Category Archives: bipolar

I’ve had a relapse and I didn’t recognise it

Mondays are therapy days for me. I start the week with a wringing, a venting, a draining, a regaining. I start with talking about all the things I need sorted, and after 45 minutes of talking about random things, I get to the thing that’s hurt me the most.

For the last four weeks, every therapy session has ended in my crying, unable to voice anything of what I’d been feeling. I’d finish crying at therapy, go to work, manage to get through the day and drive back to pick up the kids. During this drive, I’d send voice notes to a friend asking me how I was doing. I’d start to a bright note, and by the time I was done, I was choking with tears or outright crying trying to tell her what was going on.

I’d get home and do what was required of me, bare minimum and then lose myself on Twitter or Instagram because nothing numbs you to yourself like the details of other people’s lives. This has been my way of functioning for over three months.

I’d fall asleep — aided by my medication — by 8.30, without putting my things away: books, painting things. I’d tell myself I was just going to rest my head and the next thing I knew I was waking up a little past midnight, groggy af and looking around me to see why I hadn’t finished all that I wanted to. I’d put things away in the kitchen, put my undone art work away, then go back to bed. Only to wake up reluctantly at 5 a.m., manage breakfast, bathe — myself and the kids — get everyone out of the house, do a school drop off and head to work. Rinse, repeat.

Through all this I had been journaling, organising, supposedly listening to my feelings and managing bare minimum exercise. I was supposed to have been in touch with how I am feeling. Everything was written down, include the nights I went to bed hoping I didn’t wake up the next day. I ignored that as the stray suicidal ideation that assails all of us once in a while. My appetite was dropping but because of a recent weightloss, I thought I had been ignoring my eating only because I was afraid to put that weight back on. I was supposed to be on the path to being better.

Yet this Monday, as I sat crying in my therapist’s room filled with books​, I was hearing myself and him telling me that I had a relapse of depression. That for over four months now he had been noticing the change in my mood and was guiding me with exercises and direction so I could overcome it or deal with it. But this Monday, when I broke down, he had to tell me in as many words that I had relapsed.

So why hadn’t I caught it? Why hadn’t all my journaling for mental health, all my organising, all my breathing and meditation helped me in a) keeping this at bay and b) helped me identify that I was going back to those dark, futile spaces I had left some time ago? 

Both the mental illnesses that I have been diagnosed with have depression as a huge component. The last time I was deeply depressed was very different. I was crying all the time, I refused to eat for days, I was afraid to go out, I had attempted suicide and I was incapable of functioning. For me, getting better, then, meant functioning. And here I was, two years after my severe depressive episode, functioning well. Work, kids, and reading all of it was on track. And yet, with each passing day, my ability to go on was diminishing. My ability to do work outside of my workplace was reducing. My temper was shorter than it had ever been. And for five months, I had missed all the signs of being depressed.

I was forced to confront it only when I took a look back at the last two weeks and realised how I had been crying every day. How I had been craving sleep because I didn’t want to be awake and feel these things. How I had been skipping meals and was rarely ever hungry. Add to that not being able to do the things I love, I decided to talk to my therapist about it. And lo, as I was speaking it dawned on me what he had seen for so long. That I had had a relapse.

I started this post to talk about relapses in objective terms but clearly I am feeling too miserable for myself to be of any good to you, dear reader. But I shall still try.

Things I have learnt with this relapse are a few. Let me try and enumerate them.

  1. That it is possible to function and go on with life doing adequately what is required of you through depression. I think this state occurs when you have therapy to buoy you and a regular life and routine to adhere to.
  2. That even though you’ve been in the thick of depression, you are so aggressively focusing on dealing with your disorder, that you can be completely blindsided EVEN THOUGH YOU ARE CONTEMPLATING SUICIDE. 
  3. That your last depression needn’t look anything like your current one. Like I mentioned, the last time I was a creature only existing because I had breath in my body and a beating heart. This depressive episode, I work, eat, sleep (ish), and do what is required of me. My only red flag this time, which I totally overlooked, was that I wasn’t enjoying anything I was doing. That my energy to do anything was progressively decreasing. To a point where if I sat down, I didn’t want to get up, move, breathe, blink. I wanted to become part of wherever I was sitting.
  4. That being ultra-focused on recovery and maintaining status quo means you are missing all the red flags.
  5. That you can do everything right and you can still be depressed.

