When Normal Isn’t Normal

abnormal

“The only normal people are the ones you don’t know very well.” – Alfred Adler

I dislike using the word normal in reference to mental health. There is no true normal. Everyone has their own quirks and idiosyncrasies. I prefer to use the word “average”. I have average days. I feel like I fit in, like I’m not struggling against myself and my brain and I actually get along. I’m not antsy, irritable, or depressed.  I sort of miss the energy of hypomania, but average is nice.  Sometimes I get a few of these days strung together, maybe even a couple of weeks.   It happens between hypomanic events and depression. It’s still not normal.

On my average days I can enjoy life. I can be happy; my moods are stable and not as magnified. I still have breakthrough moments of sadness and anxiety, but I recover quickly. It’s still not normal, though; there are drawbacks. I still feel like I’m waiting for things to go bad, for the other shoe to drop. I feel better, but I’m still nervous about trusting my own judgment, that there is still something lurking inside that will turn a seemingly simple decision into something horrendous. Overall, I feel good, but never entirely carefree.

Since these average experiences occur between hypomania and depression I’m somewhat leery of what’s going to happen next. This is the main reason I do not refer to my periods of feeling average as normal. I know at some point the average feeling will end and something will eventually replace it . I don’t know if it’s going to be depression or hypomania. If it’s hypomania, how far up will my mood go? It can range from being slightly euphoric and energetic to completely out of control. If I move into depression, how low will I drop? Will I become suicidal again? Will this be the depression I don’t survive? This is my worst fear, that I’m one mood swing from taking my own life.  The statistics make it a coin flip that I’ll attempt it.

There is a positive side to this, especially these days.  I’ve been in treatment for eight months, the longest I’ve ever lasted before going off my meds and I feel better more often and for longer periods.  Although the fear of relapse  occasionally rattles around in my brain, I don’t sit around and ruminate or try to hide from it.   Being afraid of the depression and anxiety cause me to be more depressed and anxious.  I now have reason, however, to not see this as a stressor or trigger.

My most recent hypomanic episode passed without any major incidents. I felt a bit more energetic and occasionally irritable, but nothing unmanageable.  The medication and therapy are working, so although I’m concerned about the next mood swing, I’m not trying to hide from it or lock myself away in fear. I haven’t had an episode of depression since early this year, so I remain positive.  It’s possible that I may be in a sort of remission and the average days will continue.

That’s about the best I can hope for and as close to “normal” as I can get for now.

Antisocial Media

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“Everyone has the right to believe anything they want. And everyone else has the right to find it fucking ridiculous.”
— Ricky Gervais

Like most people, I’m an avid user of Facebook. I’m slowly delving into other forms of social media. I have a Twitter account, but I hardly ever tweet (If you want boring blog updates, feel free to follow @Rider324. If I ever get a decent amount of followers I promise to be more interesting). I mostly use Twitter to follow a few of my favorite people, especially ones known for causing a bit of controversy with their tweets. Ricky Gervais, Patton Oswalt, and God (actually a writer from The Daily Show) are examples. I’m still trying to understand Instagram and although I watch videos one Vine I’ve never had the desire to post one. So with all of this, Facebook remains the one I am most active on. I belong to several different groups covering my main interests: sports, books, mental health, and several others. I post pictures of my son, memes, (hopefully) witty and thought-provoking statuses, take part in discussions, poke fun at my friends; pretty much all the usual Facebook activities.

So what does any of this have to do with being bipolar? A great deal, actually. I’ve noticed a few trends, some recent and some not so recent. My social media use provides an excellent mood tracker. This is a vital tool in managing bipolar disorder. The downside is that it provides a very public mood tracker. My friends can notice the obvious differences between my depressive and hypomanic states, as well as the occasions in which I’m feeling average. The other problem is that, much like what happens in real life (as stated in last week’s entry), people tend to get driven away and abandon ship. I’ve lost count of how many Facebook friends I’ve lost over time. Most of them bailed because of religious and political statements I’ve either made or shared. I’ve pissed off a lot of people over the years and I can probably count on one hand the number of times I’ve ever apologized for it.

