Friday, October 31, 2008

Wellness Activity: Volunteering

I spent last night volunteering and it made me feel really good. In this case, I volunteered to make telephone calls for Barach Obama at the home of someone I didn't know, but who lives in my neighborhood. I'm not sure how much I accomplished, but the camaraderie was very satisfying.

In the last year, ever since my mother died, I haven't volunteered. When she was alive, I spent the last two years of her life playing my Autoharp and singing at her assisted living facility once a week. Once she died, I thought I'd be able to go back there and sing again, but it makes me too sad. And while I could do the same activity at another senior facility, I spent so much time playing and singing for my mother that I'm not sure if I'll ever be able to do it again without feeling sad.

Still, as Dr. Bernie Siegel says in 101 Exercises for the Soul: A Divine Workout Plan for Mind, Body, and Spirit, "Volunteering is very important for creating a meaningful life. It helps you define what you are here to accomplish by actively doing it. For this exercise, choose one way to volunteer in your community, and make it more than a one-shot deal. Think about what the right form of service is for you. What skills do you have? What do you enjoy doing? Who would you like to serve?"

When I re-read this chapter, I realized that rather than continuing to wait and hope that I can sing for seniors without feeling sad, it's time to find another activity. As some of you know, one of my dogs died last December, and the other died a few months ago. I miss them terribly, but I promised my husband that we'd wait for at least six months to adopt another dog.

So...I've decided to volunteer my time at a local animal rescue organization. That way, I can walk dogs, which I miss doing, and have dogs to love, which is something that makes me feel good.

What volunteer activities do you do? How does it make you feel?

Thursday, October 30, 2008

Ten Worst Side Effects (Part 2)

The following is part of a excerpt from my eBook: Bipolar Depression Unplugged: A Survivor Speaks Out. It is copyrighted material and may not be copied.

5. Head Sweats. While I know that some people on medication get body sweats, I experienced head sweats, and they were awful. If I had been more like Pollyanna (which I’m not), I would say how grateful I am that it was just my hair that got drenched.

4. Hand Tremors. It’s difficult to laugh at this one. I was taking two medications that caused hand tremors and the combined dosage made the tremors increase from imperceptible twitch-like flutters to the full arm movements of a symphony conductor.

3. Weight Gain. During the worst of my illness, food was my only pleasure. I made do with Ruffles® potato chips, blue cheese, Stouffer’s® anything, Dryer’s rocky road ice cream, homemade nachos, popcorn with melted butter, whipped cream on everything, Fritos®, and cases of 7-Up®. I gained thirty pounds and felt that I looked like Jabba the Hut from Star Wars. How depressing is that?

2. Brain Drain. I developed a condition called cognitive memory loss where I not only forgot words and phrases, but entire paragraphs. I would be talking and in the middle of the sentence, I would abruptly stop and have no idea what thought I was seeking. During this period I, who have always prided myself on my quick wit and verbal acuity, spoke like Lenny in Steinbeck’s Of Mice and Men.

1. Hair loss. At the time, perhaps because Silas (and a lot of other psychiatrists as well) was unaware that a high dosage of Depakote causes hair loss, he didn’t warn me in advance. The one constant in my life is my hair. It has always been brown, thick, and straight. Sometime during my illness, my hair began thinning. But one morning I awakened, looked in the mirror, and it had become gray, fine, and curly. This was the final insult!

* * *
At the beginning of June‚ I decided to stop taking medication once again. Perhaps there is one moment when your body rebels and says‚ “I’ve had enough. I can’t take it any more. In trying to change your biochemical imbalance‚ you’re creating more havoc than I can possibly fix. I’ve given you side effects to signify that we’re in a crisis mode. I know you’re a bit dim-witted these days, but what more must I do to grab your attention?”

Honestly, I’ve always been suspect of people who hear internal voices. Since it’s another one of those mentally ill indicators‚ let me state for the record that my body didn’t actually talk to me. My decision to stop taking medication was an analytical one based on the lack of efficacy of the medication and its debilitating side effects. Besides, it was a good time of year to try some other form of treatment. Before my never-ending bout with rapid cycling began, July and August traditionally had been good months.

In my next session with Silas, I explained what I intended to do and why.

“There are no studies to confirm that any alternative treatments work,” he said in response.

“Surely, I couldn’t feel worse than I already do,” I answered.

Silas shrugged, paused for a moment to look at me, and then recommended a reasonable schedule for withdrawing from the medication. After I wrote him a check, we shook hands, and he wished me luck.

For the first time in months, I left his office with a bounce in my step. As I walked down the hall toward the elevator, I smiled, looked upward to acknowledge Alexander Pope, and then straight ahead as I pressed the elevator button and silently said, “Hope springs eternal in the human breast; Man never Is but always To be blest.”

