Tuesday, June 14, 2011

Chronic conditions

At five in the afternoon last Tuesday, I was walking to the bathroom and I paused and rubbed my eyes with the heels of my hands and I realized that the reason why I had had trouble getting work done was not because I was lazy or just generally distractible but because I have bipolar disorder and an anxiety disorder and so I have bad mood days sometimes.

A little later, I took a walk. I take a walk every day, going twice around the pond in front of the library. As I was walking I wanted to stop and lie down on the grass because I felt weak, like the weakness one feels when one has the flu. When I got back to the lab, I wanted to lie on the floor. A mood episode, to me, is not just between my ears, it is physical; it feels like pain throughout my body, it feels more like this than just having bad feelings like remorse or shame or deprivation.

I tried to figure out why I felt down. I couldn't think of any arguments or conflicts that I had had that were important. It was my first day back at work after Memorial Day weekend. Long weekends and vacations are disruptive to my routines and often set me up to have a bad mood. This is unusual, I suppose—people seem to enjoy having a long break from work. I could think of things that contributed to my bad mood, but I couldn't think of anything that could explain it entirely.

I thought that maybe I was dumb or lazy or weak-willed for having the bad mood day, as if it was my fault. I felt irate because I do a lot to manage my mood. I always take my medicine, I see a counselor, I have a healthy routine, I sleep well, I eat a lot of fruit, I go for walks, I meditate. I can do a lot of things to make my mood better most of the time, overall, but there's no way to keep myself from having bad mood episodes every so often. I used to be constantly distressed by my mood disorders; with treatment, I'm now happy most of the time. Psych problems are generally managed rather than cured. Psych treatment has made bad moods rarer, less intense, shorter, and they distort my understanding of myself less. When I have a bad mood day now, though, I am afraid that it's all over, that my mood will go back to the way it was.

If someone is hit with one arrow, it hurts; if someone is hit with a second arrow, it hurts more. The first arrow is pain, which is inevitable, and the second arrow is suffering, which, with practice, is optional. It’s common for people to be afraid of the dark. When they’re in the dark, some people are afraid of aliens. It’s natural to be afraid of the dark, but if, when you’re in the dark, you imagine being abducted by aliens, that narrative makes you more afraid and makes it harder for you to make good decisions to compensate for the fear of the dark.

Before I started getting treatment, mood episodes would cause me to ruminate on how much suffering there is in the world and how bad I am and how I can never do enough to become authentic, and all of that negative thinking worsened and prolonged my mood episodes. It was rare for me to just be depressed and feel sad, I would feel guilty. Rumination made me think that despair is normal and that it is normal for me to not like myself. I ruminate less when I have a bad mood episode. If I can find something about the circumstances around my mood that I can fix, I try to do that, but it’s more often the case that I need to quiet the part of me that is telling make-believe stories about what’s wrong. When I’m having a mood episode, worries will crawl up, but thinking about what to do about them at that time is often overwhelming, so I defer consideration of some worries by literally putting them on the calendar for a day or two ahead, when I’ll be feeling more competent to make good decisions. This works. I think that counseling and mindfulness practice have both contributed to this. I regard it as an accomplishment that when I have a bad mood day, I’m able to be merely sad, instead of feeling guilty or inadequate or ashamed. I don't brood anymore.

I normally have a few cups of coffee or tea each day. When I noticed my mood on Tuesday, I had iced rooibos tea, it's decaf. I sometimes use caffeine to get through a rough patch, but, last Tuesday, it was better to be tired and depressed than to be alert and depressed and maybe anxious, too.

Sometimes, working hard makes me feel better because it’s challenging and fulfilling, but, sometimes I need to rest, instead. Tuesday evening, I quit work early. I watched House while playing Hunters on my iPad. I felt bad, but I was distracted in a mindless way from my problems. I felt too weary to engage directly. I normally feel guilty when I spend my time idly, but I felt no guilt over this idleness, I felt accepting of my limitation. 
I take two kinds of medicine to manage my psych disorders. I take lamotrigine, an anti-convulsant mood stabilizer, it’s supposed to keep my mood from going too high or low. Lamotrigine has done a perfect job of preventing hypomanic episodes: I haven’t had one since I started taking it. Lamotrigine also has a mild sedative effect. I also take clonazepam for anxiety. It mellows me out, I feel calmer throughout the day. I take my pills about an hour before bed. At first, I just expected clonazepam to help me by making my temperament more serene, overall. I have found that it helps me in more nuanced ways. I can fall asleep precisely when I want to. I used to stay up until 4 AM, whether I wanted to or not; I could lie in bed for hours waiting to fall asleep. I don’t have to worry, anymore, about whether I’ll sleep soundly: I always do. The hour before I go to bed, as the clonazepam takes effect, I relax. I’ll read a book and eat some cheese and not worry about anything. This is when I feel the clonazepam most intensely, and this gives me a very calm window of time. As I’m getting ready for bed, I practice having mild thoughts, to have an easy bearing with myself.

