Category Archives: mania

Part iii: What do I expect in my first therapy session?

If you’ve just come to this, then here are parts 1 (Do I need a therapist?) and 2 (How do I know this therapist right for me?)

When I signed up for therapy and decided that I was going to go it didn’t even cross my mind to prepare for it. That’s usually me, absolutely no foresight. Sometimes, I think I live my entire life just by winging it. But, as I was saying, I went entirely unprepared for my first appointment with the psychiatrist. All I knew was I wanted to feel better. I wanted stop feeling like I was going to dissolve or explode or any of those feelings of restlessness that used to grip me in those years. So when I went to my appointment, I started to say some basic thing with no real relevance because how do you get to the heart of what you want to say when you’re sitting across a stranger? About two sentences in. I started to cry. The rest of the appointment is a disaster but more about that later. For now, I’ll just tell you what I think you should expect from your first appointment for therapy.

Overcoming resistance:

First, from within. You will find resistance from within yourself. You will want to put things out there politely, even though you want to get to the problem immediately, you’ll still keep things pleasant and polite and understated the first time. You’re never really getting to the ugly details. This is normal. You can’t just talk to a stranger about all the darkness in your life. To combat this, I suggest you list things down starting a few days before your appointment. I still list down my questions, ideas and themes I want to discuss at my appointment but I do it the day before now, instead of a few days. I say do it a few days before because as you near your appointment date, you’ll find it is on your mind and your mind will keep bringing up things you should talk about. It’s best to start two or three days before the appointment and to keep jotting them down as they occur to you. This will help you structure your session and what you want to say in it. Once you’ve got them down on paper, you’ll find you have enough distance from the issues to at least last one session coherently enough to explain your situation. And that’s exactly why you need to do this: in order to convey clearly to your therapist why you’re seeking help.

Whys and whats

Which brings me to they why of things. Once you explain you problem to the therapist, most of them are going to ask you this or a variation of it, “And what do  you want to achieve from therapy?” This is a good question because it forces you into a position of trying to understand why you’re doing what you’re doing, which is therapy. Some of us answer saying we want to be more happy, others — like me– say we just want the pain to stop and want our life back in order and in some semblance of control. Some of us specifically say we want to be stronger, others say they’re doing it because someone asked them to or that they want to save a relationship. Loads of reasons why people go into therapy, yeah? Find your reason. Simple statement, few words, and don’t worry about sounding like an idiot. You won’t and it’s okay if you do.

Participating

A therapist is not a magician. Once you state your problem, it might be that your mental health professional might take over and conduct the session, and that’s okay for now. But it’s extremely important to participate in your sessions. Help your MH expert with details you think are important, correct them when they are wrong so that they get a better idea of your life. Ask questions about what you need to do next; ask them what their treatment plan is and, if medications are involved, ask tiresome, relevant and really involved questions till you get your answers. Be in charge of your narrative.

Your shrink

What must your shrink be in order to trust them?

  1. They must listen to you in a calm, unhurried way. No checking phones, or answering calls that seem, well, not important; no looking distracted or unintersted, and maintaining eye contact. Your doctor or therapist must let you talk and not hurry you. The first shrink I ever went to talked to me for 11 minutes or so while rifling his papers and said, “Yes, yes, you have bipolar disorder, take this medicine.” That’s it. It was a terrible, terrible experience. He didn’t explain what it was, what I must do, what I need to do next etc.
  2. They shouldn’t show any signs of judgement. No raising eyebrows at your colourful sex life, no change in expression when you say you actually hate someone you love, etc. Walk out of there if any of this happens ever.
  3. Finally, your MH professional should discuss the treatment plan with you and seek your consent to go ahead with it. Ideally, they should also tell you how much it’s going to cost per session. But feel free to ask.

Emotion wise, be prepared to feel a little underwhelmed or, as it happens to some one us, brimming full of hope. Both feelings are a bit deceitful and neither of them tells you whether this is going to work out or not. Persistence is usually the key to getting the results from therapy that you are looking for. Continue therapy sessions, and suddenly you’ll find that the voice of your therapist is now becoming your inner voice and you’re on the road to getting better.

I conclude this series with a final and fourth part, where I will talk about recovery. If you have any suggestions, I’d love to incorporate them. 

Part i: Do I need a therapist?

(This is Part 1 of a four-part series on how to get help if you think you have a mental illness.)

For months after I wrote this, I received emails that said all kinds of things. Many were warm and confiding, many were heart-breaking and, yet others were full of questions. The few years since I’ve written this, the one question that keeps repeating itself from various sources, time and again, is “I am sad/unhappy/out of control. How do I know I need help?” The emails always make me sad and somewhat heartened. Sad that so many  people go through life with such pain that it stops them from being who they want to be. I am equally heartened because this many people are paying attention to their emotional states, listening to the voice of their hearts and considering that they might need help.

