How I manage bipolar disorder

Content warnings: mention of self harm and suicidality

You may know from earlier blog entries that I have Bipolar 2. This means I never get fully manic, but have episodes of depression, hypomania, and mixed states. It is this condition that I perhaps consider the most disabling of my diagnoses, I think mostly because of the gap between the social model and these impairments. I’m pretty sure there’s no combination of supports and decreased access barriers that could fully prevent me from having bipolar episodes through the rest of my life. While I am not reliably stable enough that you should consider my self-care a perfect way to prevent bipolar episodes, I have picked up some useful skills over the years that do keep me more stable than I used to be. I will tell you about some of those now in case they are helpful.

Sleep: I require extra sleep in order to function, usually ten hours a night. What is even more important than the amount is that I keep to a strict schedule, especially for bedtime. Getting too little sleep is a risk for hypomania, and getting too much is a warning sign I might be entering a depression.

Walks outdoors: Please don’t read this as the infamous “have you tried exercise?”, because it’s only a small part of my self care and not everybody finds it helpful. But it does seem for me that going for a walk every morning helps me stay sane. I am not sure whether it has more to do with moving my body, soaking up vitamin D, and/or the reassurance of routine itself that is useful. Oh, and it is a good time to listen to wizard rock, a special interest thing for me – I think engaging in special interest stuff can be a positive thing for many autistic people’s mental health.

Meds: I love my meds. I especially find antipsychotics useful for my brain, but of course “your mileage may vary”. I am usually diligent about taking pills – my emotional support animal and I have a system. I’m not allowed to feed her until I’m taking my meds – and, conveniently, she gets hungry twice a day when my doses are scheduled. Thus I can’t stall too long or skip them entirely because she’ll cause havoc until I comply with her dinner plans. Unfortunately, I am liable to skip a pill or two when I’m hypomanic, under the illusion it will keep me feeling good longer. This is a bad idea. This is a classic feature of bipolar disorder though – the brain’s wheedling that skipping meds is okay.

Moderating stress and outside commitments: this isn’t doable for everyone – if employment is your only chance of income or you have dependents, there may be stressors you just can’t get out of. For me, trying to hold a job was a huge stress (not least because it involved a lot of masking my autistic traits), and I feel supremely lucky to have gotten on SSDI. It’s also important for me to only take a class or two at a time and to be wary of adding any other new commitments to my life. Certainly having some regular activities can be nice structure/routine, but my history clearly demonstrates that “normal” amounts of work/commitments/stress/etc put me at huge risk for increased mood episodes.

Community: Everyone has different needs around amount and type of social interaction, but personally I’ve found I do benefit from some interaction with people I can relate to. This is carefully curated, however, given my autistic traits. For offline interactions, I do best when I can build friendships by seeing someone in the same time/place/activity every week. This makes the hangout much less stressful and I am better able to connect than I am when coping with unpredictable elements. I am lucky to have friends who are amenable to this accommodation. Besides that, most of my social life is online, and that suits me well. Not only is the method of communication easier than the speech people typically expect in person, but the reach of the Internet allows me to connect with people who have similar experiences as me. Through Twitter I feel like part of a larger community of queer and disabled people, and it’s good for my brain to feel like I have a place in the world.

Supports for co-occurring conditions + masking less: My bipolar episodes seem less frequent and milder over the last year or two, and I think one of the changes that has affected this is the fact that I have been able to incorporate more disability supports into my life and decrease the amount I mask my neurodivergencies. (I’m placing these components together because for me they both have to do with claiming my disabled identity, decreasing shame, and asserting my rights.) As I use AAC, let myself stim more, utilize academic accommodations, explore executive function supports, structure my life to avoid PTSD triggers, and try to find environments where it is safe to be noticeably disabled, I experience less distress. This appears to be decreasing my vulnerability to bipolar episodes. (It should be noted that it’s not safe to be noticeably disabled in many environments, especially for multiply marginalized people, so not everyone is able to make these kind of changes to their life.)

Symptom tracking: I developed a system for monitoring some of my warning signs and significant symptoms that takes about a minute a day and results in charts my providers and I can look over to discuss how I’m doing. This can help identify potential episodes early on, giving me a chance to intervene before things get too bad. The items that you choose to monitor should really vary from person to person, but the items I track are: mood on a scale of 1-10 (morning and evening), sleep, anxiety, irritability, intrusive thoughts, sensory overwhelm, self harm, suicidality, whether I took my meds properly, and whether I cancelled plans/missed commitments.

