Tuesday, July 31, 2007
I tell you this because some days, no matter how well I'm feeling, I'm just off. Yesterday was one of those days. I've been waiting a week for a new prescription for my eyeglasses and I've been having a low-grade headache for the last few days. Also, I can't read as much as I usually do because I have blended lenses and needed a fairly strong change to the reading part of the glasses. So I couldn't work on my manuscript.
I was recovering from all the emotion of Saturday night with my mother. I spent the morning at the optometrist, then went to the library and checked out five black-and-white photography books for me and five books on watercolors for my husband. I had lunch, read for awhile, and took a brief nap. And I still didn't feel energized.
Ordinarily I would have taken a walk but I was too tired. So after dinner, I decided to do yet one more thing that I know makes me happy: I watched The Sound of Music for the 100th time (I'm just guessing). The music by Rogers and Hammerstein is sublime. Robert Wise did a wonderful job of direction.
I can't tell you how much I love Julie Andrews. She's one of my favorite actresses of all time. Christopher Plummer is perfect as Captain Van Trapp. The scenery is spectacular. And it's a feel-good story.
While I've since learned that the film isn't very accurate, and the link I'm providing tells a more accurate story, unlike Joan Gearin who's written the "real story" for the National Archives, whenever I feel sad, I sing My Favorite Things. I get tears in my eyes when I sing Edelweiss. And when I feel at all self-doubting, I sing I Have Confidence in Me.
So, since I've shared my deepest secret about my favorite cornball film, my question is: What's yours (favorite cornball film, that is)?
Saturday, July 28, 2007
Friday, July 27, 2007
"I swear by Apollo, Asclepius, Hygieia, and Panacea, and I take to witness all the gods, all the goddesses, to keep according to my ability and my judgment, the following Oath.
To consider dear to me, as my parents, him who taught me this art; to live in common with him and, if necessary, to share my goods with him; To look upon his children as my own brothers, to teach them this art I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone.
To please no one will I prescribe a deadly drug nor give advice which may cause his death.
But I will preserve the purity of my life and my arts.
In every house where I come I will enter only for the good of my patients, keeping myself far from all intentional ill-doing and all seduction and especially from the pleasures of love with women or with men, be they free or slaves.
All that may come to my knowledge in the exercise of my profession or in daily commerce with men, which ought not to be spread abroad, I will keep secret and will never reveal.
If I keep this oath faithfully, may I enjoy my life and practice my art, respected by all men and in all times; but if I swerve from it or violate it, may the reverse be my lot."
Thursday, July 26, 2007
Why is it that when we all have problems, and give each other suggestions, no one says, "I've talked to my doctor and he/she had this great advice for me."
Do any of you--other than Marja--have doctors you like? Do you feel that they're knowledgeable about your illness? Are they knowledgeable about medication? Are they making good recommendations for wellness tips? Do they help you sort out issues relating to your illness?
I'm just wondering. Although I genuinely like my current psychiatrist, I only see him a couple of times a year. One of the reasons is that I'm currently not carrying health insurance (I'm sure I've written about this earlier. After years of paying top dollar for lousy coverage, they canceled me when I tried to get more reasonable coverage. The reason? I'm medication resistant and don't use the typical bipolar medications. But that's a different issue.)
Anyway, over the last 14 years, I've seen five different psychiatrists--all of whom were highly recommended. Across the board--other than my current doctor--I would say that they had such a negative and limited view of this illness that it's astounding.
I'm interested in other points of view on this.
If you don't want to talk about your doctor, I'd be interested in what kind of care you'd ideally like. Thanks.
Wednesday, July 25, 2007
May rarely gets out because her conservator lives so far away. She loved the warmth of the sun on her face. She couldn't believe how many buildings had been built on what used to be the Ballona Wetlands. She loved seeing the funky houses in Venice (CA), the boats at the marina, the color of the ocean. She loved the camaraderie. She doesn't have children of her own and she was so grateful to be included.
May's enthusiasm almost overshadowed my mother's ennui. I tried to maintain my enthusiasm but it took a lot of effort. I have always loved and admired my mother's joi de vivre. I can't imagine it's gone forever. Perhaps it's just hiding beneath her dementia.
I've got to figure out what to do about it. Her "new" doctor can't help me because he doesn't know her as she was. Last week I had intended to take her to her "old" doctor so that I could seek his opinion and advice. But then my sister intervened and once again spoiled my plans.
I still think that seeing my mother's old doctor may be the best solution. After all, how can someone who doesn't know my mother tell me whether her behavior is a result of dementia or the medication she is currently taking?
What saddened me so was that my mother who has always had this sparkle in her eyes is becoming increasingly difficult to be with--both physically and emotionally. It was almost impossible to get her into my car because she's not helping at all.
When we returned to her assisted living facility, I couldn't bear the thought of struggling for the second time to get her from the car to the wheelchair so I decided to let her caregiver and two assistants handle this and I wheeled May inside.
As I was leaving, my mother was angry at me rather than happy that I had tried so hard to make her day something special. The mother I have known and loved my entire life would have kissed me goodbye and said, "Honey, I love you. Thank you for all you've done for me today."
The mother who was there yelled at me and said something unkind. I knew it was the dementia speaking, not my mom. Still, as I drove away, tears streamed down my face.
Tuesday, July 24, 2007
Marie wrote a comment on my post from yesterday. She is currently experiencing a mixed state of hypomania and depression. While I've read about it, I've never experienced it. So...if you do or have, I'd appreciate it if you'd either share your experience with Marie or you'd suggest other sites she might visit.
Marie, my first suggestion would be to contact your psychiatrist about this. In my experience, some of these problems are medication-induced--but that may just be me. As you know by now, in most cases, I'm the exception to the rule.
My second suggestion is to do research. Off the top, I'd suggest Living Manic Depressive by our friend Jinnah, Dr. Phillip Long's Internet Mental Health, Dr. Goldberg's Depression Central, and McMan's Depression and Bipolar Web.
If anyone has better suggestions or more personal information, please write ASAP.
P.S. Marie, I was just checking out some blogs from my blogroll and visited Meredith's The Mental Feminist and she's got a link on mixed states to Empirical Insanity. Both posts may be helpful.
Monday, July 23, 2007
From yesterday's comments, I guess that some people go through the irritable and annoyed phase and others don't. In my case, hypomanias actually consist of three phases.
