Hiatus

Dear Followers of my blog,

I will be going on hiatus for the next three or four weeks. I hope to resume my postings after that, but I may have to delete my website. I will let you know in advance. Thank you for your kind support.

Linda

Loss: Financial Security

I have to admit—although I hate to admit—that the loss of income and financial security, and the concomitant loss of peace of mind, due to my bipolar disorder troubles me greatly.  I am profoundly grateful that my workplace provides a long-term disability plan.  I cannot imagine what I would have done without it.  I am aware of and regret the unfairness that other people with a mental illness—perhaps most people with a mental illness—have far less than I do, that they must struggle far more.  But that knowledge does not assuage my concerns and fears.  I cannot help but think what a difference it would have made to my rather meager savings and pension accounts if, for the last twelve years, I had received a salary, annual merit increments, a salary increase due to a promotion, and regular negotiated contract salary increases.  I cannot help but rue that hypomanic spending in the early years of my illness has cost me so dearly.  My heart sinks with every financial report as I watch my hard-earned savings dwindle.  I feel helpless that I am unable to take prudent care of problems that my aging condo present, and what will I do if an appliance breaks down or there is a large assessment (which, in fact, has just occurred–what will I do?)?  What makes me feel so powerless and vulnerable is that, given the state of my health, there is absolutely nothing I can do to improve my financial situation—I simply cannot work.  Naturally my income decreased when I went on LTD and I have had to make numerous adjustments, but I have found that living more simply is not as arduous as I thought it would be.  That will not be the case when I retire in one and a half years–my income will decrease by fully a third, necessitating considerable changes in the way I live.  I have begun to anticipate these changes: I am looking for a smaller, less expensive place in which to reside (although it pains me to give up the home I love); I no longer buy books or rent DVDs—I have discovered the public library is a fabulous resource; I meet friends for a coffee rather than a meal; I am vigilant about ensuring no wastage when grocery shopping; and so on.  I doubt I ever again will be able to visit my hometown and all my friends there.  I am thankful for what I have, I cannot emphasize that enough, and I am learning ways to be more frugal, but I cannot help missing those things I used to take for granted, including a comfortable retirement.  Instead I look to my senior years with anxiety.

Dangerous Thoughts continued

In the first part of the essay I discussed morbid thoughts, complete indifference to whether one lives or dies, and incidences of self-harm, the precursor, I think, to suicide.  Here I will discuss suicide and how I have learned to prevent it through my “safety list”.

When I begin to have suicidal ideations, which can escalate to concrete plans,  I pull out a  neatly organized and laminated “safety list”.  My list begins with a reminder to WAIT.  My rationale for this is that in an hour or two, or even less, the desire to take one’s life may not seem as urgent.  You can commit suicide any time, so what difference does waiting a little while make.  I developed this attitude mainly from reading a research report (for which, unfortunately, I do not still have the reference).  Every year many people attempt suicide by jumping off the Golden Gate Bridge in San Francisco.  One particular researcher interviewed survivors and every one of them said that at the instant they jumped they realized that they were making a huge mistake, that their problems were not insoluble after all.  The researcher hypothesized that the same was true of non-survivors, although I think that inference could be challenged.  Nevertheless, the main finding is powerful.  It created within me the intense imperative to wait when the pressure to commit suicide is high.  (While I was trying to track down the article to which I refer, I came across other studies of survivors that report more mixed findings.  In terms of waiting as a means of challenging thoughts of suicide, the original article has been of enormous benefit to me, even if others have not replicated the finding exactly.)

If “wait” is not enough and I need more assistance, and if it is working hours, my next step is to Telephone My Psychiatrist; if I tell the receptionist that it is an emergency, she  will inform my psychiatrist, who will speak to me right away or call me back almost immediately.   (I realize how fortunate I am in having such a professional and caring psychiatrist.)  If it outside of working hours, I can Use the Pager that one of the partners in the practice carries at all times.  If I cannot handle the urge to commit suicide any longer with the three methods just described, I call 911.  These are the four main tools I have for preventing suicide.  I have come across other resources, however:  the suicide hot line; the Emergency Room of the nearby hospital; the local RCMP detachment, which is one block away; and the local fire department with its paramedics, which is two blocks away.  I include the telephone numbers for each possibility, because when I am desperately fighting the compulsion to attempt suicide I do not want to be scrambling online or searching my memory to find the number I need.  This list is invaluable.  As soon as I feel I cannot handle thoughts of suicide, I immediately have at hand several effective and efficient resources.  I think it is only fair to mention, however, that I did not prepare this list until after my suicide attempt.  Eventually I realized that I needed to seek help far earlier in the dangerous thoughts process than at the point of attempting to take my life.

