Anxiety + Bipolar = ?; Mental Illness ÷ Access to Care = Bullshit.

As you might recall, my most recent post was about my anxiety symptoms. While my depressive symptoms have improved significantly since I started taking mood stabilizers, and my hypomania remains an enigma, my anxiety is pretty much as awful as it has ever been. True, I haven’t had a full-blown panic attack since stopping cymbalta, which is an indescribable relief. But, I still spend a good part of every day feeling like I an irrationally agitated, frightened, impatient and jittery worrywart.

Funnily enough, it only recently occurred to me that anxiety is not a typical symptom of bipolar disorder. The two poles in bipolar are (1) hypomania and (2) depression. As far as I can tell from Dr. Goggle, anxiety is most often present as a symptom in a person with a bipolar disorder in one of two ways. First, a person can have what is called an anxiety-based “mixed state” as part of their bipolar disorder, meaning they have either anxious hypomania or anxious depression or both. Second, a person can have a separate, co-occuring anxiety disorder.

There are many different types of anxiety disorders, like panic disorder, social anxiety disorder and obsessive compulsive disorder. From what I have read about the different anxiety disorders, it seems most likely I would be diagnosed with Generalized Anxiety Disorder or GAD. This disorder includes symptoms like:

  • Persistent worrying or obsession about small or large concerns that is out of proportion to the impact of the event;
  • Inability to set aside or let go of a worry;
  • Inability to relax, restlessness, and feeling keyed up or on edge;
  • Difficulty concentrating, or the feeling that your mind “goes blank;”
  • Worrying about excessively worrying (this one is my favorite and totally me);
  • Distress about making decisions for fear of making the wrong decision;
  • Carrying every option in a situation all the way out to its possible negative conclusion; and
  • Difficulty handling uncertainty or indecisiveness.
For anyone who knows me personally, I think we can agree that the above list describes me to a T. I do all of the things described above and while, at times, that has made me a very good attorney, it has not made me a very good partner or mother. In addition to the psychological symptoms listed above, the physical signs and symptoms of GAD may include:
  • Fatigue;
  • Irritability;
  • Muscle tension or muscle aches;
  • Trembling, feeling twitchy;
  • Being easily startled;
  • Trouble sleeping;
  • Sweating;
  • Nausea, diarrhea or irritable bowel syndrome; and
  • Headaches.

Again, this is pretty much my life (except the headaches part). So, it seems to me, in my vast expertise as a non-psychiatrist, non-psychologist former lawyer who gets much of her medical information from online articles, that I might have GAD in addition to BPII. If true, this is problematic.

The first line medications for GAD are antidepressants, except those don’t work for me anymore and, more importantly, could exacerbate my BPII symptoms. The second line medications for GAD are antipsychotics, many of which I tried last year and none of which helped with my anxiety, although they were great at knocking out my insomnia. Another category of drugs used for anxiety is benzos (e.g., Xanax, Ativan, etc.). I already take one of these meds, Klonopin (also known as clonazepam), every night for sleep and anxiety-related purposes. While it does help with sleep, I have felt little to no relief in terms of my daytime anxiety symptoms. Plus long-term use of benzos is generally frowned upon because they can be highly addictive and have nasty withdrawal effects (although not all psychiatrists agree that long-term use is bad).

So it seems I am in a bit of pinch. Whether my anxiety is related to my BPII or is a separate illness, I am not sure how it could be treated effectively without  risk, either in exacerbating my BPII or resulting in addiction. Luckily, I am not the one who has to make this decision; someone far more qualified and knowledgable about BPII and anxiety will do an evaluation and determine where my anxiety is coming from and how my meds should be adjusted. Unfortunately, I can’t seem to find a person, or a clinic of persons, with the expertise I need that doesn’t cost at least $400-500 for an initial evaluation and $200-300 for subsequent treatment sessions. No insurance accepted. Typically, therapy and med management occur once a week or once every two weeks; best case scenario then is $1000 for just my first month.

