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.

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!    

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.              

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.