Tag Archives: Dual diagnosis

A Familiar Conversation

Those who share some of my issues will be relieved to know that I am taking steps to obtain a supply of my bipolar meds again. Having dropped the ball during the previous months and the stresses I’ve been having, I have been without them for nearly a month now…and it’s not good.

At last, I became resigned to using precious funds on a visit to my old psychiatrist, because my plans to find a new one hadn’t panned out and there was no longer any time to lose. However, when I called the number, I found out the practice had just closed. Turns out he is still in practice, but with a new group clinic. So I called the number, and was told I need to go through the standard intake process before I can be given an appointment with him or anyone else. On the bright side, they might be able to match me with someone who will take my insurance for part of the cost.

So, yesterday, I found myself participating in an intake conversation. This feels weird on a couple of levels: first, it always feels overwhelming for me to try to summarize my present and/or past condition (can I just give them the address of this website, please?)  Second, the questions on the intake are familiar to me from both ends: before my diagnosis, I worked at a counseling center and did phone intakes regularly.

I know why they have to ask certain questions, and I know what answers they are looking for. I know what red flags they are trying to spot. I know the clinical descriptions of the things they describe. And although I know these things, I need to answer the questions like a patient and not a co-clinician.

Something else about this, for my readers who share my issues with addiction: the intake person asked me about any history of substance abuse. If it hadn’t been on the form, I would have brought it up myself. Whoever I end up seeing will, like my old psychiatrist, be fully informed about my history of addiction and recovery. I can’t overstate how important this is: one of the drugs I used to abuse came from a psychiatrist years ago. It wasn’t their fault, but as a person in recovery it’s my responsibility to make sure doctors of any kind know that certain drugs are not appropriate for me.

At the end of the questions, I was told they need to consult my insurance before they can schedule me an appointment. They will call me back, the intake person said. I promised myself I’d wait at least until tomorrow before calling again, but I feel anxious because some medical “we’ll call you back” things have not gone well lately.

So that’s what’s going on. Nothing very fun or inspirational right now, but I know many of my readers have been there. Part of living with our conditions is sometimes doing that footwork, one step at a time, and dealing with the frustration of not doing it very well.

The Cycle of Apologies

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I am so tired of apologizing, but I don’t see how I can stop doing it. I’m not even sure I want to stop doing it.

I don’t want to live my life as a walking apology, but I also don’t want to become the kind of person who sees no need for regrets about how my condition and/or my shortcomings affect others.

Recently, I was having an interaction with someone that involved me sending an email every day for a certain purpose. I was consistent for a couple of weeks, then skipped days. When my dip ended, I began again, apologizing for my lapse and saying it was okay if they didn’t want to continue. They gave me another chance…and, after some days, it happened again.

It’s only the latest iteration of the type of cycle that defines my life:

Stage 1: I’m back! So sorry I haven’t done the thing for (insert length of time here.) I’m going to try really hard to do the thing again, because the thing is very important to me. 

Stage 2: Look, I did the thing. See? I did it some more. I can do the thing. I can do the thing every day. So grateful to be doing the thing.

Stage 3: I am sort of doing the thing, but not well. I’m sorry. Can we talk about this later?

Stage 4: *silence*

Stage 5: Hi. I haven’t been doing the thing. I want to start again and I can’t and what does it matter anyway because I know even if I do it won’t last and I’m sorry, so sorry; I know you must think the thing isn’t important to me but it is, I swear it is, and so are you…

Was it unrealistic of me to even try something that relied upon consistent, daily performance of a task? What if I had said, look, I really want to do this, but I have a mental health issue and a history of interruptions in my functioning? Would that have been being realistic and sensible, or would it be seen as making excuses?

What if I say to my doctor, look, I’d like to nod and smile and tell you I’ll exercise every day, but the only exercise I have been getting during the really bad times is digging through cupboards for band-aids?

Where is the line; where does a realistic assessment of my condition end and making excuses begin?