Wednesday, October 29, 2008

Ten Worst Side Effects (Part 1)

Although I had intended to write a post about "negative self-talk," I'm tired and decided to post instead about side effects from medication. It seems like a number of people are having difficulties these days, and I thought you might be entertained. The following is an excerpt from my eBook, Bipolar Depression Unplugged: A Survivor Speaks Out.

FYI...After a few comments from readers, I decided I needed to add a caveat, part of which I explained in my response to PJ. From the moment I began taking medication, I was sick almost every day for six years with the worst imaginable side effects. (And once I stopped taking it, it took almost four more years for my brain to heal itself.)

I believe there are three ways to deal with adversity. First, I could rant and rage and spew forth my misery--which has never made me feel better and certainly wouldn't have been pleasant for my husband, son, and the people I care about. Second, I could write serious pieces about how I'm feeling--which I do in my journals when I need to. Third, I could poke fun at my situation, and use humor as a method of healing.

During periods of adversity, my sense of humor has always been my saving grace. However, it only works for me when it is coupled with a game plan for finding ways of resolving problems, and a willingness to engage in a wide variety of other wellness activities.

* * *
Ten Worst Side Effects
During the next 18 months, I alternated between depression and hypomania, and Silas (my psychiatrist) recommended the following medications in different combinations and dosages: Ativan, Effexor‚ Depakote, Lithium‚ Descipramine‚ Imipramine, Klonopin, Tegretol‚ Verapamil‚ Wellbutrin‚ and Zoloft. They call this cocktailing medication, surely a bad choice of words when 60 percent of manic-depressives abuse drugs and/or alcohol.

The only way I could bear this dreadful ordeal was through humor. To entertain myself‚ I compiled a David Letterman list of the ten worst side effects. I must admit that I didn’t include sexual dysfunction because it seems like such a personal disclosure, but suffice it to say that many psychiatric medications affect your sex drive. Having revealed that, here is my list in reverse order:

10. Vomiting. This symptom can be thought of as morning sickness for the mentally ill. Many antidepressants cause nausea and/or vomiting (in which case you should call your doctor). The drag is that it doesn’t go away after the first trimester.

9. Dry mouth. At the worst stages, I felt like I was walking around with a tampon in my mouth.

8. Flatulence. I never knew this word until I read it years ago in The World According to Garp by John Irving. But let me tell you that a farting woman is far worse than a farting dog.

7. Constipation. It used to be that every morning after I ate breakfast, read the sports section of the newspaper, and had a cup of coffee, I would have a bowel movement. I always thought that my regularity was caused by my disgust at the bad behavior of professional athletes who are getting paid so much money that it makes me “shit.” Once I started taking medication, I was lucky if I had a bowel movement every five days. (Yes, I know there is medication for irregularity but enough is enough!)

6. Sleeping Problems. The only people who worry more about sleep than manic-depressives are new parents and narcoleptics.

(to be continued)
The preceding piece is copyrighted material and may not be reproduced.

Tuesday, October 28, 2008

Is the Glass Half-Full or Half-Empty?

My husband and I just returned from a lovely three-day vacation to Morro Bay, California. As I mentioned last week, he was participating in a painting workshop, and I took my digital camera, which I'm learning how to use.

We arrived Friday afternoon and the weather was spectacular--warm and clear. The next two days the area was socked in with fog. On the second day, I tried taking photos in the fog, and they were so-so.

At first, I felt sorry that I hadn't taken a photo of Morro Rock the first afternoon when I could see it so clearly from the balcony of our room and could also show the fishing boats and bay. But then I realized that I have the same attitude about photography as I do about wellness. I see the glass as half-full rather than half-empty. What that means to me if that if something I'm doing doesn't work, I try something else.

So, I drove out to Morro Rock and realized that if I shot upward, I could capture one perspective--even though the top was fogged in (Photo 1). And if I hiked around the other side, I could get a shot where there was no fog (Photo 2).
However, I didn't think the second shot was as interesting so the question was: What else could I shoot? And while I'm not a great bird enthusiast, the area is known for its birds. So, I took a bunch of shots and particularly liked the one where there bird is "talking." (Photo 3).

And when I had tired of the birds, I drove to a different part of town, and there were some wonderful trees, and I loved shooting them.

As I was thinking about my experience, I realized this: For me, the glass is always half-full. That's the way I live my life, and that's why I've been able to achieve wellness. The older I get, the more I know that the only way I can only retain wellness is by being with people who feel the same way.

Wednesday, October 22, 2008

Psych Central Award

Dear Friends,
Although I'm still on vacation, I was pleased and surprised to learn that Psych Central considers this one of the Top Ten Bipolar Blogs. The others are listed here. See you next Tuesday.

Susan
P.S. Congrats Bradley!

On Vacation

Dear Friends,
In addition to our mini-vacation, I need a few days off from blogging. I'll be posting again next Tuesday. Hope everyone remains happy and healthy! As always, I like to leave you with a smile, so once again, I offer the graphic from the Cattlemen's Stress Test.

