Group Therapy

You may have figured out through reading this blog that I’m not a huge fan of the different types of therapy (eg. Cognitive Behavioural Therapy). I think most of the exercises they make you do are stupid and I don’t think they have ever actually helped me. Not that they actually are stupid. Apparently they help a lot of people and if you’re one of them then that’s great for you, but I definitely am not. I’ve had many arguments with my therapist about it because she insists that they help most people and doesn’t want to believe that I am one of the few who do not benefit from it. Eventually she stopped trying to make me do them and now we just talk, which helps me so much more. In my last post I mentioned how some of the things she has said to me completely changed my perspective and helped to improve my life, and this is completely true. I benefit from her talking to me about any issues I’m having and giving me examples of what I could do instead of, for instance, freaking out.

All that being said, she convinced me to join a CBT group that she was starting for adults with ADHD. We had our first session the other night and the first question she asked each of us was what we wanted to get out of this group therapy. My response, “I don’t know.” And luckily she let me leave it at that or we would’ve been there for a while because I honestly have no idea what I expect to get from this group. I don’t have the highest opinion of CBT but my previous experience (which included attending group therapy twice) was for the depression, not ADHD. I’m not expecting much but I figure I might as well try it, can’t hurt right? The “exercises” probably won’t help me much but maybe something someone says will. That’s how it works with my therapist. There is one major problem though, the sessions are two hours long. Try getting a bunch of people with ADHD to sit still and pay attention for two hours when their meds are starting to wear off. I give her credit though, she brought “toys” that we can play around with during the session to help keep us engaged, and she encouraged doodling, which is what I did for the entire session. It helps a bit, but being seated for that long is still pretty brutal. Oh well, I'm sure we'll get through it somehow.   

Back At It

It’s been a long time since I’ve written anything, it started off as “writer’s block” and then I just kind of forgot about it. I’d like to start writing again though, to share my more recent struggles with ADHD and Bipolar and maybe help someone along the way.

Earlier this year I had a lot of trouble with anxiety and periods of emotional distress (basically just out of proportion reactions that had me sending intense emails to my therapist when something happened that stressed me out and made me anxious) but with a few medication and lifestyle adjustments we have been able to dull these down quite a bit. For the anxiety, my psychiatrist increased the dose of one of my antidepressants and had me go off caffeine (luckily for me I don’t get caffeine withdrawal) and since then I have been doing very well. I also received some “words of wisdom” from my therapist. Every time I was anxious about something she would ask me what was the worst thing that could happen and then get me to give her possible solutions if that did happen. After doing this for a few months she made me realise that no matter what happens, it’s not the end of the world and I will find a way to figure it all out and that has calmed me down quite a bit. I’m fairly chill and at ease nowadays, which is a very weird feeling for me. Reducing my anxiety has also helped a lot with the emotional distress because I don’t freak out about things anymore, but my therapist helped me as well. Initially she just had me try to distract myself when I was upset so that I could get through those periods relatively unscathed but then one day when I went to see her, we talked about my most recent distress period and she said what if you just didn’t freak out? What if you accepted that you were anxious or upset about something and then just let it go, moved on? And somehow that worked. The next time I was getting panicky I just let it go and all was good. Strange that that’s all it took but hey I’m not complaining.

On another note, my presentation skills have definitely improved. I used to get really nervous and I would be shaking while I was giving my talk but that barely happens now. I recently gave a talk and didn’t shake at all! I don’t know if the reduction in my anxiety helped with that or if it’s just that the more you give talks the more comfortable you are but I feel like it was a combination of both.

So overall, I’m doing pretty well these days, at least on the bipolar side of things. I still struggle a lot with the ADHD symptoms. The main problems are that I have a lot of trouble getting motivated to do work and that my brain goes dead around 3 pm. Now, I do tend to go in to work earlier than most people but I still wish I could work longer without my energy being drained or my brain shutting off. I guess that that’s my next goal for therapy. And maybe I would benefit from some more medication adjustments. I guess we’ll see. I’ll let you know how it goes.  

Mindfulness

       Every therapist I’ve been to has tried to get me on board with mindfulness, which is basically a type of meditation, but I’ve always been very resistant to it because there is no way I am going to sit and meditate or listen to zen recordings, etc. The therapist I have now initially tried to get me on board by introducing me to Acceptance and Commitment Therapy but I only lasted a couple of chapters. It doesn’t matter how much it will help, I am never going to sit and think of meadows or chew my food a hundred times trying to identify each individual flavour. That’s just not happening. However, she recently started me on Dialectical Behavioural Therapy which takes a very different approach and so far seems actually doable. Now, I have been seeing my current therapist for about 18 months and she has been through almost every type of therapy out there with me, all of which have failed miserably. I give them a shot but usually end up thinking that the exercises are stupid and ineffective so she was relatively surprised when she managed to finally find something that I was on board with. 

       The main reason for starting me on this type of therapy was that I experience very extreme emotions and am incapable of calming myself down so I get desperate and turn to other people to talk me down. Unfortunately, most of them are just scared and overwhelmed by it (and probably not all that pleased either) so it ends up damaging the relationship. This type of therapy starts by teaching you distress tolerance, giving you ways to self-soothe when these emotions hit. In my opinion, this is way more effective than writing out your thoughts and trying to tell yourself they aren’t true. I haven’t experienced one of these episodes since I started this therapy so I don’t know how well it works for me but it just seems much more practical. It is also applicable to trying to fall asleep, something I often have trouble with, because falling asleep requires you to be able to self-soothe (apparently this is a skill I never learned). Anyway, I have now moved on to the next section of the workbook which is mindfulness and geesh why couldn’t all the other books be this straightforward?! Within the first two pages of the chapter I knew exactly what mindfulness entailed and how to practice it without meditating for an hour. Basically mindfulness is just being aware of the present moment, recognising when your attention wanders, and bringing your focus back to the current task. How difficult is that to explain? And you can practice it at any time: when you’re reading, watching TV, having a conversation, etc. As you continue to read they do give specific exercises you can do, some of which involve picturing meadows and clouds, but they are just options so if you aren’t into it you can just stick to the basics. Eventually all this practice is supposed to improve your concentration and reduce the time you spend worrying about future and past events, making you happier and less anxious, so we’ll see how that goes. For now I’m just glad that I don’t have to meditate every day.

