This and That

Here I am, as busy as a weasel.
I was hypomanic yesterday afternoon, and, boy, was it fun. My enjoyment was impaired only slightly by a suspicion that I was behaving a bit strangely. I had all the classic symptoms: I was unable to shut up in a meeting, my language became more convoluted, and I drove recklessly. I felt compelled to mention Zeno of Elea and the Duke of Wellington several times. I also entertained the following thoughts:

1. I am so clever!

2. Work is so fun and absorbing!

3. How I love test and software engineers! (This is particularly nutty — when I am in my right mind, I would like nothing more than to strangle the entire Mission Planning group because their work is invariably late and shoddy.)

4. How fun it is to think!

I’m betting this is connected to going off of my antianxiolytic. Ever since, I have the great pleasure of thinking much more clearly. Why, just yesterday I performed a minor but sweet mental feat without thinking: I looked up Alcibiades’ mother’s family name in a book I’m reading about the Peloponnesian war. Years and years ago, my mind effortlessly retained the general layout of most texts that I read. While I didn’t have the entire text of Middlemarch neatly arranged in my head (a trick of the late literary critic Northrup Frye), if I needed to find a particular passage, I could always recall its location on the page. I lost this capacity years ago, but apparently have regained it entirely.

This is big. For years I’d been mourning — mourning, I tell you! — the loss of a whole series of Stupid Brain Tricks, and even if others don’t notice or care, it’s distressing to shed brain functions wholesale. My moods are have been volatile, but it’s more than worth it. Strangely, I’m much less anxious, and am less prone to disappear into what I think of as my Dark Tunnel of Misery, a mental state that renders me unable to hear or see others.

In other Fascinating Mood News, I have been slacking on walking and meeting my social obligations. This weekend I intend to restore those habits, since the next phase of my quest to become The Perfect Mental Patient begins Monday.

Lately my mood has settled into a weekly cycle that I can’t shake. Sunday and Monday I am positively crippled by depression. My spirits begin to lift on Tuesday, and by Thursday I am as brisk as a bee in a bottle. On the bad days I struggle mightily to shift laundry from the washer to the dryer, and there seems to be no hope of folding it once dry. I spend Thursday mornings bustling around the house knocking out even the most repulsive tasks, and at work I crank widgets briskly.

I’m not sure how to handle the down times. A part of me refuses to accept periods of low productivity, so I castigate myself early in the week. Three days later, I am positively smug with accomplishment, resting secure in the knowledge that I am busy and therefore good. I’d like to treat myself with compassion, but my Inner Protestant can’t stop carping. I’ll have to devise a solution and share it.

One last thing. On If You’re Going Through Hell Keep Going, the author shares a list of things she’d like to do someday. Imagining future self visiting London, for example, helps her to survive brutal lows. I will have to try this on Sunday, provided I can move my hands.

Love to all.


Things Are Getting Worse, Not Better — What to Do? What to Do?

Over the last several days, I have been wrestling with a difficult issue: in three crucial ways, I am getting worse, not better.

Most people around me deny it, but I know damn well that my cognitive problems are getting more serious. I’ve gone from mild difficulties with word recall to forgetting that entire conversations ever occurred. This has led to several incidents at work ranging from embarrassing to near-catastrophic, and I am afraid — and I think this fear is realistic — that eventually I may not be able to work.

I’m also becoming more withdrawn socially, and this affects me in a couple of ways. First of all, during my depressed phases, I find it nearly impossible to carry out commitments I’ve made. For instance, if I sign up for a class, as I did at church, I know damn well that depression will prevent me from finishing it.

At the same time, because of my bouts of severe depression, I find it hard to maintain the social supports that I need. When I am truly down I simply withdraw. I can’t talk to people that I don’t know well or enter unfamiliar social situations. I don’t have a good social network now, and despite my best efforts, I don’t seem to be able to keep it together long enough to expand it.

All of this leads to a larger existential question which I will certainly not answer today, but which I’d like to pose to you, the readership: I think it’s fair to say that my adult life up until now has not been a happy one. I’ve been crushingly depressed, in and out of hospitals, and unable to maintain the sort of stable relationships that preserve sanity. Given that things are getting worse and not better, what kind of quality of life can I expect as I grow older? It’s unlikely that I will enjoy a fruitful retirement that includes a loving spouse, friends and hobbies, and travel. In fact, I’m facing the very real possibility that I may not be able to work to retirement age. If my life was unhappy at the height of my intellectual and social powers, what is it likely to be in the future? Tied to this is the question of what I have to offer potential friends or a hypothetical spouse.

As I said in my last post, both of those questions may be the wrong ones to ask if, as I suspect, the answer could lead to further depression. I don’t want to torture myself with unanswerable questions or insoluble problems. So I’d like to set the larger issues aside and start with a relatively concrete piece: my cognitive lapses.