Therapy/group therapy: I’m not someone that thinks disabled people have to be “compliant” with treatment a doctor dictates in order to successfully manage our conditions, but I’ve often gotten something out of showing up for my appointments. It’s a huge cost benefit analysis, because treatment can so easily be harmful to trans and autistic people, but given my brain I kind of feel like I’ve had no choice but to risk the bullshit in order to try to glean the potential benefits. I’m lucky that my current therapist is decent. I’m not able to see him often enough for deep trauma work or anything, but he serves as a sort of check in/case management/sounding board type person that is still useful to me.

Okay, those are the major components that come to mind, but I’ll note a few extra topics that I’ve found useful at various points in case you want to look into them more: vitamins/supplements, connecting to my spirituality, peer-run support groups, dietary changes (this one’s complex for me due to eating disorder, but still worth mentioning), journaling, creative writing, engaging in special interests, and routines.

Do you have tips from managing your own mood disorder you want to share? Please comment!

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“I am from”: a poem

I don’t plan to normally post poetry on here, but this piece I did for a recent school assignment contains themes highly relevant to this blog, so I decided I will share it. (I used to write poetry all the time; but it’s not really currently my thing. Not sure why.)

Content warnings: ableism, heterosexism, cissexism, involuntary treatment (including restraints), abuse, filicide, vague Holocaust reference, vague self-harm reference

 

i am from altitudes, latitudes, longitudes

towns and cities, forests and deserts

houses and apartments and tents and sleeping bags

i am from values – a childhood refusal of meat and an adolescent refusal of school

i am from habits – ink, fibers, fidgets, scars

 

but mostly, i am from people

i am from people who have been stigmatized

institutionalized

fetishized, pathologized

disenfranchised

sterilized, experimented on, exterminated

 

i am from people who have been kicked out – young rain, grimy streets

locked up, restrained – screaming the pierce of unwanted needles

policed – our clothes and bedrooms

impoverished – mountains of paperwork just to survive

shocked – pain meant to train us

to act less queer

and more neurotypical

sickened – empty pill bottles, turned away from the ER

misgendered – the hollow feeling of unseen selves

cis doctors can deem ineligible for transition

deadnamed – IDs betraying unasked-for history

the Ms and Fs written in stone

ignored – eyes skip over us, accommodations unmet

assumed incompetent – the fake syrup of “baby talk”

left to die – nursing homes don’t care to set us free

abused, assaulted, murdered – and our caregivers get sympathy

for how hard we must be

to deal with

 

all this, and my people

have chained themselves to buses

crawled up the steps of the capitol

testified in congress

occupied senate offices until dragged out of our wheelchairs

resisted arrest

voted where allowed

called senators on text relay

sued the state

 

my people have crowdfunded each other’s surgeries

bound each other’s chests and zipped each other’s dresses

taught each other, parentless, to apply lipstick and tie ties

given advice, doctorless, how to choose a mobility device

and how to use the apps that amplify our voice

we’ve taken in our unhoused youth

gotten married

ordained our own clergy

danced and performed and marched our true selves

crashed the conferences where professionals like to talk about us without us

designed the research no one else is doing to increase our quality of life

taught our teachers what are actually our real names

 

my people defy norms

loud – rainbows and glitter and flags

proud – rocking and flapping and drooling

our existence, in this world, is indeed resistance

 

so i am from everywhere my people are oppressed

and i am from everywhere we fight back

 

Credit: I don’t know who came up with the phrase itself, but I found the quote I referred to (“my existence is resistance”) on one of my favorite shirts to wear by Model Deviance Designs – go support them!

Thanks for reading.

What hypomania feels like (to me)

Content warnings: self harm, suicidality

Hypomania is often tinged with anxiety or irritability even when it’s not a full mixed state, but I’m going to start by describing the sheerly happy version.

It’s a bit of a drug. One of the closest fictional analogies I’ve noticed is Felix Felicis: everything seems to be going my way! (This temporarily feels true even about things that arguably rationally aren’t that great.) I get smiley, giddy with the sensation of the gods smiling upon me. My voice is more expressive, I speak more than usual, my words in any format are fast and possibly too excited to fully make sense, I act way more social than is generally in my nature. I feel like bouncing. I flap more. I have boundless energy to accomplish my goals, because I just know for once they are actually achievable. I’ll have a wealth of Good Ideas, which I may flit between, or I may end up obsessing over one in particular. Last time through I fixated on a sudden idea for a new novel, and proceeded to write eight thousand words of outlines and notes over the course of twenty-six hours. Over the next few days I completely ignored other responsibilities and interests, despite a lingering abstract knowledge that they were possibly important. I might not be able to explain why the ideas that are flowing are indeed good, either to bystanders or my future more sane self, they just seem very convincingly right. (I.e., I’ve just got a good feeling about going to Hagrid’s! Except, Felix sort of guarantees that your ideas will work out for the best, whereas hypomania-induced ideas are possibly doomed.)