Susan

Tuesday, October 21, 2008

Small Changes

In her book, Inner Peace for Busy People: 52 Simple Strategies for Transforming Your Life, Joan Z. Borysenko, Ph.D., discusses change. She writes, "Psychologist Ellen J. Langer discovered that people who try new things are healthier and happier than those who stay in a rut. Even choosing a different route home from work benefits you. In her book, Mindfulness, she makes the point that variety keeps us engaged in life.

"You might be able to zone out if you've taken the same route a hundred times, but if you're on unfamiliar turf you have to stay tuned in. Tuning in encourages curiosity and results in a more adventurous life. An acquaintance of mine chose to drive a new way to work one day and got rear-ended in a traffic jam. But all's well that ends well. She married the man who slammed into her.

"This week, try making two small changes every day. Take a different street to work, turn off the television for an evening, go to a restaurant that serves exotic food, change your brand of toothpaste, smile at someone you don't know, show up at work wearing Groucho Marx glasses, go to a different supermarket, get a more daring hairdo, eat dessert first, or buy or borrow a piece of clothing that you never wear. The possibilities are endless.

"At the end of the week, reflect on what these little changes produced. Then think about your life. If you're in a rut, identify one small step you might take toward change. There's a whole landscape to explore once you leave the beaten path."

FYI...This will be an easy assignment for me since this weekend my husband and I are going away for a three-day painting workshop at a beach community about four hours away. But if anyone decides to try this...let us know what you do!

Monday, October 20, 2008

Happiness

The more I write this blog, the more I think about relationships with other people, and the older I get, I believe there are some people who seek happiness and others who don't.

"Is happiness a skill that, once acquired, endures through one's ups and downs?" asks Mattieu Ricard, a Buddhist monk and author of Happiness: A Guide to Developing Life's Most Important Skill.

"There are a thousand ways of thinking about happiness, and countless philosophers have offered their own. For Saint Augustine, 'Happiness is a rejoicing in the truth.' For Immanuel Kant, happiness must be rational and devoid of any personal taint, while for Marx it is about growth through work. 'What constitutes happiness is a matter of dispute,' Aristotle wrote, 'and the popular account of it is not the same as given by the philosophers.'"

How does Mattieu Ricard define happiness? "By happiness, I mean a deep sense of flourishing that arises from an exceptionally healthy mind. This is not a mere pleasurable feeling, a fleeting emotion or a mood, but an optimal state of being. Happiness is also a way of interpreting the world, since while it may be difficult to change the world, it is always possible to change the way we look at it."

Do you believe that people choose to be happy? Is it a personality trait? Or is it a skill they acquire?

Friday, October 17, 2008

Top 10 Wellness Activities (6-10)

This is the second part of the list of top 10 wellness activities that I regularly pursue.

6. Reading uplifting books on healing and related topics. One of my constant activities is reading a host of uplifting books on healing, spirituality, wellness, and related topics. There are always wonderful tidbits I pick up, which I either may not have thought about before, or which I've learned about but forgotten. I'm currently reading: If the Buddha Got Stuck: A Handbook for Change on a Spiritual Path by Dr. Charlotte Kasl. I wrote about it a few weeks ago and as I mentioned, the author provides simple yet sound advice.

FYI...I no longer read any books about bipolar disorder or depression. What I learned a long time ago was that most books on the topic (and for years I read everything that was published) are so negative and downbeat that they're not at all helpful. I am now firmly convinced that if I read and think about wellness, I'll be well. But if I dwell on illness, it will make me ill.

7. Keeping a mood chart and journal. I've written about this many times and there is no need to belabor it. But I still keep a daily mood chart and journal. The journal is helpful because it enables me to chronicle my life. And while I no longer need the mood chart to figure out patterns of behavior, and things that trigger depression, I do know that if I ever take a downturn, the mood charts will allow me to figure out why.

8. Eating nutritional food. This is a no brainer. We all know "we are what we eat." I'm blessed because my husband is a wonderful cook and he's the one who markets and cooks. But, we both know we feel better if we eat nutritional food. It's not that I don't occasionally eat junk food, but not on a daily basis. I also know that, for me, drinking water is very important. I carry a water bottle with me (a metal one so I don't contribute to planetary waste by using plastic bottles), and probably drink about eight glasses a day.

9. Praying. Since this is a secular blog, I rarely talk about religion, but I do pray with regularity. I'm so very grateful I'm well and I frequently thank God. One of the best books I ever read about praying was written by Malcolm Boyd, a family friend who's a gay Episcopal priest. In Are You Running with Me, Jesus? he talks about prayer as being conversations with God. You don't have to read a prayer book. You don't have to be in a church or temple. You can just talk to God when you're running, cooking, or doing your daily activities. (While I'm Jewish, I share Malcolm's attitude about the importance of communicating with God in a casual way.)

