mental health

“Can I come into the Out Now?”

Initially, I felt as if there was nobody I could tell about my mental health. A deep feeling of isolation began to build higher around me. I felt locked in the freezer like the alien Bov, Ow, from the DreamWorks movie Home. I was imprisoned inside a glass cell where I could only be a spectator of life, but not a participator. The absurdity of Ow asking, “Can I come into the out now?” resonated with me. The stick locking him in the freezer was a representation of me holding my own tongue. The time to have a voice, and tell this part of my mental health story is now: it is time to come into the out now!

Wendy Williamson states, “Music was always giving me hope and making me feel. I connected with music because I wasn’t connecting with much else…” (p39).

“All day staring at the ceiling Making friends with shadows on my wall All night hearing voices telling me That I should get some sleep Because tomorrow might be good for something Hold on Feeling like I’m headed for a breakdown And I don’t know why I’m not crazy, I’m just a little unwell” – Matchbox Twenty

In December of 2015, I was diagnosed with a chronic mental illness. I have bipolar type 2. I have bipolar. I am not bipolar. There is a difference in those two statements, and it is a very important one. I have bipolar.

In any event, my isolation felt encompassing. Who could I talk to this about? As I thought about it I couldn’t help but remember some of the responses I received when I told people I was suffering from anxiety, for some it seemed akin to cancer or HIV.

That said, the stigma around mental illness is slowly changing in some circles, but it does still carries a mark of disgrace in other circles. For example, telling people I suffer from Post Trauma Stress Disorder (PTSD) seemed so much easier because the stigma here seems to be wearing away much quicker. However, I do worry that perhaps PTSD is just becoming more of an idea parallel to police officer, and other emergency rescue personnel. Regardless, bipolar, who could I tell about this?

The beginning, and the pivotal point, started with a question and a statement: “who are you?” and “stop defining yourself by what you are not!” My response is absolute; my heart is beating rapidly, I have cramps in my stomach, my brain is racing, it’s hard to breathe, my head hurts, my vision is spotty and jumpy, and my mouth is dry…

Anxiety

“I don’t know why I act the way I do Like I ain’t got a single thing to lose Sometimes I’m my own worst enemy I guess that’s just the cowboy in me I got a life that most would love to have But sometimes I still wake up fightin’ mad At where this road I’m heading down might lead I guess that’s just the cowboy in me The urge to run, the restlessness The heart of stone I sometimes get The things I’ve done for foolish pride The me that’s never satisfied The face that’s in the mirror when I don’t like what I see I guess that’s just the cowboy in me” – Tim McGraw, The Cowboy in Me

I knew instinctively that something was wrong, but it wasn’t something that I was eager to explore. It certainly wasn’t a thought that gave comfort, but no thoughts gave comfort at this point. My mind was dark and shadowed, and everything else seemed bound to follow that dark shadow. A heaviness set in. Isolation became a solid ice block that was surrounding me with a slow melt that was never enough for me to break out of. Sleep eluded me, it became something so distant that it wasn’t even a whisper anymore. On and on it went.

The only place that I felt mild relief was with my children, and even this was so subtle that I only noticed it when I was separated from them. A ball would form in my chest, my breathing would hitch and tighten, and my head would start to hurt. I would feel nauseous, my thoughts would race and create scenarios of disaster that ended with my failures. My vision would blur, my mouth would go dry, and sometimes I’d shake. So, with my children in mind, as well as my upcoming return to work I began to seek help. This process was a challenge unto itself. If it wasn’t for my stubborn persistence to fix this for my children’s sake I would have given up, and turned further inward until I imploded.

However, I found light at the end of the tunnel when in January of 2013, I began seeing a psychiatric nurse; a psychiatric nurse is a registered nurse who can perform therapy. It had been a long road just to get to this point, and I took myself into his office with a self-diagnosis of anxiety. For one and a half years it was never questioned. We promptly began Cognitive Behavioural Therapy, also known as CBT. Basically, this is a form of therapy that helps a person learn to recognize and change negative thought patterns, as well as learning to use logic to control anxiety. I saw this therapist weekly, and I began to learn and understand some amazing things about myself. I learned some scary things as well. I appreciated his blunt honesty with me, he called me out on things I had never actually realized about myself. In an infuriating manner he would look me right in the eye, sit back, and ask, “How’s that working out for ya?”

