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Posts Tagged ‘The suffering brain’

I’ve been in a tough place.  Since my dog died almost two weeks ago, I have in some ways crawled in a hole.  I’ve continued to work (actually started to work – my first day on my new job as a cashier at a healthy supermarket was the day after I put Buddy down, which was in some ways very good timing,,,to have a new beginning and something to focus my energy right then).  I’ve continued most of my self-maintenance activities – which are quite a lot by most people’s standards.  I go to therapy every week.  I do peer counseling over the phone (30 minutes each way) with my friend Byron every week.  I went to a meeting of the Depression and Bipolar Support Alliance the other night. I talk with my buddy Monty on the phone every week.  I talk on the phone with my friend Lynn 2-3x a week.  i swim 2-3x a week.  I dance on an average of twice a week.  I talk with my housemates – especially Tom who is an extrovert and loves to engage.  Several friends have called me since getting the word about my dog, and talking with them has been good for me.  I got a flood of condolences after I put the word on Facebook and there has been some comfort in feeling a community around me.

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All these extraordinary resources and support have not kept me from being in other ways quite lousy.  Before this one, I’ve written one blog post in three weeks, At the Sunday dance I was in a miserable place – tight, contracted, depressed –  mostly not even able to dance.  The same weekend Buddy was dying, I went to parts of the three-day retreat for my entrepreneurship program, where I dramatically expanded my vision for my business – but I have since (until today) done nothing to move those plans along, and that has been seriously discouraging.

And I have been staying in bed.  With Buddy, I was almost always up by 7: “Hey, I have a dog to feed and walk – let’s get going.”  Not hard, really – I naturally wake up early.  It’s rare for me to sleep past 7.  I often wake up well earlier.  When I’m on the manic side of things, I get up and at ’em.  When I’m depressed, I lay there awake, trying to be asleep, getting myself in a progressively more and more foul mood.  Until 7.

Now it has felt like there is nothing to get up for.  I have stayed in bed until 9, 10, 11, 1.  Last Saturday I woke up at 6:30, but kept going back to bed until 1.  That’s a very long time to lay there awake.  It’s a depressive thing, I know – people with depression do this.  At my depression and bipolar support group the other night, there was a whole little conversation about how many of us have done this.  But I haven’t done it for over a year.  I’ve been miserably depressed at times, but not stayed in or gone back to bed.

Today was different – and I owe a lot of it to my friend Kate.

I’ll give myself kudos for making the call.  When I got off work last night, I was in a lousy mood, so I made two calls.  I left a message for my friend Johanna – and then I reached my Milwaukee friend Kate.  Kate and I have been friends for over a dozen years.  We usually talk every few weeks and it had been about that long.  She is under a lot of family stress and was glad to first talk about that – and it felt good to provide supportive listening to my friend.

Sometimes you need help from a friend.

Sometimes you need help from a friend.

Then she turned her finely-honed, intuitive, professional counselor attention to me.  She knew and loved my Buddy – and deeply loves dogs – so she gave me great support around that.  Then, when I talked about staying in bed, several positive developments tumbled out:

  • She asked me if my local friends knew what a tough place I’m in.  I acknowledged probably not.  After I got off the phone with her, I had a talk with my roommate Tom in which I fessed up.  It felt good to do.  I had a similar conversation with my other housemate Will today.
  • I committed to get up today at 7 a.m.
  • Kate suggested that I be a good loving father to myself and take myself for a walk.  She also shared her belief that Buddy’s doggie spirit is still with me and that I should practice feeling him with me when I walk.
  • Kate knows about my entrepreneurship program: almost took it herself, and completely jumped in my shit when I got depressed and almost didn’t follow through with it.  (“It’s not right for me – but it’s totally right for you.  You need to do it.”  And she was right.)  She got me to commit that today I would spend two hours working on my plans for my business.

The commitments I made to Kate turned my day around, though not without some pretty significant wavering.  I woke at 6:45 and got myself out of the bed by 7.  But then, after a trip to the bathroom, I came back and sat on the edge of the bed, staring at the floor.  I had told Kate that I would call her when I got up (more accountability).  After a half-hour of this stupor, I texted her about what was going on.  She texted back, “This is a loving kick in the ass – GET GOING!!!”  And it worked – I went downstairs and had breakfast.

But then I spent another half-hour doing the same thing before my 9 a.m. conversation with Monty – then afterwards spent 30 minutes more sitting and staring at the desk and another 30 minutes back sitting on the side of the bed.  I was precariously close to going back to bed – “I never told her I wouldn’t go back to bed” – but I knew that if I did that my commitments to work on my business and go for a walk would be greatly at risk.  And I remembered a woman at the support group the other night who spoke very compellingly of how she reached a point where she knew she had to summon all her force and just will herself out of bed.  I felt myself tapping into her determination as I finally headed to the bathroom to shave and, at almost 11 a.m., to get dressed.

