Chris Aiken's article, Eight Ways to Improve Cognition in Bipolar Disorder, opens with these paragraphs. Ironically, what Aiken calls troublesome, I find immensely reassuring. My experiences are real!
Chris Aiken's article, Eight Ways to Improve Cognition in Bipolar Disorder, opens with these paragraphs. Ironically, what Aiken calls troublesome, I find immensely reassuring. My experiences are real!
This month I have been posting at Batshit Crazy Preacher instead of Prozac Monologues. It's a series of daily reflections for Advent, the Christian season of preparation for Christmas. Watching and waiting, not so much shopping and decorating. Lots of people are posting images and reflections on social media for #AdventWord. But me, well, you could expect that mine would have a Prozac Monologues flavor, regardless of the venue.
So in case you don't follow both blogs, here is the link to one of my posts in which I explain the neuroscience behind a particular spiritual discipline. Not meditation, mindfulness, breath prayer, those typical crossover exercises that regulate cortisol. No, I'm talking about learning, at the cellular level, complete with my drawing of a neuron.
Blessings, all.
Advent is the season of spiritual preparation for Christmas. The idea is to slow down, not speed up. Spend some quiet, reflective time. Remember the reason for the season... Honestly, I think about setting up an Advent wreath, that sort of thing. But our candle holders broke. They broke years ago. I guess I'm just not into the candle thing.
Most years, the closest I get to Advent wreaths, calendars, whatever, is a box of twenty-four wee drams of Scotch from Master of Malt. I know, I know, Scotch is not what your psychiatrist recommends for your recovery toolbox. At least it usually take me well past the twelve days of Christmas to finish the thing.Anyway, this year I found a practice that does spark my imagination, #AdventWord. It is an international community of prayer that you can enter in whatever way appeals to you. There is a daily meditation to read, based on a different word every day. Advent Word, get it? The ones so far this year are tender, deliver, strengthen, earth, rebuild, fellowship, and glory. People post photos on Twitter or Facebook, or scripture passages, or songs inspired by the word. You can get a poster with spaces to color in each day. You can doodle, decorate the word, or draw whatever comes to you. When it's finished, it's supposed to remind you of a stained glass window. The whole project lets you do whatever prayer style works for you.
Thanksgiving is one of my hypomanic seasons. I'm getting better at not taking on projects that worry my wife. In fact, I have given up gingerbread houses altogether. Which is not to discourage you, just to acknowledge that they were once my one great weakness. That woman in the fringed dress down there? - Each bit of fringe was an individually placed sprinkle, separated out from a container of red, green, and white sprinkles. See what I mean?
But I did learn some things from my hypomanic gingerbread houses. And learning is good for the brain. The following post is a repeat from ten years ago, when I was in the throes of it. It explored the relationship between gingerbread and cognitive behavioral therapy. I am one of many who have a love/hate relationship with CBT, which I freely acknowledged to my CBT therapist in our first session. Nevertheless, she persisted, and I persisted, and I do rely on it daily and have written about it from a variety of angles. So here it is again, for those of you who want to explore CBT and also for those of you who want to know how to make a nine patch quilt out of fruit rollups:
Cognitive Behavioral Therapy - Gingerbread Style, 11-25-2010
First Cognitive Therapy Technique -- Distraction
Human beings are pattern-seeking creatures. Place us in an absurd situation, we feel stress. We respond by ritual behavior, or clinging to biases, or even inventing an explanation. Does this sound like anything happening around you for the last several months?
Some of these responses serve us better than others. Biases preserve energy by saving us the time it takes to make case by case evaluations. But they also can be mistaken and rob us of original insights.
Invented explanations are how we manage the terror of acknowledging any bad thing that is out of our understanding or control. Why did Daddy hit me--again? Who is to blame for all these fires lately? How could my candidate have lost? We tell ourselves a story that makes sense of the event, relieving the pain of uncertainty, and thus gaining control over our emotions.
I went searching for a Viktor Frankl quote. Mental health pro-tip: When desperate, Google "Viktor Frankl quotes." I mean, how does even the most desperate, darkest depression argue with a Holocaust survivor?
Here is what I found:
So I'd make my own image if I were inclined to that sort of thing, like if I were having a hypomanic episode. It would be three boxes, left to right.
On the left would be a screenshot of a webpage saying something like, Cannot open page because search timed out. Maybe, Cannot find printer. I saw those images on my laptop a lot last week.
Moral of the story: You will, too.
That's it. That's the good survivor story. Hopeful. Virtuous. I have told that story, and when I do, I get all kinds of strokes, including publication of my writing on other websites.
Some of it is true. It did get better. For me. For now.
For now.
There is more to the story. When I tell the more, I do not get publication. I don't even get acknowledgement that my submitted piece was received. I guess I am submitting to the wrong websites, to places that have one story they want to tell, the good survivor story.
And like I said, it's true, some of it. According to David Conroy, there are 50 million people alive today who have struggled, are struggling, or will struggle with suicide. 45 million of them will die of... something else. That's success, right? 90% of us will find another way.But that's not the same as the good survivor story. Because for the 45,000,000 of us who survive, we have all kinds of stories.
Psychiatrists and people with bipolar both have told me that my book captures what the manic experience is like.
Reviewers tend to say either, She must have written it when she was manic. Too bad her editor didn't fix it. One star. Or: She must have written it when she was manic. So glad her editor didn't fix it. Five stars.
