Self-care is an important factor for any human – those who fight a mental illness will recognise that good self-care both indicates and mitigates the severity of an episode.
For me, I find that when I am running high my self-care will be mixed. I will take a lot more time over my appearance; I will file and paint my nails, wear make-up and style my hair. The flip side is that I begin to skip meals, drink too much coffee (at work) or alcohol (at home) and get through pretty much a pack of smokes every day. So outwardly I tend to look more ‘together’ but internally I am falling apart.
This pattern is flipped in a depressive state. I eat plenty (granted, it’s never healthy – I just graze more) and my getting-ready-routine is perfunctory at best. Showering feels like too much effort; after a shower I will need to dry my hair and that requires more energy than I have available. Usually showers get pushed into the evening, when I can allow my hair to dry naturally, and even then I’ll usually be seen with my hair pulled into a loose bun because it’s too greasy to leave hanging free.
Good self-care is the first bullet point on the crisis line operator’s script. Every time I’ve called the out-of-hours number the response has invariably been “Have you thought about taking a bath?” or “Maybe you could make yourself a cup of tea.” It’s known to my team that these things don’t work for me, but for an over-stretched NHS crisis service it is standard fare. Improve self-care; improve mood. And there’s a lot to be said for that approach; it’s just that when you’re in the depths of depression or on the summit of Mania Mountain you really couldn’t give a fig for looking after number one. Your energy is being spent on either avoiding a tearful meltdown or writing endless pages of nonsense. There’s nothing in the budget left for caring for oneself.
I think that if more people understood the subtle indications that good or bad self-care provide then there might be more awareness of how mental illness affects almost everything in day-to-day living. On the down days my roughly tied up hair and lack of foundation shows the world “I used all my energy up by getting out of bed.” And on hypo days you can read my rouged lips; “Hello world, bring it on!”
Self-care is a manifestation of loving oneself too. It means the difference between feeling worthless and worthwhile. If I can spend a little time on myself when I’m low, it can be a welcome diversion from the turmoil of loathing that characterises my mental state. One thing I have learned over the years is that self-care can be disguised in mindfulness. Instead of forcing myself to show myself some love, I will instead set myself a mindfulness exercise such as doing my nails, or making a cup of tea. This way I do not have to acknowledge consciously that I am worth more than I think I am. I simply come out the other side feeling an iota calmer – better – than I did when I began.
I’ve debated writing this all weekend, but I have come to the realisation that I would be a hopeless advocate of mental health transparency if I hide aspects of what having mental illness entails in my life.
In the days running up to crisis day I’d been scoring 8s and 9s on the mood tracker app. Thankfully I had diazepam and zopiclone at home, so I was managing it reasonably well (note to self – speak to pdoc about an alternative to the less-than-effective Valium). It was unpleasant, uncomfortable and on Friday it became uncontrollable.
I should mention also that I’ve been having hours unaccounted for, which is pretty scary in itself. It is mostly down to needing to use zopiclone during the day to bring the edge off the high mood; it can cause retrograde amnesia if you don’t sleep after taking it.
On Friday I hurt myself. I don’t entirely recall why, or what the motivation was; the first I was aware of it was when I knew I needed to call 111 for some help. I’d not taken a zopiclone that morning, but had had a few mg of diazepam. The lovely person on the other end of the line called a paramedic car for me and off we went to the hospital.
I have just realised I’m writing this like a newspaper report, and that’s not the point of my blog. I want to be clear over the emotional rollercoaster I’ve been on for the last couple of weeks. It has been awful, mentally draining, even physically draining and yet I have been restless nonetheless. My mind has not caught a break, and what’s awful about it is that a break from thinking is exactly what I need.
What is awful is that I don’t understand the reason behind hurting myself. Normally I ‘ride the urge’ for a while; I resist and resist until the need passes and I’m quite good at turning to healthy coping strategies such as mindfulness practice and mindless television. I’ve not been that manic since I first for unwell, and I thought I was over it – I guess having had such a long period of only having mixed or hypomanic moods made me forget how dangerous a true manic mood can be.
I’m speaking to my CPN tomorrow and hoping that she’ll have some bright ideas for managing this; although I’m also hopeful that the crest of the wave has broken. I am planning to be back to work on Tuesday too. Fingers crossed!
