Across and Inside my Universe

Unsafe

Well, I'm not safe.

Lability is uncomfortably high (I hope I'm using the term correctly).  My state of mind, my emotional perspective, keeps shifting so much that any decision I make, even fully believing and commiting to it, I can be doing just the opposite five minutes later (or half an hour, hour, etc.).  The place from which I am interacting with the world from, feels as though it's on a mess of shifting tides and currents.

Part of me thinks, well, isn't this just weakness of character, not being able to stick to anything or operate from a stable state of self or being or mind or whatever?  That word, stable, though, is part of the key.  The whole shifting currents thing, is another.  I'm NOT STABLE right now; I'd not call myself UNstable in a crazy, psychotic way, but  . .. well, basically what I've described above.

It is tempting to fall into the trap of thinking, hey, since I'm seeing this problem, and acknowledging it, doesn't that mean I'm functioning well enough to be or feel safe?  I've fallen into that trap before.  While identifying this stuff, prioritizing it, taking some actions with it, etc. are positive and functional, healthy things, the very nature of being so . . . well, volatile isn't quite the right word, I'm not going to lash out in an extreme way (although I guess suicide and other things actually are pretty extreme) at anyone else (hrm, I've been highly irritable and rather snappish, which I've been not pleased to have acted out as much as has been, the last few days; it has been uncharacteristically frequent and drop of the hat.)  I've been quite reactive and on a short fuse, not even necessarily being aware of having a short fuse, until I snap at my husband.

I've been irritable and snappish before, without the high lability; mixed states suck.  There is more here than just that, although mania and depression certainly make matters rather worse . . . 

I have therapy tomorrow, and I don't know if my psychologist will recommend the hospital.  We've already taken some familiar and not so familiar steps, around here.  Any excess medication my husband has hidden.  A step taken once before, for a time, that I've asked of him again, is to not leave me alone at home for three hour+ stretches.  Two hours feels like it'd be kind of rushed for anything extreme, but that may be because I'm particular.  I hate to scare him like this, but on the other hand it feels the responsible thing to do.

So, he may need to stay home from church on Sunday.  This would carry us to next Wednesday, when I'll be home alone for most of the rest of the week.  If I am still highly changeable/feel like my behavior could turn 180 in the blink of an eye/feel like my mania or mixed state or whatnot is pushing me to danger, then we'll have to probably hospitalize me or figure something else out.  I am REALLY hoping that I'm not like this, then.  It usually has only ever lasted a few days, 3 or 4 tops, but I had this a week to 10 days ago for 4 days or so, and now again and it's just rather scary.

I dunno, maybe I'm a wuss and not taking responsibility, when I say that I can't seem to be able to say that what I decide right now will be the place from whence I could reasonably still be operating an hour from now, etc.

The pull to reckless and harmful, serious things of a variety of types is strong, although I am currently fighting them.  Some things you can't come back from, and some you maybe  shouldn't (okay, definitely stuff to bring it up tomorrow in therapy.)

Edit:  This talk of lability, and danger, and unsafeness, and my assessments thereof, are based mainly on how my psychologist has assessed me most recently last week when discussing the same kinds of things, as well as in the past, the few other times that it has been this bad (all since early 2012, really).  Things I'm saying here are based on concerns he's discussed with me about my safety and stability and such when I'm in this/these states, having experiences as I've been this week and being all over the place, and stuff.  My safety has been a major issue and concern to him, in many of the ways I posted about here, and some things I haven't posted.

Edit:  Also, I do have upcoming appointments with my psychiatrist, later this month and then in August as well, since my urologist cleared me for going back on psych meds/back to the psychiatrist (I know one doesn't necessarily mean the other but he has pronounced my kidneys fine, after a CT and a cessation of the most distressing symptoms . . well, I may need to check one more thing with him, but he did clear me.)  Still, I may be contacting her sooner, by email I guess, if my psychologist thinks I need to go to the hospital.  Maybe her emergency nmber would be better, I don't know?  I' ve left a message on there before.

Do What Hurts the Most to Improve What Hurts the Most

Or:

No pain, no gain.

That's a little black and white, but since running from pain is what I do best, learning to just sit with my pain, heck, learning to recognize when what I'm doing is a defense or running from pain, is pretty much where I'm at alot of the time.  Yes, even after all these years of therapy.  I was sooo un-self-aware back then, and therapy's helped me alot through the years, subjective though my opinion might be.

So, to improve in areas where you social anxiety bell starts ringing, you need to at least approach that bell and face some of your fear, and learn that you can deal with that situation, without retreating, in order to make gains in that area.

