Today is a day to talk about something people don’t talk about often enough.

When I attempted suicide I was staying in my mom’s basement, temporarily, and I decided it was the final move. I was very depressed, and I didn’t talk about it at all (except to thousands of anonymous faces on the Internet). She didn’t want to read about my disorder, and neither did my stepfather. There was a language barrier. And a willingness – they had their own idea of what bipolar was and didn’t want that challenged.

I had been depressed a long time and part of it was chronic, intrusive ruminating about suicide. Aching to do it, and having to talk myself down. It was a constant struggle in a bleak existence and it seemed a bottle of pills could get me out.

But with suicide, you’re not ending your pain, you’re giving it to someone else.

My mom and I had had problems and all, but I didn’t want that to make her feel guilty. It was not her fault. It’s nobody’s fault, just my own decision, in the end. Ten minutes after taking the pills I changed my mind and called 911. When the ambulance arrived I was losing consciousness, and I woke up three days later in the intensive care unit. Then another ward. Waking again, mom at my side holding my arm, not looking me in the eye. She tells me that they’ve decided (she means he has) to boot me out of the house. She tells me lies for reasons.

I stayed in the locked ward for five days, three of those in a suicide room. A padded room with no fixtures, no furniture, just a mattress and an unrippable blanket I shivered under despite its thickness. There was a video camera in the top corner of the ceiling aimed down to take in the whole room, barely bigger than the mattress. I wondered who was watching. Just nurses?

Then I was gone, transferred to the unlocked ward and free to roam the halls as I arranged new living arrangements on the outside. It took longer to recover from the depressive episode but I no longer felt the acute urge to die. I was glad to be alive as things changed.

The betrayal I felt post-suicide attempt, facing a lack of education by my family, could have been prevented. We could have made contracts, shared information, and worked together. Sought help and psychoeducation. Instead they covered their ears and I didn’t speak, until it became a trauma for all of us.

That’s why on World Suicide Prevention Day we have to speak up, to tell our stories and reach out to those who are isolated. If you’ve been sort of thinking about it, read this first. If you feel an imminent urge to kill yourself, call 911 and go to an emergency room. I found that suicide is an impulsive thing, and you can endure by dealing with those impulses until things change. It always changes. Want help? Call 1-800-SUICIDE or another of many resources. There is help and hope.

The “A Day in the Life…” essay contest is sponsored by Astra Zeneca. They’re asking for essays, videos, art, or songs and offering a $1000 prize. I share Philip Dawdy’s scepticism; he says it looks like “soft advertising.”

The Bipolar Testimony Project by Equilibrium is doing a survey on bipolar, and asking for personal testimonies (no payment or contest). They aim to get a snapshot of life with bipolar across the globe. The stories I’ve read so far are not happy ones. I’m not sure what this project may lead to, but what it could be great for is shrinking the mental health monkeysphere.

The Facing Us contest seeks cute YouTube-style videos, film student PSAs, and amateur art. The videos are to raise awareness and the graphics to raise money by selling greeting cards. What does it raise for me, you, all of us? Number one, it raises memories that may help clarify life now.

My story; my story is one of neglect, years of misdiagnosis, severe side effects, family abandonment, financial ruin, discrimination, a suicide attempt, self-medicating due to lack of real treatment, lost relationships, disability, and a pile of dumb things I shouldn’t have bought while manic. Homelessness and hospital wards, struggling to survive.

Then there’s beating addictions (I don’t even smoke ciggies now, yay), finally finding a great pdoc, meds that do help, a housing subsidy for a decent apartment, fun and rewarding volunteer work, more time for writing, and finding someone to love who didn’t run away at the mention of bipolar. I don’t cultivate self-pity and don’t seek it from others; bipolar just is what it is and I accept that now. I’ve learned a lot and value the perspective. This is all good, yes?

Yes and no. Ultimately, my story is one of a malfunctioning brain that reacts to seasonal light, sleep problems, severe stress and sometimes nothing I can identify. I’ve been stable one day with life under control then woke up the next morning suicidal; same with hypomania and mania. Everything I do to manage bipolar only makes the episodes less severe. They still happen; have since I was a kid and will until I die. That’s my real story: hopelessness.

I wonder what contest that would win.