10. Stress reduction and relaxation techniques. Many of the things I do are somewhat related to stress reduction. If I'm tense, I do breathing exercises or blow my harmonica. If I'm worried about something, I take a walk. If I feel a bit down, I clear my mind, and think about all the things I'm grateful for. If I feel unhappy, I watch an upbeat film or listen to music I like.

Most of all, I concentrate on feeling well. Over time, I have learned that life is too short to dwell on negative things or spend time with negative people. I have always been an optimist by nature, and even when I was ill, I felt hopeful that some day I would be well. Now that I am, I feel so lucky and so grateful that I hesitate to waste a moment of my time with people who don't have a positive outlook on life.

Thursday, October 16, 2008

10 Top Wellness Activities (1-5)

"When I'm feeling blue, all I've got to do, is take a look at you." Actually, these lyrics are from A Groovy Kind of Love written by Phil Collins in 1988. In my case, when I'm feeling blue, all I need to do, is engage in any or all of my top 10 wellness activities.

1. Badminton. This is my newest activity. The fact is that aerobic activity is great for healing depression. But it's also fun for me to be taking a class at a local community college so I can play with 18-20-year-olds. I'm getting better each time, and it feels great that I've reclaimed my athleticism.

2. Sunshine. While there are lots of books discussing the benefit of light therapy, the moment I feel a little under the weather, I go outdoors, and stay there for awhile. If I'm in the mood, I take a walk. In the old days when I was very depressed, I would just shuffle to the yard and sit in a chair for ten minutes with my face facing the sun. If I felt a bit better, I weeded. There's sort of a Zen-like quality to mindless weeding. If I had a lot of energy, I did home improvement projects.

3. Playing a musical instrument. These days, I am playing the accordion, electric guitar, Autoharp, recorder, and harmonica. While the word "playing" may be somewhat of a misnomer, the fact is that even when I just strum the Autoharp, blow in and out on the harmonica, and do scales on the accordion, I feel so much better. But, since playing instruments is truly a delight, I actually try to spend an hour a day playing an instrument and singing songs as well. There have been numerous studies showing the value of music therapy.

4. Gardening. Again, horticultural therapy has been found to truly help people feel better. Maybe George Bernard Shaw was right when he wrote, "The best place to seek God is in a garden. You for dig for him there." Or perhaps it's just a connection to nature that is so soothing. But, even if I just spend 15 minutes watering flowers, it makes me smile.

5. Blogging. We all know the value of writing to heal. I believe that blogging to heal is equally important. First of all, it's just a wonderful sense of accomplishment to post five days a week. Second, it allows me to share information with people who might find it helpful. It also enables me to connect with people through writing rather than talking. And I feel that sharing information on bipolarity as well as wellness activities is highly beneficial.

Tomorrow, I'll list five more of my top wellness activities.

Wednesday, October 15, 2008

How to Be Well (Part 2)

I guess the real question is: What does it mean to be well? For me, the definition of wellness has evolved over time. I used to think that being well meant being "completely normal." I figured that once I'd beaten this illness, I would never evidence any bipolar symptoms again.

This year I decided to redefine what wellness means to me. While I feel good most of the time, I still sometimes have symptoms. As I've mentioned before, a few weeks ago, I began to have a very low energy level, which made it difficult to get up in the morning. Since Adderall works for me, I'm now taking 10-20 mg. every morning so I have no difficulty getting up.

The only problem with Adderall is that it sometimes produces a low-level hypomania. Again, for me, all that means is that I have a higher energy level than normal. In days past, that would mean that I talked too much, too fast, and too loudly, and sometimes felt irritable, and wasn't very patient. However, now that I know these are symptoms, I work hard to alleviate them.

So, I've decided that I still consider myself well even though I have to take Adderall, and I have a few symptoms that I try hard to mitigate. By coming up with a more realistic expectation of what constitutes wellness, I can feel like I've made great progress.

One of the difficulties of bipolar disorder--as far as I'm concerned--is that there aren't enough success stories. And maybe one of the reasons is because the goal is "total normalcy." But, what is "normal?"

I know plenty of people who aren't BIPS (bipolar) who feel depressed and remain so for months at a time. I know lots of non-BIPS who talk too fast, too much, and too loudly. I also know lots of non-BIPS who are irritable, impatient, and sometimes downright hostile.

In fact, I'm sure we all know people whose behavior appalls us, but who aren't concerned about it at all. Do you ever wonder why certain "normal people" don't monitor what they do or say, why they never apologize for their "bad" behavior, and why no thinks they're sick when they act out?

So, I figure that my self-discipline in controlling things is a sign of success. I'm proud that I'm so conscientious about keeping mood charts. I think it's great that I have a daily diary of what I accomplish, how much medication I take each morning, how my energy level is throughout the day, how much exercise I do, and note what time I go to bed at night, and any behavioral patterns that concern me.

