Category: Annals of Bipolar Recovery

How I Am Feeling

My dialectical behavioral therapist Lori H. assigned me a homework task. I was to write down, for our next meeting, how I am feeling these days. I was also encouraged to share the result here on my blog.

But here’s the thing: it is very difficult to find the necessary words. It’s not that I’m generally inarticulate. Rather, I’m not sure there are words which capture my present emotions, because what I have been feeling is kind of contradictory.

On the one hand, I have feelings of happiness and hope. Whereas in the Spring I was terrified about it coming, in the end I had a lovely 60th birthday party. My teaching is going well too. Whereas last year at this time I was getting lost during my in-class lectures, having to stop the class while I overcame the shakes, this Fall my lectures are almost like they used to be. What’s more, I have both Saima and Anita at home, which is another lovely facet of life these days. As I wrote last time, I am experiencing an “upward spiral” these days, wherein: I feel confident enough to take on a harder task; and then I succeed at that task; and that makes me even more self-confident; and so on.

Yet it would be inappropriate to say, “I feel happy and hopeful”. For, on the other hand, I have powerful feelings of sadness and dread. The sadness stems in part from my other daughter Moon, who moved away last Summer. I miss her terribly and frequently cry when I think about how distant she is. The dread is all about Winter coming, and about whether I’ll be able to maintain a positive attitude as the days get shorter and colder. I do hope to flee the Winter for sun and warmth at least a few times, but I don’t have travel plans locked down yet. That leaves me nervous.

Doing Better, But…

I have been doing better since my hospital stay in the Spring. Seven weeks on the psych ward at Victoria Hospital here in London, ON, seems to have really helped.

Numerous friends have asked me what has been making the difference. I thought I’d post something about that here.

I think the first really important change is in medication. The run-of-the-mill anti-depressants had stopped working for me. So, my medical team at the hospital decided to try something unorthodox: they put me on an old-fashioned drug called Nortriptyline. Invented in 1963, it’s one of the first-generation anti-depressants. It had fallen into disuse after Prozac and the like SSRIs were developed, because it’s lethal in overdose. Hence, it’s not a drug you want suicidal people having ready access to. But things were desperate, so they tried me on it. To make sure that I don’t overdose should I have a really suicidal day, my wife Anita stores the pills in a hiding place, and only gives me three days worth at a time. It’s a bit of a nuisance for both of us, but it makes good sense safety-wise.

Another factor is an “upward spiral”, as I call it. I am feeling much less scared, and more competent, so I take on somewhat harder tasks. When I succeed at those, that makes me feel still less scared and still more competent. So, I take on something even harder. And so on. So, for instance, I was able to travel north for a fly-in fishing trip in June with my friend Emily. Long-time readers will know that much chaos ensued. Yet I kept it together. Next time, I flew up north by myself, and even spent several nights on my own back at my endearingly creepy motel in Nipigon. Another example. In August I went to a major philosophy conference in Rome, though I didn’t present anything. In October, I’m going to another conference, in St John’s Newfoundland, and this time I will be giving a talk.

The third thing that really helped me improve, I think, was the Summer weather. Sunshine, warmth and being active outdoors are all very good for my mood, including in particular the ability to overcome emotionally trying events. I just seem more psychologically resilient between May and August.

This leads me to a current worry. That “But…” in my title. I am afraid that the change of seasons may throw me back into really serious anxiety and depression. Currently, I am trying to find ways to reassure myself. Three things may help. First, I am back teaching. I’m even writing: yesterday I completed a draft of a sole authored book review, the first in a long, long time. Success at work should help me make it through. Second, I am planning trips to warm, sunny places over the winter months. That’s not going as well as I’d like, as so far I only have one trip planned, viz., to give a plenary lecture in Montevideo in December. But I’m hopeful that other opportunities will present themselves. Third and finally, I am trying to emphasize to myself the fun things that I can do during Ontario’s winter. I got up on skis last year; maybe I can do that again, only more frequently?

A Recovery College Course on Living with Suicidal Thoughts

The Canadian Mental Health Association (CMHA) has a program called the Recovery College, and I will be volunteering there. See https://cmha.ca/what-we-do/national-programs/recovery-colleges/. In particular, in conjunction with CMHA employees and other volunteers who have experienced mental illness, I will be creating a course on living with chronic suicidal ideations.

