Tags: bipolar disorder

beyond your front door

On Feeling Broken

My therapist (Melissa) has been on vacation for the past two weeks, and normally I would just take a brief break from therapy while she's gone, but things have been so unstable for me lately that I decided to take her up on her offer to arrange for a colleague to see me once a week while she's gone.

The colleague's name is Ilene, and I hadn't expected great things from two 1-hour appointments with a stranger, especially since I've been working with Melissa for something like 8 years and we've established a really effective, productive rapport. But something interesting came out of my two appointments with Ilene: I sort of had to tell her my story in a "big picture" kind of way that doesn't tend to happen with someone who already knows you ... and it led to me having some realizations.

I told her about how I was a massive overachiever for the first 30 years of my life. I was always the best student in the class, the most dedicated worker at my workplaces, the most involved friend, the most talented this-or-that at everything I committed to. And I committed to lots of things.

I got my first paid job when I was 15, and worked steadily almost constantly afterward (stopping working only while attending school in Scotland in 1991-1992 [because it wasn't legal for me to have a job there] and during the few months in 1998 when my tendinitis became so bad that I couldn't use a computer for a while). I worked the whole time I was in college (except, as I mentioned, in Scotland) and grad school. I generally did people-oriented volunteering in addition to my paid work, both during school and while just being a normal person working in the outside world. And during that year in Scotland when I wasn't permitted to have a job, I took a full load of classes and worked very hard during the week so that I could spend every weekend traveling to places I'd researched. I didn't have a "job," but I was still constantly achieving things, even if it was only visiting the places I "needed" to see. (My mom is very big on the obligation of traveling, the requirement that you see as much as possible. I'd totally bought into this without even noticing.)

For those first 30 years of my life, I was working extremely hard to be the person my mom had always required me to be. She'd never allowed me to be vulnerable, to fail, to need anything, to want anything, to feel anything. If I showed vulnerability, I was mocked. If I asked for help, I was criticized for causing problems. Pretty much from birth, I was expected to help her, support her, agree with her, and make her proud. When she told stories about our life, I was always heroic and superhuman (such as her take on our life with Ernie, in which this 7-foot-tall violent man was supposedly "scared of Kimmy because she was smarter than he was"). I was expected to do great things with my life, probably become a famous author (this was what she most often predicted for my future).

And so I spent those first 30 years of my life building and maintaining an unconscious persona, unknowingly putting on a performance for my mom even when she lived hundreds of miles away. I didn't know any other way to live a life, because this was all I'd ever known. Doing anything else—failing, being weak, letting people down—was terrifying to even contemplate, because it had always been punished. I wasn't aware of this, of course. Looking inward at all was something I'd always been pretty much forbidden to do, so I focused on performing for the audience that was the world and didn't even realize that I should be experiencing an internal life as well.

I thought of myself as extremely capable and accomplished. I thought of myself as a very happy, stable person. I was never depressed (except for a couple months after someone I dated broke my heart in a really harsh way, but that seemed pretty justified, and I got over it reasonably quickly and never allowed it to affect my work or anything). I worked hard; I volunteered in my free time; I nearly always had a boyfriend; I had a very active social life in which I was often the person who organized events and pulled groups of people together. I was energetic and upbeat and succeeding at life!

This all started to crumble a bit when the tendinitis in my arms got bad enough in 1998 that I wasn't able to work for a while. I'd always derived much of my sense of self-worth from my achievements at work and school, and suddenly I was unable to function as expected, and that rocked my world a bit. I felt down sometimes. Then a close friendship exploded in a rather dramatic/traumatic way, and the former friend said a lot of very mean things to and about me, and that left me pretty hurt and confused. (I'd been trying so hard! I'd been doing everything right! Why were things going wrong? Why would someone hate me? This was like my worst nightmare!) But I stayed pretty positive, given the circumstances, moved in with a more supportive friend, and eventually was able to get another job, where I was working when I started grad school and met Shannon.

Now, looking back, I can see that I entered a hypomanic episode somewhere around this time, when I started taking on more and more and more responsibilities. I decided to work in two different graduate degree programs simultaneously, working on an M.F.A. in Creative Writing and an M.A. in English Composition. I was something of a star in both programs, partially because I put in ridiculous amounts of time and effort. For a paper that might need 10 sources, I might consult 30 or 40 sources instead, putting in far more work than the teachers required or requested. I would just get started on research and be unable to stop myself.

