Me Again, with a Report on My Intensive Outpatient Program

April 3, 2010 at 3:05 am | Posted in Dealing with Mania, My Fascinating Mood, Rage, The Heath Care System | Leave a comment


Like me, this guy may be subject to irrational frenzies, but he's still furry and wistful.

As I’ve noted, I’m now involved in an intensive outpatient program at a nearby hospital. It’s a huge commitment — nine hours a week — and it’s necessarily eating into my blogging time. I’ve given myself permission to write a good deal less, partly because of the IOP, and partly because I hate the trappings of the 21st Century (as you know).

As I was buzzing around the house cleaning obsessively (a new hypomanic symptom for me — I’ve spent much of my adult life living in squalor), I figured out a couple of things concerning my loathing of the mental health system.

As I’ve mentioned, two-thirds of our therapy sessions in the IOP are run by a gentleman whom I will call A, who is the best therapist I’ve ever worked with. I mean, this guy beats the godlike Dr. B who treated me when I was in graduate school (though Dr. B was dashing and handsome, and the IOP therapist is not especially attractive). Oddly, the remaining third of the program is run by a woman, V, whom I would cheerfully strangle. She easily ranks among my worst therapists, and I’ve endured sessions with counselors who were so incompetent that they presented a public health menace. I spend much of her hour disassociating, which I haven’t done since the last time I was hospitalized.

Why does she rile me so? For that matter, why does my soon-to-be-former shrink drive me nuts? I often puzzle over this as I drive home from evening sessions. I figured part of it out two nights ago, and more while organizing my junk drawer this morning.

First, V is a crappy listener. She spends her sessions with us pronouncing all-too-familiar 12-step and therapeutic truisms. “Take it one day at a time” is undeniably excellent advice, but we need concrete coping strategies, not general rules. A, on the other hand, asks questions, expresses empathy, and helps us to explore how to cope with our lives and illnesses. The contrast is striking.

What’s more, whenever I do speak V flatly contradicts me, essentially saying that my experience is uniformly wrong or mistaken. This enrages me so much that I snap my mouth shut for fear of snarling ugly imprecations. For example, V thinks my shrink walks on water, and I’ve reached the conclusion that said shrink is a quack. It’s not surprising that V should favor this doctor — they both recite irritating cliches instead of engaging with patients. The real horror is this: the arguments between me and V reproduce the tiresome and seemingly inescapable dialog in my head. No wonder I’m angry precisely one third of the time at my IOP — it’s like seeing my most misery-inducing interior monologues come to life.

Of course, some of you are probably thinking that I should be more grateful for the help I’m getting. I’m sure this is true. It burns my ass, though, when people who are not in a position to know suggest that I’m too cynical and negative about the health care system. I hate being told that I should be grateful for crappy care. I approach each new drug, shrink, and therapist with buoyant hope, and my anger is largely a product of intense disappointment.

It’s interesting that A and V subscribe to the same theoretical model. Many clinical studies have reached the conclusion that the form of therapy matters less than patients’ perception that their therapist genuinely cares whether or not their quality of life improves. I may be wrong in feeling that V is uncaring, but the mere semblance of arrogant indifference is profoundly disillusioning.

Enough. I actually am grateful for A’s help, and the handouts and techniques have proven valuable, not just in the group, but in everyday settings.

Love to all. I will likely write more this weekend.


How Much Can I Control My Moods? In Which I Turn Back to God

February 19, 2010 at 5:18 am | Posted in Dealing with Depression, Dealing with Mania, My Fascinating Mood, Philosophical Problems, Wellness | Leave a comment

St. Augustine, Bishop of HippoFor me, the question above torments me at times; the answer seems to change from day to day, whiplashing me from guilt to hopelessness to a fragile hope.

When I did a swan-dive from mania to depression on Sunday, the speed and seeming inexorability of my descent awed me. When I’m depressed, I flog myself to stick to even the mildest wellness routines. When I ascend into mania, everything that I ought to do is effortless, a pleasure. I walk, socialize, and pray without thinking and with enjoyment. I see God working in my life. And just as I’m leading a more or less blameless life, the depression crashes back over me, and I’m like King Canute in the fable, commanding the waves to turn back. Canute wets his feet; I drown. God turns his face from me.

