Links from Here and There, Plus Commentary on Social Isolation

August 30, 2009 at 5:16 am | Posted in Links, Sociability | 2 Comments

I was moved by this letter to the Atlantic; the writer’s struggle to find working meds and consistent insurance is certainly familiar. I found this missive via If You’re Going Through Hell Keep Going, a poetic take on bipolar disorder that blends myth with lovely images.

I feel guilty for not discussing the ABC special on Mad Pride. I didn’t see it because I don’t have a TV, and I believe that the medium as it has developed distorts all attempts at intelligent conversation. However, Liz Spikol of The Trouble with Spikol live-blogged it with wit and accuracy, if you’re interested. There’s also a good deal of information on the Icarus project website, since they were mentioned prominently and have apparently received a lot of traffic as a result.

Salon and The New York Times have been actively covering the psychiatric problems of troops returning from Iraq and Afghanistan; the stories about post-traumatic stress disorder, suicide and homicide are tragic. It sounds from the coverage as if the armed forces are so desperate for fighters that they accept people who already suffer from psychological disorders; after multiple tours, these soldiers have little hope of working the system and remaining sane.

On the topic of social isolation … boy, do I identify with this snippet from Mentally Interesting:

Pains and worries that shyness and anxiety encapsulate are self-fulfilling prophecies. A lack of alcohol, the awareness that I shouldn’t mention any of my personal problems lest I start rambling and the slightly clipped manner than medication has instilled in me has made sociability a nightmare. Because I am so nervous, I end up doing all the things I don’t want to: haltingly blurting out a personal problem, then nervously trying to cover up for myself by rambling, then feeling so self conscious that I can’t properly focus on a conversation, then my concentration slips and I lose the thread entirely, so I end up saying something rather odd, which lands like a lead balloon, and then I feel too stupid to contribute again. I also have very little to talk about, being that my life is pretty much spend most of my day alone, have no money or no job and feeding the cats. Just idiotic, simple things like a conversation with another human bean has become so stressful to me that I avoid it. Everyone feels this way to a degree. My degree is just more steep than some others’.

Yes, yes, yes. Boy, am I one for saying odd things that seem, before they come out, as if they are perfectly appropriate. Then when I see people’s reactions, I realize that I’ve just exposed my weirdness, and I lapse into a difficult-to-puncture silence.

In fact, all of the blogs and websites I’ve been reading speak movingly about the problem of social anxiety, which seems to worsen with age, and with the conviction that not only will the author never be normal, but that she won’t be able to channel or hide her abnormality so that it’s either charming or entirely internal. I’ll try to write on social anxiety and isolation later today in a bit of a self-help vein, but for now I’ll simply remark that it’s one of the most prevalent and miserable and least-discussed symptoms of bipolar disorder.

More links and love later.

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Some Useful Resources on Health Care Reform

August 29, 2009 at 9:30 am | Posted in In the News | Leave a comment

I don’t know about you, but while I have very specific ideas about what I do and don’t want in health care reform, I’m not really sure where to get concrete, truthful information about how it will affect me. This morning I’m going to spend some time assembling links that may help you to educate yourself, if necessary.

First up is this excellent page from The New York Times that brings together all of their recent articles about reform, as well as plenty of video clips and interviews.

That’s a good place to start, but what if you want to know the nitty-gritty of the bill itself?

Open Congress is an interactive web page that gives the full text of H.R. 3200, America’s Affordable Health Choices Act of 2009, the bill currently before the house. The site includes reader commentary and links to recent news articles and blog posts, pro and con. There are plenty of opportunities here to track and join the online debate.

To take action, go to the website for the National Alliance on Mental Illness website’s Legislative Action Center. Puzzlingly, the Depression and Bipolar Support Alliance website doesn’t address the issue — at least not that I could find. Regardless, once you’ve made up your mind about health care reform, it’s an excellent idea to let your representatives know how you feel before the August recess ends. Most will have a website that will allow you to register to be notified of any upcoming town hall meetings — I will be attending one on Tuesday, one of the last before Congress reconvenes.

So there you have it. There’s no reason not to get involved in the debate.

One Way to Break Out of Bipolar Self-Absorption

August 29, 2009 at 1:15 am | Posted in Uncategorized | Leave a comment

One of the things that most shames me about being bipolar is that I know darned well that I’m self-absorbed. I’m constantly monitoring my internal weather, often to the exclusion of noticing others’ pain or happiness. Depression is a naturally self-absorbed state, since the pain is so distracting that it becomes difficult to break out of one’s tight gray box to notice even the natural world, let alone those pesky Other People who don’t understand. And manic people are so convinced of their brilliance that they can’t shut up and listen.