Phase 1: Increased energy. A extraordinary feeling of happiness with myself and the world. A very loving feeling towards the people I care about. An uncommon ability to get things done. A huge burst of energy from the moment I awaken until I go to bed. An expanded ability to multi-task. An organizational acuity that is second to none. A willingness to engage with people. A desire to spend more time with people I care about--and even those I don't. I've written about this in earlier posts so I won't dwell on it here.
Phase 2: Increased irritability and annoyance. During this phase, I start feeling burned out. While I still have a lot of energy, I don't have that "I love the world" feeling. If I've been playing my Autoharp at my mother's assisted living facility, and jumping up and down to help all the participants turn the pages and stay with me, I suddenly feel that the staff should be more helpful in doing this.
If I am going out of my way to help others pursue some area of interest in which I have an expertise, I suddenly feel that my focus is scattered and I need to be concentrating more on my own goals and objectives.
While I still enjoy spending time with people I like, I also prefer spending more time alone. This is a very good time for me to write but as was evident on Friday, I sometimes rethink the activities I'm engaging in. Do I really need to blog seven days a week on this blog? Why am I writing the John From Cincinnati blog? (Since I've already proven that "Yes, it's easier to build a far larger audience when I write about popular culture, do I still need to continue to prove this? What is to be gained from writing that blog?)
If I'm with people and they say something that annoys me, I'm genuinely annoyed. Unlike a few weeks earlier, things don't just slide off my back. While I try not to "snap" back at people, I am not always successful. I am certainly less willing to ignore things that days or weeks earlier wouldn't have bothered me at all.
I become far less happy, joyful, and kind. I dislike being criticized in any which way. When my dog was attacked and a friend emailed me and suggested that I take him to the vet, I was "pissed" that she assumed that I didn't take my dog to the vet.
Now, of course, that was compounded by the fact that I'd spent two hours the preceding night at the Veterinary Emergency Center and an hour that morning at my vets. But a week earlier, I would have ignored her comment rather than feeling the need to email back and say, "Of course, I took Spike to the vet."
I don't have the same level of patience. In phase 1, I'm patient with everyone. In phase 2, I'm less patient with almost everyone except my mother, husband, and son.
I guess the bottom line is that in phase 1, my behavior is so extraordinarily tolerant, exuberant, patient, happy, kind, accepting, and loving--that it's no wonder that I burn out.
Phase 3 is sliding into a depression. Again, I've discussed this in quite a lot of depth. So tomorrow, I'd like to explore ways to regulate the first two phases so that the third phase doesn't happen.
Sunday, July 22, 2007
I think that one of the downsides of hypomania that we don't know enough about is the irritability and annoyance phase. I finally realized that I haven't been mildly depressed for the last few weeks: rather, I've been irritable and easily annoyed.
Why is that? Perhaps together we can figure it out.
Do you have these periods? When do you get them? Is it after or during hypomanic episodes? Do you suddenly feel that perhaps you've been giving too much and getting too little? Does something switch inside you? When do you realize that the pleasure of helping others has faded and you have needs you'd like someone else to fulfill?
Do you ever think: I've been there for others. Who is there for me? Who is going to buoy me up when I feel a bit down? Who is going to provide the uplifting remark, the praise, the positive comment? Who is going to say: How can I help you? What can I do for you?
(to be continued)
Friday, July 20, 2007
Again, for me the causes of a depression are a mixed bag. Extended hypomanias—even ones that are fairly benign—zap my energy. It feels like I’m giving a lot of myself to people and it’s draining.
While I love playing the Autoharp at my mom’s, it’s also quite exhausting. Not only do I perform, which I enjoy, but I also have to help many of the residents turn the pages of their song books and I find myself jumping up and down for almost 90 minutes.
Driving my mom up the coast was draining as well. As much as I hoped it would renew her spirits, it didn’t. And as much as I enjoyed myself, it was stressful. Although my mother has dementia and a multitude of physical problems, for the most part she is always glad to see me and I can feel her love. For the past few weeks, she’s been feeling lousy and even the strength of my spirit and love for her hasn’t seemed to make a difference. It’s difficult at best!
The incident with my dog Spike was stressful (and expensive). The aggravation over my sister’s behavior with my mother was stressful and infuriating.
I also know that I’ve been talking too much on the telephone. While I try to monitor myself, it’s difficult, and I feel bad if I think I’ve dominated conversations with others and spent too much time talking about myself.
What would be best would be for me to take a few days off and escape to the mountains or the beach with my husband and son. But my son has one week left of summer school and we only have the budget for one fairly brief vacation. We just learned that my son needs his wisdom teeth removed—another unexpected expense.
Finally, there are days when I wonder whether blogging is worth the effort. It's time to cut back a bit. What I really need to do is to finish the manuscript for my new book. A number of my bipolar friends have made comments (of which I'm truly appreciative), which I’m currently inputting into the manuscript but it takes a lot of time and I probably have five more days of work.
I had asked two doctors to review my manuscript. One read it but was too busy to truly evaluate it. The other never responded. (Again, this was very distressing. I wrote a second email and said, "If you're too busy, I'll understand but please let me know.") What I never can understand is being ignored.
I should be concentrating the rest of my efforts on generating freelance writing assignments and other revenue producing work rather than blogging. While I love to write my blogs, and while the number of people who read them has significantly increased, the feedback is about the same.
There are a small number of people who comment. It’s difficult to tell whether others don’t comment because I’m not meeting their needs or because the posts don’t resonate with them. Perhaps, like some other bloggers, I should limit my postings to twice a week. I need to look at this anew.
I'm taking a few days off and will return next week. By then, I'll know what schedule works best for now. Have a nice weekend!
Thursday, July 19, 2007
While being truthful is a quality I admire, it's not one I could always engage in. I used to think it was better to "walk away" than to tell someone something unpleasant. I used to find it impossibly difficult to say, "I have a problem with your behavior," or "I can't do that (whatever) because it's not consistent with my morals and values."
I believe I was able to change for two reasons. The first is therapy. While my therapist never diagnosed my illness, she did help me learn how to express my emotions honestly and openly.
The second is surviving 120 depressive episodes. During the worst of these periods, I felt like each time I "came back," it was if I had survived a death-like experience. After surviving enough of these, it finally seemed like I learned a series of lessons that have remained with me.
One is that life is too short to "lie" so I might as tell the truth. It might not make everyone else happy but it sure does wonders for me.