For Muggles, I think imbibing just the right amount of caffeine begins to relay the experience. I have energy! Actual energy! My spoons do not follow their usual expiration date of 4:00pm, and it doesn’t take my usual ten hours of sleep to replenish them, I can just – do things. I believe I am brilliant, extremely competent at everything I might want to do. I am chipper and genuinely friendly. The world is… uh, there’s some idiom about things seeming to be the color of a rose? Well, I think it’s saying, the world looks more deserving of optimism than usual.

Unfortunately, as I mentioned, these descriptions do not reflect the full spectrum of hypomania. I’ll set aside actual mixed states for another post, and just address here what is for me frequent – a hypomanic episode, or a stage in an episode, where the elevated mood gets intertwined with anxiety and/or irritability. Often my first few days of hypomania feel like what’s described above, but as it continues it morphs into this more distressing version.

All the energy remains, if not increases, but it funnels into rapid thoughts that jump not from creative project to creative project but from worry to worry. I’m on edge. And what really gets me, what leads to the worst consequences, is that my ideas still feel true and brilliant. But they’re now, rationally speaking, worse. I pace in circles, hitting my head. Why? I’m not sure, it just seems like the thing to do. In fact, I can’t think of anything else that would be better. Possibly one of the healthy ideas professionals have tried to train me to think will actually occur to me, like “take a PRN”… But if it does, it sounds absurd – nothing’s wrong, you see. I don’t feel depressed, so I must be fine.

But the “good ideas” are liable to get more and more destructive, and there is little chance to think them over before enacting them – they just seem too Right to second-guess. I might vaguely identify that they are actually terrible ideas, but my brain has labeled them quite clearly as important and sensible and in need of immediate action. My capacity to argue those labels with logic is drastically impaired. And anyway, there is a heavy sensation of inevitability: these are ideas that, once they occur to me, can’t not be done.

It’s this kind of thing that periodically ruins my life. This is why one of the suicide attempts that landed me in the ICU for a few days was at the end of a really, really good day. I wasn’t upset. It’s just, the idea occurred to me, and it seemed like The Thing To Do.

Can I just say how frustrating this is? Not in the moment, I mean, just overall as a thing I live with. Knowing that my brain is really, really good at talking me into terrible ideas at moments I am really, really bad at evaluating them accurately – good at talking me into impulses at moments I am bad at slowing myself down – it makes it hard to even slightly trust myself. Professionals worried about me try to get me to do “verbal safety contracts”, a.k.a. promise I won’t kill myself, and I’m just like… yeah, I’d love to be able to promise that. I’d love to feel like I have that much continuous control over my future actions. I’d love to feel like it’s probably never going to be life-threatening to believe the things I think.

Spoiler: verbal contracts don’t work for me. Personally, taking a PRN antipsychotic, or better yet a few of those over a couple of days, is more likely to work. It has a chance of chemically interrupting the hypomania, or at least squelching it down towards well-at-least-it’s-not-getting-worse. But will it even occur to me? Ideally I’ve identified that I’m hypomanic in the first place, and then mentioned it to someone who can prompt me to take the pill. Obviously emailing my therapist is a good option for making this happen, but also if I mention my mood on Twitter sometimes friends will be like, “um… is there anything you should be doing about that?”, and that’s enough to remind me. You’d think I’d have it down by now without needing external prompts, but, brains are quite the thing.

If this whole thing is resonating with you, here’s a very brief summary of some of the things that help me manage my bipolar disorder (I’ll write a more in depth post on this another time): meds, very strict sleep schedule, regular contact with providers, daily charting of warning signs/symptoms, curated sensory environment, masking autistic traits less/using AAC more, avoiding contact with abusers, plenty of quiet time, ongoing safety precautions (example, picking up prescriptions weekly so I never have so many meds on hand that an overdose would be likely to kill me), routines, being open with my support system.

Brains are quite the thing. I’m trying to learn to be careful about mine. You too? Please comment below.