My Experience Only. YMMV.

Posts tagged ‘psychological pain’

Bad Thoughts and Tattoos

Sometimes I have bad thoughts. We all do. I find that mine fall into three groups.

The first kind of bad thoughts are when I want to snap or snipe or snark at my husband, despite the fact that he is indispensable to me. He takes care of me, understands me, helps me, hugs me, feeds me in ways I can’t begin to describe.

When those bad thoughts arise, I have a brief internal chat with myself. (It looks like I’m thinking what to say because that’s exactly what I’m doing.) Then I choose not to say the nasty thing or I think of a less-nasty way of saying it. (I’ve written about the phenomenon before in “Managing My Anger” https://wp.me/p4e9Hv-kw.)

The skills involved are impulse control, the use of “I statements,” and the ability to rephrase. I try to say something that will get my point across without hurting or making things worse. These are techniques I have learned over the years, which makes me think they are things that can be developed with a little practice.

Learning to restrain myself has prevented many a fight. Some people find this style of communication inauthentic or wishy-washy – that I am tiptoeing around my husband instead of saying what I really think. All I can say to that is that it works for me and for our marriage.

The next kind of bad thought is the kind that comes with depression: I’m useless. I’m pathetic. I can’t do anything right. I’m worthless. Jenny Lawson (aka The Bloggess) talks about these thoughts in her book Furiously Happy, and she has one thing to say about them: Depression lies. These are the thoughts of a biochemically influenced brain that makes you miserable and sometimes wants to kill you, or at least kill your possibility of happiness.

Fortunately, my husband has read Jenny Lawson too. When I express these bad self-thoughts – and it’s best if you have a safe person to tell them to – he reminds me. He doesn’t try to deny the thoughts (You know you’re not worthless. You do lots of things right). He tells me, “That’s depression lying to you.” I used to get stuck in these cycles a lot before I was properly medicated and before I had his help and that of my therapist.

Then there are the really bad thoughts, those of self-harm or worse. Most of the time I don’t have these anymore, but when I do, there is one thing I can do. (Actually, there are more things I can do, but this is one that works for me.) I look at my tattoos.

The one on the right wrist is a symbol for bipolar disorder made up of punctuation : ) :  in the form of a smiley face/frowny face. This reminds me that my brain isn’t working right and is sometimes out to get me.

The other is on my left wrist, near my scars from self-harm. It is a semicolon. You may have heard about the Semicolon Project or seen the semicolon symbol on t-shirts or jewelry.

The semicolon is my favorite punctuation mark. It comes at the place in a sentence where a writer could choose to put a period and stop; instead, she continues the sentence. The semicolon says, “My story isn’t over,” something you’ll also see on t-shirts and such. (I’m thinking of making that sentence my third tattoo.)

Recently I had a bout of those really bad thoughts. But I looked at my tattoos and told myself, “My story isn’t over yet. I still have things I need to do.” One of them is to tell my story, in this blog and in a book I’m trying to write.

My tattoos helped me get over the bad thoughts. They have paid for themselves many times over. I never regret getting them. They may have saved my life.

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.

Is My Pain as Real as Yours?

The other day I got a comment on a post I wrote a while back called “Who’s a Spoonie?” (https://wp.me/p4e9Hv-h6).

The commenter said that I was wrong to use the term “Spoonie” for those with mental illnesses. The kinds of disorders that merited the appellation “Spoonie” were only those that involved a “physical debilitating condition where pain and fatigue play major roles.” That I am not a Spoonie. That the language is not mine to use. That I am a part of the problem.

Let’s take a closer look at some of those assumptions.

Mental illness is not an invisible illness.

I wrote about that, in a post called “Is Bipolar Disorder an ‘Invisible Illness’?” (https://wp.me/p4e9Hv-gI). Disabled World (https://www.disabled-world.com/disability/types/invisible/) seems to think it is. Their definition specifically includes mental disorders:

These [mental] diseases can also be completely debilitating to the victim, and can make performing everyday tasks extremely difficult, if not impossible.

