When Covid-19 And Bipolar Recovery Collide With Unexpected Results

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I have spent the last five weeks in a psychiatric hospital for management of a Bipolar 1 Disorder episode.

I am no longer sick. But still fragile. Like an egg without its shell. I always reach a point on the return to wellness where I can get no better in the controlled bubble world of the hospital. A point where staying longer is of no benefit and can even become detrimental.

I ventured back out into the world at the end of last week. A world that hasn’t grown any softer in my absence. It is the same hustling harsh, bruising, breaking place it always has been, but perhaps more so. No one was fighting over toilet paper five weeks ago.

That said, after any admission for a Bipolar episode, jumping back into my life can feel like steel wool on newborn skin in the early days.

No one can tell by looking at me when I leave the hospital that I need rehab and resilience building before I am ok again. For me, on average that takes the same amount of time I was hospitalised for. So, in this case – another five weeks.

People tend to be congratulatory about me being well enough to come home. I don’t want to be a downer. I am grateful to be home. But just because I’m out of hospital it doesn’t necessarily mean it’s over. It can look like it is slinking away not to be seen again for a couple of years. But appearances can be deceiving.

Once, this illness spent a whole year of my life bouncing me in and out of hospital so often, I got dizzy. By the end of that year, in which most months had held a hospital admission for me, it had nearly killed me. So, that’s why I don’t think about exhaling as soon as I am home.

Today is my fourth day at home. I am still acclimatising. But I also recognise something unexpectedly positive borne of the last five weeks.

Being in hospital with Bipolar symptoms has prepared me for the Covid-19 headlines very nicely.

I get a sense from these headlines and the empty toilet paper and pasta aisles in the supermarket that many people are panicking, or at least are very worried by the uncertainty they are being force fed right now.

I am still in the mindset it took to get through my last five weeks. I lived that time (and do every time I go into hospital) in two-day increments. Why? because it is pointless to look or plan any further ahead. Neither I nor my psychiatrist could fortune tell what would happen. Five weeks of observing, tweaking medication or not, and then waiting another two days before assessing again.

To be clear, there is a difference between not taking something seriously, and choosing to engage only in what is in front of you. I take my Bipolar Disorder seriously, especially when it flares. But does that mean it would be helpful to spend my entire admission panicking that this is the time I become a permanent inpatient (they exist)?

Or should I break it into chunks the size of a couple of days and hit repeat, until at some unknown time in the future I am out the other side?

I’ve spent early admissions, years ago, engaging in the first option but have learnt that the way through with the least energy wasted is the second one.

In the same way, I take the Covid-19 pandemic seriously. But you won’t find me panic buying or worrying about whether or when it will end. Breaking this issue down into two-day increments feels helpful to me right now. Every two days (or sooner if the headlines change dramatically) I reassess the basics: Do I and my immediate family have enough food, water, medication and accommodation for the next two days? I am fortunate. So, far the answer has been yes.

Is there any point in trying to predict what might happen next month or even next week, and worrying about it?

None!

Because no one knows where we will be then. You can only act on the information you have at the time.  And if right now your basic needs are met and you are well, don’t buy more and more and more food or toilet paper (unless you are doing it for the vulnerable members of our population).

Breaking the overwhelm of a difficult situation with no known endpoint into smaller portions lessens the strain on our mental health and preserves our energy for more productive tasks.

And if we do it often enough that’s what will get us to the other side of this situation too.

 

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Update 27.2.2020

 

Update 27.2.2020

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Photo by Emiliano Arano on Pexels.com

And so, we enter week four in hospital.

I emerged from the manic symptoms about a week ago. Pummelled into exhaustion by the high doses of Lithium and antipsychotic medication, and by the manic episode itself. Even in a hospital setting, taking all the right medication, and having good insight into the symptoms, manic episodes accrue a negative energy balance. It means when you eventually recover you are depleted, bone tired.

And this is where it gets tricky:

That exhaustion can mimic rebound depressive symptoms. One improves with rest and dialling back the antipsychotic medication. The other progresses beyond exhaustion to include other insidious signs that envelop you in a black, poisonous mist. Appetite drops off. The words ‘zero fucks left to give’ cast in a concrete block take up residence in your skull. Motivation evaporates and has to be faked until it decides to return in its own sweet time.

For a week now my psychiatrist and I have been watching and waiting. At first, we were both hopeful. We even (stupidly) dared to imagine I could be well enough to discharge by the end of this week. There is a reason we have a policy of never looking more than two to three days ahead when I’m in hospital. It’s because this illness has taught us – there is no point.

My psychiatrist entered my room mid morning today, looked at me back in bed and said

‘This isn’t good. You’re usually out walking.’

I turned towards him.

I don’t like it when his face arranges itself into concern within ten seconds of seeing me. It confirms what I already know. It also reassures me, because it is evidence of how well he knows me.

I have tilted towards depression, in the opposite direction to where I was headed when I was admitted.

This means we change our treatment plan in the opposite direction. We will cut back the Lithium and we will increase one of the two antidepressants I take. We will give it two or three days.

UNLESS…

My mood begins to shift back up before then, in which case I will inform the nurses and they will page my psychiatrist for further instructions. We don’t want to risk another ascent into mania. I’m not reaching for a YoYo or rollercoaster metaphor here, because they both imply the possibility of fun, which this decidedly is not!