Getting down to business 11-1-13

Then I spent 90-120 minutes working on my business!  That went extremely well and left me in a really pretty good mood.  What had felt intimidating and overwhelming and discouraging – developing an 18-day email class on healing through bipolar disorder – now felt eminently doable.  I practically did a little victory dance.

Then I wrote a few emails (including one to Kate), paid a few bills, then went for that walk.  On the walk I rehearsed two poems – one that I’ll perform at Jubilee in a week and one for a big poetry concert in March.  Then I mowed the front yard lawn: the front yard was where Buddy spent most of his waking time, and this was a hurdle for me – but it went fine, felt like a success.  Now I’m writing this blog post.  In 90 minutes I’ll go dance.  At this time yesterday, I would have been pretty nervous that dance could be a lousy experience – today I’m very hopeful that I will have a good time.

Thanks Kate – and your well-timed, virtual, loving kick in the ass.

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Up and down together is good news!

I’m inhabiting a mixed state today.  There’s lot of evidence that I’m still down (for the last ten days – today I’m calling myself a mania-depression 8, “Definite physical contraction”): on the conference call I was on this morning, my responses were really flat; my unconscious is still trying to generate the “This is all bullshit” mantra (though i have new tools to wrestle with this – which I will describe in a different post).  So it’s clear to me that my biochemistry has not shifted – I’m still down.

When I’m up, I’m very keen about this blog.  I believe that it has lots of value to offer – to mental health professionals and other helpers, to family and friends of people with bipolar disorder, but especially to my brothers and sisters who also suffer with this condition.  I picture that writing these mostly autobiographical posts will spill over into finishing my memoir, which is largely about bipolar disorder – and that this will then also reach and help people.  And I picture more books – why not? I have the professional credentials and the lived experience.  And finally I picture public speaking on the topic.  Again, why not?  I’m a terrific public speaker and get tremendous satisfaction from it.  All this will spill from the baby steps of writing this blog, day by day.

When I’m down, as I have been, I’m usually discouraged about my writing.  This blog seems useless.  “What do I have to say to anybody else about bipolar disorder when my own condition is still so out of control?”  And if my blog is worthless, the whole scenario of books and public speaking falls apart.

Today I’m clearly down.  Yet I’m encouraged.  Yesterday I had three separate encouraging experiences around my blog.  I had two days earlier sent the link to this blog to an associate who is very centrally positioned in the local mental health community.  I got her reply email yesterday morning, in which she raved about the blog up one side and down the other.  Then the piece of stand-up comedy that I performed at church yesterday (see yesterday’s post “A piece of manic comedy”), which in my down state I thought was badly written and would not reach people, did reach them – in spades.  More affirmation about my writer’s voice.  Then, in the evening, I wrote that blog post i just referenced – and couldn’t resist the assessment that it’s a good piece of writing and one that has a lot to say about bipolar disorder, that it could be useful to many people concerned about bipolar disorder, especially my cohort with the disorder.  My carryover from all this today is that I’m more believing in my writing voice, in this blog – and in all the other elements of a positive future that I see spilling from this blog.

So today I’m down – and encouraged.  My take on bipolar disorder is that the target is not so much mood stability as what I call bipolar integrity.  The problem is that these two states, mania and depression, operate so separate from each other – they polarize. We are like two different people that have no crossover, that don’t talk with each other.  Each side has gifts to offer, but those gifts don’t come to fruition as long as we are so split down the middle.  We need to integrate those two parts.

The da Vinci Vitruvian Man represents for me an image of wholeness, of integration.

The da Vinci Vitruvian Man represents for me an image of wholeness, of integration.

Today my up state and my down state are co-existing.  I’ve got flat responses and self-destructive rumination – along with encouragement about my writing and my future.  I’m not having fun – my mood is not up.  I would not say that I am happy even.  It makes me realize how attached I am to my up state, even with all its negative implications (ungrounded, out of control, creating the crash that comes after).  But I’m not discouraged.  So I have elements of my up state, but am not really up.  And I have elements of my down state, but I’m not really down.  I would not say that I’m in balance, because when I’m there I don’t have the elements of suffering that I have today.

Yet this is fundamentally encouraging.  The integration that I see as central to my healing is happening.  Part of me wants to try to leverage the good elements, to pull hard to get out of or away from the down elements – to get myself feeling good.  But another, i think wiser part, is saying, “Soak in this state.  Appreciate, relish this state.  Out of this mixed state will come the integration that is the key to your positive future.”