Wednesday, July 18, 2007
Before we left, I talked to the head administrator. I learned that the nurse hadn't just left but was going back to school and taking on a new position elsewhere. I explained my concerns. She said that the doctor is very receptive to their nurses and she appreciates it. I still told her that I felt he was pompous, he hadn't returned my phone calls promptly, and he'd never examined her--none of which was acceptable to me.
Still, I said I would meet with him to explain my expectations and to see if he can meet them. I also said that I felt bad when I had expressed my concerns to the nurse, planned on meeting him last Friday, and wasn't told that he was leaving.
While she didn't respond (don't you just hate it when people can't say, "I'm sorry. He should have told you he was leaving." Or "I'm sorry that no one told you he was leaving."), I let it go. This is a relationship we need to continue and I'm willing to be flexible as long as my mother is receiving good care.
I decided to wait and discuss her bruises when I returned from our drive. Within a few minutes, we were in my van driving up the Pacific Coast Highway. I only wished I had a Mamas and Papas album in my CD player. I was hoping that once mom saw what an extraordinarily beautiful day it was, her spirits would be uplifted.
The color of the ocean was splendid--ranging from an almost cobalt blue to teal. Even though I've driven this stretch a thousand times, it never ceases to amaze me. We headed toward Malibu, thinking it would make Mom feel better if our destination was an ice cream shop. She's diabetic but every so often, we buy a sweet for a treat. She's 85-years-old and very good about her diet but a little deviation goes a long way.
We stopped and got a piece of coconut cake. It didn't make mom feel better, but the drive made me so much more relaxed. When we returned to my mother's home, and her caregiver and I tried to get her in the wheel chair, I realized what the problem had been. Because my mother has been unwilling to participate in physical therapy and unwilling to walk, her mobility has decreased in a major way.
So, in order to get her into the wheelchair, I almost had to lift her out of the car. Even with the two of us working in unison, it was very difficult to get my mother into her wheelchair and she "cried" out that we'd hurt her. I apologized but explained that since she wasn't helping us, we were doing the best we could.
The bottom line was that I now understood why Mother had so many bruises. No one was hurting her. It was true that she was "hurting herself." By refusing to help us, we couldn't help but bump her around a little, and with her thin skin, this translated into bruises.
As I drove home a few hours later, I felt that I had handled things as well as I could. While I had been worried and angry before I talked to the administrator, I calmly presented my concerns and listened to her answers. I didn't accuse anyone. Rather I listened and then tried to figure out what happened.
Tonight, I'm far more relaxed. I realize that my mother is getting the best possible care but sometimes things happen. What makes it more difficult is when people don't tell me the truth or don't follow through on what they say. But all things considered, my mother's level of care is better than most--by a long shot.
The lesson I learned--for myself--is that if I don't want to end up the way my mother has, I have to continued to remain in top shape, physically as well as emotionally. I'm working hard on both!
At the time I didn't say anything because my mother doesn't like doctors very much and the entire experience was quite stressful (for me). I had to keep my mother calm, oversee the visit, be the liaison with the head nurse, and deal with a doctor who seemed like a pompous jerk from the get-go.
My sister was there for this doctor's second visit. He didn't examine my mother this time either. He did bill Medicare $250 for a ten minute visit. They paid $20. I decided this doctor is probably running a scam. I plan on reporting him to Medicare.
What so distressed me was that he was recommended by the nurse, who I've known, liked, and trusted for more than a year.
Later, when I thought about the nurse's recent behavior, I realized that I may have misjudged him. When I told him I found it curious that the doctor didn't examine mother, he didn't really respond. When I told him that the change in medication the doctor recommended for my mother was making her worse, he said, "It takes awhile to kick in."
When I told him that the doctor's fee was outrageous, given the time he spent with my mother, the nurse didn't say anything. Last week, when I called him and told him that we needed to talk on Friday when I came to play the Autoharp, he said, "Sure."
Yet, when I arrived on Friday, he wasn't there. When I learned that he had quit and wouldn't be returning, I was stunned.
I'm not sure why the nurse left or what his "deal" was with this doctor. What I do know is that he betrayed my trust.
I also know that the visiting nurse who came yesterday found that my mother has significantly more bruises on her legs. Today I was told that the nurse (who left) had told my mother's caregiver that my mother had "hurt herself" because she had been combative when they've tried to bathe her in the morning.
I find this difficult to believe. What I do believe is this:
1. I don't trust people who dance around the truth.
2. If my mother has become "combative," it's medication-induced or she's not being treated properly.
3. Just because a person complains doesn't mean her complaints aren't real. If my mother doesn't like the way she is being bathed, then I should have been told.
4. When a person feels powerless, she may lash out.
5. If anyone has hurt my mother in any way, I will find out about it, and ensure it never happens again.
Today...because of my sister's actions, I felt powerless to help my mother. My way of dealing with it was to write about it. Tomorrow, I will visit my mother, talk to the head administrator of the facility, and solve the problem.
I have always been a problem-solver. But, in the past I know that sometimes I became ill because I was so disappointed by other people's behavior and didn't know what to do with my feelings. Now, I blog to heal and that's a huge step forward.
Tuesday, July 17, 2007
My mother had a tear in her leg. Her skin is very thin but this was a particularly bad one. There has been a problem with her new doctor at her assisted living facility, and a problem with the head nurse. I had everything under control and was handling it. Out of nowhere, my sister--who's a control freak--once again felt the need to undermine my authority and take over.
I was taking both of our dogs on leashes for a walk. My 24 pound terrier was attacked by a pit bull. As the pit bull had my dog's paw in his mouth, his owner started screaming at me that her dog doesn't bite.
A month ago a friend's mother fell and broke her arm and pelvis. My friend's brother and his wife who allegedly came to help--didn't--and then stole all of the staples in my friend's mother's guest house and refrigerator on their way out of town.
I ask you: Who's mentally ill?
Monday, July 16, 2007
Next week, I'll post my review of Riding the Roller Coaster: Living with Mood Disorders by Marja Bergen. I'm sure that most of you know her from her blog, Roller Coaster. She, too, is a talented writer (and photographer and artist). Her book is one of the most positive books I've ever read on mood disorder. And if you're interested in spirituality, it's a must for your library.
The best thing about this blog is meeting a group of soul mates with whom to discuss my symptoms as well as a group of friends I truly like. So, thank you Howard, Marja, Sydney, Jinnah, Jason, Staggo, Diane, and so many more.