I presently envisage the course having three segments.

The first will address the question of why having suicidal thoughts is so disturbing. In fact, this question sounded absurd to me when I myself was first confronted with it, posed as it was by a psychiatrist in the mental hospital. It rang as odd as “Why is intense pain so disturbing to you?” Indeed, at the time I found the thoughts of suicide so distressing that I preferred to die than to continue having them. Ultimately, though, I think the question calls for an answer beyond “The thoughts are per se awful”. Part of the answer, in my own case, is that having suicidal thoughts makes me feel pathological – mentally ill: “normal people”, or so it seemed to me, weren’t regularly bombarded by salient opportunities for killing themselves.

The second segment of the course would highlight a surprising fact, namely that having suicidal ideations is very common, and many, many people simply learn to cope with them. Just as some patients simply live with voices in their head, some people somehow live with thoughts of serious self-harm. How many people? We are doing some web-based research on the actual numbers right now, but I expect them to be high. Firstly, because my psychotherapist Dr. W estimated in a recent session with me that about 30% of her patients over 50 suffer from them chronically. Secondly, in my initial discussions of the topic with friends, a large portion who seem otherwise mentally fine have told me in confidence that the option of suicide occurs to them at least occasionally. One perfectly healthy friend told me, for example, that she had undergone an especially tough day dealing with her students and was struck, that afternoon, by the thought that if she leaped off the university bridge into the Thames River, she wouldn’t have to put up with the annoyance anymore. I was gob smacked. Another friend told me that she finds herself weirdly compelled to jump off subway platforms and apartment balconies. She’s very uncomfortable in either situation, though she’s otherwise “normal”.

I want to stress this fact because, given that there’s a taboo on talking about one’s own suicidal tendencies, the commonness is little known. And, as I say, knowing about it makes me feel more “normal”, less damaged. (We might include a segment on why the taboo exists. Is it simply shame? Is it that people don’t want to alarm their friends and family unnecessarily?)

The third and final segment would take on the issue of how to live with suicidal inclinations. I’ll want to include here my own recently discovered technique. As discussed in a recent blog post, I achieve an appropriate distance from the dark thoughts by:

– giving them a name, specifically ‘Sue’ for su-icide

– telling myself that they are invasive thoughts, coming from a malfunctioning part of my brain

– saying, as a mantra, that Sue does not reflect my overall values.

In brief, I recognize that the thoughts really are mine in a sense: it’s not as if someone else planted them in my head. But I also recognize that they don’t reflect my genuine self. Beyond my own, we will try to include other tips from patients living with suicidal thoughts.

If you, dear reader, have also found yourself having suicidal ideations and have been shy to talk about them, I’d be grateful to hear from you. Your correspondence will help, anonymously, with crafting the Recovery College course.

Surviving Fishing Chaos With Bipolar

My fishing trip up to Esnagami was full of adventures and misadventures. This will turn out to be relevant to my recovery, so bear with me while I list some of the latter.

Even before leaving London, the chaos (as my fellow angler Emily and I called it) began. The bus company where I had reserved a trip to Toronto airport emailed me at 11:30 the night before, to tell me that the bus was cancelled. I had to scramble to buy a replacement ticket on a competitor, Robert Q, at three times the cost. Chaos continued pre-trip when my bag of rods did not make it to Thunder Bay. Air Canada had, for the third time, misplaced the bag temporarily. They couldn’t even manage to load the bag on the plane in Toronto! Emily and I had to purchase replacement equipment to be able to fish up at the lodge. (Air Canada promised to reimburse us. We’ll see.) That pitstop in Thunder Bay meant that we were very late arriving in Nakina, Ontario, a four-hour drive northeast of Thunder Bay. Helpfully, the owners of the motel where we were staying left a key for a room in the door, so we were able to get in and sleep; unhelpfully, we forgot to take the key out of the door. Anyone could have come into our room overnight!