The most perilous of the dangerous thoughts encompass the planning of suicide and the implementation of the suicide plan.  In my abortive attempt what I did first was figure out how to end my life.  I wanted a method that was as quick and painless as possible, and that would not endanger anyone else, which limited my options.  I thought shooting myself would fit my two criteria best, but I had no idea how to procure a gun, even though we were always being told on the news how easy they are to come by.  Eventually I narrowed down the method to one, which freed me to complete the other aspects of the planning process.  I was again hospitalized at this point.  Previously I had considered ways to ensure that my body would be found in a timely manner, but as I was now in the hospital I did not have to worry about that problem.  I managed, under the watchful eyes of the nurses, to write letters to my cousin (essentially my only remaining relative at that time, although we have had the good fortune to locate another) and my two dearest friends in which I described how much they meant to me and why; explained that I felt suicide was my only option and that I was doing it rationally, of my own free will; and finally, that they must not feel any guilt or other negative emotion, that I was now more emotionally settled than I had been for so many years.  The letters were written on note cards with a picture of a Kandinsky painting on the front.  I labeled the envelopes with the name, address and telephone number of the intended recipient.  I still had the box from which the note cards had come and I placed the three cards in it.  As well, I inserted my address book with asterisks beside the names of all the people I thought should be informed as quickly as possible.  Finally I included my will and a list of my assets with the name and telephone number of my financial advisor.  I wanted all the paperwork to be taken care of to lighten the onus on my executor as much as possible.  I had a fright one day when my inpatient psychiatrist (the on who treated me in the hospital) stopped by to speak to me, saw the box and came over to look more closely at it as he liked Kandinsky’s paintings too.  If he had opened the box all my preparatory work would have been revealed.  But he did not.  (As a matter of interest I only got rid of the box and its contents two years ago, in 2010.  Even though I have had innumerable  suicidal ideations since 2005, when the events I have been describing took place, I have not been imminently suicidal since then.  I am not sure what purpose the box served for me.)

I had finally earned a pass to go out of the hospital unsupervised for an hour.  I lived nearby, and I went home and did what I had intended to do to end my life.  But like the survivors in the research study I reconsidered my action some time later and telephoned the nurse to whom I has been assigned for the day.  She arranged for an ambulance to pick me to return me to the hospital.  She gently chided me, as did all the nurses whom I encountered.  “What were you thinking?” they all asked.  I have to say the psychiatric nurses on my ward were utterly professional and would never have breached confidentiality.  But as in any small community the residents soon discovered much of what was going on.  So my three roommates knew I had attempted to take my life, and they did not question me but looked at me strangely.

I met with my hospital psychiatrist every day, and at our next session his inoffensive question “So tell me about yesterday” led to my impassioned defense of every adult’s right to choose whether to live or to die.  He replied with some comment about this was my depression speaking.  I became enraged and would not give an inch on my position.  We repeated this exchange for days, I really do not know how long.  I think my anger was fueled by several factors.  One was that I still had a strong desire to end my life, but of course I was watched very closely, which irritated me no end.  Another was a sense of being outnumbered.  This was a teaching hospital, so at this particular time of the year when I met with the psychiatrist, my nurse that day and the psychiatric resident were there as usual, plus an intern and a student nurse, both just starting their psychiatric rotation and strangers to me.  The last two looked at me with wide eyes and sat at the edge of their chairs, ready to bolt out of the room if something scary happened, I have no idea what they imagined that might be.  In the face of all these people I had to maintain my position, even though I was becoming embarrassed about my actions and wished the whole mess would just go away.  Then there was the fact that I was feeling guilty because my psychiatrist had trusted me with an unsupervised pass and I had betrayed him.  I am not sure how this impasse would have been resolved, but between ECTs and a new medication my mood got better—it did not just improve but became normal.  I distinctly remember waking one morning and lying still, trying to identify this unfamiliar feeling.  Finally I realized it was happiness, something I had not experienced in about seven years.  The feeling stayed with me for two wonderful months.  (In 2010 I had another 2-month episode of feeling normal, happy.  But that has been it for happiness since my diagnosis in 2001 and several years before that.  Feeling ok has been my goal since the beginning of my illness.)

By chance my hospital psychiatrist was in the same practice as my outside one.  After my suicide attempt he asked her to speak to me.  We had a good relationship and she had always been kind, gentle, empathic, but on this occasion she began by being icily angry.   I do not know what we discussed, but somehow she wrested from me not just a promise but a solemn vow that I would never attempt suicide again.  She knew the importance I give to promises, so a solemn vow would be very binding indeed.  And it has worked, of course; it just is not in me to break a vow, let alone a solemn one, without overwhelming cause.  So that has been a powerful deterrent against suicide for me.  Another potent deterrent has to do with the controversial death of a family member in the mid-1950s—it was unclear whether it was an accident or a suicide.  The impact of that uncertain death has been felt through three generations.  The person who died was a relative’s father, the relative I mentioned earlier.  I cannot allow her to carry the burden of two unnatural deaths.  I cannot abandon her this way.   These are highly idiosyncratic deterrents to ending one’s life and reasons for staying alive.  I expect every person struggling against suicide has his or her own individual reasons for choosing life, things which clutch the heart, but what is important is to be able to retrieve those incentives when necessary.  In my case it is another list I keep handy, one with just two words:  vow; abandonment.

I have been describing thoughts I have had and continue to have whenever I am more than okay depressed.  I named these thoughts “dangerous thoughts” because I believe they are dangerous; they can result in injury or death.  If there is one lesson that I hope has come through this essay, it is the paramount importance of being well prepared to handle and dispel dangerous thoughts, the sooner the better.  There are many health care professionals who can help us develop strategies that make sense to us that we can turn to and carry out immediately and easily.  Each of us with bipolar depression will have different deterrents to suicide and different life-saving plans, for that is what they are, but through our own distinct plans each of us can be saved.  A life saved is a priceless treasure.