Break Out 'The Routine'

       One of the things they are very adamant about when you have bipolar or ADHD is that you stick to a routine. You’re supposed to wake up at the same time, eat at the same time, take your meds at the same time, exercise at the same time, and go to sleep at the same time every single day. Unfortunately, I don’t do routine, and my work isn’t routine either and I’m assuming this adds to the sleep trouble I already experience and likely also affects my moods. The reason I’m bringing this up now is that I arrived at the field station a little over a week ago and had to deal with a 3 hour time change and a whole new, incredibly sporadic schedule. For the first week I was happy, energetic, and didn’t sleep very much (hypomania at its finest) which would have been great if I had had work to do but work-wise the first week was pretty slow. Unfortunately a few days ago I experienced the not-so-unfamiliar crash into depression (although somewhat milder than I used to experience). I’ve been oversleeping, I’m always tired, and I’m completely apathetic about everything, I just can’t get myself to care (which is not ideal when you only have a few weeks to get experiments done). On top of that, I feel like a failure because I can’t motivate myself and I’m worrying about what other people think when I stay in bed for 12 hours. 

       One of the worst things about it is that the depression phase always lasts so much longer than the hypomanic phase so my times of not being able to get motivated are not completely balanced out by my times of extreme productivity. One of the other worst things is that I have had zero success in finding a way to overcome my lack of motivation. I can’t seem to overcome the extreme desire to ignore the alarm and fall back asleep for another few hours, or to just lie on the couch and watch TV. This is also the one area where my therapist has been very little help. She refuses to suggest ways that I could get myself motivated, she just sits there and waits for me to come up with something on my own but I never can so we end up just sitting there in silence for a while. I get that your therapist wants to teach you to become self-sufficient when it comes to solving these sorts of problems but there has to be a point where they can give you a hand. I’ve been struggling with these periods of depression where I can’t get myself motivated for a long time and clearly the things I try aren’t working so I could really use some help. Anyway, getting back to the disruption of my not-so-routine routine, being at the field station has definitely affected my mood but this happens at home as well, probably because I’ve never fully followed a routine. I abhor the idea of a 9 to 5 workday and I enjoy being able to get work done on my own terms but I may have to give this whole routine thing a try when I get home. I just hope I can find the motivation to stick with it.

Zzzzzzzzzz...

Guess how many hours of sleep I got last night? 

Three.

I didn’t fall asleep until 4:30 am and then was wide awake by 7:30 am (luckily for me, a lack of sleep doesn’t turn me into a zombie anymore). If this was just a one-time thing, it wouldn’t be that big of a deal, but I have struggled with sleeping for as long as I can remember and do you know how annoying it is to lay awake for hours on end, desperately wanting to fall asleep? Even as a kid I would spend hours trying to fall asleep and then would wake up again in the middle of the night. The same happened all through high school (no wonder it was so hard to get me out of bed for school in the mornings) and through my undergrad. I have spent countless nights tossing and turning or pacing around my room because I just couldn’t shut my mind off long enough to fall asleep, either that or I wake up at 4 am raring to go. During my undergrad, when I was misdiagnosed with depression, my sleep troubles were attributed to that and I was put on sleeping pills because nothing else would work. Then when I received my bipolar diagnosis, I figured that that was causing my sleep problems because for a little while after starting the antipsychotics I found that I could fall asleep easier, my mind didn’t race as much. However, those effects wore off and so far no changes to my drug regimen have been able to permanently solve my sleeping problem and it was then that I determined that the ADHD was actually responsible. This is the only thing that really makes sense because the sleep troubles started before the bipolar kicked in during high school and when I looked into it some more, I found that many people with ADHD report having difficulty falling and staying asleep.

So what do you do about it? Unfortunately, sedatives are out of the question because they’re not meant for long-term use and melatonin tablets don’t seem to do it for me. Right now, my psychiatrist is altering the antipsychotics but I believe that that will only be a temporary solution to the problem as I seem to build up a tolerance to the sedative effects very quickly. However, there is something I came across recently that may have some merit and could be worth a shot in the future. When reading up on ADHD and sleep trouble I came across an article that suggested taking a second dose of your stimulant medication at bedtime. And why not? You use it during the day to calm your system and keep you on task so why wouldn’t it do the same at night, keeping you on the task of falling asleep? Now I’m sure a lot of you are skeptical of me calling falling asleep a task but when you spend countless nights wide awake in your bed because your mind won’t shut off, falling asleep really does become a chore. There’s a quote saying that falling asleep is the easiest thing to do, all you have to do is close your eyes and drift off, and I read somewhere else that it takes the average person 7 minutes to fall asleep…who are these people?!?! Sleeping is the hardest thing I’ve ever had to do, hopefully not for long though.

Self-Esteem

       I’ve always had trouble talking to people and since ADHD makes it harder to learn social skills, I figured that I just lacked them and so I was told about a book that outlines social rules, etc. Unfortunately the book was completely useless because I already knew most of the things they were telling me, this led my therapist to believe that I do have social skills I just don’t use them and she couldn’t figure out why. For the most part I agree, I think I do have the skills but my problem is that I feel like I have nothing to talk about, I have trouble coming up with things to say (plus my auditory processing disorder makes it difficult to grasp what everyone is saying in real time) and this basically comes down to a lack of self-esteem. I’ve always believed that everyone is more important than me and I couldn’t see why anyone would want to hear what I have to say or listen to my problems so I’ve always just stayed quiet. Apparently I don’t give myself much credit (or that’s what I’ve been told), and I do hold myself to very high standards, especially since I believe that I should be able to do things the same as everyone else regardless of my disabilities, but I think it will be a long time before I believe that anyone would want to listen to me when I’m upset or something.