Now I come to the actual fishing chaos. Our first afternoon went off well, except for Emily’s line getting caught in the propeller. At first, we thought she had a big fish on – her line went out so quickly. But soon I understood that she had only caught our motor. Sigh. The second day was more problematic. We headed for Betty Falls at the extreme east end of Esnagami Lake. I managed to get us lost, thinking we had driven too far. I turned us around and headed back west, only to arrive in a shallow bay in which we ended up stuck on a reef near the shore. (We had been casting to the shoreline, one of us got our lure tangled up in a tree, we went to retrieve that lure and got stranded.) We eventually got ourselves free from the rocks and I realized, re-looking at my GPS-based Google Map, that in fact we had been just shy of the falls when I prematurely turned us around. So, turn around again; head east again. At Betty Falls, we started to catch some small fish. Life was good. Until… I saw Emily holding her newly acquired rod; moments later, I saw her rod in the water; she had somehow lost her grip on it. We watched as it sank to the bottom and out of view. We had to head back to the Lodge in the hope that the rod case had been delivered in our absence. (It had. Yeah.) The following day, the Sunday, we were taken out by my friend Liam as our guide. There was essentially no chaos under his guidance and both of us caught trophy-sized fish. We paid for that calm the next day, however! A gust of wind grabbed my lucky fishing hat and, like the rod before it, the hat too was “donated” to the lake. Things only got worse. The next day, Tuesday, we drove the boat about 10 km to the north end of the lake, because there were winds in the forecast, and we wanted to fish a bay where we’d be sheltered. Eric, our host, marked clearly on a map where the weed beds were in that bay, and we headed directly to them. Things didn’t start off too badly: Emily caught a couple of walleye as we entered the bay. But we spent the whole morning trying the spots Eric suggested, and I got skunked. Around 1 pm we decided to head back south. Easier said than done! Once we exited the bay, we realized that the winds were much worse than we had anticipated, and there were by now six-foot swells out on the lake. Emily genuinely feared for her life as our boat filled up with the water crashing over the bow. We spent a very tense hour or so travelling back towards the lodge and had to pull the drain plug on the boat to get the accumulated water out. Total fish on that Monday, after defying death: the two little walleye that Emily got at the outset. Things really turned around on the Wednesday afternoon, when Eric took us out… but not before yet another mishap. Emily and I were fishing near the bottom for walleye, and my jig got stuck on a rock. This is an occupational hazard of walleye fishing: if you aren’t getting caught on bottom, you aren’t fishing deep enough. Unfortunately, my line went under the boat, and I was afraid that it would get trapped in the motor again, so I shut the motor off and got the line out from under us. And then, the motor wouldn’t restart. I set to trying to get the motor running, all the while drifting farther and farther from the snag. Next thing I knew, all my line had run out and I had an empty spool on my rod, and no replacement line in the boat.

As a bit of an aside, it occurs to me as I list all of this both that the old adage that fishing requires lots of patience is true, but that it’s true for a reason that isn’t widely recognized. People imagine that patience is necessary because the angler is sitting around, doing nothing, waiting for hours on end. Instead, patience is required because, if you are actually going to catch fish, you are going to be running plenty of little risks. You will, for example, cast near the shore where there’s a potential for your lure to get stuck in a tree; and you’ll keep your jig close to the bottom sometimes. You’ll also need to do some travelling. That’s because the easy-to-catch, risk-free fish near home have already been caught by someone else decades ago. The thing is, running little risks means that even the careful will experience lots of chaos. Lots. Hence the need for patience. (There’s a metaphor for life here: a low risk life is likely to be a low reward life too.)

Nor was the chaos over once the fishing ended. Air Canada seemed unsatisfied with misplacing my rod case on the way up, and delayed my flight back to Toronto so long that I arrived around 1 a.m., July 1st, when all the buses back to London had already left. I was stranded at Pearson airport until the morning.

I am posting about all this chaos here on my blog because there is some very good news, namely that I did not panic. I did not even lose my cool. Throughout all of the tribulations, I was able to problem-solve. It was like the old Rob had returned to take charge. In that respect, despite the many misadventures, it was a really good trip.

Anti-Suicide Safety Plan

It’s a good idea for people with suicidal tendencies to have a safety plan. A plan which may be consulted at times of crisis.

The time to create such a safety plan is while one is well. In light of this, my new Dialectical Behavioral Therapist Lori has suggested that I work on mine now. And since the purpose of this blog, way back when, was to share the results of my homework, I thought I’d present the results here.

My safety plan appears on a phone app called “mood tools”. It has four sections: Warning Signs, Coping Strategies, Reasons to Live, and Contacts. (Well, okay, the app actually has six sections. It also includes Places for Distraction and Other. But I don’t use those.)

