Tag Archives: cyclothymia

The Not So Secret Life of the Manic Depressive

On Monday of this week, 15th February, BBC showed a documentary [still available to watch on iPlayer if you are in the UK]  following up on Stephen Fry’s landmark documentary on living with bipolar disorder, The Secret Life of the Manic Depressive, which was shown 10 years ago.  I remember watching that documentary vividly.  So much of what I heard and saw from the contributors resonated with me – I didn’t have a diagnosis of cyclothymia then, but I did have suspicions.

This blog is part live blog, part reflection on the show. In bold is the key event/moment in the show, the rest of the paragraph is my commentary which I hope will be intelligible even if you have not watched the programme.

Stephen Fry, post suicide attempt, decides to see psychiatrist – and then he sees one!  This is evidence of a BIG difference between private healthcare and dealing with the NHS. And he tells us he was immediately admitted to hospital. Again, wildly different than experience of NHS – with the enormous and unending cuts to NHS mental health services there are no beds. And in most cases there is no possibility of hospitalisation without a section – and a good deal reliable rumours suggest doctors are avoiding sectioning people who need it because they simply have nowhere to place them.  Stephen Fry’s experience is (absurdly given how essential mental health treatment is) one heavily inflected by his economic privilege.

Kids in the school talking about how “bipolar” is used as an insult really drill to the heart of living with bipolar spectrum disorder.  People do not like it.  It’s not charming, it’s not represented as ‘useful’ (however inaccurate that is) and featured in a regular show, it’s not cool.  It’s also something I reflect on a lot in terms of disclosing my mental health issues – I am always conscious that once people know my diagnosis they will rationalise or dismiss everything I do or say in reference to that label – enthusiastic? Nope, just bipolar.  Annoyed? Nope, bipolar. Inspired? Loud? Introverted? All symptoms.  You stop being a person.

Stephen Fry’s psychiatrist is talking about how difficult travel and crossing time zones can be to managing your mood. It reminds me of the difficulties I had whilst I backpacking round the world with my then-partner.  She would become furious that I was exhausted by our flights across time zones, and furious my mood would plummet with my exhaustion, and furious I could not explain why I was so unhappy so suddenly.  It made me anxious, guilty, furious at myself.  I turned her lack of understanding inwards and began to hate myself for all the things I wasn’t; all the ways I couldn’t be.  We split up many years ago now, and since then I have learnt a great deal about my needs in terms of rest and sleep – but those experiences burned me and I find it difficult to imagine being in a relationship ever again.  Who would live with cyclothymia if they didn’t have to? That’s what dating someone with cyclothymia means; you have it, we have it.

Narrator is talking about frequency of self-medication versus reluctance to take prescribed pills.  Sadly, the show seems to dismiss this as bipolar folk simply being unwilling to put up with side effects and preferring to manage our conditions in other ways.  This obviously resonates with me – I’ve written before about self-medicating and my attempts to manage my cyclothymia with lifestyle and other changes.  But, as I’ve also written, the choice between medication side effects and uncontrolled mood swings is nowhere near as simple as psychiatrists would have you believe, or this program suggests.  Medication side effects are brutal.  Not enough is done to facilitate good medication choices, not enough is done to help people manage the side effects, not enough is done to acknowledge how destructive side effects can be on every other part of your life.

I note that, in reference to Scott’s experience, the psychiatrist shrugs off his query/anxiety that he will be ‘like a zombie’ on mood stabilisers, exactly the conversation I had with a psychiatrist, and it proved completely inaccurate.  I was zombified.  It became untenable for me to live like that.  No follow-up on Scott after he doubles his lithium dose, I hope it works for him, I fear it won’t.  I note also, there’s no discussion of talking therapies or alternative approaches to treatment – it’s ‘medication or nothing’ on the NHS, regardless of how ill fitting that may be for an individual.  This issue – and the considerable weight of evidence which suggests medication-as-only-intervention is an inadequate way to manage mental ill health – is offered in response to the show in this blog by Richard Bentall, Professor of Clinical Psychology at Liverpool University.