Dangerous Thoughts

Any of you with bipolar disorder who read my November 7 post “Loss:  I Used To . . . . “ probably deduced that I was hypomanic at the time I wrote it.  Since then I have undergone a 5-day episode of rapid cycling, and two episodes of mixed state of a similar length.  I did not do well during these periods, as usual, and emerged only to fall into a deep depression which still holds me in thrall.  Yet, as I wrote in my previous post, I have been invited to many Christmas-season events and have been enjoying myself, in spite of the large core of depression which inhabits me.  The brain is a miraculous and often subtle organ.  I cannot understand how it is possible to be deeply depressed and yet be able to take pleasure in certain activities, even if only briefly before becoming drained and exhausted.

Because I am deeply depressed right now and because it is the holiday season, which is often distressing for people with mental illness, it seems a fitting time to conquer that taboo of silence about dangerous thoughts.  I will describe some of my dangerous thoughts and some of the strategies I have developed that help me to deal with them.

At times I am morbidly introspective:  I am indifferent to whether I live or die, I believe that my life is not worth living (I do not know how often I say to myself and to my psychiatrist, “This is a life not worth living”), and I have thoughts of suicide.  In the past I have resolved on attempting suicide, cut myself, planned suicide attempts, and attempted suicide on one occasion.  I probably would have tried to take my life more frequently, and may have succeeded, except that my psychiatrist was ever vigilant and committed me to hospital whenever the signs did not bode well.  But, in spite of this unpropitious history, I am still here, alive, recurrently OK, and writing this essay.  I know that other people with severe bipolar depression have experienced similar thoughts—probably, like me, often.  These are the nitty-gritty of bipolar depression, not the soft topics such as identity and loss that I have written about previously.  Yet we do not talk about them; it took me about six months to confide in my psychiatrist, whom I like and trust.  I remember blurting out the mildest of these dangerous thoughts one afternoon when a friend and I were having coffee and she literally as well as emotionally backed away from me (she could not push her chair back any further, and her back was almost part of the back of the chair)—to protect herself from being sucked into my mire, I suspect, and who can blame her.  But that only illustrates that these dangerous thoughts are the big secret, the elephant in the room.  Thus I feel compelled to write about this emotive issue; it merits examination.

Morbid thoughts, to me the mildest of the dangerous thoughts, can fill my mind, making consideration of other ideas difficult if not impossible.  They usually occur when I am alone but sometimes when I am with others.  It can be surreal to be carrying on a conversation with a friend about, say, a book or a movie with one part of my brain while another part is trying to suppress horrendous and disturbing images.  My morbid thoughts take the form of a wide variety of images.  Two images I face repeatedly are (a) hacking off pieces of my body, leaving bloody remains, in order to look slimmer—this is probably related to my obesity which has resulted mainly from my illness and from the medications required to control my illness, and left me in an awkward, unfamiliar body and with a wretched body image; and (b) smashing my car into a cement overpass (first making sure there is no one around who might be endangered by my action), accordioning it with me inside—this is probably a precursor to thoughts of suicide.  I have found that it is possible, with effort, to control morbid thoughts, even to rid my brain of them for a while.  It entails finding something that will engage my mind, engross it in some simple but distracting activity before the morbid thoughts take hold.  What works best for me is to revert to childhood in a sense, to play scrabble, card games or board games on my computer.  A couple of hours of this is generally enough to banish my morbid thoughts, temporarily at least.  Another trick is to tackle housework and paperwork, but this is not as reliable (or as much fun).

For many years the first thought I had upon waking was that my life was one not worth living.  Such thoughts are still common, the more frequently the deeper my depression. They are augmented by frequent emotional pain and suffering, which I foresee stretching out into the future with no end in sight.   This is a passive stage, in which I leave it up to fate to decide if I live or die, although sometimes I court death, call upon it, as I have described in a previous post.  I am completely indifferent to the outcome.  Yet concurrently I engage in activities that are designed to make my life better, such as working out with a personal trainer (although I have not done so for a year now).  If I truly did not care whether or not my life came to an end, why would I do these things?  The only answer that occurs to me is to make life worth living again, although I have not done so with a great deal of success to date.  It appears that I am not giving up even when I say, and am convinced, that I am.  How I have made sense of this contradiction is to imagine that I have a powerful life force deep inside me.  I visualize it as a flame. Much of the time it burns low and flickers but it never goes out.  It once burned with a blinding light, before I developed bipolar disorder, but it does not any more.  Nevertheless it still emits light of varying degrees of intensity, light that brightens my life for a moment or moments and may one day brighten my life most of the time once again.

Contemplation of suicide and incidences of self-harm are serious dangerous thoughts that must never be ignored.  The first two types of dangerous thoughts should not be ignored either, but in my experience as soon as suicide is considered the stakes are raised qualitatively and quantitatively.  I am able to live relatively safely with morbid thoughts and with thoughts of low self-worth, but thoughts of suicide and self-harm are not at all safe.  I went through a period when I cut myself—forearms, abdomen and thighs.  I felt great shame about the cutting and could not talk about it, even to my psychiatrist.  Just writing about it now, years later, raises memories of the shame; in truth, I am reliving the shame.  My psychiatrist only learned about the cutting by accident when, during one session, she handed me a prescription refill.  As I leaned forward to take hold of the piece of paper, my sleeve rose a little and the marks were visible.  Another hospital stay followed.   You might wonder why, if cutting was so shameful to me, I continued to do it.  My thinking, due to depression, was distorted during this phase of my illness.  I felt that the flow of blood carried out with it the emotional pain.  I also believed that physical pain replaced and was easier to bear than psychogenic pain.  I can see now how ridiculous that reasoning was, but it made sense at the time.