Bipolar disorder and depression are included in their partial list of “invisible illnesses.” And if you want to talk about “everyday tasks,” consider the number of bipolar and other sufferers who can’t get out of bed, can’t shower, can’t leave their homes, can’t work.

The condition must be physical.

To the best of our current knowledge, bipolar disorder and many other mental illnesses spring from glitches in the neurotransmitters in our brains. The brain, a physical organ. Neurotransmitters, a physical substance.

Pain and fatigue are required to play major roles.

Well, I’ve written about that too, in a post called “Depression Hurts” (https://wp.me/p4e9Hv-6Z).

My head and eyes hurt from all the crying spells. My back hurt from lying in bed all day. I had painful knotted muscles from the anxiety that went with the depression. I had intestinal cramps because my overactive nerves led to irritable bowel syndrome. I had headaches and eye strain from the over sensitivity to light and noise. And I had the general flu-like malaise that is practically the hallmark of depression. You know the one. Every bone and muscle aches, but you can’t think why.

Were these aches and pains psychogenic? Undoubtedly some of them were. But others, like the irritable bowel, were all too demonstrably physical phenomena.

Oh, and are they chronic? I’ve lived with them all for years. Not all at the same time, maybe, and not without times when the pain let up. But are all Spoonies required to be in constant pain and fatigue? Again, Disabled World says not.

The language is not mine to use. 

Sorry, but language doesn’t work that way. Once a word is released into the wild, it goes where it wills, acquiring new usages and new meaning. And “Spoonie” is certainly out in the wild. The essay that first defined it is all over the Internet. The suffix -holic has escaped from the word “alcoholic” and is now used for dissimilar ideas including “shopaholic” and “chocoholic.” Can we say, “No, you mustn’t do that. It must be reserved for alcohol addiction”? We might, but it’s not going to happen. Trust me on this. I have some training in linguistics.

I am part of the problem.

I suppose so, if you believe there’s actually a problem. In my post on Spoonies, I asked:

Isn’t that how Spoon language started – as a way to begin a conversation on what invisible illnesses are and how they affect our lives? Not a secret language that only those who know the password and handshake can use.

Obviously, opinions on the subject will vary, and mine is only one among many. I cordially dislike exclusionary language. Does anyone else want to weigh in?

The Gray Dog and Me

Nothing is really wrong.

Feeling like I don’t belong.

– The Carpenters “Rainy Days and Mondays”

After quite a long spell of stable feelings (and maybe some productive hypomania – https://wp.me/p4e9Hv-y4), I’ve hit the wall of depression again.

Not full-blown depression, like I’ve had so often in my life. This is technically dysthymia, which is psych-speak for a low-grade depression, sort of like a low-grade fever that makes you tired and headachey and not wanting to get out of bed. To curl up in a blanket and sleep. To take aspirin and forget about everything else.

That’s where I am. I’m not wrestling with the Black Dog (https://wp.me/p4e9Hv-5Y). Call it the Gray Dog.

I am finding it very hard to write this, but I am pushing to do it, because at the moment, that’s one of the few positive things that I can point to – that my husband can point to – and remind me that depression lies.

What depression is telling me now is that I haven’t accomplished anything in my life. That I skated through high school and missed wonderful opportunities in college. That my jobs have been a pointless series of minimal value to anyone. That my writing is self-indulgent crap, unoriginal and meaningless.

Depression is telling me that I don’t matter. That I am becoming invisible. And that it’s my own fault, for never going out, for not reaching out. It’s not quite the self-pitying whine of “If I died, no one would come to my funeral.” It’s more like turning into a particularly ineffectual ghost – frightening no one, bringing no message from beyond, just fading and losing substance.

Depression is telling me that the future is bleak. I have a writing assignment now, but in a month it will be over and I’ll be right back where I was – at the edge of panic or worse, despair, or worst, both.