Rachel’s story of experiencing her worst lows at night, alone, as a teenager resonates with me.  The difficulty for parents to identify more-than-average-teenage-melancholia is enormous. The story of medical services failing to identify her mania after she jumped from a balcony is all too common.  The discussion between Rachel and her CPN about sectioning her if she becomes a danger to herself in future is really concerning for me, because it’s evidence of fire-fighting rather than working on managing and improving her overall health through a variety of interventions (not just medication, which is all they say she has currently) now.  But I may be making too many assumptions with not enough information here.

It strikes me there is an enormous selection bias in this show towards people who believe it is easier now than ever to speak about mental health issues and receive a positive response.  Because if you’ve not disclosed to your friends, wider family, whatever, it’s because you are aware (or sure) of the potential for a negative reaction – so you’re certainly not going to blow your cover by contributing to this show.  If you’ve experienced negative responses you are not going to keep talking – this idea that ‘we’ can only combat stigma by talking is incredibly problematic for me.

When you are subsumed under stigma, you simply cannot speak, cannot contribute to some ill defined, under funded campaign to combat stigma.  Time to Talk Day came and went this year and I did not mark it on here.  Why? Because I didn’t talk about my mental health on that day to anyone who did not already know.  Had any of my friends who do not know about my cyclothymia asked how I was, I would not have disclosed my difficulties to them – not least of all because my mood was pretty good on the 4th of February, but also because a charity-sponsored day does not make people more prepared to deal with the mental vomit that is chronic mental ill health and the ongoing needs and demands that generates for me.

On Time to Talk Day  I asked all my friends how they were and made myself available to them in all the ways I always do.  But whilst starting a conversation may be a manageable goal, it’s continuing conversations about mental health that is the hard thing, and it’s continuing conversations which will actually start to change or erode stigma, and generate sufficient public feeling to pressure the government to actually invest in mental health services.

The ‘not so secret life of the manic depressive’? For me, save for this blog, it’s still a secret. Stigma around mental ill health is still enormous. And there is still so little out there to help people like me – and people, perhaps, like you – live with bipolar spectrum disorders including cyclothymia; regardless of well intentioned attempts of shows like this to change that.

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World Mental Health Day

I planned to post yesterday in recognition (celebration doesn’t quite fit does it?) of World Mental Health Day but my home broadband is on the blink.  Although, posting a day ‘late’ sort of illustrates what I want to talk about today.

I’ve always been a bit sceptical about specific ‘days’ for various causes, awareness raising or similar because what does it mean to say there is only one day you need to stand against homophobia? Or only one day on which bisexuals become visible? Or only one day on which we need to try and prevent suicide?

I like the idea of rallying people to a single day, bringing the energy together all at once for one big bang of impact.  I understand none of us have the energy to fight, full whack, every day, for each and every cause that has a day. But how many people think about these causes on other days? How many people thought about the importance of campaigning for better funding for NHS mental health services today? How many will think about it tomorrow? How many will act on it next week? Next month?

I don’t have much confidence in ‘awareness’ days. I don’t think they shift how people think of things in any significant way. And I think it’s too easy for politicians, celebrities, and anyone else with only a passing or superficial interest in these topics to ignore the ongoing issues of underfunded mental health services, and WCA-driven suicides (to mention just two of a hundred pressing issues) if they have paid lip-service to ‘caring’ and being ‘active’ on those things in the news and papers the day before.

Ultimately too, for me and for so many of you reading this, ‘mental health day’ is every day of our lives. Thinking about how my mental health is today (good, bad, hypomanic, depressed, stable, wobbly, neutral…) is the most consistent, basic way in which having a mental health problem has reshaped my life.  Even when my mood is fine – neutral, not at either end of a swing – contemplation of my mental health is the foundation of my day. How do I feel this morning? How much can I do? When will this stable mood end? How much can I do before then? What should I commit to now if I might be miserable next week. For this reason, days like World Mental Health Day seem like another reminder of my difference from the cognitively normal who get to neatly end their contemplation of mental health with the conclusion of the day.

What do you think? Does World Mental Health Day mean something significant for you? Does it achieve more than my cynical rendering acknowledges?

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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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On [non]therapeutic interventions and feelings of failure

I’m having something of a tough time at the moment.  I’m struggling with my work and as that is all I have in my life right now, that has an enormous knock on impact on my mood.