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If I am to make my life’s work reaching out to other people who also have bipolar disorder – and being an expert on the condition – that means embracing the pain that people with this disease suffer.  Because people with this condition do suffer – suffer tremendously. People with simple clinical depression also suffer tremendously, but there is something about the exquisite pain of – again and again – dropping from feeling good to feeling so bad, that is incomparable.  So I need to be ready to really embrace the pain of my brothers and sisters with bipolar disorder.

I cannot do that, except to the extent that I embrace my own pain – and I don’t embrace my own pain. I don’t love my downs.  I don’t love me when I’m down.  I love being up, I hate being down – and when I’m down I hate myself.  And I don’t write when I’m down – or if I write, I don’t post it, because it’s “too dark”.  That’s got to change – this blog has got to be balanced.  I just went through eleven days of being down – and I didn’t write one thing.  If all of my posts come out of my up place, the blog will be imbalanced and it won’t work.  So far it is imbalanced that way.

You gotta do the work, walk the talk - take it all.

You gotta do the work, walk the talk – take it all.

 

There’s this support group for bipolar folks here in Asheville (Magnetic Minds, http://magneticminds.weebly.com/) – that I don’t go to.  Is it because I can’t bear to face what we go through?  My work, in part, is to go to that support group – to really ante up, to belly up to the bar, to really take if, full.

I’ll keep you posted on this.

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(md rating: i started at a 9, very contracted, state this morning and have come up over the course of the day to a 7, slightly depressed)

When a previously very active blog on the topic of bipolar disorder, written by someone who has self-identified as a survivor of the condition, suddenly goes offline for eleven days, with no word of explanation, it would be kind of natural to surmise that the writer has gotten depressed.  In this case, that speculation would be 100% accurate.

Monday morning the 12th, I drafted a post that I – for reasons I don’t remember – never put up,  In it, I wrote, “As always when I’m not depressed, I worry when the next depression is coming and how bad it will be.  Walking the dog this morning, I was not very responsive to the Spotify music playing through my phone (Steve Earle, who just yesterday was really rocking me).  Is this an early warning sign that a depression is looming?  Or just a part of how mentally preoccupied I am today?”

I wrote that at 10 a.m., still identifying myself as an md 5, slightly expanded.  I actually didn’t feel speedy, but felt too off-center to call myself a 6, in balance.  Over the course of the next couple of hours, I watched myself tumble precipitously into a deep depression, landing at a 9, very contracted.  I spent the next eight days mostly in this 9 state – which, in the mania-depression tab at the top of the blog, I define as “pain in my brain radiates out into the rest of my body when i attempt to function at all.  Movement itself becomes so painful that i wince against the pain, may lean against the wall for support, get very still or immobile to get under the radar of the pain – flee into sleep just as much as possible.”  For periods of an hour or so here and there, I would slip into a 10, completely unable to function – I would sit and stare at the floor.  A couple of days I stayed in bed well past my usual rising time of 7 a.m., but I never spent the day in bed nor returned to bed when I had arisen – things i frequently do when I’m at 10 (but actually have never done for the last year or more).

Mornings tend to be my worst time,  Afternoon and evening brought me little if any relief for the first 8 days of this twelve day stretch, but the last four afternoons my mood has lifted some in the afternoon – like today, to a 7, slightly depressed.  When I was at the bottom of this particular well, I couldn’t picture blogging: not only did I not have the physical energy or mental clarity for this task, I was extraordinarily discouraged about the whole enterprise: “What do I have to say to anyone about bipolar disorder, when my own illness is still so out of control?”

Today I feel like blogging.  Today, I once again feel like I have something useful to say about this terrain.  I’m still showing no signs of ramping up into a mania, still have been spending my mornings back at 9, still am a little depressed at my best moments.  I’ll sure be watching for the subtle signs that I’m tipping into a mania, which requires very different strategies than when I’m trying to cope with depression.  We can talk about this in another post (and I’ll eventually put a bunch of this stuff into a page at the top of the blog).

Meanwhile, it’s a good time for a post-mortem.   I’ll spend the next several posts trying to make sense of the up and then the down (I wrote a few posts about the mania while it was happening), what I might have done differently, what is helping me to surface, etc.  Writing all this may help me in the future – and may also be helpful to you readers of this blog.  There’s no shortage of material here.

