Saturday, December 30, 2017

Not Crazy

I work in a coffee shop in downtown Santa Cruz. We have many customers and passersby who are not well. My coworkers call these people “crazy.” And other things I won’t repeat. And it is painful.

THEY ARE NOT CRAZY.

They are not well. They have had rough lives. They have done too many drugs. They have mental illnesses. They’re actually really nice people if you can get past the paranoia and fuck-off front they put up.  I know. I did it today.

Her name was Laura. She came in with a formerly homeless man who bought her a cup of coffee. She was needy and loud. She asked for the bathroom code and I gave it to her. (My coworkers would not have done so.) Ten minutes later, she was still in there. I knocked and she yelled at me angrily. When she came out she approached the first person she saw, assuming they had knocked, and got in their face about it. They brushed it off, thankfully. I got her attention and told her that her coffee was ready and gave her ice water. She proceeded to ask for a cup of ice. She migrated outside, and then back in.

Several hours later, she was asking for the bathroom code again and my coworker was not giving it to her. He directed her to the register, where she bought another cup of coffee and got the code. About thirty minutes later, she was talking loudly to no one in particular, and a customer approached me asking that she be kicked out. Reluctantly, I found my supervisor and passed on the message. She employed another coworker to ask her to leave, who was, frustratingly, gleeful about his mission.

When I left work today, she was still wandering around the building. I smiled at her and said, “have a nice day,” and she smiled back and said, “you too.”

That is not crazy. I am kicking myself for not approaching her myself and seeing if I could quiet her down before it escalated to her being asked to leave. She wasn’t dangerous.


It frustrates me that our businesses cater to the well-minded. That an apparent mental illness makes one ill-suited  for quality customer service. No. We’re not social workers. I know that. But we’re humans. We all have our demons. Can’t we give each other a little grace?

Thursday, December 21, 2017

A "Therapist's" Prayer

I gave a presentation, or rather, facilitated a prayer, for one of my classes this last semester. Yes, I, Annie Williams, lead prayer. She who rarely prays (for myriad reasons), wrote out a “scripture prayer.” That is, I chose scripture, related it to our work as therapists, and wrote a prayer around it. I chose Psalm 13:

How long, O Lord? Will you forget me forever?
            How long will you hid your face from me?
How long must I wrestle with my thoughts
            and every day have sorrow in my heart?
            How long will my enemy triumph over me?
Look on me and answer, O Lord my God.
            Give light to my eyes, or I will sleep in death;
My enemy will say, “I have overcome him,”
            and my foes will rejoice when I fall.
But I trust in your unfailing love;
            my heart rejoices in your salvation.
I will sing to the Lord,
            for he has been good to me.

Then I explained myself: this is the natural progression of life. We suffer, we wonder where God is, we grow weary, etc. etc. BUT. There is a but. At some point, we are able to say verses 5-6 in earnest. It isn’t linear. Some people live 5-6 without experiencing 1-4 in depth. Some people circle 1-4 for decades.

So I wrote this prayer:

Dear Lord,
            We pray for our future clients and for ourselves. We pray this psalm for them and for us. We hold on to hope that in your goodness we will be able to proclaim verses 5-6 in earnest, and that our clients will be able to also.
            Help us be witnesses to that reality: that you have been good to us, that you are good to us, and that you will continue to be good to us, and that there is hope even when we have every day sorrow in our hearts.
            Help us be patient with you, our clients, ourselves, and with illness.
            Help us remember that it is all in your timing and your plan, not ours. We are nothing without you.
            We thank you for the opportunity to walk the various roads we will travel with others.
In your name we pray,
Amen


And that’s about as close as I get to proclaiming 5-6 myself.

Sunday, December 17, 2017

Multiple Personalities of Bipolar II

I feel like there are multiple me’s. A depressed me. A hypomanic me. An euthymic me. A mixed state me. An anxious me. An agitated me. A suicidal me. I behave badly in most of these states. The euthymic me is the safest. It’s where I am now. But it is constantly threatened by the possible presence of the other me’s. Well. No. Now I am anxious me and the energetic me. I am paranoid that January will lead down the yellow brick road to hospitalization.

It’s quite simple: I get more energy, I work and go to school, I work opening shifts (and school is like a closing shift), I feel powerful and alive, and then, suddenly, something shifts. The energy becomes agitation seemingly overnight. My skin is in the way. I can’t get far enough away from myself. I work harder. And somewhere along the way, dragging a razor across my skin seems like the proper solution for crawling skin. It creates a burst of relief (and a pang of guilt).

Soon no matter how hard I work, the agitation prevails, and then my energy begins to peter. Soon, I just feel like shit. Soon, the energy not only peters down to “normal,” it dips to a depressed level. I become sluggish and unmotivated and utterly unhappy. Not that I need to be happy, per se, but this is a far cry from even reasonably content. Quicker than you can say antidepressant, I am a danger to myself and all I can think about is a way out.


That’s how I wind up in the hospital. I go through all those versions of me, starting with an energetic me and ending with a suicidal me. I morph from one to the next seemingly overnight. There never seems to be time to seek medical intervention. It’s fast; it’s scary; it’s bipolar II.