At about 3am last night (insomnia ho!) I was reflecting on my experience of CBT; why was it so useless to me?  I thought about a typical interaction I had in any of the 6 sessions at either of the three times I had CBT.  It would go something like this;

CBT Practioner: “So, what is difficult for you at the moment?”
Me: “I can’t sleep”
CBT P: “What stops you sleeping?”
M: “I feel tired, I go to bed, but as soon as the light is off my mind gets noisy and I can’t relax.”
CBT P: “What thoughts keep you awake?”
M: “That I’m a bad person. I think of all the bad things I’ve ever done and my stomach turns to a knot of anxiety and I go over and over and think about how people must think of me as a terrible, stupid, useless person”
CBT P: “Can you give me an example?”
M: [after some hesitation at saying these things aloud] “Yes. I phoned work the other day, my boss answered the phone. I said ‘hi, it’s me’ like I would to a friend, not a colleague, and she didn’t answer, so I immediately said “it’s [my name], it’s me.” And then we had our conversation”
CBT P: “So what makes you anxious about that?”
M: “I imagine she thinks I am an idiot, that I can’t even deal with a simple phone transaction properly. I embarrassed myself”
CBT P: “That one small thing?”
M: “Yes”
CBT P: “Do you think [your boss] thinks about that? Did she say anything? Has she indicated she thought it was odd?”
M: “No. I know that, logically, on the balance of probability, she doesn’t even remember it. I am sure even if she did, she wouldn’t care enough to keep thinking about it or make any conclusions about me. I’d be surprised if she even remembered it, it happened more than 6 months ago [insert time spans of up to 15 years in this for different things that keep me awake]”

And that is precisely the problem I have with CBT.  I can identify my thought processes as irrational, I can imagine the most likely and rational response other people have to all these imagined faux pas, I can even have confirmation from people that, no, they don’t hate me because I didn’t hold the door open for them 6 years ago that one time.  But I am perfectly capable of – skilled at, even – holding two pieces of contradictory information in my mind at once.  I can know, be 99.9% certain that people on the street aren’t talking about me, laughing at me, but I’ll still hurry home and slam the door closed behind me, heart pounding, because there are two parts of my brain – one sane, one insane.

Insane.  A strong word, but in it’s purest, most precise meaning, that can be the only description of the thoughts that drive my anxiety and unhappiness. It is apart from rationality, it is apart from reasoning, and thinking it out.  As I told the final CBT Practitioner I met (who was disillusioned with CBT too, and enabled me to voice my problems with it, for which I am grateful): “if I could think myself out of this, I would have done it already. I’ve been trying to think my way out of it since I was 14”.

He smiled and agreed, ‘yes, it has limitations’.

I can understand I am wrong, and still feel with every fibre of my being, the wrong thing to be true.  When I went private, very briefly, for therapy/counselling, I discussed this with the counsellor. She kept saying, with a bit of surprise, “it’s like there’s a split, you have a split in your thinking, two halves”.*

But I still feel like I failed at CBT and not the other way round.

Right now, for example, I am very unhappy and very demotivated. I’m not getting any work done and I’m angry with myself for that, and that anger isn’t translating into action.  I look at my life; I am financially set for the next 12 months, I have a nice home, enough food, enough clothes, I am doing the thing I supposedly love (PhD) and I’m doing it in one of my favourite cities in the world. I am unburdened by serious responsibility or serious health problems.  What on earth have I got to be depressed about? How dare I?!

And I know, of course, as everyone bleats and shares and reassures “depression isn’t about circumstance, it’s not about how great your life is, anyone can be depressed”.

But, as we established above, I am really good at holding two conflicting pieces of information in my mind at once.  I’d never judge a friend for saying they are depressed when I think that they have a good, or enviable life; I’d just offer support and love and help in anyway I could.  But me? I look at my life, all the opportunities I have, all the opportunities I am sitting in the middle of failing to take advantage of, failing to ‘grab the moment’, failing to do things people would give their eye teeth for that are sitting open to me and I cannot understand why I am not happy.

