Bipolar and sense of identity

Often times when I don’t understand all the complexities of my brain chemistry, I (consciously and subconsciously) find myself blaming myself for everything being terrible, with little logic. Therapists often have pointed their fingers at various possible traumas for the causes, but I really had no big traumas in my life that I can think of, so I felt the responsibility of being sick fell on me. I felt guilty in a strange way, like serving a prison sentence for a crime that I did not want to commit, as I’ve heard someone describe.

I’ve been asking myself a lot of questions regarding why I had such a volatile sense of self in this last post, and got some lovely feeedback from you, which made me rethink what identity actually meant. I’ve studied “identity” from an anthropological perspective in college, but it turned out psychologists care about a different aspect of identity. Things like “schema.” At first I thought my unstable sense of self might have had to do with my history (living in so many cities/countries growing up, and not being close to family) but I didn’t consider my illness as a cause. With some quick Googling, I found a wonderful post by Elizabeth Brondolo, PhD called, “Who Am I? The Effects of Bipolar Disorder on Identity.” Here is an excerpt:

Some scientists think our identity reflects our underlying schemas. Schemas are mental structures that are comprised of thoughts, feelings, sensations, attitudes and memories that are linked together around a common theme.

Some of the schemas we have are related to our sense of self—our personal identity. These schemas are shaped by our life experiences, and they reflect our interpretation of these experiences. We can think of these schemas as our internal representations of our most important values and our deepest fears.

Schemas about our personal identity can be organized around themes of competence, acceptability, lovability, and strength, among other themes.  The thoughts, feelings, and memories we associate with each theme develop over time. They represent our observations of ourselves in action in the world and in relationships with others.

That’s schema as a general definition. Dr. Brondolo claims schemas have a different effect on us who are bipolar.

But developing bipolar illness can have a significant effect on the schemas we hold about ourselves. Bipolar disorder is a biological illness, but these biological disruptions affect our behavior and our mental processes. In turn, these changes can have a significant effect on our ability to function in the world and to relate to others. As we observe these changes and have new experiences as a result of bipolar disorder, we can develop a new set of schemas. For example:

– If the symptoms of bipolar disorder interfered with our ability to concentrate and plan and disrupted our ability to work or study, we may develop schemas about incompetence.

– If bipolar disorder drove us to behave in an unpredictable or unusual way (i.e., we were aggressive, impulsive, or hypersexual), we may develop schemas about our unacceptability.

– If we were rejected by others and lost relationships, we may develop schemas about being unlovable.

There is an example in the rest of her post about a woman in her twenties that almost is identical to my experience, but what I’ve bolded above was so validating for me. As a result of getting the illness, I wasn’t able to perform as I had before because of the symptoms. That made me feel more incompetent thus less worthy; I felt like a failure- even though that isn’t true sans illness. It makes me believe, and hope, if I can get stable again somehow and get back on my feet, I will maybe be able to feel differently about myself again through new experiences.

Advertisements

What does “recovery” even mean?

It’s been a really weird week this week. My depression hit an all time low but my family finished signing off the papers for a dream flat in the city. The general mood is celebratory but my depression is sticking out like a sore thumb. I feel bad that I’m dampening the mood, but my family knows me too well for me to successfully hide what is going on. The irony– family gets a new home, feels like dying. My dad asked me how I’m going to do my room, and I have no answer. I used to love interior decorating and remodeling homes and thought that my past self would have loved this opportunity. I just stood in my new empty room with two large french windows and immaculate wood paneling and thought, I’m not sure if I’m going to be here long. I remind myself that my thoughts are very distorted and negative.

Recently I’ve been catching myself asking this question: “is this as good as it gets? Maybe I’m expecting too much out of life with this condition”- which was something I would  never have questioned when I was healthy. I was a go getter and nothing was impossible for me if I gave my 110%, and maybe that was naive. But if I were to lower my expectations of what I can do with what I’ve got, what does that look like? What does this illusory “recovery” look like? What does the future hold? Of course, no one can know the future for sure, but there must be a way of finding out whether or not if there was a trajectory for people with this disorder.