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This morning i woke up with painful physical contraction immediately present.  Some days it takes an hour or more to kick in, but today it was immediate: i had not even stirred when i knew that the pain was back.  And, whereas the affective side of my disease – discouragement, negative self-talk, etc. – sometimes does not immediately (or sometimes not at all) accompany the physical pain (brain pain), today that affective side of depression was also present immediately.  I was, from the moment i gained consciousness, immersed in very painful emotion and cruel self-talk about myself and my life.  And the deep cognitive component of my condition was also in full gear – i was mostly believing these painful, discouraging thoughts about who i am and about the state of my life.

All this was so painful that moving around in the bed at all made it worse.  (The pain in my brain radiated out to the rest of my body.)  So i did everything i could to stay still – and preferably drift back off to sleep, which i did on-and-off until about 9 a.m.

At about 9 a.m., i finally convinced myself that i needed to get up, even though i knew that this would make me feel worse – which it did.  My face went into a painful grimace and i was so contracted that breathing and walking were both difficult.  As i tried to move out of my bedroom and down the hall towards the kitchen, at a couple of points i had to lean against the wall to steady myself.  But i knew that, among other things, i needed to let my dog out, so i kept going.

Sometimes, when i have slept this late – and when Buddy has not spent the night outside, which is his preference in warm weather (last night rain was forecast, so i brought him in) – he immediately wants to go outside.  But other times he wants to cuddle first, and this was one of those mornings.

As i sat down next to him under the kitchen table (on the nice thick area rug there, one of his favorite places) and began to talk to him, I was immediately shocked by how sweet were the words that came out my mouth!  I couldn’t believe that this sweet talk was emanating from the same brain that had, up until this very moment, been totally castigating me.  The words were so melodious, so gentle and tender, that i wanted to make them and hear them just as long as i could.  As long as the sweet words kept coming,  i felt lots, lots better emotionally and even physically.  And Buddy was still in no hurry to get going.  The couple of times i pulled a bit back and asked him if he wanted to go out, he immediately extended a paw onto my leg or arm or chest in his classic gesture of “No, don’t stop yet.”

Finally, i felt an internal need to “get going and get some things done”, did fully pull back – and Buddy immediately got up and asked to be let out the back door.  As I did so, much (but not all) of the physical and affective pain came back.

I almost immediately got a business call, which kicked me into gear.  While i was on the call, i was (as so commonly is the case) distracted from the physical/emotional/cognitive pain – but it all came back almost immediately when i got off the phone.  The gentle rain that had been falling left off and i walked Buddy and our neighbor dog Lucy back up the hill.  I was still in a lot of pain.  (So many people encourage me to get out and walk when i’m in this state, not knowing that physical movement – at this stage of physical contraction and brain pain – makes it worse, causes the brain pain to radiate out into the rest of my body.)

When i am feeling better than today, I like to reserve this first walk of the day for keeping my mind mostly empty, where it can be receptive to creative or interesting thoughts.  (I carry a little spiral pad and often jot lots of notes for stuff i want to write.)  But this morning i almost immediately threw my brain in the direction of memorizing a poem, a mechanism that i regularly use to distract myself from all that is going on within me.  Sometimes that works really well, and this morning it worked pretty well.

I came back and received another business-related call, but this time from a colleague whom i know and very much like.  Again i functioned – and even felt – very well while i was on the call.  When the call ended, i was immediately back in physical pain – but much less affective or cognitive pain, because i like talking with this friend and liked a couple of the plans we had made.  And i was encouraged to see myself functioning, overall, so well – on a morning when i had not been sure that i would be able to function at all.

It’s now a couple of hours later.  I am functioning fine: not, yet, attempting any complicated mental tasks – just sitting here writing this note.  (And even typing fast and well – i just ran a spellcheck and had not left an uncorrected typo in the whole note!)  I’m in a lot of pain (brain and body contracted, face grimacing, breathing too deep hurts), but i’m functioning fine – and less discouraged, mostly liking myself ok, and feeling a lot of compassion for this guy who is hurting so badly.

I’m pretty happy to have come this far, on a day that started so much worse.

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My ride has been very bumpy for the last two weeks.  I completed two huge, exciting projects about three weeks ago – and about a week later crashed pretty hard.  I haven’t stayed on the floor for the whole last three weeks, praise god – never more than 3-4 days at a time, but i have also not had more than about 3-4 days at a time without again ending up there.  And this morning was as bad as it’s been.

I was so painfully contracted that any movement increased the pain – it was like trying to move through a solid wall of hypodermic needles.  I retreated to the sofa, which i have not done much in the last 9 or 10 months, but have done about three other times in the last couple of weeks.

