Showing posts with label mind. Show all posts
Showing posts with label mind. Show all posts

Anxiety My Old Friend - Will I Let It Kill Me?

Anxiety and stress are not the same thing.

Stress is a physiological experience in the face of a change in the internal or external system. It has its plusses and minuses. A little bit of stress over something you can do something about [I need to make that doctor's appointment] provides motivation to get it done and satisfaction (a nice hit of dopamine) once you do it.

via GIPHY

On the other hand, chronic stress that cannot be resolved [I never knew when he would explode] exhausts every resource the body has to maintain homeostasis/balance. And that's not good.

Anxiety describes the negative thoughts and feelings that accompany stress.

via GIPHY

It's not the only feeling that could accompany stress. When faced with changes like a new job, a challenging ski slope, or a date with the person of your dreams, you might also feel excitement.

via GIPHY

Or maybe not. "Good" change and "bad" change are labels we apply from our own perspective. As far as the body goes, they don't really figure in. The physiological response is the same.

Consider a winding mountain road in a snowstorm. Some people default to excitement. [That would be Colorado-raised me.] Some people default to anxiety. [That would be my California-born wife.] The people who can't help but default to it have an anxiety disorder. These are my people.

Anxiety Defined

Anxiety is the intense, excessive, persistent worry, fear, or dread about everyday situations, present, future, and imagined future. It's a normal enough experience. It becomes a disorder when "intense" tilts over into "excessive" to the point of interfering with daily activities.

Insert side comment here: People who have a mental illness, whether social anxiety disorder, depression, or schizophrenia, are not a different kind of people. Almost every symptom of a mental illness is a "normal" experience - shared by people who do not have a mental illness. These experiences do not need to be diagnosed or treated, until they pile up and become so intrusive that they become unmanageable, until they interfere with daily activities.

The physical manifestations of anxiety include fast heart rate, heavy breathing, sweating, and fatigue. How do we get from a thought to a heart rate? The brain - that's how.

Anxiety in the brain


Anxiety involves an interaction of three different parts of the brain in particular.

It begins when the amygdala senses a threat. The job of the amygdala is to leap into action at the sign of a threat. The amygdala initiates a sequence that releases adrenaline and cortisol to gear the body up to address the threat. As with the body's response to other stress, these hormones cause the faster heart rate and heavy breathing. Blood flow increases to the limbs to prepare it for action, and away from the digestive system - when your life is in danger, lunch can wait.

The prefrontal cortex, the "thinking" part of the brain, provides information and interpretation that mitigate or support the threat. [That's a garter snake, not a rattler. It's harmless.]

The anterior cingulate cortex sorts through the sense of threat and the additional information to find patterns and determine whether the current situation is a big deal or not. It tells the amygdala whether to calm down or GET MORE EXCITED!

The difference between anxiety and anxiety disorder

When there is a threat, the amygdala goes into action. When the threat goes away, what is supposed to happen is that the amygdala and all its downstream partners stand down. The body returns to its pre-threat state.

When the threat is chronic or, even worse, unpredictable, then these systems do not stand down. They just keep pumping out that cortisol.

In the brain, the amygdala increases in size.

Under constant assault from cortisol, the hippocampus (memory and emotion) and prefrontal cortex shrink. The hippocampus gets stuck on negative memories and emotions. [I call this the little time machine inside my brain. It plays the worst of my past on an unending loop.]

The connection between the amygdala and the prefrontal cortex that could moderate the fear goes down.

In other words, the brain changes. It changes in a way that reinforces the the problematic pattern, raising the risk for depression and dementia. Yuk!

Everybody gets anxious is not a helpful thing to say to a person with Generalized Anxiety Disorder, Obsessive-Compulsive Disorder, Panic Disorder, Post-Traumatic Stress Disorder, or Social Anxiety Disorder. These are real things. They have tipped past the experiences of everybody. And a warm bath or deep breathing do not fix them.

Healing the problematic pattern may take many forms: distancing from the chronic stressors, medication, a variety of modalities in psychotherapy, even therapy dogs.

