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 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!