Yesterday, despite withering guilt, I left work sick. I’ve been missing too much work lately, but I felt that I couldn’t stay. To my intense humiliation, when I told my section head, I wept and shook so hard that she escorted my to the nurse’s office and refused to let me drive home until I’d spoken to him. Oh, God. My madness on display for the whole section to see.

As I set off on my commute — so much more pleasant now that I have my lovely and perfect Charger — I suddenly knew what was wrong. On Saturday, when I was still incandescent with mania, I’d had an encounter with a friend that shook my sense of myself. I used him, he used me back, and we both left feeling alarmed and frankly repelled. I didn’t feel precisely guilty, but I know that I had harmed him and the relationship, and that I would have to talk to him about it. This came to me with the force of a religious revelation; in fact, it was a religious revelation.

Typically I will suffer any indignity or commit any crime without apology if either will help me to avoid initiating a Relationship Talk. In connections of all sorts, more than anything I dread finding myself in the role of Demanding Woman. As a result, I am easily controlled. If anyone accuses me of “drama,” I fall right into line. My most recent boyfriend, God bless him, caught on to this quickly and used it remorselessly. At the very end, his sudden, bizarre descent into cruelty would have plunged any rational woman into hysterical rage; he branded my mild attempts at rational communication “drama,” and I cut him off entirely rather than play out the role of Dido.

Imagine my dread, then, when it came to me that in order to ease my depression I would have to call a meeting and express my needs clearly. Yikes.

The meeting itself proved instructive (he was free to stop by immediately, since like every last one of my friends, he’s been laid off). It’s strange — for all that I loathe them, I’m good at difficult conversations of all sorts. I cruise through critical evaluations at work, for example, watching myself respond without a trace of defensiveness and formulate a plan for improvement on the spot. I carry out these plans, too. Accordingly, my supervisors come away with a higher opinion of me, and I become a better employee. So I conducted myself well with my friend, and he responded with relief and similar candor.

As we spoke, I realized that he had been waiting for me to set the tone for further interactions. If I’d accused him of horrors, he would have accepted the charges; if I’d said that our bad behavior fulfilled me as a woman and begged him to treat me accordingly, he would have made every effort to do that, despite his instinctive revulsion. I approached the incident with calm curiosity, explored the issue with him, then set a new bottom line for our interactions. I expected him to reject my request out of hand, even to end the friendship. We’d discussed numerous times how we wanted to treat each other and be treated, but I’m not naive, and I know that people will often express a desire to change only to reject every opportunity to do so.

Imagine my pleasure, then, when he agreed to my suggestion with relief. I expected him to hate me for telling him what I wanted; I’d behaved as if wanting anything at all was a cruel imposition. He’d done the same, which led to a hilarious-from-the-outside waltz in which we tried to discern each other’s wishes, and to lead accordingly.

So my depression lifted markedly. Somehow knowing that I can control it humbled me as much as the feeling of total helplessness that I’d had earlier in the week. I responded with near-indignation, asking God (who had turned back when I approached him), Wait, does this mean I have to do the right thing, even when it’s hard? And that I don’t need a therapist to tell me what the right thing is? If my mood depends upon conducting myself well, it’s worse than I thought.

Since last week I’d suspected that the my campaign for perfection was trivial. Getting off the Internet and leaving my cell phone at home delighted me independent of mood; whether I dutifully walked, for example, depended entirely on my preexisting mood. The latter is trivial, the former profound.

Another humbling reflection: I know what I need to do to feel better. Typically it’s the very thing that I am sure will leave me a Bad Employee and an unloved outcast. I’ve adopted certain habits because I believe they stand between me and oblivion. As I discovered when I quit my antianxiolytic, the only way I can find relief is to let them go. Hm.

So, yeah, I need to re-read St. Augustine’s Confessions and reacquaint myself with that brilliant and very human saint. Perhaps, in a characteristic burst of irrelevancy, I’ll discuss them here.

Love to all.

