Bipolar Mixed States and PTSD – Finding Doctors Who Can Deal

FreudIn the last city I lived in I had a Freudian psychiatrist. Don’t ask me how it happened because like many things in my life I didn’t really plan it. He looked very much like a short version of my father and that just made the whole Freudian thing a lot weirder. In his narrative regarding my bouts of anxiety and workaholism, I was always trying to save a man who couldn’t be saved. It was true that I tore through a number of jobs in establishments owned by dysfunctional men but when I tried to tell my doc that my interest in improving the business was selfishly motivated he would shake that conviction.

It’s weird for a psychiatrist to be Freudian. Usually they have more interest in cocktailing drugs than rehashing the past to fit an analytic narrative. But I he listened to my stories and responded with meaningful questions and suggestions (most of the time_. We had a good rapport and for the most part we had the meds on track. Until I went hypomanic. I don’t think he was quite ready for that.

Bipolar disorder is extremely hard to diagnose accurately in a timespan less than a year or even two. In my experience, the psychiatrist or psychologist has to witness the mood disruption first hand to really believe in the diagnoses. Most bipolar people don’t go to the doctors when the hypomania takes hold because it feels good. But I did, finally. I have found that psychiatrists, used to seeing me in a depressed state, when confronted with my crazy, they balk. My psychiatrist in the new city pretty much dumped me as a client when I fell into the K hole of a mixed state and wound up in the hospital. It did not make the whole thing any better

I could tell the difference in Dr. F’s assessment of me. I was experiencing a mixed state which is usually what drives me over the edge. I am miserable but with energy that is turned against me in the form of panic, restlessness and agitation. Unfortunately he upped my dose of Lithium at the same time he reduced my Wellbutrin. This did bad things for me including amping up the tremors. As a Reiki practitioner and artist this was a problem–my hands would shake on my clients which was distracting to say the least. That mixed state unraveled my life. All of my traumas that been coiled tightly in the realm of my subconscious broke free.

Mixed states are hard to treat. For me, the most effective method is heavy sedation in the form of Klonipin. It takes the anxiety down a notch or two and while it doesn’t allow me to function, it does allow me some reprieve from my adrenals. Now this has become almost a pattern–it happened again this year. I don’t know what the answer is because the BP and PTSD are tied up in knots, together.

Has anybody experienced this recurrence of mixed states that is triggered by PTSD? All of my self-care like meditation, Reiki, exercise and balanced meals may help prevent these episodes but once they are upon me, nothing seems to work. Any suggestions?

Body of Evidence

In many ways our bodies are physical records of our lives both inner and lived. Areas of knotted fascia (the webbed connective tissue that keeps everything in place) may be the result of the time I fell off my bike as a kid. You would have thought it would have healed by now but no. The body keeps a ledger of missteps.

We all know the commercial with the pathetic looking puppy and neglected family–depression hurts…everybody. It’s facile but not wrong. Depression amplifies pain and distorts it (and perhaps adds some reverb and a little delay). Depression lives in the body as much as the mind. Pain, the accumulation of extra pounds and lethargy are all the real deal for a depressed person.

For me, this is the baseline level of pain I feel (when I’m not hypomanic). Add PTSD and anxiety and it’s a wonder I function at all. Depression, anxiety and hypervigilence tax the body’s autonomic nervous system–the system that regulates the body’s functions (like blood pressure, digestion and heart rate) in order to bring it into homeostasis.

When that system is clogged up with constant triggers to its fight/flight response it remains engaged–meaning the body cannot rest and repair itself. Adrenaline is dumped straight into the bloodstream and when that runs out, it’s cortisol, a hormone that among other things makes us hold on to fat. Gross

It was this what brought me to the ER this summer. I had so much anxiety, I was constantly in a state of hypervigalence AND I was depressed. It was like being tied to a chair while being tickle-tortured but without the fun. Right now I’m feeling the restlessness again, along with the heft of depression. It’s not yet a mixed-state but it’s about one state over.

For anybody else who has or is experiencing this special brand of torture here are some things I have come across that can be helpful if I catch it in time.

1. Creative therapy. Automatic writing, fast drawing, sculpting clay or putty, beading, singing, playing a musical instrument and whatever else is kicking around in there can draw the attention away from self and onto something tactile or sense-oriented in other ways. It only works if you can manage to divorce yourself from the outcome. It isn’t about making art, it’s about the act of creating and it doesn’t matter if it’s good.