As far as mood tracking goes, the usual pattern is this: when I’m hypomanic my status updates and comments are much less serious. I joke around frequently. My responses are quick and humorous (although in my own humble opinion, I’m goddamn hilarious). I will poke good-natured fun at my friends and they respond in kind. I love that give and take as we troll each other back and forth. When I’m in the throes of depression, a couple of things happen. Firstly, I tend to disappear for weeks at time. Several friends noticed this pattern immediately and I would get frantic private messages and texts asking if I was okay and if I needed help. When I did post, I noticed that my posts tended to be much more aggressive, bordering on outright rage.

I do enjoy debating politics and religion with my friends, but these posts would go beyond that. Looking back, much of what I would post seemed to be indirectly attempting to poke certain people in the eye. With a flaming stick. Obviously, some people took offense and unfriended me. Others engaged in debate in which we mostly decided to agree to disagree. Surprisingly, not many people told me directly that I was as full of shit as the things I ranted about. I don’t mind that. I am a very difficult person to offend. I like to think that I can take as well as I dish it out.

I’m not going to go into exactly what I posted or what my political and religious views are, because that’s not what this blog is about, but rather how my online behavior is affected by my mental illness. I’ve often been told that my posts go too far, or that I’m just angry. I disagree with the latter, but I can understand the opinions about the former.

Again, in reference to last week’s entry, this kind of self-imposed isolation (this time online), either intentional by disappearing, or unintentional by annoying the crap out of people, has consequences. I’d very much like to use Facebook and other forms of social media to promote awareness of mental health issues and help destroy the stereotypes and stigmas that we crazy people face on a regular basis. Eventually I’d like to start a Facebook page just for Tales from the Loony Bin once I get more followers. This would allow me to separate my usual rantings from my discussion of serious mental health issues. The problem is, with many of my posts, people no longer respond. I don’t know how many people in addition to those who unfriended me either ignore my posts or have me blocked. I try desperately to promote this blog but I often feel as if I’ve disenfranchised the better part of my audience.

The Fine Art of Isolation

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“Everyone I know
Goes away in the end
You could have it all
My empire of dirt
I will let you down
I will make you hurt” – Nine Inch Nails “Hurt”

Not surprisingly, I’ve spent a great deal of time reading about bipolar disorder. I’ve read articles by psychiatrists, blogs by other bipolar people, and several websites dedicated to mental illness. I am constantly looking for people with whom I can compare symptoms and advice on coping mechanisms. I found some excellent sources, and some that are sub-par. When it comes to coping mechanisms almost everything I have read include what most consider essential when it comes to coping with bipolar disorder: a reliable support system. A group of friends, and/or family that can help not only recognize symptoms but help you cope with them. This seems fairly obvious, but what if something prevents you from maintaining that support network? To quote from Hamlet, “Aye, there’s the rub”.

As an example, I had a great number of friends at one time. Each and every one of them was like family. Once I had mostly ruined my life through my hypomania and crashed into crippling depression and was finally diagnosed as bipolar, people began to distance themselves from me, or so it seemed.

I’m not saying they ran away or abandoned me because I was bipolar. Quite the opposite. One of the symptoms of my depression is that I withdraw and isolate myself. I don’t return phone calls, I don’t socialize, and I even stop any social media activity. I did that a lot; so much so that a lot of friends got tired of the frustration of dealing with me. I pushed a lot of people away, many of whom really did try to help. When I was forced to resign from teaching, several people made suggestions as to what I could do next, such as tutoring or teaching SAT prep courses. The problem was I couldn’t do it. I was in such a depressed state that I couldn’t even imagine returning to any kind of work at that point. My response, however, was to yes everyone to death and then ignore their suggestions. Again, people got angry and frustrated and gave up.

I’m not angry at anyone for their reactions and I don’t feel abandoned in any way. I so completely isolated myself that I made damn sure almost everyone was gone. Not everyone was put off by my behavior. Several friends put up with my infuriating behavior and helped as much as they could, often going above and beyond whatever help I asked for.

This isolation is detrimental in a couple of ways. I have cut myself off from my most important support and also it adds to my irritability when I am hypomanic. Those are the times I look to get out and socialize and interact with other adults, but instead I wind up home in front of the TV.

