A Quick Recommendation

Agitating for change is a deeply American -- and profoundly healthy -- action you can take.
Agitating for change is a deeply American -- and profoundly healthy -- action you can take.
I’d like to begin today with an insight that I had a couple of days ago: Lately I’ve been actively, publicly fighting stigma, and that’s one of the best wellness tools I’ve ever discovered.

Most importantly (and I think I’ve mentioned this), I give a presentation at work about communicating with people who have disabilities. The presentation itself is very commonsensical, including such advice as “Acknowledge people with disabilities,” “Communicate directly,” and “Respect requests for privacy.” The power lies in standing up in front of a large group of my coworkers and starting right off by saying that I’ve been diagnosed bipolar for 13 years (that leaves out the eight years I spent stumbling from doctor to doctor searching for an accurate diagnosis). As one audience member put it, it was surprising and delightful to see a normal-looking, perfectly competent person who has manic depression when, in his words, “When you hear bipolar you think of people going postal.” Oh, my. Such honesty. I also show slides of a woman who uses a wheelchair skiing, and a woman who suffered a stroke with her beloved custom recumbent bike. All of these images help to shake free people’s idea that having a disability means living a lonely life of misery.

I’ve done other things to fight stigma, ones that are somewhat easier for people who don’t work in a large organization that’s devoted to the ideals of diversity and inclusion. Perhaps the simplest is to sign up for legislative updates from the National Alliance on Mental Illness. They track legislation that impacts the mentally ill and send out regular email updates that include simple steps you can take to agitate for change. On one occasion we had the opportunity to write letters about health care reform to the Obama transition team; I immensely enjoyed producing my three-page, single-spaced, obsessive screed. It may not have influenced policy much (I demanded single payer), but it was wonderful to think of Obama aides learning from and perhaps noting my perspective.

If you’re an Obama supporter, it’s probably worth going on the Organizing for America website and signing up for email updates. This led me to visit my Congressional Representative to argue for a public option in health care reform. That seems not to have worked, but it was still worth it to have 15 minutes of a staffer’s undivided attention to tell my story and let my views be known. In fact, I’ve decided to visit regularly, since the office is just a few blocks from my house.

Wherever you start, I think it’s an excellent idea to get active. Legislation like mental health parity gets passed precisely because humble folk like us press for it with letters, petitions, and other forms of public pressure. We shouldn’t let the pharmaceutical companies do all the talking, since they’re out to protect their own interests.

More later, I hope, including a book review.


Charity and Worth

As I was driving home from my nearest pretentious natural foods store, I reflected that maybe I do deserve to earn what I make.

You see, ever since I got my current job, I’ve been hounded by the sense that I’m not worth nearly what they pay me. After all, I’m bipolar, and therefore a bad employee, right? Never mind that I’ve developed specialized skills in the two years that I’ve been there, or that I really do bring a special creative flair to my position; I have been haunted by the feeling that a jealous god will snatch it all away because I’m not good enough to have it.

And maybe it will be wrested from me; I can’t know that. But this evening I began to entertain the thought that, yeah, I work hard, and I’m not overpaid now, I’ve been underpaid before. I work for a company that really values its workers and treats them well, and to be honest, after being an academic for so long, I expect to be smacked around, shit on, and then paid poorly to work part time with no benefits. For two years now, it has puzzled me to be treated like I deserve, not just a generous salary, but excellent health and disability insurance, and respect and reasonable accommodations for my disability.

What got me thinking along these lines? Well, I gave money to a hobo outside the pretentious grocery store, and talked to him for a few minutes. Yes, it reminded me of how tremendously lucky I am – I couldn’t help but be conscious of the difference between us: me with my bulging Trader Joe’s grocery bags, he, largely toothless, begging for scraps. And yes, I thought as I usually do that there but for the grace of God go I. I could so easily be homeless. I’ve seen in my bipolar support group how quickly that can happen. But for once, instead of feeling unworthy, I felt moved to share, and I did. I gave him three bills without checking to see what they were first (it’s not like I was carrying 100s, or even 20s, so this was no great act of courage).

