition itself involves feeling both pain and suffering. Bipolar disorder involves both pain and suffering. Well, what do you know? We’re only human, after all.

As I’ve mentioned before (even on my other blog https://wp.me/p4e9wS-zY), I’m running low on money and clients in my freelancing business. Therefore, I’ve taken up searching job ads online for part-time, work-from-home gigs. (So far, Indeed is the only service that has presented me with reasonable options. I sometimes apply for as many as three a day.)

It’s filling out the applications that has me stumped. Oh, I’ve got a fine resume – one on Indeed and another file I can send to jobs not listed with Indeed. I can write a decent cover letter. If there are editing or writing tests, I can handle them too. I have way more education and experience than I need, but I explain in the cover letter that part-time, contract, or freelance work is what I really want at this time in my life.

Then come the other questions that many ask.

Am I a veteran? No.

Am I a U.S. citizen or do I have the necessary documents to work in the U.S.? Yes.

Is English my first language? Yes.

Am I male or female? Yes.

What race do I identify with? Yes.

(Those aren’t really yes/no questions and are usually marked as optional, but I answer them anyway.)

Then comes the real stumper. Am I disabled? Well, that depends.

Most of the application forms state that they abide by EEOC regulations. Some of them even have a handy list of what are considered disabling conditions – and bipolar is one.

So. Do I take them at their word and believe that they do abide by EEOC regulations, in which case I can reveal my bipolar condition without penalty. In fact, if the company is trying to prove to someone that they are abiding by those regulations, the answer is probably yes, I should.

But we all know that such questions, while well-meaning on the surface, may actually be used to screen out disabled candidates. So perhaps I should answer no.

The deal with the regulations is that employers must offer “reasonable accommodations” to let disabled employees do their jobs, unless the accommodations for that condition are not feasible because of expense or other reasons.

So, as a person with bipolar disorder, what actual accommodations would I need?

The main ones I would need are the ability to work remotely, from home, and to have flex time. Those cost an employer nothing, usually.

And those are precisely the kinds of jobs I am applying for – work-remotely jobs in which you can make your own hours, or at least partially.

So when it comes to “The Question,” I have been answering “yes.” For the purposes of work, I am at least partially disabled by my bipolar condition. I cannot work full time. I have trouble working in a bustling office with lots of people around. I need flex-time to work around my symptoms. (I can still meet deadlines, though.)

Funny, but the forms don’t have spaces or yes/no questions on those subjects.

I have considered the idea that I am doing this all wrong. That I should not disclose my bipolar disorder until I have the job (and for those who don’t ask the question, that’s what I’ll have to do). That after I have the job is when I should discuss accommodations.

But dammit, all evidence to the contrary, I am a cock-eyed optimist. Those EEOC rules are there for a reason and I am that reason. I know that when most employers think “disability,” they think “wheelchair” or “impaired hearing.” But there it is, listed right among the possible disabling conditions – bipolar.

So far I’ve gotten a few form rejection letters and mostly a resounding silence. And in the meantime I’ve been scrambling for other clients and other assignments.

But I hope the day will come when just one of my potential employers means what it says about disabilities.

Photo by Athena, Creative Commons

Last week I dissed a story that I read online about self-care for bipolar disorder, which consisted of praise for sleep, pets, and creativity, things which anyone with bipolar already knows are good for their mental health.

It was pointed out to me by someone who should know that I was wrong to make fun of the researchers, since they were students learning valuable lessons about how to conduct research studies in the first place. Which led me to believe that it was all the reporter’s fault for presenting their results as news.

Anyway, as an apology to researchers and grad students everywhere, I’m now going to praise a research study that would otherwise get a “well, duh” from me.

Huffington Post (UK) shared the good news:

Knitting could save the NHS [National Health Service] vital funds because it leads to a healthier population, reducing depression and anxiety, slowing the onset of dementia and distracting from chronic pain, a new report has found.

The study was primarily focused on the benefits of knitting for the aging, but since depression and anxiety were two of the conditions that it reportedly relieves, I thought it might be relevant to bipolar disorder too. Now someone can do a study to confirm or deny this idea.