Could I be allowed to stop making promises, or even implied promises, that set me up for the inevitable apologies?

There’s no way for anyone else to assess, or even for me to assess reliably, the subjective amount of effort I’m making. So how can I, when unable to perform consistently, express that the thing, principle or person is still important?

Can I ever be good enough, do enough, love enough to have it mean something?

These are not new thoughts, and the search for balance will never end. I’ve made progress on some aspects of it. I’m better about not making commitments during my “up” phase that are completely unrealistic, and I’m more forgiving of myself than I used to be. But shame still saps way too much of my energy, and delays the return of good self-care after a dip.

I want to conquer shame and let my apologies be simply an expression of regret–always remembering that an apology means little in the absence of a sincere effort to do better.

When All Else Fails…

Tell the truth. It’s something I tell myself about the things I write. Can’t be clever, or cute, or topical today? Then just be authentic. Tell the truth about something, and let it be enough. I’ve been surprised, sometimes, by what eloquence emerges or where it takes me.

Truth: I’m sick. Sicker than I’ve been in a long time. Dangerously depressed, physically ill in ways that are making it much worse, and apparently bent on my own destruction. The slow slide of the past year is accelerating, and I’m afraid I won’t be able to stop it. I fled a recovery convention early two weeks ago, unable to tolerate the crowds and unable to shed my shame long enough to celebrate still being clean.

Truth: I stopped taking my meds for nearly two weeks and now have to titrate the dose up again.

Today I had another medical appointment. I got some more of my blood work back, and confirmed that the thyroid issues are getting worse and not better. My blood sugars are acting up, thanks to the weight gain

(insert every gut-clenching description of shame and frustration I’ve ever written here)

and I need to monitor them and take a little medicine for them again. As for the hormones, apparently my bipolar meds are interfering with the treatment.

I am at last being referred to an endocrinologist, but it will most likely be a slow process. I am being advised that the best, most disciplined eating plan I can carry out should not be expected to do more than (hopefully) keep me from gaining any more.

My meds are covered for another six weeks or so…time is running out to find a psychiatrist who takes my insurance and is willing to accept a new patient.

Meanwhile, life is happening to my loved ones and they need me. They need me to love them, and help them, and be capable of thinking.

Truth: I would rather die than fail them. The trouble with this sentiment is that dying would be failing them.

Truth: The early posts on this site annoy me now, because they were written by a woman making strides forward in her recovery. As I fear sliding back in time, I become the audience she is trying to reach. I resent her for having hope I don’t, even as I wonder how I can become more like her. I wouldn’t give up what I have learned, but I don’t want to believe I will never feel so much grace again.

I am ill enough not to be able to come up with the longer pieces I enjoy posting on this site; attempts tend to peter out after a couple of hundred words. I am giving myself permission to post shorter things until I improve.

So, goodbye for now. Only for now. I have not given up.

Don’t Take This From Me

All right, bipolar disorder. You try to take a lot of things from me. Sometimes you succeed, and sink your claws into your prize until I wrench it back. Fine. Keep trying to take my sleep. Or my energy, or my sex drive, or my consistency, or any optimism about the future…go on, I’ll keep fighting the good fight against you.

But not my ability to think. Not my intelligence. Hands off.

I want to believe that this creative slump I’ve been in is just that: writer’s block, or a dry spell. Perhaps the natural result of some life stresses, or mental fatigue from some recovery work. A normal, natural ebb tide in the rhythms of my mind.

I don’t want to see that a lack of creativity can also be the result of impaired ability to think…and I’m terrified of seeing that kind of impairment in myself. I know it’s a fact of life when living with bipolar disorder: depression can make it hard to concentrate, hypomania can make it hard to focus, and meds can have side effects that blunt our sharp mental edges. Intrusive thoughts, feelings of unreality and any number of mental hijinks mean our processing speed can go way down when responding to input.

“But what if it’s not just that?” a terrified voice whispers in my head. “What if in the last decade you’ve actually lost something? Forever?”