This became my weekly dumping ground, which worked like a pressure valve. I’d build and build, and then release it all in a verbal spewing. I also began learning techniques to manage my anxiety. However, as time moved forward I began to feel as if I had opened Pandora’s Box. In actuality Pandora’s Box had been opened for a while, but I had managed to pretend it wasn’t.

Acknowledging Pandora’s Box began with “who are you?” To my surprise, and horror I couldn’t answer. Try as I might to force an answer, I couldn’t. My confused and racing mind swirled around images of Alice and the caterpillar:

  • Caterpillar: Who… are… you?
  • Alice: I- I hardly know, sir. I’ve changed so many times since this morning, you see…
  • Caterpillar: No, I do not ‘C.’ Explain yourself.
  • Alice: I’m afraid I can’t explain myself sir, because I’m not myself, you know.
  • Caterpillar: I do not know.
  • Alice: Well, I can’t put it any more clearly, sir, for it isn’t clear to me.
  • Caterpillar: You? Who ARE you?

Another life altering moment came out of the words, “stop defining yourself by what you are not.” Lightbulbs flashed in the dark, flickering in and out. I had built my entire life, up until this moment, by defining myself by what I am not. I had no idea how to define myself by what I am! “Who are you?” Excellent question, who am I? “I- I hardly know, sir…” Anyway, for a little while this treatment was all I needed, but life was going on around me, and when I wasn’t missing it I was forced into it.

When we relocated I went through a nightmare trying to find a new therapist. I returned to work, against the advice of my old therapist, and my world continued to spin faster and faster. My anxiety was starting to cripple me. One of the scariest things I have ever been told occurred during this same time period. In a state of desperation I called my old therapist, he stated “if you continue down this path you will end up hospitalized, a full breakdown.” Medication was introduced, and stubbornly I insisted on returning work. I suffered a severe anxiety attack…

Post Traumatic Stress Disorder

“Trying to push this problem up the hill When it’s just too heavy to hold Think now’s the time to let it slide So come on, let it go Just let it be Why don’t you be you And I’ll be me? Everything that’s broke Leave it to the breeze Let the ashes fall Forget about me” – James Bay, Let it be

Forced into life can have dangerous effects, and I continued to spiral. As a result, there is a blurry period that I can pull bits and pieces from. One such piece is part of the conversation where medication was introduced, my psychiatric nurse stated, “You’re scaring me…” I missed the rest of what was said as I dipped deep into my own thoughts. You? I’m scaring you? Try being me, I am terrified! You? Who are you… I tuned back in to hear him say, “…I need to refer you to a psychologist…”

With my resolve down, and my desperation high I remember consenting to the medication. I stood at the pharmacy in a daze, everything in slow motion, trying to hide inside myself so nobody would see, or know, or ask questions. That nobody included myself. Blur, and blur, and blur. Now swallow.

The medication I was prescribed was Pristiq, it is an antidepressant that affects the serotonin and norepinephrine levels in the brain. Julie Fast states that, “Bipolar disorder medications are among some of the most difficult of all psychiatric medications to prescribe and manage” (p40). I would say in my case it was even harder given that I was taking medication without a full diagnosis, I had no idea at this point that I was deal with bipolar disorder. I have since learned that antidepressants can cause rapid cycling in people with bipolar disorder, and that was probably what I was experiencing since I never could catch my breath during this time period.