       On the other hand, people generally don’t choose to talk to me that much, my therapist says that it’s either because they think I’m shy or they think that I don’t like them because I don’t talk to them but maybe I’m just not a very likeable or approachable person, who knows. I’m really not as shy as people think (at least not anymore) and my not talking to you simply means that I’m not a conversational wizard. I have come out of my shell quite a bit in the past year though. I’m starting to give myself some credit and now have a bit of confidence in myself. Plus, getting a diagnosis and being properly medicated massively boosts your self-esteem. You are no longer crazy or a horrible person, there are explanations for how you act and you can help control it with drugs and therapy which completely changes your perspective on things and gives you a reason to hold your head up high. I just spent a week talking to tons of people I didn’t know (or didn’t know well), something I never would have done a couple of years ago. Now, I’m not going to lie, alcohol does help but I no longer require it to have a real conversation with someone.       

One Year Anniversary

       It’s been about a year since I was diagnosed with and began treatment for bipolar disorder. It’s been a long, gruelling journey and I still have a long way to go, but I think I’m impressed with the progress I have made and I’m glad to be done with the process of medication adjustments. I still have my moments but for the most part I no longer spend days in bed because I’m too depressed to do anything, I don’t go into hypomanic episodes where I lose all impulse control and end up drinking excessively, the fits of rage and intense mood swings have disappeared, and I’m gaining more confidence because I now have some control over my life. Most of this is due to the cocktail of drugs I take every day but I also owe a lot to my therapist, she’s helped me take some of the blame off of myself and changed my way of thinking about things (at least to some extent). I hate that it took so long for them to figure out what was wrong with me because I spent years hurting people and making them think that I’m unstable and just not a very good person. I’ve definitely dug a pretty big hole for myself but hopefully I’m on my way to getting myself out of it.

       I’ve also learned a lot about my learning disabilities in the past year and this has helped to explain many of my perceived “inadequacies.” I now know that my difficulty with doing things the way others can is not my fault and has nothing to do with my intelligence or capabilities and I also know that ADHD is a lot more than just the inability to pay attention. Unfortunately, I’m still expected to fit into the little box of expectations which occasionally makes me appear incompetent. I can’t make everyone understand what exactly my disabilities entail and I’m always going to have to do things that don’t come as easy to me so I’ll have to work harder than most other people. I don’t mind the hard work but it would be nice to have things catered to my abilities on occasion. I have to give a talk next week which is a little scary because I know I have difficulty understanding what people are asking me sometimes, my working memory is less than ideal, and it can take a while for my brain to actually process the question (meaning that I’ll know the answer about 30 mins or so after the question has been asked). This can all lead to an incredibly embarrassing moment, hopefully I’ll get out of it with my dignity still intact. 

       What do I still have to overcome? I think the biggest things are the inability to get myself motivated and my inherent need to procrastinate. Motivation and procrastination are a big problem with ADDers and I am no exception. I often dub myself the world’s greatest procrastinator and I’m sure people who know me can vouch for that. In general, I work better under pressure so if there is no impending deadline it’s hard to get myself motivated to do something. One of the strategies is to set your own deadlines but I find it hard to stick to that if there’s no one else depending on me, so that’s something I still need to work on. In terms of just motivation, ADDers tend to get bored with things pretty quickly (hence our consistent lack of follow through) so I lose my motivation for working on a project a lot sooner than I would like. I’ve tried a couple of things to improve on these problems but again, I lack the follow through so about a week after implementing my new strategy I’m right back to where I started. At least I’m trying though and hopefully one of these days I’ll find a strategy that works.  

Side Effect or Symptom?

       One of the worst parts of starting treatment for any mental illness (including ADHD) is the myriad of side effects that accompany the beneficial effects of your medications, and the more medications you’re on, the worse it gets (I’m on five). Now, if you’re like me, you learn to just suck it up and ignore it, particularly when you are on a year long venture of medication adjustments. The problem with this is that your doctor can’t help you if they don’t know what side effects you’re experiencing and you may end up ignoring a real physical illness. 

       Last week I had the stomach flu, it started with a couple days of having no energy to do anything and then the next day progressed to nausea, lack of appetite, and [the opposite of vomiting], all of which can be attributed to my medications. However, that night I was very cold when I went to bed and had trouble falling asleep, when I finally did I woke up an hour later both boiling hot and freezing cold. Most people would have recognised this as a fever and chills, but I lack self-awareness (something that’s common with both ADHD and bipolar) and am so used to just ignoring every bad physical feeling I get that I didn’t realise I was sick. The following day was the same but that night I was kept awake by excruciating stomach pains and I finally realised that this wasn’t my meds, I had the stomach flu.  Unfortunately by this time I only had a day of discomfort left so the minimalist diet and excess of fluids hadn’t happened all week (probably why I was in so much pain) and I had probably infected a bunch of people, all because I thought my symptoms were side effects.

 

       Now, misdagnosing the stomach flu is not the end of the world (except that you become the “outbreak monkey”), but what if it was something more serious? It leaves me to wonder how many psych patients don’t receive prompt treatment for physical conditions because they wrote off their symtpoms as side effects. However, on the other hand, you risk becoming a hypochondriac, attributing even mild side effects to the plague (ok maybe not necessarily the plague but you get the point). So how do you find a balance between the two? How do you determine exactly what symptoms are real and what are side effects? Beats me. Hopefully this won’t be a problem for me anymore because I think we finally have my meds stabilised (which I’m very excited about, finally after a long year I can try and get back to my life!) and side effects should be minimal from here on out. For everyone else, I would probably consider informing your doctor of all your side effects, just to be safe, but try and refrain from storming into an ER claiming you have the plague!    

ADHD

So this isn't a real post but I thought I would give you guys an opportunity to understand some of the struggles ADHD can cause and it kind of goes along with what I was talking about in my last post.  These are postings from an ADHD blog that I came across and it probably explains things better than I ever could so have a read if you're interested.

ADHD and Grad School

http://neuropsychologyclinicadhdlab.blogspot.ca/2011/08/brilliant-minds-with-learning.html

http://www.psychologicalscience.org/index.php/publications/observer/2007/march-07/learning-disabilities-in-graduate-school-closeted-or-out-in-the-open.html

ADHD and Social Skills

http://neuropsychologyclinicadhdlab.blogspot.ca/2011/09/adhd-and-social-challenges-at-work.html

Cognitive Behavioural Therapy for ADHD

http://neuropsychologyclinicadhdlab.blogspot.ca/2011/12/cognitive-behavioral-therapy-invisible.html

Me? Immature?

