3 July 2000 – Diary
Spent a fair part of last week in what would have been described as a “mixed state,” some anxiety, some mania. According to my schedule I should have been depressed, but I wasn’t. I’m starting to get depressed now.
Basically, my hypomanic state lasted one week longer than it should have. I hope that this is not a sign that my moods are becoming more unpredictable. That would be frightening as I have developed a system of coping that is based on my state being so predictable.
However, that one week period also is causing me to question whether “mixed states” is something that actually happens or if it is a long standing case of misdiagnosis by psychiatrists.
I’m not denying what people feel. It’s just that in describing what we feel we use such imprecise terms. Suppose that I am anxious and irritable at the same time. By my standards I would be in a mixed state because anxiety is a signal for depression for me and being constantly irritable is a sign for hypomania. But was I really feeling anxious, or did I use that term to describe a different set of signals.
I’m pretty good at reading the signals my body / emotions are passing on to me, but I know I don’t get them correct all the time. In fact when I was first diagnosed, I misread lots of the signs of hypomania as signs of depression. Suppose that last week I did it again and my anxiety wasn’t, well, anxiety. Supposed they were signs of hypomania and I was misreading them. Remember I was expecting depression, so I would have been tending to read the signals from my body as signals for depression.
I do remember thinking that my depression was acting a bit peculiar and it was only a few days later when the physical twitchiness that definitely signals hypomania started that I switched from thinking I was depressed to thinking I was hypomanic.
So, was I in a mixed state or did I just read the signals wrong and mistake my hypomania?
The language makes it so hard. The word “anxiety” really has no precise meaning. It could describe a wide range of things that could indicate either depression or hypomania. And if you check a lot of the other words we use, they are also equally imprecise. Is difficulty in thinking caused by slowness in forming thoughts “confusion” or is difficulty in thinking caused by having too many ideas “confusion.” For me it’s important because one signals depression and once signals hypomania.
I wonder how many persons describe how they feel to psychiatrists and because of the words they use the psychiatrist gets a mistaken idea of what the person meant. I think that the definitions for mania and depression should be rewritten to state more precisely the symptoms that we experience. The lack of precision does a dangerous disservice to us bipolar persons who are trying to monitor what we are experiencing.
4 July 2000 – 20 July – Diary
Today is day three of my new schedule. I’ve made some changes in the way I organise schedules to prevent some of the difficulties I have had in keeping to schedules. My “new and improved” schedule incorporates some of the following ideas:
I need to plan a fixed routine for each of the seven days for the week. This includes Saturdays and Sundays too. There are no unplanned days for a bipolar person.
As far as possible, I plan so each day is the same. This includes Saturdays and Sundays. This means I plan to wake up at the same time each day and go to sleep at more or less at same time each day (which, by the way, wreaks havoc with any type of night life).
It also means that similar tasks start at similar times. For example, if work starts on a week day at 8 am, then the weekend chores start at 8 am on a Saturday morning. When tasks happen at the same time, it is easier to contain the mania and plod on through the depression.
When I make plans during the day, I often plan a choice of tasks that might happen in each slot. This is necessary because when I am depressed, I often cannot do the scheduled task. With a choice of tasks, if I balk on the task I have scheduled, I have something else to do.
The critical thing for me in having a schedule is feeling as if I am in reasonable control of the day, not in getting everything on the schedule done. In creating the schedule, I plan is what I want to do. Then at the bottom of the schedule is a group of three or four other tasks of different difficulties (simple, medium, high concentration / stress) that need to get done but not urgently.
If I don’t feel like doing what I scheduled, I try to do one of the things at the bottom of the list. By doing something I wanted to do makes me feel better at the end of the day, even it is not the main task I wanted accomplished.
When planning the day, I try to leave more time for routine activities than they need – that allows me some breathing room when things start to go wrong. In addition, I leave some clear space in the day for unplanned activities so that when things start going wrong, I have some time to fix them.
There is a bit of a paradox in the way I schedule things. I am fairly rigid about time, but pretty flexible about activities. As a bipolar person it is hard to predict what I will or will not be able to do at any given instant. But it generally is much easier to schedule time, provided I can choose what I want to do with the time.