It's an added plus to find people I like who are so talented in so many ways!
Sunday, July 15, 2007
~F. Scott Fitzgerald, The Crack-Up
"Seven years ago I had an attack of pathological enthusiasm. I believed I could stop cars and paralyze their forces by merely standing in the middle of the highway with my arms outspread."
"I was much further than you thought, and not waving but drowning."
"The aggravated agony of depression is terrifying, and elation, its nonidentical twin sister, is even more terrifying—attractive as she may be for a moment. You are grandiose beyond the reality of your creativity."
Since I always believe in ending on a positive note...here are a few quotes and a poem about hope.
"We must accept finite disappointment, but never lose infinite hope."
~Martin Luther King, Jr.
"The very least you can do in your life is to figure out what you hope for. And the most you can do is live inside that hope. Not admire it from a distance but live right in it, under its roof."
Hope is the Thing with Feathers
Hope is the thing with feathers
That perches in the soul,
And sings the tune without the words,
And never stops at all,
And sweetest in the gale is heard;
And sore must be the storm
That could abash the little bird
That kept so many warm.
I've heard it in the chillest land,
And on the strangest sea;
Yet, never, in extremity,
It asked a crumb of me.
Saturday, July 14, 2007
Having said that, I remember that dootz of SurfCountry suggested that I tell you the story of my photography class final. Here goes...
Although I had an "A" going into the final, I was quite worried about the written examination. All of our other work had been photographic assignments, which I genuinely enjoyed. At this stage in my life, grades aren't important to me--I care more about learning.
Still, I hadn't taken the class pass/not pass because I didn't want the teacher to think I am a dilettante. But I was concerned because I hadn't taken a final exam in almost 40 years. One of the reasons why I majored in history as a UCLA undergraduate was because I preferred writing papers to taking written exams. I don't ever remember taking a multiple choice and true/false exam in college. But because Santa Monica College is a community college, most professors give multiple choice exams.
As the exam approached, I was in fine shape. All semester long--only six weeks in this case--I had earnestly done my reading. In truth, that was my modus operandi when I was an undergrad. Also, I wanted to be a role model for my son. For the last two years, I had pleaded with him to stop waiting until the last moment to study and to do his homework. So I had to practice what I'd preached.
Despite my preparation, the day before our final I spent three hours studying with a fellow student. When I returned home, I went over the material we hadn't covered together. When I went to bed that night, I felt confident yet nervous. I'd carefully read all the material but much of it was new to me and somewhat technical. I also was aware that my memory isn't what it once was.
The day of the final, I arrived an hour early at school so that I could do a last-minute review but our classroom was filled with other students who were taking a final before us. So I spent my study time chatting with my fellow students.
Once I entered the class, I felt slightly tense. As I sat down to take the exam, I "lost it" and began having the same pain in my stomach that I used to have during high school geometry tests. Not a good sign since I'm math challenged and math test phobic.
After 30 minutes, I noticed that some of my fellow students had finished. However, the moment I knew I was really in trouble was when the two women in our class from Japan, who are not native English speakers, walked to the front of the class to turn in their exams.
As I watched them place their papers on the pile, I started sweating bullets, and felt a wave of confusion. I blankly starred at the questions and suddenly couldn't remember whether a photograph with too much light is under- or over-exposed. I forgot the definition of depth of field. While I remembered f-stops and apertures, I couldn't remember how to achieve a silhouette. Within moments, I began worrying about answers I had confidently answered moments earlier.
Worst of all, although our teacher had spent the previous class teaching us all about flashes, and colored lenses, I couldn't remember one thing from that lecture, and I believe there were at least 6 out of 50 questions on that subject alone.
After an hour, I turned in my exam, said my goodbyes to my professor and barely made it to my car because I was so tired. Once I returned home, I felt like going to bed although it wasn't yet dark.
When my husband asked me how I did, I said, "God, I hope I passed. I forgot everything and if I get a bad grade, our son will never let me forget it."
Later that night, my son suddenly came into our bedroom and said, "So mom, what was it like to take a test after all these years?"
"Okay," I muttered, as I looked up from the book I was reading.
"Did all your studying pay off?"
"I hope it did," I answered, placing the book on my nightstand. "I must admit that I haven't taken a test in a long time, and I'm not good with multiple choice exams. I'm a bit worried."
"You should have asked me for help," he (with the 3.71 GPA) volunteered.
"I never thought of it," I lamely said. I didn't feel the need to point out that he hadn't offered this help before the exam.
"Well, I can call in next week and show you how to get your grade by voice mail," he said.
"My teacher said she was going to take a brief vacation. I don't think we'll get our grades for ten days," I said with palpable relief.
"Sure," he said as if he didn't believe me for a minute.
Well, the bottom line is that I was right. Although my son started calling the next Monday on my behalf, the computer voice kept on repeating that the grades for this class were not yet available. Each day when I heard that the grades weren't in, I breathed a sigh of relief.
After a week of no grades, my son lost interest, and I figured out how to call and punch in the proper codes myself. When I finally learned--almost ten days later--that I'd gotten a "B" in the class, I was weak with relief. Thank god, my teacher never notified us about the grades we received on the final. I'm assuming there is a way to find out, but I would prefer to remain ignorant.
When my son teases me because he's carrying a better GPA than I am--despite his procrastination--I smile. For the time being, I'm quite content with my 3.0. But next semester, I do plan on taking a workshop in how to take a multiple choice exam. While I don't feel compelled to compete with my 18-year-old son, I still have a reputation to uphold.
The older I get, it's becoming more and more difficult to maintain my edge as a role model.
Friday, July 13, 2007
The most surefire way to control it is to refrain from being with people. But after spending months alone during a depression, the last thing I want to do is to be alone just because I'm a bit too talkative.
In a way, I think it's just one of those symptoms that people may not like, but there's a part of me who truly doesn't think it's all that bad. When I'm depressed, I may not see my friends for five or six months. So...when I'm hypomanic, I don't see that it's all that terrible if I talk a bit too much.
For a few years, when I noticed I was talking too much, usually after the fact, I would call and apologize. I'd say something like, "When I thought about our lunch together, I realize that I dominated the conversation. It's a sign of hypomania and I'm sorry. Next time we're together, you can talk the entire time."