Am I getting dumber?

It doesn’t help to know that there are multiple ways to answer such a question. It doesn’t help to know that for everything I may have lost, there has certainly been growth in other parts of my psyche. It doesn’t even help to remind myself that all humans face mental as well as physical declines that come with age.

The terror I feel is illogical; it’s the terror that comes from a threat to my sense of self.

It’s the terror of the question: “If I’m not smart, what am I?”

My brain is the only thing I ever learned how to trust: not my body, and certainly not other people. My brain was what let me escape into books. It was the only thing that let me build some self-esteem with test scores and teachers’ approval; it helped me win a chance for more education and a different life. It let me build an internal world strong enough to keep me alive, a world ready to integrate the spirit when I finally began to discover it.

My brain runs the metaphor factory of my psyche. What would I do if its edge got too blunted? How could I live? It’s not a question of self-esteem, although it is a good idea for me to keep examining the idea that I have no worth if I lose a few IQ points.

It’s a question of survival.

Is my fear realistic? I feel anxious even asking. Okay, let’s look at some facts. Line up my current self and my…oh, let’s say 30 year old self. Before the painkillers, before childbirth, before any psych meds but the occasional antidepressant. Give both selves a battery of cognitive tests; throw in an SAT and GRE just for fun.

Results? Yes, there are some real phenomena here. I fall short of the 30 year old in data retrieval speed, working memory, manual dexterity, ability to multitask…ugh. I would imagine the gap is at least slightly wider than a gap created by only the passage of time, too.

Here’s one snippet I found on the subject:

“Mood typically receives the bulk of our attention when it comes to descriptions and discussion of bipolar disorder; however, in my sessions with individuals living with the disorder, it’s common to hear concerns about their lessened cognitive capacities. To be more specific, I’m referring to the experience of decreased cognitive capacity relative to the period of time before any sustained bipolar mood symptoms arrived on the scene.

Examples of the kinds of deficits reported are difficulties with linguistic working memory (word retrieval), difficulties with planning, prioritizing and organizing of behavior (executive functioning), problems with retention of what’s been read or listened to, as well as the experience of mildly dulled or slowed thought processes. For some with bipolar disorder, it’s like they’ve experienced a gradual decline of brain power from their previous baseline level of function.” —Russ Federman, Ph.D. in Psychology Today

This resonates with me; I believe I have lost something. Since I started out with a lot, I’m still very sharp on my good days–but I’ll never be the gleaming tack my younger self was.

Ironically, thinking about this in clinical terms helps me with the fear. By replacing a vague description with specific terms, it reins in my tendency to expand into dark scenarios. It also gives me hope by letting me see that the aspects of my brain function that have taken the hardest hits are not threatening the core of the metaphor factory.

For now.

Poised

What does it take to return from a trip into the dark? A long bout of clinical depression tends to be followed by a long and gradual return, but shorter dips require a quicker springback. How do we master the art of coming back? How do we put aside regret and tackle the life that has piled up outside our door?

Cyclothymia. That’s what my doctors call it. I live with a certain ongoing level of bipolar depression, but within that come fluctuations that tend to last only a few days. After that few days I begin to feel better, but it’s hard for me to poke my head out because I fear what I will find.

There’s an image from science fiction that keeps coming to mind when I think of this. Many years ago, I saw an episode of The Twilight Zone (well, a brief reboot) in which a harried suburban mom finds a magic stopwatch. She discovers that saying the phrase “Shut up!” causes time to stop for everything but her, and “Start talking” makes it resume. At first it’s wonderful: she can hit the pause button on yelling kids to take a bath or nap or anything she wants.

Then, with no warning, sirens blare and the TV tells of nuclear hostilities breaking out. Missiles are coming, there’s chaos in the streets and she is surrounded by crying children and an avalanche of noise. Overwhelmed, she screams “SHUT UP!”