At ProzacMonologues.com I like to focus on what is happening inside the brain, to help me remember that my issues are not mere thoughts. They are experienced in my body. Here's an article with much more detail about the sympathetic and parasympathetic nerve systems and how they function.

A physical therapist friend, encouraging me to take a leave of absence to deal with my tattered brain, once told me, It's just like a broken bone. It takes time to heal.

I do wish it healed as easily as that broken foot is healing. But these issues do respond to treatment. If your anxiety interferes with your life, you don't have to suffer alone!


photo by author
Red Green Show meme from imgur on Pinterest

Tips for Successfully Managing Your Stress and Anxiety

Anxiety and stress are simply parts of life for most people, especially when we try to juggle multiple responsibilities. However, if your stress and anxiety attacks have begun to impact your ability to function in everyday life, then you need to seek out ways to manage these emotions. ProzacMonologues.com explains the importance of finding strategies that help you to manage your anxiety both at the moment it occurs and long-term.

Guest blogger Julia Mitchell, lifestyle expert at outspiration.net contributes this piece about tips to manage stress and anxiety. I (Willa) have added a few links to previously posted pieces from ProzacMonologues.

Develop Skills to Proactively Manage Stress

Raising children, earning a living, maintaining family harmony and wellness, and pursuing your passions can all be stressful. While each of these things may contribute to creating the life you want, they can also undermine your overall well-being, if they cause you too much stress. The Anxiety and Depression Association of America notes that you can equip yourself to manage stress and prevent anxiety attacks by building healthy habits with sleep, exercise, food, work, play, attitude, and self-fulfillment.

You can also pick up a new hobby like gardening, which has been shown to help mitigate stress. Not only do you have the opportunity to get your hands dirty while watching what you've planted grow into healthy edibles, you'll be getting much-needed Vitamin D as you spend extra time outside. For expert advice and pointers, go online and visit Home Garden Hero.

Identify and Manage Your Triggers


It's a good idea to identify the situations that trigger your anxiety so you can take constructive steps when you encounter those things or avoid them. Triggers are external events, large or small, that prompt your body and mind to respond in a seemingly irrational way. The response is generally flight, fight, fawn, or freeze. As Be Calm with Tati explains, you have to learn your triggers in order to disrupt this cycle. Then you need to implement some deep breathing exercises so you can calm down and focus on what happened and why.

This Prozac Monologues post, Tips for Surviving the Holidays, was originally written for the specific event of an extended family gathering. But its suggestions for managing triggers can be applied in a variety of contexts.


Create a Low-Stress Work Environment


There are things you can do to make your workspace less stress-inducing, particularly if you work from a home office. Reduce clutter by putting items in designated bins labeled "to do," "to read," and "to file." Make sure the lighting is adequate and easy on your eyes. Use a planning system that works for you, whether paper or electronic. Evaluate your office desk and chair for ergonomic comfort. It's well worth making the investment in a good office chair that places you at the proper height to use your computer easily.

You can also manage work-related anxiety in other ways. If your current job is what's making you anxious, consider a new position or different career path. Just remember that before seeking new opportunities, creating an updated resume by utilizing a type of free resume maker is a good idea. You can use a free online resume template to customize with your own copy, profile photos, and color scheme.

Dealing with Anxiety in the Moment


When you're in the grip of anxiety or a full-blown panic attack, it can be difficult to know how best to handle the situation, which is why it is best to develop strategies ahead of time. Do some deep, abdominal breathing. Focusing on your breath can have a calming effect. As you inhale, allow your abdomen to expand, and then try to make the exhale slightly longer and allow your abdomen to relax. The University of Texas MD Anderson Cancer Center suggests using guided imagery to fill your mind with thoughts, images, sounds, and smells of positive experiences.

You can also go for a walk, do yoga or tai chi, or engage in vigorous exercise, such as dancing or running. Take a moment to question any catastrophic thoughts that are running through your mind. As the saying goes, "Don't believe everything you think."

Here is a Prozac Monologues post, Recovery in Progress, that walks the reader through my own experience of an anxiety attack at a NAMI conventions, and the tools I (Willa) used to manage the incident.


