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Posts tagged ‘depression’

Bipolar Disorder: Mood and Food

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FDA looks to ban trans fats. Exceptions made if consumed while depressed, anxious, or without anything better to do.

The Daily Show

If that were true, I could eat all the trans fats I wanted, because my bipolar 2 often leaves me depressed and/or anxious.

In fact, my friend Leslie, who is my partner in depression, invented the perfect snack for depressive times: a ruffled potato chip dipped in cream cheese with an M&M on top. My husband starts to worry about me when I ask him to get those ingredients at the store.

But there’s a reason for our peculiar snack. Leslie and I are simply self-medicating.

“Blood sugar and carbohydrate intake are very important to the brain,” according to Everyday Health. “Your brain runs on glucose and depends on carbohydrates to supply the energy it needs. Carbohydrate intake also prompts the production and release of important neurotransmitters, such as serotonin, which creates a feeling of calm and well-being and reduces depression. So people with bipolar disorder may be indulging in a form of self-medication when they eat sugary snacks during depressive lows or manic highs.”

Not that self-medication is good for us. Bipolar people are more likely to have type 2 diabetes than the rest of the population. Three times more likely. One of the risk factors for type 2 diabetes is excessive weight and we all know and bitch about the weight gain from our assorted meds. Prescribing ourselves the Ben & Jerry’s treatment is not going to help, even though it may feel like it at the time.

So what are we supposed to be eating to help stabilize our moods? Of course, people will recommend turmeric, cider vinegar, or the latest “superfood.”  But every serious list I saw looked like this:

  • complex carbohydrates, especially fruits, vegetables, and whole grains
  • protein in the form of lean meats, poultry, fish, and low-fat dairy
  • omega-fatty acids from fatty fish (such as salmon), walnuts, and flaxseeds

In other words, exactly the kind of diet that is recommended to everyone for general good health! I think this comes under the heading of self-care, which is not always easy to do. Especially when I’m so depressed I can’t even manage a microwave cup of mac-n-cheese, or when my husband brings home a rack of ribs that he bought on sale.

But if I am stable enough to shop and cook and eat properly, those recommended foods may be good for my mood disorder as well as my body. According to bipolar.newlifeoutlook.com, eating protein “promotes serotonin and improved moods.” They also note that researchers in Italy say “increased consumption of omega fatty acids helps reduce depressive episodes and decreases the risk for suicide in patients with bipolar.” So apparently fish is brain food after all.

The other common suggestion in this realm of self-care is to keep a food journal, or I guess in this case a food and mood journal, to keep track of what you’re eating and how it affects your moods. If you’re the journalling sort, by all means, give this a try. As for me, I blog rather than journal and I know you don’t want to see a lot of “ate salmon, felt energized; ate chips with cream cheese and M&Ms, felt sad.”

The fact that food and mood are related is just one more example of how the brain and the body are intertwined, interdependent. It gives us a clue about the kinds of self-care that may do the most to help us stabilize our moods. And it gives us a chance to take more control, if we can, of our mental as well as physical health.

The Fire and the Window

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When Anthony Bourdain died by suicide and I told someone the news, he asked me, “Why?”

I was taken aback. “What do you mean, ‘why’?” I replied.

“You know,” he said. “Did he have money trouble? Break up with his girlfriend? Have some disease?”

That’s a common reaction to suicide and it’s uninformed. Real-life stressors can contribute to suicide, but they are almost never the whole story. People die by suicide when the pain of living seems greater than the pain of dying.

Gregory House, the misanthropic, genius title character of House, M.D., once said, “Living in misery sucks marginally less than dying in it.” People who kill themselves don’t believe that. They believe the opposite.

The best metaphor I ever heard for suicide was the plight of people in the World Trade Center’s upper floors on 9/11. There were the flames. There was the window. And that was the choice. Suicide happens when a person sees only two alternatives and both are equally horrible, or nearly so.

The bullied child does not take her own life because she was bullied. She was in pain, for a variety of reasons that included bullying. It was a factor, but it wasn’t the reason. She was hurt. She was isolated. She was depressed. She couldn’t believe that things would improve. She wanted the pain to stop. She believed she faced the choice between the fire and the window.

