Is This What Recovery Looks Like?

I was diagnosed with bipolar disorder in November 1995, about a week before my 45th birthday. Since then I’ve been under the care of five or six different psychiatrists. I’ve had four stays in psychiatric units where I saw other psychiatrists. And I’ve had several counselors. They’ve all told me that I have bipolar disorder. Even the federal government agrees, giving me disability for it. So why am I feeling like I don’t really have bipolar anymore? It’s complicated.

I haven’t had a major episode in two or three years. But I have continued to cycle up-and-down from hypomanic moods to depressive moods. And it’s been mild compared to what it used to be like. I no longer believe that I have god like powers to affect reality, usually. And I don’t have those deathly suicidal depressions anymore either, at least not very often. Overall I would have to say that I’m doing pretty good. But I don’t know what to think about myself. If I’m not having severe mood episodes am I still really bipolar? I know it doesn’t make sense to question it, but I’m really struggling with this issue right now.

Okay, I know what you’re thinking. And you’re probably right. I take six or eight medications specifically designed to control my mood episodes. I am definitely medicated. It’s very common for people with bipolar disorder who are better because they’re medicated to the gills like I am to believe that they no longer have the disorder. Of course the reason we think that is because we are medicated to the gills, but we don’t see it that way. The usual next step is to believe we don’t need to take our medications anymore. That’s the trap we fall into. We get better and we think we’ve done it on our own and that we don’t need the help of the drugs anymore.

I have done a lot of work on my own it’s true. In fact I’ve worked like hell to try and get better, and I still do. So I will take credit for at least some of my success. But if I were not on this medication cocktail I’m on now I would not be writing these words to you. There is no doubt that these medications are powerful. They have definitely had the power to make me much worse than I would’ve been without them. I still suffer painful and debilitating side effects from them. But they have also had the ability to lessen my moods and my cycling. They’ve helped me to get better. So I’m not about to quit them.

Talk therapy has also been very helpful to keep me alive while I’ve had a tentative hold on consensual reality. A common understanding is that therapy doesn’t really work until you’re stable on your medications. I don’t think that’s totally true. I’ve had a lot of help to get to this place that I’m at now, from a lot of caring and compassionate people. And I’ve had it at times when the medications just hurt me. When they didn’t help me at all. In fact that’s pretty much been true until the last two or three years. So I’ll give talk therapy a lot of credit for where I’m at now.

It’s also true that the talk therapy has worked better in the last two or three years since I’ve been on this new medication regimen. It’s given me some breathing room to get a better handle on how to manage my moods on my own. I’ve learned a lot of tools and tricks over the years that I can use to help stave off impending episodes. I try to use these tools all the time. And I can use them more often and to better advantage now than I could before the medication took hold. But there are still times when I’ll take an extra Klonopin or some Abilify because I’m starting to ramp up too high. And the lamotrigine mood stabilizer I take helps to moderate my depression better than anything I’ve taken before. The medications are still very useful.

So I’ll ask the question again: Is this what recovery looks like? And if it is, how do I function in it? It’s been so many years since I was truly functional in society I don’t know how to do it anymore. And I am definitely not the same person I was 25 years ago. Of course none of us are, but that’s not what I mean. When I experienced the mixed state episode in ’95 that got me the diagnosis I changed. To me it felt as though I might’ve had a stroke. I didn’t, but that’s how dramatic it was. I can definitely break my life into two distinct pieces: Before and after that episode.

Before the episode I cycled a lot and I had some very serious depressions. But I spent a lot more time in a hypomanic reality. In between depressions I was normally hyper most of the time but then I would have times when I would have way more energy, creativity and confidence and would do great things. These were distinct episodes of hypomania, and they were generally followed by severe depressions. I also spent a lot of time in a mixed state where I had one foot in each reality. Looking back I can clearly see that I was living in a state of bipolar cycling. But mostly I was functional and I had a pretty good life. I got a lot done and I did some really good things for the world.

After the episode I was much worse. I spent more and and more time in depression and less time in hypomania. My outlook on life became very bleak. In truth I felt completely hopeless. I had no belief that I would ever get better or would ever have any other reality than what I had then. And what I had then really sucked. My various psychiatrists tried me on drug after drug after drug. I’ve probably taken at least a couple of dozen different psychiatric medications. Few of them worked. All they did was make me sick and make me feel more helpless. My life was totally out of my control.

I should mention that concurrent with my mental health issues I also had some very severe pain issues. Horrible migraines and a damaged back plagued me. I had never had any luck with doctors helping me with pain. They never believed me. Pain is subjective and if you don’t feel it yourself you may not believe other people do. At least that’s the attitude I ran into time and time again with the medical profession. But about 15 years ago I finally met a compassionate doctor who was willing to take me seriously and prescribed large doses of opioids to help my pain. I’m not a big fan of opioids, but for the first time in decades I was able to live a physically functional life without constant debilitating pain.

Pain and depression are known to be linked. When you’re depressed you feel pain more. When you’re in pain you get depressed. It’s pretty clear. So a big source of my depression was suddenly improved. It wasn’t gone by any means but I was much better. An easing of my pain then allowed the easing of my depression, at least to some extent. Talk therapy and counseling helped me a lot during this time. I was probably getting better even then, but it was so slow I couldn’t tell I was. The positive attitude of my therapist really helped pull me through those hard times.