Having a structured routine is helpful for me. It was difficult for me to have a regular schedule before I started taking medications, because my sleep schedule was so erratic. Now, I know that I can go to bed on time every night, wake up on time, feeling refreshed, and then have time for a relaxed morning routine before I start working; the momentum from this routine helps me start, even when I don’t feel like it.

It is rare that a bad mood descends or lifts in the middle of the day; it’s more normal for me to have a bad mood start or end after a night’s sleep. On bad mood days, I often go to bed with the attitude that, even if I have a bad mood today, it’s possible that I’ll feel better the next day; this doesn’t make the mood go away, but it’s a little bit of hope.

On Wednesday I was feeling poorly, too. I felt averse to spending time with other people. Depression is tricky because it makes me want to be alone, but spending time with people, especially laughing, is one of the best things I can do to improve my mood. I go to a Bible study group on Wednesday evenings, but I thought about not going; maybe I should just have some quiet time alone. I’m glad that I decided to go, anyway.

When I arrived, I offered the disclaimer, “I’m having a bad mood day, and so I might have trouble listening or paying attention.” My friends in my Bible study have the sort of understanding that before we talk about Bible things, we express what has us preoccupied. It sucks when you are standing in line at a convenience store and you make a joke to a stranger about the Go-Go Taquitos, and the joke doesn’t go over well, and you think it’s because he’s a well-dressed professional who is too fancy for jokes, and then you notice that a lot of people in the 7-Eleven are wearing suits and dresses and then you see, out the window, orange stickers on a lot of the windshields of the cars in the parking lot, and you realize that these people are in between burying someone and having Caesar salad and finger sandwiches and there is no way in which any joke about Taquitos could be funny to them. It was helpful for us to have a shared understanding of my state so that we could have sensible expectations about how I would react. This consideration is normal for us, whenever someone is having a difficult time, we try to listen to them and be accommodating.

It was helpful for me to join in an engrossing conversation about the Beatitudes; I was so focused I stopped thinking about how badly I felt. We were talking about the last Beatitude, the one about persecution. I don’t think that I’ve been persecuted; I’ve suffered and I’ve felt pain, but I haven’t been attacked very much for my beliefs and values. I was inspired hearing my friends talking about making good decisions when it was hard. Feeling proud of other people helps me be less concerned with myself.

We talked about people who seem to always be happy, and one friend said that these people are putting on a mask. I was confused, because I know people who I think are genuinely consistently happy. My friend clarified that it’s a good kind of mask. I think that what she meant was that the people who seem to always be happy, or at least hopeful, are so by way of choices that they make. Another friend talked about smiling; even if you’re having a bad mood, smiling can make you feel better. Self-expression doesn’t just need to be descriptive, it can honestly represent aspiration.

On Thursday, when I woke up, I felt better. Last year, I got the flu and felt nauseous for a few days and almost vomited. After the flu passed, I still didn’t feel like eating normal food. The last time that I had the flu, someone recommended that I try Gas-X; when one has an upset stomach and doesn’t eat as much as usual, gas can build up in the intestines and make eating again uncomfortable. I think the Gas-X was helpful. So, even though, on Thursday, I didn’t feel beset with depression, I tried to be careful with myself. I took breaks, I worked on easier, less-stressful projects. It felt good to be doing productive work and to be able to concentrate again. There was a power failure on campus that night. I had been hoping to work extra to compensate for the low productivity on Tuesday and Wednesday, but I think that the power failure was a happy accident for me. I ran some errands and then got home early and had time to relax.

I rely on my close friends and family to help me with my psych problems. I have some close friends that have bipolar disorder, depression, or anxiety, and their camaraderie is encouraging. However, confronting my psych problems is a solitary challenge because my mind is the only one in my head.

I could feel robbed by my psych problems, and try to figure out how much happiness they have cost me, how many hours I’ve wasted lying awake in bed or oversleeping in the morning, how much more research I would have gotten done or how many more books I would have read, but this line of thought has not been productive for me. Instead, I find that what I’ve done to treat and manage my psych problems is some of the work that I’m the most proud of. I am more acquainted with my mind than I would be if I didn’t have the disorders. My problems have forced me to learn that there is more to my mind than my thoughts. As much as I try to find positive things about this, I do feel like having these psych problems has been a loss, overall.

This is probably going to affect me for the rest of my life. I will always have bad mood days. Everyone has bad mood days, but I think that my bad mood days are worse than average, and that’s not fair. As I age, my condition will probably worsen; I will probably have more frequent and deeper depression. Electroshock therapy might help. Even though my psych problems will not disappear, and they may get worse, I do not need to be hindered by despair.