Of all the things that suck about having a mental illness, the lack of affordable care is right up there with not getting to drink alcohol and feeling like the world’s worst parent multiples times every single day. I realize that insurance companies are largely to blame for the deluge of mental healthcare providers fleeing the insurance system, but that doesn’t make it any less frustrating. If I need physical therapy, no problem, just pay my $25 copay and I’m good. If I need psychological therapy, not a single provider in my area who is accepting new patients is “in network.” Sure I can submit claims each month based on my out-of-pocket expenses, but until I hit my very high deductible, I don’t get shit back, despite all the money we pay each month in premiums. It’s a scam and, more importantly, it keeps many people with mental illness from accessing proper care. I am lucky to have the financial support of my family, which makes my care possible (although it may not be enough to support accessing the particular expertise that would be most helpful to my condition). Many more people with an illness just like mine, or much worse, simply don’t have and can’t get the necessary financial support for proper care.

Lack of access to healthcare due to insurance company policies, and consequent financial barriers, is not only personally devastating to many people and their families. It is also another example of the stigma against mental illness. Physical illnesses are covered and “in network” providers abound. Mental illnesses receive very little coverage and “in network” providers are practically non-existent. This is bullshit and everyone who knows anyone with a mental illness, or has had their life touched by mental illness in any way, should be furious. And if you don’t think mental illness has played a part in your life yet, just wait: What happens when your parent, your sibling, your friend or your child is diagnosed with a mental illness? What will you do then?

Everyone needs to pay attention now; fight the stigma and fight for affordable mental health care now. If we don’t speak up, if we don’t take action, this problem is bound to get worse (supposing that’s even possible).

I am not sure exactly what we should do. I’ve started by writing this blog in hopes of convincing other people that mental illness is not some aberration or character flaw. It is not a failure of personal effort or lack of positive thinking. It is an illness, just like cancer, diabetes or arthritis. And it can affect anyone, any time, for reasons you would never suspect, like having a baby (or two). But I don’t think speaking (or writing) is enough. I’m sure there are organizations out their working for change, like NAMI. Maybe we can help them. Or, maybe you can just tell the person in your life that has a mental illness that, although you don’t understand what they are going through, you recognize that they are struggling and that they are brave. I think that would be a good place to start.

 

 

 

 

Everybody Panic

**Note to the Reader: I started writing this post a couple of weeks ago, while in the throes of a severe episode of anxiety. Ultimately, I found writing the post at the same time I was experiencing these symptoms too triggering, so I set it aside. I finished the post just recently.**

In the last 72 hours, I have felt more anxious, uneasy, fearful, on edge, [insert additional synonyms for anxious here] than I have felt in months, maybe even since I left treatment. We’re talking, “Hold please, I think I’m going to have a panic attack now . . . uh, okay, I guess not, that’s a relief. Let’s . . . wait, I think it’s really going to happen now; I just need a minute to sit down, maybe lie down actually . . . ,” kind of anxiety. Every single waking moment. I have been so eager to be alone in my bedroom the past three days, I have gone to bed directly after tucking in my four-year old.

I don’t know why this is happening. I mean, I know I have a mood disorder, so duh, I have crazy mood swings, but usually there is some sort of identifiable trigger — like it’s the weekend.

I remember when I used to love weekends. I would be so excited for that two-day break in my work-week to exercise, hang out with friends, go out to eat or see a movie. After our oldest was born, weekends become more complicated but my husband and I managed to maintain most of our prior activities, by taking turns with the baby or having one of my husband’s parents babysit. Sure we went out less but we still managed one or two dates a month, including dinner and a movie, if we could stay up that late.

Weekends are now the hardest part of my week. They involve two adults trying to keep three very mobile, loud and irrational toddlers from maiming themselves or each other, shattering eardrums or eating things that are not food. For me, it is the perfect storm of wanting to keep everyone safe and happy and nobody being safe or happy (at least not at the same time). While I constantly feel like I need to do something, I also feel like I can’t do anything right and that it’s going to be this way forever because we will always be outnumbered and the kids will only become more willful and unpredictable. Basically, I get super freaked out, am no fun at all and spend most of our family activity time wanting to run home and hide in my bedroom closet until Monday.

So weekends are a trigger. But the last three days have been a Wednesday, Thursday and Friday. These days are usually pretty low-stress for me (unless I have to go to the pediatrician’s office three times or find out my husband is flying to the Middle East for work next week). I have gone running each morning, to therapy and to visit a good friend. I have spent time outside in the warm weather, played with the twins in the backyard and taken them for walks. We went to baby swim lessons and watched the Muppets during lunch (yes, I am raising my kids to appreciate the classics). I even sat down and finally made a list of potential book projects.