Find Long-Term Stress Management Strategies


If you're prone to anxiety attacks, then it's important to have a long-term plan for managing the stress of daily life. Establishing an ongoing practice of meditation and/or a slow deliberate movement, such as tai chi, qi gong, or yoga can be helpful. If your anxiety has resulted in sleep disturbances, irritability, difficulty focusing, or ongoing muscle tension that last for more than a month or so, it's time to seek professional help.

Journaling and cultivating your sense of humor may also be helpful. Evaluate your responsibilities and consider whether you can realistically fulfill them; you may find that you need to delegate some tasks. Develop the habit of taking breaks from stressful activities. Make sure to spend some time outdoors whether hiking, running, walking, or simply enjoying a park bench in the sunshine.

In this post, Frazzled Cafe and Ruby Wax, the comedian, with master's degrees in psychotherapy and mindfulness-based therapy, describes how these activities can be used to channel the brain's functioning to relieve stress.


Find and Implement Your Anxiety Solutions


Anxiety can be present at any phase of life, whether you're a parent, student, worker, or retiree. It's important to develop constructive ways to manage stress so that you can live your life and meet your responsibilities. There are many methods of managing and prreventing anxiety, ranging from exercise to finding a less stressful job to journaling and to professional therapy. Figure out what works best for you and build some healthy habits that will be useful in both preventing and managing anxiety when it occurs.

If you are dealing with stress, anxiety, or other mental health disorders, join Willa Goodfellow on her journey to research and process these issues in her own world through ProzacMonologues.com.

Note: Many thanks to Julia Mitchell for this, my first foray into guest contributors. You may have noticed the different voice. Less... loony? Julia is a lifestyle writer, not quite my wheelhouse. But there is a lot of interest in mental health lately that is not about mental illness. Those two terms do get used interchangeably. Julia inspires me to continue the conversation with another post about how stress and anxiety differ and what the brain has to do with it. See ya next week.

photo courtesy of Pexels
clipart by Microsoft online
photo of toolbox by Eric Strandberg and used under the Creative commons license
flair from Facebook

Questions Work Magic: How They Change the Brain

Quick - What does a lemon taste like?

I know what a lemon tastes like. Tell me something else instead:

What just happened inside your mouth?

David Hoffeld asks another one: Want to know what your brain does when it hears a question?

His article from the website FastCompany.com explores the neurological consequences of hearing a question. Questions temporarily hijack the brain. Did you immediately think about lemons? First, serotonin is released, causing the brain to relax. Next you get a hit of dopamine. The question takes over your thought processes while you think about the answer. The technical term is instinctive elaboration.

The hijacking doesn't last forever. The person who was asked the question can choose to ignore it, can argue against it, can go off on a tangent - though for people with ADHD or bipolar disorder, a question that interrupts our train of thought may cause us to derail.

But Hoffeld cites a number of research studies that document when you ask somebody whether they are going to do something, you increase the probability that they will do it - buy a car, vote in an upcoming election, even donate blood.

Questions not only alter your perception. They can even alter your chemistry. Chances are, when you read the lemon question, you started to salivate.

Why Writing Bar Tales of Costa Rica is Good for my Mental Health

Mindfulness


Mayo Clinic describes mindfulness as a type of meditation in which you focus on being intensely aware of what you are sensing and feeling in the moment, without interpretation or judgment. Practicing mindfulness involves breathing methods, guided imagery, and other practices to relax the body and mind and help reduce stress.

For some of us, these meditation exercises, "close your eyes, focus on your breath..." are difficult, frustrating, and stress inducing. Particularly for people with a trauma history or ADHD, mindfulness can be a land mine.

For others, the whole enterprise sounds like woo-woo mental health. Add some essential oils and affirmations - who needs therapy or, God forbid, medication?

But there's more to mindfulness than nonsense.

The same Mayo Clinic article identifies several mindfulness practices. Three could be taken as basic concepts:

  • Pay attention
  • Live in the moment
  • Accept yourself

How does that work out irl - in real life?

