How Culture, Communication and Relationships Hinder BP Progress

Over the course of my BP II discovery and diagnosis (anywhere from 5-20 years), I have lived in 2 distinct cultures where the communication expectations varied greatly.  Both discourage speaking up assertively or transparently.  Conflict in one culture is ignored and suppressed whereas it is handled passive-aggressively in the other culture.  What does this have to do with mental health?  A lot.  Unhelpful communication norms are likely found in most cultures, and I believe this has had a far reaching impact on my mental health.  I find this particularly profound as a woman where there is even more pressure to fit society’s social expectations.

As an immigrant, I did not realize the toll that communication mores would have on my ability to express emotions or ideas.  I believe that neither culture I have lived in is ideal for encouraging healthy communication, but the adjustment from one to the other has taken more than a decade to finally identify the subtleties that can trigger and worsen my BP II symptoms. For example, in my old culture, I could say something that a listener might not agree with like, “The minimum wage should be a living wage.”  They might sarcastically or dramatically respond, “…yeah, like that’ll happen… .”  Their opinion is clear enough and shows they are not in support of what I said.  In my new culture, the response to my same, unsupported statement would be, “mmmmm.”  This “mmmmm” is the same response when someone says the weather is nice or that a politician is crazy – whether they agree with it or not.  It’s a polite “out” where no opinion is expressed.

Even beyond cultural considerations are the communication norms that begin to evolve in a relationship where someone has BP.   The other partner develops their own language of dealing with the inconsistencies of conversations with BP me.  It’s the language of quiet.  It’s not exactly stonewalling by purposely blocking conversation, but it is strategically communicating to keep from rocking the boat.  The intent is to keep me on an even keel. However, it has the equivalent effect to the “mmmmm,” but it is more blunt in its delivery because, as an intimate partner, they are expected to give and take in communication instead of cautiously tiptoeing around my illness.

The reason this affects BP so much is that it loves silence and loneliness.  When people do not engage in a way that opens conversations wider, there is no place for the thoughts or feelings to go except for to be swallowed deep back inside.  Over time, bipolar me realizes I should not utter them in the first place because they will end up regurgitated back in my gut whether I tried to talk or not.  This is what illness feels like.  When depressed, my thoughts and feelings are swallowed again like a bottle of pills.  My thoughts that were not thoughtfully considered and given solid air time by another person become pieces of poison that rip into my gut and destroy my ability to be awake and engaged in this world.  When hypomanic or in a mixed episode, the same conversation pieces that were ignored become a painful and rebellious liquor I swallow.  When conversation is diverted to keep me quiet, my feelings come out as anger, rebelliousness and carelessness.

My health comes at the expense of keeping society, family, a partner or culture comfortable and content.  These groups often use tactics that shorten life’s important, difficult or longer conversations, especially on someone experiencing bipolar.  Cutting this conversation potential away from someone with bipolar might be from frustration, fear, a lack of awareness or aloofness.  However, it is damaging to my bipolar because my voice needs to get out.  The more I swallow my words, the more my body feels like a crypt holding phrases that could have been discussed to keep me vibrant, resilient and connected.

 

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Posted in Feelings, Mood, Overall Health, Uncategorized

Whispers

I was having what you might call a “bad day.”  Thoughts of suicide were clinging to me, and I was neither asleep or awake.  Nobody noticed the lead up when I was asking to get together for a coffee, but suddenly I was a chosen charity case. My family thought I should come with them.  I did.  I slept about 16 hours straight and was awakened by whispers.  They were whispers about me.  It was if though they were stripping away my skin and exposing my wearied soul to everyone who wanted juicy gossip.  The quiet woke me, and I was frenzied to get away as fast as I could.  I collected my things and left without eye contact or words because they were too painful.  I was ashamed beyond the hell that burnt my dwindling sense of humanity.

I do not know how to recover from the betrayal and stigma that was their entertainment.   “Oh, but they were just worried about you.”  Lovely.  Maybe when I am less vulnerable but still unwell they could notice.  It was as though they were watching a tightrope act and only saw the risk after the ambulance took the performer away from a 10 story fall.