Now, normally when I’m moved to do something kind, I avoid doing it, not because I think the other person is probably unworthy (i.e., will spend it on crystal meth), but rather because I dread having the human interaction. I dread a lot of different kinds of social interactions, and being cast in the role of Lady Bountiful is definitely tough one to swallow. But in this case I followed the quick movement of my heart, and damned if it didn’t benefit me tremendously. We spoke briefly — for less than five minutes — but it was something of a human interaction for both of us. Since the closest I’ve come today to a friendly exchange is discussing automatic email notices with my supervisor, I probably needed it as much as he did. And afterward, like I say, I felt strangely worthy of my salary. It’s not that I earned it in that moment, precisely — it’s just that I realized that when I allow my heart to think for me, I am capable of kindness. Also, I’m no more worth my salary than he’s worth $7 — but I’m also no less worth it.

So I decided how much to pledge to my church for the coming year, knowing that they work very, very hard for the hungry and homeless in this town. And, yeah, it’s more than I feel like I can afford. But part of recognizing the element of luck in our circumstances is being willing to give away some of what I have.

Love to all, and a shout out to anyone who’s feeling depressed or grieved tonight. You’re in my prayers.

A Bakers’ Dozen of Strategies for Dealing with a Task That Seems Overwhelming

Feel free to creep along like this little dude -- just take a step, no matter how small.
Feel free to creep along like this little dude -- just take a step, no matter how small.
Everyone’s done it: gazed gloomily at a do list or inbox task and thought, “It’s hopeless. I don’t know where to start, and even if I did I would never finish this hellacious task.” The frightening item can be anything from brushing your teeth to mopping the floor to writing your dissertation; whatever it is, the following strategies consistently help me to get started, and often to finish.

1. This is the most important strategy, a veritable Secret to Success: break an overwhelming task into tiny, tiny pieces, then tell yourself that you only have to do the first step. I’m not talking smallish steps like “cook dinner.” I’m talking, “1. Take out the cookbook; 2. Find the recipe; 3. Take down the ingredients and arrange them on the counter.” And so on. You get the point. Sometimes taking down the cookbook is all you’ll manage, but chances are, once you take that first step, you’ll develop just enough momentum to keep you going to the end. Write those steps down; if you try to keep them in your head they will just become all jumbled, and you’ll feel overwhelmed again in no time.

To give another example, I’m trying to install my programmable thermostat, a job that everyone tells me is simple if only you turn off the circuit breaker so that you don’t electrocute yourself. (Electrocution would complicate things significantly.) So far the massive steps I’ve taken are: “Look at the circuit box and find the right breaker” and “Remove thermostat from packaging.” No matter. As long as I keep doing a step or two a day, I will get it done. And of course, if you complete a step or two, pretty soon it’s easier to finish the task than it is to pack everything back into a cabinet.

2. Figure out what materials you need or what preliminary steps you need to take, and deal with those first. I find that I often avoid even small tasks because I don’t have the materials I need: three gunmetal jump rings for jewelry making, or nail polish remover for a pedicure. Or perhaps I need to do the dishes and wipe down the counters before I can cook comfortably. In either case, the first small step is to make a short list of preliminary jobs and get them out of the way. So instead of beginning with “take down the cookbook,” step one is “empty the bottom rack of the dishwasher.” In some cases there may be a whole chain of things that need to happen. Just trace the chain back and begin at the beginning, whether it’s cleaning out the refrigerator or setting a pan to soak, and start there.

3. With chores that don’t lend themselves to individual steps, I set an alarm for a minimum slice of time. For yoga that’s 20 minutes; for this blog it’s 30. For things that I really dread, like opening the mail, it might be five or 10 minutes. Whatever. Just set the alarm and jam through that sucker as fast as you can. Again, momentum will often keep you going once the alarm goes off. Whatever happens, you have the choice to keep working until you’re done, reset the alarm, or just quit. The key is to agree with yourself that you really only have to do 10 minutes, and that you’re perfectly free to quit when your set period is up. If you start with the intention of doing an hour of 10-minute periods, you’re still going to balk at taking that task on. If you hesitate to try this strategy, thinking, “I won’t be able to get anything done in five (or 10, or 30) minutes, remember a favorite saying of David Burns, the author of The Feeling Good Handbook: you can only do 15 minutes’ work in 15 minutes’ time, so you might as well get cracking and make good use of the next five to 15 minutes. Even minimal periods really do work. For example, I finished my dissertation by making a bargain with myself to write for two 45-minute stretches a day. Within two months, I was done with a book-length project and had earned my Ph.D.