I didn’t really have a problem to discuss in my group tonight. I’ve been hypomanic and that’s upset my snugglufagus (the unpredictability more than anything I actually did). But I realized that the upside of hypomania is also the way to reassure someone worried about the downside. Framing things in a positive way, and including them in fun. I figured I could share that. Until I got to group and became too annoyed to talk.

I can’t be specific of course because that would violate confidentiality, but a couple of things happened that always annoy me.

One was a certain person dominating the group. Every time someone laid out their issue, s/he was the first to speak up with a loud opinion–usually not a useful or helpful one, just a lot of judgment. “You should” this and “you’re too” that. Other people could barely get a word in edgewise. Really this is a problem for the facilitator to handle, but s/he didn’t.

The other thing that bugged me was unsolicited drug advice. It’s happened to me before; I’d bring up a problem and nearly all the feedback would be “have you tried drug X” and “there’s this other drug” or “increase your dose” etc. Like, STFU people, none of you are doctors and I don’t feel like explaining my whole medication history, and that wasn’t what I was asking about anyway. Tonight it wasn’t I who got that kind of feedback but it happened to a couple of other people and it was hard to break through the amateur doctoring dog-pile to ask the person what s/he was actually looking for help with–which wasn’t medication.

So should I have said something louder or interrupted them sooner? Told them how annoyed I was? Or do what I actually did, write angry words about it in my journal later on?

Venting may not be the best solution to anger management. A study demonstrated that ruminating on anger may displace it. In an experiment, participants were provoked and told to write about their anger. Then they poured hot chili sauce into a cup of water that someone else would have to drink (displaced aggression). People who wrote/vented their feelings poured more hot sauce in the cup than a control group who waited and were distracted instead of ruminating. Even eight hours later.

It’s better to distract, take a breather and all that stuff.

I’m breathing better now, the anger faded. How do I deal with this irritation next time I’m in group, though? I’m not a facilitator so I can’t tell anyone to stop playing amateur doctor or to let someone else have a chance to speak. According to other research, my feeling ostracized and unable to control environmental irritants is likely to make me angrier so it’s even harder to speak up in a reasonable tone. But I should be assertive, right?

I don’t know, it’s confusing. Distract myself, that’s what experts say, so I guess next week I’ll become fascinated by the ceiling tiles.

A little note: while Googling stuff about psychology experiments with hot sauce allocation, I also found a lot of links advising parents to control behavior with hot sauce. Putting hot sauce on a toddler’s thumb to curb thumb-sucking, for example. I wonder if some parents may be dousing thumbs with too much sauce if they’re feeling frustrated and angry?

Links:

Chewing on It Can Chew You Up: Effects of Rumination on Triggered
Displaced Aggression, Bushman et al., Journal of Personality and Social Psychology 2005

A hot new way to measure aggression: Hot sauce allocation, Lieberman et al., Aggressive Behavior 1999

When ostracism leads to aggression: The moderating effects of control deprivation, Warburton et al., Journal of Experimental Social Psychology, March 2006

I’ve had ECT. It helped, and it hurt. It was administered in a skilled, humane way with fully informed consent, and the slight anterograde memory deficits were not as extreme as I’d feared. But I won’t say they aren’t bothersome. Neither will I say I regret having ECT, since it quickly pulled me out of a very severe treatment-resistant depression when nothing else would. Death was the imminent fear, and what I was rescued from. It’s something opponents of ECT tend to overlook. Hospitalized after a suicide attempt, I’d been in and out of the hospital for months. Every day all day I obsessed over and staved off an intense urge to die. Tired of fighting, I had given in to the urges before. ECT was appropriate as an option.

“Normal” people don’t want to deal with depression, they want it gone and for you to behave how you used to. In that sense, you could view ECT as social control, but then all forms of treatment for depression are too. People suggest this herb or that vitamin supplement, which drug they think you should take or which one they think you should quit. They recommend talking to a therapist (instead of them). They tell you to wake up earlier and get over yourself already and at least pretend to be happy, smile, smile. Fit in. Be like us. Just about the only thing they don’t press you to try is ECT.

After having ECT, I wondered why. My experience was nothing like those horrifying movie scenes: screaming women dragged by evil nurses into decaying rooms to flail wildly under straps, with the same sound effects used for electric chair executions. It wasn’t like that at all. My pdoc discussed it with me as an option, with cautions of its risks. I talked to co-patients in the ward who’d done it, and they all said positive things besides some nasty headaches and forgetful moments. I saw the difference in their faces as light crept back in. What was this unfamiliar underground of satisfied consumers? Why hadn’t I heard their voices?