A good friend called and i let the call go to voice mail.  I like talking with Tebbe, but was no way up to this.  I laid really, really still and the pain subsided.  i didn’t fall asleep as i hoped, but in about 40 minutes i felt enough better that i thought maybe i was at least a little bit out of the woods.  Wrong.  I returned to the sofa.

(I’m not quite sure why i don’t like going to my bed during the daytime, when it is so comforting to me at night.  Maybe some internal norm that you aren’t supposed to be in bed during the day.)

But i did have a phone commitment that i actually wanted to keep.  My friend Byron (back in Chicago) and i talk on the phone for almost an hour every week.  We each listen to the other for a solid 20 minutes, with typically a little chit-chat between each other’s “counseling session” and at the end.  (We met, over 25 years ago, doing a personal growth, peer counseling methodology called Re-evaluation Counseling.  Neither of us is involved in that organization or approach anymore, except with the somewhat modified form of “co-counseling” attention that we still give each other.

We always start with a quick update on “How are you?” – and this frequently informs our decision of who should talk (receive attention, love and support) first. We both knew, from my few words about having a real hard day – but even more from the paralyzed sound of my voice – that i had better be attended to first.

I took my 20 minutes in a different way than i ever had.  Over the course of the morning, i had been strongly resisting the nihilistic thoughts about myself and my life which only sometimes accompany my depressive contraction, but were trying to get at me today.

I fought hard to stay rigorously with just my immediate physical reality – observing my brain.  I picked up a couple of expressions from an interview on Fresh Air, about a year ago, with a clinical psychologist who has written a book about his terminal cancer – and has dealt with extreme depression for many years.  He used two terms that i had never heard before, but which i grabbed onto immediately because they spoke so much of my own truth: he referred to depression as “your brain is in pain” and “is suffering”.

So this morning, as i lay very still on the sofa, I thought “My brain is in pain – let’s observe it and see what i can learn.”  I thought words like “malfunctioning”, “misfiring”, even “having a little seizure”.

A shrink speculated with me years ago that maybe the reason that  anti-seizure  meds seem to work for bipolar disorder is similar to why they work in preventing seizures: they somehow help the brain get more solid, more resilient, more stable.  They’re not just mood stabilizers: they are maybe even more accurately “brain stabilizers”.

I remembered that i had the day before missed my dose of Lamictal, my morning mood stabilizer.  (I’ve been told by a couple of shrinks that Lamictal has a little bit of energizing effect and is best taken in the morning, whereas the Seroquel that i take in the evening has some sedating effect.  It does, in fact, sometimes – even at the low dose that i have over many months worked my way down to – totally knock me out, and i no longer can sleep through the night without it.  i do kind of resent this, because i used to be a good sleeper.  Maybe eventually i’ll wean myself off it, but i don’t know.)

I tend to not have any real confidence that these two mood stabilizers – which have been my drug regimen for almost five years now – really help me any, but i keep taking them in the hope that they actually are doing some good.  But thinking about my brain as having a kind of seizure prompted me to get up and take today’s dose of Lamictal.

So, as i lay very still on the sofa and talked to Byron, i treated my whole self very tenderly, speaking slow and soft and saying out loud some of what i had been thinking about my suffering brain.  By the end of my 20 minutes, i was actually feeling a little better.  The outside rain had let up and the outside sun had come out, so i decided to see if i could sit up out on the porch without the pain reasserting itself.  And, amazingly, it did not – and i enjoyed sitting out there on what was now a lovely early autumn day.

And by the end of Byron’s 20 minutes, i felt even better.  I had said during my time that i was releasing any expectation that i would accomplish anything today.  “I’m liable to stay right here on the sofa all day, to be unable to move around much at all without the pain coming back.  Walking the dog feels right now way too much, but he’s outside free to run anyway” (which he always is in our country location).  “I can’t picture that i will have it in me to go into town for choir rehearsal tonight.”

But, amazingly, by the end of Byron’s time, as we were starting to wrap our phone call up, I told him that i thought i might be ready to tackle a fairly mentally challenging task that i was very attached to getting done today.  Iwasn’t quite sure this was so, but i thought maybe.

My energy state continued to right itself fairly rapidly over the next hour – and then gradually over the rest of the day, until now (having returned from choir and even one high-priority errand on the way there) i’m basically fine.  There’s no predicting about tomorrow, but in this moment i’m really fine.

Maybe the Lamictal kicked in that fast to get my biochemistry back right with the world, but I bet my shrink would say that was impossible.  Maybe my biochemistry was just getting ready to shift anyway.  It often does happen that fast – and I can’t believe this could have happened without that being at least being part of the picture.  But the interactions between my biochemistry and my psychology are so complicated that who knows what drove what.

All i really know is that i am very, very grateful.

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