While I was commuting to SFSU to attend grad school full-time, I was also taking in a lot of freelance proofreading work at home, amounting to around 40 hours/week. Then Shannon and I decided to get married, and instead of waiting a year or so as originally planned, "we" started planning the wedding right away (I put "we" in quotes, because I took on most of the planning myself). Then my in-laws offered to help us buy a house, and I took on pretty much all the house-searching, and then all the arranging of inspections and such when we did find a place to buy. I just kept taking on more and more and more. And then my English Comp program at school started pushing me to start my student teaching (which was a crucial part of the program) ... and things started to crumble in a more dramatic way. I found the idea of student teaching terrifying (What if I'm not good at it and I let the students down?), and anxiety started to escalate. I've always been an anxious person, but I'd never really actually *noticed* it until then, when it started to get really, paralyzingly out of control.

And then I started to get sick. Sick enough that I had to drop out of school and had to stop working. We had no idea what was wrong. I was having all kinds of wacky symptoms (severe dizziness being the worst) that seemed unrelated to each other, and doctors were stumped for months. Eventually, a smart neurologist figured out that I had a disorder called Chronic Hyperventilation Syndrome (which causes all kinds of seemingly unrelated symptoms because it drains your blood of oxygen, and oxygen-starved blood starves every system in your body), which is generally caused by anxiety and is usually treated with talk therapy and anti-anxiety drugs ... so they sent me to a therapist and a psychiatrist for the first time.

The year was 2000/2001. I was a grad school drop-out. I was no longer able to work. I'd been diagnosed with a mental illness (which was causing a physical illness). I WAS FAILING LIFE. My relationship with Shannon deteriorated as I became depressed and withdrawn but had no idea how to understand what I was feeling, let alone communicate it to anyone else. In therapy, I talked almost exclusively about my relationship with my mom (which I had never previously considered problematic in any way), and lots of stuff got stirred up, but it stayed pretty superficial for the first few years. Shannon and I worked things out with some couples therapy, but I still didn't really understand what was happening inside me or how to deal with it.

I went on disability in 2002 or 2003, because I hadn't been able to work for a couple years and figured maybe it would take me another year or two to get back to my old self.

And now here we are, more than a decade later, and I am still on disability, still not "back to my old self," and I've come to doubt that I will ever "get back to my old self," because I've realized that "my old self" was a persona, a performance, a facade I presented to the world because I didn't realize that people were supposed to be something more than that. Up until my crash-and-burn in grad school, I thought I was "doing it right," that I was "succeeding at life," that I was HAPPY. The periods where I thought I was most successful, I now realize, were probably times when I was hypomanic without knowing that's what it was. But I thought I was "winning." And now I look back and see how empty my life actually was. Don't get me wrong: I did a lot of fun stuff, and I made a lot of great friends, and I learned a lot of great things ... but inside myself I was hollow. I didn't know how to want or feel things in any *real* way ... I only wanted or felt things I thought I *should* want or feel. Things I was *allowed* to want or feel. I was performing for an audience, and didn't even realize that I was doing it, because I didn't know life could be any other way.

Now I know there's another way. I've learned to stop directing all my attention at the "audience" and have figured out how to direct some of that attention inward. I've looked inside myself, paid attention to the fact that sometimes I feel things or want things or need things, even when it's inconvenient for other people (or even inconvenient for *me*). It took me a long time to figure out how to do it with any degree of grace or skill, and I fumbled badly at it for years, but that journey started with my grad school crash-and-burn and a smart neurologist who told me what I really needed was a therapist. I'm very grateful to that neurologist, but she started me on a very painful journey.

I feel like an egg that's been cracked open, and there's no way to stick the slimy stuff back inside and seal up the shell to hold things in like it did before. I used to see myself as this extremely capable person, and now I just seem ... broken. When I try to work—whether it's freelance proofreading or clerical temp work or even just volunteering playing Scrabble with someone in a nursing home—my anxiety inevitably begins to mount, eventually becoming unmanageable, usually resulting in a major depressive episode. Once even resulting in psychiatric hospitalization because I became suicidal. Will I ever be able to be a "normal" working person again? Will I ever be able to be a contributing member of society? Or will I forever be this egg with the hideously cracked shell, with my slimy insides just leaking all over the place, unable to hold in what everyone else is able to contain in order to function in the wider world?

