My Experience Only. YMMV.

Posts tagged ‘reading’

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.

Books About Bipolar and Other Fun Topics

I love reading. Always have – except for the period when a major depressive episode stole it from me –https://wp.me/p4e9Hv-qp. I’m never more than two feet away from a book or, at this point in my life, an ereader. Reading is how I explore the world.

So naturally, in trying to better understand my disorder, I read about it. And because I’m interested in psychology in general, in addition to books about bipolar disorder, I read about other mental illnesses as well.

Let me share some of my reading with you.

For sheer delight as well as profound insights, try Jenny Lawson’s Furiously Happy: A Funny Book About Horrible Things. Amid the hilarious stories of life in her other-than-typical family are insights into depression and social anxiety, along with a manifesto of defiance – the will to be, well, furiously happy.

The other easily approachable book is Allie Brosh’s Hyperbole and a Half: Unfortunate Situations, Flawed Coping Mechanisms, Mayhem, and Other Things That Happened. What started as a humorous blog grew into a book (with quirky illustrations) featuring two chapters in particular, “Adventures in Depression” and “Depression Part Two,” which are about as good as writing about depression gets. A second book, Solutions and Other Problems, was scheduled but has been postponed indefinitely.

And while we’re on the subject of funny books about mental illness, there’s Surviving Mental Illness Through Humor, an anthology edited by Jessica Azar and Alyson Herzig.

Perhaps the best-known book in the field of bipolar disorder is An Unquiet Mind: A Memoir of Moods and Madness, by Kay Redfield Jamison. In it, Jamison deals openly and honestly with bipolar disorder, particularly with mania and psychosis, along the road to becoming a doctor herself. She has also written Robert Lowell, Setting the River on Fire: A Study of Genius, Mania, and Character, about the famous modern poet, but I haven’t read it yet, so I can’t comment.

Birth of a New Brain: Healing from Postpartum Bipolar Disorder, by Dyane Harwood, is another recent book that I haven’t read yet, either. But I know Harwood’s writing and expect it to be a stand-out, as well as the only book I know of on that particular topic.

Other books on bipolar disorder include Lost Marbles: Insights into My Life with Depression & Bipolar by Natasha Tracy.

For books about depression, the definitive work is The Noonday Demon: An Atlas of Depression, by Andrew Solomon. A thorough examination of depression, including the author’s own, it is practically a reference book on the topic, though much less dry than that makes it sound.

Darkness Visible: A Memoir of Madness, by William Styron, is another classic on depression that I really ought to read, but haven’t yet because I’m not that fond of Styron’s writing. (Sophie’s Choice is his best-known work.)

For mania, I recommend Just Like Someone Without Mental Illness Only More So: A Memoir, by Mark Vonnegut, M.D. The son of Kurt Vonnegut, Jr., the author deals less with his celebrity father, instead focusing on his saving-the-world-style mania during his pursuit of an M.D. degree.

Other books that I can recommend include:

  • My Lobotomy, by Howard Dully, a memoir of a boy who was lobotomized for no particular reason other than the fact that his stepmother hated him, and the difficulties he encountered in and out of institutions.
  • Ten Days in a Mad-House, by Nellie Bly, early undercover journalism at its finest. (I wrote about her experiences in one of my earlier posts: https://wp.me/p4e9Hv-hG.)
  •  Shrinks: The Untold Story of Psychiatry, by Jeffrey A. Lieberman, a history of the development of the field from the buried memories days to the biological understanding of today.
  • The Man With the Electrified Brain: Adventures in Madness, by Simon Winchester (who also wrote The Professor and the Madman, about the making of the Oxford English Dictionary). Despite the title, this is not about electroshock treatment, but rather dissociative states.
  • Rebooting My Brain: How a Freak Aneurysm Reframed My Life, by Maria Ross; and My Life Deleted: A Memoir, by Scott Bolzan. These books, about a cerebral accident and amnesia, respectively, don’t speak directly to bipolar disorder, but I found them interesting as accounts of rebuilding one’s life after a significant mental condition.

And for an opposing point of view, if you must, there’s Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America, by Robert Whitaker. Once you’ve read the title, you pretty much know how the book’s going to go; I don’t recommend this anti-psychiatry screed.

What books do you recommend? Which have helped you?

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.

