Wednesday, March 5, 2014

Emergency! Begin Rumination Now!


My very old mother-in-law falls one night heading for the bathroom. She calls an ambulance. At the hospital they say there's nothing wrong, no particular cause, and no injury from the fall, so back home she goes. When we visit the next day, she can't walk, her ribcage hurts and she's short of breath. Crisis. 

I act. I insist on calling her doctor. He asks some questions I relay to her because she can't make it to the phone, then he says if her breathing gets worse to go to the hospital. The next day it's worse, but she won't go. I call an ambulance anyway. (My husband and his siblings aren't taking this too seriously. I'm the only one ringing the alarm bell.) This time they tell us she cracked a rib and punctured her lung.

It turns out well. The puncture is small and the rib will heal on its own. She spends one night in the hospital (telling each visitor as they leave: "Remember, DNR. If it comes to that, don't intervene").

It would seem I handled it well, right?

But after a crisis has passed, within a short time my vigilance turns inward. I begin to examine myself - from every conceivable angle, in every conceivable light. And again I find plenty to ring the alarm bells about.


  • Could I have prevented any of this?
  • Did I do the correct thing at each and every step?
  • Did I insult anyone?
  • Maybe I contributed in some undefined way to it all happening in the first place?
  • Did I overreact? Did I underreact?
  • Was it really my place?
  • Have I caused a rift in the family? 
  • And, finally, how will I survive - not the crisis but the anxiety that follows?

When I consider every angle, from every perspective, in exhaustive detail, I find myself at the crux of everything. This thing I do, this anxiety show - it's like paranoia turned inside out. Instead of forces outside myself conspiring against me, it's me causing, directly or indirectly, presiding over, knowingly or unknowingly, and bearing responsibility one way or the other for every misfortune imaginable. I blame myself on each and every count, with no evidence or argument, and meting out no mercy. I even blame myself for blaming myself. The crisis itself is resolved, but for me it's just beginning. It's already gathering steam.

Yes, of course I didn't overstep my bounds! Of course I couldn't have prevented it! Of course I didn't cause it in the first place! Of course people weren't judging  me - they were busy dealing with the crisis! Of course I wasn't "wrong" because there is no one right or better way to handle things - there's just me as I am with my strengths and intentions. Of course I'm not perfect.

Of course to all of that.

But I don't believe it - not in my bones or at the bottom of my mind. I can't accept it. I won't let it rest. I worry; I ruminate. To ruminate is to chew the same wad of food over and over without ever breaking it down into manageable bits your throat can accept. When I worry, my mind chews on itself in the same way. Even when there's absolutely no point in it and I know it - especially when there's no point in it - my anxiety roars down the tracks like a runaway train. Except the runaway train is on circular tracks.  

It's a terrifying ride. It makes your head hurt, it keeps you up all night, it makes you literally pull your hair out and scream and cry. It makes you doubt your sanity. It makes you doubt you can ever get off and that you'll walk away under your own power if you do.

                                                *     *     *     *     *     *     *

Most people stay on that train until someone stops it or it runs out of fuel. For me, somewhere along the line I must have learned (by trial-and-error?) another way to pause the broken record. Sometimes when I've been on the same groove for a very long time, or the ride is especially rough, my unconscious mind tries to hit the brakes. It issues an imperative to create a new crisis, one that is about me, one I did cause and can control (well, usually). There will be no paralyzing uncertainties. No one else will be involved, much less endangered (except they will be, and it will hurt them terribly because they love me). I really will be at the center of this crisis and at every one of its turns because I created it and am carrying it out.

For me this imperative is usually in the form of incising my arm or thigh with a razor blade, or burning myself with a "safety" lighter - the kind you use to light a gas grill - or taking too many pills but not enough to kill myself. Sometimes I bang my head, sometimes I slam my fist against the floor or drive my leg into some furniture over and over again to watch it bruise in living color. The worse the anxiety, the worse the damage I do. 

Thus, a new crisis is born to take the place of the old one. One train pulls into the station, another one leaves. And pretty soon this new one's picking up speed. The needle's hitting the groove. I'm getting anxious.

                                               *     *     *     *     *     *     *

The crisis with my mother-in-law and what ensued was relatively mild. I didn't end up hurting myself. I white-knuckled it through. But it says something about anxiety, I think, that spending a good two days paralyzed by self-doubt, chewing my lips, balling my fists and hitting my head with them, spewing my circular "reasoning" all over some Facebook page (or no, please, not my own) and telling my husband long into the night that I was such a worthless piece of shit I'd do everyone a favor by being dead - that was a milder case of anxiety.

Bipolar cycling plays a part too - but a small one. This is anxiety's show, although bipolar sometimes sings backup. Everything starts with worry, continues with worry, and ends in worry - if  it ends at all. Obviously going over and over the past and future, obsessively and inconclusively (or all too conclusively) is futile. But it's also self-perpetuating and self-sustaining. It becomes me, or I become it. We swallow each other.

Psychiatrists call this kind of worry "rumination" for a reason. Cows chew their cud to digest. Some anxious humans chew their thoughts just as steadily and vigorously, but for us the cud doesn't thin or pass, it just gets larger. It lodges in the mind undigested. And sometimes it only comes loose when a new crisis emerges to take its place - even if we have to whip one up ourselves. 

Then we can start all over again, chewing our thoughts, wringing our hands, picking up steam.

Friday, February 28, 2014

Friday, February 21, 2014

You Wake Up Saying

“It’s not that you wake up one day, saying, I’m going to kill myself today. It’s that you wake up every day, saying, I’m going to try not to kill myself today.”

