Monthly Archives: June 2015

Thinking about chronic mental ill health

I’ve been reflecting recently on the way I view my own mental health.  I write often on here, and on twitter, about hitting a ‘hypomanic period’ or a ‘depressive period’ because, as I leap from one to another, I think of them as separate events.  But not only does a hypomanic ‘period’ inevitably lead into a depressive one, they aren’t isolated incidents.  They are, cumulatively, cyclothymia itself.

It’s been useful (necessary?) for me, up to now, to think of them as separate events which I pass between and through rather than thinking of them, along with my ‘stable’ periods, as a whole, and a connected manifestation of cyclothymia.  I needed to think of them as distinct periods which had clear starts and ends because then I am not always ‘within’ cyclothymia – I didn’t know how else to conceptualise it, how else to describe it without suggesting it defined my entire life.  Increasingly, this kind of thinking has made me feel more despairing about experiencing highs and lows; why can I never stamp those emotions down permanently? Why do those feelings keep resurfacing when I beat them down last time? What am I doing wrong that I can’t win the war?

I’m thinking, today, about the language of chronic illness.  I found this article an interesting read: 5 ways you’re not ‘living’ with chronic illness which recommends some shifts in how we think about our own chronic ill health in order to prevent it taking over/directing one’s entire life.  When I decided to stop therapy and come off meds I believe I addressed the first point – stop looking for the why.  There are many, many theories from genetic to social and beyond that propose reasons why individuals develop cyclothymia and other conditions; none of them offer me a solution. So why was I pursuing treatments which offered me little help but were founded on one or more of those theories?  As I’ve said before, med free is not the right choice for everyone, but I got so little from the various drug treatments I tried, walking away instead of pouring more energy into finding the ‘miracle’ cure for me was the right way to stop living under cyclothymia and start living with it.

Point 2 is also something I’m fortunate I’ve been able to achieve.  

Point 3 gives me pause though; you’re not living with chronic illness if you’re hating yourself.  Self-loathing is both symptomatic of cyclothymia and caused by it.  I, like many other people I have spoken to with this illness, have lost things and people that mattered because of some of the ways cyclothymia manifests itself in both action and personality.  And, as I mention above, I come to hate myself for not being able to fix myself, for not being able to simply step out of this restrictive jacket of cyclothymia and into a life of cheerful ease.  Which leads me, as it does the article, into point 4; you’re not living with chronic illness if you’re fighting it.  This doesn’t mean stop trying to improve my health and manage my illness; it means accepting a paradigm shift from thinking of it as something to be ‘cured‘ or ‘fixed’ to thinking of it as something to be managed, contained and yes, as the article’s title says, lived with.

I am not failing because the ups and downs keep coming. I am not [and I struggle to write this, but I must try to explore the idea] unlovable because I have mood swings.  I am coping.  I am managing to get through my life in lots of ways that are great, and celebratory.  I am not a fighter – I am resilient.  Winning (if we must persist with the language of a fight) with chronic illness like cyclothymia, means carrying on each day and finding and using new ways to make life easier, moods more manageable, and life more fulfilled.

For example, right now I’m once again in a particularly brutal down-swing.  And I find myself compulsively harming myself; simply to contain my emotional extremes, in order to, for example, prevent myself from crying on the bus home, or from weeping during a party.  If I think of each down-swing as a separate event, I have no explanation for my self injurious behaviour.  

If I think of all my down-swings as part of a single experience of mental ill health (which of course, is precisely what it is and why my entire emotional experience is diagnosed with a single condition) then my current behaviour is simply a resurgence of a symptom I have less frequently than some others. It’s just a ‘flare up’ of one of the least pleasant elements of this illness. And if that’s true, it’s not that I’ve totally failed to maintain my previous progress, it’s just that, this time, the down-swing is particularly intense and as long as I keep moving forward (point 5 from the article) after this, and keep thinking of what I can do to make those symptoms less destructive and emerge less frequently (perhaps by identifying what has pushed me that bit further this time – stress?) then I am living with cyclothymia. I am still in control.

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Sleep

I am obsessed with sleep.