       ADHD comes with a number of less than desirable qualities, most of which only really affect the person with the disorder. However, there are a few that make the general public not want to associate with us, for instance not understanding social rules. It has recently been brought to my attention that children with ADHD generally do not pick up on social niceties or appropriate and expected social behaviours and this leads to others seeing us as rude and immature. The social rules that most people just know are lost on us ADDers. How do they just know it? I have no idea, it’s not like they all took a course in social behaviour, but that’s exactly what a lot of people with ADHD need. This isn’t as much of a problem when you get diagnosed as a child because you are put in therapy or have special sessions in school where you are taught all the things that the rest of the world just picks up on. But when you’ve been diagnosed as an adult, who knows how different your life would have been had you known all these social rules.

       The reason I bring this up is because I recently had to contact someone to ask for a favour and I was told to make sure I asked nicely and included some chit-chat (I’m not sure whether I should read into the fact that I was expicitly told to include chit-chat regardless of whether or not it was required). My first thoughts were “What exactly is meant by chit-chat?” and then (once my therapist gave me some examples) “I have enough trouble coming up with things to say to people I know well, I have no idea what to say to someone I’ve only talked to a handful of times.” The ONLY thing that popped into my head was the weather, and that’s because I read on a website that is aimed at helping people with ADHD develop social skills that you should always be updated on the weather and the news so that you have something to fall back on during awkward silences (and yes I realise how pathetic it is that I have to go on websites to learn social rules but like I said, ADDers need a course on this). Now I never in a million years would have thought to add in some chit-chat at the beginning of my email, the way I see it is that if you don’t talk to the person regularly they’re going to know you want something so why not just come out and say it? Why do you have to dance around the subject first and waste everyone’s time? My therapist says that it’s just expected and that people like to be buttered up a bit before being asked for a favour (in order to entice me to partake in chit-chat, my therapist has equated it to foreplay, which I feel is way more important than chit-chat but anyway) which now has me concerned about how many times I may have come off as rude because I didn’t know to start off with some chit-chat, no examples come to mind but I’m sure it’s happened a number of times. Actually, one example does come to mind, when I email my therapist I always go straight into my problem, which is probably a little bit different than doing it with someone else but it’s probably still rude. I tried to ask her if it was rude but my emails to her aren’t being delivered at the moment so the answer is forthcoming…

       This whole discussion with my therapist about social behaviour and ADHD got me thinking about a number of other examples where I didn’t conform to social rules and probably came off as immature or inappropriate. Unfortunately, there is nothing I can do about it now, and I just have to hope that, like my bipolar behaviours, people will put it behind them and realise that I’m working on it. My therapist wants to start an ADHD group so that we can be socially awkward together (actually the point is for us to learn how to associate with the general public but that’s how I view it). I’m not big on group therapy but we’ll see, and then I always have my websites. You better watch out, before you know it I’ll be a pro chit-chatter and will be out-socialising all of you! Ok not really, but hopefully I’ll improve.          

Auditory Processing 101

       So it’s been a while since I’ve made a real post (my rant a couple weeks ago doesn’t count) because February was a busy month for me, I had two presentations and my qualifying exam, but now that is all over with so I can get back to updating you on my…journey, for lack of a better word. 

       I had a bit of a rough time early last week because my learning disabilities showed their ugly faces during my exam and it really frustrates me that I can’t show people how much I know and that I usually end up looking incompetent. My examiners recommended that I do a few presentations each semester so that I can work on my communication skills which I will gladly do, I mean getting some practice in that area can only help. However, I think that they expect miracles and when your brain isn’t wired properly, practice makes perfect really doesn’t apply. I can practice presenting day in and day out but that’s not going to help when my brain doesn’t process a question properly, I’m still going to end up looking incompetent. Now I realise that auditory processing disorders aren’t common learning disabilities that everyone has a bit of knowledge on so I’m going to quote a few things from the audiologist’s report just to give you an idea of what I’m dealing with:

-She may have difficulty absorbing even simple language information.

-When in a noisy location (cafeteria, pub, bar), [she] will have more difficulties making out what is being said than the average listener.

-When listening to someone who mumbles, speaks rapidly or has a heavy accent, [she] will be at a great disadvantage as compared to normal listening peers.

-Rapid speech poses a difficulty, as it is the language which is hard to interpret.

-[Her] results indicate a slight memory deficit, at least in the auditory realm, and a more significant deficit for working memory.

-Stress can worsen the ability to take in information.

Sounds like fun eh? Now if I had known all this during my undergrad, I would have actually been able to benefit from the accommodations available to me (ie. note takers so I don’t have to rely on my listening skills to get the information). Grad school however is a whole different story as everything is a lot more verbal: you have to give presentations and answer questions, any exams are done orally, and at the end of it all you have to do an oral defence. And unfortunately there aren’t many accommodations that can be put into place in these situations. There are resources available that can teach me how to cope with my disability but these cost money, something I don’t really have in excess. My therapist is having me go to the centre for student’s with disabilities though so maybe they’ll be able to help out.

Therapists

       Today my therapist had to cancel our appointment (and all her others) and I was slightly devastated, partially because I’ve been having a “I'm a worthless loser” week and partially because I actually kind of enjoy going to see her and I already think that I don’t get to see her enough. [The weirdest thing is that I had a dream last night that she cancelled my appointment, no lie. I should really try to hone in on that apparent psychic ability.] Now, I’m sure she had a very good reason for not going to work today but I still couldn’t help being a little angry because I needed her and she didn’t show up. It didn’t matter that she really has no responsibility to me whatsoever or that dealing with me is just what she gets paid to do, the emotional part of my brain didn’t want to hear it. This is where the relationship with your therapist gets a bit tricky. You want to like them and feel comfortable with them so that you'll talk to them and they can help you, but at the same time you have to realise that they’re not really your friend. Their job is not to be at your beck and call 24 hours a day. My therapist already goes beyond this for me so I have absolutely no right to be mad at her but sometimes it’s hard to get the rational part of your brain to communicate with the emotional part of your brain.