I woke the next morning and I felt like something was missing, some part of me just didn’t wake up from the night. I moved though the morning like a soul lost in the fog, but weightless and enjoying the floating. I remember to clearly sitting at the breakfast table with my family and being dimly aware that life was going on around me, but being so lost that I couldn’t break the empty stare at nothing. Then BANG. I stretched, and WOW it felt great! I looked at my husband, ignoring the complete look of shock on his face, and stated “I know what it is, I feel SOOOO relaxed. I feel almost intoxicated with it! And it is so quiet in here.” I tapped my head. “I feel like someone reached inside me and turned off all the noise!” This actually was another of those life altering moments. My mind was noisy constantly, like static on a television screen. I hadn’t noticed because it had been so long since it had been quiet. I felt happy, I felt ecstatic. Initially, I was unable to be angry; it was like any emotion I had hit a glass ceiling, and just rolled along it like a wave that slowly decreases and blends back into the body of water it rolled out of in the first place.

Meanwhile, I continued my battle to find a new therapist. At the height of my search I was actually told, “You don’t want to come to our clinic. You can, but it would be a conflict of interest for you.” Anger, frustration, sadness, isolation. Time after time I was run up against these bars to mental health assistance. I hit a number of hurtles. Thankfully, again my own stubborn persistence pushed me through. I finally found a local psychiatrist who gave me an official diagnosis of Generalized Anxiety Disorder which is basically chronic anxiety, and a misdiagnosed Panic Disorder. He decided that since I was tolerating the Pristiq we wouldn’t make any change. I also found a wonderful local psychologist who was able to continue my CBT with me, and we also started Eye Movement and Desensitization and Reprocessing (EMDR).

EMDR is a trauma therapy that involves remembering a past stressful event, and uses eye movement to reprogram the memory with a positive opinion. New beliefs replace the old. It includes elements of CTB with bilateral eye movement.

Given my recent anxiety attack at work, I did a guarded bit of talking about some of my work experiences and Post Traumatic Stress Disorder (PTSD) entered my diagnosis. PTSD involves disabling psychological symptoms that develop in the wake of trauma that is outside the normal range of human experience.

As I looked into what that meant I felt like I was a hallmark. Persistent symptoms of increased anxiety, difficulty falling asleep, difficulty staying asleep, concentration problems, irritable, anger outbursts, startling easily, loss of interest in activities that used to give pleasure, emotional numbness, detachment, estrangement, avoiding activities/situations associated with trauma, attempts to avoid certain thoughts/feelings, repetitive and distressing thoughts about particular events, and etcetera. I checked all the boxes. A statement that hit home for me from Williamson was, “I wasn’t suicidal, but I wanted it to all go away” (p105). I was so tired of struggling to just get through a day, an hour, a second.

Time continued to move forward. I was still suffering with anxiety. I had knowledge and awareness now, so sometimes I was able to control it to a degree or at the very least just know what was going on. The psychiatrist decided to increase my medication dosage, and for a short while I seemed to tolerate that as well. However, I started having flash rage. Completely uncontrollable flash anger, not physical, but nevertheless very scary. That was the last straw for me, and I started to wean myself off the Pristiq. Before I made the final leap off, the psychiatrist confirmed that I was making the right decision.

Unfortunately, Pristiq is one of the hardest medications to come off of because the lowest dosage is 50mg. Another unfortunate, is that because of how the pill is created it can’t be cut into halves; cutting the pill would allow the dosage to release too quickly into your system causing overdose. Taking a pill every other day is equivalent to playing ping-pong with your brain. Therefore, I had to come off cold turkey, or so the psychiatrist told me. Nausea is an understatement, and I suffered brain zaps. Basically, it felt like my brain was having a muscle spasm. It went on for weeks.

There were days when I laid down on the cool floor, clinging to it and hoping to stop the swaying motion and quiet the zapping. I would lay there and force my body against the floor in an effort to stop the motion and just pray for the end. Somewhere from the fog of my tortured mind a thought floated up, and I wondered is this what addicts suffer? I swore never again. No professional I came into contact with told me any of this information, and having never taking any medication before I had no idea what to ask.