My chief warning sign used to be suicidal ideations. But now those are chronic. I have them even on my best days. So, they aren’t really a warning anymore, just a nuisance. (“Sue” is almost always around.) Instead, the indication of real danger now would be an obsession with suicide and a felt urge to actually carry it out. I’ve also learned while in hospital that the last pleasure to go is social contact. My strongest suicidal urges correlated with no longer wanting to interact with anyone. Thus, a second warning sign would be losing interest in seeing people.

My anti-suicide plan also contains a long list of coping strategies. There are things to calm me, like: doing a meditation, especially a gratitude meditation; using “box breathing”, where I breathe in counting to four, hold for four, and then exhale for four; and various grounding techniques such as counting five things that I see, four things that I hear, etc. There are things to get me moving, like doing a run or cooking something. There are mantras that I recite. Saying to myself “change is constant, loss is constant, unfairness is constant, mistakes are constant, conflict is constant” helps me radically accept difficult things. I also have my new technique of naming the suicidal thought, recognizing that “Sue” is an invasive thought from a malfunctioning part of my brain, and stressing to myself that intrusive suicidal ideations don’t reflect my overall values. A third kind of mantra that I use for self-soothing involves reminding myself that, when climbing a mountain, sometimes one has to go down into a crevasse; doing so feels like losing ground, but in fact even the downward trajectory is a brief part of the larger success.

I also have a list of reasons to live. First and foremost is being able to spend time with family and friends. As I say, it’s only at my absolute lowest that I don’t enjoy that. Similarly, there’s time with my students, past and present. Granted, if I am super suicidal, it’s likely that I’ll be suffering from anhedonia and so won’t be able to just dig in and do enjoyable things. Nonetheless, I can tell myself that pass-times which I used to enjoy will come back again: the joy of reading, music, fishing, and travel have always returned in years past. A different order of reason for living is the knowledge that I can help others by staying alive, and that many people I care about would be irrevocably hurt if I gave in to the suicidal urge.

Next in my safety plan is a list of contacts. I have listed two suicide prevention hotlines: the local London, Ontario one, Reach Out at 866-933-2023 and the new national Canada-wide one, 988. I recorded the address of a “crisis stabilization space” – 648 Huron St. – which affords an attractive alternative to going to Emerg. The space has about a dozen beds for those in mental health crisis for stays of up to three days. I also have listed the phone numbers of numerous friends who have helped me in the past. The app has the power to directly dial these folks if I click on their name, so I don’t even have to open another program to get through to someone.

I have been doing a lot better since I left the hospital, and some of this looks unnecessary right now. But I know, based on past experience, that I am likely to face dangerous levels of suicidality in the future, so I should always have this safety plan handy.

What’s “Well Enough”?

It’s very difficult to get thorough mental health care here in London. The resources are stretched too thin. The only way to get lots of attention from an entire team of professionals is to remain an inpatient until one is well enough to leave the hospital. I was talking with Anita about this on Saturday, over Mother’s Day dinner out, when she insightfully asked: What would be “well enough”? I’ve put a bit of thought into that.

I have both anxiety and depression. (I’ve often wondered why they go hand in hand. Any thoughts?) I’ll divide my discussion that way

On the depression side of my symptoms, “well enough” would certainly require getting over my pressing suicidal ideations. Here inside the hospital, there aren’t what I’ve taken to calling “suicide affordances”, i.e., salient opportunities for killing oneself. As a result, I don’t think much about harming myself while I’m in here. But outside the hospital, there are suicide affordances galore. As an example, there’s a lovely bridge crossing our little Thames River which we walked over on Sunday. Unfortunately, the bridge immediately brought to mind the possibility of jumping off it. Until I can stand on a bridge without being aware of the opportunity it affords for suicide, I don’t think I’m ready.

In addition, before leaving hospital I’d like to have recovered an interest in activities that used to be entertaining, like reading fiction. I don’t expect to get back my ability to do work-writing any time soon – I am resigned to putting all of my energies into teaching and service instead, those being the other two components of my job as a professor. Nor can I expect to recover a life worth living, even though that’s the ultimate goal of treatment. But I’m still not interested enough in, say, reading a novel to exit the hospital.