But none of this self-care, socializing or meaningful activity has helped. I am jumpy, my heart races constantly and I am always too hot. My hands shake and I have trouble sitting still. I am impatient with everyone, including my children, so I find myself spending as much time alone as possible. I don’t want to eat. I don’t want to listen to anyone talk. I don’t want to talk to anyone. I don’t want to make any decisions. Every single thing feels like too much.

Living with this level of anxiety for the past three days has been particularly frustrating because I saw my psychiatrist a few weeks ago and we tweaked my meds to specifically address my anxiety symptoms. And I felt better. I really did. But now I do not. Definitely not. So I suppose it could be a meds thing, maybe we tweaked too much, or not enough. Medicating a mental illness involves a great deal of trial and error and, unfortunately, the errors affect your brain, which is a pretty big part of who you are and how well you function.

Another possible reason for this spike in my anxiety is that my mom and step-dad are here to help out while my husband is out of town. Last year, when I was still misdiagnosed and improperly medicated, I would often have my most severe panic attacks and most debilitating episodes of depression when my parents were in town. I was spending most of my days holding on for dear life, trying to manage work, a household of six and mothering three small children. My husband works a billion hours a week, so I was responsible for the lion’s share of household management and parenting-related stuff. But, when my parents showed up, there was suddenly, magically two additional people whom I trusted to do much of the work I was doing. And once that safety net was in place, I couldn’t help but let go.

It wasn’t that their visits made me more sick; the anxiety and depression had always been there, I just held them in as best I could because I had to take care of my family and perform well at my job. Once I felt my most important people, my children, were safe without me, I could stop trying to hold it all together and instead fall apart. My parents’ visits were like a safety valve for my sanity. So maybe having my parents here now, despite all the positive changes in my mental health, weekly schedule, self-care, etc., is triggering a relapse to the anxiety symptoms I had before; a sort of pavlovian relapse (because clearly I wasn’t enough of a science experiment already).

There is also the fact that their visit has completely thrown off my weekly structure. My brain, like all Bipolar brains, really, really benefits from structure, structured days, structured weeks; we just like knowing what’s going to happen next. But my parents really, really like helping, so they basically took over 90 percent or more of my regular, daily tasks. While this sounds lovely and was certainly done with the best intentions, it definitely threw me off my game. The tasks they were doing were part of my daily schedule and my contribution to the household. Suddenly, I had nothing to do and having nothing to do is a very bad thing when your mind is your enemy. I ended up spending far too much time in my mind, which, as Anne Lamott once quipped, “. . . is like a bad neighborhood, I try not to go there alone.”

Another possible factor is that my husband was away for almost a week. His absence can be hard and anxiety producing, especially in the evenings and at night. Being the only parent in the house, even when there are other adults present, feels like so much responsibility — sometimes more than I can bear. At night, every cry, every bump, every “mommy” makes me jump out of my skin, and the quiet feels even worse because I can only anticipate the next noise. It’s excruciating. When my husband is home, even if I am the one on night duty, I don’t experience any of this agitation or fear. Having another parent present makes me feel like I can screw up and someone of equal responsibility and love for our kids will be there to fix it. Also, our oldest child will freely harass me with bedtime-related requests for hours and won’t stop no matter what I say or do or refuse to do. But my husband shuts that kind of thing down like a boss. Particularly on days when my anxiety is really high, knowing I have a human hammer when it comes to bedtime is a huge relief. And after my husband got home, I did start feeling somewhat better.

I talked with my therapist the following week and we agreed that the lack of structure, or the significant, unanticipated change in my structure, was likely the biggest contributing factor to my anxiety attack. Although I’ve known for some time that I feel better with structure, I did not realize, until now, that lack of structure or a significant change in structure could be so devastating.

It seems I will need to create alternative structures or schedules for any visits, vacations, schools breaks, etc., of sufficient length to throw my brain into its unhappy place. In other words, my life is now, in large part, an administrative project. Fortunately, I enjoy making tables and spreadsheets more than the average bear. Peanut butter and jelly sandwiches are also nice.