When I was diagnosed as a BIP in 1993, I would have been thrilled if my doctor had said, "You're atypical bipolar II, but don't worry about it. I've got patients who take a small amount of medication, but are so disciplined that their condition hardly affects their lives at all. They keep mood charts and participate in a wide array of wellness activities and truly have their situation under control."

Tomorrow, I plan to write about my top 10 wellness activities!

Tuesday, October 14, 2008

How to Be Well (Part 1)

As I drove to my badminton class yesterday, I thought about how grateful I am that I can commit to a biweekly class for 18 weeks. Two years ago was the first time in a long time that I could enroll in a class and attend every session.

One of the problems with frequent depressive episodes was that for the longest time I didn't know when they could hit. Unfortunately, I hadn't yet realized that my lifestyle and my response to stressors was contributing to these episodes. But now that I've figured things out, it's truly a joy to be able to sign up for classes I like, and participate in a host of activities.

In the last few weeks, I have spent time with a number of friends and acquaintances who are out of sorts, seem somewhat lost, and aren't truly engaged in activities they enjoy.

In some cases, they're retired or semi-retired. (Some are employed, but after decades spent working at the same career, they've lost their passion and their interest in it.) A few are taking a break for medical or psychological reasons. But, the commonality is that there is no order to their days. They seem to have forgotten--or perhaps never knew--how to balance their lives. And they don't have a sense of mission as to why they're on the planet.

After a few days spent with people like this, I began feeling a bit under the weather myself. If there's one thing I truly dislike, it's being with people who are lost or drifting and either won't admit to themselves that they have a problem, or won't try and seek a solution.

In the bipolar world, it's easy to blame everything on medication and doctors who lack insight. In life, there seem to be many people who are seeking someone else to blame--whether it's their childhood, a former spouse, a lack of money, or their situation in life--whatever it may be.

As far as I'm concerned, no matter what the causal factors, ultimately we're responsible for finding meaning and happiness in our own lives. For me, that's what wellness is all about. And that's what I intend to write about this week.

Stay tuned!

Monday, October 13, 2008

Anatomy of a Depressive Episode

I originally posted this on Saturday, but I'm posting it again because I believe it's an important topic to discuss. My response to Kelly on Friday was about ways to try and deal with a depressive episode in the work environment. And my list of five recommendations was geared to trying to help her feel better as soon as possible in order to be productive at work.

However, Friday night when I was sleeping (I have many of my best ideas when I'm dreaming), I realized that in focusing on depression and work, I didn't discuss some of my other theories about the nature of depressive episodes. Thus, the reason for this post.

I believe that depressive episodes usually have some sort of triggering event. In my own history of more than 120 depressive episodes, this was always the case even when I wasn't aware of it. And the cause was usually stress.

So...what I recommend to everyone who is suddenly feeling worse and whose medication is no longer able to mask the symptoms is this:

1. Keep a mood chart (I've written about this many times and you can check my archive for my recommendations on how to do this). Try and figure out what is causing your current depression. Is it work-related stress? A relationship problem? A seasonal problem? A medical problem? etc.

2. If your medication has worked well in the past and suddenly isn't, what has changed? Have you added a different medication to the mix? Have you changed the dosage of what you're currently taking? Are you noticing symptoms that you haven't before? Or, do you just think that your medication is "pooping out," which does happen.

3. Is it a seasonal problem? No matter how well I'm feeling and how happy I am, I always have a problem in the fall. While I make it a point to spend more time outdoors and increase my level of exercise, for the past number of years I usually have to go back on Adderall, the one medication that works for me. And this year is no different. I'm on a very low dosage of Adderall, but without it, I can't wake up in the morning.

4. If you can determine the trigger(s), or even if you can't and need help to do it, it is undoubtedly a good idea to talk with a counselor or therapist. Or if you decide that the way you handle stress is a constant problem, then I would recommend yoga, meditation, gardening, deep breathing exercises, and/or playing a musical instrument (which for me makes a big difference).

5. Try not to panic. In past years, one of the biggest problems I faced when I could feel a depression on the horizon (and I could pinpoint it within three days) was that I panicked. I don't mean that in the sense of a panic attack (I've never experienced one). It was just that I'd undergone so many depressions and they had become so debilitating that I was terribly concerned whether I could survive another episode. I believe now that my anxiety about the advent of the depressive episodes undoubtedly heightened their impact.

These days I know that my depressions (and I hesitate to use the word because it's not truly a depression; it's just a lower level of energy) are caused solely by seasonal change. I'm sorry they occur, but they are easily treatable and may only last a few weeks or a few months.

I know that Adderall works for me, and I have no hesitation in taking it. Since I can tell when the depressions end, I can titrate off it quickly with no ill effect.

Also, I also know that Adderall does have certain behavioral side effects, which I try to monitor. My mood rises during the day. If I don't monitor my behavior, I tend to talk too much, but since I'm aware of it, I try hard to make sure I listen to others. Also, if I'm a bit too wound up, I take small breaks during the day, and play an instrument or breathe. I am too enthusiastic, which I also monitor (While I don't find this to be problematic, I have learned that others do). And that's about it.