My mind is in shut-down mode now, so I’m not promising any lengthy text. Everything is very overwhelming and too much stimulation so my brain has given up trying to make sense of anything. I just wanted to take the opportunity to talk a little about what a manic high looks like for me.
Hypomania is a wonderful thing most of the time. I get creative, energetic and become very sociable. When that tips over into true mania, I start to hate the whole mental illness package. The benefits of a hypomanic mood are far overshadowed by the meltdowns that come with severe extremes of mood. Let’s take yesterday as an example.
I felt a headache/migraine coming on, so I came home planning to lay down in the dark and hopefully stop it before it got too bad. Of course, my mind wasn’t having any of it; as I made my way back to the flat I could feel it ramping up to a new, dizzying height. In reality, I should have taken a diazepam before it got out of control, but once again I thought I could fight it with sheer willpower.
From around 2:30 I’d been drowning my head with cheap wine; around 3:30 I decided I’d had enough of fighting my brain and took a zopiclone hoping to go to sleep. I will admit to not recalling much of the evening past around 3:30; my hubby tells me he came home to find me sitting on the bed and laughing hysterically. Retrograde amnesia is a side effect of zopiclone, and it is a scary one.
I wish I’d had the presence of mind to just call someone from the EIiP team when I felt the mood switch up into sixth gear, but I couldn’t think straight. All I wanted was to feel better, calmer, and I wanted the quick-fix version (cause seriously, what can my psychiatrist do over the phone?)
I’ve called in sick to work today; I let my colleague know that I’m in a high level mood and rather agitated. On the one hand, I’m glad I did because it means I’m not dealing with voices and irritability and rage and frustration at work. On the other hand; being at home in this mood really isn’t any fun. I don’t really know what the solution is, and that annoys me. I wish there was a quick-fix sure fire way to change it all.
This afternoon (as I have Twittererered), I have a battle in my skull. A stinking headache (migraine?) is fighting against awful, intrusive thought for dominance. I want to lay down. I want to pick a fight. I want to take paracetamol. I want a drink. I want to sleep. I want to go out. I want to sleep. Yes, I want to sleep.
So there’s our compromise. Sleep would be a fine thing, if I could manage to slow down enough to get some. Ever had too much caffeine? That feeling that you’re running way ahead of the pack, and you’re going to make your personal best time in the marathon we call life? That’s my mind, except instead of a race track I have a mission to reach Mars by dinner time.
Eesh. Kinda sucks right? I did a post about counting my blessings, but I think I’m past that point. The benefits of hypomania (mania now?) are trampled on by the downsides. Like fleeting thoughts in my mind that I’m not sure even belong to me – how can gentle, quiet me think of hurting another human?
Vaguely homicidal ideation is a new one on me. Normally Eve is my source of selflessness but I guess she’s asleep. Actually, I know she is; there’s only one personality in my head currently. I miss her; and there’s three words I never thought I’d say.
To wrap up this rather brief post I will remind myself to look out for myself. I am my own best advocate and my own best friend. Be kind to yourself, Alex; you deserve it.
One of the key features of a hypomanic or manic mood for me is the incredible 180 my mind takes when it comes to routines. Typically I am a homely creature; I like working regular hours and coming home to make dinner for my beloved. We go out, sure, but normally that looks like doing the pub quiz on a Wednesday evening – and even then we’re usually home by half nine. I tend to be satisfied with my job, with my status and income.
But wow, doesn’t that all change when my mood does. The idea of going home to routine sends me frantic (not exaggerating). The steady 8:00 till 4:30 of office work doesn’t challenge me nearly enough. The cups of tea by the fire I usually so enjoy when I have alone time are replaced with alcohol – not to excess, but enough that I feel like I’ve rebelled a little.
It is a mental rebellion of the strangest kind. The studies all say that bipolar mania includes risk-taking behaviours and I see that in myself when I am running fast. Thankfully I don’t seem to become hypersexual, I don’t turn to drugs and I don’t go parachuting. But the lust for change and excitement that lurks behind the need to take risks drives me up the wall.
It becomes a mental battle of wills. The aspects of me fighting each other – my intellectual knowledge that I really should <stay home>/<meditate>/<take a bath> vs the impulsive side that craves <a night out>/<a night-time walk>. And it is beyond frustrating; it often gets to the point that I am raging angry with the people around me who are trying to keep me safe.