In the last scenes of the episode, she leaves her motionless family and walks through her town among the statues of people frozen in various attitudes of terror. Raising her eyes to the sky, she beholds a missile poised a hundred feet above the ground.

For some reason, the episode made a big impression on me. I kept imagining what she might do next; whether there was anything constructive she could do. Would she load her frozen family into a vehicle and try to travel somewhere away from the kill zone? Would transports even work? How long would she wander alone, making and discarding plans under the poised death in the sky? How long would she be able to stand it before she closed her eyes and whispered, “Start talking?”

When I’m rising from the lower levels of a cyclothymic dip, I feel life waiting for me. But I don’t feel the good parts of it waiting–I’m not un-depressed enough for that yet. What seems poised over my head is a fearsome construct, made up of whatever stressors I had going on before I fell low enough to shut down, multiplied by days of hiding and neglect and whatever damage I’ve done to my body and brain.

A small part of my psyche seems to believe that if I don’t come back yet, these stresses will go away. It wants to keep hiding, even though I’ve returned enough to be miserable and be ready to come out. And when I do begin to engage more, the slightest new stress makes me want to scream “Shut up!” and retreat again.

It takes courage to come out and try to be in the world with some semblance of normalcy again. Perhaps not the kind of courage anyone else would notice or respect, but it’s there. I’m very imperfect at it, but every time I start doing more things you can bet I’m fighting an intense drive to pull away and shut down again.

Coming back at a reasonable pace, a pace quick enough to give me a few good days before my next dip but slow enough to keep me from freaking out, is a skill set I’m acquiring slowly. I try to be conscious of where in the cycle I am, and make a point of not trying to do too much the first day I feel better.

It’s been more than four years since I stopped using drugs to deal with my mind. I’ve still struggled with using food, with varying degrees of success. I’ve worked with doctors to treat my disorder, balancing benefits and drawbacks of different meds. I fully expect to deal with these cycles for the rest of my life.

This fear of coming back I describe, the fear that the poised missile made me feel, is my enemy. The greatest development I could see for my soul in this life–the thing that would bring me closer to being the hero of my personal dreams–would be to win freedom from fear’s rule.

I Miss My Badge

I don’t want to be here today.

Today, I don’t want to be a poet, or a homeschooling mom, or an unpublished writer, or an addict.

Today, I especially don’t want to be a person with bipolar disorder.

Instead, I want to be putting on some professional-looking clothes and driving to my job at a hospital, or treatment center, or therapy clinic.

I want to wear a badge with my picture on it.

I want to sit down in a consultation meeting with my colleagues and discuss clients. I want to write case notes. I want to be giving presentations to groups.

These desires and the regrets about not being able to have them are a regular part of my life. So why do I feel them so sharply today?

In our storage space, there are several boxes containing my textbooks, notes and papers from my time in graduate school. Things I read and wrote between 2002 and 2005–not all of them, but the ones I felt to be worth keeping through several moves. I’ve been looking through them to find some materials I want for my daughter, who is taking psychology this year.

During this, I got reminded of a couple of things. I looked at papers I wrote, and the teacher’s comments on them, and the tests I took, and I remembered how much potential everyone thought I had. My papers were really good, I was smart, and a highly respected supervisor thought well enough of me to offer me a private internship right out of school.

Picture Marlon Brando, crying out “I coulda been a contender!” It’s how I feel sometimes, interacting with people in the field and realizing I was on track to be one of them.

Reading my work and liking it, reading the words of teachers who used to gush over it, and remembering wonderful moments with clients makes me feel so sad, angry and resentful sometimes. I resent this fucking disorder for stealing my career.

Let me be clear: there’s nothing I’d rather be doing right now than helping my daughter get through high school. I’d like to think that even if I had still been working instead of learning to live in recovery and manage my mental health, I would have postponed whatever needed to be postponed to help her.

But I’d like to have had the chance to make that sacrifice–and I’d like to have hope that I could work in the field again when she no longer needs me at home.