Before I start trying to answer the question that is the headline of this post, I’ll state at the outset that I am no expert. Everything that I list here is entirely my own experience and any suggestions I offer are drawn from how I have gone about getting help, and getting things to be a little better in my life. So with that out of the way, I’ll get on with it 🙂

I’ll go back to many summers ago when I was distraught and it felt like I was being overcome by something I cannot describe. It was the feeling of watching a gigantic, and I mean really fucking enormous, wave rise in front of you, bearings its dipping fangs and threatening to completely obliterate you the minute it loses its battle with gravity. And you? You’re rooted to the spot, like you’ve been many times in a dream, unable to move and save yourself. This feeling attacked me often and intensely when I was a teenager. I have still not learnt to identify it or name it. Overwhelmed? Panic attack? Anxiety? I don’t know and, honestly, now I don’t bother with labels. I just know I am unwell and I (almost always) do my best to take care of myself. This feeling never really went away until therapy started kicking in but I got better and better at hiding it, or worse, escaping from it. And at my worst moments, I’d tell those around me, “Help me, there’s something wrong with me. I need help.” People around me knew just as little as I did, and therefore there would only be helpless hugs, or empty consolations or brushing away of things.

It was when things broke down completely — including me — that I realised I needed some level of help. A very personal incident finally pushed me over the edge and I went to a doctor to get diagnosed. The story of my diagnosis is for another post, one I want to pay particular attention to because it was not something I’d wish on anyone at all.

In the meantime, however, here’s how you can decide that you need to go to a therapist.

  1. When your life falls apart: Simply put, if your heart or your hands or your legs weren’t performing the functions that they were meant to, you’d see a doctor. Similarly, when your mind doesn’t do what it needs to do, you need to get help. What does that mean? Because the mind is tricky and it’s always working; and while it’s working, you think you’re doing the right things, behaving the right way, making the right decisions. And yet, outside of you is chaos. You don’t eat on time (or at all), you probably don’t sleep well (or at all), you’re short tempered, unable to meet even daily goals, you probably overspeed, have accidents, bad relationships. You probably are never able to make decisions when they need to be made because that action paralyses you, and then, suddenly you’re at a point in time when you need to make that decision. So you make that decision last minute, under compulsion, with no more time to consider the matter carefully. You probably miss deadlines, flake on a lot of plans, lose your temper really easily. Needless to say you’re unhappy a lot. The above list is for high-functioning individuals who, despite keeping their jobs and relationships, still find themselves fighting with or being drowned by dark thoughts, for want of a better phrase. When nothing in your life is working, and you find yourself justifying all your fuck-ups (because face it, not being able to perform with a steady mind is going to fuck things up even if it wasn’t intentional), blaming everything else for your circumstances and unhappiness, it might be time for you to consider getting help .
  2. If you’re not high functioning, then this is simple. You’ve probably been sitting in bed for days, have barely eaten or washed this week, you’ve disconnected possibly every phone call that’s come in and have lived your life entirely online. You’ve cried incessantly, you’ve opened up to perfect strangers because the pain inside you felt akin to strangulation. If you’ve done this for over a month, you definitely need help. There may be no diagnosis, there may be no medication (thankfully) and it might be a really mild depressive phase, but catching it in time and fixing it is key. Even better, your treatment might only include a therapist talking to you to get you back on even keel for a bit, asking you to exercise, pick up a hobby.
  3. A third way to consider getting help is when a trusted and trustworthy friend or family member gently suggests (not when you’re having fireworks burn up the room “You’re crazy! Get your head checked”) that you might want to consider getting help for the sake of your own peace of mind.

For me, it all comes down to functioning. People say the point of therapy is that it should open up the pathways to happiness. I call BS on that. The point of therapy is to help you get on track and function fully, individually, to be able to help you achieve your goals and above all, treat your mind and your self with respect. If happiness, as we define it, is the byproduct of that then, yay.

I’d like to once more stress on the functionality bit. It’s not just doing your daily chores and completing your work responsibilities. It’s  being able to function in all areas of life without wanting to slash your wrists or overdose yourself every second day. What areas of life would I say these are? Being a productive, contributing individual: be that at work or home. Being a person capable of love, empathy and kindness: towards strangers, friends, family, oneself, and other living beings you might be fond of.  Being a person who takes joy in their talents, passions and hobbies: to function in this area is to be able to give yourself time that is exclusively yours. This is essential to feeling fulfilled.

I went to therapy because I didn’t love myself (my therapist would argue I still don’t). I went to therapy because the thought of death was blissful (it still is, many times). I went to therapy because I had two little children and I knew needed to be there for them, in spite of believing that anyone else would do a better job of raising them than I would. I went to therapy because every day was a real struggle. It was morning too early and day light felt like scalding water being poured on me relentlessly. I went to therapy because, finally, after all is said and done, our spirits genuinely subsist on hope.

 

 

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.