But one day I realized that rarely, if ever, have other people apologized to me. I can't remember the last time a friend said, "Gee, I'm sorry that I'm never there for you during your depressions." Or "I'm sorry that I never invited your husband and son over during your depressive episodes because that would probably have made you feel better."
Or "I'm sorry I never asked you how I might help you." Or "I'm sorry I never volunteered to drive you to the doctor." Or "I'm sorry that when I knew you needed freelance work, I never hired you to do a project (two good friends always were there for me and they know who they are)."
So, while I have been sensitive about my own behavior and I used to make a special point of apologizing when I felt I was a "little over the top," or possibly offended someone in some way. I don't anymore (well, at least with most people).
The people who are truly my friends know that hypomania is just a phase and I'm doing the best I can. They realize that I truly can't help talking a bit too much or being a bit too enthusiastic. At best, they find me amusing. At worst, they tolerate my behavior because they love me.
Or maybe they realize that they, too, have personality traits that I probably don't like but that I tolerate because I love them.
Thus, I'm done apologizing for my behavior--possibly forever. If you want to be my friend, you'll have to accept me for who I am, warts and all.
Thursday, July 12, 2007
While my advice is for Carla, it's really much broader than that. After a decade of being very ill with bipolar mood disorder--and believing what my psychiatrists said, which is that it's biochemical in nature and there's not much I could do to "cure myself" other than find the right medication--I no longer adhere to that philosophy at all.
Now, I must state upfront that I come to this illness from the depressive side. It's quite possible that if my initial depressive episode, which I experienced when I was an 18-year-old freshman at UC Berkeley had been diagnosed, and if I had received good counseling, and if the therapist or counselor had known about the importance of life event stressors, I may never have gotten sick.
But, it didn't happen that way. Although I sought help, it took 25 years for me to get a diagnosis. I have survived 120 depressive episodes over 39 years. Still, I can't speak for anyone but myself. However, I believe the following:
1. Yes, untreated depression gets worse but I'm not necessarily in favor of giving medication to college students and others who are experiencing a depressive episode but who haven't participated in counseling or therapy.
2. I do believe that if a person is severely depressed, the only way out may be medication. However, I don't see it as a long-term solution. I believe it is only part of a long-term solution and that some of us can make such significant life changes that we can effectively stop taking medication or that we can take it only during depressive episodes. (Again, I'm not speaking about people who come to this illness from the manic side, who suffer from psychosis, or who have some underlying pathology.)
3. I cannot tell you how important it is to understand what "event" or "events" triggered your first depressive episode. I believe that you not only need to understand it but to resolve it in order to get better.
4. I don't believe that bipolar disorder should be as debilitating as it is. I do believe that the treatment of this illness is awful and that the drugs are ineffective for many of us because aside from Lithium and perhaps Lamictal, they haven't been developed for this illness. I also believe that in many cases, they make people feel worse rather than better.
5. I believe that lifestyle has a huge impact on this illness. I strongly believe that exercise is critical and that every single bipolar person should be participating in an exercise program.
6. I believe that diet and nutrition are very important and every bipolar person should be given free nutritional counseling.
7. I believe it's critical to know what your stressors are and how to alleviate them.
8. Personally, I believe in the following adjunctive therapies: music therapy, horticultural therapy, massage, exercise and movement therapy, pet therapy, counseling (or some sort of talk therapy), light therapy, prayer, positive thinking, humor therapy, expressive writing therapy, and a host of others.
9. I believe that dwelling on illness rather than seeking wellness makes people feel worse.
10. I believe that finding one's life work makes a huge difference.
Finally, I believe that loving relationships with family members and friends makes life worth living.
Wednesday, July 11, 2007
I'm responding to the question you pose in your comments to part 2. After a number of years of experiencing depressive episodes in April and October, I decided that the seasonal element was important even though my doctors didn't. I researched Seasonal Affective Disorder and I read Winter Blues by Norman Rosenthal M.D., one of the the foremost experts on SAD.
These days, you can find all this online. When you read more, you'll learn that some people experience summer depressions like yours; others experience spring-fall ones like I used to, and there are lots of different combinations as well. I tried using a 10,000 Lux light but it didn't help. But for some people, light therapy is very effective.
A few years ago, I read that in addition to the change in seasons, these depressions may be caused by "anniversaries" of events. The trigger for the April depression was obvious. That's when I started college in 1968 and within five weeks, my first depressive episode had hit. Once I found that out, over time I was able to end this episode.
I couldn't come up with a life event for the October depression but that might have just been seasonal. Still, my solution was to begin spending lots of time outside, starting in September. It doesn't alleviate the depressive episode entirely but it can lessen its impact.
While I know that weather affects me, the moment I'm feeling "blue," I begin to spend more time outside. I garden, do home improvement projects, play tennis, walk, and go biking and hiking, dependent upon other commitments, how well I feel, and my energy level.
Most of all, I say to myself, "One bad day doesn't have to lead to a full-fledged depression." So, in essence, I took away the fear factor, which had become a real problem. When Zoloft used to work (14 years ago), I had three days from the time I felt a depression on the horizon, to stave it off naturally or begin taking medication. What I learned--about me--was that once a depression took hold, it was very difficult for me to get rid of it.
All those years ago, if I didn't pay attention to the advent of the depressive episode, and either identify and remove the trigger or start taking medication, it would be a far worse episode.
These days, the seasonal element isn't as much of a problem but the triggers still are. My last depression (October 2006) was caused by an incident with a client. I had just finished helping edit her book, I thought we were all set for an ongoing relationship, and within a day everything changed. After a telephone call from the New York Times where they said they would review her book, she decided she was going to become very famous (once again) and thus didn't need to be "polite" and "well-behaved." (It's a long story and one I'm not going to share.)
What I can say is that I will not allow anyone to treat me badly. I told her how I felt. She said it was my problem, not hers. I had to quit because there was no other option. My depression was caused by stress (from the loss of income), and from disappointment (an ongoing theme in my depressions). I realized what was happening but I couldn't stop it.
What compounded everything was that prior to taking the five-month job with her, I had decided I could no longer write my own books because of my frequent depressive episodes, which precluded me from publicizing them. I had hoped that "editing other people's books" or co-writing books with them was the solution. My experience with my client convinced me that this wouldn't work because I would always be dependent upon other people for my happiness, income, and sense of well-being.