That’s why I like this guest post from Zen Habits despite the silly name (“Three Jedi ind Tricks to Feel Better in a Nanosecond”). The author’s blog, Freedom Education, was a bit of a disappointment, with too much focus on the Law of Attraction for my taste. That said, I highly recommend this guest post.

Love to all.

A New Entry in My Fall Advertising Campaign

August 28, 2009 at 4:00 pm | Posted in Goal Progress | Leave a comment

Since I often feel the need to give myself expensive treats, I created the following:

Author’s Suspicions Confirmed: Cognitive Impairment Common in Bipolar Disorder

August 28, 2009 at 5:40 am | Posted in Cognitive Problems | Leave a comment

I’ve been on Google Scholar researching the relationship between cognitive impairment and bipolar disorder again, and the news is bleak. As I suspected, study after study finds a significant relationship between deficits in cognitive function and bipolar disorder, even when bipolar patients are in remission. I should point out that since I only have access to abstracts (I do not subscribe to a raft of medical journals), my ability to analyze the studies critically is limited. However, the studies I reviewed included several meta-analyses, which backed up the results of individual studies.

The last time I researched this topic systematically — about two years ago — researchers were still unsure if lingering depression caused the cognitive deficits they routinely observed in manic-depressive patients. A good deal of research has been published within the last two years indicating that even during remission most bipolar people show deficits in executive functions and verbal memory, in particular. Study results also suggest that, far from inhibiting cognitive function, lithium has a neuroprotective effect. Many bipolar patients would disagree with this last, but my experience certainly bears out the rest.

According to Wikipedia, executive function includes “planning, cognitive flexibility, abstract thinking, rule acquisition, initiating appropriate actions and inhibiting inappropriate actions, and selecting relevant sensory information.” Though a citation is missing for this list, these are the skills that I’ve seen referenced most commonly when discussing executive function.

Also via Wikipedia: this list of situations compiled by psychiatrists Dan Norman and Tim Shallice in which executive function plays a role:

1. Those that involve planning or decision making.
2. Those that involve error correction or troubleshooting.
3. Situations where responses are not well-learned or contain novel sequences of actions.
4. Dangerous or technically difficult situations.
5. Situations which require the overcoming of a strong habitual response or resisting temptation.

Clearly, executive function is crucial to social and occupational success.

Though this research is scary as hell, it squares with my experience, and vindicates me to a certain extent. When I worry about memory slips — often ones with serious consequences, especially at work — people tend to brush off my concerns. For me, this research confirms a set of facts that I’d suspected all along: that the cognitive deficits I’ve been experiencing are real, and that they are not iatrogenic (that is, caused by treatment). For instance, often and often I’ve experienced the inability to find a concrete noun. That started in my late 20’s, and has gotten markedly worse. At first I attributed it to mood stabilizers; now I’m pretty certain it’s a result of the disease itself.

It’s interesting to note that a good-sized subset of studies suggest that healthy first-degree relatives of bipolar people often experience the same sorts of cognitive deficits. So there’s plenty of bad news to go around. Cognitive deficits are also associated with poor occupational and social outcomes, which gives me a frisson of horror.

So, bad news this time around. I wish I could say it were otherwise.

Love to all.

Goal Setting Part I: A Few Hints for a Crucial Life Skill

August 24, 2009 at 3:43 am | Posted in Goal Progress | 1 Comment

I pride myself in my ability to set goals. I ponder them carefully, type them up neatly, post them here and there … and then promptly forget about them. The exception is work, where we enter our goals into an online document, and our annual performance rating is directly tied to whether we succeed in reaching them.

I have been doing better with my most recent goal of saving for an emergency fund and accelerating payments on my non-mortgage debt. I’ve been using a couple of techniques that I’ve mentioned elsewhere, but I’d like to add a few and pull them all together into a single post.

For me, the first step of the process is start now — right now if you can — and then recalibrate slightly every week. Many people suggest that you start with long-term goals, say, five years, then gradually break them down to a year, six months, a month, and a week, then come up with baby steps that you can take today, tomorrow, and so on. This can definitely work if you know where you want to be in five years. However, it can be just as effective to decide upon a simple 30-Day Challenge. You can use the Zen Habits forum for support, or simply go it on your own, perhaps telling key family members and friends about your plans.