One Simple Piece of Advice About Rage

January 23, 2010 at 6:28 am | Posted in Dealing with Mania, My Fascinating Mood | 1 Comment

Artemis the Huntress

Artemis, the Greek goddess of the hunt. When Acteon accidentally caught a glimpse of her in her bath, she turned him into a stag and his own dogs ripped him limb from limb. Lately, that's been me.

Lately I’ve been fuming pretty much nonstop, to the point where I resolved to write an entry on “How To Defuse Anger.” I felt like I needed to research it, though, because I have no idea how. You see, I haven’t been angry for years. When I quit my antianxiolytic, I found myself getting more and more irritable. Since I quit it entirely, I’ve been brooding nonstop about real and imagined indignities.

This unsettles me. I have been a peaceable, easygoing creature for years. When I think back, I realize that I’ve been calm and sweet … since I started an antianxiolytic. Before then, when my rage-bomb went off, it was thermonuclear. Now it looks like I may have been drugged into sweetness for all these years. Uh-oh.

I did have one piece of advice: Do whatever it takes to restrain yourself from throwing a carpet-chewing fit. If you do, people will lose respect for you and busy themselves trying to thwart you. As usual, though, I can’t follow my own advice. Allow me to give an example.

In order to get to the office at 6:30 a.m., I have to leave home more or less in the middle of the night. Two days ago, as I was pulling out of the parking lot outside my condo, I saw a guy in a hoodie standing on the corner. I don’t know about you, but when I see a guy standing around idle, I figure he’s up to no good.

As I rounded the corner, I saw that this dude had his dick out and was yanking on it while glaring at me intently. “Well, there goes the neighborhood,” I thought. And as I drove off, the new Dr. RandR began to spin up into a hissy fit. I wasn’t shocked — while it didn’t impress me, it hardly struck fear into my heart. Rather, I felt boiling impatience. Great, now I have to worry about this stupid dickweed jumping me. I couldn’t remember if flashers are suppose to be dangerous or not. Damn it, I thought, this is a matter of property value. A lot of single women live here, and we don’t need random guys hanging around jerking their willies. I decided to go back and give him what-for.

I felt no fear. I knew that confronting this guy wasn’t sensible, but I persuaded myself that it was The Right Thing To Do. I wasn’t planning to get out of the car, but I was ready to give him the rough side of my tongue. I have a gift for invective, and I can reduce a roomful of rowdy 18-year-old guys to shocked silence by reeling off slang terms for acts they’ve never even seen on the Internet. Heck, I’ve drawn a carving knife on a woman-beater. (“Are you going to stab me?” he jeered, puffing out his chest. “Yeah,” I said flatly. And he ran like the coward he was.) So I was ready to rout this guy like the Romans at Cannae.

Of course, he was gone when I got there. I drove around, but was left impotently grumbling, “If I ever see that [adjective describing an obscure and terrible act][insulting noun] again, he’s going to be sorry he was born.”

I knew this was stupid as I was doing it, but white-hot outrage made me reckless. As I took off again for work I thought, whoa, I am dangerously pissed. I’m going to have to learn some anger management techniques. And irritability can be a symptom of hypomania. So is reckless driving, another sport I’ve taken up recently. So, off to my shrink. I’ll let you know when I’ve figured out constructive ways to defuse anger. As always, feel free to suggest things in the comments.

Love to all.

Would I Return the Bipolar Gift: Part II

September 22, 2009 at 4:17 am | Posted in Dealing with Mania, My Fascinating Mood, Philosophical Problems | Leave a comment

If you could, would you click your heels and land back in Kansas?

If you could, would you click your heels and land back in Kansas?

Yesterday I raised the issue of whether I would snap my fingers if doing so would relieve me of manic depression. It turns out to be a two-part question: first, do I wish I’d been born normal? Yesterday I reached a tentative “no.” Interesting that this morning I almost feel willing to be another person to escape this curse. A person who could start a business and go briefly without life insurance. A person who hadn’t had an adult life that has been difficult at best.

I want to set aside that question, though, to consider one that is, on the surface, much more simple: if I could, would I choose to be cured from this day forward? I have always felt in my idle moments that I’d swarm all over that opportunity. First, let me name the negatives of being bipolar.