2. Tense/Relax Meditation. This is the kind of meditation I can do in the midst of a mixed state, when mindfulness meditation is a no-go because of pain or restlessness.  First, center yourself within your surroundings. Make note of sensory data–what do you see, hear, smell, feel and taste? If associations pop them up, notice them but don’t hop on the train of thought. Let them fall away. Keep your breath grounded in your senses. Then tense your muscle groups individually, hold for a few breaths and relax. Notice the difference?

3. Move It. Honestly it doesn’t matter if you’re prepping for a marathon or cleaning the attic. Moving uses the extra adrenaline as fuel. It can be fun too–I like Wii Fit Plus Rythm-Fu, or putting on a record and dancing like a fool. Other ideas: jumping jacks? Shooting hoops? Walking around town? Yoga? This is where I often fail. The pain and stuckness become so unbearable I feel I can’t move. I suffer for it. I get mad at my doctor for suggesting it. But I have found that it works.

The point of these activities is to get out of the brain and into the body, even if it’s just for a few minutes (though longer l, definitely better). It’s about reconnecting with the body and feeling it in the moment, trying to let negative associations go.

That’s enough proselytizing. I’d love to hear input from others.

Hitting the Hard Reset

Right in the middle of my outpatient treatment I had to fly back home for my brother’s wedding. I was tweaked, blinking extra in the harsh light, unsure of my footing and definitely not ready to deal. The whole thing was a mine field of emotional triggers between my family, friends and the city itself, the backdrop for some of the most traumatizing experiences of my life. I had been away from it all for a year and during that year I had every possible anxiety reaction my body.

First my hormones went crazy. My skin broke out worse than it ever has since high school. My fight/flight response was so hyperactive I was practically electrocuting myself with my own nervous system and dumping adrenaline straight into my stomach like battery acid and kicking my spouse throughout the night. I had all my stress reactions at once–weight gain, getting sick every other week, stomach pains, breakouts, insomnia, panic attacks, asthma attacks and that frakking muscle in my lower left lumbar that spazzes out whenever I’m on the fritz. Which I was, hence my trip to the ER.

The tail end of hospitalization is not a recommended time to travel cross country to participate in a large family gathering. Out of all of the self-care tactics I had picked up in treatment, the only one I could hold onto was mindfulness. I was not meditating yet but I was watching my emotions bubble over me and fall to the ground, popping as they hit the pavement. I could see them but they weren’t  affecting me. I couldn’t tell if I had just turned it off or if CBT was actually working.

Now that I’m trying to actively participate in life, it’s not that easy. It isn’t as easy as pulling off a wedding and taking a vacation from losing my mind. Then, I knew that I would return to the safe pit of un-sane-ness, where it was OK for me to be a mess and work on my own safety. Last night my lumbar muscle started again which reminded me of the self-care I have been largely avoiding. Only three months out I already need to hit the hard reset before I find myself back where I started. I think I need to start where I started last time. Counting sheep.

My Excuse? Exercise Bulimia, CBT and Realistic Resolutions

Over at Harsh Reality, Opinionated Man says:

I keep seeing these fitness blogs with their 2014 resolution posts. Many of them have the title “What is your excuse?”

Opinionated Man has some rather hilarious and perfectly valid “excuses” for not becoming a carb-obsessed, fatty hating gym rat.

I thought I’d address this resolution trend myself because I am aware that it started with mommy blogger “Fit Mom’s” abrasive challenge to women to stop being lazy. It was obnoxious. It stirred up a shit-storm of feminist furor which in turn incurred the wrath of muscle bound meat heads who think bagels are the work of Satan and anyone who can’t bench press a school bus is a newbie. Comment threads on top of comment threads full of haters.

Fit Mom irritated me, I admit. I am not jealous of her. I don’t want to spend five hours a day in the gym and have the entire world take note if I gain a half a pound. I also think the inner drill sergeant tactic is ridiculous from the standpoint of CBT, which actually has a body of evidence to support it. So yeah.

What’s MY Excuse?

Exercise Bulimia

Fit Mom is a self-admitted bulimic who believes she has conquered her eating disorder yet works out for five hours a day. I don’t know her and won’t pass judgment but I know for me, that much time spent working on my body would not be a healthy thing.