4. Play upbeat music. If you have an iPod and iTunes or the equivalent, make yourself a mix called “Happy Tunes” and really crank them as you cook or write.

5. If the task is a regularly occurring one like writing or practicing an instrument, have a little ceremony to ease yourself into it. The key here is little — don’t clean your house basement to attic. To use the example of blogging again, I make myself a cup of coffee, turn on my Pandora station or specially chosen “work music” (Download’s III or Autechre’s Chiastic Slide), and set my alarm. A cup of coffee or another beverage is a good, small ritual, as is a quick review of an inspiring quote.

6. Know what conditions you need to work and create them. I cannot work with a messy desk — it makes me feel cramped and anxious. (I suspect this makes everyone nervous, even proud slobs, but that’s another story.) I can’t cook in a dirty kitchen. Again, don’t feel like you have to clean your desk or mop the floor before you can write or cook. Instead, set a regular date with yourself to take care of the preliminaries so that you’ll be more inclined to apply butt to chair (or eyes to recipe book) when the time comes.

7. Some people work well on a reward system. I find that if I buy stickers at the craft store and set up a system, I am more likely to carry out loathsome tasks. Decide how many stickers each step is worth in advance, then dole them out as you work. You may want to give the stickers a real-world value, depending on how difficult the task is. When I was practicing networking (something I suck at for obvious reasons), each sticker was worth $2 towards a professional treatment. It took a long time to earn one — those suckers are expensive — but it really helped to have a goal to work towards. If you do decide to use a reward system, be sure to give yourself the reward promptly so that you’ll associate the reward with the task. So, for example, the minute I earn my facial I call to make an appointment for that afternoon. Another commonsense tip: if you have a problem behavior like eating or spending money, it’s not a good idea to reward yourself with chocolates or facials. That’s why I’ve stopped using prizes for myself; they’re just too damn expensive. The fact is, though, that the human mind is so fundamentally silly that it may well accept just the stickers themselves, and take pride in looking back and stroking stickers from past tasks.

8. When you’ve done your first step, take a moment to give yourself genuine praise. All too often, the tendency is to think that 15 minutes of work is nothing, and that you don’t deserve to feel good about having done it. Nonsense. When I’m writing down my steps, I deliberately insert “Revel in your clean floor,” or “Congratulate yourself on a job well-done” as specific, regular steps.

9. Do the “Prescription for Procrastinators” in David Burns’ The Feeling Good Handbook. Also, read anti-procrastination books like The War of Art regularly and implement the tips you find there. Believe me, I’m just scratching the surface here.

10. Make sure you start well before any deadlines so that you don’t feel obliged, rushed, or otherwise pressured. Count back from the due date, allot what seems to be a reasonable length of time for each big step, then increase that by at least a third. One of the biggest pieces of wisdom I have to impart: Everything always takes longer than you think it will.

12. Another piece of wisdom that’s time-tested and true: You work yourself into feeling. You do not feel yourself into working. That is, if you wait to work until you “feel like it,” you’ll be waiting a long time. When’s the last time you ever simply yearned to mop the floor or open a fleet of bills? Do the job knowing that either it’s going to suck start to finish but you’ll feel better once it’s done, or (actually more likely) that once you’ve gotten started you’ll kind of get into it.

13. Make the task as sensually pleasant as possible. If you’re going to mop the floor, add essential oils to the hot water and breathe deeply. Make sure you have a nice cup of tea nearby. Set up a space heater if it’s cold. Whatever. Just make sure you’re not suffering physically by breathing nasty fumes, thirsting, freezing, or otherwise suffering.

That’s my advice. Now I’m off to take do 20 minutes of yoga.

Finally, an Excellent Crisis Plan Form, Plus the Most Fine Madness First Aid Kit

I’ve been searching for awhile now for a decent crisis plan or advanced directive; I finally found one by opening a document that had been sitting neglected on my desktop for weeks: Sonny Kentucky’s Madness First Aid Kit, which I stumbled upon while strolling around the Icarus Project Website. (I just can’t say enough good about those folks — it’s a community of people with whom I really resonate. The link is on the right.)