So how do I cope with having such a small support system? It’s not easy and it’s exhausting, but I manage. I write, I try to keep myself occupied and on a schedule, and most importantly, I stick with my treatment. Medication and therapy have brought me a long way. I’ve now stayed in treatment for six months, and his is the longest I’ve done so. The previous times I would go for a few weeks, start to feel better and then disappear from therapy and toss out the meds. With my limited options, treatment is a necessity and so is holding on to the small group of friends that I still have.

No Self Control

bipolar

 

“If I could control tomorrow’s haze
The darkened shore wouldn’t bother me
If I can’t control
the web we weave
My life will be lost in the fallen leaves”
–David Bowie, “No Control”

I mentioned in a previous entry about the difference between mania and hypomania that there are other states besides those and depression that can affect a person with bipolar disorder. These states can be just as devastating, if not more so, than the expected swings between hypomania and depression. Some of these I’ve experienced and some I haven’t, so I can’t completely talk about them from a personal point of view, but what I can, I will. The one thing all of these other states have in common is that, just like bipolar disorder itself, there is no way to control them.

The first of these are what as referred to as mixed mood episodes. It is a combination of mania (or hypomania) and depression. These episodes can be very dangerous because they can combine the suicidal ideations of depression with the abundance of energy of hypomania. The thoughts of suicide and self-hatred mixed with manic restlessness can be problematic to say the least. Not only are there thoughts of suicide, but the energy to act upon them. Mixed mood can last anywhere from a few hours to a few days. On the roller coaster that is bipolar disorder, this is the most out of control part of the ride.

I’ve experience mixed mood on rare occasions, but luckily not for long and they ended before I was worked up enough to physically harm myself. I hated myself, my life, my actions and even my own uncontrollable thoughts. My brain kept hammering me with the fact that every shitty thing in my life was my own fault and nothing I did could ever change that. As is usual with hypomania, my thoughts were racing and constantly battering me with the fact that I was a worthless asshole and I kept replaying everything I had ever done to hurt not only myself, but those around me that I cared about. It was a repeating slideshow of painful memories.

Another danger to the bipolar person is called rapid cycling. Rapid cycling is when a bipolar person experience four or more hypomanic, manic, or depressive episodes in a 12 month period. This doesn’t mean, however, that episodes follow any predictable cycle. The pattern is quite random. The quick mood swings of rapid cycling can occur within a few hours or a few days. This roller coaster carries a high risk of suicide. Diagnostically, mania lasts one week, four days for hypomania, and two weeks for depression. These minimums are for the purpose of diagnosing bipolar disorder.

I’ve been lucky enough not to have experienced rapid cycling. My depression can last for months and my hypomania is usually several weeks. But again, they are not predictable cycles. Through therapy, medication, and educating myself on my illness I have become better at identifying certain cues as to what I may experience next. In addition tracking my mood, there are other signs as well. Sleep patterns are the most telling for me. If I’m not sleeping, I know something is happening. If I can’t sleep but don’t feel tired during the day, and I feel tense and restless, I know hypomania is to blame. If I can’t sleep and can’t bring myself to get up and get moving or begin sleeping during most of the day, it’s a sure sign depression is creeping in. Identifying what are called prodromal (early) symptoms is a key for me in trying to hold off a bipolar relapse. I can never control my moods or change the way my brain thinks, but as long as I continue with my treatment, I can manage the symptoms somewhat, and that’s about the best I can hope for.

The last thing I would like to share is the concept of what have been called “breakthrough events”. Breakthrough events usually occur during days when I am feeling average. I may be having a good day by my standards and something happens. It could be anything, a song on the radio, something on TV, or even a comment someone makes and it sends me into a completely irrational emotional state, usually depression. Whatever progress I’ve made or episode I’ve overcome is just shattered. Everything just gets shot to hell without any warning and I wind up sitting and crying over something I’ve read or heard or watched. Again, this is part and parcel of bipolar disorder. It is an irrational disease and the breakthrough events can be lasting. I have to accept this as part of my illness and learn to deal with it. My brain fucks with me on a daily basis, sometimes sending me into self-loathing with no warning at all. Like I said, I can only manage as best I can and keep trying to make it through. I take my meds and stay in therapy and track my moods. These are my weapons in this particular fight.