The report added that knitting “is a sociable activity that helps overcome isolation and loneliness, too often a feature of old age,” and, I might note, of mental illness.

There are many, many articles that extol the benefits of creative pursuits for those with bipolar disorder and other mental illnesses. Although the notion of “basket-weaving” is outmoded and stigmatizing, other creative activities are commonly suggested as part of self-care. (I discussed this in a post called “Tools for Tackling Bipolar Disorder.”)

Coloring seems to be the most popular recent trend, but drawing, painting, collages, and all sorts of needlework are well thought of too. (I would certainly put crocheting in the same category as knitting.)

But then there’s the other side of bipolar – mania. I don’t know a lot about creativity and mania because I only get hypomania. But I do know that when I’m hypomanic I can get a lot of writing done. (Whether it’s good writing is another question.)

However, if you’ll forgive anecdotal evidence, I once knew a woman who did experience full-blown mania as part of her disorder and was not well controlled on medication. One year at Christmas she decided to make green velvet dresses for all three of her daughters.

As she spoke of her progress over the ensuing weeks, however, it was clear that the project was not going well. She kept rethinking – and redoing – all the sewing. She didn’t like the design, or she didn’t think they’d fit right, or she saw some other flaw. She never finished the dresses.

Other people may have better experiences with mania and creativity, of course. I hope you’ll share with me if you have.

The idea of creativity as a way to be sociable intrigues me. Sewing circles are a time-honored tradition among neurotypical people as well as those with mental disorders. (A friend of mine and her cronies had what they called the “Stitch and Bitch Club.”) Needlepoint, quilting, and indeed all of the fabric arts can be group activities.

For those who aren’t into those kinds of needle-centric activities, there are classes in scrapbooking, drawing, painting, ceramics, sculpture, or other creative art forms, often available through local adult education programs, museums, or shops that sell arts and crafts supplies. And of course, writers’ groups abound at bookstores and other venues (though presenting one’s own work at such a gathering may be too daunting for some with self-esteem issues).

I should probably get involved with a writer’s group myself. I’ve had to give up needlework because of my eyesight and shaking hands. But I’m all for doing something for my brain. Lord knows, it needs all the help it can get.

 

References:

http://www.huffingtonpost.co.uk/entry/knitting-linked-to-health-benefits-including-reducing-depression-and-slowing-dementia-report-reveals_uk_5aa63cb0e4b07047bec7feee?ncid=tweetlnkukhpmg00000001

knitforpeace.org.uk

“Tools for Tackling Bipolar Disorder” https://wp.me/p4e9Hv-uT

 

New research from Western Sydney University has revealed that simple self-care strategies, such as spending time with animals and getting enough sleep, are helpful for people managing bipolar disorder symptoms. (https://medicalxpress.com/news/2018-02-pets-people-bipolar-disorder.html)

Sleep, pets, and photography – everything in one bundle

This is not exactly news, but the headline (“Sleep and time with pets help people living with bipolar disorder”) reflected my life so perfectly that I had to read on.

It turns out that the research involved only 80 subjects and was conducted by Edward Wynter, an honors student, who says he hopes “that knowledge of effective strategies can inspire proactive therapeutic engagement and empower people living with bipolar disorder to improve their health and wellbeing.”

And here’s the money quote:

This research reveals support for strategies already well known to professionals and people living with bipolar disorder, including those relating to quality and quantity of sleep, and drug and alcohol abstinence; but this study also highlights the effectiveness of several strategies yet to be explored such as spending time with pets and engaging in creative pursuits. (emphasis added)

Here’s some news, Mr. Wynter: Spending time with pets and engaging in creative pursuits are not “yet to be explored,” except perhaps by researchers. As he himself notes, professionals and people with bipolar disorder already know these concepts. I wonder what sort of grade this research gained him?

I’ve written about pets and creative pursuits myself. Service dogs for the mentally ill, for example (https://wp.me/p4e9Hv-nN):

Emotional Support Animals are dogs or cats (or, less commonly, other animals such as miniature horses or guinea pigs) that live with and provide comfort to a person with a psychiatric disorder, [t]ypically … one that qualifies as a disability under the Americans with Disabilities Act (ADA).