No matter which you choose, you’ll want to set a so-called SMART goal, as illustrated by this handy graphic:

As you can see, goals should be specific, measurable, attainable, relevant, and time-bound.

As you can see, goals should be specific, measurable, attainable, relevant, and time-bound.

Man, I like that graphic, which I got from that amazing resource, istockphoto.com. No, I don’t get any money from them, and, no, it wasn’t free — just very cheap.

Anyway, let’s start with specific. When you first come up with a goal, it will probably be vague, in my case something like, “Get control of my finances.” The trouble with that is, it’s so nebulous and huge that it’s impossible to come up with concrete steps to get there. “Eat better” and “Exercise more often” are other examples of vague goals. “Start saving money” is more specific, but still not good enough, since it doesn’t say how much I’m going to save or what I’m saving it for. Without that information, I won’t know when I’ve reached the goal, or why I should even pursue it. So the first step of my goal reads: “Save $1,000 for an emergency fund.”

The next criterion is that it be measurable. Thus the $1,000 part. If you want to eat better, you might shoot for a certain number of grams of fiber a day; with exercising, you might choose 20 minutes three days a week. Numbers are crucial here, even though some goals, like “Be more compassionate” may not seem to lend themselves to numbers. The key is to isolate one way in which you can demonstrate compassion — by doing lovingkindness meditation for five minutes daily, perhaps, or by giving an genuine smile to 10 people you see in a day — that is tangible and countable.

Whether a goal is attainable can be difficult to judge. For some people, and in some areas of your life, a stretch goal (to use the corporate buzz term) might be inspiring. I prefer things that I absolutely know I can do, since I find failure tremendously discouraging. I chose $1,000 because Mary Hunt, author of the excellent Debt-Proof Living, suggests that you save 10% of your after-tax income. That strikes me as reasonable, and it means that I will meet my goal in less than six months. That seems like a long time, but I can always accelerate my rate of savings if I find that I can handle 10% with ease. It won’t be easy to meet this goal — I’ll have to change a lot of habits and work hard at it — but it is certainly attainable.

R is for relevant, which simply means, that the goal you’ve chosen aligns with your values and lifetime goals. Only you can know, of course, and it may take a certain amount of journaling and soul-searching to discover the answer. I embraced my current goal because it’s a step on the way to becoming a certified yoga instructor. I could work on this long-term goal with my finances in disorder, but I’d be a lot less likely to succeed, and money would narrow my options. So even though financial goals don’t move me like they should, now that I’ve tied saving for an emergency fund to a valued long-term goal, I find it easier to work towards the former seriously.

If you don’t set a deadline, you’re not really setting a goal; therefore your goal should be time-bound. You can set the deadline more or less arbitrarily (I will eat 35 grams of fiber a day for 30 days, then reevaluate), or you can back into it like I did. In any case, come up with a deadline and record it along with the rest of the goal.

I believe in setting one goal at a time and starting small. My goal right now is to save 10% of my next paycheck — eminently doable, but still difficult for me. Thank God for ING Direct — they make it impossible for me to just snatch money out of my account when I simply must have that thnead — the thnead that will languish on my bookshelf or in a drawer once I’ve acquired it, only to be purged six months hence. One technique that I’m using to reach this goal is an experiment. As of yesterday I’ve decided not to buy anything but absolute necessities for a week. So no prepared foods, no thneads of any sort, no flowers, no essential oils; I am allowed to pay my bills and give money to my church and the Depression and Bipolar Alliance, and I can buy groceries and gas. No paper towels or other paper goods, though, since you can always substitute Kleenex for toilet paper or vice versa. That’s my weird approach, which I will discuss in more detail in an upcoming post.

Goal-setting, right. Having one goal at a time means that you’re less likely to forget it, which is key for those of us with mild cognitive problems. It also pours your energies and time out onto a single object, thus improving your chances of success. I find that meeting goals is a lot like picking up laundry — for every item you try to cram into the bundle, another sock or pair of panties (read discipline) falls. Having a single goal can blunt this effect.

Your goal should be written, posted, and looked at. This last is actually the hardest part for me. Now that I’m advertising to myself, I either have to surprise myself with messages or take a moment to focus and read them, or else they will simply become a taken-for-granted part of my visual background. So stop, look, read, and muse on that sucker.