Let me tell you about my recent five week stay in Costa Rica. First, the back story:


Prozac Monologues

My first book, Prozac Monologues, began with a hypomanic episode during an earlier trip to Costa Rica. I wrote a series of comedic monologues in an effort to not be mindful. The monologues danced around the memory of a recent Prozac-induced traumatic experience. It began with a bizarre thought, and moved on to some other weird stuff: dissociation, thought broadcasting, paranoia, and the like. 

Years later, once I was correctly diagnosed with bipolar disorder, I added edgy essays about that experience and everything I learned about bipolar disorder while trying to figure out what the hell happened to my brain. Like many memoirs, Prozac Monologues is a hybrid of my story and my issue. Sheila Hamilton's podcast, Beyond Well, captures it. Here's the linkIt's also a great read and now available on audio.

Bar Tales of Costa Rica

So what about Bar Tales of Costa Rica? My second book is exactly what the title promises: the stories I heard while sitting in bars in Costa Rica. That sounds like a very different book. Am I a genre hopper?

Yes and no.

via GIPHY


Bar Tales is about a milieu, a place and the people in it. It is not about mental illness. There are passing references to my own. But that's not the point. No references to research. No descriptions of recovery strategies. Stories heard in bars - it's a very different book.

Still, it is a sequel. It picks up where the monologues left off. In the first book, my wife Helen and I thought about moving to Costa Rica. Several months later, we did buy a little house in Playas del Coco. Didn't quite move there, but we spend several weeks there every year.


That's where I continued to work on Prozac Monologues. It's also where I gathered my bar tales, most of them at my sister's hotel and restaurant, the Pato Loco, which means "crazy duck." Other sites included El Bohío (referenced in the first book), Pacifico Beach Club, Coco Palms, and Soda Navidad.

You could call the second book a segue to the first. I turn a corner. That would be a right turn that leads me out of my neighborhood Los Canales, on to the Boulevard de Iguanas, and over to a whole new cast of characters: Patricia, Bruce, Andy, Sydney, Monique and André. Bar Tales is about their stories.



So why is this book good for my mental health?

As I am polishing these tales for publication in the spring of 2024, I spent several weeks in Coco for research. Research.

I wasn't sitting in bars, gathering tales - though inevitably a couple got added to the collection. This time I was gathering sensations. Physical sensations.

Trauma and Sensations

Sensations - these are at the heart of my mindfulness technique.

  • The person who has experienced trauma sometimes gets stuck in the past, reliving a loop of troublesome sensations. And let me tell you - being suicidal, as I was, is traumatic.
  • Or, in the face of current strife and stress, that person might dissociate - disconnect from present anxiety by going numb.
  • Or, based on deeply rooted thought patterns about bad things that happened in the past, the person faces the future with dread, anticipating - and pre-experiencing - a repeat of negative experiences.

Each of these are ways that we lose or escape the here and now. I think of here and now as my worst subject.

The thing is - here and now is where joy lives.

Let me repeat that.

Here and now is where joy lives.

So my research, gathering sensations, experiences in the present, kept me anchored in here and now.

And it filled me with joy.

What color are the rooster's feathers? - bronze head and breast, black legs, wings of teal and red.

What sound do the geckos make? - chk, chk, chk. How about the howler monkey? muffler dragging on concrete!

What do mangoes smell like when they are sitting in the field near my house in the hot sun? - like a fortified sweet wine.

What does carne en salsa taste like? Beef stewed in a rich vegetable sauce with hints of smoke when Juan cooks it all day in an iron pot over a wood fire under the mango tree.

What does it feel like to walk in the surf? Caressing waves, then grit in my sandals.

I walked around town with my phone in my hand, making voice memos, describing these sights, sounds, smells, tastes, and sensations. My mind fixed on the present, there was no room there for regrets about the past or anxiety about the future.

Health Benefits of Mindfulness

Mindful meditation has been demonstrated to reduce anxiety, depression, stress, pain, insomnia, and high blood pressure.

There are many ways to do mindfulness. A review of literature published in Clinical Psychology Review, Effects of Mindfulness on Psychological Health, summarizes the context of mindfulness practice in its Eastern and Western versions and its application in a variety of psychological treatments.

What I offer here is one simplified self-help practice for addressing panic and anxiety, a disciplined version of what I called my research:

Focus on your environment.