Anyway, here’s the link for the crisis plan. Like the author, Mary Ellen Copeland, I suggest that you fill it out slowly over the course of several days rather than trying to rip through it in one sitting. If you’re like me, you may tend to whip through such things in a burst of enthusiasm, then lose them or forget to implement them.

The Crisis Plan above comes from mentalhealthrecovery.com; I was impressed during my short (30-minute) visit — Copeland has many excellent suggestions for improving wellness. I particularly like how she gives specific, concrete suggestions concerning how to go about certain activities that bossy people like me always recommend. For example, people preach that you must have friends, but it can be hard for mentally ill people to develop and maintain friendships. Copeland explains how to make friends, and gives a lot of basic dos and don’ts that you’ll need to bear in mind as you reach out. (And that I need to bear in mind as I reach out.)

Copeland offers a $15 online course on how to develop what she calls a Wellness Action Recovery Plan; I think I will take it and report back. I liked her free material enough to want to support her, and to know that I could benefit from her insight. Also, $15 seems like a really reasonable price. I like the fact that many bipolar people (who may be unable to work or underemployed) can probably afford it.

Coming up, perhaps even today: the benefits of engaging in mental health advocacy and stigma-busting, and another book review.

20 Strategies for Dealing with a Crippling Depressive Episode

My darling Julia, who has seen me through many a rough patch.
My darling Julia, who has seen me through many a rough patch.
Reading If You’re Going Through Hell Keep Going reminded me — as if I needed reminding — that sometimes depression is so terrible that you’re lucky to brush your teeth, let alone go hiking. For those occasions, I offer the following list of coping strategies:

1. If you’re thinking seriously of suicide (for instance, planning it or being tortured by compulsive thoughts about death), go straight to the hospital. Same goes if you’re hurting yourself in any way. If you aren’t safe to drive, have a friend or family member pick you up. If, in your judgment, you might hurt yourself, don’t worry about insurance or anything else — just go. Being in the hospital sucks, but you may meet a shrink who can change up your meds in a beneficial way.

2. Call your psychiatrist, if you have one. Don’t permit yourself any excuses (“She doesn’t understand,” “He’s always too busy to return my call”). Just call.

3. Call a local crisis line (your doctor should have one on her answering machine), or call 1-800-273-TALK. Again, no excuses about how things aren’t bad enough or you’ll be better soon (I get surprisingly optimistic about my health at the very thought of getting help) — just call.

4. Go on any of the following websites and post to the discussion groups: Depression and Bipolar Support Alliance, The Icarus Project, or Find the Light. Let people know that you’re terribly depressed and need love. It will come pouring out over you. The Icarus Project crisis discussion group is particularly supportive and caring.

5. Call a friend and sob shamelessly. Again, no excuses. Read the post on phone phobia if you need help talking back to your negative thoughts. You may have to call people — even a single person — daily until you feel better. Do it.

6. Read books you love or watch a movie that pleases you. Patrick O’Brien’s 20-volume Aubrey-Maturin series has seen me through more than one low point.

7. See to your physical comfort and hygene. If it’s miserably hot, make sure you turn on a fan or air conditioning, if you have it. If it’s cold, take a hot bath or crank up the heat. Don’t suffer any more than you have to. Also, try very, very hard to bathe, brush your teeth, and wash your hair. These simple steps will improve your mood, even though they seem like too much trouble.

8. Open the blinds. Get that vitamin D, and get some natural light on your retinas. This will help you to sleep properly, and will energize you a bit.

9. Have a friend come over and clean, or, if you can afford it, hire someone to come in. It’s embarrassing to let anyone see how far you’ve let the dishes go, but professional cleaners, in particular, have seen it all and really don’t care. A a filthy house will drag your mood down; a clean one will lift it. I actually have to keep my house clean at all times. If I don’t, my mood will begin to spiral downward.

10. Accept help when it’s offered, and ask for help if you need it. I always get into a weird, prideful place when I’m depressed, and I find it hard to let people help me. I also think too slowly to spell out what I need. This should be a part of your crisis plan. If it’s not, ask your friends what they think you need, and then ask them to do it. If you can’t do any of the things on this list, have a friend come over and help you.

11. Get out into nature, even if that just means finding a single plant. Study that plant. Pretend you are that plant. Turn yourself over to the plant completely for as long as you can. List its parts, touch it lightly, notice whether it has new growth.

