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.  

Bittersweet

     Attention-deficit disorder. Bipolar disorder. Auditory processing disorder. And no one figured out I had any of them until my early twenties. Years of doctors, therapists, wrong diagnoses and ineffective medications until I (and the people around me) had had enough and suggested that there was something else seriously wrong with me. Within days of starting the new medications, I was a new person. A one hundred percent turnaround. I was happier, more social, and (relatively) stable. No more psychotic, out-of-control episodes induced by my bipolar brain. No more depressive episodes so severe that I would spend days just trying to get myself out of bed. I mean, I still have to fight with both of these disorders on a daily basis. Medication isn’t the be-all and end-all (I still experience episodes of depression and drunken mania, albeit less frequently) but it has made a significant difference in my life. The rest will be subjected to years of psychotherapy. I guess it’s a good thing I like my new therapist, eh? Third times a charm.  

     Some people may think that finally getting a proper diagnosis and treatment plan would be incredibly enlightening and may even provide a great sense of relief, and in some ways (or for some people), that’s true. For me though, it’s extremely bittersweet. Yes, I now know I’m not crazy or just an outright horrible person. I know that there’s still hope for me and that I will no longer be unpredictable and harrowing to the people I care about. Unfortunately, I am also more aware of what these same people have had to deal with during my “episodes” for all these years. [I hope they know how sorry I am and how guilty I feel about the way I’ve treated them, regardless of whether I could control it.] In addition, I get to spend the rest of my life taking a cocktail of drugs and fighting off these exhausting conditions because, like I said, medication doesn’t fix everything. Every day I have to fight to get motivated and stop procrastinating, to fend off the mood swings and sudden, inexplicable rage, to overcome the cognitive impairments associated with my learning disability, the list goes on and on.  And more than anything, I have to fight to prove myself, to show that I can be dependable and that I can accomplish just as much as everyone else. This is especially true since there remains a lingering stigma associated with being mentally ill (and I proved myself to be very unstable prior to my bipolar diagnosis).

     Now, getting back to the point of this blurb, I had been diagnosed with ADHD a few years before the bipolar diagnosis came to light but no one had ever really explained to me what exactly ADHD was or all of the symptoms associated with it. Last week, however, I brought up a couple concerns about bipolar disorder to my psychiatrist and he told me that those particular symptoms were most likely due to the ADHD. He then recommended a book for me to read, “Driven to Distraction.”  Before I read this book, all I had ever known (or assumed) about ADHD was that it caused restlessness, an inability to concentrate or focus, and hyperactivity in some people. After reading this book, I had a list of twenty some-odd symptoms that could be explained by ADHD alone. It was like the authors had written the book about my life. It was a freakishly accurate description of me. I also found out that many of the symptoms that had led me to believe I had bipolar disorder could also be explained by ADHD, which is probably why these disorders are often comorbid. Unfortunately, as eye-opening and self-revealing as this book was for me, it also provided a detailed description of how I have treated the people I care about and how they must have been feeling all these years. And once again, I am left feeling horrible and guilt-ridden. 

So, like I said, this diagnosis, this whole process, is extremely bittersweet.