Simultaneously I began to dwell on the notion of suicide, something I still do although less frequently.  Initially it was a frightening idea, but gradually it came to feel more and more natural.   Without conscious awareness of when it had happened, I realized that I had come to the decision to end my life, that it seemed to be the right thing to do.  Once again my psychiatrist had me committed.  With time and effort, and the help of wonderful nurses and doctors, I rejected cutting and suicide as legitimate and rational ways of managing depression.  Instead I prepared a list of actions I could take when dangerous thoughts threatened to overwhelm me.  Given how much I have written about the significance of friends in my life in past essays, you might think that calling a friend would be my first strategy, but in fact this strategy did not even appear on my list (which I still have, although I have not needed it in three or four years).  I simply did not want to impose on my friends in this way, to lay such a burden on them.  I also did not want them to see me so desolate and despairing.  I knew how a friend might feel because I had been that friend on one occasion. Someone I knew because we had been in hospital at the same time called me late one evening to say good-bye.  He had swallowed all his medications and was drinking heavily.  He used his cell phone so I could not tell where he was and he would not reveal this information to me.  He continued to telephone me, which made me think he wanted to be found, but he refused to disclose his location and his voice was weaker with each call.  I was desperate.  I telephoned the hospital ward where he and I had stayed so often and the suicide hot line and the police, but no one could help me.  Finally he told me where he was, but he would not allow anyone but me to take him to the ER, or he would complete his suicide attempt in another way.  I was afraid he would follow through on his threat, so I began the half hour drive from where I lived to where he was.  I was so frightened I would not make it on time, but I did.  He was very ill and remained in hospital for an extended period of time after that incident.  However, if he had died or had suffered some permanent damage I would have carried feelings of guilt for the rest of my life, even though I had tried my best to help.  So I never want to put a friend of mine in that position.  But for other people calling a friend to stay with them for a while may be a good option.

I shall describe my safety list in the next post.

Hypersensitivity and Friendships: Unreliability

I wonder if anyone else has this experience, that of losing time.  I sit down for five minutes and find the two hours have passed.  This means that I do not get done things that I intended to or that I go to bed much later than I wished.  It also means that I am often late, which becomes irritating even to the best of friends.  I see this as a form of unreliability, because my friends cannot count on me showing up on time or even make a guess at how late I will be.  Until recently most did not have cell phones, and the person I see most frequently still does not have one, so I could not call to let them know when I would arrive.  This led to ridiculous situations in which I telephoned the cafe and asked barista to please be on the lookout for the woman with white curly hair named _____ , who will probably be sitting near the counter and let her know that Linda will be late.  It is amazing how often my friends get the message, bless those baristas.  If I were meeting more than one person, the situation was easier.  I could just tell them to carry on with their plans and I would join them when and if I was able.  I really was not inconveniencing anyone, the group could do as it wished.  But if I were meeting just one person, then that person truly was discommoded, sitting there on her own, not knowing when I might show up.

For awhile I improved and was regularly on time, but I seem to be slipping and I do not know why.  My psychiatrist says it is the effect of some of my medications; perhaps.  I feel terrible about being late and take many precautions to be on time.  For example, I lay out what I intend to wear the night before, including jewellery.  I make certain that whatever purse I will be using is fitted out with everything I need.  My water bottle is on the counter, waiting to be filled.  I check the day before that my car’s gas tank is sufficiently full.  And I have three alarms set at ten minute intervals to get me on my way.  I do not know what else I can do.

As I used always to be early, it is frustrating for me to be late, but not as frustrating, I imagine, as it is for whomever I am meeting.   Because I am hypersensitive to the person’s reaction to my lateness, I am edgy and withdrawn by the time I arrive.  When I realize I am going to be very late, I want to turn the car around and flee back home. I simply feel unable to face my companion.  On these admittedly rare occasions I am so agitated about my waiting friend that I have to concentrate with all my will on driving safely, that I do not speed or drive recklessly in my anxiety to arrive as quickly as possible.  I am an emotional mess by the time I turn up, and it takes a while for me to calm down and to try to enjoy the encounter, although, of course, I attempt not to reveal any of this to my companion.  One kind soul said to me that to be early or late is interesting, to be on time is boring, but I doubt that perspective is widely shared.  Rather, I expect that my friends are thoroughly fed up with me.

Another manifestation of unreliability is that I frequently have to cancel or leave early carefully arranged social engagements.  Obviously cancellation, due to a sudden deepening of my depression, is not calculated and my friends have been most understanding.  I often become tired at social events, especially those involving a large group of people, due to the effort required to interact with many individuals and to follow conversations when several different people are speaking.  As a consequence, I find myself leaving early.  But whether I cancel or leave early, I cannot help but agonize how the recurrence of such incidents has affected the issues I wrote about in a previous post on friendships:  that I do not hear from others unless I initiate contact; that  I am not being invited to meet with a friend, just to get together; that I am not being included in social activities.