After all the planning, I’ve learnt to be fairly easy going about what I get or don’t get done. Planning only carries me so far in getting tasks done. When unseen events come up and when the day falls apart, there isn’t much use bemoaning how the schedule for the day failed. It’s just as easy to shrug my shoulders philosophically, go to sleep and start over on the following day. And it’s a lot easier on the nerves and a lot more guilt free.
Sometimes I even give up on my schedule halfway through the day, accept that the day is a lost cause and just do what I can in as good humour as I can. That’s life and it doesn’t happen only to bipolar persons. There’s success and there’s peace of mind and these days I prefer peace of mind.
I also found the following specific things help a lot in having a good day:
I need about an hour of quiet time each morning to wake up. Although I occasionally do some chores during this time, I often just have a cup of hot chocolate, answer some e-mail, and generally get myself in the frame of mind to cope with the world. Sometime during this hour I write down what I need to do for the day. By the time this is finished I feel as if I can cope with the world.
If I am in a depressed mood, this period calms me down and allows me to get the courage to face the day. If I am manic, the plans structure the tasks so I don’t have a haphazard day.
In order to get quiet time I get up early. At present my quiet time is from 4 am to 5 am. I’m not recommending this time to others but it works for me because of my work schedule (see below). The quiet time is before I start my usual morning routines and chores. It does not replace or displace them in any way.
Just for the record – this idea of quiet time was borrowed from a friend of mine who does it. I’ve tried it and it works.
I need 7-8 hours of sleep. I used to sleep 4-6 hours a night. Now I sleep a lot longer. I’ve found the extra sleep makes a dramatic difference in how I feel, almost to the point that I would recommend eight hours sleep as the first line of action in dealing with being bipolar. I think it works better than medication in keeping me stable once I become reasonably stable.
Of course eight hours a night is an awful lot for active people nowadays and I often find myself trying to cheat at bedtime to get some extra stuff done. In fact I often have to be sent to bed (“Why are you still awake?” C. asks). Even when I don’t really feel sleepy I go to bed and because I am one of those persons who has no trouble falling asleep I am usually out cold within ten minutes.
Getting eight hours of sleep also has created a dramatic change in my lifestyle. If I get up at 4 am and I get eight hours sleep – I go to bed at…8 pm. Try not to laugh please. I usually get in bed somewhere between 8 pm and 9 pm, but I start organising for bed at 8 pm.
This has naturally brought any nightlife crashing to the ground. I don’t mind – most of my friends have children and socialising takes place on afternoons and early evenings. And I really don’t miss the pubbing too much. Of course even things like dinner parties get a bit difficult to do. Even sex cuts into my sleep.
The reality is of course that I can do the occasional night out. But I do have to schedule them carefully and I have to make sure the following night I get proper sleep. These days I tend to beg off on requests to go out at night as I’d rather be feeling good the next day. Early dinners are now in.
Sex is a bit more spontaneous, thankfully, but even that has to fall into a pattern that allows me to get sleep. Sex two nights in a row is pushing it, three nights is close to impossible. I definitely cannot make two nights of little sleep – I begin to destabilise almost immediately (or my control goes, it is sometimes hard to tell).
Sleeping more was one of the hardest patterns to set up because of substantial changes in lifestyle it required. But it seems to have paid off the best of everything I have tried.
I’ve started getting to work early. Right now I get in about one and a half hours before anyone else. There are two advantages. If I miss I get to work more or less on time anyway (well, most of the time). There is also a psychological advantage of being at work before anyone else gets there that can often offset the panic or anxiety that depression brings on.
In addition, I use some of the time to gather my thoughts, get a cup of hot chocolate and settle in. This is in some ways very similar to the quiet time I organise for myself at the beginning of each day. And of course this quiet hour or so is a great time to clear work from my desk without getting interrupted.
I’ve started doing about 60 to 90 minutes of exercise everyday. The exercise has a few purposes. They add a piece of the structure to my day. I have a tendency to be overweight because I eat like crazy when I am depressed (currently 15 lbs over my desired weight), so the exercise is to offset the weight gain. My family has a history of heart attacks, so I try to push for cardiovascular fitness. And I don’t particularly like being a wimpy git with no muscles.