The politician who dies by suicide in the face of a major scandal does not kill himself because of the potential scandal. He dies because he sees his choices limited to shame, humiliation, despair, and ridicule. He believes that what happens to him will be as bad as dying. He is caught between what he sees as the fire and the window.

Mental illness can make it difficult to see that there are other choices. The distortions of thinking associated with serious mental illness can make us see only the fire and the window.

The one time that suicidal ideation got the better of me and I was close to making the choice, my thinking was just that twisted. I was faced with a choice that seemed to me would ruin someone I loved. I thought that I could not live with either choice. One was the fire and the other the window.

My thinking, of course, was severely distorted by my mental disorder. The thing that I thought might rain destruction on the other person was much smaller than I believed. There were ways out of the dilemma other than dropping a dime or killing myself. If we continue the metaphor, the fire was not that big, or that implacable, or that inevitable, but I couldn’t see that. In the end, I hung on long enough for my thinking to clear and for me to see other options.

I don’t actually know what was going on in the minds of the souls who were trapped in the Twin Towers. I don’t mean to lessen the horror of their deaths or wound their families by speaking of suicide this way. The reality of their choice is so far distant from the choices that other people who consider suicide face.

But that’s kind of the point. People who die by suicide don’t see any other way out. If they seem to be responding to what most people see as survivable hurts or solvable problems, people say they can’t understand how someone that rich, that successful, that beloved, that full of potential could have not seen that help was only a reach away.

The person who dies by suicide doesn’t see the hand reaching out. Only the fire and the window.

 

If you are considering suicide, call the National Suicide Hotline: 1-800-273-8255.

The Appropriate Committee

 

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When I was a teenager, my life was spent resenting the Appropriate Committee. I always ran afoul of them.

It seemed there was some nebulous group, invisibly judging us and deciding whether what we did, or wore, or how we acted was appropriate or not.

Part of the Appropriate Committee was, of course, the adult world. Teenagers were supposed to be polite and respectful and not talk or play music too loudly. To do otherwise would be inappropriate.

The social milieu was also part of the Appropriate Committee. How we monitored one another to make sure our pants weren’t too short, or that we didn’t wear ankle socks, or that we didn’t stay in the Girl Scouts past Brownies. The punishment was derision.

Of course being bipolar didn’t help. Both adult and junior versions of the Appropriate Committee took note of my mood swings – my loud, inappropriate laughter; my extreme, inappropriate crying; my extended, inappropriate isolation.

I tried to defy the Appropriate Committee. I laughed at them, thought they were stupid, and vowed not to let them run my life. They did anyway, of course. They were all-powerful and I had not yet gained the wherewithal not to care. It was like a pervasive, invasive form of bullying: Everything I did or said was wrong. The rules changed capriciously. I was punished with disapproval, mocking, and the wrong kind of laughter.

And they broke me. At times I tried desperately to fit in, to live up to expectations, to suppress my differences. At other times, when the effort became simply too much, I let my natural weirdness float to the surface and looked for the few other like-minded individuals that could tolerate that. Depression set in and, rarely, hypomania. I still dressed “wrong.” I still laughed at the wrong things, and too loudly. I still isolated and wept.

I thought that when I grew to adulthood, I would no longer be subject to the censure of the Appropriate Committee, Of course, that was completely delusional. I learned that the Appropriate Committee for Adults was a powerful force. It is particularly insidious in the business world, where it judges not just your appearance, but even seemingly minor matters such as where and how you eat lunch (with the “cool kids,” of course) and how you spend your breaks (cigarettes OK, crossword puzzles not). There’s still the problem of being laughed at in meetings and needing to go into the restroom to cry.

I finally realized that the Appropriate Committee exists in part to perpetuate stigma. So many of the behaviors of people with mental illness defy societal norms. It’s the Committee that insists we fit in, no matter what we’re feeling. It’s the reason that neurodivergent people are so reluctant to admit their differences in public and try their best to “play through the pain,” something that isn’t good for them, or for athletes either, really.