Exercise bulimia can be just as damaging to your body and mind as the purging kind. Obviously your body and the comparison of it (implicitly or explicitly) to other women is an obsession. I mean, go ahead, be a fitness instructor but you don’t have to taunt “fatties” (not my word, or hers, to be fair but one used frequently on comment threads regarding this publicity stunt) with your four recent offspring and perfect abs.  

Some of us have invested serious time and work caging the beast of our eating disorders and are trying to learn kinder, gentler ways to keep our bodies in shape. It was the confrontational stance of “What’s YOUR Excuse?” that irritated me. In fact it triggered me. I’m sure it did the same for others.

All I frickin want to do is work out, knock it down a size or two. I quit smoking 15 months ago (go me) and swore a blood oath to my spouse to disengage from my 20-year-old eating disorder. So I can’t starve myself and I can’t purge. To be clear, purging includes working out for six hours a day. Sorry Fit Mom, you could still be a bulimic. Just because you aren’t tossing your cookies doesn’t mean that the mechanism of the eating disorder isn’t active.

Having gone through CBT, every week is like a new year with resolutions and such. Sometimes my resolution is to do a half an hour of Rythym Fu on the WII TWICE this week and traipse through the ‘hood (which is a hilly rain forest) once. That is not going to give me six pack abs but it is an attainable goal.

Taping a picture of my face Photoshopped onto Fit Mom’s body and writing “What’s Your Excuse???” in bright red lipstick on my mirror or obsessing over a size or a number on a scale or a measuring tape is all crazy-making behavior and not likely to produce the desired result. I mean, like I said, Fit Mom does have great abs.

Mixed States Weekly: ‘High Tension Lines’

tension lines - a portrait

high tension lines – (c) 2013 eccentric states

During my stint as an Impatient/Outpatient, we had a weekly group that the facility was not allowed to list as ‘art therapy’ because there were no actual art therapists involved. What we created were ‘soul collages’ and were supposed to represent a feeling or a subject matter. I can’t remember what theme was for ‘High Tension Lines” but I made great use of wallpaper swatches.

The ‘soul collage’ is something I took away with me. I keep it close by because sometimes I can’t articulate myself with words. I actually have a giant stack of magazines, maps, more wallpaper swatches, pens, crayons, charcoal, watercolors, magic markers and a little desk next to my bed. It’s pretty much all I have as far as space goes but it’s a worthwhile use of it. These days I don’t really bother with a theme or subject matter. I just pick out some images and dive in.

I love art almost as much if not more than I love writing. It was my second passion (reading being the first). My love of visual art extends to enjoying it as well as making it. Images are capable of evoking so much and the viewer consumes it in seconds, taking it in and making it part of her.

When it comes to art, I’m an over-sharer, maybe. I don’t think art is valued remotely enough in the US. So I share. As for collages and mixed media, I really like Wangechi Mutu’s work and Karen Klimnik is one of my favorites.

Work Shy – Working While Bipolar

depressed_workOne of the very first jobs I held was as a barista at a coffee shop that was like a bar for underage goths to drink black coffee and pretend to read Sartre. It had vegan food before vegan was really a thing. And it was in Florida. Amusingly, Florida is pretty much the goth capital of the country. Marilyn Manson (the band, not the guy) hailed from Fort Lauderdale and, you know, parents and people who liked banning things in general, pretty much thought they were the devil. You would think that with the sun scorching down people wouldn’t really want to wear black from head to toe but you would be wrong.

I lived in Tallahassee.I moved there while in a manic state and was still pretty ‘up’ when I got my job. I was what all the Craigslist ads refer to as a ‘rockstar barista.’ I was fast, funny, thought five steps ahead and was pretty much always on. The hypersexuality of my mood state helped. It fueled my game with the customers. That continued for awhile. I had a lot of ‘firsts.’ It was probably the longest hypomanic episode I’ve had.

When I crashed, my work suffered. This is not uncommon for bipolar people. The excitement of a new job itself can be a trigger for hypomania. Eventually that train runs its course and the boss thinks you’ve lost your passion, that you’re losing your touch, that you can’t handle the workload or that you’re on drugs.