Then a couple of years ago after I was put on a new mood stabilizer I went through a period of several months when I wasn’t hardly depressed at all. I remember telling my therapist I didn’t know how to act. My default had been depression for so many years I didn’t know how to not be depressed. It was very weird and I felt totally uncertain about how to behave. Of course the depressions came back again. And I got better again. I was still cycling, but it was different. At this point I see this dynamic of cycling as a spiral. Each time I spiral through the cycle it’s a little different and I’m a little better. And so I’m back to my original question again.

Is this what recovery looks like? Because I still don’t know how to handle it. My cycling may have calmed down but my anxiety has gone through the roof. I have PTSD so I know that’s part of it. And I know anxiety is just a part of being bipolar. I’ve also been looking into social anxiety disorder lately and it’s pretty clear to me that I have all the signs. Add these altogether and I’m paralyzed. I feel crippled by anxiety. I’m so terrified that I’m going to be humiliated that I won’t even lean into trying something. I stop myself before I even get started. This could be a whole other post so I won’t belabor the anxiety angle right now. I’ll just say that the anxiety doesn’t help me feel stable.

So I started another new drug to help with that. It’s been less than a month so I can’t tell how well it’s working, but I have some hope, despite the fact that it sort of wipes me out. I assume that in time I’ll acclimate to it and that it’ll help me be less fearful of social interactions. Maybe this will be my final hurdle. Until I can move beyond it I’ll continue to try to accept myself and my diagnoses and function in the world as best I can. Yes, I’m still bipolar and always will be, but maybe this is recovery and I just don’t recognize it. I think that as I get more used to it I’ll feel like I really am better. Like I really am in recovery. And that’s the goal isn’t it? Maybe I’m already there. I hope so.

Seeing some light at the end of the tunnel,

Steve

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Cycling While Stable

I wrote a blog post last November on my 67th birthday about how I thought I was doing much better since I’ve been on a mood stabilzer that actually works. It’s been about a year now that I’ve felt this relative stability, but lately I’ve been looking back at my behavior over the last few months and I realize that I’ve actually been cycling thru hypomania and depression quite a bit more than I realized at the time. Impulsivity is the biggest and most problematic issue for me. But obsessive thinking is a close second. The two go together for me too often and I make a fool of myself in situations where I should know better.

Over spending is another one that’s gotten me lately. Impulsive again, and obsessive. These are all symptoms of Bipolar illness and apparently I’ve been experiencing them frequently. I didn’t really see what I was doing at the time but at some point I realized it and I stopped it, or tried to. But I still act too impulsively and without proper forethought. It drives me crazy and embarrasses the hell out of me. I say things or write things in emails that are out of line with my sense of self, and I portray myself in ways I’d rather not. I can’t seem to stop blurting things out that make me look and feel stupid, both in print and in interactions in real life. I attribute this mostly to the hypomania but I see there’s a clear element of depression in there too.

I guess I’m in a mild mixed state, where I experience both the highs and the lows that are the hallmarks of manic depression. I go there when I see the effects of my hypomania and it upsets me, so I get depressed. Then I feel better and act out stupidly again. Then I get depressed. Then…. You get it… It’s a vicious cycle. I have a diagnosis of Dysthymia as well as Bipolar type 1 and PTSD. Dysthymia is a constant state of low grade depression, and I can see that it’s an appropriate diagnosis for me because I feel a bit “down” almost all of the time. I’m not really sick but I’m sad and feeling the loss of the vitality that the hypomania brings.

I’m a bit disconcerted by all this. It makes me realize once again that I’ll always cycle thru these emotions, maybe more easily at times than others, but they’ll always be there, up and down, again and again, even when I’m “stable”. It sometimes feels like a bleak future for me, but I refuse to accept that it’s going to define my life as I get older. At times it feels like I don’t have enough time left to get it right, but then I see that I really have all the time I need and I can do it if I just keep trying. I’m still pretty young after all, and people do amazing things in their 60’s and 70’s and well beyond that.

I have a lifetime of experience that tells me that, tho I’ll still cycle much of the time, I’ll also have relatively calm periods when I just feel OK. During these times I can assess my actions and behaviors and make decisions to act less impulsively and obsessively. I can learn to think things thru more thoroughly before I act or speak. Seeing these aspects of my personality lately has given me an impetus to renew my commitment to taking better care of myself, more consciously. I already think of myself as a conscious person, but obviously I don’t always live up to these expectations of myself.

I’m continually learning to cut myself some slack for my failures. It’s a big part of healing for me. I still hate myself for the slightest misstep, and beat myself up mercilessly. Suicidal ideation is not that far away at times, tho thankfully it’s not the problem it used to be. It’s a hard thing to experience as frequently as I have in the past. It’s too often been the default setting for my negative emotions when I screw up and it’s very hard to uproot it from my consciousness. Now I’ll still feel bad about myself, but usually not so much that I want to die.

In fact I want to live, and live well. So I’ll keep trying to moderate my moods and be more aware of them as they cycle back and forth thru my consciousness. It can be a blurry line between accepting responsibility for my actions and recognizing that the manic depression has “pushed’ me in certain directions that are not in my best interests. I think I’m getting better at seeing these differences all the time. After all I just caught myself for the ways I’ve been blowing it recently. This gives me hope that I can actually keep doing it. All I have to do is stay aware of my thinking, and treat myself with gentle loving care, the way I try to treat other people. It’ll be a big challenge, but I think I can do it.

Cycling consciously,

Steve