Bipolar Robbed Me of Reading

I don’t remember a time when I couldn’t read.

Except when bipolar disorder took it away from me.

I was what they call a “natural reader” – someone who learns to read without being taught. Someone who just picks it up out of the air. And for me, reading was like breathing. It kept me going, kept me alive. Reading was part and parcel of my identity. I was never without a book within reach. I read while eating, walking down the hall, going to sleep, riding in a car.

Throughout my undiagnosed childhood years, reading was a way for me and my brain to play nicely together. If I was depressed, I could lose myself in escapist fantasy. If I was hypomanic, I could soar on adventures. And during the in-between times, I had access to unlimited worlds – places, people, situations, ideas, conversations – both familiar and strangely new. Reading was my joy and my solace.

For many years, reading was therapeutic. I could not only lose myself and escape the unpleasantness of my disorder for a time, I could learn more about depression and bipolar disorder, compare my experiences with those of others who struggled with mental illness, discover how medicine and law and psychology and sociology could shine a light on my experiences. I could even (God help me!) read self-help books, which were popular at the time, and learn all sorts of theories and techniques that didn’t improve what was wrong with me.

Books and words were my life. I got degrees in English language and literature. I read for work and for fun. I edited magazines, wrote articles and (occasionally) children’s stories, worked on textbooks.

Then my brain broke and reading went away.

I had a major depressive episode, which lasted literally years, and during that time I found it nearly impossible to read.

Why? My old companions, depression and hypomania.

Depression made me dull. I didn’t care about anything and found no happiness even in the books that had always been my refuge. I remember picking up a book that I more than loved and had returned to dozens of times, that had shaped my life in many ways, thinking that the familiar words would touch something still buried inside me. But this time there was no magic. Not even interest. The words were flat and dull, mere ink on the page. Reading – engaging with an author’s ideas, imagining characters, following plots and dialogue, discovering facts – was beyond me.

And hypomania? My version, instead of bringing euphoria, brought anxiety – an overwhelming twitchiness and fear of the unknown, jumping not just at shadows, but at the idea of shadows, things that had never happened. My attention span shrank to nearly nothing. I could barely read a few pages, not even a chapter, and when I was finally able to get back to a book, I was lost, disconnected.

Now that I am recovering from that episode, I am glad to say, I can read again. I read myself to sleep at night once again instead of crying myself to sleep. I devour entire chapters, keep at least two books going at once (one fiction, one nonfiction), delight in revisiting old favorites and seeking out new authors and genres (YA fiction and steampunk) and topics.

Not everything I read is uplifting. At the moment I’m deep in Octavia Butler’s Parable of the Talents, a post-apocalyptic science fiction dystopia that is eerily prescient for a book published in 1998. But I can tell when it’s getting too deep and frightening and switch off to Jasper Fforde’s Thursday Next literary fantasy Lost in a Good Book before the strife and struggle can drag me down.

And I can tell you this: It’s better to be lost in a good book than lost in your own broken brain.

 

The Scientific Tease

Fun doctor

I know the headlines and accompanying news stories are supposed to give us hope: New Treatments for Mentally Ill, Scientific Advances for PTSD Suffers, How Research Is Finding Causes – and Possible Cures – for Bipolar Disorder, Brain Science May Explain OCD.

But the reality is that those headlines are teasers. Once you read the story, you realize how little is new, how far from reality the science is, and how long it will be until the supposed cures make any difference.

I’ve written on the subject before (http://wp.me/p4e9Hv-7Z), and included a link to a short video that explains the scientific process, from original study up to the time when a new drug or treatment hits the market (http://www.vocativ.com/culture/junk-science/).

But drugs aren’t all the scientific world is offering for people with bipolar and other mental disorders. There are transcranial stimulators, magnets, fMRI, and other technologies that hold promise for at least understanding our illnesses and, in some cases, treating them. Studies of the human brain, DNA, epigenetics, neurotransmitters, precursor chemicals, and more are touted as ways to unravel the mysteries of why some people get mental illnesses and some don’t; why some medications work for some people and not for others; and how the medications that actually do work do what they do.

If you are buoyed by the hope these scientific articles and the advances they hold out, you may envision a world in which parents can tell when a baby is liable to depression and watch for early signs; a troubled teen can be diagnosed with bipolar 1, 2, or psychotic bipolar; which particular “cocktail” of drugs is the best fit for an individual; how a small machine can send signals to the brain that will ease the symptoms of, well, anything.