I thought I was out of the woods once I got on the “correct” medication. My symptoms of depression disappeared like it was never there. This must be recovery! Alas, that was only for a while until I hit another massive depressive episode worse than the others I’ve experienced, and quite different. I moved across the country, which brought up a lot of stressors. The meds I took were not working and it almost seemed futile to be taking them so religiously. Because New York is a bit livier than Chicago, my anxiety spiked and I wasn’t able to get out of the dissociation. I felt like I was living on borrowed time, and that I was going to be gone any minute now from this planet that I did not belong. Things looked like it was getting better, but then I crashed again.

When does this cycle end? What does recovery even supposed to look like? A common definition is that there is a lack of symptoms of depression, mania and hypomania and that it doesn’t disrupt life. For me from where I stand that seems like a tall order, and maybe not so realistic. No symptoms? At all? How will this ever go away? Then the second question is, is it realistic to be able to control the symptoms or lessen them? So far for me, it has been hit or miss. I try to adhere to a healthy lifestyle, and it seems like there is a correlation, but most of the time, other external factors seem to smooth out all the work that has been done.

I would really like to live to live my life and not just live for the sake of being alive, even if it doesn’t mean returning to my old self before I got diagnosed. Is that asking too much?

Another move

Back on the mood roller coaster, everything is so terrible. There is no reason why, as depressive episodes go, but I feel guilt, embarrassment, shame all rolled up in one bitter package of self loathing. My reality is the total opposite. My family is moving to a lovely new place by the waterfront with a great view of Manhattan- it’s been a dream for us to actually move to this neighborhood and I should be thankful, instead I feel flat and sad.

I made some progress with my new therapist thinking about the disparity between my depressed self and my normal (and hypomanic) self. Why is that my self regard so deeply dependent on my mood? Most importantly, why is my self respect so low when I’m depressed? What is fueling this? When I’m depressed, to me, I’m less important than an ant. My existence feels like a waste of space. I feel like I have thoroughly failed to achieve the purpose of my being, which is to be a productive member of the society. When I was first hospitalized, I was shocked that the doctors and the nurses at the ER wanted to save me more than I wanted to save myself. When I’m hypomanic, or just plain normal, I feel confident, and feel deserving of happiness. This creates so much cognitive dissonance and an unstable sense of self. Truth becomes a shaky ground, and I become less trusting to myself. My judgments become implausible, which makes me less independent as a person. A fully grown adult should be able to make her own judgment about what to do, but I catch myself cowering because I simply don’t trust my thoughts and my judgements.

It’s becoming very hazy where the illness ends and I begin. How much of this is “actually” me, and how much of this is the illness speaking? I can feel my sense of identity eroding every single day. Not that I had a solid one to begin with. I’m scared that this move will bring me additional stress and push me further down the black hole where I feel nothing.

What a good day looks like for someone with biopolar disorder

Today is absolutely blissful- especially because this feeling is often short-lived and quite rare for me. I feel good about myself. Regardless of what I have achieved or not achieved, I like myself for who I am. And why shouldn’t I? Why shouldn’t anyone with bipolar not feel good about themselves? I can’t stop being thankful despite everything that’s happened, and all the help I’ve received along the way on my road to recovery. There are no intrusive thoughts or voices that plead me to disappear from the face of the earth. It’s not uncomfortable to laugh as it usually is for me during the depressive episodes, because it comes naturally. It makes me almost believe that humans are not inherently evil. It’s so quiet and calm, like my head is in a zen garden. Colors shine brighter and inanimate things appear more lively. Others tell me that the sallowness in my cheeks are gone, replaced by a peachy pink. There are sparkles in my eyes. My body temperature is higher. In fact, it’s even difficult how I could even have thought those things during my dissociation… I don’t understand how I could have been afraid to leave the apartment. I don’t see how anxiety could have prevented me from going to bed. I can’t imagine dissociating. I can’t imagine why the phone calls were so hard to make. It’s like someone planted that thought into my head, like in Inception, the film. In this state, I don’t understand how I could ever be depressed. I’m typing this so fast, because ideas are flooding into my head. Thoughts are racing. I can’t keep up.

