Sunday, December 9, 2007

Mood Watch - 43

Since my last “Mood Watch” I went through yet another depression. This one lasted about eight days. It’s hard to know exactly when these things begin, although they lift so abruptly that there’s usually no ambiguity about the terminus. As in most cases, it didn’t prevent me from doing everything I absolutely had to do, but it wiped me out in terms of getting anything else done.

I’ve been OK — in good spirits, actually — for about ten days now. But the depressive spells have been so frequent since mid-September that, although individually I can correlate them to a particular circumstance, in aggregate it now looks more like one long depression with brief reprieves, which certainly suggests a strong biochemical underpinning. However, that’s really just an educated guess. I suspect that would be the case even if a gaggle of psychiatrists observed me every minute. There’s just so much about mood disorders we still don’t know.

One thing we do know: you can’t “snap out of” or “power through” a depression. I don’t get that kind of thing as much as I used to — in fact, most of my close friends are very supportive — but occasionally it still happens. And when it does, for the most part it reflects not a concern for me but rather for the person offering the “advice.” They find it inconvenient to be around someone who is depressed, and the easiest solution is to talk and act as if it isn’t an illness but a character defect.

Ironically, the effect is generally the reverse of the one intended, since it simply increases the sense of shame and isolation felt by a person suffering from depression. Those who experience strong, consistent support generally recover more quickly.

Saturday, November 17, 2007

Mood Watch - 42

From October 31 through November 5 I was on the road again, this time for a brief research trip combined with attendance at the annual meeting of the Southern Historical Association, which has a deserved reputation as one of the more pleasant conferences in the historical profession. Unlike my previous trips, I had no responsibilities that put me in the public eye, I made sure to rest and relax more often, and I had a thoroughly good time. It was almost like a vacation. I returned to Columbus, still in good spirits, and had exactly three more good days. Then I fell into one of the blackest depressions I can recall.

This particular episode lasted about six days. As usual its onset and departure were abrupt. But it felt existential rather than biochemically based, and the very fact of its occurrence exploded the hypothesis that the connection between travel and follow-on depression was principally a function of adrenalin, stress and fatigue. In fact, it plainly points back to an earlier hypothesis, namely that the travels are good for me, and my return from them necessarily involves returning to an environment I do not like and which both my therapist and psychiatrist have warned me for years is a “toxic” environment that, in their view, is heavily complicit in the depressions. Which is to say it plays a significant role in both their frequency and severity.

This is actually good news, I suppose, because it gives me something external to address, instead of supposing that it’s all biochemical and therefore beyond my reach except through pharmacology. The trick, however, is going to be finding a constructive way to address the problem. But I’ll think of something.

To repeat a point made earlier, isn’t exactly easy to set down these thoughts in a forum that anyone with an Internet connection can read. I would imagine that while some people consider it courageous, others consider it self absorbed or even exhibitionist. I wish I didn’t care what people think, but I do. And so writing these entries is often a matter of just gritting my teeth and doing it. Still, emails like this one underscore the fact that I’m performing a needed service. I received it at the end of October, and am sharing it with the writer’s permission:

I just wanted to take a moment to respond to your most recent posts. I’ve been through two periods of depression / anxiety (about 3-6 days each) since moving out to ______, and I wanted to say that reading your post helped me to feel something — “better” or “more normal,” I guess, for lack of a different word at present.

While I obviously wouldn’t wish depression on you, I’m glad that you shared your thoughts. Additionally, I noted your post from 9/21 and frankly, I hope that you decide not to discontinue the blog. It seems like your decision towards openness, including the blog, has made a difference to a number of people (myself included), and I hope that it has brought you more peace and strength than you’re aware of.

Monday, October 29, 2007

Mood Watch - 41

Since my last post I’ve been through three periods of depression, each of about four to five days’ duration. They’ve followed the same pattern as most of my depressions. That is to say, my energy level will drop, usually for some plausible reason, so at first I just seem tired and in need of rest. I take some time to recharge my batteries, but they don’t recharge. Instead — and quite quickly — my mood drops into such a trough that I can hardly stand to do anything but sleep, and I sleep as much as I possibly can. At such times, not only do I have no interest in my regular work (or anything else), I feel a sense of foreboding about it. It makes me anxious even to check my email. When I go down to campus to teach a class or attend a meeting, I feel no sense of emotional connection. I can’t “read the room” to understand its tone — whether, for instance, I’m making any sense to my students beyond the mere fact that I can speak complete sentences. If I have to type something, I can hardly figure out how to organize my thoughts, and I notice I make a lot of typographical errors (I’m generally a pretty accurate typist).

All in all, the effects are about as debilitating as a bad case of the flu, except that the hallmark is a pervasive sense of misery and shame, as well as the fear that I will never return to normal. Cognitively I know that this is distorted thinking, but at a gut level this is simply hard to believe — it’s striking the extent to which one’s biochemistry informs our impressions of what really makes sense and what doesn’t.