Unfortunately, that’s not true. Oh, there is scientific research going on – although there would be more if funding for mental health issues were taken more seriously. But not all that research will result in effective, practical treatments for mental illness – more closely targeted drugs, new understandings of various psychological models, new methods of diagnosis. A breakthrough, when it comes, may even be discovered as an unexpected side effect of something else entirely.

Besides, can you imagine these wonder drugs and diagnostic tools, and nanobot treatments (or whatever) making it to the vast majority of the mentally ill? Will psychologists be able to send clients to get an fMRI to pinpoint problems, and will the insurance pay for that? How would you convince a homeless schizophrenic to place his head in that clanking machine, hold still for half an hour, and answer question? How long will it take the FDA to study and approve a new drug, and will it cost $12,000 or more per year? And will insurance coverage even be available because it’s still considered “experimental”?

Frankly, I can’t see most of these heralded miracle treatments making their way down to the community mental health center level anytime soon, even once they’ve been developed, tested, proven, and put on the market. Like so much of medicine, I fear psychiatric advances will be available only to the rich or those with platinum-level insurance. And although one in four Americans will experience some form of mental illness in their lifetimes – and millions more friends, relatives, caregivers, and loved ones will be affected by it as well, psychiatric topics don’t draw government or university funding or charitable support the way other conditions like HIV, breast cancer, and heart disease do.

So forgive me if I see those uplifting headlines and think, “Pfft. More pie in the sky.” I do think progress is being made and will continue to be made, but I doubt whether it will be soon enough, or tested enough, or cheap enough, or available enough to benefit me. You younger folks, now – you may still reap the benefits of these remarkable advances. But in the meantime, while you’re waiting for that magic pill or Star Trek device, keep on taking the meds you’ve been prescribed, and talking to your psychotherapist, and building a support system, and taking care of yourself.

For now, let’s work with what we’ve got.

Trigger Warning: Trigger Warnings

What is a trigger warning?

Let’s start with a more basic question. What is a trigger?

Just as a literal trigger activates a gun, a figurative trigger activates your mental disorder. It’s a stimulus that sets off either a manic or depressive phase, or a bout of PTSD.

Triggers are usually unique to the individual. What sets you off may not affect me at all.

Over the years I’ve learned what my triggers are, and so do most bipolar or PTSD sufferers. Loud noises and large crowds trigger my anxiety, which is why I could never work at a Chuck E. Cheese. My depressive phases don’t often have triggers except for bad dreams about an ex-boyfriend. Most of my depressive episodes just happen without a trigger.

Generally, one avoids triggers, because who needs more manic or depressive phases in addition to those that occur naturally, with no prompting?

A trigger warning is something else. It is a notice that someone puts at the beginning of a piece of writing to warn readers that the subject matter may be intense. Ordinarily, trigger warnings are given for major life events that have caused trauma and may cause flashbacks, severe stress  or other extreme reactions.

Some of the most common trigger warnings are for graphic depictions of rape, suicide, self harm, or physical or sexual abuse. The trigger warning says to a potential reader: If you don’t want to encounter this material, if you think it will make your illness worse, or cause you undue stress, don’t read any further.

Although we call relatively minor stimuli triggers, they usually do not require trigger warnings. If you’re going to write about having a fight with your mother, you probably don’t need to put a trigger warning on it. If your mother hit you in the face with a frying pan and sent you to the ER, you might need to place a trigger warning on your post about it.

Online, the standard form for trigger warnings is first to state, often in all caps, TRIGGER WARNING and state the type of trigger it is – TRIGGER WARNING: SELF-HARM, TRIGGER WARNING: SUICIDAL THOUGHTS, etc. To be extra sensitive, the writer leaves a number of blank spaces or a few dots before beginning to write the difficult material. This gives the reader the choice of whether to scroll down and read it or not.

Trigger warnings have become controversial, particularly in schools and colleges. Many pieces of literature and even textbooks on history or sociology discuss difficult topics that may be triggering. For example, a novel might feature a rape as a plot point, or a history text might discuss slavery.

Some people believe that a trigger warning will help a prospective reader know whether reading further will provoke a strong reaction. Other people believe that trigger warnings are a way of coddling the weak and letting students avoid challenging material that is necessary for the class.

