Tag: depression

On Getting Easily Flustered

I have been doing much better. But there’s are curious symptoms I wanted to write about, to inform the interested and to garner opinions about what might be going on.

Let’s begin with “doing much better”.

My anxiety symptoms are mostly in remission. They do hit me once a week or so, seemingly out of the blue: suddenly, I feel afraid, but with no obvious cause and no obvious object-of-fear. It seems that, roughly weekly, my brain pointlessly fills with cortisol, a fear hormone. That’s no fun; but, as I say, it happens infrequently.

“Sue”, as I call my suicidal ideations, pops up much more regularly than fear does. It’s still the case that, pretty much every time I see a bus, I’ll think, “I could jump in front of that”. I’ll look at my daily pills – especially the Nortriptyline, which is fatal in overdose – and the thought of taking them all will just show up in my head. However, I’ve worked hard to just let Sue be there, reminding myself: “It’s just an intrusive thought; it’s coming from a malfunctioning part of your mind; it doesn’t reflect the overall values that you as a complete person have. Let it be there.”

(An aside. I was trying to explain to a philosopher friend what it’s like to have thoughts which, in a sense, don’t correspond to who you really are. What the heck can that even mean? I still don’t have a good answer to that question, but I did think of an analogy that helped us move forward in the conversation. An intrusive thought is like having a song stuck in your head. Someone mentions Abba’s “Dancing Queen” and, damn it, the song starts playing in your mind. Worse, now you can’t get rid of it, except maybe by choosing a different “ear worm”. Trust me that “Dancing Queen” emphatically does not reflect my aesthetic values, yet it can intrude in my mind!)

My symptoms are mild enough that I’ve been able to increase my workload at Western. I had been at 50%, for a couple of years at least. Well, and I was at 0% in the Spring of 2024, while in the hospital. Starting this month, however, I have increased both my research load and my service duties, rising to a total of 65%. The plan, if I continue to improve, is to increase to 85% in April and then 100% on July 1st, 2025. It’s a somewhat scary prospect, I’ll grant you, but I think it’s the right approach. I am fear-cited.

In short, as I’ve been telling people, it’s not that I’m “fixed”. Nonetheless, I am coping much better with my chronic symptoms, and I plan to continue on my “upwards spiral”. There are caveats, however. And this takes me to the topic of today’s post.

First, I have developed some nervous ticks. The toes on my left foot curl in and out much of the time. I also find myself picking at my fingernails compulsively. Most embarrassing of all, whenever I do anything that requires even a mite of concentration – climbing the stairs, taking the phone out from my pocket, starting a challenging sentence in this blog post – my tongue protrudes. Poor Anita says that it looks like I’m constantly sticking my tongue out at people! I try to restrain these behaviours, but to no avail. That’s one caveat.

A second caveat to my ongoing recovery is that I now get very flustered by tiny incidents. The other day, for instance, I couldn’t delete an “invisible table” from a Word document. The program said that there was a table present – but I didn’t see anything, and no method of deleting material seemed to remove the phantom. Objectively speaking, this was a small thing. Yet it drove me into an absolute tizzy, and I needed to call Anita over to help calm me down. She helped me, but I was already in a state, and it took a long time to return to normal. (Eventually we opted for saving the problematic section of the paper as a txt document, and then copying it back into the Word file. In fact, this was even my idea. But I was shaking with ill-humour by the time we got there.) Another instance. Down in Uruguay, I needed to use an adapter to plug in my computer. The adapter I had with me kept falling out of the electrical socket. Another miniscule problem. Yet, here again, I had an outsized reaction. I felt confused, stumped, incompetent, frustrated.

 The phenomenon of over-reacting reminds me of what used to happen years ago with respect to anger. As a young man, I didn’t like feeling angry. It was a scary emotion. In my experience as a child, anger had been a hallmark of a chaotic, dangerous situation. As a result, I wouldn’t let myself get angry at big things: back then, I’d sublimate the feeling, withdrawing and going temporarily quiet, say, instead of yelling. My anger had to get manifested eventually, however, and I think it did so in the following way: I would get tremendously mad in the face of tiny problems; I’d absolutely fume because a bus was a few minutes late, for instance.

My thought, taking anger as my analogy, is that my negative symptoms haven’t simply vanished. Instead, they’ve recently found other outlets. Rather than getting released through frequent episodes of fear and despair, my longstanding demons are nowadays showing up (in an outsized way) in response to miniature frustrations. They are also showing up as nervous ticks.

I have another potential hypothesis. My diagnosis is Bipolar Type II, after all, and that includes hypomania as a central symptom. The latter famously manifests itself as tons of energy and creativity, as impulsive buying, as risky behavior. Less famously, it sometimes shows up as free-floating irritability. Realizing this, my alternative conjecture is that I’m actually experiencing hypomania again, after many years experiencing unipolar depression.  