Over the years I have eliminated all other behavioral problems, including spending too much money, trying to "save" people who are needy, and participating in too many activities.

So, I guess what I'm saying is that in my case, my wellness activities cannot prevent Seasonal Affective Disorder. And since bright lights and a dawn simulator don't work for me, nor do vitamins and alternative remedies, I take Adderall, knowing that it causes a low level of hypomania. But...even this isn't a problem because I try hard to monitor my behavior, and prevent behavioral patterns that have been problematic in the past.

Friday, October 10, 2008

Depression and Work

Kelly wrote to ask what to do about work since she's feeling so depressed and her performance is suffering. This is a difficult question to answer. Initially I said that by the time my depressions were truly debilitating, I was already a freelance grant writer so it wasn't a problem.

The value of freelance work is that you can do it whenever you feel like it. Even though I had deadlines I couldn't miss, if I was feeling a bit under the weather, I could work later in the day or even at night, and for most of my career I didn't miss a deadline. Later, when the medication caused havoc, it destroyed my career. And while it was salvageable, I no longer was interested in grant writing. These days I'm semi-retired so it's not a problem.

At first I didn't think I could offer Kelley any advice about how to handle depression in an organizational setting. But the more I thought about it, the more I realized that I do have some suggestions. The problem as she stated it is that she's feeling so hopeless that it's difficult to motivate herself.

Kelly,
First of all, I'm wondering if you're taking antidepressants and why they're not helping you get rid of the "hopeless" feeling. In the best of times, it usually took 14 days for the antidepressants to kick in--that is when they worked. And once they worked, I felt 100 percent better and could motivate myself. (Later, they didn't work at all, but I'm an unusual case.)

I've read a lot about work and depression and many of the books suggest you should discuss your condition with your boss to see if there can't be some accommodations made, which will help you in the short term.

Given my own experience, I've got to say I disagree. About five years ago I took a part-time director of development job for a nonprofit organization, and did tell the boss about my illness (primarily because the salary was way below my usual fee and I needed to explain why I wanted to be paid more).

My disclosure initially enabled me to get the salary I wanted and to work the hours I wanted. But, about a month into the job, I learned that my boss was a real "nut-job" and had a history of taking advantage of the people who worked for her. When I tried to see if I could report to someone else within the organization, she used my illness against me by suggesting the problem was mine rather than hers. It's a long story, but it was very unpleasant. Ultimately, I had to resign because my health is my most important priority.

A few years later, I accepted a book editing position, and once again disclosed the illness because the author/client wanted me to work side-by-side with her for five days a week and I felt I could could only stand to be with someone for three days a week since I was only recently feeling well.

Although I did a terrific job editing the book, I had numerous difficulties dealing with this client. Again, she tried to blame my illness for our problems rather than her behavior (which I learned had been problematic with a lot of former employees). Since I'd already been through this once, and knew that my own behavior was very professional, and hers wasn't, I didn't allow her to take advantage of me. But, I felt that if I'd never mentioned the illness, I would have been better off.

So...having said this, my own experience suggests that disclosing the illness is fraught with problems. If other people have other experience with this, please let Kelly know.

Back to your original questions, which is how to motivate yourself when you're not feeling well, I guess I would suggest the following: 1. Talk to your doctor to see why your medication isn't working. 2. If you're not exercising, try to start. Aerobic exercise, which is truly difficult to start when you're feeling depressed, can ultimately make you feel better if medication can't.

3. Whether or not you're feeling motivated, there must be things you need to accomplish each day. While I don't know what kind of job you have, I do know that as a writer and grant writer, it was critically important that I make progress every day. So I wrote myself a detailed daily list of what I needed to accomplish. Whether I felt well or not, I slowly worked through my list. While I may not have been enthusiastic, that was less important than getting the job done.

4. The worst feeling in the world is letting things slide and hoping no one will notice. Ultimately they will, and the last thing you want to have happen is to have a less than stellar performance appraisal or be fired (in this economy). So, even if you decide not to disclose your depression to your boss, is there a colleague (or a therapist outside the work environment) who can help you figure out what you need to do to be productive until you feel better?

5. Also, I'm not sure if your work environment is helping to cause your depressive episode. If it is, you need to make sure you're talking to a therapist or counselor about the problems caused at work and see if you can figure out ways to improve things.

Since I don't know enough about your specific situation to give better advice, these are my top five ideas for now. If anyone else has suggestions, I'm hoping you'll provide them. Kelly, if we need more info to help you, let us know. All my best!

Susan

Wednesday, October 8, 2008

Does Bipolar Wellness Need to be So Elusive?

PJ's comment on yesterday's post caused me to write today's. She's only been diagnosed within the last year and wonders how long it's going to take to get well, whether she'll still have highs and lows despite medication, and I guess perhaps just wants my perspective on all this.