First, what am I doing already to cope? Well, at work and at home I keep detailed lists of things to do, and this does help to prevent any given task from falling through the cracks. I’m also extremely organized. I do not count on memory to help me to locate files, for example — I just file them properly. These two strategies are not enough, however, since I tend to forget either that I’ve had a conversation regarding a particular issue — say, that I’ve asked the preparer about the status of a data deliverable — or I can’t remember what was said a day later.

So what else could I be doing? I could document every conversation that I have, or conduct all important conversations via email. However, the first is a little too obsessive even for me, and email is often not the most effective way to either get information out of people or get them to take action. So I’m not quite sure what to do.

When I don’t know what to do, I look for resources that will tell me. So:

1. If my shrink can’t help, maybe there’s a local therapist or psychiatrist who specializes in dealing with early memory loss. I can ask my therapist for a referral, and I can Google local resources.

2. I can also call the Employee Assistance Program at work, which is amazingly efficient when it comes to finding everything from cat-sitters to house cleaners. Granted, this is more serious than finding a good accountant. Nonetheless, it might be worth a try.

3. I also wonder if there are books that address these problems. I’ve never seen anything in a book on bipolar disorder, though the research shows that cognitive problems are inherent in the illness. People do have memory loss for other reasons, however: chemotherapy, normal aging, and the various forms of dementia being obvious examples. So it might be worth my while to search Amazon for books on coping with memory loss.

One thing is for sure: I can’t continue to pretend this isn’t happening. It’s a threat to my livelihood, and thus to the core of my identity; I need to confront it, and to try everything in my power to reverse or compensate for my cognitive deficits.

So here’s the plan: I will hit Google, the EAP hotline, and Amazon, and report on what I find. I will also continue to write about these three intertwined issues, as frightening as they are.

Mental Meteorology: Why Bipolar and Depressed People Are So Damn Slef-Absorbed

Depression and manic-depression create the conditions for violent inner storms.  Is it any wonder, then, that we're experts in our own internal weather?
Depression and manic-depression create the conditions for violent inner storms. Is it any wonder, then, that we're experts in our own internal weather?
I was conversing with a friend the other day about a fact that I regret, and that humiliates me: I’m self-absorbed.

On the rare occasions when I’m hypomanic, my ideas seem too brilliant and urgent for me to be bothered to wait for others to catch up. I’m so focused on the sparkling web of interconnected words and the supernovas of thought that I can’t pay attention to others’ feelings and needs.

Depression is the much more common state, and when depressed I suffer from an exquisitely painful focus on my own thoughts — thoughts of guilt over everyday slips and stutters, of terror that others will discover the bizarre nature of my thoughts, and ultimately, thoughts of death and deliquescence. The voices in my head offer furious criticism of my every word, move, and passing notion, assaulting me with cruel jibes and threats. When I’m in this frame of mind — often and often — I find it difficult to spare much time for the concerns of my friends, family, and coworkers. It feels like I’m living in the gray tunnel of a carnival ride where shrieking creatures fly at me with instructions to touch.

I’m most fascinated, though, by the self-absorption that lingers during my more normal periods (and I have been feigning normality with some success for three years now). When I’m well, I’m constantly and not totally consciously monitoring myself for signs that the illness is returning. If I laugh a little too heartily or take a corner in my car with tires chirping, I hope for a few days of mild mania; if I feel heaviness in my chest and find myself staring blankly at a to do list, I start scanning anxiously for more depression. No matter how clear the skies, I’m always scanning for storms.

In his book Living Well with Depression and Bipolar Disorder, John McManamy characterizes this state as follows:

Yet even with our brains firmly held in place by the best medical science has to offer, there is no peace of mind. At any minute, any second, at the slightest provocation, we are all too aware that the insides of our skulls can break loose from their pharmacological moorings and indiscriminately tear down what took us a lifetime to build.

Simply losing a night’s sleep may trigger a manic episode, not to mention the stress from work or a relationship breakup. And past trauma, bad lifestyle choices, and failure to manage stress conspire to set us up like sitting ducks.

Hence the need for vigilance. Many people with bipolar disorder are encouraged to keep mood journals, which they and their psychiatrists track like meteorologists keeping watch on hurricanes in the Caribbean.

Yes, exactly.

And yet bipolar and depressed people remain capable of unusual compassion and empathy, and generally delight in offering help and advice to friends trapped in grief or sadness.

My friend (remember the triggering conversation) told me that he had suffered from a near-fatal heart infection, and that for some time after, the slightest murmur or chest pain could send him into near-panic. He believes that for months or years he was self-absorbed in much the same way as I am. As time passed, so did his vigilance, and now he is able to interact with people more freely, without that constant inwardness.