       It gets even harder when you start to think about the fact that it’s really a one-way relationship. You are completely dependent on them for your happiness and sanity but to them you’re just another patient. I’m not saying that they don’t care about their patients but you are still just a part of their job description, they see tons of people just like you every week. My therapist told me recently that I wasn’t a parasite, that by participating in our sessions I help her hone her counseling skills (as do her other patients), but in reality that’s just what we are. We go on and on about ourselves and our problems and we milk them for their skills and strategies without giving anything back. But I guess that provides the line between friend and therapist, although sometimes it can get a bit smudged. And plus, I’m sure seeing us finally happy at the end of it all is gratifying for them, this is what they chose to do for a living after all. So I guess I just need to work on getting myself to realise that it’s not personal, that this isn’t a friend who’s blowing you off, and hopefully I can hang in there until our next session.      

My Brain Needs Glasses

     Back when I first started seeing my new therapist, one of the main things she was trying to do was to get me to believe that it was okay to have bipolar and ADHD, that it didn’t mean I was defective. One of the things she said was that my brain just needed glasses (and then she told me about a book with that title which I haven’t read). She said that you wouldn’t call someone who needed glasses defective so I shouldn’t call myself defective. I never really got the relation though. Then the other day something struck me about how my brain worked not on the ADHD drugs, but on the bipolar drugs.

     I’ve been studying for my exam and I noticed that everything seemed so much simpler and made so much more sense now. These are things that I have learned numerous times before but had always just memorised the facts, I could never fully comprehend it. I realised that since I started the bipolar meds, everything seems to get through a lot easier. I’ve mentioned before that it’s like watching fifty different TV channels at once, now imagine trying to learn or comprehend something with that much going on, it’s next to impossible. This is where the whole my brain needs glasses thing comes in. For almost ten years now, my brain has been fuzzy, just like how the world is blurry when you need glasses.  But once I started the new meds, the “haze” disappeared and now I’m finally able to think clearly, my brain got glasses. Studying is so much easier than it was during my undergrad because there’s no longer anything clouding my ability to learn, I finally understand everything I’ve been taught in the past four years. Now I realise that me suddenly understanding everything could be because I’m older but for one thing, I doubt that my IQ has increased all that much in the past couple years and for another thing, it’s hard to believe that my mind clearing up after I started the bipolar meds is just a coincidence. 

     It’s unfortunate that it took so long for me to get some clarity; I kind of missed out on ten years of my life. Sometimes my therapist asks me about how I felt during high school or my undergrad and I can’t answer her. She says that she’s older than me and if she can remember high school then I definitely should be able to, but I can’t. The past ten years are just a hazy blur that I wasn’t really there for, not mentally at least, what’s it called? Non compos mentis? That terminology may be a little extreme but I think you get my point. All in all, I’m not defective (although I still think that my brain is at least defective), not because I have bipolar or ADHD and not because I wear glasses.              

Stress

     The other day I mentioned that I’ve been having a bit of a rough time lately, and I couldn’t really put my finger on why (except that we’re still working out my drug regimen). And then last night something happened that had me a little stressed out and panicked and I became hypomanic (which was followed by a short but intense bout of depression). Now, I normally lack any ounce of self-awareness. Doctors and therapists ask me questions about myself or about the effects of increasing the dose of one of my medications and I honestly have no idea what the answers are. I’m sure it’s very frustrating for them because it’s not like anybody else can answer those questions for me but most of the time, I know nothing about myself. So imagine my surprise when I was able to make the connection between me being under stress and the occurrence of hypomanic episodes. This makes perfect sense though, and if I was self-aware I would have realised this a long time ago, because stress is on the list of things to avoid if you have bipolar disorder. Unfortunately, I’m a grad student and stress is part of the job description. Not to mention I am currently studying for an exam that I really need to pass, so a little extra stress is inevitable. But how do you study when your mind is going at a million miles an hour and you couldn’t sit still to save your life? And then when the depression hits and you can barely get out of bed, how do you study then? What about on exam day, how do you get through it if the stress induces a hypomanic episode and you can’t get your thoughts straight? The answer: I have no idea.

     I’m sure there are a number of therapeutic techniques that allow you to cope with stress and prevent it from triggering a hypomanic episode, or to lessen the severity of an episode once it hits, but I haven’t been dealing with this disorder long enough to have mastered any of them. I’m still working on recognising when an episode is starting so that I can ignore my brain and keep myself from doing something stupid and irresponsible. And since there’s only a month until my exam, I don’t really have a surplus of time in which to work on any coping strategies. Hopefully my therapist will have a quick fix, or the new psychiatrist can adjust my meds to make me a bit more stable, otherwise I’m seriously out of luck. Then again, I was pretty much out of luck when I developed the disorder so this really isn’t anything new, just another wonderful hoop to jump through.        

The Ups and Downs of Bipolar

     So I’ve been having a pretty crappy bipolar week this week. It started last Friday, I felt really good about the fact that I was no longer hiding my disabilities and that people were interested in what I had to say and by that night it had escalated into the beginnings of a hypomanic episode. I guess I should explain what hypomania is; in short it's mania without the hallucinations and delusions (which is characteristic of Bipolar Type I, hypomania is characteristic of Type II). When you’re experiencing a hypomanic episode, you are excited and almost euphoric, you have intense amounts of energy, it’s “go go go” all the time and at superhuman speeds. You talk fast, you multitask like it’s nobody’s business, you sleep less, and sometimes you have an incredibly short fuse and will lash out at anyone around you without warning. Now, on one hand, you’re experiencing a true “high” and feel pretty awesome for most of the episode and you can be extremely productive (provided you can control the restlessness). On the other hand, you have no impulse control whatsoever and also, the higher you fly, the farther you fall. Once the hypomania ends, you are left exhausted and depressed. 