My own opinion is that a trigger warning is like chicken soup: It won’t hurt and might help. It may mean that a student asks for an alternative reading or assignment, but it also may mean that the student simply wants to be in a safe space – not surrounded by strangers, for example – before reading the material.

People that believe trigger warnings should not be given have usually not experienced the kind of emotional breakdown that can result from unexpectedly confronting a traumatic topic. Very likely they have never even been in the presence of someone who has had such an extreme reaction.

I suppose that ideally, we could all read any material and simply brush it off if we found it troubling. Unfortunately, for those of us with mental disorders such as bipolar illness, PTSD, and anxiety disorders, this is simply not possible. A trigger warning may prevent someone from having a public meltdown and others from having to witness one.

I don’t know why that should be controversial. It seems like simple courtesy to me.

Things That Work – Sometimes

Right now I am in the middle of a fairly deep depression. It has gone on for days, which is unusual now that I am more or less stabilized on medication. But there is no let-up in sight.

This time is one of those I-have-nothing-to-look-forward-to moments; plus the holidays; plus the need-to-see-my-therapist thing; plus the have-an-appointment-with-new psychiatrist-but-it’s-not-till-March thing; plus the whole no-spoons-to-get-out-but-really-need to-get-out-of-the-house feeling; plus the various catastrophizing-about-finances-and-the-IRS problem; plus the there’s-something-I-really-want-to-happen-but-if-it does-it-won’t-be-soon-and-may-not-happen-at-all.

Let’s see. Is there anything else?

Oh, probably, but that will do for starters. Of course to a lot of people, those would be everyday annoyances and I would be having your standard pity party. But for a bipolar person, with my brain chemistry, it’s an invitation to a deep, dark pit.

So what are the things that help pull me through, or out, or up? And what are the things I can do while I just ride it out?

Well, there’s music. I’ve written about that before (http://wp.me/p4e9Hv-42). There are two long-form musical bits that have been known to lure me out: The Mikado and The Pirates of Penzance. Occasionally when I haven’t gotten out of bed in a while, my husband will put on a DVD of one or the other and wait for me to appear in the door of his study. There is usually beer or snacks, and I can sing along (badly but loudly) to my heart’s content. Heart’s content – now there’s a good thing. Going to see live productions of Gilbert & Sullivan was an activity my sorority used to do, and one of my best memories of otherwise-difficult sorority life. (I mean, really, can you picture me in a sorority?)

Then there are distractions. These don’t actually improve my mood, but they can help me avoid dwelling on the above list of what’s-wrongs. If I have the concentration needed to read, that’s my go-to choice. (I’ve also written about “comfort reading”: http://wp.me/p4e9wS-3n.) I usually try to keep one fiction and one nonfiction going, so I can switch back and forth.

Sometimes, though, I don’t have the concentration to make it through a chapter. Then it’s time to try TV. Something familiar, non-challenging, not too fast-paced. Cooking shows work, or something like Pawn Stars. True crime or true medicine. Shows where I already know the characters and the back-stories: Castle, Bones.

When I don’t even have enough concentration for that, I go for stupid clicky games. One round of Candy Crush Soda Saga is about as mindless as you can get and still be breathing. Even playing out all five lives takes about 15 minutes. Or I can turn off my brain entirely, play obsessively, and get lost for hours of not-worrying about anything more important than making six-letter words in AlphaBetty.

Occasionally I can do light-as-popcorn forms of social interaction. Phone calls with a depressed friend or one who always has a silly joke ready or one who reads the same sorts of things that I do. Instant messaging. Facebook.

Sometimes, though not often in this state, I can force myself to work a little. Or work on my blogs. It’s difficult and not really satisfying and sometimes even painful, but if I can do it, it’s probably the best thing for me. Accomplishing something – anything – helps build a step out of the pit.

As for the usual advice – rest, exercise, nutrition, meditation – I usually can’t manage those. Except for sleeping. I’m a world-class napper. Also a world-class insomniac. Don’t ask me how I manage that. It’s a gift. I have a new exercise regimen that involves walking up and down the stairs more times than I really have to. My husband makes sure I eat at least one good meal a day. For meditation I pet a cat.

Then I wait.

I know that this will not last for weeks or months or years the way it used to. I’m just going to be miserable until I’m not anymore.

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