It's like, as long as I was "performing," and didn't *know* I was "performing," I was the perfect citizen. I was a great student, great employee, great friend, great whatever. I was *successful*. And now I feel like all I'm successful at is ... well ... being a good person? Honestly, I think I do a decent job at that. I'm pretty successful at listening to other people, being flexible in my world view, questioning my own assumptions, but then taking my own thoughts/feelings/needs/opinions/experiences into account when making decisions. I'm pretty successful at looking at myself (at my slimy, leaking, yolky emotional mess) and figuring out where it's coming from, seeing how it affects me and the other people in my life, and coming up with creative ways to deal with it. I think I've done a pretty darn good job at working with Shannon to create a strong, supportive, loving, intimate, truly *deep* friendship and marriage.

But you can't put "Being A Good Person" on a resume. You can't list "Marriage Development" as a job you've performed. You can't list "realizing that I have feelings" as an acquired career skill. You can't say, "Trauma therapy," when you meet a stranger and they ask what you do. I've spent the past decade+ working really hard at stuff that is more important than any paid job I've ever had, but it still leaves me feeling like I'm not a "whole" person. I'm that broken egg. I can't hold down a job, like any "normal" person can. Increasingly, I wonder if I'll ever be able to do that again, and that is absolutely terrifying to the part of me that still fears the judgment of the audience/mom. Shannon shrugs calmly and says, "If you aren't able to work again, we'll manage," like it's no big deal, and I know he's being honest about how he feels, but it's difficult for me to be so accepting of that possibility.

Some part of me still defines my worth by what I'm contributing to society, and I feel like mostly all I contribute these days is to myself, to my own health and well-being, and I don't have a lot of internal resources left over to contribute to the rest of the world. I feel like I don't even have enough left over to contribute as much as I should to *Shannon*, let alone the other people I care about, let alone society as a whole! I feel like in 1998 I started failing at life, and in 2000 or 2001 the failure became catastrophic, and I don't know if I'm ever going to bounce back. I think I probably need to change my definitions of "success" and "failure," but I don't know how to do that in the context of the society I live in and the past that forms my mental framework.

I guess that's my next "career challenge," if "Facing Mental Illness" is now my career.

I have bipolar disorder. I have generalized anxiety disorder. I have PTSD. These are challenges I have to face every day. For much of my life, I was able to hide these ugly truths inside that fragile egg shell where no one could see them, not even me, but now the shell is broken and those truths are out in the open, and I can't pretend they aren't there now that I know how to see them.

I have to figure out how to live a different kind of "successful" life, how to stop seeing myself as "broken." I'm not sure how to do that. But all I can do is try.
hide, headache

Depressed

Been depressed for about a week and a half. Still don't have a psychiatrist, despite the numerous phone calls I've made. Most are not taking new patients, some don't do medication management, and some simply don't call back at all. One guy said he was willing to squeeze me in if I couldn't find anyone else, so I went to see him after a couple weeks of fruitless phone calls seemed to be starting to trigger a spiral into depression. This was Monday last week. He was really aggressive and dogmatic, insisting on factually incorrect information about bipolar disorder ("mood changes cannot be triggered by external events such as lack of sleep") and harassing me about why I don't have a job. I left much more depressed than when I arrived, which seems like an indication that he is not the right psychiatrist for me. So I continued to make more fruitless phone calls. Finally, today, on my therapist's recommendation (she's been getting increasingly concerned about me), I called the actual insurance company, MHN, and they said that *they* will make the calls and find me the names of some appropriate psychiatrists who are accepting new patients. So at least I can stop going through these stupid lists and making phone calls every day, only to get turned away over and over again.

In discussion with Shannon, I decided to start taking Zoloft again, as of last Saturday morning, because it *did* help with my last depressive episode ... it just means I'm back to daily headaches, nausea, and sedation. It's just a short-term plan, until I can get a new psychiatrist who can prescribe me something that will hopefully not cause me so many side effects. I just didn't want to let the depression keep spiralling downward while I was endlessly searching for a Meds Doc.

Been very withdrawn, not wanting to interact with people at all, just wanting to be left alone.
sick

Mostly Coughing, but Also Mental Health

Coughing


I saw the pulmonologist today and was quite disappointed, as she didn't have a lot of useful stuff to offer. Her main advice was this: "Keep doing what you're doing, and eventually the coughing will stop, though it may take months." Yay? She also urged me to continue to minimize my physical activity, because anything that makes me breathe more deeply/heavily will certainly exacerbate the coughing (soon afterward if not immediately), which only continues the feedback loop of more coughing irritating my throat, thereby causing more coughing, which in turn irritates my throat further, thereby causing more coughing, etc., etc., etc. ad ininitem.

The pulmonologist also ordered some tests, just to make sure the cough isn't being caused/exacerbated by anything like a sinus infection. So when the authorizations come through from my insurance, I'll get to go have some CAT scans ... possibly one of the medical procedures I've never had. I've had MRIs, EEGs, EKGs, and who knows what else, but I don't remember any CAT scans.