With general hypersensitivity and with both manifestations of unreliability I exert much effort never to let my friends know how anguished I am.  I realize this means that they do not know I need support, but I am ashamed of my hypersensitivity and have been reluctant to let anyone know about it.  I realize that hiding my hypersensitivity in order to preserve friendships may in fact be doing more harm than straightforwardly revealing my feelings would, but the impulse to conceal is so very strong.

Bipolar disorder has an insidious effect on relationships; it is so isolating.  No wonder I often feel lonely and alone, something before my illness I never had to face.  Always spending Christmas, New Year’s and my birthday on my own underscores these feelings and the circumstances of personal interactions to which my bipolar disorder have brought me.

Post Script

Since writing the two blogs on friendship and these two on hypersensitivity I have realized that, while my relationship with friends has in many cases changed significantly, these friends are still willing to be part of my life in some way.  Whenever I invite someone to coffee or lunch, she seems delighted to join me, and our time together is filled with stories and laughter.  Most of my e-mails are answered so promptly I can scarcely believe it, often within the hour.  On the rare occasions I telephone someone, surprise and joy are evident in her voice.  So although I frequently feel lonely and alone, I must remember that there are still people in my life who care about me, although they demonstrate it less frequently and almost solely at my initiation, and it is of a nature different from what I formerly thought it was.  The friendship may be quite different, but it is still good–I must not forget this.

Post Post Script

As I write these blogs, I always assume I am writing mainly for myself, a way of ordering my thoughts, seeing things from different perspectives, arriving at different conclusions, learning more about myself–and if my words have meaning for someone else, I am so pleased and amazed.  It  surprises me to see that people are reading my blog, and it never occurred to me that my busy friends, whose work life involves so much reading, would be looking at my posts.  But at least a few must have, because since my two blogs on friendship and two on loss I have received many invitations for Christmas-related activities–I have not had such a busy and varied holiday season in a dozen years–and a couple of offers to plan some short trips we might do together in the near future.  I feel humbled and grateful that people I care about would respond so quickly and generously to my written words.

Hypersensitivity and Friendships: Three Examples

Bipolar disorder has transformed my former ease in my friendships to the fear that I am driving my friends away with my moods.  It is a powerful fear that compels me to be almost morbidly sensitive to anything that might be interpreted as a slight or a criticism or a distancing.  It also impedes me from talking about my moods, about my illness in general, when a little explanation might help my friends to understand why I act as I do on occasion.  It is the distortion of a normal and useful protective mechanism  into something abnormal and unhealthy.  It is hypersensitivity.

I was a sensitive child, quick to be embarrassed, blushing rapidly and profusely.  In high school I realized these reactions were detrimental and I worked hard to overcome them.  I was able to step back and analyze my feelings of hurt and humiliation.  I slowly grew to recognize that in virtually all cases the person/s did not intend to cause me pain and that the problem was with my inappropriate interpretations.  When I developed bipolar disorder, however, this sensitivity returned in an extreme form that my psychiatrist refers to as “hypersensitivity”.  These days it seems that I am wounded frequently and badly, and examining the circumstances with an open mind is difficult, if not impossible.  My psychiatrist suggests several plausible explanations of the painful situation that are far more sensible and likely than the one I cling to, but I cannot seem to let my version go.

As an example of hypersensitivity, last year I ordered online a floral arrangement to be delivered to very dear friends in Montreal to commemorate our 40 years of friendship.  I had selected a superb arrangement:  it suited my friends perfectly; it conveyed my thoughts exactly.  But it was not the one that was delivered, as I could tell from the description my friends provided.  Several arrangements later the correct one finally arrived.  My friends took these mishaps in the spirit of adventure–what arrangement will come next?–and fun.  I, however, was devastated, absolutely shattered.  The entire occasion was ruined for me.  It seemed to me that the whole point, celebrating our friendship, had been lost in the debacle.  I came to believe that perhaps the fiasco was a sign that the friendship was coming to a natural end.  My friends assured me at the time and since then how much they appreciated the gesture and how much pleasure the floral arrangement gave them.  But I still feel ravaged and inadequate, as if the mix-up in arrangements were my fault.

Another example:  A couple of days before Christmas last year I e-mailed some friends to announce that my cards would be arriving almost on time, a vast improvement from previous years, when they might not have arrived at all.  I was feeling a bit proud of myself for being, for once, sufficiently organized to carry off this feat.  I wanted to share this sense of accomplishment with others.  Within a couple of hours a number of friends had let me know, politely of course, that they no longer send Christmas cards.  My reaction was that, as usual, the intention of my actions and the outcomes were completely discordant.  I felt foolish and gauche and hurt.  I could not help but wonder how many people now were frantically getting me a Christmas card that they previously had not planned to send.  How can I let people know that I get pleasure from sending cards on a variety of occasions and do not care whether or not the gesture is reciprocated?  How can I convey how distressed I am that a friend would do something for me from a sense of duty?  Again something that originated out of joy and excitement went disastrously wrong, and I was left once more with the sensation that all I am capable of is misjudging and messing up.  (This year I am sending e-cards, which I hope will simplify things.)