It doesn’t surprise me that people who have bipolar disorder have one of the highest suicide rates out of the psychiatric disorders out there. If you can see how good life actually is, and see how good it could be, how else would you respond to the depressive episode that follows the mania/hypomania? It’s also difficult to be compassionate for your depressed self, because when you’re on the flip side, you can’t (readily) imagine how things could be so bad. It’s not impossible, but it’s hard- reading what I’ve written during the depressed and dissociated states, it all comes rushing back to me. About how it felt: how desperately I wanted out of my body, and how painful the persistent intrusive thoughts were. How I was scared out of my mind at strangers on the street, and scared that I was going to be attacked at any given moment. I felt unsafe for no logical reason.

As someone who is already not very in touch with her feelings, my cycling between hypomania and depression makes me distrust my feelings as a guide, even more. What is real? Is what I’m feeling too exaggerated for what’s happened in reality? Does it even make sense to evaluate your feelings like that? Is my depression making feel stronger than I should? Or during hypomania, could it be that I’m feeling too confident than I should? It’s possible that the reason why I ignored my feelings all these years was because my mood swings would have made it impossible to look “perfect” on the outside, and as a result I coped by squashing my emotions into a narrow range. Having perfectionist tendencies, I do tend to be obsessed with being “proper.”

I’m not doing much of anything today, but I’m happy. I know that when I wake up tomorrow, I may not feel this way again for a while, but I literally live for days like these.

Managing chronic dissociation

I’ve been gone for a while, in a few different ways. I came off of social media and my blog for a while because of my anxiety and the negative self-talk that comes with depression. I been also feeling like I wasn’t in my body. When it got bad, the thoughts went to wanting to not exist, whatever that took. I’m not sure if “fantasized” is the correct word here, but I would imagine day after day hoping the pain would go away, and how it could go away, how it could just all end. The awful thoughts that hurt me somehow kept persevering- “you’re not worth it,” “you don’t belong anywhere,” “you’re useless,” “you have not future” etc. Mindfulness exercises were not enough to overcome the noise in my head, and distraction was the only way to keep myself safe. I finally came off of the Ativan I was taking it at night for sleep and anxiety, and the anxiety came back like it was always within me. It made me shiver and shake when I was in bed from the physical sensation of anxiety- I couldn’t trace back to what I was anxious about. It was like ants crawling over my body from toe to head on my back.

Through it all, I dissociated. Well, I’m actually dissociating now as I write. I’ve dissociated for a straight month. I should point out, I don’t have Dissociative Identity Disorder or Borderline Personality Disorder, for which dissociation is a common symptom. No one has figured out exactly why I dissociate. My therapist thinks it’s because of the trauma of becoming diagnosed with bipolar and the aftermath of getting used to the condition. My doctors thinks it was the Ativan I was taking or the level of Lithium I was on. My mother thought it was from the big move. It could be because of many things. Whatever the reason was, I kept dissociating.

Being asleep makes the reality more “real” because you’re actually supposed to feel a bit foggy and dream-like while you’re asleep. So it’s not strange to say that reality is more authentic in one’s dreams for someone who dissociates. When I’m awake, everything is so dull, colorless, not reactive. People passing by seem fake, like puppets placed in the fake world you’re supposed to interact in. You don’t feel like you’re in your own body or that you have any agency. You constantly feel confused by where you are and who you are. You feel invisible because you think you’re actually watching a movie instead of what is happening as a reality. Sounds uncomfortable? You bet. This is your whole day, from when you open your eyes, until you fall asleep. There are some things that I’ve done to cope with feeling dissociated all the time. I can’t say they cured it, but it helps with managing it.