~ Deborah Treisman
(David Foster Wallace's editor)

Thursday, February 20, 2014

Unfurl Your Fingers One By One

Nothing anyone can do will open it. It hurts all over to be frozen shut, and it seems final. I feel that way a lot. I can't let go.
All I think you can do is try to remember warmth. The more you remember, the better the chance your fire will grow. You have to thaw from the inside. 
And then it might be possible to offer your open hand to life again.

Thursday, February 13, 2014

Change.org Petition to Fund Research to Cure Mental Illness

Change.org Petition

Organizations like change.org can command MUCH more attention and influence than individuals. So please sign this petition (no registration required - just one click) to increase funding for research on mental illness. We need better treatments, and maybe even cures.


http://www.change.org/en-CA/petitions/to-the-president-and-congress-fund-research-to-cure-mental-illness

Monday, February 10, 2014

Do You Really Want to Know Your Future?

A discussion is going on among my Facebook page's members about whether bipolar disorder is a "progressive" illness. Does it usually worsen over time despite medications, therapies, lifestyle changes, social support and all the other ways we've been told or believe will help? Is it possible to cut the number, frequency and severity of episodes? And if it is, could this eliminate or ameliorate the damage done to our brains' anatomy, neuronal function and cognitive skills?

Virtually all sources agree that UNTREATED bipolar disorder will worsen over time. And once a brain has had a manic or depressive episode, it becomes many times more likely to have another one. Left untreated, this process ("kindling") accelerates: more and more episodes, worse in severity, oftentimes rapid cycling and mixed states.The brain structure and neuronal function change.

But what about TREATED bipolar disorder? The impression most popular sources give is that if intercepted early and controlled with medication, bipolar does not have to be progressive or degenerative. Things will start looking up, they say.

But, as you know if you have this disorder, even started early the treatment is hit and miss. It works sometimes, others not, and there's a seemingly lifelong pursuit of the right medication cocktail. Does that kind of treatment -- the real world kind, what people actually get -- interrupt or stop the natural progression of the disease?

The literature is not clear. Some say the process can be halted; treatment will give us an outcome close to "normal." Personally, I have my doubts. It's an established fact that people with mental illnesses die an average of 25 years earlier than people without one. More is going on than just lack of treatment or lack of supports (or lack of housing, money and jobs). The 25 year life expectancy gap gets more disturbing the more you look into it, because it turns out that it is true even after controlling for suicide, co-occurring disorders and lack of health care (and those other "lacks" I mentioned). Mental illness itself seems to make you die earlier. You are more likely to die of cardiovascular disease or diabetes if you also have bipolar.Why remains a mystery.

People on my page, called Bipolar Over 30, talk a lot about how our bipolar disorder seems to be getting worse as we get older. Treated early and steadily or not, we still tend to have more and more episodes over time, and/or they are more severe and disabling, and/or we have permanent cognitive deficits and collateral problems that make life very difficult. We find ourselves more and more disabled by it even if we had and continue to get the best treatment. BUT NOT ALL OF US DO. There is wide variation among individuals.

What do you think about this? If you are middle aged, has this happened to you? Do you see a lighter or a darker future ahead for you?

I tend to believe the research that says bipolar worsens over time and so does our ability to function day to day, for "anecdotal" reasons: I see it in myself and others I've talked to. I think popular sources that say otherwise are whitewashing things, being "positive" in hopes of motivating people -- perhaps mercifully but not honestly, and perhaps not very helpfully in the long run.

But how should you handle this information if it's true? Does it rob you of hope and motivation to continue? What does it mean for your outlook, expectations, planning, -- and for your family or caretakers? Does it profit anyone to receive this information, earlier or later in their lives? Would you want to know in advance if your bipolar disorder will probably be a degenerative brain disease just like M.S. or Parkinson's, albeit with the same uncertainty about any individual's outcome? 

Personally, I want to know. But, knowing, I will live out the rest of my time on earth as if I didn't.


Saturday, February 1, 2014

A Stash

I did something today that was strange and unsettling, but I'm not going to undo it. I there are others who understand why, and even some who've done the same.

Three days ago, I suddenly tripped and fell into a reeling depression. An incident among my family in which I played a key role - a bad role - devastated me. In just those few days I've gotten increasingly suicidal; in fact on the day of the incident I took a small overdose (small because I took them one by one and after seven I blacked out). My husband came home to find me passed out and barely responsive so he confiscated my supply of that drug. 


Today I woke up still feeling desperate and full of dread, so immediately, frantically, I searched my mind for sources of more of that drug. No ideas. But I made myself come downstairs, fed my dogs, ate breakfast, read the paper, went on the Internet and began to feel better. I even thought maybe that awful incident wasn't as momentous as it seemed. Maybe I hadn't caused a major irreparable rift. It could be just a bump in the road. But when I went to get coffee in the afternoon, I saw a bottle of leftover pain medication next to the coffee machine, enough to kill me.

So, without feeling suicidal or even depressed anymore, I STILL HID THE PAIN PILLS WHERE NO ONE BUT ME COULD FIND THEM. And it was such a relief. Even though my mood had just changed from really bad to okay, and I knew that happened all the time, and probably would continue to do so - I still wanted a suicide tool in reserve. Just in case one time it didn't and I stayed in hell.


In the end, all that matters to me is that I'm not trapped at the bottom of that pit with my suffocating hopelessness, flaming pain in every cell of my body, and screaming in my head that never pauses even for a minute and will never end. So I stashed the pills.

Does that make me brave or a coward?