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Posts tagged ‘support systems’

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.

 

Tracking Your Moods: Low-Tech, High-Tech, and In Between

Many therapists and people with bipolar disorder recommend journaling as a practice that allows you to track your moods and figure out what your triggers are. And many individuals do well with journaling.

I didn’t, however. I tried starting a journal of what I was doing and what I accomplished daily. It rapidly turned boring and whiny. My entries looked like this:

Accomplishments:

  1. Paid cell phone.
  2. Forced myself to finish work assignment.
  3. Finally got off that stupid level of that horrible Candy Crush.

Writing is what I do, but journaling, especially when depressed, was an unrelenting series of pitiful nothing. Instead, I started this blog (on 1/7/14). In my blog, I could write about anything. Still, it wasn’t much good as a way to track my daily moods.

Technology is starting to address that problem. Recently some inventions have come on the market that promise to help you track your moods not just daily, but hourly (or even more often). Most of these devices resemble what would happen if a Fitbit and a mood ring had a child.

Most of them claim to monitor your moods by tracking your heart rate and/or your breathing. (One notes that it tracks your steps too, so you don’t need an extra device to do that. Another promises to monitor galvanic skin response, pulse, and skin temperature, which sounds more like a lie detector than mood tracking.) Then you take that data and compare them with what you were doing at the time and voilà – a mood journal.

Of course, these devices make certain assumptions – for example, that when your heart rate is elevated, you are anxious or tense. Needless to say, there are plenty of other things that can raise your heart rate and breathing. Sex, for one. Or running. Neither one of which is necessarily a source of anxiety for everyone. There is, as far as I can see, no way for the device to tell when you are depressed. They appear to assume that everything except anxiety is normal.

Then there’s the fact that you still have to journal. The devices work on the theory that you can look for patterns in your breathing and respiration, then figure out what you were doing when that happened. Upgraded devices and apps are planned that will add calendar and location functions to make this easier. But if you’re in your house the whole time the moods are happening, it won’t tell you much.

(One brand of these devices is available only from an employer, health plan, or EAP, which, if you ask me, is pretty creepy. If there’s anyone I don’t want to have information about my moods, it’s my employer.)

My friend Mike came up with an in-between solution that uses both higher-tech and lower-tech approaches to monitoring his moods. Over a period of several months, Mike had been on four different drug regimens for depression. Not all of them worked, and he was unsure which did the most good.

His idea was to go to his social media and chat apps and take a look at when he was the most active, engaged, and responsive. Then he looked at what medication he was on at the time. He noticed, for example, that in the first few weeks of April, he was posting more about accomplishments and responding to others’ posts and chat messages. A quick check of his pharmacy records and he had a pretty good idea of which medications were working best. No journaling involved – the evidence of his increased energy was right there in front of him, already recorded. And no $150 expense for an emotional tracking device.

Maybe journaling is right for you. Maybe a wearable mood tracker is the thing that will help. But don’t overlook the tools you already have. Think about them in new ways and you may already have a handle on understanding your moods and meds.

Sources

https://www.l2inc.com/daily-insights/spire-wants-to-be-the-fitbit-for-your-emotions

https://www.entrepreneur.com/article/239743

http://nerdist.com/sentios-feel-wristband-fitbit-for-your-emotions/

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.

Five Things Psychotherapy Has Done for Me

Why pay $250 an hour just to talk to someone?

That was my sister’s reaction when I said I was going to start seeing a therapist. This is my answer.

Mental health symbolWell, Lucy, while a psychiatrist doesn’t cost 5 cents anymore, therapy can be had for a lot less than $250. There are community mental health centers with sliding fee scales – which is what I was going to then. There is insurance, for now at least. I’ve even known psychotherapists who would accept less than their usual fee for long-time patients in temporarily dire straits.

And I’m not paying to talk to just “someone.” A therapist usually has at least an M.A., and sometimes a Ph.D. Psychiatrists have an M.D. or D.O. They have years of training, more years of experience, and colleagues they can consult if your problem is particularly challenging or out of their area of expertise. You can also find peer counselors, religious counselors, and proponents of every variety of therapy or treatment you can name, from neuro-linguistic programming to electroconvulsive therapy.

Now, as I reflect on my clueless sister, I’ve started thinking about all the things that therapy has done for me.