Sounds so simple, doesn't it?

When spelled out intellectually like that, it does, but feeling it is quite intense and often difficult.  Still, I've gained some sense of efficacy in some areas I needed improvement in; oh, how many more there are!  

A month ago, when my husband started physical therapy after his arthroscopic shoulder surgery, I went with him and saw the therapist who'd been my physical therapist several years ago.  He's the owner of the place, so quite capable (or seemed so to me).

He asked after my recovery, and was unpleasantly surprised/startled to find that my total knee replacement recoveries have turned out so poorly.  He kind of quietly threw out there that perhaps some strengthening, exercises and such, could do improve things quite a bit, if not solve the problems entirely.  He expressed his sadness that I was in such lasting pain and again seemed to think that improving strength would help.

I found myself out of sorts after hearing this, and as I lay in bed that night I realized, "He's saying that I don't have to be in pain; that there is something I can DO about it."  I felt anger, because how does he know I haven't worked hard?  I have.  I felt frustrated, that he would just assume that something COULD be done, because I've had to come to terms with being in pain alot.  I felt anger that he was dangling no or less pain in front of me, if only I would CHOOSE it, the implication being that if there was something I could do to improve my situation and I didn't, then I was CHOOSING to be in pain (or at least, in as much pain as I am).  I did realize eventually however that most of this was how I felt upon hearing or pondering what hea said, and wasn't necessarily what he said, or meant.

I chose, last week, to get over myself and have my husband ask him what I could do (the holiday being kind of nuts, I couldn't make it to many of his physical therapy appointments, although I could have done better than I did).  Why let pride stand in the way of possible improvement?

What the physical therapist suggested is standing up and down out of a chair, like I used to do at physical therapy and at home during recovery, using legs only no pushing up on the arms of the chair with my hands, etc.  He also said I can use a pillow in the chair if I can't stand up without using my arms without it.  To that I thought, "What, does he think i'm THAT weak?"  I can actually stand up from a crouch now, and it was less than a year ago when I couldn't do that; I'd gotten in a crouch and was stuck (it felt like I had no way to make myself fall over either, weird as that sounds, so I could get up from there, so I felt trapped and feared getting in a crouch again).

However, a week or two ago I crouched without thinking about it, and got out of it myself (with agonizing pain, naturally, but still I did it.)

So, I'm going to start doing three sets of 10 of these, several times a day, with a day off in between here and there, as when you are strength training I know the muscles sometimes need time to build back up.  Or something.

I've got an office-style chair that I can and do usually keep set really low.

The thing is, standing up without any assistance from my arms, or from setting my legs farther apart, has the pain hitting a level 7 during the whole muscle-pushing process.  Level 7 is alot.  So, to stand there and do it ten times in a row, rest for a minute or two, do ten more, rest, and 10 more . . . well, that's alot of pain.

Still, I don't, I really don't, want to let pride or complacency get in the way of possible improvement, so an extra heaping of pain it is, and I'll note down every two weeks how my pain is, of differing types in my legs, and do this for three months at minimum.

I'm not optimistic, but  I guess we'll see.  If there's only a minor improvement, is that enough given that I'd likely have to keep up with some level of strength-boosting/painful activity to retain this improvement?  It depends on how much, if any, improvement we see.

**

On another note I don't think messing w/meds is a good idea.  I'm actually desperate to have higher Lamictal to be a barrier between me and aspects of my mania that I had forgotten how they felt, partly because I couldn't understand how I could feel that way and still be me; however, I am starting to be reminded.  I was going to go back up on Lamictal but just upping it a little, made the urinary system a touch worse, enough so that I just cannot make myself go back up; it'd be like having to use a hammer to squash a bug on my hand - I can't make myself do it.

I really, really don't want to get off the med, but I really, really can't live with the developed side effects either.  Just, this isn't me not wanting meds, I tried to make it work for a long time.  There's practically no choices left, of mood stabilizer (lithium has such a high side effect profile? is it? that I'd really like to let my kidneys and bladder heal up and have some time where I'm not constantly worried about my health and side effects; however, the mania isn't just going to go hide under a rock.  Ugh.)

Bipolar Extremes: Responsible or Not?

That title is very black and white, is it not?

In a recent Psychology Today blog post, entitled The Elephant In The Bipolar Room, it is proposed that what if the paradigm regarding whether bipolar people caught in the extremes of their illness, the dark depressions and the really high manias, shifted from the view "that we are incapable of remaining in control when mania and depression reach a certain intensity", to something like "what if we could be highly functional while manic or depressed?"

