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Posts tagged ‘mutual support’

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.

 

Caregivers Need Care Too

While there are professional caregivers, family members often provide care and support for those with bipolar disorder and other mental illnesses.

My husband of 35 years is my caregiver. He does a spectacular job – making sure I have my meds, taking me to my appointments, running the errands that I have no spoons to do, keeping the house quiet when I need to sleep, making sure I eat at least one nutritious meal a day.

It’s a lot. And there are things I can give him in return. Things he needs.

Appreciation. When my father was dying of cancer, my mother was his primary caregiver. One day she came to me, wanting me to tell her that she was doing a good job. She knew that she was. She just needed to hear it from someone else, someone who could tell her that her excellent care had been noticed and appreciated.

Appreciation – validation – is the thing that caregivers need most, to replenish themselves, to allow them to keep doing the things that are so vital for their charges. And it’s the easiest to give. When you’re in the depths of depression, it may be difficult to remember to say “thank you,” but it means a lot to your caregiver.

Now I’m mostly out of my depression (usually), and I say “thank you” a dozen times a day. And he always responds, “You’re welcome, friend.”

Alone time. Primary caregiving can be a full-time job. I know that one thing I need in the process of healing is alone time. Dan needs it too. He needs time off, even if that’s just time to retreat to his study and watch a movie or go outside and dig in the garden. I can always reach him if I really need him – for example, if I have a panic attack – via cell phone if nothing else. But, as the saying goes, you can’t pour from an empty vessel. That’s part of the reason that he’s able to give me so much of what I need.

Couples time. This doesn’t necessarily mean sex. It means time spent together, doing something other than dealing with mood swings and trauma. It’s a little gift we give each other. Sometimes I sit through a movie I don’t really care for, just to give him the gift of snuggling on the couch. He got me color-and-bake ceramic mugs that are great for creativity and distraction. One rainy afternoon we sat together and each colored one side of the mugs.

Life stuff. Dan does most of the chores and tasks of daily living, but I do what I’m able to. I earn money. I pay bills online and do most of the other computing, except what he does for leisure. I help with cooking to the extent I can – sous-chefing, finding recipes, breading or mixing or inventing dressings and sauces, making grocery lists. He can ask me for help too.

Sharing my spoons. When I do find myself with a few spare spoons – a little extra energy occasionally – I try not to be selfish with it. When I have spoons to spend, I like to shower and dress and go out for lunch. But the other day, I showered and dressed and went for a walk in the woods with Dan, something he’s been longing for. My spoons ran out pretty rapidly, but he appreciated that I made the effort and shared one of his delights. It was another gift that cost no money.

In other words, when you have a caregiver, don’t think it’s all one way. Your caregiver needs care too. Small or large, what you are able to give will be appreciated.

 

The Tools for Tackling Bipolar Disorder

When you’re facing bipolar disorder – which is, when you have it, nearly every day – there are some things you can do to lessen its hold on you. But in order to do so, you’ve got to have the right tools. Try to collect as many as possible for best effect.

Shall we take a look at what they are?

The Usual Suspects

  • medication – to tame your symptoms, level your moods, get your brain back in gear, and/or regulate your energy
  • psychiatrist – to prescribe your medications (a primary care physician may also do this)
  • psychotherapist – to discuss with you the issues you haven’t resolved, the problems you still have, and the things the medication can’t do

Self-Care 

The two most important tools you need for self-care are sleep and food. Without either, the body can’t function properly, and if the body doesn’t function, the brain is less likely to function properly either.

Ideally, the food should be nutritious and eaten regularly, but let’s face it, that doesn’t always happen. But you’ve got to give your body something to run on. If there are carrot sticks there, eat them; if there is mac-n-cheese, eat that. If there’s Raisin Bran, well, it’s easy to eat and requires no preparation. Try for at least one substantial meal per day – two is better, if you can manage it.

(Of course, this advice doesn’t count if you have an eating disorder. In that case, see your doctor or psychotherapist or support group.)

Support

Find support where you can – a friend who’s willing to listen, a support group online or in real life. Try for a combination of these and don’t rely on any one of them for too much. Maybe you have a friend you can phone once a week; a support group that meets every two weeks; and an online group or two of people who really understand, with links to helpful articles and blogs. Before you know it, you’ve got a support system, especially if you count your therapist (which I do) or have a supportive family (which I don’t).

Spoon Theory

If you don’t know what this is, see https://butyoudontlooksick.com/articles/written-by-christine/the-spoon-theory/. Basically, Spoon Theory is a way to measure how much energy you have on any given day – and an understandable metaphor for explaining your symptoms to others, and a shorthand for other people who are also up on the theory. It can also help alleviate the guilt of not being able to do all the things you are “supposed” to do in a day. It’s not an excuse, but an explanation.