I have found that daily exercise works better than everything else except sleep in keeping me stable. It is also at least on par with medication and in addition adds a psychological boost that medication does not offer, all with none of the side effects of medication (don’t jump off the medication just yet – the key word is daily – which is not so easy to do). And daily exercise tends to dampen the mania somewhat and make lighten the depression.
Of course the bp cycles make exercising a challenge. When I am hypomanic, anything I want to do in the gym is possible. I can cycle and run faster and longer and lift heavier weights effortlessly. When I am depressed, I want to leave the gym after twenty minutes. Cycling and walking on the treadmill becomes hard to do and my speeds and intensities drop. Weightlifting becomes painful and my muscles hurt when I am doing lighter weights. And I keep asking myself why am I doing this to myself.
My exercise on the cycle machine is instructive. At what I would consider feeling normal I can cycle on the machine at about 82-90 rpm and level 10 resistance for 30 minutes and consider it a good workout. In hypomania, I can cycle at 95 or more rpm at level 11-12 resistance and not consider that I done any work at the end of half hour. With depression, I have to reduce the resistance to level 9 and I fight like crazy to stay pedaling at the 75-85 rpm range. And I want to stop after 15 minutes.
Because I cannot really have a fixed workout schedule in terms of intensity, I’ve found it more useful to set a minimum time that I spend in the gym and do what I can while I am there. I have a minimum routine of half hour on the cycle machine and half hour on the treadmill that I do regardless, whether I am cycling at a snails pace or walking slower than the little old lady next to me. If I am feeling depressed, I focus my discipline on staying for the hour and doing the best that I can do. If I am feeling more normal or hypomanic, I increase the intensity and add some weight lifting into my routine.
As a result, I do not have a routine of gradual improvement of strength or stamina. What I can do on a day varies wildly from day to day and week to week and one good week can be followed by one in which I cannot even lift the weights I did in the great week.
Of course this goes against everything exercise instructors say. My feeling is the instructors are basically right, but their standard advice just doesn’t work for bipolar persons with rapid mood swings and rapid changes in strength capabilities (real or perceived). Even the idea of reliable and steady fitness gains makes no sense. Being bipolar means that we are inherently unreliable because we so often need to divert energy that would have gone into being reliable into staving off the effects of depression or mania.
When I exercise, I do make comparisons to see if I am doing better, but I compare like with like. I never compare this week with last week, but rather how am I doing now in my depressed state to how I did last time I was in a depressed state (2-3 weeks past). That is a more realistic comparison and that is where I look to see if I my overall fitness is improving.
Of course it’s hard to measure fitness gains with such a complicated pattern. But I try.
The important thing I have found out is to get to the gym and spend the hour doing something. It isn’t to push myself to the limits. I do not subscribe to the “No pain, no gain” theory. In fact think that the idea of trying to push myself each time I go to the gym is a great way to get myself turned off from going to the gym. Particularly when I am depressed. My exercise routine is fixed in time, but not fixed in intensity.
At the moment I listen to myself and my moods and I do the best I can. I do push myself but I strive for a pleasant experience in the gym rather than an intense workout. And some days I do the absolute minimum of my routine – without shame or anxiety. That way I feel encouraged to go back the next day, and the next. I figure I’ll never win a body building contest (and may not even lose all the flab on my waist), but then again that’s not the point. The point is to add a therapy into my overall lifestyle that helps me to cope with being bipolar. That it is healthy for a variety of other reasons is just icing on the cake, so to speak.
And who knows, I might even one day have washboard abs.
I’ve had to rethink socialising. I’m beginning to realise that I can cope when I have a rigid schedule. However, as I have found out, life isn’t particularly kind to rigid schedules. I’ll have a quiet week. Then I’ll be invited to dinner on Wednesday. Then a friend show up in town to visit and I have to see him. Then my sister in law asks me to look after the kids on Saturday morning. There’s a problem at work that requires that I work late and interrupts my exercise pattern.
I’d like to say this was the exception, but I’ve realised that every week is like this and it wreaks havoc on trying to stabilise a fixed schedule.
I’m learning to break off work at a fixed time regardless. This is not so easy to do because I was one of those persons who liked to finish something once I started it. Now, I just say that there are other important parts of my life that need attention and I can finish this tomorrow.