On the anxiety side, I think I’m almost there in terms of “well enough”. The very good news is that the overarching fear, which used to just float freely in my consciousness with no apparent object, has subsided. On the other hand, I’m still very fidgety. I’m still restlessly crossing my legs. I’d like to be on something that controls the fidgeting better. And I’d certainly like to be well enough that I’m not afraid of going for a run. Maybe that’s another sine qua non of leaving the hospital, running being so important for my overall health.

Beyond the above, there’s also the issue of my physical health. My blood pressure keeps plummeting down into the seventies. I gather that’s really, really low because the nurses look at me funny – like I’m a walking corpse – when the machine shows that figure for systolic pressure. It’s likely the nortriptyline, the first-generation anti-depressant they tried me on, that is responsible. I am off it for the time being, until the team comes up with a plan. I think I need to be on an effective and safe anti-depressant before I leave my care team behind.

How I am doing

My blog has been dormant for several months now. I thought it would be good to provide some kind of update on how I’m doing. I’ll divide it into the three aspects of my Bipolar symptoms: depression, mania and anxiety.

Starting with depression, what I think of as my severe grief symptoms – e.g., fits of crying and abiding sadness – are essentially in remission. The combination of electroconvulsive therapy and SSRI medications seem to have worked on that aspect of my mental illness. My suicidal thoughts are largely under control as well. Mostly, I have only passive suicidal ideations these days. For instance, I notice opportunities for suicide – “I could step in front of that bus”, “I could cut my wrists with that knife”, “I could drink that radiator fluid” – and sometimes I wish that I simply wouldn’t wake up. But I haven’t been in serious danger lately. What I’m really struggling with depression-wise is anhedonia, i.e., a loss of interest in activities that used to give me joy. I need to force myself to read fiction, watch TV, or listen to music. I have no great desire to go fishing even when the opportunity presents itself: I hardly fished in the Summer and Fall and didn’t get out even once while down in Uruguay. Another holdover from depression is that I haven’t had energy or focus. In particular, and as a result, I can’t write hardly at all. (Hence the long period without even an update to this blog.)

Turning to mania, I haven’t had a hypomanic episode in years now. Indeed, I wish I could trigger a manic phase, because that’s when I used to get so much done! I’ve made so much progress that I’m not even sure that Bipolar Type II is the right diagnosis anymore. I may need to change the name of my blog…

The really bad news is that, while I never experienced anxiety until five or six years ago, now it’s a constant daily presence. It has replaced the hypomania – and that’s an unhappy trade-off. I seem to be free of anxiety symptoms only when wholly distracted or when lying down. (Between the lack of energy and the desire to be horizontal to fight back the anxiety, I am spending a lot of time in bed.) The phenomenology of the anxiety is peculiar. It is free-floating fear with no object: often there’s no thing that I’m afraid of, I simply feel afraid. It’s as if there’s simply too much cortisol in my blood stream, and so my body and mind behave the way frightened creatures do (tensing up, being overly vigilant, feeling threatened), though there’s no threat. Surprisingly and sadly, no medications seem to help. There doesn’t seem to be an antidote that I can take and make the objectless fear go away.

An unhappy recent development, illustrating the anhedonia and anxiety working in tandem, is that I nowadays lack the energy and enthusiasm necessary to get out running; and I feel afraid on the relatively rare occasions when I do lace up my running shoes. Running is so good for my physical and mental health, but for a month or so now I can’t bring myself to do it, especially not by myself, but not even with a running partner.

I might sum up the curate’s egg that is my mental health these days by saying this: because I can’t bear the thought that it’s permanent, I’ve been telling myself that I’m in the anxiety phase of my recovery. Let’s hope that’s right.

Life at Homewood Psychiatric Hospital

Friends have asked about my daily activities here at Homewood. As I complete my first week, I thought I’d write about that.

There are the usual routines of: shower and shave, brush your teeth, get dressed. There are the morning and nighttime medications, distributed through the window by one’s shift nurse (every single pill encased, distressingly, in its single-use plastic container). There are seemingly constant meals down in the cafeteria: always two protein options, one of which is vegetarian; always some fruit to choose from; usually there’s a dessert that tempts me, even though as a diabetic I should refrain.

By my reckoning, there are three different kinds of group therapies that help fill up the days.

There are recreational therapies. Creative arts on Mondays and Wednesdays (this week, ceramics and also making a doodle with a Sharpie pen and then colouring it in). Horticultural therapy on Thursdays — today I potted a plant in a traditional Japanese style, using moss and twine to house the soil, instead of a ceramic pot. Music therapy on Friday mornings, which I mentioned in a previous post. The rationale is that all these help patients get grounded and make them feel that they are capable of doing new things.