               

     When my episode started Friday night, I felt awesome! Actually, I felt awesome for the entire weekend and my mood kept improving every minute. By Monday night I was talking (to myself) at a hundred miles a minute, blasting music, pacing/dancing around my apartment, and just having the time of my life. And then all of a sudden I was calm. My euphoria had subsided and I was on my down. At first I just got super tired and ended up passing out a lot earlier than usual. Now, normally the depression sets in right away and when I woke up Tuesday morning I wasn’t expecting to be able to get out of bed but to my surprise I didn’t feel all that bad. I wasn’t happy but I wasn’t depressed either and judging by the degree of hypomania I had reached, the depression should have been pretty severe, but it didn’t come. I had a relatively normal day that day and yesterday started out pretty normal too, until I got home that night. Apparently the depressive episode had just decided to hold off for a bit, to make me feel secure and then when I least expected it rip the rug right out from under me. I had felt fine all day, we went out for a celebratory dinner and I was in a perfectly good mood when I got home. I got into bed and put on an episode of Bones and then it hit, the intense depression that allows follows a hypomanic episode. For no reason I was crying hysterically and I couldn’t stop. I was (silently) screaming because my mind was going at a million miles an hour and I had no control over the thoughts that were racing through. Good thoughts, bad thoughts, neutral thoughts, you name it. It was all rushing through my head at once, like trying to watch fifty different TV channels. I eventually ended up crying myself to sleep and then spent all morning in bed. I had to go to school for a bit this afternoon and I’m glad that I actually got myself up and left the house because it brought my mood way up. That’s not always the case though. A lot of times I can’t get out of bed for two or three days, and even if I do manage to get out of the house for a bit, I just end up going straight back to bed when I get home. Hopefully this is a sign that my condition is improving but I’m not holding my breath. There is nothing predictable about bipolar disorder, regardless of how well your treatment regimen is working and mine clearly isn’t figured out yet.

     I’m seeing a second psychiatrist in a couple of weeks, maybe she’ll be able to make some changes and get me back to my life.       

Stigma

     What’s the first thing that comes to mind when you hear the words “mentally ill”?  Most likely it’s people who wander the streets, clearly experiencing a break from reality, or who’s illness is so severe that they require institutionalisation, or even an incredibly dangerous criminal. The media has done a pretty good job of stereotyping psychiatric disorders. Let’s face it, the mentally ill people we see in movies go way beyond the average definition of crazy, every serial killer portrayed either has bipolar disorder or schizophrenia. And while in some cases these portrayals are accurate, there are many high-functioning mentally ill people out there, I myself am living proof (and my therapist assures me that I am not like the people wandering the streets). But even more importantly, the majority of these people don’t pose a danger to anyone (except maybe themselves). Lately mental health associations have been campaigning in an effort to make the public more aware of the realities of mental illness and to eliminate these stereotypes (something that is long overdue). Nonetheless, when I found out I had bipolar disorder I couldn’t help but worry about what people would think about me when they found out. Would they think I was crazy? Would they think that I wasn’t capable of the same things everyone else is? Would they think I should be locked up in a padded room? Ok, maybe this is a little extreme, but you get my point. Not everyone is going to think that there is nothing wrong with being mentally ill.

     Luckily for me, I’ve yet to encounter someone who has had an outwardly negative reaction to discovering that I have bipolar disorder, but I’m sure this won’t always be the case. Then again, everyone doesn’t need to know about it. Once my medications are stabilised and my condition is under control, there will be no need to tell anyone in order to explain my manic or depressive behaviours. The only problem is that recovery can take years. You get put on this drug and that, trying out higher and higher doses of each one, you have to deal with a myriad of side effects and spend countless hours in therapy. Unfortunately, I lack any ounce of patience. I like results. I like things to be done ASAP, not to be dragged on for months.  This poses a huge challenge for me in therapy because it doesn’t take days or weeks for this type of thing, it takes months or years and this frustrates me to no end. I like my therapist---okay I’m going to go off on a tangent here for a second:

It turns out that therapy doesn’t have to involve lying on a couch while someone writes down everything you say. I know eh? Who knew? Well ok, I was aware that most people don't have you lay down on a couch but until about eight months ago, therapy (and doctor visits) for me did involve someone writing down every word that came out of my mouth. Now I understand that taking notes is generally a good thing because it allows your therapist to remember what you talked about in your previous sessions but seriously, how is having someone write down your every word comforting? Your therapist’s office is supposed to be a safe place where you can talk openly but having someone transcribing my thoughts and feelings just makes me feel incredibly self-conscience and does not make me want to talk. Enter my new therapist. The first time I went to see her I was incredibly confused. She wasn’t holding a clipboard, she didn’t show any sign of wanting to write down what I said, she was just going to sit there and talk to me, have a (relatively) normal conversation with me and not make me feel like a mental case for having to go see her. Since then, she has become the only person in the mental health profession that I have ever trusted or been willing to talk to and a big part of it is that she doesn’t shove the different approaches down my throat like it’s a one-size-fits-all thing. If I think the exercises she gives me are stupid, I can tell her straight up and then we're done with it. Plus, like I said last time, she lets me email her between visits because it’s easier for me to talk to her that way. Anyway, she’s kind of awesome (hopefully she never reads this or I’ll never hear the end of it), and if you don’t like your therapist this much then get a new one, otherwise you’ll get nowhere, trust me. 

     Alright, where was I? Oh yeah, I like my therapist and I don’t mind going to see her, but it’s such a slow process. There’s nothing I can do about it though, I’m just going to have to deal. I have now completely segued and am not sure how to bring this back around to the point of this post but basically, the media makes life seriously difficult for people like me.  Hopefully this will change but in the meantime I’d like to get stabilised so that telling people is no longer a necessity.

Three posts in as many days, can you tell that I’m trying to avoid studying?

Social Skills of a 5 Year Old

     I’ve never been very good at the whole social thing. Everyone thinks I’m shy and quiet, and I admit that I am incredibly introverted, but I think most of it is that I just suck at connecting with people and coming up with things to say. I don’t enjoy being socially awkward and if I could participate in the conversation I would, but for some reason I just never developed these skills, hence the title of this post. Now part of it is because I have an auditory processing disorder and the name basically says it all, my brain doesn’t process auditory information as well as it’s supposed to. [Apparently I’ve had my brain scrambled a few too many times.] About 50% of the time I don’t fully understand what is being said to me, this leads to a lot of smiling and nodding. I will understand eventually but it may take me a while so if you have a question to ask me you may need to be prepared to come back later for an answer. Usually about 30 minutes after a conversation ends, I suddenly realise what the person was talking about and end up thinking “Damn, I could have said this and this.” And if there are more than a few people involved in the conversation, forget it. By the time I process what the first person has said, three other people have already responded and I have no idea what they said so I just sit there and try to not look too confused. This also happens in noisy environments (such as a pub) because my hearing is very sensitive and I’m also unable to discriminate between what the person is saying and the background noise. It causes some trouble in terms of articulating what I want to say as well. I always know what I mean but I can never seem to get the other person to understand, and then I get frustrated and give up, likely leaving the person I was talking to thinking that I’m a moron. Luckily I never had any desire to be a teacher.