The other switch over is the behavioural management of active Bipolar symptoms. For me it means telling myself to do the opposite to what my body wants me to do. So during a manic episode I should seek out quiet environments, be on my own, try not to overexercise. During a depressive episode it means kicking myself out of bed, engaging with others, and above all else exercise, exercise, and then exercise some more.

What a mind fuck.

While I continue to wait out my life in two to three day increments, I don’t feel inclined toward gratitude. But that’s largely depressive symptoms talking. So, I will do the opposite and stubbornly find something to be grateful for. Here we go:

I am grateful that at their current level my depressive symptoms are much easier to manage and tolerate than my manic symptoms were. The intense manic irritability has disappeared, and my concentration and short-term memory have mostly returned…for now.

 

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Interruption To Regular Programming

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Photo by Anna Shvets on Pexels.com

I am in hospital, compromised by my standard symptoms that precede a manic or depressive episode. Looking more manic at this point though. The three symptoms are: lack of concentration, loss of short term memory, and pathological irritability.

If you have never been ravaged by them, then listing these symptoms can make it sound as though I am just a bit ditzy and cranky.

So wrong.

It’s going to take it out of me but let me see if I can paint a more accurate portrait of this beast. I am not yet so sick that it has silenced me.

The memory loss and lack of concentration leave my brain moth eaten. Holding onto thoughts long enough to articulate them takes a lot of effort. It is like using tweezers to try and catch tiny fish darting around in a big aquarium.

And the irritability? Surely as a rational, compassionate human being I should not feel so permanently unreasonable. I always insert the word ‘pathological’ in front of this symptom to try and describe just how out of control the stream of swear words is that run through my head when I am surrounded by people within ten metres of my personal space.

I say ‘pathological’ to describe the feeling of having hundreds of mosquito bites, my hands tied, and someone running a feather over the bites while they make fun of me. Sometimes it feels more like I’ve been sandpapered and then doused in lemon juice.

It is excruciating.

I will eventually get better. I always do. I know in time I will have the reserves to write properly again, and I will eventually go home and continue to rehabilitate. But for now, any spare energy is going towards doing what I need to do to get well, and if anything is left over it is going towards giving some moral support to my husband and children. So there may be some time between posts.

I always hope it won’t be too long but have been here often enough to know that it will take the time it takes and focusing on it won’t speed my recovery.

Stay tuned.

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Not So Body Positive

Big cat on the street in the city

I came across an Instagram image of an obese cat recently (not the image in this post). The accompanying caption referred to the cat as a ‘body positive icon’. And it made me stop and think about whether a cat can, or even should be, an icon of body positivity.

I have never felt qualified to comment on the body positivity movement. As someone who lives with thin, white, straight, (mostly) able bodied privilege, I have been reluctant to wade into the hornet’s nest of opinions the words ‘body positivity’ evoke on social media. Until I saw this.

Continue reading “Not So Body Positive”

The Comparison Trap

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Photo by Skitterphoto on Pexels.com

I liken comparing myself to others to a landscape of skin. In some areas that skin is as thick as a crocodile’s. Very little penetrates it. Take social media. I came to it old enough to have a solid sense of myself. My self-esteem and body image didn’t grow up in the glare of Instagram. FOMO generated by someone else’s curated holiday/body/green smoothie/adorable family snaps is foreign to me.

Other tracts of skin are a little thinner but still not easily breached, a bit like a callused heel. My career path and choices have held few twinges of comparison. Maybe in the early years of my veterinary career I did some comparing. But that was part of the trek of working out what sort of vet I wanted to be.

Writing and advocacy work have only evolved in the last few years, and I view other people’s work in these areas as something to either aspire to or steer away from. Yes, it’s comparison, but a cool, dispassionate kind.

Then there are the areas of soft skin, vulnerable, but hidden away too deeply to be strip searched by comparisons. My relationship with my husband fits here, I couldn’t compare us to anyone else, because what we have is as unique as a fingerprint.

Then there’s skin ripped open at unnatural angles.

Continue reading “The Comparison Trap”

What Defines You?

For me, the taste of my rubber snorkel mouthpiece, the smell of seawater and the sight of pink coral with black fish darting around it, was the beginning. I was about four, snorkelling in the shallows on the Saudi Arabian side of the Red Sea. That defined me. Indelibly.

But mostly, what defines me only does so temporarily. Eventually those moments, decisions and experiences split open and peel away like dead eucalyptus bark to reveal fresh influences and redefinitions.

I remember the first time I felt desired. A look like lightning in the middle of a lake. And a sentence.

‘You are not like other girls. You are better.’

It shaped a part of me that felt proud to be different. We laughed at those ‘other girls’, whose sole ambition in life was wifedom and motherhood, women who threw themselves at him while we toyed with each other. My emotions stayed safely walled off from the chaos of love.

I was defined by my untouchable smugness.

Continue reading “What Defines You?”

Misunderstood Mania

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What do you know about mania?

Everyone knows depression is bad. But does this mean mania is good because it supposedly sits at the opposite end of the bipolar spectrum?

Mania is often painted as the cartoonish counterpoint to depression. Perpetually bright, happy, and fun. But it is not fun. It is the character in a horror movie who starts out friendly but then morphs into someone with sinister, glowing eyes.

Mania assaults your senses.

Continue reading “Misunderstood Mania”