Distraction

Let’s face it, it’s all too easy to dwell on your symptoms and how miserable you are. And if you’re at the bottom of the depressive well and your meds haven’t kicked in yet, there may be nothing you can do about it.

But maybe there is. Do you know a person who tells good jokes – or really bad ones? Do you have music you used to play but have forgotten about? Do you know of a TV show that features people whose lives are an even worse train wreck than yours? Do you have a go-to movie that never gets old no matter how many times you see it? (Mine is The Mikado. )

Creativity

If that distraction involves creativity, so much the better. 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, you don’t have to paint masterpieces. Just keeping your brain and your hands occupied is a good idea.

Comfort

Soft warm, fluffy things and smooth, silky things are soothing. They just are. Cats and dogs come instantly to mind (they also provide distraction). But I also have a collection of teddy bears and other plushies that I sometimes cuddle with. These are “comfort objects,” which is an actual psychological Thing. (I wrote about them once: http://wp.me/p4e9wS-k9.) I even took a plush bunny with me when I went to have a sleep study.

Stubbornness

This may be the most important tool of all. Be stubborn. Take those meds, even if you hate them. Eat that egg, even if you don’t feel like it. Go to that appointment, even if will take all your spoons for the day. Call that friend, even if you don’t think a joke will help. Post on your support group, even if you feel you are alone.

We can’t let bipolar disorder beat us. Not when we’ve got so much to beat it back with.

Why Do I Write About Mental Illness?

I have bipolar disorder. But that by itself isn’t the answer. Here’s why I write about mental illness and mental health.

It’s what I do. I’m a writer. It’s what I would be, bipolar disorder or not. I’ve been writing since I was a kid, and writing and editing professionally for decades. But that isn’t the whole answer either.

It’s what I have to do. I have plenty of topics to write about besides mental illness. Over the years I have written poetry; a few children’s stories; and articles about martial arts, religion, cats, education and teachers, technology, architecture, and other subjects. In addition to this blog, I have another – janetcobur.wordpress.com – in which I write about whatever crosses my mind or my path – books, news, humor, and the things that made me name my blog Et Cetera, etc.

But this blog is the one that I have to write. It started as journaling but quickly – in a matter of weeks – became more.

It’s what I am. Mentally ill, that is. A life-long acquaintance with – or rather, experience of – a mental illness makes the subject one that goes to the bone. I can’t call up a memory from my childhood that doesn’t involve desperation, sobbing, and disaffection, or fragile, giggling glee at things no one else noticed or cared about. My college years were marred by distress, anxiety, and apathy. My adulthood has been marked by breakdowns, immobility, and psychotropics. I can’t get away from the subject, even if I try.

I have the skills for it. I have read a lot about mental illness and bipolar disorder, in self-help books, more scholarly works, memoirs, and even fiction (http://wp.me/p4e9Hv-nE). I have an academic background and an intelligent layperson’s knowledge of science and psychology. I can share that perspective with others.

It helps me and others understand. Examining aspects of bipolar disorder necessitates that I learn more about it – and therefore about myself. Planning, writing, and editing posts help me clarify my thinking about this illness I live with every day. Sometimes I am just too close to it until I step back and look at it from a different or even new perspective. That’s one of the benefits for me.

The feedback I get – comments from readers and other bloggers – leads me to believe that what I write has value for them too.

It needs to be talked about. The general public – society at large – doesn’t understand mental illness. There are widespread jokes, misunderstandings, and inaccurate media portrayals. Above all, there is discrimination – in jobs, housing, medical treatment, the legal system, and more. There is more trash talked about mental illness and psychotropics every time there is a mass shooting incident or a domestic terrorist bombing.

One of the solutions to these problems is education. Most of the writing I’ve done in my life has been on (or near) the subject of education. I consider myself an advocate for education. And now I am an advocate for education about mental illness. That education should start in public and private school health or social sciences classes. It should continue in adulthood for those who never learned it in school.

Celebrities like Glenn Close and Richard Dreyfuss have big names and big audiences and a vital message to spread about mental illness. I don’t have the big name or the big audience, but I do what I can.

Because the people, including me, who live with bipolar disorder and other mental illnesses every day, need messages of hope and sympathy and experience and activism and explanation and thought and outrage and kindness.

And that’s why I write about mental illness.

 

 

 

 

Which Way Is Out?

What do you get when you take two people, three doctors, eleven prescriptions, two pharmacies and an insurance company?

