My Experience Only. YMMV.

Posts tagged ‘mental illness’

Does Emotional Abuse Cause Bipolar Disorder?

I belong to a fair number of bipolar support groups on Facebook and I often read posts or comments from people who attribute the cause or the severity of their bipolar disorder and/or PTSD to emotional abuse, particularly in childhood and particularly from family members.

I can’t really comment on PTSD since I don’t have it (though one therapist mistakenly diagnosed me with it), but I do have some experience with emotional abuse.

First, let me say that what I experienced was never physical abuse, unless you count deserved childhood spankings, which I know some people do. No sexual abuse, either – no “funny uncles” or neighborhood predators. (There was one older man that all the kids warned one another to stay away from, but I did, so I don’t know if the rumors were true.)

My childhood was pretty idyllic, if you get right down to it. My parents never divorced. We lived in a neat suburb of starter homes with excellent schools, where I got good grades and praise. We frequently visited our extended family in the next state, with plenty of aunts and uncles and cousins, farms and chickens and horses, along with occasional trips to local state and national parks. We went to the nearest local church, which did not emphasize hellfire and brimstone. If there was any mental illness in my family, I never knew about it.

And yet, sometime during that childhood, bipolar disorder began to manifest.

My life, of course, was not perfect. I was smart and loved school, and was very different from my parents, who weren’t big readers and didn’t know what to do with me, especially in the area of developing social skills and guiding my education. I fought with my sister, but not any more than other siblings I knew.

But then there was the bullying at school – the first emotional abuse I can remember. I’ve written about that before. At one point I noted:

There was the boy who chased me around the playground, threatening me with what he claimed was a hypodermic needle.

There were the kids at the bus stop who threw rocks at me while I tried to pretend it was a game of dodge-rock. Never being good at sports, I came out of that episode with three stitches in my forehead. I don’t know which upset me more, but by the end of it all, I was hysterical. And not the good, funny kind.

And there was my best friend and the birthday party. The party was for her younger sister and all the attendees were about that same age. My BFF and I were supposed to be supervising, I guess. But while I was blindfolded, demonstrating Pin the Tail on the Donkey, she kicked me in the ass. Literally. In front of all those younger kids.

It seemed a bit extreme.

I have also read about bullying and its relation to emotional abuse, and written about that:

“Our results showed those who were bullied were more likely to suffer from mental health problems than those who were maltreated,” says Professor Dieter Wolke of the University of Warwick in the article. “Being both bullied and maltreated also increased the risk of overall mental health problems, anxiety and depression.”

He adds, “It is important for schools, health services and other agencies to work together to reduce bullying and the adverse effects related to it.”

So. Emotional abuse in my childhood, in the form of bullying. Did it cause my bipolar disorder?

Probably not. But it sure didn’t help.

I was already at the least depressed and most likely bipolar by the time all that happened, and was certainly bipolar by the time I encountered undeniable emotional abuse in young adulthood.

But I firmly believe that the roots of my bipolar disorder were located squarely in my brain, between the synapses, due to the lack or overabundance of neurotransmitters or other brain chemicals. That’s the current thinking, and it makes sense to me. (Of course there’s the possibility that in the next decades genes or gut bacteria or some other factor will prove to be involved, but given present science, I’ll stick with the brain chemistry theory.)

I don’t think that the emotional abuse caused my bipolar disorder. But I sure as hell know that it exacerbated the illness, which has made it all the harder for me to make progress in finding peace and healing over the decades.

But I can only speak for myself. Your mileage may vary.

From Panic to Manic to Proactive

Hypomania isn’t all bad. Right now I’m facing one of my worst triggers, and instead of retreating into depression, I kicked into hypomania. Then I harnessed as much of it as I could and channeled it to work for me.

Here’s the sitch. My longest and most vicious major depressive episode (which lasted literally several years, even when I was under treatment and on medication) was triggered by, among other things, massive financial problems. (There were other factors involved: health problems, family health problems, family problems, irrational thinking, strained relationships, and bad ol’ neurotransmitters.) I was unable to work. There was plenty of anxiety along with the depression, you can be sure.

So here I am again, almost a decade later, once again in dire financial straits. I’m able to work, but only part-time and telecommuting. Then one of my biggest, most reliable clients cut way, way back. I made the mortgage this month, but next month looks iffy at best.