Diagnosis. When I first started going, back in the 80s, I could only afford one of those community mental health centers with the sliding fee scale. (At the time, I paid $5 per session.) There I was diagnosed with depression. The primary treatment they offered was “talk therapy,” but I had years and years of mental difficulties to talk about. Later, when I was seeing a psychiatrist, I was re-diagnosed with bipolar 2 and anxiety disorder. Suddenly, my past became a lot clearer, even if my present was still messed up.

Medication. There has been a lot of it over the years. I started, as so many did, with Prozac, which had a noticeable effect on my depression. It was like the difference between watching a black-and-white TV that got only one channel that showed only tampon commercials, compared to a wide-screen color TV that got hundreds of cable channels. The meds I’m on right now keep me functional, at least enough to make a living and be creative.

Perspective. When I first started going to my current therapist, the word I used most often to describe myself was “pathetic.” I no longer call myself that. Dr. B. helped me view parts of my past in a different light and helped me develop techniques and strategies to deal with the problems I was facing at the time. Now she keeps me on track, reminding me that I have the tools to cope with many of my recurring problems. And she reminds me how far I’ve come since my “pathetic” days.

Couples counseling. When we married, I was still smack in the middle of clinical depression. (My husband had problems too, but I don’t want to talk about them here, except to say that a codependent and a depressive living together can never decide where to go for lunch. And that was the least of our difficulties.) Several times since then, we have had to turn to counselors to work on problems related to sex, money, and just plain living and communicating together.

Group therapy. Actually, though I’ve attended group therapy a few times, what I’ve learned from it is that it’s not for me. I do appreciate the fact that it’s there if I should need or want it, and that my therapist can recommend a group if she or he is going to be away for a while. Perhaps I just haven’t found the right group yet, although the support communities I’ve found online may serve part of the same purpose.

In short, therapy has given me my life, my sanity, my coping skills, my emotional strength, and my creativity back. And I can definitely say that professional therapy has been worth more than 5 cents, or whatever insights my sister could have offered.

 

Who’s Crazy Now? A Guide to Gaslighting

“You’re crazy. I never said that.”

“That’s not the way it happened. You’re crazy.”

“No one believes you. You’re crazy.”

“You’re crazy. You’re just overreacting.”

What do these statements have in common? Obviously, they involve one person telling another that she or he is crazy.

More subtly though, the speaker is saying that the other’s perceptions and feelings are invalid, untrue – wrong.

And that’s gaslighting.

Gaslighting describes a mind game that emotional abusers use to control their victims. (Gaslight is also an old movie, in which a husband uses the technique to try to convince his wife that she is insane. The victim of gaslighting is usually a woman and the perpetrator usually a man. Of course this is not always true. Either sex can be the gaslighter and either sex the gaslightee.)

But what does gaslighting have to do with bipolar disorder? Someone who is in the depressive phase of bipolar – especially one who is undiagnosed – is especially susceptible to gaslighting. The very nature of depression leaves a person wondering, “Am I insane?” To have another person reinforcing that only strengthens the idea.

Back when I was undiagnosed and in the middle of a major depressive episode, I had an experience of being gaslit. My grasp on reality was not entirely firm at the time, both because of the depression and because I was physically, socially, and emotionally cut off from the outside world, family and most friends. This isolation left the gaslighter, Rex, in a position of control.

I endured everyday denials of reality, like those mentioned above, but the most obvious one – the one that made me aware that I was being gaslit –happened when I suggested that we go for couples counseling. Rex asked if I was sure I wanted to, as he and the therapist could declare me a danger to self and others and have me put away. That, of course, was not true and I knew it wasn’t, which gave me my first clue that something was amiss.

When we got to the couple’s sessions, Rex tenderly held my hand and spoke of how concerned he was about me and how much he wanted to help me get better. In other words, he was saying that I was the crazy one, and that he wasn’t. That is the very basis of gaslighting – to make the other person seem or possibly even become crazy.

Once a person recognizes the gaslighting for what it is, she can begin learning to trust her own perceptions again. For a person in the grips of depression or mania, this will not be easy. I know it wasn’t for me.

It took a long time and a lot of healing before I could recognize what had happened, how my circumstances had been controlled, how my perceptions had been invalidated – how I had been gaslit. That was a vast revelation. It was like turning the tube of a kaleidoscope and seeing a different pattern come into focus. The elements that made up my life may have been the same, but the new perspective changed everything.

Having someone outside the situation who can validate your perceptions is an important tool in recovery. Sometimes a friend or family member can perform this function, but mental health professionals who have been trained in the process are often more successful. They are the people we often turn to to tell us we are not crazy, that our feelings are valid, and that being the mind game of gaslighting has affected us.