No, wait – I’m not finished.

THEN add another person, two banks, a credit card company, a missing check and a disputed charge.

Mix in bipolar disorder, clinical depression, and several months of previous stress.

Anxiety DisorderWhat you get, first of all, is something that rhymes with buster-cluck, and then a dangerous situation: Two people under pressure, neither of whom can function well enough to find any solutions.

There is enormous inertia. You make a few calls, get a few responses. Fine, you think. That’s taken care of. Except days later, it isn’t. There are new overdraft notices, rapidly dwindling supplies of psychotropics, and occasional fits of tears.

So you take another swing at it. More phone calls. More revolving phone trees. More dropped calls. More suggestions that you really need to get someone else to call someone other else to resolve it and here’s a handy 1-800 number that takes you to a department that never heard of you, your problem, or the company you’re dealing with.

Yes, they all agree. It’s important that you don’t run out of your psychotropics. It would sure be nice if there were enough money in the account to pay the premium for the crappy insurance. It’s a mystery why no one has any record of the complaint you asked them to file.

Another day. Another no check. Another no drug delivery. By now we’re getting into mixed states: immobilizing depression and nail-biting, catastrophizing anxiety.

You look for possible work-arounds. Maybe the local pharmacy can sell you enough pills to tide you over. But, oopsie! Your bank balance just went from -$53 to -$82. And the insurance won’t pay for drugs at the local pharmacy any more – only through mail order. Which brings us back to D’oh!

This is not hypothetical. This is happening.

What do we do now?

Well, we split up the tasks. I work on the drugs and insurance end, while my husband works on the banking problem. We both hover over the mailbox, waiting for the check.

We take turns. Both of us having a meltdown at the same time is not pretty. I’ve seen it. Trust me on this.

We do all we can do and then stop. For the moment anyway. When the pitch of my voice starts rising to dog whistle range and I start sniffling and tearing up, I know I’m just moments away from becoming incoherent, which may demonstrate the need for the psychotropics, but is not actually any help in getting them.

We try to take care of ourselves. Dan can sleep (I can’t), so he does. He buys my comfort foods (fried rice, mashed potatoes). I decide that this may not be the best time to be reading a new, fast-paced zombie apocalypse thriller and switch to a familiar old standby character study with no crises worse than deciding when to have a child (not a small thing, but on the scale of introspection to pulse-pounding, pretty low).

There’s never a good time for these cosmic pile-ups to happen, but now is unusually bad. The last few months have brought assorted financial and medical troubles (the two being related, of course), plus the death of three elderly pets within a couple of weeks of each other. Dan is dealing with the fact that the house he grew up in is up for sale. I haven’t been getting as much work as usual. Soon, I will have to look into expanding my client base.

After I get the drugs. And after they start to work. Whenever that is.

Sorry I don’t have anything encouraging or amusing or informative to share this week. That’s just the way it is sometimes. And now is one of those times.

 

The Therapeutic Hug

People Group Teamwork Holding Logo. 3D Rendering illustration

Big Group Hug

The common wisdom is that a person needs four hugs a day for survival, eight for maintenance, and twelve for growth. I doubt that this is confirmed by any scientific studies and I doubt that it is true. If it were, there would be millions of people on Earth who would not survive.

I would be one of them. Despite being married to one of the two truly world-class huggers I’ve met in my life, I do not get my four-a-day. And certainly not twelve. Assuming eight hours a day for sleep and eight hours a day for work, that would leave eight hours to work in twelve hugs. That’s one and a half hugs per hour, and I suspect half a hug just won’t do.

In fact, I know it won’t. Scientific research has been done on the 20-second hug. It releases oxytocin, a pleasure and bonding chemical in the brain. Half a hug would need to be 40 seconds long to do the proper amount of good, and young lovers and newlyweds tend to be the only people who give hugs of that duration.

Then there’s the question of what constitutes a hug. For greatest oxytocin effect, I would recommend the full body hug – toe to toe, torso to torso, heads on shoulders, arms tightly squeezing. But you probably can’t give that particular hug when you run into an acquaintance in the supermarket, especially not 20 seconds worth, without blocking the aisles.

Other variations of hugs that may be less effective are the side-by-side one-shoulder squeeze (and the multi-person variant, the Big Group Hug), the manly back-thumping, and the A-frame hug (standing a distance apart and leaning in for a hug from the shoulders up). Then there are the virtual hug, usually written ((hug)), with the number of parens indicating the length/intensity of the hug, and the proxy hug, in which you delegate a person to pass along a hug when you’re not able to be there. None of these seem really conducive to the 20-second, made-for-thriving hug.