In the past, this would have resulted in major mental symptoms, and physical ones as well. (Better you shouldn’t ask, but my digestive tract responds to stress in an overwhelming manner. I know, TMI.) I would be immobilized, unresponsive, and spend most of my days on the sofa when I wasn’t in the bathroom. I would abandon the financial problems – and myself – to my husband’s care, for as long as he could keep everything together. Until he burned out too.

During this new version of assorted crises, I seem to have a better handle on things, and I credit hypomania. I am trying to better the situation, though not yet particularly effectively, but steadily.

I am looking for new clients and more work from my old ones. I am looking for other sorts of telecommuting jobs, and even part-time outside work that seems to be within my modest-at-this-point capabilities.

(This process is hindered by the fact that all the job search engines are lousy. When I say I am a writer, I get leads for technical aerospace writing and service writers for car repair shops. When I say I’m an editor, I get invitations to become a driver for Uber. True story.)

I pursue these avenues every day. Soon after this post goes up, I have a networking “date” with a former client and a former co-worker.

And in the meantime? When the days stretch out with nothing happening and the sofa calling my name?

I blog. I work on my novel. And I take surveys.

Admittedly, none of these pursuits brings in mortgage-payment-sized money. But the surveys bring in a couple of dollars a day, which is pitiful, but helping with a getaway my husband and I planned before the finances went belly-up. (My husband is still working, but his wages alone aren’t enough to pay all the bills. We need both of us, a situation familiar to millions of people in the U.S., with or without mental illness.)

And, aside from the getaway, which it’s too late to cancel, we’ve instituted cutbacks. We typically spend way too much on food and now must revisit our newly married days, when we subsisted on mac-n-cheese and tomato sandwiches. It’ll be good for us, I tell myself. We could both stand to lose some weight.

I don’t know how long my “proactive hypomania” will last, when our financial situation will improve, or whether my energy level will survive after it does. Or, for that matter, whether we’ll end up eating cat food under the Third Street Bridge and fighting stray dogs for cold french fries.

But right now, for now, I’m dealing. And that’s something I couldn’t do before.

Cheerleading or Celebrating?

I was prejudiced. I admit it. When I was in high school, I believed that all cheerleaders fit the stereotype – “buoyant and busty and just plain dumb,” as the singing group Uncle Bonsai put it in “Cheerleaders on Drugs.”

I still don’t really understand cheerleading, especially on the scale of professional sports. But I know some good people who have participated in cheerleading and cheer coaching, so I’m willing to give them the benefit of the doubt.

But that’s not what I wanted to write about today. I want to discuss the kind of cheerleaders that offer support to those of us with bipolar disorder.

I suppose traditional-style cheerleaders are supposed to give encouragement before a thing is done. But I prefer ones who cheer after something, no matter how small, is accomplished.

That is to say, I prefer cheerleaders who say, “You did it!” to those who say, “You can do it!” (This is another YMMV post. This is just my own experience. Your mileage may vary.)

Cheerleaders-before-the-event are common in mental health circles. “Smile! You can do it!” “Do volunteer work! Give it a try!” “Get out there and meet new people! You’ll feel better!” “Get some fresh air and exercise! It’s easy!” But the fact is, no, I can’t always do it or give it a try. No, it’s not easy, and I don’t feel better.

It’s good to know that someone believes in you, but to me, cheerleaders set me up for failure. If I can’t manage to smile or exercise or whatever, I have disappointed not just myself, but the person who thought that I could do it, whatever “it” is. Remember the Little Engine That Could? It was thinking, “I think I can,” not “Someone else thinks I can.” What does that someone else really know about how severe my symptoms are today or whether my meds are having their desired effect or how many spoons I have?

I prefer cheerleaders-after-the-fact – those who join me in celebrating victories, no matter how small or insignificant they may seem to others. “Hurray! You paid a bill today!” “Congratulations! You phoned your mother!” “Good job! You took a shower!” “Go you! You put on pants three days this week!”

These are accomplishments – things you actually did, not things that you might or might not do. They’re tiny victories, maybe, and you don’t see memes that encourage you to do them. To neurotypical people, they wouldn’t be accomplishments at all, just normal functions of everyday living. It’s too easy to picture cheerleaders-before-the-fact saying these things half-heartedly or sarcastically. “Oh, great. You fed the dog. Woo-hoo.”