I’m not without hope. There are possibilities for me, if I take care of myself; it’s just that the kind of career I dreamed of is beyond my reach. But I could work in the field someday, if I found an employer willing to accept someone with my kind of history. I have my degrees, and I’m smart, and I don’t have a criminal record.

There are also possibilities for volunteer work, or being able to make presentations at places. I write well, speak well, and have things to say.

Acknowledging all of that, I still need to honor my feelings of sadness today. Not just about the big regrets, but about little things I noticed too. For example, my handwriting used to be a lot smaller. Is it just me getting older, or did the years of drug use steal some dexterity for good?

We all deal with feelings of too-late and if-only. We all battle Gazpacho Soup syndrome at times. I’m used to analyzing my past mistakes. But today, I’m grieving a part of my loss that actually was not my fault. I didn’t make myself bipolar.

Accepting my condition works best when I can see the changes in my life as a stage of development, focusing on what I can learn. But I suppose it’s understandable that I’d long to be in a different or more prestigious classroom sometimes.

Cease-Fire

“I come to thee for charitable license,
That we may wander o’er this bloody field
To book our dead and then to bury them…”
–Shakespeare, Henry V, Act IV, Scene 7

It is not the first battle, or the first defeat. It will not be the last. The psyche is an arena that seldom knows complete peace.

Are you like me? Do you stand on the muddy field after the cease-fire, looking aghast at the damage? Have you stood this way hundreds of times, heartbroken at yet another failure to keep destruction contained?

Maybe it was a full-scale war, months or years long, ending in severe consequences for your life in the outside world. Maybe it was a smaller skirmish, one that no one else even saw, only days long–but a day can last a very long time on these unreal fields.

Perhaps your attack against yourself was swift and unsophisticated, or perhaps you gutted yourself with sharp swords and exquisite accuracy.

It does not matter, at this moment. You try to tell yourself it could have been worse, or lasted longer, but right now you don’t care. The point is it happened, it happened again, it fucking happened again.

You scream with frustration and grief. You fall to your knees and pound your fists into the muddy ground. It isn’t fair, you shriek; why does war erupt again and again, why can’t you just stop it?

The sky does not care what you shout at it. The odd bird chirps, loud against the comparative silence that hangs in the air between your cries now that the clash of weapons has stopped.

Eventually you get tired. God, you’re so tired, and the rage isn’t helping anyway, and you fall silent. And when you are quiet, you begin to hear the voices of the wounded.

It’s time to lay it all aside. They are still alive, and they need you. Crawl through the mud to clasp a bloody hand. Lift an unconscious body to a stretcher. Give water. Do the next thing that needs to be done; respond to the next cry.

“I’m sorry,” rasps one fighter as you wash away blood. “Forgive me,” whispers another as you close a wound. They all weep, talking about how they should have tried harder, trained harder, fought harder. They push feebly at your hands, saying their wounds are not so bad. Surely others need you more (I deserve it, I deserve it rings in the background of their speech and your heart replies no, it was my fault, I am the one…)

Some just turn their face away and say “Leave me alone.”

You don’t blame them. What do they have to look forward to, after all? Being carried to the healers, days or weeks or months of recuperation, maybe a few pleasures or times of companionship followed inevitably by another trip to this bloody war zone? Of course the next battle calls to them more strongly than any joy they might find before then. It will take time for courage and hope to rise.

You want to tell them the war is over; that this was the last battle they will have to endure. You want to tell these loyal aspects of your Self that their courage and perseverance are now to be rewarded. You want to tell them it’s time to beat their swords into ploughshares and sing only the songs of peace.

You want to let them rest all winter. You want to lead them, in the spring, to the greening field and let them build a temple to harmony and wholeness.

But you can’t.

Or perhaps you can; just don’t lie to them and claim they’ll never have to defend it. You can’t deny that the enemy is still there, still part of you, and will attack again.

You can make that temple beautiful. You may manage a longer interval before the next conflict. You may reduce the casualties. You may learn to be a better medic. But the war is not over, and never will be.