Lastly, although I remember feeling OK, I literally cannot remember what that actually felt like. It seems amazing that I ever enjoyed life or could ever enjoy it again.

In formal diagnostic terms, one would have to exhibit these symptoms for fourteen days to qualify for a major depressive episode. Mine generally last three or four days; occasionally five, but that’s unusual. When I bounce back, it’s abrupt, just a matter of a few hours.

It’s always tempting and sometimes useful to look for correlations with external events which may act as catalysts or triggers. Over the past year a very strong correlation has emerged between business travel and depression. I return from a trip; a depression ensues. My therapist and I have theorized about the possible connection. A couple of explanations have seemed plausible and it’s possible it’s not an either/or question. But at the moment, the front runner is that these trips, in the nature of travel, are tiring and disruptive of my normal routine, and also usually involve giving a public presentation — often two or three in quick succession — so that I have to “gear up” to be animated, energetic, etc. Taken together, it’s no surprise that this would have an effect on my biochemistry.

Since I can’t avoid business travel — it’s pretty much a bedrock component of my professional activity — the issue now becomes whether to just accept the fact that depression will be the likely sequel or, more imaginatively, to find a way to manage the problem. One possible solution would be to make sure I get periods of regular rest during these trips and as far as possible adhere to a normal schedule.

I should have a fair degree of control over my time when attending, say, academic conferences. Invited lectures are a different matter. Having gone to the trouble of flying me in, putting me up in a hotel, and paying me an honorarium, my hosts generally try to get as much mileage out of me as they can. My most recent trip, for instance, involved:

a. dinner with students

b. a 90-minute workshop

c. breakfast with more students the next day

d. a meeting with yet more students at mid-morning

e. lunch with faculty and students

f. another meeting

g. a 90-minute public lecture, including Q&A

h. dinner with faculty

… to which I myself added item g(1): a few afternoon beers with some grad students.

It’s not a question here of being exploited. I liked everyone I met and had a very enjoyable time. Indeed, one could almost posit a connection based on the abrupt transition from a warm, validating atmosphere to, well, the regular workaday world. But if there is something to the thesis of these depressions emerging from my having to remain “on” for extended periods, notwithstanding the wear and tear of travel — then in the future I’m going to have to request what might be called “reasonable accommodation” for the disorder; i.e., a lighter schedule.

Friday, September 21, 2007

Mood Watch - 40

Plainly this blog interests me a lot less than it used to. I maintain my professional blog with a fair degree of regularity — in part because whenever I attend conferences, visit archives, etc., I invariably meet readers who appreciate the blog and tell me so. I feel therefore as if I’m performing a useful service.

With this blog, however, I feel very differently. I’m not sure I’m performing a useful service even to myself. True, on the positive side I have this year encountered at least ten individuals with bipolar disorder or similar conditions. It’s not that hard. A few have contacted me after reading the piece I did a year ago for Inside Higher Ed. But most contacts have occurred after I drop into a conversation the fact that I have bipolar disorder. The opportunity occurs more often than one would think. When I do so, invariably I am approached afterward, rather furtively, by some individual who also has bipolar disorder. Without exception they have kept the condition a closely guarded secret. They’re afraid. They worry what their families will think, their friends, employers, lovers. Often the conversations they strike up with me mark the first time they have spoken openly about the disorder. They are full of questions — what medications I take, what strategies I employ to lead a (more or less) “normal” life, etc.

But mostly they wonder how it is that I have the courage or foolhardiness to treat the condition as if it were an illness like any other. Don’t people look at me funny? Aren’t my colleagues skittish about dealing with me? Have they not written me off as anyone who could produce work of consequence? And in truth, I am morally convinced that some people regard me as the ghost of a once promising historian.

Too bad. I’m convinced that in being open about the disorder I have made the right decision. It enables me to draw upon the support of friends. It helps me to grow in a spiritual sense: I feel more at home with myself; and I can look at my increasingly middle-aged face in the mirror and believe that I possess at least a smidgin of courage and intgrity. But much more importantly, it gives me the chance to talk to people who are similarly circumstanced. Most of them have hidden their disorder to such a degree that, regardless of what statistics may say, they simply cannot believe that there are others like them — still less that this and similar disorders are as common as dirt.

Anyway, as to my mood itself: Overall it has been surprisingly good for the past several months. And I notice that the occasional bad spells correlate strongly to circumstances. Fortunately I’ve enjoyed considerable success in distancing myself psychologically from those circumstances. I’ve truly been amazed by what a difference that has made. In my opinion it has been a greater factor than any of the several medications in my arsenal.