 

 

 

 

 

 

20 Reasons why parenting with mental illness is hard

Many of these reasons are not limited to parents with mental illness but apply to parents generally. This shit is hard, whether you are certifiable or not. So I present to you, in no particular order, the following 20 reasons why parenting with mental illness is hard:

  1. Even when you wake up knowing it is going to be a shit day, you still have to get out of bed.
  2. Crying in front of your kids.
  3. Having to explain to your kids, in a non-scary way, why you are crying.
  4. The screaming (mostly theirs).
  5. The guilt (all yours).
  6. Feeling scared and incompetent, which leads to acting irritated and impatient with your kids and your partner.
  7. Medical need for consistent, uninterrupted, 7-8 hour sleep periods vs. teething, illness, nightmares, diaper fails, thirst, scary noises, heat, cold, etc.
  8. Feeling afraid of spending time with your own kids, especially when there is no other adult around to help in case you mess up or break down.
  9. Not being able to chase a tough day of parenting with a glass of wine.
  10. Having weekends become a trigger.
  11. Missing good parts.
  12. Wondering whether you have passed on your illness to your child; and wondering whether it will pass on to one of your grandchildren.
  13. Being hypomanic at your kid’s birthday party.
  14. Feeling socially dysfunctional and/or terrified at all the other birthday parties.
  15. Having to ask your spouse to carry the parenting load alone when you just can’t, not for one more minute.
  16. Being the overzealous, annoying safety patrol person at the park, because you can’t not say something.
  17. Feeling overwhelmed with love and anxiety, simultaneously, every waking minute of your day and knowing this feeling will last for years, if not forever.
  18. Being very, very organized (e.g. meals planned, bags packed, weekly schedule on paper), but inevitably becoming increasingly unorganized until you can barely remember what day it is. Repeat ad nauseam.
  19. Wondering whether your struggles as a parent are truly related to your mental illness, or if you’re just not very good at parenting.
  20. Questioning your decision to have children at all, given the hereditary nature of most mental illnesses and the likelihood that you would be less debilitated by your illness if you were not a parent.

*Credit for awesome card pictured above goes to Emily McDowell Studio

 

I am afraid of trying but more afraid of not trying 

If you have a mental illness, any mental illness, you learn to shape your life around it. It is a part of you, sometimes a small part and sometimes a very large part. Regardless, you cannot ignore it. Sooner or later, it will not be ignored. At the same time, you should not allow it to define you. For instance, I am not bipolar; I have a bipolar disorder, just like other people have major depressive disorder, an anxiety disorder or cancer.

My hope is to live my most meaningful, joyful and satisfying life, while giving my illness the respect it is due but not one bit more. I have yet to figure out how to create this balance. I worry that, because of my experiences last year, I give my illness more respect than it is due. I have not gone back to the job I left in October or begun to search for a new one. I have not started writing a manuscript, registered for a half marathon or done anything else that might be considered a mid-to-long term goal. Absent the (more than) occasional bout of the plague among our three children, my days are pretty low-key. I am busy from early morning to past my bedtime, but I am not doing anything particularly challenging, or not intellectually challenging.

I miss the intellectual challenge of my old job and, at times, I feel confident that I could return immediately with little to no need for a catch-up or re-learning period. I worked as an Assistant Attorney General for six years and never once felt unable to perform my job at the highest level, until last year. Now that I have been properly diagnosed and am taking the correct medications, what is stopping me from going back? I’m not an invalid; I’m just someone with a mental illness. People with mental illnesses work. They work really challenging jobs. Why not me?

Honestly, I am afraid. I am afraid that if I go back to my old job, or on to something new, I will fail to recognize the line between challenging work-life balance and triggering overload of responsibilities. Or worse, that I will recognize that line but choose to cross it because, despite all my bluster, I will be unable or unwilling to admit I can’t do it all.

There is also the fact that sometimes, even on the easy days, my brain decides it wants to totally freak out and I have to dunk my face in a sink full of cold water so I don’t have a panic attack right as the twins wake up from nap. And the times when my hands shake so badly it is impossible for me to thread the elastic band through the side of my son’s nebulizer mask. There are nights of insomnia and weekends of heart-pounding anxiety and sudden tearful outbursts that I can’t explain, to myself or my family. These kind of mood swings make me question whether a regular office job is feasible.

