Tag Archives: Mental health

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.

Across the Chasm

Making some kind of authentic contact with you (and you can be anyone) is hard for me these days. Not that it’s ever been easy, but in the past I’ve sometimes been in settings that help to break the ice.

Right now, I’m aware of a visual metaphor for what happens when I try to meet you. I picture our place of meeting–the place where there is some real, non-bullshit exchange between us–as a small plateau on a rock spire in the middle of a vast chasm.

That’s where the magic happens, but first I have to get there.

In my metaphor, I start out in the swamp. Call it the swamp of shame. Why not? The very first challenge involves shame, because it’s what taking any action requires me to face. To wake up, to pull myself from inertia, means facing shame. The shame of seeing where I really am; the shame of what have I done and how could I have gotten here and why didn’t I do something sooner.

The squelchy ground tries to hold on to my feet with every step, but if I persevere I get to firmer ground at last…Wait. Why can’t I see where I’m going?

Right. I’m out of the swamp, but onto the plain of mental fog.

The mental fog of sleep deprivation. Of a screwed-up metabolism or poor self-care or the damn psych meds so necessary to keep doing my best. Trying to block my path, trick and exhaust me into turning back, or just remind me of how pathetically slow and uncertain my steps are.

But, if I persevere, I reach a place of clearer air and fuck, that’s a big mountain.

Even though experience has taught me that its height and steepness is partially illusory, it’s hard not to be intimidated. The mountain represents the amount of effort needed to take an action in the face of depression, not to mention more mundane resistances such as laziness or procrastination. It takes juice to tackle it, and humility to accept the necessity of one uncertain or scrabbling step at a time.

But, if I persevere, I ascend far enough up the slope to see the entrance of where I need to go and oh god, I do not want to go in there.

Did you ever see Indiana Jones and the Temple of Doom? My condolences. Anyway, picture the bug-filled tunnel from that. Bugs squishing under my feet, my ears filled with the clacking of millions of tiny mandibles, and my skin crawling under the brush of millions of legs.

I’m making my way through the tunnel of resentment. Resentment, envy, jealousy, self-pity…all trying to keep me separate from you. Trying to make you other, or keep me other, or just cause me enough pain and frustration to make me think it’s not worth the trouble. Trying to click and squelch and slime away the love I feel for you and the truth of our human connection.

But, if I persevere, I reach the other side of the tunnel. I’ve left the bugs and enclosing tunnel behind. The ground is firm rock beneath my feet, and the air is clear. I can see the spire ahead of me, and the small plateau where we will meet–and the bottomless, black chasm between here and there.

You probably guessed it. What’s the most primal, deepest barrier to experience? It’s fear. It’s the chasm of fear, and it yawns between me and you.

Fear of rejection. Fear of judgment. Fear of things we don’t have names for, fear that makes no fucking sense in the face of a logical weighing of risks and benefits. Fear ingrained, to a greater to lesser degree, into the most primitive structures of our brains.

I must weave a bridge from gossamer-thin filaments, made from the only materials and power I have. The same materials that made up the rocks my feet found in the swamp, or the handholds on the side of the mountain. The same power that guided me through the fog and illuminated the tunnel.

The materials and power of my self, my stories, the things I believe and the grace that animates them. As thin (but strong) as spidersilk, the bridge they create will make the terrifying journey possible.

Here is the story I tell myself about our meeting. I tell myself that even though I don’t see it, you have gone through a journey of your own to get to that plateau. I tell myself that you’ve got a swamp and a foggy plain and a tunnel and a chasm too. I tell myself that we are kindred, and that we must be pretty important to each other if we go through all of this to meet.

Yet I know I could be wrong–maybe, for you, it really is just going out for a cup of coffee.

Positive Feedback

What has happened to me in the past year, and especially in the past few months, is really not hard to understand from an engineering point of view. It’s a classic positive feedback loop.

If you’re in marketing, positive feedback means people like what you are doing. In engineering, not so much. “Positive” just means that the output of a system is feeding back into it in such a way as to produce more of that same result.

More snow on mountaintops melts as a result of global warming. The snowmelt exposes more dark material where snow would have been. More dark material absorbs more sunlight, causing more warmth, causing more snow to melt, and so on. Science is full of examples of such positive feedback loops.

My recent visit to the endocrinologist (who had a cancellation and saw me within a week, much to my surprise) has me trying to think about where I am in a more logical and solution-oriented way. My metabolism developed a serious problem, we don’t know exactly when. I put on weight, which raised my blood sugars, which affected everything from mood to immune system to energy levels. The thyroid issues got worse, which led to more weight gain and more blood sugar issues. The sicker I got, the crazier I got. The more tired and dumb I felt, the more I neglected my self-care and got sicker. Sometime in the past three months the process sped up.

It is painfully obvious that if I’m going to have a chance to survive this phase of my recovery, I have to accept where I am and try to set aside baggage about how I got here. The endocrinologist has given me meds that will address my issues, but it’s up to me to take them. She has told me my sensible food plan should be adequate once the meds have had some time to work, but it’s up to me to practice patience and not go back to self-destructive eating.

I have to take an active part in healing this body, the one I have at this moment. I can’t wait until 10 or 20 or 40 pounds of it is gone. I need to take this body for walks, and feed it well, and give it its medicine.

I don’t talk much about it on this site, but I used to be a scientist. My first degrees were in the field of biological science, and I used to work in labs. I was trained to think like a scientist…and I have to try.

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.