To make matters worse I believe I came off the medication into a worse place then before I went on it. I felt like whatever barrier I had in place to help me cope before taking the medication was gone, and I was alone. As I got more and more distance from the medication I went to a real bad place. I knew I was there, but I was powerless to get out. Williamson’s description is a good fit for me when she states, “Everything had turned to anger inside me and now I was spewing it out like hot, molten lava erupting from a volcano…” It was during this time that I heard the second scariest thing in my life. My psychologist in a very deadpan manner stated, “If you get angry, you need to go to the hospital immediately.” It was my psychologist who stated that she felt we might be dealing with Bipolar Type II. I took this query to my psychiatrist.

That psychiatrist and I have never really seen eye to eye, so when I returned to his office asking for his help with this possible diagnoses he didn’t even want to consider it. He insisted that he felt I had Generalized Anxiety Disorder. After going back and forth for a while he finally gave me the screening test, and I had a positive screening for Bipolar Type II. He refuse to say definitely that I have it, only that it is a very high probability, and that I should not return to his office unless I wanted to take medication. I should mention here that every time I visited this psychiatrist he wanted to give me more and more mediation, I told my husband that if I accepted all the prescriptions from this psychiatrist I could open my own pharmacy. I never once felt as if he wanted to help me. I left his office that day with a list of possible medications to do my own research on, as well as websites to research bipolar symptoms. I never returned to his office.

The anxiety diagnosis had ticked some of the boxes, but I never felt like it was a complete fit. Make no mistake, I suffer from anxiety, but there were always other little things that the generalized anxiety disorder didn’t explain, and the PTSD didn’t either. I had brought the idea of Bipolar out very early in my treatment, but I couldn’t get anybody to listen. I now know that Bipolar Type II is one of the hardest to diagnose, and is commonly misdiagnosed as anxiety/panic disorders or depression. On average it takes 10 years to get a diagnoses of Bipolar Type II.

“Out of all the hours thinking Somehow I’ve lost my mind” – Matchbox Twenty

Bipolar Type II

“I used to recognize myself It’s funny how reflections change When we’re becoming something else I think it’s time to walk away So come on, let it go Just let it be Why don’t you be you And I’ll be me? Everything that’s broke Leave it to the breeze Why don’t you be you And I’ll be me? And I’ll be me” – James Bay, Let it be

So, what is Bipolar Type 2? BP II is a misunderstood, complex, and chronic form of bipolar disorder. BP II is characterized by periods of depression and hypomania, and it tends to be a disorder that co-exists with other disorders like anxiety disorders, and substance and alcohol abuse. It is a biological illness that is caused partly from problems with the brain’s neurotransmitters. Fast and Preston point out that, “This illness is predictable” (p19). They also state that, “…many people with bipolar disorder can achieve stability once they have a treatment plan that helps them prevent the symptoms that characterize the disorder” (p2).

The basic differences between bipolar I and bipolar II can be broken down into four points.

  1. Types of episodes: BP I involves mania, it may or may not involve depression. BP II involves hypomania and depression
  2. Elevated Mood Span: With BP I mania lasts at least 14 days, but with BP II hypomania lasts at least 4 days.
  3. Span of Depression: If there is depression with BP I it lasts at least 14 days, and with BP II depression span is 14 days.
  4. Impairs Functioning: With BP I there is an impairment to functioning, with BP II there is an impairment to functioning, but only during depression.

In terms of BP being a biological illness, the description that I found the easiest to understand explained it as follows: you can be born with the gene for bipolar disorder the same as you can be born with the gene for heart disease. The disease may never trigger. So, similar to heart disease if you make healthy life choices you may carry the gene, but you may never suffer from the disease; the same is true of bipolar disorder. Fast and Preston state, “…bipolar disorder is an illness triggered by stressful events” (p157).

Keys to maintaining bipolar episodes involve non-stressful environments, an environment that is structured, sleep, diet, exercise, therapy, medication, awareness, and a support network.

When I was trying to understand what Bipolar was, particularly BP II, Less Than Crazy: Living Fully with Bipolar II by Karla Dougherty was one of the first resources I read. I found myself in tears within the first few pages when she described me, and how I was feeling. Dougherty wrote, “There was always something nagging that stayed with me, this ‘extra’ persona that even my superego couldn’t control. I couldn’t have been truly happy, not really, because I was always afraid of reaching for something I desired… – I worried about all of it, incessantly…Anxiety was always there as my shadow companion…All my worries were equal. They multiplied and came together like one of those balls of rubber bands, growing bigger and bigger with each new fear. To say I was exhausted all the time is an understatement. I was overwhelmed by my mind, and my body couldn’t keep up” (p5-6). She goes on to describe hypervigilance and its crippling effects, another area that hit home for me.