  1. I like the posts you write about your psych condition(s). They're honest (in a society where such talk is usually swept under the rug) but not self-indulgent. The only thing I would add is that Americans seem to think that happiness is the baseline human state, which I find to be a preposterous and harmful belief. If an individual is depressed, it causes them to contrast their gloominess/apathy/dread/what-have-you with an idealized state of happiness and contentment, which makes them feel even more depressed in many cases. I like Freud's take: "transforming [...] hysterical misery into common unhappiness."

  2. Thanks, Graham, especially for not finding this writing self-indulgent. I tried to make sure that this piece, in particular, didn't have a happy ending.

    I try to be happy. I'm mostly happy now, and, after years of untreated mental illness/existential dread, happiness is strange and difficult for me to get used to. I've been interested in seeing your recent series of links on happiness being overrated. I think that I've recently started to try being engaged or attentive, rather than happy: engagement is something I have more control over. It tends to cultivate happiness, or satisfaction, but it's easier for me to regard engagement as worthwhile on its own.

    I dig the Freud quote.

  3. Also, before I started treatment, before I considered it, I didn't think that it was possible for me to be happy. I actually think this is a combination of my psych problems and my roots in Reformed theology. When I came to think that happiness was possible for me, that was something that made me consider getting treatment. I see that obsession with happiness can be its own kind of despair, but, for me, the possibility of happiness made me open to consider making changes.

  4. I am also really encouraged by reading what you have to say about mental illness; if I ever had a patient or friend who was struggling with their diagnosis I would probably cut them out a few paragraphs from this. A lot of metal illness- depression, bipolar, schizophrenia, or addiction- often ends up being managed more like diabetes, with frequent self-awareness and appropriate little interventions, than like strep throat or ITP.

    I'm intrigued by this discussion of happiness because I had always thought happiness was a matter of happenstance- that is, your mood is always going to be affected by the slings and arrows of outrageous fortune. It takes a bedrock of something- positivity, faith, another person, whatever works for you- to ride those waves. I guess a lot of people misuse substances or relationships to get there. For me, it's God's love and faithfulness. What do you think that bedrock is for you, Alex?

  5. Matthew, thanks for the compliments.

    I like the film Amélie, in particular, the idea that people in the film find happiness or grief in huge things, like the traumatic death of a parent, in things that seem huge, like a soccer game on TV, or in very small things, popping bubble wrap, putting one's hand in a barrel of beans. So, for me, my perseverance comes from the values that I have, the ones that have been taught to me or that I have picked out and cultivated, it comes from the relationships I have with my friends and family, from the fulfillment I find in doing good work, even if that's difficult to feel on a bad day; my perseverance also is supported by enjoying good coffee or books or watching Regina play or the way I brush my teeth. There are ways to polish that perseverance: I find that writing, meditating, talking with people, help my perseverance emerge from my personality to my actions.

    Thanks for the thoughts!

  6. I enjoyed this. Your bad mood days seem to be different than mine.. mine tend to be more along the lines of bad mood weeks. I'm in one of the bad mood periods right now, unfortunately. Each day during that time is different from the one before, maybe one day being not so bad, the next being absolutely terrible. Then maybe going 2 or 3 days feeling alright, just knowing that the underlying problem is still there and will probably come back soon. Today, for instance, is a not so bad day, but I'm feeling physically drained and since I'm off of work, I'm taking the opportunity to relax and be unproductive. I spent time in the chapel earlier today meditating, just hoping for some calm.
    Matthew, in the past, I did misuse substances to find a measure of happiness. And at some point, I felt like I had to have everything to be happy. Not just material things, but I felt like I needed to have close friends, a steady paycheck, a strong relationship with God, and just an overall good "life situation" to be happy. And when things were bad, and I lost all of that, I crashed, hard.
    First of all, I obsess about being happy a lot. So that drags me down a lot. Now that I realize that, I focus more on just getting through my days, not chasing happiness. Happiness is not a concrete goal to reach. It's found in different ways by different people. Secondly, I've honestly just realized that I'm content with just waking up each morning and continuing to pursue the goals that I've set for myself thus far. Not life long goals, just, you know.. finish school. Find an outlet for my music. Keep on eating healthy and being active. Things like that. When I lack the close personal relationships that I always used to have, or I struggle with romantic relationships, or I question things with God, or I'm flat broke, I just keep moving forward with those goals and tell myself that if I do that, then I control my happiness. I was always so obsessed with being stable and sane and I never thought I'd find that, but now that I've accepted that I won't because of my disorder (at least not how I imagined it), I just balance it out and work myself out of my bad moods when I find myself sinking too deep into them.

  7. Lauren, I like how you describe finding contentment in small, attainable, meaningful goals.