How much did I get last night? What’s my average this week? This month? How many times did I wake up last night? What arrangement of pillows gives me the best sleep? Did I sleep too much? Do I have a real headache or have I slept too much/too little? I could go on and on.

Sleep – too much or too little – both reflects my current mental state, and dictates it.  When I’m on a fairly steady keel I find I sleep a solid 8 hours, usually waking once, invariably waking groggy (I’ve never been a morning person) but rested.  Running into, and during, a depressive period I sleep terribly but frequently – upwards of 10 hours at night and often napping during the day – and walk around in a fog of exhaustion and anxiety.  During manic periods I sleep little, sometimes as few as 3 or 4 hours a night

I have a sleep tracker on my phone and have been coveting a fit-bit ever since I learnt they too track your sleep. Right now my sleep tracker tells a sad story – more than a week of sleep below my ‘ideal’ 8.5 hour line punctuated by 1 night of 11 hour sleep followed by an especially miserable 5.5 hours.  The mood cost of this? Anxiety, exhaustion, slow thinking, poor attention span and a niggling feeling the world is about to fall down.  Am I sleeping badly because I’m in a low or am I in a low because I’m sleeping badly?

There is quite a bit out there in internet-land about the importance of good sleep patterns if you have bipolar [spectrum] disorder.  A few online sources suggest that lack of quality sleep can trigger a manic period.  I’m not sure my own experience corroborates that and one might also question presumption of cause and effect implied in that conclusion (i.e. does sleep deprivation trigger a [hypo]manic episode or is the first sign of a hypomanic episode reduced need for sleep?). As I say above, I find lack of sleep corresponds with the beginning of a depressive period (although again, is it lack of sleep, or is it that I don’t sleep much because I’m hypomanic and then I, inevitably, have a depressive period?).

What I have found, conclusively, is that maintaining a reasonable sleep pattern and getting enough sleep (8 hours) each night is the best method I have available to maintain a stable mood.  I usually make it to about 3 weeks feeling ‘normal’ if work/life stress is average and I get a regular, uninterrupted, 8 hours.  It’s not much, it’s the time I live for though. The time I think least about whether I am happy or sad and, therefore, the time I am happiest.

Right now, I’m under quite a bit of pressure at work and over the last month have spent more time sleeping on friend’s floors, hostel beds, hotel room beds and buses than I have in my own bed.  It’s getting to the point where I’m fantasising about a week where I don’t have to set an alarm for any time before 11am (because, my brain is still out to get me and if I don’t set any alarm at all I sleep for 12 hours) and wondering if I’m setting any new records in surviving sleep deprivation without actually being technically sleep deprived (7 hours sleep on average the last 2 weeks)

Identifying how important decent sleep is to my mood is more than half the battle, I’m sure of that.  What is harder to deal with is what my obsession with sleep means for social and romantic life.

Ever fallen into bed with a new lover, then checked the clock as you finish and realise you needed to be asleep an hour ago? Then immediately ruled out anything else by turning over and concentrating on going to sleep? Ever left parties early, not because you had an exceptionally early morning or important shit to do the next day, but because you didn’t want to ruin the rest of your week with one disrupted night’s sleep? Ever refused a friend a place to stay because one night with someone else in the room means sleeplessness, and sleeplessness means a lost week?…And on and on it goes.

I love sleep.  I really do.  I love getting into bed, burrowing down, hitting ‘sleep’ on my phone.  I love waking up but not needing to go anywhere and just lazing in the in-between-haze of asleep and awake.  I just don’t love needing that more than almost anything else in my day if I want to be functional, coherent, and, most of all, sane.  I’d love just the odd late night without consequences.  Just a few sneaky early mornings without feeling like I have bugs crawling under my skin or that my brain is going to vibrate out of my skull.  And I do wish I wasn’t so obsessed by everything to do with sleep, because I think it’s a dead giveaway that I’m nuts when I meet someone new and my entire life is quickly revealed to be dedicated to a Good Night’s Sleep. It’s surprisingly hard to make an obsession with sleep – something we all, quite clearly, do – seem normal.

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