Which gets me thinking: Doctors say bipolar is really hard to diagnose. But if people who have it know it when we see it, what if we wrote a screening tool? Bear with me here. I'm thinking something like this:
They say: A distinct period of abnormally and persistently elevated, expansive, or irritable mood.
What we hear is: Are you abnormal?
To which we answer: No. I mean, duh.
Suicidal people have not been quiet this year during Suicide Prevention Month. Most years we are the topic of conversation, not the source of the content of all these campaigns. But Twitter, at least, has been filled with our own voices this year. I have always shot my mouth off, and seldom taken the party line. Which means my voice is never included in the campaigns of the typical mental health organizations.
This is Suicide Prevention Week - from September 8, 2011
When I started Prozac Monologues, I didn't know there was a Suicide Prevention Week. I spent a month writing about suicide in June, 2009. I chose June because it is the month when the highest number of suicides take place. So I wonder why the officially designated week is in September. Maybe because when everybody else is so happy about the sunshine in June, they wouldn't give any thought to the darkness? Maybe because they didn't ask those who are suicidal?On the other hand, family members can be one of the most significant resources for a person's recovery and stability.
In my own case, my wife is the one who described the symptoms that helped my psychiatrist recognize that I have bipolar, not major depression. But once that happened, what did she, as a family member, as the member of the team with day to day, hour to hour access, receive by way of help and guidance?
Nothing. Not a word. Butkus. Like, not even a pamphlet.
Nope, nothing. She worried. She worked from home to protect me at my sickest. She shouldered every responsibility. She thought through and recommitted to and excelled at "for better for worse, for richer for poorer.
Eventually she got to Family to Family, NAMI's program for education and support of people whose family members have a mental illness. And that helped. It gave her a skill set. It let her know she was not alone. It was more than a brochure.
What she needed was Aimee Daramus's new book Understanding Bipolar Disorder: The Essential Family Guide. Daramus, a clinical psychologist with over twenty years of experience in mental health, from psych units to private practice, has written the definitive guide for family members of people with bipolar. She takes you by the hand and leads you from a chaotic landscape to a steady path.
Frankly, I was gobsmacked by that question. It came in response to reading my book, Prozac Monologues: A View from the Edge. The book is a comedic memoir of misdiagnosis and a self-help book for bipolar. It is both uproariously funny and brutally frank about my suicidal episodes, usually at the same time.
There are two directions to go with that question. This particular psychiatrist cares about both.
What kind of behaviors and qualities could he display that would make the relationship more helpful? Honestly, not all psychiatrists are interested in this question. I don't do relationships; I use psychopharmacology to treat psychiatric disorders, a psychiatrist once told me. Well, that had the benefit of clarifying things.
How can I improve my diagnostic skills? Nevertheless just about any psychiatrist wants to get the answer to the puzzle right, even the ones who treat patients as no more than a puzzle.
Fifteen years! From the hypomanic first draft of Prozac Monologues on a yellow legal notepad to a published book, and the nail file that inspired it all.
The book was officially released into the wild this week and will be celebrated in two launches, one sponsored by Paulina Springs Books in Sisters, OR, and the other sponsored by Prairie Lights in Iowa City, IA.
It's a good time to talk about gratitude. Forgive my self-indulgence. It is a day to reflect.
First, people have asked whether it was hard to write about such dark times in my life, if it retriggered some of those emotions. Occasionally, it did. Occasionally I would have a sleepless night remembering, in particular, difficult encounters in treatment. One can forgive sincerely. One can forgive over and over. Still, the brain remembers. I don't harbor resentments, but I can't always hop off the time travel machine that is my brain, how it repeats the tracks laid down by past traumas.
CW: Cynical Warning.
Anybody else cringe all through Suicide Prevention Day/Week/Month? Anybody else roll their eyes at the "Ask for Help" messages? Or search the lists of "Warning Signs" to make sure you're covering your tracks?
Are you a potential helper and confused by that paragraph? Did you design this poster? Let me explain it to you. The psychiatrist doesn't accept your insurance. The psychiatrist who does accept your insurance doesn't treat your issue. There isn't a psychiatrist. The therapist is available six weeks from now. Or later. What's the point of therapy anyway, the therapist isn't going to pay your rent, if you could make rent you could manage your mental illness just fine, thank you very much.If you call a help line, what if the cops arrive to handcuff you in front of your neighbors to help you enjoy your free trip to the ER? That's the only thing that will be free. If you go to the ER, you may or may not be admitted. Either way, the bill will leave you homeless.
When nothing else worked, Social Rhythms Therapy got my bipolar under control. That's why Ellen Frank is my mental health hero. She invented it.
A few years ago, I spent four weeks summarizing Frank's book, Treating Bipolar Disorder: A Clinician's Guide to Interpersonal Social Rhythms Therapy. My goal was to create a patient's guide. Here is the link to Part Four. It includes links to the earlier posts.Frank describes Interpersonal Social Rhythms Therapy like this: IPSRT [is] a treatment that seeks to improve outcomes that are usually obtained with pharmacotherapy alone for patients suffering from bipolar I disorder by integrating efforts to regularize their social rhythms (in the hope of protecting their circadian rhythms from disruption) with efforts to improve the quality of their interpersonal relationships and social role functioning.
Circadian rhythms are at the core of IPSRT. People with bipolar have difficulty maintaining the stability of our circadian rhythms, because our internal clocks, governing everything from sleep cycles to blood sugar levels to body temperature are, well, wonky.