I, on the other hand, am probably under a life sentence.

Those of you who are bipolar or depressed, do you find yourselves scanning anxiously? Do you find it difficult to pry your attention from your suffering and to focus on others? Please leave comments if you wish.

Love to all.

A Response to Kimbriel’s Recent Comment

Hi all,

I’ve been thinking a lot about Kimbriel’s comment on my post describing the research on bipolar disorder and cognitive problems, specifically loss of memory and executive function. I concluded that the outlook is bleak, considering that both seem to worsen with age. Kimbriel writes:

I don’t think any of these things have to worsen with age. Recovery is not only possible, it happens ALL the time… there are many things we can do to care for ourselves and promote our health.

I do try to stay positive on this blog, and to stress self-care. It’s named “Revolt and Resignation” for a reason, though. For me, some aspects of the disease do seem to be progressive, despite my near-absolute adherence to my medication. I do follow my own suggestions, though by no means perfectly. And yet …

While my moods are under decent control, some of the more subtle aspects of the disease are worsening. That’s scary and potentially depressing. I grieve those losses, especially the cognitive ones. Though I believe self-care can dramatically alter the course of bipolar disorder, I don’t believe there is a cure, or total recovery. This is a chronic disease whose nature is to worsen without aggressive treatment — and perhaps with it, too. That’s the resignation part.

I respect Kimbriel’s position and thank her for her comment — her attitude may well be more healthy in the long run than mine. But I have to disagree with her on the facts. Repeated research studies show that, for bipolar people, cognitive problems remain even during times of stability. The resignation part of my formula has to do with accepting the negative; the revolt part means battling it like hell nonetheless.

Love to all

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

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.

Article from The New York Times on Coping with Memory Loss

Hi all,

I just read this article in The New York Times that gives chemo patients advice on how to cope with “chemo brain,” a collection of cognitive problems that can make functioning difficult. Since many of the symptoms of chemo brain are similar to cognitive problems commonly suffered by bipolar people, you might want to take a look at this article’s advice on how to remember those pesky names and appointments.

Love to all.

How to Control (and Learn from) Compulsive Thoughts

I recently discovered — created, really — a technique for dealing with compulsive thoughts. In my experience most people with a mood disorder experience distressing, intrusive thoughts and images pretty regularly. An obvious example, and one that most people have experienced, is the impulse to jump when standing on a precipice. You don’t actually want to jump — you’re not suicidal or even depressed — but you can’t help but entertain this odd and self-destructive urge.

For bipolar or depressed people, the urges can be far stronger and more disturbing. You may have a persistent thought like, “I wish I were dead,” or, like the bipolar character in a story by Donald Antrim, you may be tormented by images of smashing your hands through a window, complete with crashing and tinkling, glass rammed into soft flesh, and blood streaming down your forearms.

Here’s the trick: any time you have one of your most persistent self-destructive thoughts, stop and ask yourself, “What am I feeling right now?” Pinpoint whether you feel anxious, humiliated, frightened, angry, or whatever. Once you’ve done this often enough, you’ll realize which emotions tend to trigger intrusive thoughts. Before I started this exercise, I believed that these thoughts reflected how I truly felt — that I really wanted to die or hurt myself. Naturally, that was upsetting. I often felt ashamed of my thoughts and afraid of them. Once I pinpointed the feelings behind each them, though, I realized that they are merely a reflex that follows from particular feelings.

It can also help to take the next step and ask yourself why you feel anxious, for example. You may have made an embarrassing error, or you may be interpreting something your partner said to mean that he doesn’t love you. Once you’ve isolated the cause, ask yourself if you can do anything concrete to take control of the situation. For instance, can you analyze why you made the mistake and come up with a plan to avoid it in the future? If you can take action, do.

If you can’t, take one final step. This one comes from David Burns’ classic of cognitive therapy, The Feeling Good Handbook. Ask yourself, How long do I intend to do penance for this event, to feel guilty or angry or frustrated? Five minutes? All day? A month? A year? If you can forgive yourself and move on tomorrow, why not just do it now? No matter how horrible the event, this can help you to realize that you needn’t suffer for it eternally.

I’ve been following this process for about a month now, and it’s really helped me to gain perspective on compulsive thoughts. In fact, it seems to be slowly rooting them out and replacing them with constructive action. I don’t do this exercise in writing, since I find that I often have bad thoughts when I’m nowhere near paper — in the bathroom, for example, or while I’m driving. It helps to write down the steps, though, and carry them with you in case you forget them in the distress of the moment.

If you try this technique, please leave a comment describing whether or not it worked. If you have your own successful system for dealing with compulsive thoughts, please share it.