Even worse, I described my hypomania and depression to my family, and they continued to share their narrowed world view that, “She’s great when she’s great, but she’s not when she’s not.”  It is such an oversimplified, inaccurate, insulting and dangerous way to conceptualize my illness.  In fact, when I’m “great” are the most troubling times because irritability, energy, and depression are often a cocktail of dangerous feelings waiting to explode into a grand finale.

 

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Posted in Actions, Feelings, Mood, Overall Health, Uncategorized

The Girl Who Told Me ‘Think Positively’

I had my first conversation with a relative who has never had real depression.  She said that she does have, “down days,” and that what works for her is to think positively.  It was a loaded comment which I believe had connotations that if I do what she does, I will not be like I am.  She did add, “maybe that doesn’t work for you” with a tone that felt like she would say any second, “…but it should!”  She was inferring that if only I can “think positively,” this emotional pain that cuts my brain like an embedded fishhook will not have days where eating tastes like swallowing balls of sandpaper, where fear grips my eyes closed, where I only hear static and where the closest I come to relating is found in a spot on my grey bedroom wall.

I wanted to scream when she told me these things about how she just “switches” her thinking.  As she talked about this, she swirled her delicately manicured fingers like she was twisting a soft serve waffle cone to effortlessly catch all the beautiful ribbons of creaminess.  Her body language and explanation of this mood altering process was as airy, free and thoughtless.  She explained the ability to shift moods and thoughts with relative ease.

I had one of those smiles with my lips upturned and my eyes blank.  What was the use in trying to explain my horror?  It would put me in a category of being a freak, unstable or totally unrelatable.  Balancing my moods by thinking of something different is only a portion of the equation. Shifting moods and thoughts is more like trying to loosen the hot, over-tightened dirty bolts on a hubcap with your bare hands.  They are unlikely to budge, but the person trying to dislodge them will expend a whole lot of effort despite the hard work.  It takes an entire life of hard work.  I have to watch every detail I do – food, exercise, rest, water, triggers, meds, med side effects, travel, drinking, caffeine, socializing, isolation, extremes, blood tests, weight gain, therapy, mindfulness, etc.  The list continues.

In fairness, this relative does not know I have bipolar II.  Most people do not.  It is easier to just say, “oh, I have a bit of depression.”  People get that.  They think they can relate to it. Close friends I tell, “I have Depression with a big ‘D'”.  Telling most people you have bipolar is comparable saying, “I have a puss-filled blister on my groin.”  Nobody wants to know that shit*.  People do not want you to have a nasty condition simply for the fact that it makes them uncomfortable you shared it.  Those closest to me say, “I don’t know what to do” or, “I just want it [the bipolar] to go away.” The answer is that I do not really know what to do either.  I think it would be swell for it to disappear.  However, I think that treating someone equally, with respect, with compassion and with independently researched knowledge about their condition are the keys in knowing what to do, what to say and for bloody good reasons what not to say.

*People that really love you will want to know so they can help you survive it.  They do not judge you – they lean into you.  I have just a few of those folks, but they are who give me a reason for trying to stay alive even though it is hard for me and them.  I hope that everyone has at least one person that “gets them” in this way. xo

 

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Posted in Basics, Mood

Binge Update 1

I did not binge for 3 weeks.  It was weird.  I started on Latuda about the same time, but I do not know if that is the reason or not.  I did not have as much of an appetite.  Other things that might have helped include:

  • Talking to my eating counselor about scaffolding and the “true/false” question I need to ask myself.  I was telling her about using public transport and looking at people.  I explained a woman with it all together – eyelashes perfect, beautiful diamonds, pricey accessories, petite, perfect figure, perfect clothes and makeup, etc.  I pictured her going to the gym then home to a luxury condo, pure-bread dog, loving relationship, etc.  My counselor told me that was bullshit.  She said I made up the whole scenario in my head to make myself feel worse.  She challenged me with saying “true/false” about everything I was thinking to test if I am just making that shit up.  🙂
  • Money pressures – no food in house
  • Water with lemon in the morning
  • Somehow donuts just not coming to mind – I don’t know how I managed that
  • Calling Lifeline 6+ times a day (I don’t like them, but it kept me busy).
  • Making my own bread (I will talk about this more in the future as it was a great mindfulness strategy).
  • Not eating ANY sugar.  I found this new sweetener called Equal Next, and I love it.  I think this may be one of the biggest reasons I did not want sugar
  • Sparkling water with lemon and mint
  • Taking meds correctly