Other writers suggest going public with your goals so that others can hold you accountable. I’ve always been shy of this because I find it humiliating to admit where I’m starting from. I imagine people thinking, Wait, she wants to be a yoga instructor but she hasn’t practiced for three days? What an unworthy being! This is the first time I’ve posted a goal publicly, and I hope that you will all hold me accountable, particularly by asking for updates every now and then, since silence typically means that I’m slipping.

That’s all for now. I’ll try to return to goal setting later, since there’s still a lot more to be said. I spent an hour exploring the Icarus Project website before coming here, though, so my back is sore and my feet have fallen asleep.

Love to all, and may you find this helpful.

John McCain’s Arrogance Shines Through

August 23, 2009 at 2:06 pm | Posted in In the News | Leave a comment

The New York Times reports here that John McCain and his fellow Republicans will take their marbles and go home if health care reform includes a public option.

So, Senator McCain, you think that the man who kicked your sorry ass in November should allow himself to be blackmailed by your remarks on the Sunday political talk shows? Your impulsivity and lack of judgment make me look like a model of self-awareness and rationality.

President Obama: Don’t you dare give in to him any more than you did to Hilary Clinton’s insistence that she be named your running mate after publicly fantasizing about your assassination. We sent you to Washington to pass health care reform and resuscitate a dying democracy. Don’t squander your mandate in the name of bipartisanship. They have no cards. Their wet dream is that the reform that passes will be expensive and ineffective, and will enrich their campaign contributors. If you let that happen, you will lose the popularity you enjoy, and the election in 2012.

Oh, and lots of people will die and suffer and go broke paying for perfectly treatable illnesses.

Just a thought.

Now, back to working on that comprehensive post on goal-setting.

Love to all.

Wow, Wow, Wow: The Icarus Project Website

August 23, 2009 at 4:56 am | Posted in Links, Resources | 1 Comment

I’m deeply impressed with the Icarus Project website — the artwork, the poetry, the organizing information. This is a truly great mad pride site for those of us who feel both blessed and cursed by madness, and who produce art about the things that really matter: delusions and dreams, bread and roses, suicide and swallowing life whole.

Love to all.

Another Recommended Blog: The Trouble with Spikol, an Excellent News Blog on Mental Illness

August 22, 2009 at 5:12 am | Posted in Links | Leave a comment

Liz Spikol uses her her bipolar blog, The Trouble with Spikol, to examine news stories in depth, including her latest post about the psychiatric history of Seung-Hui Cho, the Virginia Tech shooter. I’m impressed by the documentation she provides, and by her sensitive responses to stories that seem, on the surface, simply sensational.

The thoughtful reporting and commentary makes the archives well worth reading, as well. I don’t always agree with her: for instance, while I’m not surprised to find out that electroshock therapy is a self-promoting industry similar to Big Pharma, I disagree with this article’s implication that it’s ineffective; for some people it’s a life-saving treatment of last resort. It has serious side effects and may become less effective for some patients over time, but the fact that it’s cynically hyped doesn’t mean it doesn’t work. The comparison to Big Pharma is apt, though perhaps not in the way Spikol intended: there’s no question that the drug companies are pushers of the worst stripe, and that many prominent academic psychiatrists have collaborated with them to produce research that is questionable at best. At the same time, the very same medications have saved many bipolar lives.

Minor disagreements aside, I really recommend Spikol’s blog if you’re looking to keep up with mental health news. The blog may be in transition since she recently left the Philadelphia Weekly, which hosted it. I’m hoping that if it does move, the Weekly will provide a forwarding link. If not, her name is unique enough that a Google search should turn up her whereabouts.

Another Breaking Story: The Onion Reports that President Obama Has Bipolar Disorder

August 21, 2009 at 4:22 am | Posted in Links | 1 Comment

…Along with my other favorite world leaders, Winston Churchill and Abraham Lincoln:

I think this is pretty funny, but I can see that some might find it offensive. I like it partly because, though it is hilarious, it is spot-on as far as what bipolar disorder looks like from the outside. Or perhaps I like it precisely because it is spot-on, and I love to laugh at my own tiresome tragedy. For my money, something only counts as promoting stigma when it springs from ignorance, and this seems to be based in an intimate knowledge of the disease. What do you all think? Offensive or funny?

I found this video on Furious Seasons, a bipolar blog that tracks, among other things, the actions of Big Pharma and the Food and Drug Administration. It’s great for news updates on whatever you might be taking; check it out.

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