I realized that happy stories don’t make the news.

There was a frustrating fee to be free from that unbearable depression, and a percentage of other consumers have paid similarly. Memory loss is disconcerting. It annoys people (including me) when I forget conversations, or worse, forget to do things I’d said I’d do. The bulk of the memory problems passed within a couple of months but there are lingering deficits. It’s hard to say exactly how much, though, since there are also cognitive problems with bipolar itself.

Can’t we focus on solutions and improvements, instead of rushing to one side of the fence or another and throwing rocks? I feel like I’m balancing atop that fence (am trying to!). I see good points in both arguments, but also see they’re missing the real issue. People need treatments to recover from intractable depression and mania, and non-drug treatments for pregnant women, etc. They need reliable information about options instead of options taken away (to be replaced with what?). It’s confusing out there, with doctors overly defensive and sometimes minimizing drawbacks, while other people are domain-squatting to spread ideologies.

ECT is a storm cloud in the sky. Don’t focus on lightning bolts or silver linings. Instead notice the cloud is mostly an intangible gray, and rain may help those below.

For example, there’s The Center for Reintegration, which operates clubhouses and the annual Lilly Reintegration Awards (nominations due by June 29). The site has advice like, “Make a list of your best skills and traits (‘dependable’, ‘always punctual’, etc.) for use in a job interview.” I don’t know about you, but it’s *because* I’m totally undependable that I’m not working full time anymore.

I’ve been to a clubhouse, I’ve been to a job rehab firm, I’ve been to a charity, and the best they’ve had to offer was rewriting my resume and telling me to look for casual work in retail. As if I could keep to the schedule of a crappy minimum wage job any easier than I could in my former (much better!) career. As if it’s okay to not show up when all they want from you is face time wearing a smock and a fake smile. As if I wouldn’t lose a job like that too. And how is crushing my self-worth supposed to lead to meaningful work? How are they defining meaningful?

The key, the absolute essential thing for me, is an understanding employer and the flexibility to take time off. Writing is a good option because I can work from home and nobody’s going to get upset about long lines at the checkout if I don’t show up one day. PsychCentral is ideal, absolutely wonderful. But there aren’t many places like this. Instead of telling people to go fishing for work in the general job market, it’d be more useful if rehabbers cultivated databases and relationships with employers predisposed to non-discrimination.

Sorry to be so skeptical and negative. Lately I’ve noticed a growing number of people who are professionally ill, paid for speaking engagements and articles about how sick they used to be and how life is so rewarding now that they’re on lithium or whatever. The Reintegration Awards honor them; “The achievements of people living with severe mental illness who give hope to others facing similar challenges.” Obviously, I’m not in the running. I was offered cashier training but ended up back in the hospital instead.

It’s not Internet “addiction” (which John has debunked many times) but it does feel a bit compulsive and is definitely interfering with life lately. It’s my email. There’s simply too much of it, and it feels like every message brings work or followup so I just get more and more bogged down. Today I spent two hours on it and have still not caught up.

I’m not talking about nice, personal emails from friends and family; no, they’re always welcome. Instead it’s articles that arrive and need reading/skimming, subscriptions, updates, table of contents notifications, a couple of lists, and various links sent to me. There simply seems to be no way to keep up with the volume. It’s not all work, either, there are a few webcomics and things that are a fun diversion – usually. Not now, not when my mood is slumping and procrastination is stressful.

Okay, so having identified the problem, how to handle it? I’ve been unsubscribing from some stuff and deleting many messages unread. I’ve made an organized to-do list. I wake up and think, okay, I’ll calmly sit and concentrate on writing, and catch up. I start, but then Gmail notifies me of every message that arrives and I get distracted. I’ve been trying to disable it without success. I’m not signed into Yahoo or IM, for that reason, and deleted Facebook’s mobile app (too many txt msgs). I declared email bankruptcy in one account. I’m trying to focus but these constant distractions get in the way and I can’t seem to ignore them. That’s the part that feels compulsive. Some days I take the desperate measure of staying offline entirely. That isn’t practical, though, when there’s research needed.