Dealing with friends and family is quite another problem though. I can’t put off a invitation to dinner for the next day. And the truth be told, regardless of what it does to me, I am perfectly willing to drop everything to spend time with my niece and nephew.
However in the last two weeks this has all gotten out of hand and I finally decided to set the rules below on what to do when multiple engagements or requests are made of me that interrupt my schedule.
Only one late night from Monday night through Friday night, including Friday night. If I stay out late on a Wednesday night, I stay in on Friday night. This will often mean saying no to people who invite me out. It’s not fun to do, but I figure that 15 minutes making apologies and offering to meet for coffee over the weekend is better destabilising for 4-5 days.
There will be times that I have engagements two nights in a row because one came up suddenly (usually seeing after the kids). This automatically means the second engagement is to be cancelled. I’ve found out the hard way that having two late nights is a recipe for being unstable for the next few weeks.
Given a choice, I now organise to meet people for early dinners or breakfasts or during the day on weekends. These are much easier times to absorb into my schedule on any day.
I am learning to show up for 15-20 minutes somewhere, say hello to people and leave. It’s a bit tacky, but it does allow me to send the message to people that they are important enough to me that I visit them, without sacrificing my needs.
Although I have standard schedules for Saturday and Sunday, I have found that it is often useful to occasionally treat from Saturday at lunch time to Sunday evening as a single chunk of time. That way I can meet people and go out without worrying about the usual bedtime restrictions. The two restrictions are if I stay out late Saturday night I sleep late Sunday morning and if I go out Sunday morning / lunch time, I stay home Sunday evening. I do NOT fill the entire time meeting people I did not see over the week.
I now go out less than I used to and I see some of my friends less that I used to. On the other hand, I now see other friends more than I used to so it sort of balances out. Best of all, my close friends have accommodate my changes into their lives. The only thing I really miss is not going dancing as often as I used to.
6 July 2000 – Diary
One of my cousins is visiting from overseas, so I am entertaining. This of course wreaks havoc with my schedule so I now have to figure out how to adjust it. Sleep has been affected most because I went out last night. But when my sleep is affected, everything else gets problematic as well.
Still, learning to cope is learning to recognise upcoming problems and planning for them. This is perhaps the first time that I am looking at my schedule for the upcoming week and deciding how they are going to affect my schedule and perhaps my moods. Of course some of that is because I have a schedule at the moment.
A quick inventory. I didn’t get enough sleep last night therefore I must get a proper night’s sleep tonight. But I have a dinner that I must go to today. It is unacceptable that I miss it. Solution – go early and leave early, perhaps spend no more than fifteen minutes. Reason – keeping my schedule and preserving my sleep is more important than the dinner, however, going even for fifteen minutes shows my hosts that I think they are important. And no matter how much I need to take care of myself, relationships matter a lot.
Also, since I did not get enough sleep last night, I expect that today will be one of my low performance days. I’ve found that anticipating this makes it easier to cope when little things start going wrong.
Also, I promised to go out Friday and Saturday night, and lots of my family are visiting me on Sunday. Immediate problem – going out two nights in a row is going to wreck my schedule completely. Second problem, if I actually do all this, by Monday I suspect I will not be stable or particularly functional.
Solution – Compromise. I hand over my cousin to someone else on Friday night and I stick exactly to my schedule on Friday. I more or less stick to my schedule on Saturday but go out on Saturday night with my cousin. I override my Sunday schedule but I was going to do that anyway because of the visitors. I organise caterers to deal with the food for Sunday instead of adding two days of stress in preparing food (I have lots of family). It’s only a bit more expensive than doing it myself and I weigh the additional cost against a weekend in which everything might go awry for me. I decide it is worth it.
I warn my boss that I might not be in on Monday, or will be in late. Should my schedule and my mood destabilise over the weekend I can use Monday to set things back in position.
I’m looking at my plans and realising that they aren’t unreasonable, even for someone who wasn’t bipolar. The trick for me is first, in looking ahead. I get so caught up in dealing with today that I often forget to look ahead. The second is to stop believing that I am a superman. I can deal with the food for Sunday and I can go out all the nights, but I realise that to do that would be to sacrifice the things that make me stable. I used to think I could do it all, but I can’t.