After the pulmonologist appointment (and my discussion of it with Shannon), I took off my beloved new Fitbit, because it has been encouraging me to exercise too much. Normally, being encouraged to be more active would be a good thing, but right now I need to be less active, not more, especially given the fact that I've been hypomanic (more about this in a moment) and so don't have the best judgment about relaxing & have taken to pacing restlessly whenever I'm waiting for something because I know it will add more steps to my Fitbit tracking for the day. So I'm only going to use the Fitbit to track my sleep until the coughing stops. *pout* I hate setting aside my new toy. *pout*

Hypomania


So I've been hypomanic for a week or two, probably triggered by the constant sleep deprivation caused by coughing for the past 2 months:
  • I've been having racing thoughts.
  • I've spent a fair amount of money on stuff I don't really need.
  • I've been having trouble controlling my "pressured speech" (need to talk constantly, because I have infinite interesting things to say & can't hold back without great, constant effort).
  • I've been getting ideas for lots of art and craft projects.
  • I've been volunteering to organize/manage events like my friend Crystal's birthday party (and making an ambitious birthday present for her that is requiring hours—nay, days—nay, weeks of work).
  • I've been getting songs excessively stuck in my head, and frequently making up silly little spontaneous songs about things I'm doing at the moment.
  • I've been feeling compelled to clean obsessively and do housework that is probably too strenuous for my current physical state.
  • I've been pacing in doctors' waiting rooms (as mentioned above).
  • And I've just generally been showing most of my usual, classic symptoms of hypomania.


So I phoned the Meds Doc on June 5th & he gave me some recommendations, which I followed. Nearly a week later, the hypomania has not abated, so I phoned him again today & he gave me further recs. Note: By way of explanation, I'll point out that Zoloft is an anti-depressant, which can drive hypomania, and we therefore would want to reduce it; and Seroquel is a mood stabilizer, which can help control hypomania, and we therefore would want to add/increase it (Seroquel can also promote sleep, which is an added benefit for me right now, since the coughing wakes me up so often, causing the aforementioned sleep deprivation that can accompany/trigger/promote hypomania).

Here's the medication plan thus far & moving forward:
  1. I lowered my daily Zoloft dosage from my usual 37.5 mg to 25 mg (6/6/15-6/11/15)
  2. I added Seroquel 50 mg at night (6/5/15-6/10/15)
  3. I'm further lowering the Zoloft dosage to 12.5 mg (starting tomorrow morning, 6/12/15)
  4. I'm increasing Seroquel to 75 mg at night to help with sleep & mood stability (starting tonight, 6/11/15)
The increased Seroquel will most likely make me groggy all day, as I've already been seeing some of this effect at the 50 mg dosage, so I expect it will increase tomorrow. I hate feeling groggy when I have things to do, and feeling groggy while simultaneously feeling the pressured energy of hypomania feels just plain weird. But maybe the grogginess (is that a word?) will help me stay put & rest.

The Plan


So I'm going to TRY to REST and stop pacing around and finding reasons to walk up and down the stairs to increase my Fitbit count (and this effort will be assisted considerably by my not wearing the Fitbit).

Simultaneously, I'm going to prioritize getting to/from CWC and going to groups there as the place to expend most of my limited energy, because my therapist is on vacation for the next 3 weeks & hypomania is unhealthy for a variety of reasons, not the least of which is its tendency to segue suddenly into severe depression (of the possible hospitalization type). I figure if I have limited energy, therapy/support groups are the wisest way to use it. Fun stuff will come second. Actually, housework will come second, and fun stuff will come third. So I probably won't get too do too much fun stuff for a while. But fun stuff is necessary for mental health, too, so I'll have to make sure to get some of it.

Shotgun Players


In a totally unrelated sphere, Shannon and I saw a play last night at the Shotgun Players: Marisela Treviño Orta's Heart-Shaped Nebula, which I adored. It was a play basically written for me, combining death/loss/stars (my dad is the one who taught me to love the stars, and we even watched a lunar eclipse together once, sitting on a hay bale outside his barn one summer in Wyoming) with the use of art as a way of dealing with trauma. It made me cry and cry and cry, both during and afterward.

Shannon pointed out that some of the love story was heavy-handed, but the love story was sort of vague background for me: I was more focused on the stars, and living with trauma, and using art as a way of coping.

It won't speak to most people the way it spoke to me, but—for me—it was incredibly moving.