Dear P.J.,
I guess the best way to start out is to say that I can't be sure how things are going to play out for you. But I will give you my perspective, and hope that others will tell you how they feel. In my own case, you have to realize that I wasn't diagnosed until 25 years after my first depressive episode. And all that time ago, people didn't talk about depression. So while I had these two annual six-week depressive episodes, I had no idea what caused them.

A part of me is glad I wasn't diagnosed when I was younger because I wouldn't have wanted to wear a label when I was 18 years old. Unlike most people, I don't believe in labels and I don't believe in looking at mental illness and physical illness as separate entities. But while that's easy for me to say at 58, it wouldn't have been easy for me to figure out and say when I was in my late teens and early twenties.

So, while I did have these episodes for most of my life, I didn't feel like I was handicapped in any way. I have always fought for what I've wanted and mostly achieved it--even if it turned out that it didn't make me happy.

And maybe, since the career I ultimately pursued is writing--which is so personal and so fraught with rejection--perhaps I needed success in other fields to deal with the rejection and be able to transcend it. (But that's an entirely different topic of discussion.)

In terms of bipolar mood disorder, my own feeling is that medication will never be the full answer--even when it works. I strongly believe that if a person is feeling very stressed and disliking his or her job or having problems in his or her marriage, or having difficulties with friends and/or family members, medication can't solve the problems--and shouldn't be expected to.

If we're not getting exercise, which has been proven to be of greater value than antidepressant medication, then we're going to have problems. If we don't eat nutritional foods, then we won't feel well. If we don't attend to the spiritual aspect of our lives, then we will feel there's something missing. And if we don't continue to grow and evolve--and deal with the difficulties and darkness that's inherent in the very process of life--then we are going to have problems.

Medication cannot solve those problems. We need to develop an understanding of who we are and want we want. We need to develop skills to handle stress. We need to read about adult development so we can anticipate life stages. We need to deal directly with the people and situations that are bothering us so that we can resolve issues and figure out whether we want those people to remain in our lives or whether we will be happier without having them in our lives.

If people are psychotic, medication can help. If they are always so depressed they feel like killing themselves, then medication can help. If they hear voices, medication can help.

But, if they are rapid cycling and weren't before they started taking medication, they need to ask themselves if the medication is causing the problem. If they are hoping that whatever ails them is biochemical (whatever that truly means) rather than facing their true life problems, then their diagnosis is only a crutch and I don't believe they'll ever get well.

In answer to your question, "No, I don't think it needs to take years to figure all of this out." I did seek help when I was younger and saw a number of counselors and psychologists and I have never met less insightful people in my life. But I know that some people who are reading this blog do have counselors or therapists whose advice they treasure. And advice can come from friends and family members as well as spiritual advisers.

I guess my best advice is to say, "Whether we believe in labels or not, I believe we are each responsible for our own lives. And the disservice that a diagnosis can play--in my opinion--is that it suggests you aren't responsible for your life because you have a chemical imbalance. The truth is that diabetes or high blood pressure or cancer can be attributed to a chemical imbalance as well.

So I believe that whatever illnesses we have, we need to get the best medical care we can, but ultimately we can all be self-healers. We need to look inward as well as outward to figure out how to live our lives. We need to make sure we're not only living authentic lives, but that we are living lives that are satisfying to us...not to others.

P.J., I think if I had understood this when I was younger, I could have healed myself far earlier. I'm not sure why it took so long, but I still have years left to live so I'm grateful I've finally figured things out for now.

All my best in your journey!

Fondly,

Susan

Tuesday, October 7, 2008

Dealing Daily with Bipolar Disorder

Yesterday I received a comment from KJ whose husband suffers from bipolar disorder. She felt that my answer to Gianna provided her with hope, something she is truly needing at the moment. Since I have been well for some time, it brought back difficult memories of how different my life (and that of my family's) was for so many years.

I vividly remember how terrible I felt when I was so depressed I could barely function. Each morning I would awaken and hope that the new day would bring some sort of relief. I would wonder what I possibly could have done to have been punished so severely that I was in such terrible psychic pain. I prayed that I could survive that day and the ones to come.

I remember how hard I tried to create "normalcy" so that my son wouldn't feel he was part of an "ill" family. I tried so hard to attend school events even when I didn't feel well, and to drive on field trips so that my son would know I cared and wanted to participate as fully in his life as was humanly possible.

I worked hard to try and maintain my self-esteem even when I had gained so much weight on medication that I was embarrassed, or suffered such terrible hand tremors that I couldn't write a check, or had such awful head sweats that my hair was drenched and I looked unkempt.

I tried hard to continue my freelance grant writing career even though I was suffering cognitive memory loss and it took me twice as long to write grants and they weren't up to par, or I was so hypomanic that my behavior offended my clients. I forced myself to continue writing books even when I was unable to publicize them because I was depressed for a full year after they had been published.