Why aren’t I living the wonderful life that is sitting open to me?

Why aren’t I happy with all the great things in front of me? Why can’t I think myself out of this?

And more than that, if I’m not happy now with what I have, and I pursue and attain the next list of things I think will make me happy, how can I ever be happy? There is no pot of gold at the end of the rainbow.  Just more “oh, it’s not this pile of things and people and opportunities I need to make me happy, it’s that pile of things and people and opportunities I need, I’ll go chase them”.

It’s unending.  It’s always going to be me saying “just a little further, then I’ll be happy”.

What I need is to be happy here. I have no idea how to do that.  I just know I should be already.

* I didn’t care much for this as a response because that’s diagnostic of schizophrenia, and no, my mind isn’t split – the two contradictory parts talk to each other – that’s the conversation which keeps me awake at night.  It’s also a really unhelpful comment – yes, I know it’s odd I can hold such polar opposite thoughts, how do I stop doing it?

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You Wouldn’t Like Me When I’m Angry

I’ve spent some time thinking about what my next blog post should be.  There is a more general piece on trigger/content warnings on online safe spaces brewing in my head but today it’s a much more personal ‘state-of-me’ post.

This blog has always been about my journey through a life with cyclothymia and right now that journey has come to a cross roads.  How do I proceed? What do I need?

The biggest issue in my mental health life right now is anger.  Anger has its uses, it gets me out the house, it makes me stand up for myself, it motivates me, and it keeps me from caving in on myself when things get tough.  But it also means I lash out at people around me, alienate them and isolate myself.  Anger means I never rest, never feel relaxed, always ready and waiting for the next fight.

Anger has, I’m coming to see, become a crutch.  It’s no longer an emotion which helps me – perhaps it never was although at one time I was sure it was all that kept me alive – it’s an emotion which is just burning me up from the inside and leaving me no energy or love to put out into the world.

I’m angry about a lot of things; I’m angry I have cyclothymia, I’m angry my brain can cripple me emotionally and physically with no warning.  I’m angry about the person cyclothymia has made me – insular, untrusting, nervous, exhausted.  I’m angry about the way I’m living my life – both the choices I made that brought me here, and the factors I never had control over that caused life to end up this way.  I’m angry about the way some very important people in my life behaved, I’m angry about the way I have behaved towards others.  I’m angry I keep getting knocked on my arse by a resurgence of bad, depressive feelings. I’m angry I can’t control it.  I’m angry about the crap treatment offered (or refused) to me by the NHS and I’m angry we have had 30+ years of governments who don’t care about mental health enough to put any meaningful investment into it.

This list of things I am angry about could go on and on, and I’m angry about that.

So what I need, now, urgently, is to find a way to deal with this anger and if not erase it from my day to day life then at least channel it into some more useful outlet than the current mute and impotent fury I carry around in my chest each day.

I need to find a way to get up each morning, face the world, and do my work that doesn’t depend on, function through, anger.  I feel like I’m pedalling furiously and standing still because so much of my energy goes into feeling angry but so little of it turns into anything productive.

And too much of my anger gets turned in on myself – why aren’t I better? Why don’t I do better? Why aren’t I the kind of friend, colleague, ally I would want? Why am I unable to make myself different? Why can’t I just shut up and get on with life? And then that anger turns into self-punishment, drinking too much, sleeping too little, denying myself a social life, refusing to plan for a different future.

It’s time to change.  This is a line in the sand.  I’m going to explore ways to let go of anger and ways to generate positive energy to put into the world and to motivate me to live.

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You’ve Got that Manic Feeling

I’m back on the roller-coaster.  Or rather, I never got off the roller-coaster and right now I’m cranking back up to the top.

I felt it coming, as usual.  Over the last week I’ve had groggy morning brain which evaporates in the shower and leaves me with LOADS OF FUCKING ENERGY.  Today and yesterday I’ve barely slept – or rather, I’ve slept for the usual amount of time except for the second 4 hours I sleep lightly, waking frequently, drifting in and out of trippy dreams.

And there’s the anxiety.  That’s the other clue.