I used to get stuck in search holes (Googling things and following link after link after link endlessly, seemingly falling into a black hole) but was able to stop doing it. What do I do about this? I can’t totally ignore my email. Things need doing. I just wish it wasn’t such a demanding and draining barrage – or is that just my perception? Does anyone else suffer like this, and if so, how do you cope?

For instance, I’ve not seen much written about the “treatment” of stable and appropriate housing, but it’s been one of the most important things for my mental stability. It’s been good to see a doctor who gave me pills and a psychotherapist who talked about my relationships, but those things really didn’t have much of an impact when I was couch-surfing homeless or living in a flophouse or fighting with roommates I didn’t like. Always on the verge of being kicked out (at the mercy of someone else’s mood), or living one manic spending spree away from not having rent is extremely stressful and no amount of yoga and sedatives make it better. That kind of living on the edge is what pushes me over it.

Mental health advocacy groups are coming around to this notion as well, though they seem more interested in getting psychotic homeless people off sidewalks than the quality of housing they are put into. First things first, I guess.

Right now I’m blessed with a subsidized apartment of my own, but it’s not mental health housing and I’m not open about my illness. I live in fear that my landlord, though a very nice person, might not want me there if I make too much noise some night when I can’t sleep while manic or something. Finding housing is hard, I’ve had people bluntly trample on my human rights by saying they won’t rent to me when I said I was bipolar. Now I don’t say anything and just hope for the best.

I can’t think of anything more psychosocial, as in both psychological and social, than that.

I’m not too far down. My meds keep me stabilized enough that I don’t generally go so far up or down as I used to. No suicide attempts in years. When I have felt the urge, though, this web site was really helpful, so please check it out if you’re having thoughts too.

I do feel sluggish, though, and the amount of work I have to do is daunting (it would be no matter how little there was). So, I’ll adjust the meds and go to the support group to check in. Make sure I’m eating healthy and exercising; in fact I’ll go do some yoga right now. Wellness, here it is in practice.

That’s where the controversy of using antidepressants in bipolar comes in. It’s not prudent to take them while manic, but once I swing down I need their help to keep from falling too far. It takes a month for my preferred antidepressant (I’m not a shill) to kick in so instead of going off completely during mania, I lower the dose to minimal, then raise it when I really need it. But some doctors would say I should be off entirely. A recent study also claimed that antidepressants don’t trigger bipolar mania, as commonly believed.

No, observed.

No, known by millions it’s happened to, and by those who’ve seen it happen. But I guess the statistics in that paper balanced in different way than many people do.

Anyone would be euphoric in this situation, I thought, but then I’d been feeling good all day and not just marvelling at the gardens. There were other little things like wearing a thong with “fabulous” printed at the top paired with ultra low-rise jeans. Hypersexual.

Fabulous, life is so absolutely fabulous it’s better than a TV show. It’s fabulous enough that I can’t figure out how to make it less so without wiping it all out. I don’t know what to do, because I do know what to do and I’m doing it but still impaired and it’s frustrating for all involved.

More pills and treatments, yes, more and more, but never, it seems, enough. What is?

Signs of Mania

• Pink and orange predominate wardrobe and tastes in general.
• Waking up, untired, three hours after 1000+ mg of drugs meant to keep you asleep. Doses that would sedate a horse don’t faze you.
• Doing someone else’s laundry (like, three loads, including folding).
• Cosmetics, decorations, jewelry, and adornments of all sorts dazzle and beckon. Ooh, shiny!
• Spending on any old/odd/ooh thing without noticing costs or thinking ahead about financial repercussions.
• Singing aloud at random, without being an American Idol contestant or even a karaoke lounge lizard.
• Being scantily clad, despite mortifying medication weight gain, in cool weather.
• Galumphing through thunderstorms, laughing, mouth opened wide to collect raindrops.
• Bickering and snarking over insignificant things, irritation beyond sense.
• Everyone is your friend. You are love.

What to do if you have these signs? The usual line is to see your doctor. I’ll reiterate that, but also note that it’s important to practice self-care and rely on your support network during this time. Someone to hang on to your credit cards? Someone to veto your wardrobe choices? Someone to keep you out of the rain without protection? This kind of help may be as practical as getting more or different meds. I know I could sure use someone to supervise my shopping. Yesterday’s damage was MAC Royal Wink blue Fluidline cream eyeliner, in a spiffy little jar.

These are things I do not care about most of the time, but during these manic episodes they emerge like showy butterflies.