Getting help for the depression or bipolar disorder is also an important step in escaping the effects of gaslighting. With proper therapy and/or medication, a person’s thinking becomes more clear, accurate, and trusted. Turning off the gaslight is like turning on a much more powerful kind of light – one that illuminates your life, improves your clarity of vision, and begins to break through the gloom and despair.

And that light is more powerful than gaslight.

Furry Friends and Helpers

I’m sure we’ve all seen memes that say the best therapist has four legs and fur. When I’ve been feeling cranky, I have occasionally written responses to the people who post them. They demean the very hard and real work that psychiatric and psychological professionals do. And after all, what do the memes really say? “Have a mental illness? Just get a dog.”

Still, there are circumstances in which an animal can help a person with a mental or emotional disorder. It’s not as simple as going to the pound and picking out a pup, though. For an animal to assist a psychiatric (or other) patient, there are a number of hoops for the person to jump through.

Most people nowadays are used to the presence – or at least the idea – of service animals such as seeing eye dogs. Less common are Therapy Animals, Emotional Support Animals (ESAs) and Psychiatric Service Animals (PSAs). But they all have parts to play in promoting and maintaining mental health in persons with bipolar and other emotional disorders.

Therapy animals are most often used with geriatric patients and children with emotional disturbances. In some nursing homes and convalescent centers you find programs that bring small animals to interact with the residents. Even farm animals – chickens, lambs, piglets – may spark memories that had been hidden away for years. The animals help residents get in touch with those memories and caregivers get in touch with residents. Libraries sometimes bring calm, well-behaved dogs in so that children can read to them. The soothing presence of a well-trained dog can help a child self-regulate her or his emotions – and get reading practice at the same time.

Emotional Support Animals are dogs or cats (or, less commonly, other animals such as miniature horses or guinea pigs) that live with and provide comfort to a person with a psychiatric disorder. Typically, in order for an emotional support animal to be allowed in rental housing, documentation such as a letter is required from a physician or mental health professional stating that the animal’s presence alleviates symptoms of a patient’s psychiatric condition – one that qualifies as a disability under the Americans with Disabilities Act (ADA).

Regulations covering comfort or emotional support animals apply mostly to residences and airlines, but not other places where service animals are allowed, such as stores, restaurants, and public buildings. There, health codes trump emotional support.

Some folks confuse Emotional Support Animals with Psychiatric Service Animals. They think that “training” a dog to offer a kiss on command, or jump in their lap, or be hugged is a task qualifying the animal as an official service animal. While these are indeed ways that an animal can calm a person in distress, service animals, including psychiatric service animals, must receive special training that teaches them how to alleviate the symptoms of an ADA-defined disability.

Legitimate tasks for PSDs (psychiatric service dogs) include counterbalance/bracing for a handler dizzy from medication, waking the handler at the sound of an alarm when the handler is heavily medicated and sleeps through alarms, doing room searches or turning on lights for persons with PTSD, blocking persons in dissociative episodes from wandering into danger (i.e., traffic), leading a disoriented handler to a designated person or place, and so on.

In The Possibility Dogs: What I Learned from Second-Chance Rescues About Service, Hope, and Healing, author Susannah Charleson recounts how rescue dogs – the unwanted, unlikely-to-be-adopted dogs that languish in shelters or are destroyed – have been matched with persons who need them.

One of the stories she tells involves training a dog to help a person with OCD. The dog was taught to identify when the handler had returned to the stove three times (to check the burners). Then the dog would interrupt the person, leaning against her leg to distract her. For a person who could approach a door but not go outside, the dog brought a leash to encourage leaving the house for a fun activity.

By the way, forget about cats as service animals. Just try training a cat to do anything it doesn’t want to do. (I know that cats have been trained to run obstacle courses for agility competitions, but that doesn’t really qualify as a service for an individual with a disability.) If you are able to register your cat as an Emotional Support Animal or get a medical/psychiatric recommendation, you may be able to have your cat live with you in a pet-free community, or have the fee for a pet waived. But that’s about it where cats are concerned.

So, animals can’t be actual therapists, but they can assist in treatment and life skills for people who need help with mental disorders. When I’m less cranky, I keep scrolling past the pet-as-therapist memes and feel grateful that my cats offer me emotional support, whether they’re trained to do so or not.

 

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