Thanks for the Suggestion

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“Sometimes I think you
Don’t know what you say” – Jesus Jones, “I’m Burning”

I’ve gotten a variety of responses from people when I tell them I’m bipolar. My favorite was “Bipolar? Is that really a thing?” That’s one example of someone totally uneducated about mental illness. Needless to say, this response came from someone who felt that therapy and medication were useless and you should deal with issues on your own in a completely logical manner.   Sorry, but my brain literally does not and cannot work that way when it comes to depression and hypomania.

My least favorite response, the one I absolutely despise because it shows a total lack not only of understanding, but of empathy and compassion, is the ridiculous “Just snap out of it!” or the equally useless, “Get over it”.  Well, thanks a bunch there, Einstein, I wish I’d thought of that. Maybe next time you can tell a diabetic to produce more insulin naturally,  or a cancer patient to stop growing all those tumors. “Get over it,” is one of worst things to say to a bipolar person. For me, it makes everything so much worse; it increases my sense of worthlessness and self-loathing, that I’m not as good as everyone else and I’m just not “normal”. It’s  a dismissive and pointless statement that’s about as helpful as hitting someone in the balls with a five iron.

Anything that minimizes my illness or makes me feel like less of a human enrages me. I’ve had people tell me that everyone gets depressed, or that everyone has bad days and I’ll get over it eventually. I have to try to explain that my depression is very different, which of course can sound to others as if I’m being defensive and using it as an excuse for my moods and actions. I have to continually explain that I have a disease and my brain isn’t wired the same as everyone else’s. My depression and hypomania cannot be willed away.  My moods can change quickly and there are days where can’t even manage to get off the couch, shower, get dressed, or, worst of all, interact with my six year old son. That last one is the worst and it causes the depression  to feed on itself and there is nothing I can do to stop it or get past it. It’s an incredibly soul-crushing depression that leaves me a fetal-positioned mess with dreams of knives and warm baths running through my head.  I also can’t control my cycles of hypomania which are accompanied by an almost complete lack of sleep, racing thoughts, and extreme irritability.  This is just a short list of symptoms which show how much my brain hates me.

I’ve also been informed that, “We create our own reality.” In all honesty, I don’t even comprehend what the hell that means. If I created my own reality I’d be a billionaire living on a private island far away from idiots telling me I create my own reality. Similarly, people have offered me a host of new-age type treatments as well as homeopathic and “alternative” medicinal cures. Nope, no thanks for the hoodoo. I prefer trained professionals with real degrees and medications that have gone through clinical trials and are documented to work. I don’t need my chakra realigned, my third eye fitted for contacts, my aura polished, or an all-natural tea made of tree bark, lawnmower clippings and squirrel semen. To quote Tim Minchin, “Alternative medicine…has either not been proved to work, or been proved not to work. You know what they call alternative medicine that’s been proved to work? Medicine.”

I’ve even been told that I choose to be sick, or just as good, that I can choose not to be sick. I won’t even dignify that with a response. Some people obviously choose to be intellectually stunted.

The one thing all these responses share is that they are dismissive, belittling,  and discount the idea of mental illness as an actual disease. Just because I see a psychiatrist and some else sees a cardiologist doesn’t mean my disease isn’t as real. Like any serious illness, bipolar disorder can be fatal. 20% of people with bipolar disorder commit suicide and 50% attempt it. Those numbers are terrifying to me. I know I feel fine now, but anything can happen in the future.  It’s a coin flip as to whether or not I may try to kill myself. I know it’s not going to happen today or tomorrow, but somewhere down the line it may happen, and  it may be one cycle of depression away. That thought alone has kept me awake nights and it scares the shit out of me.

I know most people are trying to help, but some just don’t grasp the concept that bipolar disorder is an illness, just like the flu or cancer. In a recent survey, of 40% of the respondents said they didn’t believe mental illness is real.  This is why we need more awareness and education on mental illness.  Even though I have no physical symptoms I have a very real disease and I shouldn’t have to keep trying to prove it.

Let’s Party!