12. Give love to your pet. Stroke it, groom it, feed and water it, give it a treat or scraps if you’re into that. Caring for another living creature can be easier than caring for yourself, and giving love can help you to receive it. If you don’t have a pet, get a rescue the next time you’re vaguely functional. They need you, are highly therapeutic, and will connect you to life when everything else seems meaningless. Cats are soft and sweet, dogs give unconditional love, and fish are lovely. Snakes have nice skin and feel very muscular. Do it. Get a pet.

13. Get fresh flowers, or have someone bring them to you. Trader Joe’s is an excellent, cheap source of bouquets. Once you have them, let yourself become absorbed in arranging them, smelling them, and admiring them.

14. String a necklace. I’m serious. Nothing is more absorbing and zen than fiddling with tiny, brightly colored beads. Making aesthetic choices may dislodge your mood a little.

15. Breathe deeply and recite a mantra. Pick one while you’re healthy, post it prominently, and recite it at least five times when bad thoughts attack.

16. Put together a crisis plan when you’re well, and use it when you’re sick. Post it, hand it out to friends and family, and for heaven’s sake, follow it. (I tend to lose them, or put them in inaccessible places like unbookmarked web sites.)

17. Comment on this blog, and I will send you love. Lots of it, with all my power.

18. If you attend church, have lay ministers come to give you the sacrament of healing, and ask to be added to any lists for intercessory prayer. The power of prayer is well-documented by a variety of rigorous scientific studies. For whatever reason, if people are praying for you, you will tend to get better.

19. If you think you might find this list helpful, print it out and post it prominently. Heck, I’m going to.

20. Do what you love. Set an alarm for 10 minutes, or even five minutes, and write, paint, or sing. No matter how dried-up your brain feels, it will benefit you. So, yes, do it.

It’s funny. When I first started writing this post, I thought I wouldn’t be able to come up with a single meaningful strategy beyond, “Call your shrink.” It turns out that there’s a lot you can do — it’s just hard to remember all of it.

Love to all.

I mean that when I say it, you know.

Comedy and Tragedy: Links from Around the Web, and a Random Bumpersticker

Via Furious Seasons, an apparently serious suggestion from digidaydaily.com that Federal regulators allow pharmaceutical companies to create fan pages using social media like Facebook. This is, um, a really bad idea. That is, if your goal is to promote accurate, unbiased medical information. If you just want to create fans, hey, why not?

By the way, Furious Seasons is holding a fundraiser, and if you’d like to support an informative, thoughtful bipolar site with $5 or $10, it’s a good investment.

I took a look this morning at The New York Times site on bipolar disorder, and was pleased. Among other things, it offers basic information about the disease, links to various organizations like the National Alliance on Mental Illness, and, if you search “bipolar disorder,” an assortment of more specific articles arranged by date. There are multimedia features, too, including a section called “Patient Voices.” I didn’t click on it, though, because I’m afraid of multimedia.

My main complaint is the one I always have: it doesn’t really convey the seriousness of the disease, or how totally it disrupts patients’ lives. The main page is fairly dry, and doesn’t include the quirky symptoms like word-retrieval difficulties that help to distinguish the disease from major depression and personality disorders. So, it’s a mixed bag, but worth a look if you’re seeking basic information and absorbing feature stories.

Before we move ahead with links, I feel compelled to veer off-topic (which is, in itself, very manic-depressive) and muse about a bumper sticker I saw this afternoon. It read: “I will forgive Jane Fonda when the Jews forgive Hitler.” Wow, I thought, that’s nonsensical. I mean, that reveals such historical ignorance that it’s hard to know where to start. Is the guy under the impression that Jane Fonda committed genocide during the Vietnam War? Or — and I like this option — does he think that Hitler gets a bad rap, and was simply a young, idealistic celebrity? Hm. His other bumper sticker was less interesting: “I didn’t claw my way to the top of the food chain to eat vegetables.” Yawn. That one is pretty funny when the punchline is “tofu,” but vegetables? This raises the possibility that his confusion of Hitler and Jane Fonda results from constipation.

In other news, I should have a spiffy logo soon. Michael Siegenthaler of the graphic novel Skits has promised to design me one, and his work rocks. I can’t wait — it’s about time to get rid of that pic of myself in Pigeon Pose.