They then go on to talk about how this might lead to, rather than being focused on the dis-abledness of being bipolar in the 'can't control one's behavior' paradigm, in which the goal is to remove the bipolar symptoms as much as possible, instead being focused on the capability of the bipolar to function during intense states of mania and depression and why some cannot (and how to change that from a behavioral perspective).

This was one of the first major internal struggles I had, and still have, regarding my bipolar diagnosis, living with it, trying to be able to live with myself (and behaviors influenced by the illness), and still hold to a standard of personal responsibility. 

One of the first really hard-hitting notions that struck me was that if I was bipolar, I might be more likely to sin than other people.  This distressed me greatly on a variety of levels, and I was quite upset about it.  However, eventually I followed a path to realizing that IF the illness meant I might sin more than other people, the Savior's atonement would make me the same as everyone else.

That's a gross simplification of the repentance process, including ignoring the fact that to repent, you have to take responsibility for your actions, among other things.  Not just sinning and saying while you do, "Oh, I'll repent later . . ."

Still, that was one big, early concern, and a nice, spiritual answer to it.  My struggles there were more about worrying that I'd be a bad person and the relief I felt when I realized the Lord would make me as everyone else, than it was about trying to dodge personal responsibility for my actions.

The issues and struggles I had, and still have in some ways, with issues of, "Does the illness become so severe that my judgement is impaired, say, as if someone was forcing you to get drunk, and then you did irresponsible and bad things?  If someone forced drink or drugs on you, I'd think you wouldn't be responsible for your behavior.  It is my feeling that IF the illness tampers with the judgement center(s?) of the brain, then how can you entirely have been said to be acting and choosing to behave in a manner that you would choose if the illness was NOT tampering with your judgement?  My psychiatrist in fact says that your (my) brain goes into an altered state, when manic and such . . . she is of the view that you can't be held responsible, in that state.

On the other hand, though, I was raised to take responsibility for myself.  There's also the spiritual implications . . . involving repentance, and other things.  In my religion, I was raised that we on earth have free agency.  We have the agency to choose, and behave in ways that we are responsible for.

Do I feel that there are illnesses that can impair, interfere, or even take away your ability to choose as a competent, capable person?  Yes. 

Would you hold someone responsible for running out into the street and causing a car crash, if internally they truly, really believed that they were super strong, invulnerable, and there was a baby crying in the middle of traffic that they had to save?  I don't think so.  I know I wouldn't.  They'd need some psychiatric help, if they survived, but I wouldn't judge them.

On the other hand, things are not often black or white, that clearcut.  I believe that choices can be made that may be influenced by your illness, but that you still could choose to avoid the bad behavior, although it's much, much harder to do so than if the illness wasn't coloring your entire experience of the world and how you interact with it.

What I eventually decided for myself, without having answers to some or all of these other aspects of the issue, is that I will always take responsibility for myself, as soon as I return to a state of mind where I can do so.  This implies that perhaps I feel like I enter states where I feel like I'm not responsible; I don't think that's how I'd put it. 

I'd put it more like . . . . your instincts to be responsible, apply the rules of life that fit who you are when not ill, are either hidden by a cloaking device, or covered in camouflage.  At your manic worst, you don't even realize there's something you need to search for, if it's really really bad. 

At somewhat lesser levels, it's like a Where's Waldo picture, sometimes you can pick Waldo out right away and/or easily, and sometimes you put alot of effort in but have a really hard time finding him.  Sometimes it takes just a moderate, but sustained effort.

This is where AA's HALT comes in: Hungry, Angry, Lonely, Tired.  If one or more of these are present, it's going to blur your focus on the Where's Waldo hunt.

These aren't perfect analogies, by far, but they're the closest I've ever come to being able to describe how these issues, and mania, are experienced by me.

Back to the Psychology Today post:  I think it's beneficial to question the prevailing view to see what might happen if people or society took a different view.  I don't think it's as simple as one view or another; I think life, and illnesses, are sometimes messy, and a balanced view would be somewhere in the middle, but with an open mind to looking to learn from those who seem to have learned to function during their manias and depressions (managing these (including w/meds) and learning when to take care of self, being part of this though), as well as having compassion for and working with those who seem to be unable to cope in the specifics of their bipolar illness.

Not judging either end of the spectrum, nor the middle, but learning from all positions, from the variety of shades of grey, understanding that there's a wide variety of experience and illness.  Some may be much more impaired than others, some to degrees that many people might not understand.

This subject really has felt like an elephant in the room, to me, for a long time now.