There are interactive social events of various sorts, including collective trips to the gym and the afternoon check-in, where every patient describes their mood, a positive experience, and a DBT skill that they made use of during the course of the day. (Given how central combatting addiction is to Homewood’s mission, there are many different 12 step meetings taking place too, and addiction education for everyone.)

Finally, there are classes taught in Dialectical Behavioral Therapy: distress tolerance, emotion regulation, mindfulness, chain analysis, building resilience, etc. My three-ring binder is already chock full of handouts from the DBT Bible.

In addition to quotidian routines and group sessions of various sorts, there are one-on-one meetings with social workers, occupational therapists, psychiatrists, and nurse practitioners happening all the time.

To fill out the rest of the time, the last couple of days, I’ve managed to do a 3 km run on the park-like grounds behind the hospital, I’ve attempted to do some leisure reading – Time magazine or a novel – and I’ve spent lots of time chatting with fellow patients.

Bipolar Recovery at a Conference

I am at the Congress of the Social Sciences and Humanities this week in Toronto. It’s a massive conference, often 10,000 people. And it’s the first big such event I’ve attended since COVID… and since my electroconvulsive therapy.

Yesterday was the first day, and it was fun – I met up with dozens of old friends and met some new folks – but it was challenging. I found it hard to follow the philosophy talks because of a lack of focus/concentration, and hard to motivate excitement in the topics because of a lack of energy. I found myself not remembering people, which is new for me post-ETC. (A young woman, who had just done an excellent presentation, came up to say hello, telling me that I had taught her in a graduate seminar. It’s not just that I didn’t know her name; it’s that she might as well have been a stranger.)

Talk of post-ECT troubles brings me to a vicious cycle that I’ve been experiencing lately. It is showing up in my teaching too. I have difficulty with focus/concentration, energy and memory and these make me feel fear, and shame, that I can no longer do the job of a Distinguished Professor of Philosophy. The fear/shame worsens my concentration and memory, and further saps my energy. And the cycle continues.

Here is what I have been telling myself in response, and what I kept saying to myself yesterday during the conference. There is hope that the troubles continue to improve over the years as I put the shock therapy further in the rear view mirror. This would reduce the performance anxiety by objectively doing better as time passes, by continuing to force myself to practice. (E.g., forcing myself to attend additional conferences.) That’s the one hand. The other hand is that I can simply demand less from myself, or different. Being a good professor is good enough while, meanwhile, I excel at other things. Even more drastically, maybe I can accept that I’ll hereafter perform badly by prior standards but that no one will die as a result. I would still be a good person.

Anyway, the conference continues until Thursday night. Today there is a panel that I helped to organize that is squarely in my research area. We’ll see how things shape up.

How I’m Doing

There’s very good news in terms of how I’ve been doing this last month or so. Here’s the story.

I had basically plateaued from mid-August through the end of September. I was having about one really bad day a week – a day wholly dominated by fear and suicidal thoughts — and every day had some episodes of both. That state was manageable, it’s true. I was able to work at teaching, for instance, and to help with my refugee causes. But it was not “a life worth living”, which is the ultimate goal of DBT.

My psychiatrist at the Depression Centre at Toronto Western Hospital, Dr. M., was sympathetic to the latter, and he suggested that I add an Atypical Antipsychotic, aka a Second Generation Antipsychotic, to my regimen, this one newly approved in Canada in the Spring. (See here for what “Atypicals” are: https://en.wikipedia.org/wiki/Atypical_antipsychotic) In fact, none of the drugs in that family have helped before; and a couple threw me into terrible agitation, such that I had to discontinue them right away. But I was open to trying yet another.

This one had no noticeable negative side-effects. More importantly, it seems to be making a massive positive difference. I almost feel like the old Rob again.

One thing that’s still noticeably absent is my sense of humour. I’m still not back to being witty, let alone to unleashing absurdist humour on those around me. However, I am back to making progress, climbing the mountain of recovery.

[A postscript on that. My occupational therapist Hanna W. instructed me to think of recovery not as a linear slope but as a mountain with deep crevasses. When a climber comes to a crevasse, they have to go down. But even as they are descending, they are making progress.]