Skin crawling, brain itching, restless body anxiety. Tick tick tick tick….can’t sit still, can’t rest, can’t focus, can’t calm down.  This is shaping up to be a period of unpleasant mania.  It was perhaps inevitable because my last couple of hypomanic periods have been relatively mild and largely positive.

Last night I mentally composed an entry for here about dealing with anxiety; dealing with the oncoming wave of hypomania.  I was going to recommend my two preferred activities; sewing and swimming.  The former is repetitive, time consuming, and mind-numbing, the latter burns off loads of nervous energy in a really productive way that is energising in a ‘natural’ way rather than a hypomanic way.  Today I’ve been sewing for 5 hours, went swimming for an hour this morning, and I’ve cleaned the flat top to bottom. Unfortunately like almost all of my ‘coping’ strategies, when I get to the extreme end of high and low, they just don’t cut it.

I’m a little angry with myself this evening; hypomanic confidence has assured me that I didn’t need to work on a piece of work  which is due on Tuesday. I’m battling my brain over this even now; the little voice of rationalism is saying: “but it really would have been good to spend just an hour on it to assess how much additional work is needed tomorrow” whilst the booming voice of hypomania confidently shouts it down: “if we get in at 10am tomorrow that’s an hour to work on it before 11am meeting. 12-1pm planning Tuesday’s seminar and then the rest of the afternoon to work on Tuesday’s piece of work. Really, we needn’t have even worked on it yesterday. In fact, maybe we don’t even need to get in for 10am, we can definitely just wing it on Tuesday, now how about a nice triple vodka and orange?”

I’ve got a glass in my hand.  I think the comforting, friendly, fun voice of hypomania might have won this round.  It usually does.

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Creativity and Mood Swings

I have a real problem with the persistence of the idea that madness – in any of it forms but most often bipolar spectrum conditions – gifts sufferers with unique creative abilities.  This idea is circulated by seemingly unending articles and books featuring the work of artists who ‘suffered’ from Van Gogh to Sylvia Plath, Amy Winehouse to Virginia Woolf.

In part, I (and I’m not alone in this) think it’s a case of uneven representation – the many bipolar and cyclothymia sufferers who produce nothing of artistic or literary value are never reported on, the tiny fraction who do are proportionally over represented.  There are some convincing studies which suggest creative professions are disproportionately populated by people with mental health problems – again I feel cause and effect are getting muddled here.  Madness does not make you creative but if you are mad, creative industries are one of the few which are flexible enough to allow mad people (whose ability to work varies wildly as their health fluctuates) to succeed.  It’s something I wrote about briefly in the Great Big Cyclothymia Q&A in relation to work.

I can almost hear someone out there asking ‘why does it matter that people say creativity and madness go hand in hand? It’s only ever a compliment!’.  Well, quite simple; with the suggestion that madness gifts creativity and originality comes the implication that in the misery of mental ill health we should be celebrating our unique, special and oh-so-valuable gift of creativity.

I’ve often tried to comfort myself with that pleasant lie; ‘I’ve got as far as I have because cyclothymia has given me this bolts of insight’ – both when I am hypomanic and when I am depressed.  But the truth of it – or at least the thing that feels more true – is that I’ve got as far as I have with my academic studies in spite of my poor mental health and not because of it.

Despite this – or perhaps because of my own uncertainty about whether I am helped or hindered by mood fluctuations – I find depictions of madness in art and literature absolutely fascinating.  I recently read Barbara Stok’s Vincent which manages to beautifully illustrate Vincent Van Gogh’s period living in the South of France.  I was particularly struck by the way she illustrated Vincent’s deteriorating mental state.  In the three panels below, taken from several pages apart, you can see the ‘specks’ closing in on Vincent (click to embiggen).  The clear skies of the first panel become busy as Vincent begins to panic in the second, and finally almost obscure the colours around him as he becomes despairing in the third panel

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Later still, in moments of agony and disassociation, the frames spill out from their previously precise squares into jagged explosions.  What a remarkable skill Stok demonstrates, to so ably transfer a mental experience to a visual one.  And that, I realised as I read Stok’s book, is what really appeals to me in depictions and descriptions of mental ill health.