Once again, I felt I was "stumbling" in my career, and the downward spiral had begun. During my five-month-depression, I decided to launch this blog, and repackage and sell my memoir. I also decided that I'm only truly happy when I'm working on my own projects.
Although I was taking Adderrall, my experience is that no medication is effective for me when there are unresolved issues that are contributing to my unhappiness. Once I figured all this out, my depression moved from fairly severe to moderate, the Adderrall started working more effectively, and I was able to institute my personal wellness program, which I'll discuss more tomorrow.
In my first letter to you, I briefly mentioned my experience with medication. Although you and I have been labeled medication resistant, I want you to know that from what I've read from readers to this blog, as well as having studied this illness now for 14 years, most people have some degree of difficulty with medication.
The real problem is that most of the drugs that are prescribed for us weren't developed for us. And the clinical testing of these drugs has been abysmal. But that's a huge issue and one that I address in a lot of depth in my forthcoming book: Bipolar Depression Unplugged: A Survivor Speaks Out. I'm not saying this in an attempt to sell my book, rather it's just that I have written pages and pages on this and can't repeat it all here.
However, the second aspect of the treatment of depression--aside from medication--is a slew of lifestyle issues. In my own case, I finally realized--and wished I had understood this earlier-- that my depressions are triggered by life events. Over time, I decided it was critical for my well-being that I identify the triggers and try to deal with them. Otherwise, I would be forced to continue to experience these depressions forever.
At first, I tried to change myself--thinking that if I could be different than I could stave off the depressive episodes. But after years of therapy, I realized that there are some people whom I can't have in my life. They contribute nothing that is life-affirming and they are either critical of me or so judgmental that I always feel bad around them.
I also learned that when people do things or say things that are very hurtful to me, I need to let them know. The only downside of this behavior for me is that after years of being well-liked, now my honesty offends some people.
As far as I'm concerned, that's okay with me. I've decided that if people don't like me because I'm truthful, so be it. If they don't like my response to their behavior, better that they "drop me" than make me sick.
Finally, I also believe that there are a host of activities I can engage in that will lessen my depressive episodes. Tomorrow, I will discuss these in my final post in this series.
Tuesday, July 10, 2007
First of all, although I was deemed medication resistant early on, it wasn't actually true. What was true was that the four mood stabilizers they commonly prescribe--Lithium, Valporate, Tegretol, and Lamictal--didn't work. Years laters I took many more cutting edge drugs, which were supposed to have mood stabilizing effects but they didn't work either.
Over a period of ten years, I saw five of the very best psychiatrists in Los Angeles. What was interesting to me was that it was only the last doctor--my current psychiatrist--who suggested that the stimulant Adderrall might end a nine-month depression in a day.
While he also said it shouldn't be a long-term strategy, it is the only medication that works for me. I take the lowest dosage possible although over time I've needed to take more when I had a lot of depressive episodes. The minute the depressive episode ends, I have to get off it or it will cause a hypomania.
The downside is that it can throw a person into a hypomania. I always thought this is a ridiculous concern (for me) since my depressions were so horrific and lasted so long. And my hypomanias weren't that bad although they did get worse (I'll need to explain this in another post).
The point is that unlike antidepressants, which take weeks to kick in, Adderrall kicked in in one day. While some doctors hesitate to prescribe it, I must say that if they really understood the devastation of depression, they wouldn't hesitate.
The bottom line with me is that I don't abuse drugs or alcohol (and never have). A very little amount of a medication has a major effect. I kept daily mood charts for 6 years and was very conscious of any fluxuation. I always made sure that I got enough sleep. I am very responsible, very motivated, and very proactive.
Tomorrow, I'll tell you more about my overall strategy. Best of luck!
At the time of these debilitating depressions, I often thought of ways to try and feel better. Although it's difficult for people who have never experienced a depressive episode to understand, it's the most horrific experience to have so little energy that you can barely get out of bed.
And yet, once the depression is over--and if you cycle into a hypomania--it's almost impossible to imagine ever feeling so lifeless.
Still, at the time of these depressions, I used to come up with ideas for items or support services that would help me. In a debilitating depression, I knew it was very important for me to sit outside in the sun. And I often would do that...just go outside (I live in Los Angeles where the weather is sunny most of the year) and at the very least, just sit in a chair and feel the sun on my face.
I also knew that exercise is important--even if I couldn't do it. During a depression, I wondered why we bipolars don't quality for physical therapy. While it would be difficult to allow anyone to touch us (as least that's the way I used to feel), I still knew that I would feel better if someone would help move my extremities.
I also felt we should qualify for electric wheelchairs or scooters. When my mom could no longer walk because of neuropathy caused by diabetes, she qualified for a wheelchair or scooter, which she refused to get. But I took her to look at them because I felt the mobility would have been healing.
During severe and extended depressions, I often wished that I could sit in an electric wheelchair or scooter and use it to do errands in my neighborhood. What would have been good about it, is that as anyone who uses a wheelchair will tell you, people ignore you.
So...since we who are depressed feel so awful anyway, I think it would be a positive to be ignored. Yet, the value of spending time outdoors, and being able to use the wheelchair to get around the neighborhood would have been a good thing.
Also, I felt it would have been positive to have been treated as "disabled." Now, I know this sounds a bit odd, but think of it. The greatest problem with being depressed is that you feel "dead inside" but for all intents and purposes, look "normal."
When you look "normal" and don't wish to talk to people, it bothers them. However, if they think you're disabled, they'll ignore you, which for us would be a positive thing.
(to be continued)
P.S. I know nothing about the Rising Sun Healing Center (whose logo I'm using as a graphic in the upper left part of the post ). When I Googled sun and healing, it came up and I liked it.
Monday, July 9, 2007
So...I'm feeling terribly depressed and I can't get better. The medication my psychiatrist has been prescribing isn't working, and neither is acupuncture, St. John's Wort, or any mega-vitamins, minerals or amino acids.
Swimming somewhat helps but I can't afford to join a gym with a pool and my brother has taken away the key to the communal pool (a facility for the people in his non-gated but affluent community) gate because I was late in returning it (he also has a pool in his backyard).
I've spent weeks searching the Internet for success stories and can't find any. I do find the study that I wrote about yesterday. I've decided that I'm going to try and "walk away this illness." My problem is that I'm having difficulty breathing (my reaction to the mixture of medications I'm taking), my face looks like Edvard Munch's painting, The Scream, I have no energy whatsoever, and am barely able to walk around my house.