Yet, I am an intelligent, well-educated, skilled and resourceful woman. I am (was?) a very good attorney. Though I feel like I should have been back at work months ago, I am thankful nearly everyday that I am not. I don’t know what the right choice is when it comes to work. And I never imagined that whether to work or not would be a difficult decision for me. I worked hard for my degree and I always intended to be a model of working-motherhood for my children. At the same time, I never intended to have three toddlers. And I need to take care of myself so that I can be healthy and safe and so that I can take care of my family. It feels so unfair to have to make this decision at all, that my illness has essentially changed the course of my life. Sometimes I start to trace back the winding path that resulted in my breakdown, but there are so many potential factors and certain events I would not change even if I could. Nobody did anything wrong, including me. It just happened.

While I knew there was some risk of postpartum illness as a result of a multiples pregnancy, I had no idea that it could contribute to late onset bipolar disorder. My doctors did not discuss it with me, despite my postpartum anxiety after my first son’s birth. My husband knew I had struggled postpartum before, but he had no reason to expect such different and more extreme consequences from a twin pregnancy. Moreover, even if we had all talked about it, there would have been no way to know whether the possibility of postpartum bipolar would actually affect me.

Would I have made a different decision if I had known what would happen?Absolutely not. L and C are my children. I love them. I would die for them. End of story.

My diagnosis and treatment have also had many unexpected benefits. I now have strong boundaries and a definite set of core values. And if either my boundaries or values are not respected, I am one hundred times more likely to refuse to accept such disrespect. In other words, I am no longer afraid to stand up for myself, even when it might hurt someone’s feelings, cause a fight or threaten a relationship. I will not pretend to be anyone other than who I am and I will not apologize for being myself. Ever. Again.

So yeah, I am afraid of what might happen depending on what I choose to do with my life. But I have my safety plan and my safety people. There is no guarantee that things will be okay, but there never really was. I might always be afraid of falling apart, but I can’t not live my life. I am afraid of trying but I am more afraid of not trying.

 

I wanted to be a poet

Throughout high school and college, I wrote a lot of poems; journals full of poems; many journals full of poems. I still have the journals and looking back at them I can honestly say that the majority of my poems were fair to poor. However, there are a few poems that seem to me to be fairly decent, good even. Those few poems suggest I had at least the potential to write a poem, or even a book of poems, that other people may have wanted to read. Getting to that place would have taken a great deal of practice and rejection and starting over, graduate school, writer’s retreats and more rejection. But I might have done it.

I did not.

I don’t remember exactly when I stopped writing poems but I think it was towards the end of college or around the time I started law school. Yep, that’s right, I went from would-be poet to future attorney, because that seems like a logical progression. In fact, my decision to become an attorney marked a (then un-noticed) shift in my professional and personal ideals. I studied my ass off for three years so that I could become an attorney like my father, get a good, well-paid job and live a comfortable white, upper-middle class life like everyone else (everyone else being people from college, law school and television).

I practiced law for over a decade, as a law clerk, biglaw associate and Assistant Attorney General. I left my job as an AAG this past fall and have yet to decide whether I will work as an attorney in any capacity again. So basically, at 37, I am trying to figure out what I want to be when I grow up.

As part of that process, I wonder frequently about the parts of legal practice that I truly enjoyed versus the parts that I merely tolerated (or actively avoided). So far, I can say for certain that I enjoyed the writing part: creating and weaving a theme throughout a brief; telling my client’s story in a truthful and persuasive way; the unraveling of opposing counsel’s arguments in a compelling, yet concise reply brief. In short, I enjoyed legal writing that pushed me to truthfully, completely and compelling describe an event or series of events pertinent to the case. This, my friends, is poetry.

A good poet can truthfully, completely and compelling tell you the story of their loved-one’s death, their own years of captivity and sexual assault or the greatest romantic relationship of their life in less than half a page. Their words are precise. They use them skillfully. And the result is beauty, just as a painting or a sunset may be beautiful.

I don’t intend to become a poet now, but remembering that I sincerely wanted to become one when I was younger helps keep my search for what to do with myself in proper perspective. I don’t have to be what I was or anything close to it. There are so many more possibilities.