I remember how disappointed I was when my doctors prescribed medication after medication that made me worse, and never were honest about their lack of knowledge regarding bipolar depression. And the sicker I got, the more they tried to make me feel like it was my fault rather than their incompetence.

So, KJ, I just want you to know that you and Joe aren't alone. Now that I'm well, I have no idea why I had to suffer for so many years. But I can only think it was because I can now provide some solace to others. And I hope that my success in achieving wellness will allow others to realize that wellness truly is possible.

Monday, October 6, 2008

Let Your Life Speak (Part 2)

As I mentioned on Friday, Parker J. Palmer's book, Let Your Life Speak: Listening to the Voice of Vocation, is one of my favorite books. Palmer's path to finding his true vocation hasn't been an easy one. He has suffered through a few debilitating depressions, and yet he is one of my favorite role models.

The reason is because it would have been easy for Dr. Palmer to have settled for careers that were prestigious but not satisfying. Instead, he kept on pushing himself to find his true purpose when others undoubtedly would have settled for less. The following quote is a continuation of the passage I quoted earlier.

"But before we come to that center, full of light, we must travel in the dark. Darkness is not the whole of the story--every pilgrimage has passages of loveliness and joy--but it is the part of the story most often left untold. When we finally accept the darkness and stumble into the light, it is tempting to tell others that our hope never flagged, to deny those long hours spent cowering in fear.

"The experience of darkness has been essential to my coming into selfhood, and telling the truth about that fact helps me stay in the light. But I want to tell that truth for another reason as well: many young people today journey into the dark, as the young always have, and we elders do them a disservice when we withhold the shadowy parts of our lives.

"When I was young, there were very few elders willing to talk about the darkness; most of them pretended that success was all they had ever known. As the darkness began to descend on me in my early twenties, I felt I had developed a unique and terminal case of failure. I did not realize that I had merely embarked upon a journey toward joining the human race."

Friday, October 3, 2008

Let Your Life Speak (Part 1)

One of my favorite books is Let Your Life Speak: Listening for the Voice of Vocation by Parker J. Palmer. Like me, Palmer's career has evolved over time and he has suffered from some painfully long depressive episodes. Like me, Palmer has found a career he finds satisfying. He writes:

"Most of us arrive at a sense of self and vocation only after a long journey through alien lands. But this journey bears no resemblance to the trouble-free 'travel packages' sold by the tourism industry. It is more akin to the ancient tradition of pilgrimage--'a transformative journey to a sacred center' full of hardships, darkness, and peril.

"In the tradition of pilgrimage, those hardships are seen not as accidental but as integral to the journey itself. Treacherous terrain, bad weather, taking a fall, getting lost--challenges of that sort, largely beyond our control, can strip the ego of the illusion that it is in charge and make space for true self to emerge. If that happens, the pilgrim has a better chance to find the sacred center he or she seeks. Disabused of our illusions by much travel and travail, we awaken one day to find that the sacred center is here and now--in every moment of the journey, everywhere in our world around us, and deep within our own hearts."

(to be continued)

Thursday, October 2, 2008

Persevering and Problem-Solving

When I wrote yesterday about persevering to achieve wellness, I should have mentioned that the second part of the equation is problem-solving. In a job search, which is the example I used, the key when you don't get hired is to figure out why, and to make whatever changes are necessary to be successful.

Sometimes, particularly for recent college graduates, it's may be a question of a crowded market-place, and a lack of experience. But sometimes, you know you didn't get hired because your resume wasn't compelling enough and you need to rewrite it or write a better cover letter. Or you didn't do a great job in the interview, which means you need to learn more about the questions you may be asked and how to answer them. Or you did a good job in the interview, but the people you used for recommendations weren't strong enough.

The key--whether it's applying for a job, or achieving wellness--is to figure out what went wrong and to determine what you can do to fix it. Persevering without problem-solving is a waste of time. To send out a resume over and over, which doesn't result in interviews is a waste of energy. To go on interview after interview and not clinch the job means the marketplace is getting smaller and smaller and you're still jobless.

To try and achieve wellness by continuing a process that is making you sicker and sicker is also a waste of time.

My advise is this: Try and figure out what is causing your depressions when you're well. Start an exercise program when you're well. Begin a mood chart when you're well. Participate in wellness activities--whether it's playing music, meditating or gardening--when you're well. That way, it's far easier to continue to pursue these activities when you're feeling slightly depressed.

The worst feeling in the world is to feel a depression on the horizon and have no clue why it's coming, and no course of action to deal with it.

In my own experience, depressions don't come out of nowhere. There are plenty of clues, if only we pay attention to them. And the worse time to try out new wellness activities is when you're beginning to feel depressed because that requires motivation and energy, which is in short supply when you're feeling down.

(to be continued)

P.S. My first published book was Job Search Strategy for College Grads, which I wrote with my undergraduate career counselor, and I used to write magazine articles on the subject as well as doing seminars.