  • Name five things that you see right now
  • Name four sounds that you hear
  • Name three things that you feel
  • Name two things that you smell
  • Name one thing that you taste
Yeah, don't get hung up on remembering whether it's three feelings or three smells. I don't remember the order of the sensations and made it up.

The point is to redirect the catastrophizing brain, to pull it into the here and now. Remember - here and now is where joy lives.

This practice isn't the cure all to my mental health issues. And I doubt it will cure yours. But it gives our poor brains, exhausted by the three alarm fires that usually occupy them, a break. It turns down the temperature and lets a different input in.

And that's a good thing.

How Will You Get Through This Week?

Self care is not my best subject in the best of times. I can establish a routine, get up, eat breakfast, go to work, walk in the afternoon, and so on. I can hang on to good habits, eat a healthy diet, wear amber glasses at night. But that place in the list where I am supposed to do something for myself? Here is how that goes:

    Therapist: What will you do for fun this week?

    Me:



Okay, so what will YOU do for fun this week? (Clearly, I could use some ideas.)

And now there is this insurrection. How did that word work its way into daily conversation?


What Happened to My Bipolar Brain and How Do I Fix It?

The most troublesome statement in Goodwin and Jamison's Manic Depressive Illness may be this: "Complete symptomatic remission does not ensure functional recovery." This is no small problem. For some 30% to 60% of patients with bipolar disorder, simply treating their mood symptoms is not enough to help them return to a full life.

There’s a third pole that needs to be addressed for that to happen: cognitive symptoms. These often persist even when patients are euthymic, and they range from problems with memory and attention to more subtle deficits such as picking up on social cues and making wise decisions. 

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!

Gingerbread Houses and Cognitive Behavioral Therapy

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

Ritual, Stress, and Surviving a Pandemic Thanksgiving

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.

Between Stimulus and Response

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:


Okay, I confess, when you put an inspirational quote on top of a beautiful peaceful scene, it loses its inspirational value for me. That's just the way my brain works.

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.

Frazzled Cafe and Ruby Wax - Yes, I am a Fan


Ruby Wax is the founder of Frazzled Cafe, a peer support group for anyone who is overwhelmed by the stresses of modern life. As Ruby says, our brains just don't have the bandwidth. If that describes you, check it out. But bring your own coffee. The meetings moved online, a Zoom meeting on account of... you know.

Ruby is an American-born long time television personality in Britain and comedienne whose career pivoted when mental illness caught up with her. She went back to school to study the brain and got a masters from Oxford on mindfulness based therapy. Since then she has written books, toured, lectured, using her prodigious brain and her comic chops to entertain and educate about brain health.

The End of Miracles - A Review

What is it like to have depression with psychotic features?

What is a day like inside a psych ward?

What is the psychiatrist thinking?

Sometimes the best way to explore questions like these is in a story. So here is Prozac Monologues' first review of a novel.

Monica Starkman is a psychiatrist at the University of Michigan whose expertise includes psychosomatic disorders, stress, and women's issues around fertility, miscarriage, and obstetrics. In her debut novel, The End of Miracles, she turns her clinical experience to the story of one woman, Margo Kerber, a long-infertile woman who finally conceives, tragically miscarries, and then... unravels.

How To Tame Your Mind -- Ruby Wax

It's like training a dragon, only harder.

Ruby Wax nails depression: when your personality leaves town, and suddenly you are filled with cement.

She nails the problem: our brains don't have the band width for the 21st century.  Nobody's brain does.  Yours doesn't, either.

And she nails the solution: learning how to apply the brakes.

Loneliness is Lethal -- Ayn Rand is Wrong

This I've got mine; screw you thing we have going on in the US today is bad for our health.  John Cacioppo tells the story at a recent TED event in Des Moines, Iowa.



Here is the short version, with direct quotes in italics:

The human species is social.  We are just wired that way.

The Power of Apology

First, a nod to our excrutiatingly polite neighbors to the north, on the Power of Apology from Scott Stratton:



Next, inspired by Scott and in honor of Magna Carta Day - a rerun of last year's Entitled to an Apology?