The very day of the e-mail shambles I went to a shop that specializes in interesting arrangements of chocolate-dipped carved fruit pieces to pick up my carefully selected order placed the week before.  I waved my receipt around but my order was not to be found.  And the shop was out of supplies and would not be making any more arrangements until after Christmas.  By cobbling together the remaining bits and pieces scattered at the back of the shop, we managed to form four rather pitiful arrangements, which I delivered to my friends.  But you can manage how I felt, another proof of ineptness.  How must my friends be feeling, having been given such a tawdry gift?  I plunged into a deep depression, the combination of the two episodes on one day being more than I could manage.  When I returned home I destroyed the Christmas cards, which had become a symbol for me of my various shortcomings—some season of joy.

The three examples I have given are fairly large in scope.  Generally my hypersensitivity is stimulated by the small things–perceived slights, perceived disinterest in what I am saying and the like.  Immediately following a hypersensitive moment I am frozen in place and icy cold, and I do not hear a thing for what seems like several minutes but is probably a couple of seconds.  It seems amazing that an event so significant and painful to me does not register on the other person at all.  I suspect that rarely does my companion realize that he or she has caused such wretchedness; in fact, I am not sure that anyone has ever realized it.  How can they, when I take pains never to let them know what has just taken place?  But this puts me in a false position with my friends.  If I continue to be silent, how will they ever know how their innocent remarks are affecting me?  If I disclose my hypersensitivities, might they feel they had to monitor their remarks to see if they might hurt me, which would soon get tedious?  That is certainly not what I want.  What I want is that friends simply be aware of my hypersensitivity so that if I am experiencing it they will know what is happening and perhaps try to reassure me about my misperception.  I do not want a fuss, I just want all of us to be at ease during our interactions.

Loss: Life’s Simple Joys

Perhaps the most distressing loss of all due to my bipolar order is the joy I used to get from the simple things in life.

There was the myriad of soul-stirring sights:  a sunrise or sunset; a few white wisps of cloud in a clear blue sky; multi-hued light reflecting off snow on the mountaintops; the first snowdrops, those harbingers of spring; a child engrossed in drawing; the mass of varied flowers covering a mountain meadow in spring; the imprint of a sandal worn by a Roman sixteen hundred years ago; and so many more.

All those moving moments amongst friends, never to be repeated in quite the same way:  a tender, reassuring touch; shared laughter; shared tears; consolation during difficult times; celebration during good times; and so many more.  (I wish I could still laugh genuinely.)

Particular memories, much revisited:  kicking through a pile of autumn leaves, mesmerized by the array of colours and the crunchy sound as the leaves rubbed against one another; freewheeling down a steep hill, on the brink of crashing, the wind so strong in my face I could barely breathe; being the first in the lake each summer, when there was still ice floating about; going skinny dipping, the water warm and sparkling in the moonlight, no one else around; dancing, dancing, dancing, three or four times a week; walking over dry packed snow which glistened in the moonlight and made this wonderful rasping noise; picking wild berries in  the back yard for dessert; being the first to make ski tracks in the freshly fallen snow; my father’s beefsteak tomatoes, the best in the world; my mother’s apple crisp, made with our own apples, the best in the world; the sleigh ride to the cabane à sucre; lying against moss-covered stones in a creek, with the water flowing over me; and so many more.

All these ordinary little things that used to fill my days with enchantment no longer have the power to do so.  I have the memory of the elation they brought me, I know how I should be feeling, but rarely do I experience these phenomena as I once did.  A good example is a beautiful summer day, sunshine, bright blue sky.  Everyone around me is rhapsodizing about how wonderful it is and I have to make some indication of agreement.  I cannot say what I feel, that nature is mocking me, contrasting the lightness outside my body with the darkness within.  I face similar situations all the time.  I cannot make myself experience those feelings I once did, no matter how much I try.  Equally difficult, I do not want to bring my friends down with me, so I cannot discuss with them how I am really feeling, I can only do that with my psychiatrist.  That is such a delicate balance, not being false with my friends but not giving them a peek at a world most would not want to know anything about.

Loss: I used to . . .

 I used to pursue many simple activities that brought me pleasure and made my life interesting and engaging, at least to me.  Bipolar disorder has robbed me of these interests.  I resent that.  In fact, I am angry about it.  It makes me seem like a victim and I am not a victim.  I may have a  incurable disorder but I still have a life.  I do not want the days to slip by, leaving a barren landscape, nothing to look back upon when I am old and dying, which is how the last 11+ years have felt.  So this post is about identifying those pursuits that are important to me and that might be feasible to reclaim at this point in my life.  Then I will try to figure  out how I can reclaim them, at least from time to time.

 This post is also about taking control–I am fed up with saying “I used to . . . “.  Time for a change of verb to–”do”:  yesterday I did; today I am doing; tomorrow I will do.

So what are these cherished activities that I hope to pursue again?  They are reading,  walking, having music in my home, attending the arts, and travelling.

When I was engaged in these activities before my diagnosis, they bestowed many blessings upon me.  They soothed and refreshed my spirit.  They awakened my imagination, took me to other worlds, and helped me to understand my own world better.   I was introduced to unfamiliar perspectives, values, ways of doing things, all of which challenged my complacency and forced me to struggle with my preconceptions.  None of these activities left me unchanged.  That is what I have been aching for:  My days are much of a sameness; I want to be shaken up, and by something other than ECT.