My question for my mental health team will be: “Now that I’ve recognized these symptoms, how should I respond?” After all, nervous habits and petty frustration are mere irritants when compared to what I had been experiencing. Maybe, if what I am going through really are “escape valves”, I should just let them do their job. Put otherwise, maybe these are actually coping mechanisms – features, rather than bugs. And what if what’s going on is hypomania? Once upon a time, it was my friend: my most productive times as an academic have been when I’m hypomanic. So, there too, maybe the right attitude is acceptance.

Thoughts, dear readers?

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.

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.

Learning to Live with Suicidal Ideations

In my last post, I posed the question what’s “well enough” to leave the hospital. I said that a necessary condition was getting over my suicidal ideations. I wrote: “Until I can stand on a bridge without being aware of the opportunity it affords for suicide, I don’t think I’m ready.”

Yet, here I am at home, still having suicidal thoughts. What happened?

It turns out the medical team at the hospital were focused on a different question, namely, how much can they help? They concluded two weeks ago that I had benefited as much from hospital care as I was going to. In particular, they reasoned that medication adjustments were unlikely to take away the suicidal ideations altogether.

Now, the psychiatrist who broke this news to me asked what at first seemed a deeply puzzling question, viz., why was I so disturbed by suicidal thoughts? To me, that sounded like the question why I find pain distressing: both are things which are per se unpleasant. Surely, I thought, he must never have experienced a “suicide affordance” if he can ask why they are so unwelcome. Our conversation continued, however, and it emerged that there are thousands of people who have chronic suicidal ideations but who have learned to mentally distance themselves from those thoughts. Said the team, I’d have to learn to live with them as well, not letting them bother me so much. (How very Buddhist…)

My dear friend Gustavo noted that this is somewhat like game theorist John Nash, who famously suffered from schizophrenia his entire adult life. Nash wasn’t helped by medications. Instead, as he put it, he gradually began to intellectually reject the delusional lines of thinking. His voices didn’t go away; rather, he somehow managed to consciously resist them.

In the two weeks since I left hospital, I’ve been working on creating the requisite distance. My current technique has three steps. First, I identify the suicidal thought. I’ve given it the name ‘Sue’ for suicide. Second, I note that Sue is an intrusive thought, which comes to me unbidden and from a malfunctioning part of my brain. Third, I stress to myself that Sue fits ill with my overall values. Sue, in short, isn’t me.

It isn’t easy living with Sue, but maybe I can manage it.

A Month In Hospital

I’ve been in hospital for a whole month. The bad news is I was brought in feeling very suicidal; the good news is that I’m feeling better. In this post, I’ll explain how I got here, what it’s like, how I’m doing these days, and what the game-plan is going forward.

I had my monthly meeting with Dr. Desjardins, my psychiatrist, on March 26th. She concluded that I was too suicidal to be safe at home and arranged to have me brought to Emerg at Victoria Hospital. I spent 47 hours down in Emergency, seeing at least three doctors who all concurred with Dr. Desjardins. At this time, I was issued a “Form 1” which allowed the hospital to detain me for 72 hours. I then spent about a week in what Saima labelled the “holding cell” (i.e., the detox and stabilization unit). Then as soon as a bed was available, I was brought to one of four additional longer term psych wards. For three weeks, “home” has been the 200 block of the 7th floor of B wing.

Regarding what it’s like, I think I can sum up by saying that the weeks fly by, but the days are so slow. I spend my time reading email, the newspaper, non-academic books; doing phone calls and video chats with friends and family from afar; receiving lots of visitors (for which I’m immensely grateful); and pacing the hallways with those co-patients who are verbal, and largely mentally competent. (There are about a dozen patients on my ward, about half of whom are able to maintain a conversation. A couple of co-patients from up here and from the “holding cell” have, indeed, become real friends.) I also eat a lot – seemingly all the time. The food is bland, but eating makes the time pass.

I am trying two drugs that are new to me. Nortriptyline is a tricyclic anti-depressant first used in the early sixties. It’s not popular nowadays – that is to say, after the development of SSRIs like Prozac and Zoloft – because it’s lethal in overdose, hence not given lightly to suicidal patients. If I stay on it post-release, I will be given only a week’s worth of pills at a time. Quetiapine is an atypical anti-psychotic which is deployed off-label for anxiety. It’s also a powerful sleep med. The combination of the two seems to have left me calmer and more stable. I have even had a positive outlook for the last few days. I’m hoping that’s a matter of cause, i.e., that it’s the pills that are actually helping. The alternative hypothesis is that merely being in hospital, in an entirely stress-free environment, is what has me feeling better; and this happens to correlate with starting new drugs. That would be unfortunate because then I’d presumably revert to my very suicidal state when released.

Speaking of release, the current plan is to discharge me on Tuesday, April 30th, 2024. By then, Anita will be home from the Dominican Republic, so I won’t be alone in the house. And I will be on a full dose of the two new-to-me medications.

I urgently need to find things to keep me busy once I’m home, as my Summer class on early Buddhist philosophy was cancelled, due to low enrollments and my troubling state of mental health. Suggestions for how I can spend my time are very welcome. So are invitations to visit!

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.