Perhaps because a central feature of both hypomania and depression is irritability, and because a characteristic of the "bipolar temperament" is a certain tendency toward an attitude of entitlement, interpersonal disputes tend to be common in this patient population. -- Ellen Frank, Treating Bipolar Disorder

Mirror Neurons - They Change Everything

Blow your mind in the seven minutes and forty-four seconds:



You just watched V.S. Ramachandran, Director for the Center of Brain and Cognition at the University of California Sand Diego, cross the mind/brain barrier in his description of mirror neurons.  These neurons, a subset of the command neurons in the frontal cortex, are the neurobiological basis for imitation, culture and empathy.  What we see another do or feel causes mirror neurons in our own brains to fire, so that we understand or feel the same.

This week's blogpost is published late because I kept trying to explain what mirror neurons explain.  They explain everything.

They explain why rich people are not as generous as poor people.  (That may get its own post soon.)  They explain why religious people give more than nonreligious people, more time, more money, more blood.  (My source for that one is sociological, not neurobiological.  So I may not blog it, though mirror neurons would explain it.)  They explain why people who own guns are more afraid than people who do not, and why people who watch tv overestimate the crime rate.  They explain pornography.  They explain Congress.

Untangling Redemption

Kelly Flanagan is a psychotherapist who blogs.  I think that is brave of him.  Most mental health professionals keeps a decidedly low profile online.  Boundaries, you know.

Flanagan not only blogs -- he puts it right out there.

[I have been sick as a dog this week, and will share him with you, instead of churning out my own stuff.  Thanks, Kelly, for doing the heavy lifting.]

Flanagan's blog is called Untangled, and his theme is redemption: Tell a redemptive story with your life.  Now.

Immediately, he is asking for trouble in this bizarre world where meanness has become the measure of ones Christianity, and all those Christian words are distorted to stand for the opposite of what they intend.

In this Orwellian world, (where entitlement means something to which you are not entitled) Redemption means that you have paid whatever price somebody else has decided you ought to pay in mental gymnastics and conformity to their way of life.

Neuroscience of Meaningful Work

Fourteen years ago, I was offered a new job, Missioner for Ministry Development.  What's that?  Sometimes I said, I consult with organizations undergoing paradigm shift.  Other times I said, I do what Paul did.  Depended on the audience.

The details don't matter.  What does matter is that I got up every single morning rejoicing at what I felt privileged to do that day.  I considered it the job I was born to do.


Well, yes and no.  It combined my burning passion for advocacy, my deep appreciation of small congregations, and my abiding love for the highways and byways of Iowa, Beautiful Land, as the native inhabitants called it.

On the other hand, it gave me intense fourteen hour work days, conflict with long time friends, people across the state who piled their hopes, dreams and desperations on my back and the resistance of those who value certain aspects of an institution that others can no longer afford.  When we mixed all that with second generation antidepressants -- Keep trying, the doctors and my therapist said -- my bipolar II went into hyperdrive.  I was both madly productive and plain old mad.  It was beautiful.  It was ugly.  It didn't last.

Ellen Frank says that people with bipolar need to deal with grief for the lost healthy self.  It's one of the interpersonal issues that sabotage our adherence to the regimen required to maintain recovery.

The Garden of Your Mind

Mr. Rogers does with the mind what last week's post with Carl Sagan, Jill Bolte Taylor, et al did with the brain...



Entitled to an Apology?

Perhaps because a central feature of both hypomania and depression is irritability, and because a characteristic of the "bipolar temperament" is a certain tendency toward an attitude of entitlement, interpersonal disputes tend to be common in this patient population. -- Ellen Frank, Treating Bipolar Disorder

Frank goes on to explain how this attitude of entitlement plays out in the clinical setting.  Unlike the usually self-effacing patient with Major Depressive Disorder, grateful for any scrap of attention, people with bipolar get irritated at imagined slights, such as when the therapist cancels an appointment, or is late.  Sometimes, the only way the therapist can maintain the therapeutic relationship is to go ahead and apologize for these imagined slights.

Yup, stick that fork in the 220 volt socket again.

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