Friday, December 15, 2017

Proceed with Caution

I’ve written on it before, hypomania. But I can’t ever seem to nail it down. It’s just so different each time. What I’m realizing now though, is that, as written in a study on Interpersonal Social Rhythm Therapy (IPSRT) and bipolar II, bipolar is as much a disorder of energy as it is a disorder of moods. Granted, I could be noticing an increase in energy because I just finished off three antibiotics. Perhaps. But I doubt it.

This week, I have gone on three bike rides and walked the dog three times a day, with at least one walk lasting over an hour, sometimes two. I have . . . ENERGY!! It’s fabulous. I hadn’t ridden in months. The dog is getting her exercise. I’m socializing. I’m reading. I can focus.

None of these are bad things. None of these are dangerous or reckless. They’re antennas-up signs, though. At times like this I ask myself, am I sleeping? Yes. Phew. One danger averted. Am I being loose with my money? Nope. Two dangers averted. Am I agitated? Nah. Three dangers averted. So far, this is a safe energy.

My therapist said the hope is, someday, that’s what this will be for me: “oh, I have more energy, how nice,” or “oh, bummer, less energy,” instead of it being an anxiety inducing phenomenon. The hope is someday more energy doesn’t mean a full blown episode is pending, but rather, it means I clean the house or do something productive.


For now, though, I’ll be cautious. More energy? Nice, yes, but, proceed with caution.

Saturday, November 4, 2017

A Note to Myself

Between July 2016 and June 2017 I was hospitalized four times. We’ve been over this. The anxiety was crushing, the depression debilitating, and the agitation dangerous. Two of the hospitalizations failed to thoroughly treat the symptoms, so I returned shortly after discharge. In retrospect, I can see warning signs that built over time and contributed to the necessity of the hospitalizations.
Before the first stay, I was clearly hypomanic and agitated. I took on too many projects and failed to recognize my hypomania for what it was: I thought it was anxiety. My second stay and first stay were only separated by ten days. But there had been too many med changes to keep track of in that first hospitalization, so when I began to crash and the agitation returned with vengeance, we had no idea what was working and what wasn't working.
I stayed remarkably healthy for the eight months following my second stay. I had one mild hypomanic episode and some mild depression that was curtailed by a medication increase. But then school ended. And I began to work four days a week, closing once or twice. Educational tidbit: social rhythms are incredibly important for those with bipolar. That means shift work is not ideal. That means Annie feeling more energetic April 2017 and having more time on her hands and taking on closing shifts is asking for trouble, because that means getting off work at 11pm or 12am one to two nights a week. And then the energy leaves and the agitation remains and the soul sucking depression takes over. And then what? What could I have done to stop it? Nothing. It moved so quickly. There wasn’t time to call the psychiatrist and for the psychiatrist to send in new prescriptions and the pharmacy to fill them and me to take them and changes to be effected.
And similarly, after my third hospitalization, I was only out two days before the depression came back strong enough to steal my words. I sat mute in therapy and in the psychiatrist’s office. Maybe if I had the words, I would have said, “help.” And maybe we could’ve made some changes to reverse the depression, but I couldn’t speak. And before I knew it I was back in the hospital.

So what have we learned? Honor your social rhythms (don’t close at work). Watch out for energy: don’t feed it; try to ride it out with grace and gratitude. Beware of the agitated depression. Speak. Or write. Well, try to, anyway.

Friday, October 27, 2017

More from Anxiety

            Anxiety speaks. Quietly. Loudly. Quickly. It says, “ you will get sick again.” It says, “December will be dangerous, but April will be near if not fatal.” And there’s nothing you can do about it. Yet it insists that I worry. Because perhaps if I am prepared—if I worry enough—I won’t be hit as hard when the mood changes. Maybe, if I’m on the outlook—if I’m paranoid—I’ll note the subtle changes and seek help early enough to stay out of the hospital.
            And then anxiety laughs. You can’t be prepared. “It’ll come faster than the speed of light and cut you down,” it says. When depression comes you loose control—you know that. Your “supranormal” lifestyle becomes depression led and directed. All you know is sleep and solitude and suicidality.

            “It’s bound to happen,” says anxiety. Bipolar ebbs and flows and turns your world upside down; it isn’t cured. “It’s coming,” anxiety says, “just wait.”

Thursday, October 26, 2017

Bipolar's (and Anxiety's) Response to My Request

I wrote my bipolar a letter. I begged it to let me be. It seems to be listening. It’s been four months since the last hospitalization. It feels longer. It’s been three months since drug-induced hypomania. It’s only been two months without cutting. It feels much, much longer. And I am thankful.
            But I am also fearful. So long as I’m busy, I’m safer. And, as shown in a research article I recently read, I am also safer if I live a “supranormal” life: go to bed at the same time every night, wake up at the same time every morning, keep a routine schedule of work and play and healthy interpersonal relationships. I know this. But I can’t do it.
            Life is unpredictable. Well. Rather, even when life is predictable, big changes and all, my biological reaction to each change is a crap shoot. I can know a change is coming, but I can’t know if a depressive episode will come crawling out of, say, school ending.

            I have plans. I hope to start practicum next fall. I’m en route to being eligible for it. But there is a sneaking suspicion that I will be blind-sided by an episode the moment I get too comfortable and hope a little too fervently.