Still, I'm determined to lick this so I drive to my mother's house and pick up an extra walker that she keeps in her garage. That's all the energy I have. I hide it in our garage because I don't want to tell my husband what I plan on doing.
The next day after my son and husband are gone, I put on my walking shoes, a large floppy hat to hide my face, and sunglasses--hoping my neighbors won't recognize me. I get the walker, hoping that if I can lean on it I can walk at least halfway down the block. But...and this is a significant "but"...we have a steep driveway and by the time I get to the bottom on it, I'm so tired, I think I'm going to expire.
My husband and son aren't home or I wouldn't have tried this because I wouldn't have wanted to embarrass either of them. I sit at the bottom of the driveway beside the walker and pray for the strength to walk back up the hill.
After awhile, I decide that I will have to force myself to walk up the hill because I'm worried about having my husband and son return and find me and my mother's walker at the bottom. As I walk up the hill, I can't remember ever feeling worse (although, of course, I have). I make it in to the house, hide the walker in my closet, and collapse on my bed.
(to be continued)
Sunday, July 8, 2007
Of course, he has since been proven wrong. Researchers at Duke University Medical Center studied 156 depressed patients 50 and older and found that after 16 weeks, those who exercised showed significant improvement compared to those who either took medication alone or those who combined medication and exercise.
In a six-month follow-up study, Duke psychologists found that depression returned in only 8 percent of the patients in the exercise group, versus 38 percent for the drug-only group and 31 percent for the drug and exercise combined group.
And Dr. Robert N. Butler, President of the International Longevity Center at Mount Sinai Medical School in New York City, said, “If exercise could be put in a pill, it would be the number one anti-aging medicine and the number one anti-depression medicine.”
Still, for those of us who suffer from depression, motivating ourselves to exercise when we can barely get out of bed, isn’t easy.
During one of my worst depressive episodes--it lasted a year--I tried swimming—which I have always found to be the very best exercise when I’m feeling low—but it was impossible to sustain because my brother, who had the only swimming pool I had access to, refused to let me use it after I was remiss in returning the pass-key to the communal pool in his gated community. Unbelievable, huh? Talk about an absence of brotherly love but that’s a different story.
During most depressions, I always try to walk but it’s usually surprisingly difficult. Given that it’s easy to do, doesn’t require any equipment, and I can do it alone, when I’m well, it’s impossible to imagine the obstacles.
But those of you who have suffered severe depression may be able to relate to my best “trying to walk when I was depressed” story.
(to be continued)
P.S. The graphic is by Czech artist Veronika Holcova.
Saturday, July 7, 2007
I will discuss this book more in the future, but for today, I just want to quote a poem by Henry Wadsworth Longfellow that Bridges quotes in his book. Longfellow evidently wrote it when he went back for a visit to his hometown of Portland, Maine.
From the outskirts of the town,
Where of old the mile-stone stood,
Now a stranger, looking down,
I behold the shadowy crown
Of the dark and haunted wood.
It is changed, or am I changed?
Ah! The oaks are fresh and green,
But the friends with whom I ranged
Through their thickets are estranged
By the years that intervene.
Bright as ever flows the sea,
Bright as ever shines the sun,
But alas! they seem to me
Not the sun that used to be,
Not the tides that used to run.
Friday, July 6, 2007
I will miss your insight and low fees,
You have been there for me in the clinches,
If you'd just diagnosed my disease.
You know manic-depression's a bummer,
The symptoms are not always clear,
Still, my highs and my lows were so disparate,
Yet you missed them for more than eight years.
Now that I know you'll be leaving,
I am sad but I am angry too,
We are ending where we might have started,
And I mourn the loss I never knew.
Over the years, I've taken up different instruments during hypomanias. So, I've played the banjo, accordion, ukulele, harmonica, electric guitar, and now the Autoharp (I've got one just like the Chromaharp that's pictured above, which is available from the Harp Doctor in case you're interested).
When I was a kid, I played the violin (in the sixth grade), the piano (for a few years in junior high school and I was quite awful) and the guitar for many years (I play fairly well).
During prior hypomanias and depressions as well, I've written lyrics to songs I like. Since I mentioned a few days ago how much I like Blowin' in the Wind (by Bob Dylan), I thought I'd share my lyrics. Some of my lyrics are funnier than others. I wrote this one, which is quite sad to me, a few years ago during a long depressive episode.
(Sung to Blowin' in the Wind)
before you're allowed to be well?
How many times can you have such dark thoughts
and feel like you're living in Hell?
How many broken hearts can you mend
before you hear death's sorry knell?
The answer you fink comes from talkin' to your shrink,
The answer comes from talkin' to your shrink.
How many unanswered prayers can you pray
before your God you forsake?
How many years can you survive such loss
before your heart it does break?
How many times can you face each new day
before you choose not to awake?
The answer you fink comes from talkin' to your shrink,
The answer comes from talkin' to your shrink.
How many meds can one person take
before she is willing no more?
How many times can she re-emerge
before it's too much of a chore?
How many years can she try to be strong
to protect those that she does adore?
The answer you fink comes from talkin' to your shrink,
The answer comes from talkin' to your shrink.
Wednesday, July 4, 2007
How many roads must a man walk down
before you call him a man?
How many seas must a white dove sail
before she sleeps in the sand?
How many times must the cannon balls fly
before they're forever banned?
The answer, my friend, is blowin' in the wind,
The answer is blowin' in the wind.
How many times must a man look up
before he can see the sky?
How many ears must one man have
before he can hear people cry?
How many deaths will it take till he knows
that too many people have died?
The answer, my friend, is blowin' in the wind,
The answer is blowin' in the wind.
How many years can a mountain exist
before its washed to the sea?
How many years can some people exist
before they're allowed to be free?
How many times can a man turn his head,
pretending he just doesn't see?
The answer, my friend, is blowin' in the wind,
The answer is blowin' in the wind.
Tuesday, July 3, 2007
According to Wikipedia, "Independence Day (commonly known as "the Fourth of July", or "July Fourth") is a federal holiday celebrating the adoption of the Declaration of Independence on July 4, 1776, declaring independence from Great Britain.
"Independence Day is commonly associated with fireworks, parades, barbecues, picnics, baseball games, and various other public and private events celebrating the history, government, and traditions of the United States. Fireworks have been associated with the Fourth of July since 1777."