     Although this disorder plays a big role in my social awkwardness, like I said, I’m pretty sure I just never developed the skills that allow you to make small talk and connect with people. [They've shown that a lack of social skills is often correlated with having a high IQ, so I’m just going to go with that.] My therapist was really happy when I told her that I started this blog because according to her I’ve found a way to use one of my “gifts” (writing) to connect with other people. For a while now she’s been having me email her in between our visits when I’m having a rough time or if there’s just something I need to talk about (because I think she figured out that I don’t really talk to anyone else) but this actually ended up becoming the best way for me to talk to her. I don’t get frustrated with not being able to explain what I mean and I can connect with her a lot more, so now when I go to my sessions she just pulls up my emails and we talk about what I’ve written. Unfortunately, being able to connect with people via my writing isn’t going to make my inevitable social encounters any easier. I’m sure there are a number of things I could do to help improve my social skills but I have a lot of other stuff on my plate right now so I don’t think I’m ready to make that commitment yet. Maybe one day, provided I get past my extraordinary ability to procrastinate.        

I'll Do It Tomorrow...

     I think that procrastination is one of the biggest challenges I face on a day-to-day basis, and it’s been this way for as long as I can remember. In high school, I don’t think I ever started an assignment or started studying for a test earlier than the night before. I could never get myself to sit still and focus long enough to be productive if there wasn’t the pressure of an impending deadline forcing me to do so. I now know that this is largely because of ADHD, but at the time it seemed like laziness or indifference. This also explains why I was able to focus for hours when I was pressured into completing an assignment---ADHD can cause periods of hyperfocus during which you can literally tune the entire world out and be concerned solely with the task at hand (imagine how productive we’d be if we could bring about this level of focus at will). Moving on to university, I still could not get myself to start an assignment if it wasn’t due the next day and trying to study for exams was a nightmare (I often wonder whether I would have done better in school had I been diagnosed earlier, not that I did badly per se). Unfortunately for me, this was compounded by my depressive episodes during which I was completely apathetic and struggled to get out of bed.  

     And now I’m in grad school where procrastination is not an option if you actually plan on completing your degree in a respectable amount of time. Every day I fight against my desire to put work off for “just another hour.” The only problem is that that extra hour becomes two, and then three, and then it becomes tomorrow, or maybe the day after that. Waiting until the last minute to complete an assignment or study for an exam is not the best strategy, but it is doable. Waiting until the last minute to complete all your experiments? No amount of hyperfocus is going to get you out of that grind. You may as well just drop out and save yourself the tuition, that is, if your advisor hasn’t sent you out on your ass already. Procrastination is just not an option at this point in my life and I’ve determined that I need to do something about it. Maybe I’ll look into that later today, no make it tomorrow, ok maybe next week.

     My therapist told me about this website, totallyadd.com, that’s all about living with adult ADHD and there is a three-part blog posting that talks about procrastination and how to start getting out of that habit. It talks about changing your mindset when it comes to work, chores, etc. so that you no longer see these everyday tasks as grueling, and also by thinking of what you get to do after (leisure activities) as your reward for completing the tasks. In theory, this is a great idea, but how many of us are actually capable of changing our own mindset without some sort of external praise, or maybe a drill sergeant screaming at us. Although these blog posts are always in my mind, I don’t seem to be able to actually do what they’re suggesting. Instead I came up with my own method: quitting cold turkey. I tried to become my own drill sergeant, telling myself to “DO IT NOW!” rather than sit and watch TV or waste hours surfing the net. Unfortunately, quitting cold turkey requires A LOT of willpower and my inevitable disaster of a method stopped working after about a week. There are a number of other strategies out there for people with ADHD such as making to-do lists, learning time management skills, etc. but I’m not at a point where I’m willing to put in the effort, partially because I can’t see myself ever overcoming my inherent tendency to procrastinate. Hopefully I get past this stage soon, otherwise I’m toast. 

A Day In The Life...

     The alarm goes off, provided you remembered to set it the night before. [I have become slightly OCD about setting early alarms and having numerous reminders on my phone because if I don’t, I forget or will be late. I’ll miss the ever-so-important appointment that I waited months to get, I’ll leave a friend or colleague hanging, or I’ll wake up three hours after I’m supposed to be at work. Doesn’t really leave you thinking that I’m a dependable person does it?] You eventually muster up the willpower to drag yourself out of bed and you start into your morning routine: breakfast, shower, get dressed, brush your teeth. But for a person with ADHD, this doesn’t always go as planned. You lay in bed too long, you put on music and dance around when you should be eating breakfast or getting dressed, anything and everything becomes a distraction that’s just begging you to procrastinate a bit, and before you know it, you’re running late.

     You get to school, hoping no one really notices what time you stroll in at (but they obviously do), sit at your desk and start up your computer. Email gets checked, Facebook gets checked, sometimes Twitter or online news articles, and then you start to piece together what you need/plan to do that day. Most people would then set to work, being more productive before noon than the student with ADHD will be all day. This is because you have an inherent lack of motivation and follow through, an unrivalled urge to procrastinate for “just a little longer.” Plus, you can’t get yourself organised enough to start working and you just can’t seem to sit still and focus on anything for longer than 30 seconds. Then guess what? It’s lunch time and you have done nothing productive all morning. That’s okay, you’ll stay later tonight and get everything done. You finish lunch and finally start to get your act together. You get a bit of work done and start to do some reading but you keep zoning out. You re-read a paragraph three times before you are actually aware of what you read, and by this time you’ve been sitting for way too long so it’s time for a walk or a coffee break. By the end of the day, you have completed a quarter of what you planned and that promise to stay later? Well, it no longer exists because you have exhausted your concentration capacity for the day, so you head home.