  • Fake it: Emotions will not be automatic in this numb and dull state. So when you are prompted to show an emotional response to others, give them what they want. This will be easier than trying to explain what you’re feeling (like the above). Read their facial cues for clues and reiterate what they said, even if you don’t actually have an emotional response. Laugh when jokes are made, empathize when necessary. Be careful to not get worn out, because it takes energy to do this. Take breaks when needed.
  • Get exercise: This might be difficult when the anxiety is high, so in that case, it’s best to do it in a secluded place by yourself. I tried to walk in the park but I would jump every time a stranger passed by. Go wherever you feel safe. It could be a gym machine, or in my case, I walked up and down the emergency stairway in my building multiple times because it was usually empty. All in all, endorphins always help at least just a little bit.
  • Help someone else: This is another distraction skill coupled with opposite action. Focus on someone else’s problem’s for awhile to make yours disappear temporarily. Take care of a pet, do the chores for another family member, volunteer.
  • Get busy: Take up a hobby to keep your mind off of yourself and your situation. I picked up embroidery to feel productive.
  • Pretend that you’re playing a video game from the first person perspective: Accept that the dissociation will be there. Accept that your reality is “fake”. Tell yourself you’re playing “you” in a video game- pretend to play a role of “yourself” when you weren’t dissociating. Ask close friends and family to check if you sound like yourself. So far, it seems like even if you don’t “feel like yourself,” or if you’re having an out of body experience, everyone else won’t notice that you’re dissociating.

That’s all I’ve got. Hope everyone had a good weekend.

 

Dear self

I’ve been truly struggling with the transition, and having one of the longest dissociative periods I’ve experienced coupled with anxiety. This is an attempt to describe how that feels. I regret that I haven’t been active and supportive in the community lately- I’m a very empathetic person and it takes a lot out of me to engage in external struggles besides my own during my bipolar depression. I hope you’ll understand.


 

Dear self,

I want you to remember this mood, the sensations, and the thoughts in your mind right now. You are at rock bottom of the depression cycle. There were many version of this “rock bottom,” as you have experienced before, varying from suicidal to apathetic, and each time, it seems like you have less of a grip on your life than you thought. This time, I can characterize this dip in the cycle mostly as foggy and dissociative, which brings along apathy. It feels like you’ve taken your life and put it in the dryer for too long- the result is a desiccated soul that has been solidified into a ball of unusable cloth. You’re drained of the motivation you had for the things that bring you joy. To cope you escape through hours and hours of meaningless entertainment or sleep. Because the fewer hours you are awake for, you get to dissociate less. Meditating doesn’t help. Self, when I try to get in touch with you, I can’t feel your presence. I can’t tell what you’re feeling. I’ve been working on paying attention to you more, but this brain fog is a barrier from me to you and I don’t have the energy to climb up the chain linked fence. Every time I leave to go exercise in the park, the dissociation gets so strong that I can’t feel and my body is just going through the motions. It’s a terrible feeling, like having cotton balls block your five senses. Yet my family pushes me to go for walks, because it’s good for me. I’m sure it is, but it sure doesn’t feel good. I’m like those dogs in inhumane experiments trapped in zapping cages who can’t get out even with the cage door wide open. I’m often conflicted with these two competing goals- long term betterment (gained through opposite action), and listening to my feelings (being self compassionate). A therapist would say that it’s a balance. That’s like saying “it depends.” Totally useful.

I long to dream and I long to yearn again. Dreaming and aspiring might be a very natural thing to do, and I thought so too, until my health failed. So what I mean is other than longing to get better, to feel myself again. I guess I’m not courageous enough for this yet, but I want to have goals in life again, in my career, relationships etc… I want to be confident that the things I want to achieve will come with time and effort (and luck, but I can’t control that), I want to be stable, as much as you, my self.