Although I was unable to read for several years after my diagnosis and at various times in more recent years, I have gradually regained the capacity to read.  In fact,  perhaps now I am reading too much, reading instead of doing something else, specifically something more active.

The four other activities, however, have been virtually absent from my life during the last 11+ years, for plausible reasons:    Walking–I often feel unable to leave my home,  so I have become not only sedentary, but find myself in an unfamiliar body, one that is overweight, arthritic, asthmatic.  Having music in my home–For some unknown reason, I just stopped playing my CDs, although I used to play them all the time, I loved being immersed in different kinds of music, whatever else I was doing.  Attending the arts–I no longer attend the theatre, the ballet, the opera or the symphony because:  (a) I now find it arduous to drive at night;  (b) I end up taking my medications much later than usual and this upsets my sleeping pattern;  (c) It is difficult to find someone to go with.  Travelling–I doubt I will ever have the required energy and confidence to travel again, plus I fear having a severe depressive or a hypomanic episode while I am away on my own in a place without familiar resources.  And there is the pragmatic reason that I cannot afford it.

This analysis has given me a couple of ideas of how I might begin to overcome these obstacles.  I think the place to start is with walking.  I feel ready to start walking again.  I live in a beautiful part of the country with groomed walking trails galore, two literally on my doorstep.  So starting a walking program should be easy.  But I see two main barriers.  The first is to accept that I will not be able to walk as I used to, at least not right away, because of the changes in my body that I have described above.  The second is simply to find the impetus to get started.  At the moment I am determined to begin a walking program.  Alas, I have been determined about things before and not followed through on them.  Perhaps I can try something like a walking date, once a week–I hate letting anyone down, so I would try my best to meet my walking partner.  Having a coffee date to get me out of my condo at least once a week has worked very well, so there is hope that a walking date will be as successful.

I have already taken one step to re-introducing a former activity.  I simply moved my sound system and my CDs to a more accessible place.  Suddenly my home is once again filled with music.  What  a treat.

With respect to the other two activities, I think that all that is needed is a  flipping of perspective.  Who says I have to go to a symphony/theatre/opera/ballet performance at night, and with someone?  I can go to a matinee, and I can go by myself if necessary.  It would be such a treat.  I have to accept that I will never visit Africa or Asia, but I can explore the beautiful city in which I live–another treat.  And having lived with, and continuing to live with, treatment-resistant bipolar disorder, I think I deserve to treat myself as often as I can and in as many ways as I can.

I know that the plan I am proposing for myself is not a panacea and that it will not be easy to implement.  I know there will be periods, perhaps long periods, when I will not be able to engage in these activities.  But reminding myself of those things that once  lit up my life–those things I used to do–and imagining how to do them again, even if in a changed form, has given me a little surge of excitement.  I am no victim.  I am reclaiming my life.

Loss: Uncertain Friendships (the difficult explanations)

This is the continuation of the previous essay.

My friends do not see our relationship as I do (good explanation).  This idea has been on my mind for several years now, a painful one to examine and an even more painful one to accept, as I must.  I have thought of these various people as friends.  It is probable, however, that they see our relationship as something different, as something warm, certainly, as something enjoyable, but as something less than friendship–perhaps casual friend might capture it?  So they are happy enough to hear from me every once in a while, but I am not, as the saying goes, on their radar, it would never occur to them to get in touch with me.  They are busy people with demanding jobs; non-working hours are carefully prioritized amongst family and close friends.  I do not fit into either category; I do not count.

The stigma of mental illness operates at a subconscious level in my friends (good explanation).  Over the last four months or so, I have been circling around this conclusion, shying away from it, trying to avoid it.  But it will not disappear. Alice does not go through all the painful mental gymnastics that I have.  She says simply, to herself, when she has announced her illness:

 “Those with cancer could expect to be supported by their community.  Alice expected to be an outcast.  Even the well-intentioned and educated tended to keep a fearful distance from the mentally ill.”  Lisa Genova, Still Alice, p. 198

 At first I attributed such thoughts to only one person, a very dear relative.  At a dinner party she gave about a year ago, she and the other guest, whom I had not met previously, were both health professionals.  For a while there was not much I could contribute to the conversation, focused as it was on the impact of new health policies on their work, but at one point there was an opening for me.  I started by saying, “When I was a patient in a psychiatric unit . . .”.  Then I saw the look on my relative’s face: shame.  She was ashamed that I had bipolar disorder and that I had been hospitalized for it.  This realization explained so much of her behaviour since my diagnosis that I had not been able to understand previously.

Her friend peppered me with questions about what went on on a psychiatric unit.  Both women had worked for about thirty-five years in a hospital setting, and they had some idea of what happened on every other unit in the hospital, except the psychiatric unit.  I was appalled by their ignorance.  They were clearly surprised about how normal life was on 2 North.  I can only guess at how they had imagined the patients behaved.  But I think I did something for the cause that evening.

I have reluctantly come to the conclusion that part of the reason I rarely see or hear from most friends unless I initiate the contact, that part of the reason I am not invited to leisure events, is because people–even intelligent and highly educated people who comprise my social circle–subconsciously fear mental illness.  They do not understand it and they do not know how to respond to it.