And even everyday pets can help (https://wp.me/p4e9Hv-jS). As I said of my very first cat: “We needed each other. I needed someone to care about, to focus my attention outward on. She needed someone to draw her out of her shell, to care for and about her.”

And regarding creativity (https://wp.me/p4e9Hv-uT):

Coloring books and pages for adults have been the trend for a while now. (Some of them are really for adults.) Jenny Lawson draws and also puts together tiny little Ferris wheels. I know someone who can make little sculptures out of drink stirrers or paper clips. The point is … [j]ust keeping your brain and your hands occupied is a good idea.

As for sleep, we all know that proper rest is a good thing, even if we’re not always able to achieve it. And I’ve written about that too (https://wp.me/p4e9Hv-vk):

Whether you sleep too much or not enough, bipolar disorder may be the cause. There are treatments, some involving meds, and others not. Meditation, for example, helps many people sleep … It’s a thing to discuss with your psychiatrist and/or your psychotherapist.

If I, a non-professional, already know about these aspects of treatment for bipolar that don’t involve therapy or medication (though I’m not knocking either one), why is research covering this old ground? Surely even lowly grad students can think of better, more productive topics than this.

 

Just as a general rule, I dislike commercials for any drugs. They impede the doctor/patient relationship. (I’ve often considered saying to my doctor, “I’m supposed to ask you if Latuda, Humira, Prolia, Viberzi, Lunesta, Cialis, Trulia, Trintellix, Keytruda, and Boniva are right for me.”) TV – and to a lesser extent print – ads encourage people to act as unpaid drug reps. And they only advertise expensive drugs until they go generic, which is when they stop being expensive and the drug companies stop making so much money.

(If you want to read more on the issue, go to https://www.medicinenet.com/script/main/art.asp?articlekey=106198.)

But there are other things about TV drug ads that make me more than a little cranky. Like where are the ads for drugs to treat bipolar disorder?

Oh, there are ads for drugs to treat bipolar depression, as well as ones for treating non-bipolar depression. You’d think that with approximately 2.8 million people who have bipolar in the U.S. and Canada (http://www.pendulum.org/bpfacts.html), there would be a market for bipolar treatments.

Also, the ads for depression treatments don’t always get it right. A few of them say that depression is more than just sadness, or that it lasts for several weeks at least. One even says that depression is a “tangle” of symptoms, which is certainly true. (Although the tangle is shown graphically in primary red, yellow, and blue, which don’t really say “depression” to me.)

Most, however, treat depression simplistically, with hidden depression represented by a smiley face mask hiding a frowny face mask. (The colors in that ad are muted during the “before” scenes and more vibrant during the “after” scenes, which is an old advertising trick.)

The ads also make it look like the most important thing about depression is not spending time with your family or not enjoying it if you do. While that certainly is one symptom of depression, it is by-and-large irrelevant to people like me, who don’t have 2.1 school-age children to take on picnics. And it’s pretty much a guilt trip for people who do.

Then there’s how the people in the ads are represented. Oh, they almost always show one POC and one slightly older person (frolicking with the grandkids). But all of them are attractive. All of them are models. Are we supposed to identify with them? Or just expect to look like them when our depression lifts?

I wouldn’t be so annoyed by this issue if it weren’t that ads for other kinds of drugs – those for psoriasis and diabetes, for example – have actual people with the disorder in them. Testimonials from those who’ve been there, as it were. Even real-life cancer patients are now featured in ads for treatment centers.

What’s up with that, I wonder? Surely they don’t imagine that only pretty people get depression or bipolar. It can’t be that they can’t find any well-spoken, real-life people who can relate their own experiences. I for one would feel more reassured if I heard about a treatment from someone who’s lived with the disorder instead of from someone selected at a casting call. Are we all homely and illiterate? (I meet the qualification for literacy, at any rate.)

Instead of trying to convince us what medications our doctors might prescribe us, the airtime would be better spent on ads that educated the public on depression and bipolar disorder. But those would be PSAs, of course, appear only at 3:00 a.m., and not make anyone any money.

Update: I have finally seen an ad for a drug to treat bipolar 1 mania. Everything else I wrote here remains the same.

 

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