From Allie Brosh’s now famous depiction of how depression feels and Ruby Etc’s comical piece on how listening to music can vary so wildly with bipolar, to monsters which illustrate different mental health diagnoses and the exploration of anorexia Manic Street Preachers offer; art can tell us something helpful about mental ill health.  It can, in a way more immediate than dense prose or long blog posts (!), assure us our experiences are shared and give shape and substance to that thing inside ourselves which we struggle against.  Perhaps that’s also why so many people with mental health struggles feel compelled to try and record something of them in their creative output; naming the beast, drawing the beast, finding the beast in the hope it can be slain.

As for creating art and literature when mad? It has before now been a way I monitor my own mood* and what I produce when hypomanic versus when I am unhappy, or even fairly stable, is one of the many signals I use to understand when I need to take a break, ask for help, or even schedule extra working time into my month.  But does any of it happen because I’m mad? No, it’s always the things I would be doing anyway amplified, or muffled.

 

 

* I produced two self portraits some years ago, the first when I felt fairly stable, was in my typical style, the second when I was hypomanic came out of me without my really understanding how I painted so differently.

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New Year, New You?

I’ve been weighing up a New Year post in my mind for a couple of weeks now.  In all honesty there are two big things that have stopped me.  Firstly, I’ve been feeling pretty good for some of the last month or so and, as I’ve written about before, when I feel good I’m always sure I’m not going to be unwell again and I certainly don’t want to think about the possibility I could be.  Secondly, I’m more inclined to reflect on the last 12 months, and look ahead to the next, on my birthday.  There are lots of positives to this: it means you begin every ‘year’ by having a party about how awesome you are for being alive; it means (as my birthday is in September) it happens during my favourite time of year – lovely lovely autumn and even if my annual review makes me sad I get to revel in the crisp fresh air of autumn; and it means I’m not influenced by the resolutions and triumphs of those around me.

A lot of people talk about how Christmas is a really difficult time for many people, and I’m not going to argue with that.  I personally find Christmas quite easy – your proverbial man-on-the-street tends to be more polite and charitable around Christmas, most things on tv are about the strength and qualities of the human spirit, and there’s lots of good food.  New Year on the other hand? Everything on tv is telling me I need to Be Better, Lose Weight, Shape Up.  The proverbial man-on-the-street is angry, hungover, skint, and filled with rage at the dying of the light (aka Winter Nights).  There’s very little good food, and often a lingering sense of indigestion.  And everyone else seems motivated and resolved to make themselves over, no matter how fleeting their resolve might be.

New Year, and January in general, are a hard, long, self-hating slog.

Naturally, I’m not one to abstain from the spirit of the season so I’ve committed to a schedule of self hatred, despair, and introversion.

I jest.  Well…I exaggerate slightly in an attempt to wrench comedy from my current low mood.

So I’ve decided to make January into my own personal mental health review month.  What went well last year? How I am going to make this year better?

Last year was punctuated by one of my 3-5 yearly major lows.  In 2014 this took the form of an almighty argument with a friend which turned into an almighty argument with my family which turned into an almighty throwing-stuff-in-a-bag-and-running-away-and-not-telling-anyone-where-I-was.  Not one of my finer moments.  It did, despite it’s car-crash execution, achieve what I needed at that time which was a release of the tension, anxiety and sense of being trapped which had been building for months.

When you are on a tight budget – which I permanently am – it can be hard to give yourself what you need.  Especially if the thing you need (and it always seems to be) is a break from your everyday life and a brief period of self-care and self-indulgence.  Self care.  That’s a phrase that sticks with me – sounds too much like ‘woo’, too new age, too indulgent.  And, as perhaps I will one day write about – the working class chip on my shoulder doesn’t stand for any of that woolly, wussy shit.

But this is what my 2015 needs; more time, more acknowledgement I can’t keep pushing and pushing myself and hope that the crushing anxiety and exploding stress in my chest will simply dissipate of its own volition.  It won’t.  In 2015 I need to take more time to refresh myself, give my brain some breathing space, and allow myself to break a little so that I don’t break absolutely.