With depression those things can be very true–but it’s a transient state, much like the hypomanic one the boss loved so much to begin with. I loved that job. But my touch was no longer golden. My manager called me to the back office and I went, heavy-hearted, terrified about what was about to happen.
“I’ve noticed you haven’t been yourself lately,” he said, both feet on the floor and his hands clasped in front of him. It was a power position. He did it a lot.
I was quiet…I didn’t know what to say. “Did I do something wrong?”
“It’s not one thing,” he said, a little hesitantly, “it’s a bunch of things.”

I knew what he said was true. Being depressed, I probably felt worse about my performance than he did. I felt like the sun fried the energy out of me, boiled my life blood. That’s what depression always feels like to me. Like being burnt. I started crying. Fuck, I thought. I hated crying in front of people and it happened more often than I would like.

He dropped from power-boss stance to compassionate-guy position, obviously rattled by the waterworks. Most men don’t like making women cry, and Alex was a decent guy in a kind of old-fashioned way, even though he was probably 23 at the time. “What is it?” he asked. He was reaching out a branch, I could tell. There was no anger in the confrontation, just a kind of sadness. A bunch of years later, having been on the other end of this scenario–a manager firing an employee who was clearly depressed–I can say with some certainty that he was looking for a reason not to fire me.

“I have to tell you something and I don’t want the others to know.”
“Ok…” He now looked truly nervous. Alex was not a dude who liked being in the company of bare emotions. I don’t think he wanted to be the only one in on my big secret, particularly after a traumatic event happened to me earlier–one that everyone knew about to some degree.

“I’m bipolar. I’m having a depressive episode. I really don’t want to lose this job. I love it here…I promise I’ll try harder.”

His whole demeanor changed. Was it self-preservation? (As I later found out, Bipolar Disorder is protected by the Persons with Disabilities Act.) Did he have a relative with Bipolar Disorder? It didn’t really matter to me what mattered was his reaction. He told me not to worry about my job, that he was sorry I had to live with this disorder and that if I ever needed chunks of time off, he would happily accommodate me. I was relieved. I was somewhat ecstatic. I thanked him profusely.

That was then. I am now scared to death to tell my employer about my mood disorder. He’s going to notice. Even though I religiously take my pharmacopia like a good Catholic takes Communion, the disorder seeps through. Some days I am drained of energy, feeling burnt. Sometimes it last weeks. Sometimes I talk like I have no off-switch. I am good at my job. I have ideas above my pay grade but I live in constant fear that my disorder will show itself, that the depression will make a fraud out of what I believe to be the real me. This fear leads to paranoia and anxiety which in no way help the situation.

All of this shit has made it difficult to find employment. I have talked myself out of jobs I’d be suited for. I spent the better part of a year sick, eeking out freelance work and finding myself hospitalized. But I thrive while I’m working. The structure gives me room for creativity. Like many other things about me and other Bipolar people I know, it is perverse. Work is the thing that makes me function creatively, it gives me energy. At the same time it makes me feel my disorder more than anything else.

At a loss for words

lithiumSykkogirl’s post about losing words spurred me to write my own. For me lithium is the little word thief. It isn’t so much that the drug directly yanks the words out of my brain or impairs my cognitive abilities, it just slows the speed of my neural activity. That is, it does its job. The unfortunate thing is that job is to make me slower on the uptake. There I am having a conversation with my boss, with someone on the phone or my mother-in-law and all of the sudden — I blank. It could be a word like pajamas or snorkel — obviously in my vocabulary but rattling around. I am unable to make the connection.

When I’m writing, it isn’t as much of a problem. I still falter. I was having trouble with spurred in the previous paragraph–enticed? No that’s too…sexy… Encouraged? Well sort of but not really. But I’m not on the spot when I’m writing. I can go back and edit the missing words back into the sentences. They eventually come back. Most of them anyway. Now typing includes more hunting and pecking than my pre-lithium days. My fingers are more like someone learning to play chopsticks than Bach fingering a new concerto on the harpsichord.

Sometimes I feel as if psychopharms are a choke chain on my intellect, trying to keep it within confines, walking a straight line. But that way, I miss the trees. It’s a trade-off though. There have been studies that actually suggest lithium improves cognitive function–or more accurately that it protects it from degeneration. Maybe my word loss can be chalked up to depression and not a side effect of lithium? I don’t know…the jury’s still out. There is evidence that all states of bipolar impair cognitive function so I suppose I best preserve what I’ve got.