1. It involves tremendous suffering. Obvious, but worth mentioning.

2. It’s a tremendous hassle to keep all of my prescriptions filled, and if I let a single one lapse, not only do I promptly go crazy, but everyone around me gets pissed off that I could be so irresponsible.

3. I absolutely have to have health insurance through work or a spouse, because (again, obviously) I’m uninsurable on my own. I’ve always savored the irony here. In the United States, the people least likely to be able to hold a job and maintain a stable relationship have to have one or the other in order to survive. And don’t talk to me about the wonders of Medicaid. It’s hard to get, crappy when you have it, and all too easy to lose — all you have to do is get a job that pays $10 an hour or more.

4. Did I mention how hard it is to keep a relationship or a job? It tears my heart open to read comments on Icarus and other sites from bipolar people who don’t have either. Oh, and because of wild swings in energy levels (forget mood for the moment) it’s tough to keep up with friends, to participate consistently in church and community events, or even to volunteer for a political campaign. Again, I might as well be seeing something I wrote when I look at other folks’ bipolar blogs, and read posts in which they describe committing to numerous activities while manic or well, then dropping all of them and cloistering themselves when the inevitable depression strikes.

5. It’s tough to exercise. In fact, as much as I promote wellness activities on this site, I recognize that it often feels impossible to do the very activities that preserve mental and physical health.

Yeah. I’ll stop there. Trust me when I say that there are plenty of drawbacks to being bipolar.

And yet….

As I noted yesterday, if I weren’t bipolar, I wouldn’t be me. I suppose, then, that my willingness to be manic depressive waxes and wanes with my self-love and its complimentary self-hatred. This morning, as I write and drink my coffee, I wonder if I wouldn’t feel terribly diminished without the — what? — savage sparkle of the disease.

I’ve long thought that there are two types of bipolar people: those who want to be normal, and those who live for hypomania. The former group is probably more mature and well-adjusted, the latter more unstable and driven. As much as I’d like to say that I long for normalcy, I really do fall into the second group.

I leave you with quotes from two famous bipolar individuals, Vincent Van Gogh and Kay Redfield Jamison, the author of some of the most fantastic books on manic depression and suicide: An Unquiet Mind and Night Falls Fast, respectively. (I cannot recommend the second to anyone with the slightest depressive tendency — it will toss you into the throes of an episode. Read it only if you’re quite stable and want to understand a suicidal loved one.)

Darn it, I thought I had the Jamison quote right at the tips of my fingers, but now I can’t fish it up. I do remember the last line: “I am a hard act to follow.” That is to say, once you’ve felt the glories of hypomania — the fey, fast brilliance, the sense of finally being one’s true self — it’s very, very hard to settle into normality. Normality feels like stupidity when you can remember the fluid beauty of associations, the sheer ease of thought, that accompanies hypomania. For me, words take on a lovely glow — it’s as if language is a glittering web, and each word has become a node of light connected by a fragile web web to the entirety of language, from English to French and back by way of German, the language of philosophy. Jamison’s summary is quite the understatement, really.

Now, from Vincent:

At the height of artistic life there is, and remains, and returns time and again, a hankering after real life — ideal and unattainable.

I believe I’ve quoted this wistful statement before in this space, but, as an old boyfriend of mine used to say when repeating a corny joke for the thousandth time, it bears repeating. For me, Van Gogh’s statement sums up the hopeless longing that many manic depressives feel: a craving for simple stability, and for the job, mortgage, spouse, kids, friends, life that others seem to acquire with such ease, and to hold in a sort of contempt.

Yes, normalcy. I want it. I can’t have it. I try to value what I do have, and I often succeed. But I would love to click my bright red heels together and whirl my way back to a black-and-white Kansas of the soul. Yes. I would.

Love to all.

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

September 19, 2009 at 3:57 am | Posted in Cognitive Problems, Dealing with Depression, Dealing with Mania, Sociability | Leave a comment

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.

