I recently started therapy with a new therapist. His approach is CBT. Apparently that’s industry standard in the brain game. I’m really, genuinely cool with that. I’ve had more results from my crash course CBT than 20 years of psychotherapy.
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.
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.
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.
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?
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.
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.
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).