Proving to other people that I am a superman doesn’t get me any benefits. There is indeed a point at which just saying no is the wisest course.
addendum – I’m not depressed, I seem to be manic. The last two weeks shows that events can affect mood. Last week my depression didn’t show up because of my argument with an organisation. This week my cousin is visiting and I get little sleep. Both things seem to have stopped the depression and precipitate a manic mood.
7 July 2000 – Diary
I am currently furious with my mother. The dinner last night was for her birthday. I told her that I couldn’t make it and she insisted that I come. I knew that I should go, but I also knew that I needed sleep and that without it my next few days would begin to unravel. But mothers are very good at making one feel guilty. After a short argument, I told her I would come.
I spent the evening being decorative while she chatted with her friends. Because I didn’t get enough sleep the night before I had an extremely difficult time coping. I couldn’t stand being in the crowd even though these were all family and close friends. It was difficult to try to follow the thread of a conversation and the background noise of people chatting was driving me crazy. I spent a fair part of the evening in a corner of the room leaning on the back of a chair and keeping it between me and everyone else. A defensive measure that no one else probably noticed.
I was also extremely twitchy and was using the wine to help calm me. Well, it worked, but I was hungover the next day. A reminder to myself – the side effects of alcohol far outweigh the therapeutic benefits. Don’t have more than one glass of wine or one beer.
In the end I was polite enough not to do anything silly, but I also went to bed very late. The result today has been pretty much a disaster so far. I woke up late, muzzy headed, and so disoriented that I wasn’t able to organise myself in the quiet time in the morning.
I also started exhibiting a lot of the behaviours I associate with depression. I kept finding a book or magazine and reading it instead of thinking about what I should be doing for the morning. I kept dozing off. I kept putting off thinking about what I needed to do for the day. I wandered around the house in a daze. Heck, I couldn’t even make myself the usual morning cup of hot chocolate.
I made it to work about four hours late. I nearly didn’t make it because the anxiety that often makes me miss work reared up and I had to exert almost all of my control to continue driving to work. An at work I was still so disoriented that I couldn’t focus on getting any work done. Mercifully it was a slow day, but I still missed two meetings that I should have held. I left an hour early after I realised that I would not get anything done. A complete waste of a work day.
Instead of going to the gym after work, I collapsed on my living room couch and slept until 6 pm. When I woke up (even more disoriented), I decided that I would go to gym anyway. Which seemed to work more than anything else in centering me. I returned home, showered and changed but couldn’t go to sleep at my regular hour because I’d been napping all afternoon.
That’s the problem I have when things go wrong. Each incident that goes wrong precipitates other problems down the line like a series of dominoes. Any problem I have continues to echo for days in the future.
I then have to spend so much time dealing the immediate problems and trying to head off the ones that will happen down the line that I effectively become non-functional. No wonder I used to “shut down” in the past – it was in many ways an effective way to restart from scratch.
I was supposed to spend the night by my parents but I was afraid to go over. They have a television and I knew that given the way I was feeling I would watch TV until 3 or 4 am if I went by them. More plans unraveling. Sigh.
I stayed home very quietly and would still have gone to sleep way too late if a friend hadn’t passed by, wondered why I was still awake, fed me a light dinner and yelled (nicely) at me until I went to bed.
This morning I seem to be getting back on track. I’m trying not to think of all the catching up I have to do yet – it’ll just make me feel overwhelmed. One step at a time.
But back to my mother. I’m still furious with her. On top of everything I got a moralising sermon about how I need to sacrifice sometimes for other people. From my point of view, my mother’s desires and her way of looking at the whole situation shows a complete lack of understanding of what it means to be bipolar. She might think I didn’t want to spend a few hours with her on her birthday. I was thinking that the few hours she wanted would cost me the next four days of my life and a terrific effort over those four days to put things back in order. Which one of us needed to sacrifice?
Next time I’m doing what I need to do. This has cost me way too much in terms of effort.
I’m also a little shaken by the realisation if someone as close to me as my mother cannot understand the daily effort it takes to cope with being bipolar or the very non-standard attitudes, habits, and limits I apply to myself to cope with being bipolar, how am I to expect that others will understand? Have I been really lucky in getting the friends and family around me who tolerate me? I wonder what happens to others who don’t have quite such a wide support system as mine.