The more I dug into what BP II is, the more I related to what was being described. I hadn’t been able to put into words some of the things that I was experiencing, and other things I was experiencing I thought everyone experienced. A clear picture was final forming.

Thankfully, there are a number of great resources out there, and I have included at the end a list of some of those I have used so far. Again, I would recommend Less Than Crazy: Living Fully with Bipolar II by Karla Dougherty simply because it hit home for me so many times. Kay Redfield Jamison is an amazing resource as well, and she is an American clinical psychologist. As well, the Bipolar II Disorder Workbook is another helpful tool, and one of the activities it asks its readers to complete a wellness plan. Part of my wellness plan involves this piece I am writing, it helps break my isolation, educate and fight stigma, and it helps me to build a support network with you my readers.

The rest of my wellness plan has grown to include regular cardio exercise, 5 to 6 times a week. I call these things my wellness plan, but it feels like so much more. My efforts to control my bipolar has lead me to find my own spirituality, to embrace meditation, to find my love for yoga, and to learn to be in the moment. I have dedicated time to writing as part of my treatment plan, although writing has been a part of my fabric for as long as I can remember, but I stopped making time for it. I have reconnected with the creative side of myself, and I wasn’t aware of how much I missed it. In so many ways bipolar has been a gift for me.

I remember the first time I heard bipolar referred to as a gift, I thought this lady must be high because there is no way what I am going through is a gift. However, as I educated myself more, find resources for support, and embraced tools for my own stability I am coming to see that it is a gift because it has returned to me so many things I had lost. The most important thing it has returned to me, has been learning how to be being in the moment, taking time to slow down and enjoy my own life, and be thankful for the people around me that I love. I am no longer struggling completely with the “Who… are… you?” I am slowly redefining and reconnected with who I am every day. I am learning to sit with the depression and anxiety, it is what it is. I am learning to embrace, and direct my energy in constructive ways. For me, just breathe!

 “We ride and never worry about the fall I guess that’s just the cowboy in us all” – Tim McGraw, The Cowboy in Me

By Shari Marshall

Resources

  1. Mind Over Mood by Dennis Greenberger, PhD
  2. The Anxiety & Phobia Workbook 5Th Ed by Edmund J. Bourne, PhD
  3. Loving Someone with Bipolar Disorder 2nd Ed by Julie A Fast & John D Preston, PhD
  4. Mindfulness for Bipolar Disorder by William R Marchand, MD
  5. I’m Not Crazy Just Bipolar: A Memoir by Wendy K Williamson
  6. Preventing Bipolar Relapse by Ruth C White PhD, MPH, WSW
  7. Less Than Crazy: Living Fully with Bipolar II by Karla Dougherty
  8. Med Free Bipolar by Aspen L Marrow
  9. An Unquiet Mind: A Memoir of Moods and Madness by Kay Redfield Jamison
  10. Bipolar Survival Guide For Bipolar Type II by Heather Rose
  11. When Anger Hurts: Quieting the Storm Within 2nd Ed by Matthew McKay, Peter D Rogers & Judith McKay
  12. Bipolar II Disorder Workbook by Stephanie McMurrich Roberts PhD, Louisa Grandin Sylvia PhD, & Noreen A Reilly-Harrington PhD
  13. Help! I’m Bipolar by Kristi Weldon
  14. The Right Bipolar Diet by Heather Rose
  15. Text4Mood by Alberta Health Services
  16. http://www.projectsemicolon.org/
  17. http://www.dbsalliance.org/

“If you want to conquer the anxiety of life, live in the moment, live in the breath.” ― Amit Ray, Om Chanting and Meditation

DSC_0589By Shari Marshall – 2016

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