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Let’s throw it all into the mix
And open up our bag of tricks
And party for the rest of the night”
  – Warren Zevon

Being bipolar isn’t all bad.  Yes, there are unpredictable highs and lows.  The depression can be crippling, but the hypomania isn’t always a bad thing.  It’s also not as fun as people think it is when they learn what the symptoms are.  First, let me explain a little about what hypomania means and the difference between that and mania.

The diagnosis of bipolar I or bipolar II lies in whether a person experiences mania or hypomania. Both manifest themselves in the same ways:  an excited or even irritable mood, racing thoughts, lack of focus or concentration, a decreased need for sleep, being more talkative often with a rapid change of topic, hypersexuality, an increase of productivity and/or psychomotor agitation (pacing, hand wringing, general restlessness), an increase in self-esteem with possible delusions of grandeur, and finally, participation in pleasurable activities that can or will result in devastating consequences.   Additionally, both mania and hypomania can include hallucinations.  I’ve never experienced that particular symptom and I hope I never do, but in all honesty, there are some things I’ve done that I wish had been hallucinations.

The difference between mania and hypomania, and bipolar I and II is the severity of the manic symptoms. Mania is the more severe of the two and is symptomatic of bipolar I. Mania results in a definite impairment in functioning, being a danger to self or others,and possibly psychotic features. Episodes of mania must last at least seven days as part of the diagnostic criteria. Mania also necessitates hospitalization. As a sufferer of bipolar II, I have to deal with hypomania, which is less severe. There is no marked impairment in functioning, no necessity for hospitalization, and no psychotic features. Diagnostically, hypomania must last at least four days. Mania is more dangerous because it can put the life of the person and possibly those around them in danger.

Overall, bipolar disorder involves three possible moods, mania, hypomania, and depression (there are other conditions such as mixed mood and rapid cycling, but I’ll save those for another time).  For me, hypomania is the preferable condition, but it is a double-edged sword. Sometimes it can be fun and other times it can be torturous, and sometimes it can have devastating consequences because of the fun. My hypomanic episodes have covered a wide range of experiences. I’ll discuss the bad ones first and get them out of the way. My activities, which I’ve previously blogged about, cost me my family, my job, my savings, and my dignity. I burned my entire life to embers and ash and I am thoroughly embarrassed by the things I did. This actually occurred while I was chasing the pleasurable experiences.  I was able to stay up all night partying and spending absurd amounts of money.  Although it seemed fun at the time, it was my lack of impulse control that led to destructive results.

Racing thoughts and irritability are troubling as well. I can have extended periods of anger, even approaching the point of rage, and the racing thoughts are a constant assault; a barrage of disjointed, repetitive, and uncontrollable ideas. I feel as if I’m being assaulted both externally and by my own mind as well. These  are definitely not fun.

Paradoxically, there are times when I enjoy my hypomania. It is a welcome break from depression and I feel infinitely more energetic and creative. As an example, I began this blog in November of 2012 in a flurry of hypomanic behavior. I was sleeping less so I would write until the wee hours of the morning and as a result, I was posting nearly every day.  As I began to cycle down out of the hypomania  I posted less, and then eventually stopped altogether when I sank into depression. Now as I’ve restarted the blog, I’m back in treatment, on my meds and the hypomania is much less severe, so I have set the more realistic goal of publishing once a week rather than daily. Making use of my current hypomania, I’ve already completed several weeks worth of posts and scheduled them to be automatically published weekly (new blogs are posted Mondays at 6am if you want to read the latest while having your coffee).

Medication alone does not stop either depression or hypomania.  There is no magic cure, but the symptoms can be more manageable. I still feel  restless during my hypomania. I’ve had nights where if I don’t get out of the house I feel like I’m a prisoner. I begin pacing and I get irritable and easily agitated. Since medication is not a cure-all I need to find other ways to channel this excess energy.  Obviously I write, but that’s not enough.  I try to do constructive things like run errands; something productive to get me out of the house.  I’ll go to the store or do laundry while listening to my iPod.  It distracts me and drowns out my brain for a while.  I get to accomplish things.  I never would have thought that going grocery shopping or going to the laundromat would have therapeutic value, but it works. It’s also a hell of a lot cheaper than vodka, cocaine, and strip clubs.