Will I be able to do that? Well that’s another reason my 2015 is currently driven by sadness and a shunning of human company (haven’t spoken with anyone since Tuesday, oops?).  2015 is provisionally the year I intend to submit my thesis and to achieve that I do need to drive myself.  I’m not, and never have been, tolerant of anything other than perfection in myself and this will be a year that instinct is tested to breaking point.  Working out how to balance the need to push myself to my limit to produce the very best thesis I can at the very highest level I have ever worked and the very real need to hold my sanity together is going to be my biggest challenge this year.  I think it begins with taking time off and being kinder to myself.  I’ll have to see if I can learn how to do that.

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The Great Big Cyclothymia Q&A

This Q&A is almost entirely composed of search terms which have brought people to my blog.  I’m no expert, but over the years I like to think I’ve collected some instructive experiences and learnt, often from my mistakes, a few things which may, if not help others, then at least provide them with a perspective to consider as they continue researching these things.

How do you deal with a colleague who has cyclothymia?

I recommend dealing with a colleague who has cyclothymia in exactly the same way you deal with a colleague with curly hair.

If you would like to help a colleague who has cyclothymia then your first stop should be having a conversation with them about what they might need in the work place – it could be a friendly face, a regular coffee break or lunch-date with a colleague, it could be additional meetings with line managers to help flag up feelings of being overwhelmed or excessively stressed before they turn into massive problems.

If you have cyclothymia and you’re thinking about how to deal with this at work I recommend looking at the Mind website. They have extensive advice on being mentally healthy at work and the possible risks and benefits of ‘coming out’ at work about your mental health issues.  I personally have never disclosed a mental health problem to an employer, with mixed results.  The most negative experience was when I was a manager and my staff told me “you’re funny because you’re great to be around sometimes because you’re so enthusiastic and positive but sometimes you’re incredibly grumpy and it’s no fun working here then” which came as something of a surprise as I thought I was hiding my mood swings well.  If you’re considering disclosing your mental health status to an employer or colleagues remember that they probably already know something about you is cognitively….off.

Can you hold a job with cyclothymia?

This really isn’t a question with a definitive answer.  It depends on you, how well you are able to manage your moods, how you respond to stress, how much stress your job entails….Personally. I’ve found jobs which have a degree of flexibility – for example office work which has varied tasks to be completed in a month ranging from mindless data entry to complex accountancy work – to be one of the better positions I’ve held as I was able to set my own schedule for the day or week, and work around my capacity for concentration and originality at any given time.  Conversely, working in customer service, whilst tremendously easy when hypomanic, was excruciating and often-times disastrous when I was depressed.

Holding a job with cyclothymia, like any other mental health issue, is a question of how well you manage your symptoms, what degree of flexibility you need and can have, and how much you disclose to an employer and their response.

Is cyclothymia an excuse/reason for being rude?

It’s not an excuse, but it can often be a reason.

Both highs and lows bring their challenges for social interaction.  I talk over people when hypomanic and am curt with people when I am depressed.  I work hard to remind myself to think first and act and speak second.  But impulse control, as you likely know if you are reading this, can be a huge challenge when at the extremes of mood.

I always maintain that no matter what my mood, I am accountable for my actions – I apologise to friends and family I think I may have offended or upset as soon as I am able, and I try and let close friends know where my mood is so they can be prepared for some irrationality.  How well your friends tolerate your moods is down to a lot of factors – their patience and understanding, your willingness to be accountable for your actions, and sometimes, just dumb luck.

Should I tell my friends I have cyclothymia?

My close friends know, acquaintances and colleagues don’t.  As I say in the above point, having your friends understand why you may act erratically or very differently from one week to the next can help you maintain better relationships. Friends can also offer support and understanding when you really need it.

In the end, it’s up to you – what do you want to get out telling your friends? Do you want to help them understand you better? Do you want to ask them for support in some areas of your life? Do you want them to know that you understand their struggles with mental health because you have your own? All good reasons to share. If you want to tell your friends in order to get a carte blanche to treat them differently or to demand they alter their behaviour around you then you may want to think more deeply about how you relate to these people and what is reasonable, or unreasonable, to ask of people.

Does cyclothymia affect concentration?

Poor concentration is a symptom of depression.  Inability to focus on a task or subject for an extended amount of time is a symptom of mania and hypomania. So in summary? Yes.