     You get home, go for a run or hit the gym, shower, make dinner, and then you have four hours to kill until it’s time to hit the sack. Since you didn’t get much done during the day, you decide to do your work now. You hunker down on the couch (it really should be at a desk, but I don’t do well at desks so it ends up being the couch) and start in on the copious number of journal articles you’ve been meaning to read (again, always meaning to do things) or crack open a textbook. Three paragraphs in and you find yourself looking around the room, daydreaming, worrying about something completely irrelevant, the list goes on and on. And before you know it, you need a snack or the laundry needs to be done or the floor needs to be vacuumed, anything that will tear you away from those readings and get you moving. Even watching your favourite TV show becomes a chore because you just can’t manage to sit still or focus long enough. Now you’re blasting your music and dancing around the apartment because you just need to be moving and when bed time rolls around you’ve once again accomplished nothing. However, this isn’t always the case. Sometimes when you’re really interested in something or you’ve procrastinated for as long as humanly possible, you end up with a crazy intense ability to zone out the world and focus solely on the task at hand. These moments are wonderful, but a lot rarer than the moments of sheer restlessness.  

     Anyway, you get into bed but you just can’t shut off your mind. Thoughts keep racing, you’re worrying about everything all at once, and you start to toss and turn as you attempt to get comfortable enough to fall asleep. Occassionally, you drift off after an hour or so. More often than not, you’re out of bed again, listening to music until three o’clock in the morning.  It is only then that you can finally fall asleep. Unfortunately, the alarm is set for 7:30 am, leaving only four and a half hours for you to get your beauty sleep.

     Medications help but there will always be that inherent lack of motivation and follow-through, especially when you combine the ADHD with the depressive phases of bipolar disorder. Hopefully one day my "mental health team" will be able to help get me to a state of being stable and productive.

The Ugly

     I can’t even begin to count the number of times I’ve managed to talk myself into a panic attack (thank you Lorazepam) because of worries stemming from my pre-diagnosis days or from recent episodes (medication can only do so much). Before I get into that though, this is probably a good time to describe myself before I was diagnosed and prescribed the proper medications. From what I hear, I was horrible to deal with and a force to be reckoned with. I mean, sometimes I had “normal” periods and wasn’t a burden to anyone but I think the manic and depressive episodes significantly outweighed these periods. I was never fully aware of what I was doing (and am still not) during the manic periods but I have a vague idea plus what I’ve been told from others that should allow me to piece together my psychotic era. I realise that generally you start with The Good, and then move onto The Bad, and finally The Ugly. However, in my case, the story is just ugly.  Since I’ve been diagnosed there has been some good and hopefully this will continue so I can write about it down the line but for now, it’s just ugly.

     First, there’s the inexplicable rage, irritabiliy and constant mood swings. I don’t even want to think about how many times I’ve gone off on someone I care about for no apparent reason. From what I remember, I wasn’t provoked, there was nothing that could justify the onset of that amount of anger in such a short period of time. And I’m not talking about getting mad and telling someone off. I’m talking about full on rage: screaming, yelling, punching inanimate objects, etc. I left the people I care about feeling utterly terrified of me, of what I might do (although I never physically hurt anyone besides myself). [If they ever read this, once again, I am tremendously sorry. I know an apology isn’t enough and may mean nothing to some of you, but I will probably spend the rest of my life fretting and feeling guilty about what you had to go through with me.] If anything good can be said for these fits of rage, it would be that they occurred sporadically (ie. I wasn’t turning into The Hulk on a daily or weekly basis). The irritability and mood swings, on the other hand, were anything but sporadic. I was snarky and got annoyed with everyone regularly and could go from happy to sad to angry in 1.2 seconds. I didn’t want to be around anyone and some people had learned to recognise these periods and avoided me at all costs. Clearly, I was a delight!  

     Next, we have the debilitating depression and sometimes aggressive depression (part of which is the fits of rage I just mentioned) making me even more delightful to be around. I had no energy, no motivation, and most days I could barely get myself out of bed. I didn’t want to spend time with anyone, I didn’t want to talk to anyone, I just wanted to lay in bed and be sad. I had lost all hope and nothing seemed to matter anymore: school didn’t matter, family didn’t matter, friends didn’t matter. I felt so alone, no one could understand what I was feeling, and so I started pushing everyone I cared about away. I had chronic insomnia and would spend all night crying until I, unfortunately, turned to cutting. My brain forgot everything and focused solely on the pain, allowing the mental anguish I had been experiencing to dissipate at least for a little while. I finally felt some relief but was using the worst method possible to get it. After about a year of this, the aggressive depression set in.  When I say aggressive depression, I’m referring to the mixed state in bipolar disorder where you are technically having a depressive episode but at the same time are experiencing certain symptoms of mania. During these periods, I would be depressed to the point that I couldn’t get out of bed and wanted to die because I felt worthless and insignificant. Then the manic symptoms would set in, relentlessly urging me to act on the negative thoughts. [It could also go the other way where the drunken mania would become accompanied by depressive thoughts]. I was losing control. My mind was constantly racing. I became beyond desperate. I was screaming for help from people who couldn’t help me and ruining my relationships with these people in the process (what ADHD and BPD do best).  

[This blog post by another person with BPD pretty much sums it up: http://natashatracy.com/bipolar-disorder/attempt-suicide-not-die/].

     This last bit brings me to the point of this post which is the reason I cause myself to have panic attacks. I am now relatively aware of what people probably think about me after witnessing any of these episodes and unfortunately I can never take it back. I have created a reputation of being psychotic and unstable and there may not be much I can do to change this, especially since these episodes will still happen from time to time regardless of how strictly I stick to my treatment regimen. I’ve taken to spending most of my time home alone so that when the episodes strike there is no one there to witness them, but occassionally a bit of bad luck brings them on in public. I constantly worry that my future isn’t looking to bright and that I’ll never be stable enough to get where I want to be. All of this causes me to panic on a regular basis. If only the onset of a new year actually did wipe the slate clean and eliminate your past. I’ll soon be seeing yet another psychiatrist but hopefully she can help to make my life a bit more stable. I guess only time will tell.