I don’t want cheerleaders so much as celebrators, people who can join me in acknowledging that it is a victory to write my blog post, or even to make notes for it. Or even, some days, to get out of bed.

I don’t expect someone to follow me around all day applauding every little thing I do. But on days when I feel useless and unproductive, like a failure or a slug, I do like having someone remind me that I do make progress, that my struggles have value, that – as a friend of mine said – not fucking things up worse is at least half a win.

I’ll take half a win when I can get it. And a pat on the back whether I smile and get out and make new friends, or simply make it to my doctor’s appointment.

That doesn’t make me a glass-half-full person. It just means I’m grateful that the glass isn’t completely empty.

 

 

Bipolar and Growing Older

I was a bipolar child. I was a bipolar college student. I was a bipolar adult. And now that I am about to be able to get the senior discount card, I am a bipolar – what? – mature adult.

First, let me say that aging sucks. Except that the alternative sucks more. The problem is, I can’t always tell whether anything that happens to me is due to my bipolar disorder or due to aging. I fear that, since my bipolar is fairly well in check at the moment, what are left of my problems may be due to something else.

My hands shake, for example. This has been true for years, though. The neurologist called it “essential tremor,” which I think means it just happens and they don’t know why. But some medications have made the tremor worse, and one of the medications I’m taking now could be increasing the shaking. And the shaking gets worse when I have anxiety. So I think we can chalk that one up to bipolar disorder, mostly.

I forget words. Sometimes, when I’m talking, I forget the word that comes next and have to pause or talk around it until it comes back to me. Sometimes my husband fills in the blank, which is helpful, but really annoying. For a writer, losing words is scary, but the memory difficulties seem to happen more when I talk than when I write.

I know I’ve had memory lapses before that can be attributed to my medication, and those memories are gone forever. I’ve written about that phenomenon: http://wp.me/p4e9Hv-6k. But these seem to be single words that escape me, and that I can usually get back within a few seconds. It doesn’t feel like anything I’ve had associated with bipolar, so I suppose this one is aging. If it’s the onset of Alzheimer’s, I’m going to be so pissed.

I isolate. This I’m pretty sure is bipolar in nature, since I’ve been doing it for years, especially when I’m depressed. I’m also reasonably sure that I am getting less isolated as my bipolar disorder has eased. I still don’t get out much, though I did go to a fabulous (and large) party last Sunday. But I am active on Facebook and Messenger, and I write these blogs, and I talk on the phone.

On the other hand, I seldom leave the house, and that I think is an effect of aging. I have mobility and balance problems because of a bad back and some nerve damage in one foot. But bipolar is involved, since weight gain from medications also affects my mobility, and an aversion to crowds and noise is likely associated with my anxiety.

Side effects of bipolar disorder and bipolar medications are to be expected. So, for that matter, are side effects of aging. Teasing out which is which may seem futile, and perhaps it is. I just want to know which I have some degree of control over and whether some, especially the cognitive symptoms, are likely to fade, stay the same, or get worse.

Self-Care and Human Needs

Self-care is one of the hot topics these days in the world of bipolar disorder and the people who live with it. Self-care can be as basic as remembering to eat or as complicated as knowing and avoiding your triggers.

Back in 1943, psychologist Abraham Maslow created what he called a “hierarchy of needs” – a series of stages that human beings must go through on the way to the ultimate goal of “self-actualization.” With few changes, the concept, usually illustrated as a pyramid, has continued to influence the study of human motivation and developmental psychology.

So what does self-care have to do with the hierarchy of needs?

The most basic needs of human life form the base of the pyramid. These are called “physiological needs” and are essentially what a person needs to stay alive: air, water, food, shelter, sleep, clothing. Without meeting these needs, a person cannot move up to the next level of the hierarchy.

A large part of self-care is devoted to meeting these very basic, fundamental needs. Air is usually not a problem but shelter and clothing can be, for those bipolar persons who are homeless – and there are more than a few. Many of us are just one financial reverse – loss of income, insurance, options – from being homeless.