Anecdotally, my concentration levels are one of the key ways I monitor my moods.  The moment my concentration drops significantly, I know I’m heading up or down.  We’re talking about something more significant than a tendency to procrastination, or that fidgety Friday feeling we all get; we’re talking staring at a page and reading the same sentence 6 times but taking nothing in. We’re talking abandoning one task to begin another because a better idea just occurred to you.  Lack of concentration, when it’s symptomatic of cyclothymia, describes just not being able to discipline or motivate yourself into acting in any other way than you are; it can mean doing a job is like wading through treacle so hard it is to make your mind process anything, or feeling like a butterfly on speed, flitting from one idea or job to the next without a pause in between, but completing nothing.

What are the habits or behaviours typical to cyclothymia?

I’ve written in various entries about some of the common experiences of cyclothymia, from hypomania, to anxious compulsions, to the suddenness of the onset of mood swings which is characteristic of cyclothymia.  I tag entries dealing with my experiences of specific symptoms of cyclothymia with ‘symptoms and habits’

To a degree, manifestations of cyclothymia are as unique as the sufferers, in other ways, there are a distinct list of symptoms which we all experience to a greater or lesser degree – some of which are also common to other mental health disorders.

Is my psychiatrist right about cyclothymia?

Short answer; yes.  Long answer; no.

Psychiatrists have a habit of telling people with cyclothymia that without treatment it will develop into bipolar II but this seems to be anecdotal and difficult to disentangle from people being re-diagnosed with Bipolar II after not responding to treatment for cyclothymia.  Psychiatrists, in my experience, also have a habit of insisting your life will be dramatically altered because of cyclothymia, and that you cannot successfully manage it alone – this may not be true, or it may.  There are so may variables in anybody’s life which make such pronouncements utterly meaningless.

Seek advice and information on cyclothymia from your GP, psychiatrist, from Mental Health charities or advisers, and speak to other sufferers.  Do not allow yourself to be pressured into decisions or treatments you feel uncomfortable with and feel empowered to ask for second opinions.  Psychiatrists do not have all the answers, they are not sooth sayers, they do not have a crystal ball.

I wrote a little on my experiences of following, and not following, a psychiatrists advice in my post ‘things I want you to know if you have cyclothymia

Can you manage cyclothymia without medication?

Perhaps.  I can.  Or rather I am trying.  Its a continual process and it depends heavily on your lifestyle, your job, your experiences of medication and your ability to maintain healthy routines.

I have written here, and here, about my attempts to manage cyclothymia without medication.  After a few years, it’s still currently the right choice for me; it may not always be the right choice for me and it may never be the right choice for you, but it is possible.

What medication can be used to manage cyclothymia?

I have taken a slew of anti-depressants and the last medications I was on were Seroquel and Mirtazipine which worked to an extent but ultimately I decided the benefits were outweighed by the side effects.

Wikipedia has a very brief list of the medications commonly used to treat cyclothymia as does the NHS choices website (scroll down for ‘How is it treated?’) For detailed information on a drug you have been prescribed I recommend asking your doctor or psychiatrist, and having a look on the Crazy Meds site which I have always found to be both frank and accurate.

How do you live with cyclothymia?

This is the question my entire blog is aimed at exploring.  There isn’t, I am confident, a single answer.  I’m finding careful use of some medications (anti anxiety and sleeping tablets), occasional short courses of talking therapy, healthy physical routines and habits, and being tolerant of my own fluctuating reserves of energy and resolve, all contribute to me feeling in control of my life with cyclothymia.

It’s not an easy road, but it is one that it is possible to walk, with time, and effort put into finding what does and doesn’t work for you – either alone or in conjunction with mental health professionals, and supportive friends and family.

And finally, a google search term I couldn’t turn into a question;

Cyclothymia and stupid people

Unfortunately, cyclothymia does not bestow you with the super power to avoid stupid people, or eradicate them from your life. Sorry.

Have you still got a question that needs answering? Do you want to add to or query any of these answers? Please drop me a line in the comments.

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Filed under cyclothymia 101, diagnosis, medication, self-hood and cyclothymia, symptoms and habits