When I fell off the wagon was when I saw an add for candy that is usually unavailable where I live.  I got some, then got more chocolate, then McDonalds, then donuts.  If there can be a positive from all this, it was over 3 days, and I skipped meals but still had a healthy snack after bingeing so I was not getting even more calories from meals.  Instead of pretending like I had not binged and eating a normal dinner so nobody would know,  I just had my snack and said my stomach was a bit off.  That seemed to work.

What did not work was that my partner found some wrappers in the car and commented on it.  It was a semi-criticism and semi-comment, but I do not need any of it.  I am dealing with this myself and having 2 cents from someone else when I am doing relatively well is not at all helpful.

 

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Posted in Binge Eating, food, Health

Analyzing the Lonely

I came across an article about 7 types of loneliness by Gretchen Rubin the other day which led me to take the UCLA Loneliness Scale.  I realize that loneliness is the root of many of my problems but only at certain times.  It is so subjective and complex that I think even knowing when I am lonely is hard to do because I do not trust my moods very often.  Even reading the questions on the UCLA Loneliness Scale caused me to realize that what I feel is loneliness.  It is not a fleeting mood.  It is genuine loneliness.  I told my doc I scored a 55, and he was stunned.  I am not at all – I taste, feel, dribble, smell, see and hear loneliness like it is all that exists.  Being around people is not the antidote.  Often, it makes it worse because I am so misunderstood, overlooked, overpowered, a perfectionist and so ashamed of myself.

My takeaway message from much of this self-discovery is that connection and bonding with others is really important for my happiness.  My personality type and bipolar are both affecting my connections with others.  My personality at its core is introspective, open-minded, inquisitive, quiet and laid-back until there is something that triggers a core ideal. I find it hard to trust, although that has improved a lot.  I generally have difficulty finding friends that enjoy deep conversations, relationships that have the right amount of affection and depth and a balance of “me” time among my various obligations.  These are the main reasons that I find building relationships with others painful.

Bipolar II exacerbates this.  My moods right now are triggered easily.  I do not believe I am too sensitive currently, but I find that I really need more respect in my life.  The people closest to me are not respectful – from my family, to former workplaces to prospective workplaces to social contacts.  I am let down often by others.  However, I let others down often so it is almost a self-perpetuating cycle.  I largely believe this is caused by my bipolar II as I’m reliable about 60% of the time and a flake the other 40% of the time due to my irritable-style depression and/or mixed episodes.  I HATE it, and I’m still trying to get a grip.  I used to think it was my personality and blame my flakiness on that.  Now that I know it is an illness, I do not know where to attribute those less-than-desirable traits since I do not disclose my bipolar II to anyone except those closest to me.  Those closest to me do not even get that is a chemical imbalance instead of a mood I am manipulating.

 

 

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Posted in Basics, Feelings, Mood

Functional Professional or Fraud

I am in the final recruitment states for a job, and they require that you answer a question I have paraphrased, “Do you have or have you ever experienced illness or injury that may impacted your ability to perform or work into the future?”  Sure, I have had to take time off because of ECT and hospital.  It impacted my work, but IN GENERAL I hide my bipolar very well and opt for wide-ranging excuses when I have to be away from work.  I have been burnt SO MUCH by employers due to having a mental illness.  I am not a victim in this as I have probably caused employers some unexpected frustrations by having time away from work.  When I’m at work I give my all plus some.  I manage to gain promotions despite my bipolar, but they slap me right down once I am unwell in similar ways to my pre-promotion self.

Despite that, accommodating my illness is similar to a accommodating someone in a wheelchair.  Most workplaces and society do it pretty poorly.  When you have to walk an extra mile to find a proverbial ramp to get up the same curb as everyone else, I think that is discrimination.  The hoops employers make candidates jump through even in the screening process is invasive and impersonal.  If offered, I will take the job because I need money.  However, this is an example of why an awesome person with a mental health concern is not welcomed in your organisation.  Maybe that is the way this organisation intends it.  Not-for-profits are not immune to this sort of discrimination and screening out people with mental health concerns and other marginalizing attributes.  In fact, they are often worse because they do not have thorough management training, great policies, HR practices, legal advice and funding.  It is one for the too hard basket.