But, on some level, we know that hugs are therapeutic. Oxytocin or whatever, they make us feel better. Lots of hugging goes on at support and 12-step groups, and people who go to those daily might indeed make their recommended quota.

I go to private psychotherapy, however. I’ve never hugged my therapist, and am not even sure whether it’s appropriate for therapist and client to hug. It would be awkward to ask, “Can I have a hug?” only to hear, “No. That’s unethical.” But I suppose it depends on the therapist and the client and how each feels about the subject. I know sex is unethical, but hugs may be a gray area. Perhaps someone can enlighten me.

Of course, there are people who do not like to – or are afraid to – touch other people. Think Sheldon Cooper on The Big Bang Theory. People who are aware of and skilled in responding to others’ body language may be able to see the little (or, let’s face it, large) cringe when one person sees another moving forward with open arms. If the non-hugger is quick enough, he or she can quickly stick out a hand for a hearty handshake, or the potential hugger will abort the hug and retreat to a friendly tap on the shoulder.

But there are people who will swoop in and envelop you in an unwanted embrace and maybe even air kisses with smacking noises. I suspect these would be more likely to shut down oxytocin entirely, and possibly release adrenaline instead in a fight-or-flight response.

As with sex, the safest route is to ask for consent – “Can I have a hug?” – and take no – “I’d rather not” – for an answer, without taking offense or pressuring – “Aw, c’mon” – and making things even more awkward.

Still, the best advice I can give is to be proactive about hugging. Say, “I need a hug” when you do. Ask “Do you need/want a hug?” when a person you know seems to be in distress.

Avoid hugging strangers, though. That hardly ever helps. At least wait until you’ve been properly introduced.

 

 

The Comfort That Remains

Here I am, caught between reactive depression and clinical depression.

If you’ve been reading my last several posts, you know that I’ve been having a rough month. Several months. It’s been a real challenge to my hard-won quasi-stability.

3ff82b43-7ccd-4bde-8219-be5598c73452Last week, my 20+ year old cat, Louise died. The week before that, my husband’s 17+ year old cat died. So now I am trying to deal with those reactive feelings of grief and loss, without losing myself in the eternally waiting Pit of Despair that is clinical depression.

In doing that, I am trying to find things that remain to take comfort in.

I take comfort that my husband was here with me, to help me through.

That Louise had a good, long life spent in our loving care since she was a tiny kitten.

That she died peacefully, at home, in my lap, with me petting her.

That I had a chance to say goodbye to her.

That I know she loved me as much as I loved her.

That her presence and her purr helped calm me and helped me when nothing else could.

That she gave me a constant presence through a third of my life, and all of hers.

We have two cats now – Dushenka and Toby. They are young and healthy, but of course our time with them is not guaranteed. I know that, just by having them and loving them, we are inviting future grief into our lives, along with the joy. That’s just how it is.

I’ve been reflecting a lot lately on animals, humans, and what we share with each other. I know this is likely to happen again, and soon, for our dog is also aged and nearly ready to go. It’s hard. Is it harder when your brain doesn’t work right and tries to tell you that sorrow doesn’t end?

I don’t know.There’s no scale by which to compare pain, and loss, and despair, and grief. We each go through it the only way we can.

I hope that soon, at least a few of the clouds will part and I can feel something besides sorrow, express something other than pain. Maybe next week’s blog will be about healing, or coping, or sharing strengths.

Those are all things I need to be doing – that we all need to be doing.

Someone remarked this week that a recent post (http://wp.me/p4e9Hv-k8) was not about healing. It reflected, the commenter said, all the privileges I have – money (or those who can lend it to me), drugs I can take to help me through a crisis (too many, according to the commenter), a supportive husband. And that’s all true. I have these privileges and more besides – a home, work that I can do without leaving the house, insurance, a psychiatrist and a psychotherapist. Some of these come to me because of circumstances I don’t control, and some I have had to work very hard for, as I have worked hard for the ability to heal, a little bit at a time.

There are still things I cannot do – leave the house more than twice a month or so, shop for groceries, see the dentist without massive panic, stop taking the psychotropic meds that allow me to think, have a healthy sexual relationship. I expect that some of these will get better and others won’t.

But, no matter our symptoms or their severity, we as people with bipolar disorder are all in this together – or as the Bloggess would say, alone together. Maybe I have an easier time of it, but that’s far from saying it’s easy for me.

I still experience grief and sorrow, depression and anxiety, irrationality and immobilization, pain and despair, relief and help, struggle and hard work, love and loneliness.

And always, I look for the comfort that comes when I need it most, or expect it least, or believe I’ll never feel again. We all do.

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