For example, there are limits on what and how much my friends are willing to hear about my illness before I witness visible physical and emotional withdrawal.  They, on the other hand, can discuss their feelings and concerns in the minutest detail and there is no cause for uneasiness, because they do not have a mental illness and therefore what they are going to say is predictable and unthreatening.  But who knows how someone with a mental condition might react?

People know what to do if a friend has a serious physical condition.  They can set up a rotation of visits, supply a pot of home-made soup, pool together to hire a cleaning service or a meal delivery service, arrange get-togethers to support the friend early in the illness and later to celebrate milestones in recovery, and on and on.  I am not sure why they think that what they do for people who have other kinds of serious illness will not be appropriate for someone with a mental illness.

 * * * * * * * * *

 All this analysis proves what I already knew, that if I wish to continue having  the people I call friends in my life I have to accept that I am going to be the one to initiate contact.  I have to accept that they are not going to get in touch with me, for the reasons I elaborated above.  I have to accept that if I want reciprocity I am going to have to make new friendships.  I am just not certain that friendships made in one’s 60’s can have the depth of those made earlier in life, although clearly most of the friendships I have now are not as deep as I had thought they were.

I never felt loneliness until I was diagnosed with bipolar disorder, not even during the couple of years before my diagnosis, when I was just as ill.  It seems it was not me but the diagnosis that changed everything.   Friendships, once effortless and constant, even across time zones, are now complicated and uncertain.  Bipolar disorder is painful and lonely.  Uncertainty about friendships–such an aching loss.

Loss: Uncertain Friendships (the easy explanations)

This is the first half of the essay on what happened to my friendships when I was diagnosed with bipolar disorder.  The second half follows immediately.

For me bipolar disorder has been all about loss.  Certainly having to stop work well before retirement age was a dreadful loss for me to bear:  so much of my identity, of my feelings of self-worth and purpose, of the meaningfulness of my life, were rooted in my work.  As Alice, the main character in the novel Still Alice, so succinctly says:

 “[Alice] felt like the biggest part of her self, the part she’d praised and polished regularly on its mighty pedestal, had died.”  Lisa Genova, Still Alice, pp. 187-188

 But leaving work early also resulted in another significant loss, that of friendships, because virtually all of my friendships were developed through the workplace.  Again Alice expresses my feelings when she describes what she felt when all collegial relationships/friendships seemed to cease.

 “ . . . ignored, alienated.”  Lisa Genova, Still Alice, p. 198 

Alice is a female university professor who loves teaching as much as research; who loves the intellectual challenge of her work; who loves the variety of interactions with her Faculty colleagues and with colleagues at other universities; who actually thinks of her Faculty colleagues as family; and who is diagnosed when she is 50 years old with early-onset Alzheimer’s disease–and whose life is then turned upside down.  Much of this portrayal could describe me, except that I have never thought of my colleagues as family and that I was 52 when I was diagnosed with treatment-resistant bipolar disorder type II.  Early on-set Alzheimer’s and bipolar disorder are very different conditions, yet I saw myself reflected in many of the fictional Alice’s experiences, as the two examples above demonstrate.

There are few people in whose friendship I am confident.  With  all those whom I call friends–both those who live locally and those who live at a distance–the burden of maintaining the relationship has fallen on my shoulders.  If I did not periodically initiate communication, I do not know, I really do not know, if I ever would hear from these friends, if, in fact, we are still, or ever were, friends.  What does it mean, that I must initiate all communications?  What does that say about the state of our friendship, if our relationship can still so be called?  Do these people wish, in some hidden place, that I would stop getting in touch?  Have I, god forbid, become a nuisance?

For years now I have tried to puzzle out the answers to these questions.  (I know the simplest thing to do would be to ask them, but I do not have the fortitude for that, nor would I wish to put them on the spot that way.)  All my efforts to comprehend the situation, a most painful endeavour, have led to five possible explanations.  The first I reject.  The next two I believe may very well play some role in explaining the changed communication patterns between me and my friends; the fourth and fifth, a large role, the main role.

My friends are afraid of disturbing me when I am unwell (not a viable explanation).  Since 2005 I have been obviously high-functioning and quite capable of interacting with individuals and groups for considerable periods of time.  All my local friends have observed this.  Besides, e-mail–available to both local and long-distance friends–circumvents this fear, by allowing me to respond in my own time, whenever I am able to.  A wish not to disturb me when I am unwell may be offered as a rationale for leaving initiation of contact to me, but it does not seem a very credible one.

I am invisible in the lives of my friends (fair explanation).  In the case of friends who live locally, I no longer am physically present to them as I once was–we do not see each other in the hallways, at coffee, in Faculty and committee meetings, during our shared projects.  Thus I am invisible to them and consequently not considered when social plans are being made.  I want and need to be visible again; the only route open to me is the initiation of contacts, because no one else will do it.

My friends have experienced changes in personal and professional circumstances (fair explanation).  A few of my friends have had their duties and responsibilities at work considerably increased, and three have had major occurrences in their personal lives.  Perhaps others have experienced something similar that I do not yet know about.  Such happenings could easily have an effect on the frequency of our communications, and perhaps on who initiates them.  So, again I am the one who must make the effort to maintain the friendship if it is to be maintained.

The second half of this essay follows immediately.