Now over six years after I was diagnosed, two years of feeling renewed hope and finding new meaning, two years of doing so much, and having made what I think is progress, I am once more defeated. I hate the thought of anti-depressants. But I am back on them. Look at the possible side effects of the SSRI I am taking. Who wants that shit? But here I am because I cannot find the will to wake up in the morning and take on what is coming my way.

At this point, I feel like I am never going to get better and that every few years this is going to be my condition. Just when I think I have my life sorted out, the rug is going to be pulled from beneath me and I am going to fall, fail and never get up again. But who knows, right? If my last romantic relationship taught me anything, it was that words and promises mean precisely zilch. And ‘forever’ particularly means a big, fat load of nothing.

I think what might help is a social media break, a holiday, someone who loves and cares for me unconditionally taking care of me for a few days, and allowing me to be as pathetic as I am now. I think what might help is someone taking on the tasks of parenting two very beautiful, impressionable children for a few weeks. I think what might help is work can be taken off my  hands for a week. But none of this is going to happen. So I will say a prayer and pop a Prodep and remind myself that hope floats.

Part ii: How do I know this therapist is right for me?

The first part of this series is “Do I need a therapist?”

Finding the right therapist is of immense importance, if you’ve decided to opt for therapy. You’ll find you don’t know who to go for, in the beginning. Should I see a psychiatrist or a psychologist or just a counsellor? This is an easy one actually. Personally, I prefer going to a psychologist first, mostly because I want to avoid medication as much as I can. Unfortunately, I have seen the difference between a non-medicated me and a medicated me and I have to say, it really helps to have my focus in order and my moods under control. So, while I struggle with medication, I also see why I need it. But I digress.

First to tell the different kind of professionals apart.

  1. A psychiatrist is a person who went to medical school and has a medical degree in psychiatry. This enables him to prevent, diagnose, treat and understand mental illness by prescribing medication and course of treatment or therapy. She will also monitor how you react to medication short term and long term, so expect blood work and the like to be part of your interaction with her.
  2. A psychologist is someone who has an academic or doctoral degree in psychology, not a medical one. This person can is qualified to do counselling and psychotherapy, perform psychological testing, and provide treatment for mental disorders. A psychologist cannot and must not prescribe medication to you, or perform medical procedures.
  3. A counsellor is someone who doesn’t have a PhD but a Masters in psychology. In order to practice, a counsellor must have trained at an organisation for a few years before obtaining a license. Unlike a psychologist, a counsellor may not be authorised to diagnose an illness but is effective in treating one with the aid of therapy.

Now that that’s out of the way, how can you tell if this therapist is working for you? Most people will tell you go with your gut. But I am going to say ignore that advice. Here’s why. Consider that you are at a therapist because you are not feeling your very best. Consider that when you aren’t at your best, it is very likely that your ability to listen to your gut, to distinguish the voice of your gut is highly impaired. What you mistake for gut reaction could be fear of vulnerability or of having revealed so much to a practical stranger. Consider that when you are emotionally or mentally disturbed, your gut might not be your best friend. Therefore, don’t go with your gut right in the beginning. Because if you do, you’re bound to come up short almost always. The first time you go to a therapist and your gut is always going to tell you to run and never come back.

These are the things I have found useful in understanding whether a certain therapist is right for me.

 

  1. Be prepared for never knowing that this is the right person for you in the first session. In my exp, it takes at least 3 visits to figure out if it’s your gut feeling, or if you’re second guessing yourself, or if you are just getting comfortable.
  2. Do they glance at phone/clock/out the window often enough to register on you and distract you?
  3. Do they display any emotion or judgement at anything you’ve said so far? If yes, and it makes you uncomfortable, stop seeing them. You should be seeing someone who makes you feel like you are working together; and not someone who hands you only instructions on what to do. There will be instructions in the course of your treatment but that will be with your willingness.
  4. Do they talk more than you do and make you feel like you  haven’t been heard? If yes, stop seeing them. Your sessions shouldn’t be a fight to be heard.
  5. Write down notes about what you liked and what you didn’t like about the session afterwards. When/if you switch therapists, the notes you take will show you what you need.
  6. If you have a diagnosis, ask clear questions about the treatment plan and what their stand on medication is. A treatment plan should include your consent and your ideas. Don’t go to someone who doesn’t include you.
  7. Understand what your own stand on medication is, should you need it.

In short, I suggest you give it two to four visits before you decide this is the wrong person for you. Of course, there are those who immediately know whether this person is working for them or not but in case you’re wondering how to determine whether a therapist is working, these above tips help.

Good luck!