Really, it’s no fun. Taking Freud’s model, it is classic Id vs Ego and Superego. My need to find adventure is contrasted by the sensible thinking me; the me that wants to keep within respectable, ‘normal’ behaviour as dictated by our respectable, normal society. Even writing this now I am finding it hard to describe the levels of annoyance that come with temperance.
I know it’s not just me who experiences this urge to ‘be bad’. Taking an extreme example; a study published on the National Institute of Health library site suggests that 8.4% of individuals with bipolar committed violent crime – this is contrasted to the control population study that found the incidence of crime being committed to be 3.5%. The brain seems to be the cause of this increased risk taking behaviour. A study by Manchester University last year found that there was a dominance of the brain’s ‘pleasure centre’ when assessed using fMRI scans.
Knowing the possible causes does not make things easier however. All I can do is attempt to channel the energy that comes with the impulses into productive activities; baking bread, achieving targets at work and exercising. Unfortunately being a good girl isn’t as satisfying as the acts of rebellion, and I have no idea how to get over this particular bump in the road.
There’s a lot of publicity surrounding mental health awareness, and the mission to bring the general public to a better understanding of mental illness grows stronger every day. The fact is that mental illness sucks, but it’s not all doom and gloom. Here’s a few things that make it a little better for me each day (unfortunately they are in no way a reward for the struggles we face).
Depression has taught me empathy.
I am highly creative when manic.
My productivity and output at work benefits from hypomania.
Understanding delusional beliefs gives me insight into my own psyche.
I have a passion to make the world a better place.
My supporters have shown me true love (parental, societal and romantic).
I can relate to my father in a real way by understanding what it means to be depressed.
Writing is my outlet and I’ve been getting better at it.
Therapy has given me great skills and taught me how to be kind to myself.
I learn a lot about anger and sadness through my ‘alter’ – I am able to observe her pain and talk to Her about it. (Still not comfortable calling Her an alter, but I guess it’s as good a word as any!)
I get to see the world as a vibrant and exciting place.
When depression lifts I get to feel pleasure in things in a meaningful way.
What are the benefits you see in your mental illness? I think it’s harder to see the ‘good’ in relentless depression than it is to see it in bipolar disorder. And I’ve not got personal experience of any personality disorder, so I’m definitely not qualified to comment there!
One of those things familiar to anyone who has lived with hypomania or mania is the feeling of time standing still around you, whilst you whizz through the world at top-speed.
Time drags on. You look at the clock every few minutes and you’re surprised that you’ve got so much done in a matter of moments. On days like this (taking Friday as an example) I can process 36 emails in 20 minutes; and even then it feels like I’ve not worked at full capacity. My 100 mph brain is relentless in presenting myriad thoughts in quick succession. There’s barely enough time to register thought one when thoughts two, three and four come flying in for consideration.
Even Twitter can’t keep up, which really should serve as an example of just how quickly my brain flies through the day. I am forever grateful to Twitter for serving as an outlet for the random thoughts that I feel the need to express; I am also apologetic to those who have to read them (I don’t mind if you don’t!)
The other thing that happens – along with Father Time hitting the pause button – is a certain vividness that takes over the planet. It’s like I just switched from an old television to a Full-HD, 3D, ultra-clear-and-bright screen. On a day like today that is gloomy and overcast, I see the world as if it were a 28⁰C midsummer’s day. The pine trees are glorious green with wonderfully contrasting brown trunks, and the grey of the building is more akin to shimmering silver that is truly eye-catching.
I’ve refreshed my inbox at least ten times since I began writing this post. Nothing’s happening. I check the spam folder in case something interesting pops up. Still nothing. The benefit of this kind of hypomanic mood is that I am incredibly productive; with the caveat that I find it impossible to stay focussed for very long. In the little bursts of attention I get so much done though, that it hardly matters that I don’t stick with a task for more than a few minutes.
All in all, I love this kind of mood. Sure, it can be a little overwhelming, but the benefits far outweigh the discomfort. I pray to a God I don’t believe in that it stays steady; that it doesn’t go overboard or turn to a mixed mood. Whatever happens, I will thank my stars that at least one aspect of this diagnosis has a benefit.