I’ve had enough of the Appropriate Committee over the years. Now that I’m properly diagnosed and medicated and relatively stable, I could undoubtedly fit in better than at any time previously in my life. But I dress how I like, even if it’s pajamas. I play my music as loud as I want and laugh or cry along with it if I feel like it. I embrace my weirdness, my differences, and seek out like-minded weird friends who are also living in defiance of the Committee.

Maybe the Appropriate Committee is needed for some places and times and people, like theater audiences or church services. Maybe. But for the mentally ill the Committee is hurtful, and stigmatizing, and unrealistic. We can strive to overcome our differences and sometimes we need to. But sometimes it’s better just to embrace weirdness, differentness, and our membership in the group of the neurodivergent.

And when I despair, I remind myself of songwriter Steve Goodman’s lyric: “I may not be normal, but nobody is.” And I let it blast.

The Golden Glow and the Spoons

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Hypomania is as insidious as it is enjoyable.

I remember when I quit my 9–5 office job to go freelance. I remember when I made the decision. I had gotten my first bad review, ever, shortly after disclosing my bipolar disorder to my new boss.

I remember driving around shortly thereafter, running errands in the middle of the day. I felt the warm, golden glow that goes with either happiness or hypomania. I could wake when I pleased and work when I pleased. I could run those errands when I wanted. I could take my mother to her doctor’s appointments whenever I needed to. I could make and go to my own appointments as necessary.

Best of all, I felt as though I had enough spoons to do all this. I was able to keep up with the work and the errands and the appointments and, hey, if I got tired I could take a nap in the middle of the day.

But.

Eventually the glow wore off and the spoons ran out. Hypomania dumped me back into the depression I was oh-so-familiar with. I had more work to do and less energy to do it. My mother’s problems increased and I had to take over her finances as well as my own. I was teetering on the edge of a major depression, and then I fell off that cliff.

Anymore I don’t trust hypomania. First of all, I can’t distinguish it from actual happiness, competence, or satisfaction. I always question its sincerity and watch out of the corner of my eye for the coming crash. In other words, when I’m happy I can’t even enjoy happiness without reservation.

One way I keep track of my hypomania is by being aware of the number of spoons I have. If I’m flying on a hypomanic cloud, I feel replete with spoons. It never occurs to me that I will run out. When I’m experiencing garden-variety happiness, I still suffer at some point from lack of spoons. No matter how many pleasing things are scheduled for the day, I know deep inside that I cannot simply dive into all that bounty. My joy is measured out, as the poet said, in coffee spoons or in this case metaphoric spoons which I always visualize as small white plastic ones.

Stability for me does not mean that I can ignore my supply of spoons, either. I may be on an even keel, able to do most of what I want, but inevitably the spoon depletion hits, sooner or later. There is simply no more that I can do, much as I want to. And if I force myself past that point, I will surely pay for it in exhaustion, irritability, or isolation.

Spoons, therefore, run my life. If I am too happy, I have to watch for incipient spoon depletion.  If I am level, I know that I must still keep track of the spoons I use. And if I am low, my spoons can disappear altogether, to the familiar point of not being able to get out of bed.

I think the trap of hypomania is the worst of all. On a high like that I can lose track of my spoons – even forget that they are necessary. Fortunately, I don’t get the full-blown version of mania. I fear I would squander spoons recklessly, leaving me a terrible absence of any.

Spoons are a useful way to explain the energy demands of chronic and/or mental illnesses. My husband and I speak spoonie shorthand. But I wish I could experience that golden glow, that haze of happiness, that feeling of floating, without having to keep one eye on the spoon-meter.

 

Bipolar Sex: Drought and Abundance

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Here’s something bipolar people talk about amongst themselves but not so much with the world outside: sex.

The two poles of bipolar, depression and mania, govern a person’s appetite for sex. A lot of other factors determine whether the sex will be any good, or good for the participants.

Of course the above is true for neurotypical people as well. Moods and emotions – things in the brain – have as much or more to do with sex than stuff in the body. Thinking about sex and wanting sex, for example, start in the brain and without them, nothing else is likely to happen anywhere else.