Depression is telling me that I’m a terrible burden and I don’t deserve my husband, who takes care of me when I’m like this.

At the moment I don’t have the ability to believe that all these are lies.

I do know that this won’t last forever. I’ve come far enough in my healing to believe that. And comparatively, it’s not that bad. I am quietly leaking tears, not weeping copiously. My bad thoughts are not as ugly as they could be, have been.

I haven’t given up.

But I almost want to.

It’s the “almost” that makes this the Gray Dog and not the Black Dog. That keeps me taking my meds and waiting for the Gray Dog to depart. That tells me to write this, even though I doubt its usefulness.

Useless sums up how I feel. Old and tired. Detached from society.

As depression goes, I’m really in a not-terribly-bad place. Which doesn’t make it much easier to live through. A little, though. I still have my support system, and I did get out of bed today (after noon), and I’m writing, even as I doubt my ability. But if I’m quoting The Carpenters, I can’t help but feel just a wee bit pathetic.

The Gray Dog is with me. One day soon but not soon enough, it won’t be.

 

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.

Surprise!

Surprise parties are fun for everyone, right?

Wrong!

While many people enjoy the surprise element (probably the guests do more than the honoree), even neurotypical people can shy away from the practice. Coming home to a darkened house, only to be greeted by bright lights and loud noise, can be an alarming experience.

For a person with bipolar depression, autism spectrum disorder, PTSD, or other mental conditions, it can be a nightmare.

My husband once decided to throw me a small surprise party. We and another couple were cleaning up an old house while a few friends gathered back at home.

One of the people had actively discouraged Dan from having the party. Robert had experienced depression and Dissociative Identity Disorder (DID), and knew how difficult such an event would be for him. He also knew about my depression and some of the incidents associated with birthday parties in my mind.

For instance, when I was a young teen, my “best friend” and I were supervising a party of younger children. During the game of Pin-the-Tail-on-the-Donkey, while I was blindfolded, she kicked me in the ass. Literally. In front of all the kids.

It was the occasion of my first major meltdown. For years afterward, I would not even admit to having a birthday, much less let anyone celebrate it.

Robert had experienced similar traumas involving groups of children, humiliation, and abuse. He was not able to cope with surprise parties and thought I might freak out as well.

Fortunately, decades had gone by since my traumatic party experience. I had been diagnosed and properly medicated and counseled about my issues. Dan knew me well enough to realize that I could tolerate a small, low-key surprise party. And so I did.

Still, Robert was right to be concerned.

Common events at surprise parties are triggers for many people. My friend Joanie has panic attacks when there’s lightning. Would flash photography set her off? I don’t know, but I don’t want to be the one who finds out. If the party is held in a restaurant, a person who hates being singled out in a crowd of strangers may have problems. People hiding in one’s home could cause flashbacks of a home invasion. My startle reflex is hypersensitive and could easily be triggered by sudden, unexpected shouts of “Happy birthday!”

Even opening presents in front of others can be difficult if one is weak in social skills, appropriate facial expressions, or spontaneous conversation.

So how do you give a surprise party for someone with certain types of mental illness?

Don’t.

If you think you must, ask the person what kind of party he or she would prefer, and abide by those wishes. You can suggest a surprise party, with the time and place being the surprises, but again, abide by the person’s wishes.

Prepare a small, low-key surprise rather than a party. Give a present a day or two before the actual date. Pack a slice of cake in the person’s lunch. Or take the person out to lunch. (Warn the restaurant personnel not to march around singing and waving balloons, if you mention that it’s a birthday lunch at all.)

Do not have party games, unless they are non-threatening ones such as mad-libs or trivia. Forget ones involving physical contact like Twister or ones that involve sensory deprivation like Blind Man’s Bluff.

You may wish to avoid serving alcohol, especially if the honoree is on anti-anxiety medications. Booze-fueled parties tend to become loud and rowdy.