I called a national mental health organisation, and discussed my situation briefly, and the first question was, “what has your GP diagnosed you with?”  When I would not disclose, the worker told me they wouldn’t be able to advise me on what to do.  Whether I have schizophrenia or anxiety has nothing to do with what the question is asking.  I told the worker hat was a COMPLETELY irrelevant question.  I self-advocated and told her in abrupt terms that for a national mental health organisation should be equipped to support those with a lived experience in a non-stigmatizing way, particularly around a common type of discrimination faced by clients.  She transferred me.  I explained the situation to the next person and was supported to answer NO to the recruitment survey since part-time work is part of a strategy to stay well.

Even in wellness I feel a bit like a fraud.  Last week, I was feeling unwell.  I was not coping at all and facing hospitalization.  This week, I’m accepting job offers and am the old white-collar, career focused, sharp and determined professional.  I need a workplace that understands that when I am well, I give 2x what most people would to make up for the times I’m sick.  Healthy or not, that is how I choose to navigate bipolar II.  Living life this way is much more satisfying than having a bland, mediocre existence the majority of my life (which I would find somewhat unattainable anyway).

I fake it ’til I make it constantly.  There are 2 clear parts to my personality that if I’ll listen to will keep me out of trouble.  My writing shows this.  When I’m the well me, I am particular and cautious in my wording.  I avoid being witty.  When I am closer to unwell, I think that my sense of humor is on par with the world’s best comedians when it is really just a step down from a lame dad joke after he has had a couple beers.  🙂

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Posted in work

BP II and Weight Loss Surgery

I went to a free consultation 2 months ago with a doctor who’s office felt like a sweaty cattle call.  He was willing to do any surgery I wanted ASAP but would not clarify the price.  He shamed me when I told him I was not ready and was unsure about a sleeve by telling me that he sees patients like me all the time who will not get surgery but will regret it and come back in 10 years.  I am glad I trusted myself and the complexity of my health because he did not take any consideration into my complex mental health, thyroid and medication needs.

I scheduled an appointment with a new doctor who told me that there is a 48% likelihood of secondary surgery with a Lapband so they do not offer it.  They will go at my pace and check my meds every step of the way since there are concerns that lithium cannot be offered in a drip and because I’m on Nardil, a MAOI antidepressant that requires a strict diet for foods with tyramine.  They asked me if I *had* to have it, and I do need it like a fish needs water.  It has been the most helpful anti-depressant I’ve ever had, and I’ve been on bajillions of them.  They offer a dietitian, psychologist, groups and a patient liaison / surgical assistant.  A main concern I have is that the medical centre is tiny.

I still fear such body-altering surgery that takes away my stomach.  I mainly binge because of my mental health.  How will I control that?  What are the consequences if I do binge?  I still believe somehow I can pull myself up by my bootstraps despite failing on every diet I have tried.  Then part of me KNOWS I cannot.  Part of me still wants to eat absolute crap because it is the best and most enjoyable way I can self-harm.  Any diet they put me on would be really difficult given the restrictions I already have because of my MAOI.  That has been a problem with other diets, too.  It just limits me so much.  If I eat a food that is not allowed I could have a heart attack.  I am going to go back for a second consultation and check with my insurance company about how much they will cover.

Being overweight in itself is not a massive deal for me, but I hate how I cannot move and what I look like in pictures.  I want to be here for my child and not have any other chronic issues to deal with because just dealing with my bipolar II is a full time job.  My next consultation is in one month.  I am going to start exercising 30 minutes a day and continue working on my bingeing with my doctor.  I was bingeing about 5-6 times a week on 4-8 pastries a day (plus other foods), but I am down to 2 binges a week.  That would have to be around 1200 calories less a day, and exercising would minimise another 100-200 calories.  If I can eliminate 1400 calories a day, I will be doing much better and have to lose inches and weight.  I am 110 kilos right now and writing it for accountability.

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Posted in Actions, Binge Eating, Health, Medical