The depression side of bipolar sex is easy enough to map out. After all, some of the hallmarks of depression are numbness, inability to enjoy things that once gave pleasure, and a tendency to isolate. It’s hard to get your motor revving with all that going on.

Still, the depressed person may want to have sex, or at least want to want to. That’s the way it’s been with me. When I’m in a thoroughly depressed state, sex doesn’t even cross my mind. When I’m not quite as depressed, I think I might like to have sex but don’t have the energy for it. And when I’m relatively stable, there’s the meds.

It’s well known that medications for bipolar disorder can kill the sex drive and in men the ability to get or maintain an erection. Some drugs supposedly have less effect on sexuality, but I’ve never found the magic combination. Or the supposed sex-friendly drug has had side effects I can’t tolerate.

So if bipolar depression is largely a big zero for bipolar sex, how about mania?

Overactive sex drive combined with a lack of impulse control can lead to sexual excess. The tendency to minimize risk-taking behaviors means that some of that sex can be detrimental to one’s health, relationships, and self-esteem. Riding that wave is exhilarating, but then, inevitably, comes the crash and the need to pick up the pieces.

Full disclosure here: Since I have bipolar 2 and my hypomania tends to turn sideways and come out as anxiety, I don’t experience that manic sex high. On the whole, I think I am grateful for this. Sex has never been such an important part of my life that I would risk everything for it.

Once, though, I did experience what you might call a hypomanic sex drive. It smoldered for a long time, requited but unconsummated, until the right set of circumstances presented themselves. It was a restlessness, an obsessive thought, a longing for connection, rather than an ungovernable rush of need. It gave me, perhaps, a glimpse of what it might be like to be manic and sexually stimulated. But I’ll never really know.

I do know that I am glad I had the experience, whatever it was. I’m glad it was safe sex.  I’m glad it didn’t destroy relationships. But just to feel that desire again, even if only for a brief time, even with the anxiety it provoked – and there was lots – it was a kind of affirmation that my body and brain are still connected in some vital way.

Most of the time I limp along with only thoughts of sex too fleeting to act upon. And maybe this is not the best way to live, but I have made my peace with it. And once in a great while, every now and then, I still am reminded that I can have a sexual existence.

Even though I have bipolar.

Of course, as always, your mileage may vary.

The Disability Tapdance

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Once I applied for disability for my bipolar disorder and I was turned down Then I took the process as far as I could with a lawyer and he eventually advised me to give it up too. Here’s my story.

I had gotten to the end of my proverbial rope and we had gotten to the end of our money. For over a year I had been sidelined by unremitting depression. There was nothing I could do and nothing my psychiatrist prescribed or my therapist said had helped. We had been living on my husband’s salary and what was in my 401K from when I had last been able to work.

At last my husband pointed out that we couldn’t hold out much longer. He encouraged me to apply for disability. I knew that there would be lots of hoops to jump through and that there was no guarantee of succeeding. But Dan was willing to go with me to the Federal Building and help me get through it. I certainly wasn’t capable of managing it on my own.

Between the two of us, we had looked up what sorts of documents I would need and had acquired them. I was glad we were able to do this because going back again and again for missing documents would have been a horror. I had my appointment with the intake person and went back home to wait.

There were more forms to come. My psychiatrist had to fill out a long one, of course, or write a letter, I don’t remember which. I had to pay him for his time and trouble in doing that but at that point it was just another step that needed taking.

The big step was the psychological interview where I had to perform my little song and dance and convince someone that I was truly disabled. Fortunately, the appointment was not downtown in the Federal Building but in a relatively nearby office building that I knew how to find. Then the hoop-jumping and tap dancing really began.

They tested my memory. They told convoluted stories and asked me questions about them such as the order in which things happened and why the characters did what they did. They were confusing.

They tested my spatial perception. They had me put together those cubes with triangles on them to match patterns they showed me. I still don’t know what that had to do with bipolar disorder.

Then came factual knowledge. I was good at that one. I admit I guessed when they asked me how big around the equator was. I knew the easy stuff like who wrote Tom Sawyer and such.

