What Happens When Things Fall Apart

Pin Down That Mummy Hand

In my outpatient crazy classes we talked about self-care–a lot, actually. The first thing I did that helped to lift me out of my wretched little hole was to clean and organize my space. I know very well that my external surroundings are a projection of my inner state. Peaceful and zen like? Every thing is in its place. The bed is made. The laundry is put away. As I sink further and further into the chaos my space gets less and less organized. It’s one of my warning signs that things are out of whack. When I stop meditating, that is a definite flashing red light.

Somehow I managed to make it to work today, unraveled and with flashing red lights, my insides all squishy, my cognitive function deteriorating. Let’s not mention the crying fits. I work in a place that is inhabited almost exclusively by men. I need to sneak out of my office, into the bathroom and push the tears out. Like a tiny birth. Today I accidentally double dosed on Wellbutrin. It didn’t really take effect until halfway through my work day when I was on the phone and all of the sudden things became unreal like they do with LSD. My jaw started grinding, my heart started pounding and I started pacing. I think I managed to pull the phone call off without obvious signs of insanity. But did I pull the day off? I don’t know.

I’m at a familiar crossroads here. Many times in the past I have reached this point in a job and have just dissolved into depression, anxiety or mania. I make too many mistakes thanks to my holey brain and my inability to focus. At first the boss is somewhat understanding, then a little testy then pissed. So I apply the over-compensation–working extra hours that I don’t clock on for. The ensuing anxiety and down right terror wakes me up at night because I have all of this work-related anxiety.

Now that this has happened so many times I’m starting to think that maybe it is a choose your own adventure. Or better yet, maybe it’s like the Buffy the Vampire Slayer mummy hand episode where our saintly heroine was magicked into reliving the same torturous hour of retail service over and over again until she succeeded in satisfying her customer.

This was tricky because the Mummy hand was a devious trickster and the customer was a bitch. Bewitching aside, I think it’s an apt metaphor. Buffy realized that using the same tactics yet again would land her in the basement wrastling a mummy hand to the ground. She tried a new approach. It’s time for my new approach but I haven’t quite pinned it down. Much like Buffy did the mummy hand with a knife.

So I’m going to be sans husband for the next ten days. His band is touring and I can’t go with because of work and money, yadda yadda. I think that taking this time for some spring cleaning would be a good move. Maybe I’ll actually get some stuff done.

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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.

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.

Herding Kittens

Outpatient Mental Health Clinic Pt. 1

A sort of chaos pervades this place. It underscores the fact that lumping people with varying mental illnesses together at what is likely to be their lowest point is like herding kittens.

Only these kittens are blind from birth, hit by a car and have managed to survive. They start new patients as early as possible which means new people are coming in every day, shell-shocked, withdrawn and hopeless. And every day veterans leave, mostly with a renewed confidence and readiness to grapple with their mental illness and the world.

It’s my first day there and 30 people have wedged themselves in a classroom with a big square table in the middle. I find an empty spot because having just met with my therapist Beth, I am tardy. Thus begins the confusion. I have no idea what the hell is going on.

I have been given a binder with some information in it. I scour it but but find nothing particularly helpful. A young female patient leads a discussion, impassioned about defending the rights of another patient to verbalize his problems in group. She’s pissed off. The patients bicker as I sit there, balancing my binder on my knee and writing a name placard for myself in magic marker.

Group ends. They break up our day into four groups, separated by lunch. We chill for about fifteen minutes, me taking in my neighboring patients. Many of them look pretty normal–no crazed bride of Frankenstein hair, nobody forced us to wear jumpers or remove our shoes. It feels kind of like a self-help seminar in which some of the participants are visibly upset because they have likely suffered a pretty shitty night (like me) and are confused as to what this is about (like me).

Nobody forced me to come here. I plan on getting better, even though I know my disorder will never go poof. As far as the vast majority of the psychiatric community is concerned, bipolar disorder nests inside the brain– organic, genetic and permanent, although not degenerative like its cousin schizophrenia.

Most of the people here have been hospitalized for major depressive disorder or anxiety disorder, others have Borderline Personality disorder or PTSD or some amalgam. CBT can help alleviate anxiety, it can help draw someone out of a major depressive disorder, negotiate the mind-traps of Borderline and PTSD but I am highly dubious that it will help my bipolar disorder.

Only a handful of bipolars are patients here. But while I think it can help me manage some of the symptoms of depression and anxiety that are associated with BP, I am hoping it will help with my brand new diagnosis of PTSD (sort of a “duh” moment for me).

Out of Whack

Nothing says “I’ve reached my breaking point” like a visit to the ER for a quasi-psychotic episode. It stopped my downward spiral dead in its tracks. I actually don’t think there was any further down to go–ok maybe heroin addiction or joining a biker gang–but I wasn’t motivated enough to do either of those things. I was looking in the abyss in a bright orange jumper that would have fit a Yeti, spreading margarine on a crappy bagel with a spoon because they wouldn’t trust me with any other utensils, and although it was slightly less intense than looking into the time vortex, it really put things in perspective. There was literally nothing in my life that even resembled balance.

Healthy bodies trend toward homeostasis also known in Yoga Journal, by Dr. Oz and Psychology Today as balance. The term tends to have a picture of a meditating Tibetan Buddha or stones stacked in a way that looks like they should fall down but don’t. But it’s not just a new age thing. It’s the way the body works. When the body is balanced (or close to balanced) organs function like they should, vitals are all good and systems are operable. It’s also known as being healthy. As someone with a disorder that’s with me for good the idea of being healthy is some sort of unattainable grail. Balance is something to move toward. It doesn’t require perfection because nothing is ever perfectly balanced.

I could go off on a tangent about the philosophy of chairs (also called ontology) but I will spare you. I’ll spare you the metaphysics. When I refer to balance I am not talking about the alignment of chakras or taking lavendar baths and drinking a lot of tea (not that there is anything wrong with any of those things.) I’m talking about thoughts, behavior and the things a body can do as a result of being out of whack.

At the time of my ER visit I had violent hormonal acne that seemed to have appeared overnight, I had gained a fairly significant amount of weight (although some of it was because I stopped smoking…go me!!!), my IBS was a-flaring and I was having the most extreme night-time akasthia I have experienced since being off Abilify (which gave me a horrid case of the kickies much to the displeasure of my husband and cat). My heart was racing all the time, or so it seemed, like a long-winded anxiety attack.

I was diagnosed as having a mixed episode, the most dangerous state of bipolar disorder. That’s when people are the most likely to do dangerous things to themselves and others. Fortunately I was able to get myself to the hospital before taking up arms. I joke but I had violent images flipping through my brain like the slide show of Freddie Kruger’s summer vacation.

The sum total of this is that instead of being admitted as an inpatient to the psychiatric ward I was referred to the Outpatient Behavioral Health Clinic as a partial inpatient. I had no insurance, no hope of ever paying whatever the program would cost but I had to do it. It was either that or some version of oblivion. During my six weeks of care I was treated through CBT and psychotherapy along with my medicine and my own self-care.

This blog is a tactic of that self-care. If I do my job properly, I will find my people and they will help to keep me accountable. It is not going to be all about gazing at my lovely navel. I will share the things that have worked for me and the ones that haven’t and I invite you, my gentle reader, to do the same. That is all!