Make it short. Personally, spending an hour with a group of four or more, even if they are all my friends, is about all I can take. And then I want a lie-down afterward.

Personally, I could live my life happily without ever having another surprise party thrown for me (even though the one Dan threw would have to be called a success). Nor will I be upset if I never get invited to another surprise party. I’ll be too busy worrying what it might be doing to the honoree to enjoy myself.

 

Don’t Tell Me Not to Feel the Way I Feel

“Don’t be sad/angry/upset.”

“Calm down.”

“Smile. It’ll make you feel better.”

“Stop getting all revved up.”

Never in the history of ever has any communication of this sort had the desired effect on a person – especially one with bipolar disorder.

When you offer this sort of “advice,” what you are basically doing is telling the person not to feel the way they feel. Not only is this useless, it’s insulting.

It’s useless because ordering someone to feel a certain way simply won’t work. Saying, “Be cheerful” will not make it so. Emotions aren’t like flipping a switch on command. Even for neurotypical people, emotions are complex interactions of chemicals in the brain. While some people claim – or may perhaps be able to – shift their emotional state at will (from angry to merely annoyed or to neutral), it isn’t easy or natural. There’s a reason that you feel the way you do.

For the person with bipolar disorder, it’s even more difficult – if not impossible – to shift moods at a whim, especially someone else’s. Bipolar is a mood disorder. It affects moods and emotions in a nonstandard, often unpredictable way. Telling someone to alter their own brain chemistry merely by thinking about it is ludicrous.

Even if the bipolar person’s moods or feelings seem exaggerated or uncalled-for to you, that person is having an experience no different than when you feel elated or despairing or fearful. The emotions may even be more profound, less susceptible to alteration by force of will.

But telling bipolar people not to feel the way they feel is not just pointless, it is insulting. You are denying their perception of reality, invalidating their experience, dismissing their concerns, minimizing their problems, discounting their feelings. In effect, you are saying, “I don’t feel the same way, so your feelings are wrong. Change them to match mine.”

Imagine that you have written something – a report, a poem, whatever – and feel good about it. You’ve made your point and done it well. You’ve captured reality as you see it and communicated it in a way you think is clear and effective. Then someone comes along and reads it and says, “This is crap.” They have denied what you feel and believe. And even if they’re right, even if it is crap, they have profoundly insulted you. And, of course, they may be wrong.

Diagnosed bipolar people already know that their emotions do not run the same as other people’s. There’s no need to remind them of that. And bipolar people are generally doing what they can to alleviate their symptoms, be it through therapy, medication, mindfulness, meditation, or whatever works best for them. When you discount their feelings you are discounting them as persons. That can be anywhere from annoying to soul-damaging.

Adam Savage, of Mythbusters fame, sometimes wears a t-shirt that says, “I Reject Your Reality and Substitute My Own.” He is (I hope) talking about substituting a provable, scientific reality for a mythical, uninformed one.

But to go around substituting your own emotional reality for other people’s – and trying to make them agree with you – does a disservice to the people you think you are trying to help.

So, what would be better than saying, “Don’t feel ________”?

How about, “I know you feel _________ and I can see why.”

Or “I can tell you’re feeling _______. How can I help you?”

In other words, start by acknowledging that the other person’s feelings are real. Then ask what the person needs. This lets the person know that you understand his or her feelings and that you would like to help in the way that the person thinks best.

If you know other things that have worked in the past, you could suggest them (after validating the feelings, of course). Would you like me to run a hot bath? Do you need a hug? Do you just need time alone? Do you want to talk about it? Maybe later?

It occurs to me that this is not really news to a bipolar person. The ones who need to read it are the ones who are doing the invalidating, not the ones who feel invalidated.

So, if you know someone like that – a friend or loved one, feel free to copy this post and give or send it to them, if you think it will help. I know it helped me when I figured out what was going on and what my husband and I could do about it.

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