Immerse Yourself in Nature

September 2, 2009 at 4:25 am | Posted in Dealing with Depression, Dealing with Mania, stress | 3 Comments

Even stark beauty is beauty, and beauty can be found even near a missile range -- here, grasses photographed at White Sands, courtesy of

Even stark beauty is beauty, and beauty can be found even near a missile range -- here, grasses photographed at White Sands, courtesy of

I’ve been unable to find academic studies about the healing effects of nature on bipolar disorder. It figures; who stands to make money off of a good long hike? (Well, in my case, Smartwool, Patagonia and Mountain Hardware — but at least they’re environmentally friendly companies.) Even so, I believe that nature is deeply healing, and that a lot of my wellness over the last three years has to do with vigorous hiking and rock climbing. Below I’ve listed several reasons to get out into the wild, or to find the wild by the side of the road.

1. The most obvious benefit is exercise. From gardening to hiking to a gentle walk in the park, getting out into nature usually involves a certain amount of movement (though it doesn’t have to — see below). Exercise is the most reliable natural cure for depression, and can be as effective as medication in some cases.

2. It’s possible to leave your self behind, sometimes for extended periods of time. This probably sounds a little odd. After all, one of the most horrible things about depression is its persistence: it’s always there perched in the corner, if not careening around in your skull. However, if you find some aspect of nature that you like — say, a bug or a flower — and you really look at it, observing and enumerating the details, you can lose track of your misery for minutes at a time. It’s possible, with concentration, to project yourself into a bit of nature and feel yourself to be a grasshopper or spiderweb. This is incredibly refreshing and renewing if you’re tired of the sound of your own thoughts.

3. In nature, you can sit quietly and listen, and gradually you will hear the most amazing sounds. Just the varieties of bird and wind sounds can heal you.

4. If you can safely go alone, nature can provide comforting solitude when you might otherwise be lonely. With luck, you can go for hours without hearing another human voice. Sometimes this can be a tremendous relief. Remember, though, that hiking alone in remote areas can be dangerous, since snakebite and falls, for example, can be a real threat.

5. You can take a friend and have an in-depth conversation without the distractions of cell phones, internet, and other people. My cell phone does sometimes ring even when I think I’m well off the grid, but you can always turn off your ringer and really focus on present company. You can also point out lovely features to each other that you might miss on your own.

6. Nature is omnipresent. You can carefully observe a single tree, or even a bit of lawn, and spy miracles. People may think I’m crazy for studying an aphid, but so what? They’re right (though not for the reasons they might think).

A most attractive aphid.

A most attractive aphid.

7. A good, hard hike can sometimes calm hypomania, absorbing just enough of that electric energy to take you back down to safe heights. Also, when you’re hypomanic and colors shine brighter and words leap and flow, nature is more beautiful than ever.

8. You can buy a bird or bug book and look for common wildlife even in urban areas. Believe me, once you pay attention, there are plenty of creatures besides pigeons. In fact, when the pigeons take off in a flock, that’s your moment to search the sky for a hawk.

9. As Hopkins knew, the book of nature can reveal God’s grandeur.

10. If your doctor agrees that you are, to some degree, disabled, you can get free admission to national parks for life. Mental disabilities do count. I plan to hit up my shrink for a letter soon.

A female falcon in flight -- Hopkins' Windhover.

A female falcon in flight -- Hopkins' Windhover.

11. If nature itself isn’t readily available, you can read nature poets. Gerard Manley Hopkins is my favorite. Check out “Pied Beauty,” “The Windhover,” and “That Nature Is a Heraclitean Fire and of the Comfort of the Resurrection” and see if you’re not deeply puzzled, then gradually inspired. Read it aloud. It’s difficult stuff, and perhaps better grasped by the heart than the head, but in the end it rewards study. His poetry is also deeply religious in nature, and often deals with extreme emotional states. (He was certainly depressed, and perhaps bipolar.) If Hopkins isn’t your cup of tea, try Wordsworth’s “Tintern Abbey”, or Shelley’s “To a Skylark.” In truth, just about any Romantic poet will do. I’m stuck for contemporary poets; feel free to leave suggestions in the comments.

So get out there. I’m going to try to this weekend.

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