By the time they got to the word association test, I was very tired. First they gave a pair of words and asked what they had in common, easy ones like truck and train. Later they gave difficult pairs of words that seemed to have nothing in common, like acceptance and denial, but I was supposed to come up with a commonality anyway.

Finally, an interview. I remember the woman asking me if I knew what the saying, “What goes around, comes around” meant. I replied, “As you sow, so shall you reap” and she looked at me funny.

A seemingly endless time later my claim was denied and I got a lawyer to pursue it. By that time so much time had passed that I was coming out of the depression and was able to work a few hours a week. How much did I get paid per hour? he asked. “Thirty dollars,” I said, explaining that I could only work a very limited number of hours. It didn’t matter. As soon as I said thirty dollars the judge’s head would explode, evidently. Lawyer Joe recommended I drop the claim and I did. At least I was getting some work and some income even without disability.

It seemed that for me to get disability I would have had to be together enough not to need it, but sufficiently disabled that I would. Catch-22, as Joseph Heller said.

 

 

Inspiration and Mental Illness

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I was manicky this week and it affected my blog writing. I had a post all ready to go this morning, but last night I thought about it and realized it was crap. It meandered, without focus. The ideas were confused. It sucked. So I got up this morning to write something different instead.

Many of you may recognize this aspect of mania or hypomania. You do something that you think is fantastic  while in the grip of mania and when you come down, you can’t see what you ever saw in it. Or you begin an ambitious project that you work on and work on but never can complete.

I was toying with the idea of “inspiration porn” – the sort of post or story or TV show that holds someone up as an ideal, usually because they’ve lost a bunch of weight and gotten themselves into shape, or have an illness or disability and managed to do – whatever – again. Think “The Biggest Loser.” Or amputees who’ve learned to eat with their feet. It’s put out there for entertainment and to make everyone feel good that whoever it is conquered whatever it was. It takes a regular person out of the context of their lives and reduces them to their condition. And the subtext is that if this brave person can become able to do or be whatever again, so can everyone else with the same problem.

It happened to a friend of mine who was at a gym on a treadmill. A woman came up to her and said how inspiring it was to see her working so hard to lose all that weight. “Excuse me?” was my friend’s reaction. She was doing it for herself, not for anyone else, and especially not to inspire some random stranger.

The thing is, there really isn’t any mental health inspiration porn. For one thing, it would make lousy TV. Oh, they’d get advertisers – all those purveyors of psychotropics that clog the airwaves. But who would watch a depressed person finally getting out of bed and taking a shower, unless she had a coach yelling at her?

Inspiration for those of us with mental health problems takes other forms. Celebrities who speak about their struggles with mental illness are one. They are inspiring because they break the taboo about talking about mental illness in public and because they have done so to help other people.

Then there are the superstars of mental health inspiration. Carrie Fisher, Glenn Close, and Jenny Lawson, to name a few. These are people who focus light on the difficulties and struggles of mental illness. Their communications don’t stop with the announcement that they have a condition and encouraging people to get treatment, though those are also good things. But the real inspirations are those who open their lives, take others with them through the journey of symptoms, treatments, relapses, small triumphs, and bigger successes. They speak and keep speaking and keep speaking their message. They don’t make the process sound easy, because it isn’t. And they speak with authenticity and authority because we know they’ve been there.

They do inspire us because they are honest and open, and they clearly care about helping others in the same proverbial boat.

We lost a true inspiration when we lost Mama Carrie. No one will ever really take her place. But you can tell that she was an inspiration by the many people whose life she touched and how they remember her. If someday they make a movie of her life, I hope it features not only her personal struggles, but all that she did for others. Her speaking and continuing to speak despite – or because – of her ongoing struggles.

We can carry on her work by doing the same, by shedding the stigma, by talking to others, even family and friends. Recently a friend “came out” to me that she takes an antidepressant and an anti-anxiety med (the same ones I take). I was proud of her, but I didn’t make a big deal of it. But I was impressed and pleased that she was able and willing to share even that much. She was saying that she was part of our tribe.

As Jenny Lawson reminds us, in this we are alone together. And that’s inspiring. 

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