The most common advice for self-care is to pay attention to these base-level needs: Remember to eat. Stay hydrated. Get enough sleep. At times, it’s a real struggle just to meet these self-care needs. Add “get exercise” to the list and it can suddenly be overwhelming. People with bipolar or major depressive disorder often need help accomplishing them. That’s as high as we get on the pyramid.

The second step of the pyramid, which people need to work on after they’ve met the requirements of the first step is called “safety needs”: personal security, employment, resources, and health. Again, the needs on this step may seem insurmountable, and may – probably will – require help to achieve.

But they are self-care needs too. Current society may not view them as such, but that’s because they tend not to struggle with them, at least not on the level of a person with a mental disorder. Individuals can sometimes help meet these needs, but more often government, community, or charitable organizations provide necessary help. Talking about self-care at this second level may seem like pie-in-the-sky to those who have not yet conquered the first. But truly, taking care of these needs is a form of self-care, enabling one to maintain the gains represented by achieving those of the first level.

The third level of human needs – and self-care – is called “love and belonging”: friendship, intimacy, family, sense of connectedness. Again, this is not usually thought of as a part of self-care. But it certainly is. Many of us – I include myself – lose friends, become estranged from family, fail at intimate relationships. There are other places to look for ways to practice self-care on this level, however.

Therapy groups and self-help groups can lead you to people who share your problems and may be able to help you in achieving self-care. (My husband met one of his dearest friends, who provided support, listening, understanding, and companionship, at a self-help group meeting.) If in-person meetings are not possible, social media such as Facebook, Twitter, and WordPress provide opportunities to meet some social self-care needs through various groups and online communities.

The top two levels of the pyramid are not as easy to think of as self-care, and not as easy to tackle. Level four is esteem: respect, self-esteem, status, recognition, strength, freedom. And five is self-actualization: to become the most that one can be. Realistically, these are not strictly speaking things that can be accomplished through self-care. Even neurotypical people may never complete step four, and there is reason to think that few people ever reach self-actualization. These are goals to strive for, but not guarantees.

Wherever you may currently be on the pyramid, the important thing to remember is that self-care will help you reach the next step; that each follows the one before; and that your bipolar life will improve with every step you achieve.

 

Depression, Mania, and Mystery

Writing a book takes a certain amount of mental stability. Also, you have to be a little crazy.

Despite the fact that in the popular imagination, creativity is linked with insanity, having a mental disorder is not all that conducive to productive work, particularly to the sort of sustained, focused writing that a book requires.

Still, bipolar, OCD, schizophrenic, and other writers have managed to write books – and some very good and highly acclaimed ones.

I have taken on that venture myself. I am writing a book.

Now, settle down. I am not (yet) asking you to buy this book. It is still only a book in process. Nothing has been published. Maybe nothing ever will be. Nevertheless, I persist.

Actually, I have two books in the works. One is out of my hands now. It is languishing at a publishing company, where it has languished for a year, waiting for them to determine if their interest in it will lead to actual publication. That book is a memoir of sorts, based on these blog posts. Unless I want to start pimping it to agents and other publishing companies, there is nothing more to do with it right now.

In the meantime, my attention has turned to the other book. It is a mystery, and has nothing to do with bipolar disorder. Except that the writing of it has everything to do with bipolar disorder.

First depression. Depression is great for writing certain types of scenes – deaths and reactions to them, for example, which are good for mysteries. Depression, however, periodically leads to the “this book is shitty” phenomenon, which I understand is not exclusive to depressive writers.

When depression leads me into that trap, I stop writing. Instead, I do “research.” If I am not too depressed to read, I delve into books about the craft of writing – plotting, description, etc. Or I study the works of writers that do things exceedingly well – dialogue, word choice, narrative voice. I highlight examples of good technique. Then, at some point the depression lifts and I try to put what I have learned into my manuscript. Of course this means lots of rewriting and revising, which slows my progress, but, I hope, makes the manuscript better.

Then there’s mania. Or at least hypomania, in my case. It carried me through the first eight chapters of the mystery before the depression hit. If it’s a truism that depression lies (it is and it does), mania is a liar as well. Recently I was tootling along at about 500 words per day, and it occurred to me that, at that pace, I could reasonably expect to have a rough draft by July 4, ready to send to my beta readers.