Lighthouse

There are many reasons I wish I didn’t have bipolar disorder. There are many reasons I wish I weren’t an addict. None of them compare to the gut-wrenching regret about how these conditions affect my legacy to my daughter.

No matter how hard I tried to minimize the effects back when I was using painkillers, no matter how hard I tried to keep my mental issues from overcoming the good things in our relationship, it all had an impact. Today, there have been many improvements and I’m able to do a lot for her that wasn’t possible before.

However, some things don’t change. This incredible young woman still got issued a breathtakingly imperfect mother, and that’s not going to change. She sees me struggle with the large problems and the trivial ones. She sees me be inconsistent with self-care and the tasks of daily life; she sees me go through times of being weepy or rocking back and forth with anxiety or staring at the wall with a flat affect.

I try, as always, to strike a balance between honesty and appropriateness. I have enough observing ego to know when I’m in an episode, and we are matter-of-fact about them and the truth that they will pass.

I do not make a habit of beating myself up about these things, and I know I am passing on some important good messages to her. She sees me fail–but she always sees me try again. She sees me struggle with the impulses of my addictions–but she always sees me work humbly on my recovery. She sees me be sad–but she always, in an hour or day or week, witnesses me hauling myself up with the sheer power of imagination and metaphor. She sees me be down on myself–but she always sees me come back to a place of love and acceptance.

I’m teaching her that we fail, and the world doesn’t come to an end. I’m teaching her that there’s a way back from the dark places. I’m modeling humility, and perseverance, and the willingness to keep trying. I know this–but, like any parent, I want to be better. As a mother, as an addict in recovery, as a person who lives with mental health issues, I want to be a message of hope strong enough to accompany her through anything. I want her to see me fucking win.

I want to be an ever-present, shining beacon. I’m not.

I am a lighthouse.

I shine, and sometimes go dark, and shine again.

Do you know why lighthouses shine intermittently? It’s to help them stand out from stars, or airplanes, or lights from the shore. They catch the eye because of their changes.

I have no intention of taking this metaphor to the point of concluding that my daughter has a special snowflake of a mother whose light is actually better or more guiding than the steadier ones. I’m simply using this image to comfort myself, because it’s what I do.

Perhaps I can use the image to help me accept the truth more, and give myself permission to shine brightly when I shine. Does the lighthouse apologize for the dark period each time its light returns? What a waste of time and brilliance that would be!

Still In Recovery?

This weekend I had the opportunity to attend a special women’s recovery event. Part of me didn’t want to show up–what else is new? I always want to wait until I can present the best version of myself. I want to wait until some magical moment of good health and behavior arrives and appear then, proclaiming “Look, I’m here, this is me! None of those other things are me!”

But I’d been invited, specifically, by a friend who knew I had no money for a ticket and offered me a place at her table anyway. It meant a lot to me, and I was determined not to flake out. So I showed up as I am, carrying the extra weight from my latest bout of self-destruction and the extra weepiness from my latest bout of depression. I did a load of laundry, and washed my hair. I couldn’t wear my jeans comfortably, but at least the yoga pants I did wear were clean.

Hearing women chat about their lives and the people they know, I felt the usual welcome shifts in perspective. My own problems felt a bit less overwhelming as I listened to those of others, and I had the usual–yet somehow always surprising–revelations about how little these women care about my own standards for myself.

Yes, I’d been struggling with food and money and depression. I wasn’t the only one. Others had been struggling with relationships, or battling cigarettes, or had new and serious health problems. There was just one battle we were all still winning at the moment: being drug addicts who were not using drugs.

On my keychain, I carry the medallion I got on my four-year anniversary of getting clean from drugs. If I stay the course, I’ll get a five-year one next May. Lately, it’s been harder and harder to take any joy in these things because I am so aware of the insanity I’m experiencing around food.

I’m well aware that in a different fellowship I’d just be considered in relapse, period. Periodically failing with the food would mean I’m no longer clean and shouldn’t be counting any anniversaries. I don’t choose to go by these rules for a few reasons, the most important one being that it’s nearly killed me in the past by creating a “might as well” attitude and encouraging me to use drugs again. Now, I choose to keep my anniversary, despite the eating-related insanity I have experienced off and on in the last four years. I choose to believe that staying off of drugs matters enough to be acknowledged.

That being said, it’s important for me to admit to myself when I’m in relapse mode. Insane behavior with food is diagnostic for me, and it’s not very compatible with the values of recovery. If I’m binge eating to punish myself or drown my anxiety, I’m probably not using a lot of spiritual tools at the moment. So even as I hold on to my accomplishment of staying clean, I need the humility of admitting that my life is in relapse mode lately. That I need help, need to put my program first more often, need to admit I don’t know what I’m doing.

It’s said that abstinence does not equal recovery. I, like any addict, can be free of my best-known demon but making myself insane with another behavior. Looking around that room at the tables of women, I knew that each of us fell somewhere in the gray zone between living in our disease and living fully in recovery.

Am I still in recovery? Are you? Where is the line?

I can’t tell you the answer, but I can tell you about the moment I let go of the question for the rest of the day.

“Have you seen ******** lately?” a woman asked.
“She went out,” another woman answered sadly.

Out. It’s what we call it when a person disappears. Stops answering their phone. Eventually, maybe, someone hears something. Friends might try to track them down, but there’s often not much that can be done until the time is right. We wait, and pray we will see them again.

I felt the usual wave of sadness, the woman’s face vivid in my mind. I looked around the room and wished she were here with us instead of where she was.