The posts on If You’re Going Through Hell Keep Going have been heart-wrenching this week. I think it’s valuable to read them, though. If you’re bipolar, you’ll know that you’re not alone; if you’re a friend or family member who would like to understand the disease better, these raw posts will help you to understand what your loved one suffers. If you can, post a loving comment to the author — she deserves our affection and prayers right now.

Love to all.

Ending (or at Least Ameliorating) Phone Phobia

It's for you.
It's for you.
If you’re like me (that is, bipolar or depressive), you probably put up with a certain amount of social isolation. While people-seeking and pressured speech (i.e., extreme chattiness) are symptoms of mania, most bipolar people fight depression — and tend to withdraw socially — much of the time.

Taking a page from cognitive therapy, I thought I’d review some of the thoughts that go through my head my head when I’m avoiding social contact and try to come up with more positive, realistic ideas. Remember that when I say “you,” I’m pretty much talking to myself — please feel free to leave your tips and ideas in the comments section.

When the phone rings or I contemplate making a call, I think the following:

1. I don’t have anything interesting to say. However, the other person may. She may need your empathy and compassion, she may have good news to share, or she may just need a friendly voice. You don’t need to entertain, or even talk much, in order to communicate with people. You may meet your own needs by listening and thereby helping a friend.

2. I complain so much about my depression, and this person can always tell when I’m depressed, so when she asks how I am, I’ll have to tell the truth and, yes, complain. Your friends may not like it when you complain, and they may occasionally chafe at it, but they love you and put up with your oddities much as you put up with theirs.

3. This person never responds to my complaints in the ideal way. Perhaps he minimizes them (“It can’t be that bad!”), gives unhelpful advice (“You need to get out of the house”), or launches into his own set of complaints (“Life is rough. At work today…”). As your therapist is always saying, you can’t expect a perfect response to much of anything you say; it’s not realistic to grumble in the hopes of getting the perfect response. Your complaints may irritate your friends and family. They may be angry, worried, or bored. And if someone is consistently unhelpful, you can say (avoiding a plaintive tone), “Sometimes I just need you to listen and say, ‘Wow, that really sucks. I’m sorry to hear that you’re not feeling well,’ and then change the subject.” In other words, you can ask for what you would find helpful.

4. She won’t understand. Actually, I’m always surprised at how well my friends understand and relate to my distress. Yes, my depression has some nasty bipolar features and is extreme at times, but many of my friends have felt some level of depression, and they understand pretty well.

5. It will distress him to know that I’m depressed. It will probably be even more distressing if he can’t get in touch. Chances are, he knows darn well that you’re down when you avoid the phone, so he’ll start to worry if you disappear for any length of time.

6. There’s such chaos in my head — I can’t possibly have a rational conversation right now. Sometimes this is true. More often, though, interacting with others forces you to organize your thoughts and turn your attention outward. This is all to the good.

7. I don’t know this person very well, and I can’t put on a social mask right now. How much you should reveal to a new friend is a delicate question, certainly. It’s not appropriate to dump on someone who you hardly know; not only will it alarm the other person, but you need to know that someone is worthy of your confidence before you launch into a description of your nuttiness. So this one can be a legitimate objection. However, if you hope to develop a close friendship with someone, then you might want to pick up and start sharing a bit.

8. After a long day at work of trying to normal, I can’t do it for another hour. I need to decompress. This is a toughie for me. My job can be awfully demanding (it was yesterday, certainly), and by the end of the day I do feel ready to collapse into sleep. I typically write off Monday and Tuesday afternoons — for some reason, I’m just whipped early in the week. I think everyone struggles with this issue, though, bipolar or not. Remember that just like everyone else, you need a life outside of work to keep your sanity and balance, and to ward off further isolation. You need to make the effort whenever you can.

9. I don’t recognize that number. It will be bad news, and that will just upset me further. This reflects remarkable faith in your psychic ability. In fact, when I get a call from a strange number, it’s positive or neutral 90% of the time.

10. Christ, who the hell is it now? Why can’t people just leave me alone? This is just reflexive negativity; I often swear when I first hear the phone ringing, even if I’m feeling lonely and could use a friendly voice. For this one, I just try to remember all of the times when a phone call ended up relieving stress rather than heightening it.

So those are my suggestions. Answer that phone; even try making a call. And if it’s me calling, you should definitely pick up.