 

 

On Sleep

A dear friend recently mentioned she had been blogging 10 years. I checked my own blog and there it was: 2006, two posts. Ten years of writing whatever it is that I wanted to and find kind people to read it. This year, then, I feel should be the year I revive my blog. What better way to battle this sleepless night I am having, currently.

Speaking of, sleep and I have had a very contentious relationship for years. I’ve considered a sleep complete waste of time (as opposed to spending time on Twitter or whatsapp) and sleep has considered me unworthy of bestowing the restorative blessing that she seems to grant many others with. I have struggled with sleep since I can remember, which is about nine years old. Gloomy, terrifying sunny afternoons where the household would be asleep and I would dread being the only one in the house who couldn’t claim a break in time like that.

As I grew older, nights became a complete waste of time because there was so much to be done, so much time spent reading, writing, thinking of boyfriends; just so much to be done and night had a way of putting an end to those plans. Most my 20s were sleepless, unless I was so exhausted that nothing could keep me away. Phone conversations till late in the night, books I couldn’t put down, friends who stayed over. I rejected sleep.

It’s payback time. I barely get four hours of sleep every night. Which is better than one hour of sleep that I used to get about three years ago. I wake up in four hours, do something I like doing and in an hour I am back in bed. It truly isn’t ideal because the next day I am scarcely rested. Upside though, I get to do all the things I wouldn’t have gotten to do if I had normal sleeping patterns. So, if I want to make an entry in my art journal, I can do that. Or write a letter for my #100letters. Or read the books I keep buying endlessly. Or write this blog post, even. So much to do when you can’t sleep.

And yet, that’s exactly the problem. When a bipolar person is in the manic phase, sleep is the first thing to take a hit. (Depressive phase in me induces excessive sleeping but that can differ from person to person.) I’ve been trying to sleep since 10 p.m. tonight. It’s 1.45 a,m now. I’ve had a big day. And it tired me out. And yet, my mind is alive and my body, awake. I thought it was just tonight but I looked back the last four nights and I realised all those nights, I had slept little or very badly.

You’d think I’d be used to this now and would be catching signs of mania early. But I still haven’t. I still think my body will behave, so will my mind. It’s well into mania that I realise I’m there and then the irritability, the immense confidence, the rash driving, the snapping and losing of temper and the general invincibility I feel starts to make sense. And so does the sleep. Waking up every two hours, or not sleeping at all some nights.

Why sleep is important: This might seem like a stupid thing to bring into focus but it’s as necessary for me in terms of reiteration as it is for those who might be seeking personal experience with lack of sleep and bipolar disorder. Lack of sleep makes me moody: You might think it does that to everyone but it’s a challenge to me because I am then governed by my moods for the next few days. I make decisions based on how I feel and not by calm, rational thought.

Lack of sleep  makes me continuously irritable. This is tragic because everyone from a complete nincompoop on the road to my little kids bear the brunt of it. I snap regularly and I snap at complete non-issues.

Lack of sleep also perpetuates a no-sleep cycle where I cannot sleep for a few more days. It starts with one and suddenly, I’ve found so much extra time that the excitement of doing the things I love is so great that I forget to sleep. Suddenly, my mind is abuzz with ideas of all the things I can do if I don’t sleep. This adds to the frenzied activity already in my mind and then I head to a complete collapse, at the end of which I am tired, mildly disoriented, irritable, unable to work or have a fair, pleasant day, and most of all, unable to make decisions: this goes for instant decisions when I drive, more deliberate ones when I am at work and even more important ones when I have to decide for the children.

This really crisp and informative article tells you more about sleep and bipolar. It also tells you why you need to sleep, how to get adequate sleep and how you need to address the problem of bad sleeping. I found it very helpful.

What I do when I am manic and don’t sleep:
I wake up early even if I don’t want to. 
I try and eat little for dinner. 
I listen to music on headphones.
I read Anna Karenina. Or Crime and Punishment. (Sorry Tolstoy, Dostoyevski) 
Some nights, I take evil glee in the extra time and do the things I love doing. 

The last one is a bad idea because while sleep is important to everyone’s well being, it is particularly crucial to those who are bipolar. They are triggers for a very bad manic (or even depressive) episode and if you’ve been there, or know anyone who has, you know you don’t want to go there.

It’s far too late now and I have made one sketch, written two poems and one more blog post from a prompt that I will post tomorrow. For now, sheer exhaustion and sleep are claiming me for themselves, finally. And I go with the disappearing stars of dawn.

Be well.