This was mania talking. Lying, rather. In fact, there was no way I could maintain the pace, meager though it was, of 500 words per day and not a chance in hell that I could meet the self-imposed deadline.

What came next? More depression, of course. More research, this time into how various authors use dialogue tags. And a confusing attempt to improve the pacing by scrambling the order of the chapters.

Until writing mania sets in again, I plug away at scenes I know need to be written, even if I don’t know where they go, and keep my eyes and ears open for both the depressive lies and the manic ones. I have over 45,000 words written and refuse to abandon them now.

So I don’t know all that much about whether bipolar disorder is a help or a hindrance to creativity (I would suspect it is both), but I do know that it is possible to work around it.

Eventually, if I’m lucky and persistent, I’ll ask you to buy my books. Someday.

What I Learned About Ketamine and Depression

Trigger Warning – Meds

Note that I’m not a doctor or a pharmacist or any kind of medical personnel. Do not consider this post to be advice on what you should do. If the subject interests you, ask a licensed physician for more information.

What did I know about ketamine before I started doing some research?

Not much.

I knew that as a street and “club” drug it was known as “Special K.”

Then I heard that it was being used for treatment-resistant depression. Here’s what I found.

First, you can’t just go down to Brown Street and buy a few pills. That’s illegal. And what you get may include other substances that you didn’t intend to take.

So, you need a prescription for it. Once you get that prescription, usually after a consult with a psychiatrist, you need to find a treatment center that will administer the drug. Clinic operators may be anesthesiologists, as ketamine is primarily used as an anesthetic.

The treatment is delivered via IV or injections. No simple pills to take. It’s a course of treatments, each lasting 45 minutes to an hour, with a rest of an hour afterward. The treatment may be delivered for as many as six doses over the course of 12 days. (There may also be a nasal spray option, but the IV version seems more typical.)

You have to have someone who can drive you. The possible side effects include confusion and blurry vision. You can’t drive for 24 hours after the treatment, which basically means you can’t drive for two weeks, since the treatments are roughly every other day.

They don’t know how it works. I don’t find this surprising, since every time I’ve asked my psychiatrist how a medication works, I’ve been told, “They don’t really know, blah blah blah, neurotransmitters, blah blah blah, serotonin, blah blah blah.”

It’s expensive. The initial treatment may cost $500–$1,000, and a full course of treatments may cost as much as $3,800, which insurance won’t cover. These are estimated costs, based on treatment in various regions of the country. (The wholesale cost is approximately $.32 per dose, by the way.)

The results don’t last. They give relief for as little as a few hours to as much as nine months, after which a $600 booster shot is required.

You may still need regular antidepressants and psychotherapy. Ketamine may get you “over the hump” until your regular antidepressant kicks in, but is not a stand-alone treatment.

There are side effects. Confusion, hallucinations, and high blood pressure are among them, along with something called “lucid daydreaming.”

More research is needed. Duh.

The FDA has also approved trials of MDMA (Ecstasy) for treating PTSD. It is also being researched for effects on OCD, depression, and other conditions.

So, assuming that I could afford it, would I try ketamine? There’s not one easy answer to that.

Back in the days when my depression was drug-resistant, when I had spent years trying different combinations of psychotropics, when I was considering electroshock, I might well have seen ketamine as something to consider before I took that step. It should be noted that, at the time, my psychiatrist did not recommend or even mention it, so it might not have been appropriate for me whether I wanted to try it or not. And anyway, a combination of meds and therapy finally kicked in and made the subject moot.

Nowadays, I would not try ketamine (or MDMA, for that matter). My bipolar depression has moved from drug-resistant to drug-alleviated, at least for the most part. And that “most part” is enough for me. I have no need to be driven 45 minutes to the nearest clinic or to try to find a psychiatrist and anesthesiologist willing to go off-label. I am satisfied as I am.

As always, Your Mileage May Vary.

Sources

http://www.webmd.com/depression/news/20140923/ketamine-depression#1

http://www.ketaminetherapy.com/Depression.html

http://uchealth.com/intranasal-ketamine-infusion/

https://psychcentral.com/blog/archives/2012/12/01/should-you-try-ketamine-for-depression/

https://en.wikipedia.org/wiki/Ketamine

http://www.webmd.com/depression/news/20161130/fda-ecstasy-ptsd-treatment#1

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