Monday, July 2, 2007
But in terms of my mother and others...first, I have learned to listen to people and to be responsive. It's so easy for doctors and others to say, "Oh, I've prescribed new drugs for your mother and they won't kick in for a few weeks. She may say she's not feeling well now but don't worry about it. Everyone feels like that and she'll just have to wait for the medication to work."
Wrong! I waited for the medication to work for almost a decade and I find this attitude to be unconscionable. Most of the people who tell us we "just have to wait to feel better" have never felt bad. So, it's truly easy for them to say that.
I believe that most older people--like most BIPS--are probably over-medicated. When a person is old and confused, two weeks is a long time. Also, I feel that few doctors and others are sympathetic when a person, a BIP or an older person, says, "But I feel terrible right now. I'm tired all the time. I'm not myself. I feel off."
And, or course, it's worse when older people can't articulate why they don't feel well. I believe that many doctors know as little about aging as they do about bipolar mood disorder. What they hope, is that the adult children, will nod in agreement that it's okay for their parent to feel bad for while or to agree that the adult parent is being difficult.
Not me. My mother was always my advocate and I'm hers. I won't allow her doctors (or friends and relatives for that matter) to marginalize her. I won't allow them to pretend that all medication takes a long time to work. I look up every medication they prescribe and while I don't expect miracles, I also do not accept that it's okay for my mother to be uncomfortable for extended periods of time without some relief.
Second, I've learned not to be embarrassed by any behavior. At my mom's assisted living facility, many of the residents have hearing difficulties, which results in some potentially embarrassing moments.
If fact, if you don't hear well, you may not hear yourself "fart," and thus you don't automatically say, "Excuse me." If you're suffering from dementia, you certainly don't realize that you've asked the same question a few times in a row. If you're losing some of your faculties, you just may not possess some of the manners and social etiquette that you displayed throughout much of your life.
My response...so what? I know lots of well-mannered people who are so insensitive that it takes my breath away.
Finally, I know the humiliation of having an illness when people think that just because you're sick they can dismiss you, take advantage of you, judge you, and wonder why you look the way you do. At one time, I took Zyprexa and gained 30 pounds in three weeks. Luckily for me, I went off it before I got diabetes (like some other people did).
But I clearly remember the people who looked at me as if to say, "My God, you're gaining weight. Don't you realize how unattractive it is? Don't you have any self-control?" Well, you know the litany.
So, the bottom line for me is that I treat those people I love--and even others whom I may not know--with charity. They can't help it if they spill food on their clothes when they eat. They certainly don't mean to sometimes have "accidents" with their bowels. And if you're with them and they nod off, it's obviously not on purpose.
It would be very nice if more people helped those in need rather than judging them. Honestly, I could live the rest of my life without having anyone tell me how my mother or I should "act" or "be" as if they're somehow Emily Post reincarnate.
Sunday, July 1, 2007
In truth, I have always been a wonderful daughter. But, what has my illness taught me that enables me to be a better daughter to a mother who's suffering from dementia, who has naturopathy due to diabetes (she's in a wheel chair because she has no feeling in her legs), who's incontinent, who is so very glad to see me when I arrive that she sometimes tears up with relief (even though she is living in a wonderful place with caring caregivers and an ocean view), who sometimes calls me and thinks that my father, (who's been dead for 18 years), and my grandparents (who have been dead even longer) are still alive and who cries when I have to tell her that they died long ago, and who was a wonderful mother while I was growing up and still is...in many ways?
I once wrote an essay called The Throwaway People about me and my mother. I tore it up years ago but my point was that in our society, old people and people who are labeled mentally ill are throwaways. People feel they can dismiss us because we are damaged.
It would be sad enough if those people were strangers, but sometimes they're closely related to us. It's so easy for them to say, "She's not aging gracefully" (my mother) or "I don't like her behavior (me).
I have often wondered what "these people" will do when they age...when their children no longer find them entertaining...when and if they suffer a serious and debilitating illness...when their friends stop seeing them because they can't tell great stories any longer and seem forgetful...
(to be continued)
Marja writes: "I believe wholeheartedly in what you said here Susan. They are things I try to help others see as well. But how do you tell someone who you're supporting that she needs to work harder at improving her life? How do you tell her that without coming across as judgmental? And how do you know whether she's simply not able to work harder at it than she is? How do you keep encouraging a person to do better? How much should I stand by her and how much should I back off?
I'm not one to turn my back on a person who is suffering and needs support. I've spent hours with this person in the ER. And I feel one day we're going to lose her altogether."
Marja, I'll tell you what I believe and perhaps others will share their opinions as well. I don't believe you can help another person decide to live if she doesn't want to. I don't believe you should allow someone to depend upon you so much that you become responsible for her because she won't be responsible for herself.
The most we can do for the people we care about is to help them find help. We can offer to drive them to visit their psychiatrist or counselor. We can recommend support groups. We can recommend books for them to read or sites they can find information on. We can let them know that we care for them.
But...we can't nor should we want to "save them." We can't find purpose in their lives; they must find it with a therapist or counselor. We can't prevent them from harming themselves. We can't let them become so dependent upon us that they drain us of all our energy and cause us to become depressed.
Co-dependency isn't a topic I know very much about, but perhaps some of my readers do. If you allow this woman to continue to depend upon you rather than forcing her to seek help elsewhere, I believe you're contributing to the problem. I realize that you're doing it for the best of all reasons--because you're kind, caring, and genuinely want to help.
But, in my experience, there are takers and givers. And it sounds to me that this woman is a taker--and if you continue to be the giver--she'll keep taking until you have nothing left to give.
This week or next, I also plan on writing a review of Marja Bergen's book, Riding the Roller Coaster: Living with Mood Disorders. While I've just read a few chapters, from when I've read so far, this is one of the only positive books I've ever read on mood disorder. And Marja is not only a talented writer but as you can see from her site, Roller Coaster, a wonderful photographer and artist.
One of the very best things about writing this blog has been the relationships I've developed. After so many years of feeling so alone with this illness, I now have a small group of people with whom I can discuss my symptoms but who have also become good friends (you know who you are).
And how wonderful is it to not only like people and find soul mates but also feel that they're such talented writers and artists? Quite honestly, for me, it doesn't get much better than this.
So, to Howard, Marja, Sydney, Jinnah, Jason, Staggo, and so many more, I thank you for being a part of my life. It's truly a pleasure!