Friday, August 3, 2007

Mood Watch - 39

Things have been good, generally speaking, since the last installment of “Mood Watch.” I’ve been productive around the house (especially yard work) and also in my writing. Last week, for instance, I completed an 11,000-word essay for a forthcoming edited volume. I was able to adhere to my writing schedule and on most days composed 1,500-2,000 words.

The one glitch occurred this past weekend, starting on Friday the 27th and extending through Tuesday of this week. When this stuff happens my first thought always runs to biochemistry, but I’m learning to look more closely at my circumstances and the way in which they may be influencing my mood. In this instance, I concluded it was the latter more than the former.

Thursday, July 12, 2007

Mood Watch - 38

Obviously I’ve blown off this blog for nearly three months. I’ve been busy with other things, but mostly I just haven’t felt inclined to write, although I’ve kept up reasonably well with my professional blog.

My mood during this period has, by and large, been quite good. Aside from minor bouts with insomnia or hypersomnia, I haven’t had any trouble. I attribute this to three things: First, I think the Lamictal I’ve been taking for several months is actually doing its job as an anti-depressant. Second, I have a friend who is enthusiastically helping me convert my jungle of a back yard into an orderly, appealing garden — being in pleasant surroundings has done me a lot of good. Third and most importantly, I’ve identified an area of my life that was sapping my energy, creating or exacerbating my depressions, and in general doing me no good at all. I feel no need to be specific, except to say that it has nothing to do with any particular individual. But both my therapist and psychiatrist have urged me to “disinvest” in that environment. I’ve done so and have been startled by how much better I feel.

Monday, April 16, 2007

Mood Watch - 37

Forgive me, Father, for I have sinned. It has been nineteen days since my last Mood Watch. Though actually, come to think of it, nineteen days isn't all that bad.

Hard on the heels of my last trip (to the Chicago area), I took another, this time to Vermont. I went there to be a presenter at a symposium, but I arrived on Friday, March 30, a couple of days before it began. Checked into a lovely bed and breakfast and spent most of the weekend with a friend of mine who showed me around the central part of the state.

Aside from four quick business trips to Boston, I'd never been to New England before, much less Vermont. Everyone I met apologized for the scenery -- it was "stick season": too late for the winter snow and too early for the green of spring and summer and the beauty of the turning leaves in autum. But I thought the state was just lovely: lots of rushing streams, quaint villages and small towns nestled between the shoulders of mountains. All in all, I had a lovely time.

The symposium was fun, too. It has that reputation -- the organizers brings in good speakers, install them at the Northfield Inn, and everyone gets pretty well acquainted, not just over the rich breakfasts but especially in the evenings, when everyone kicks back in the living room/dining room area, cracks open a beer (or six) and talks into the wee hours.

I boarded a flight home on Wednesday afternoon. It figured that after such an enjoyable six days I'd feel a bit of a letdown afterward, but I was surprised -- even shocked -- by how quickly the bottom dropped out of my mood. By the following day I felt so anxious and nearly faint that I had to cancel a class, something I hate to do. Things didn't improve for a full week. Then, as quickly as it hit, the depression lifted. To my mind, that's the very signature of a biochemically based depression.

Tuesday, March 27, 2007

Mood Watch - 36

From about March 12 through March 21, I hit kind of a bad patch, but of the sort that illustrates the subtleties of bipolar disorder. The symptoms aren’t always the classic ones. During that period I was “down” most of the time, but the two principal features were hypersomnia and what I’ve heard a psychiatrist characterize as a “reduction in mental coordination.” By that phrase, he meant a marked decrease in one’s ability to do sustained creative work (like research and writing).

But in other respects I was okay. For instance, I continued to enjoy activities that I would ordinarily find pleasant; e.g., watching movies, spending time with friends, and working at the animal shelter.

If I can point to anything tangible that pulled me out of it, it was a trip this past weekend to the Chicago area, where I was one of the presenters at a conference. I found the experience energizing. I’m not sure if it was the conference or the travel: I often find that my mood improves when I’m on the road. But in any event the transition comes at a good time, since Spring Quarter has begun and I’ve got a busy schedule ahead.

Saturday, March 3, 2007

Mood Watch - 35

A lot’s been going on of late, and most of it hasn’t been pleasant. But to the extent that I can detach circumstances from biochemistry, I think the biochemical aspect is still running smoothly. Most nights I get enough sleep (but not too much), my energy level is OK (but not too much), and if I feel miserable at times, it’s pretty much the way anyone in my position would feel miserable. The one nice thing in all this has been the way my friends have rallied around me. And anyway, it’s impossible to be miserable all the time. I still have a lot of good moments, too.

Friday, February 23, 2007

Mood Watch - 34

Still on an even keel. Tending to get up early and go to bed early, a routine I am coming increasingly to like.

I had an interesting experience last week with a woman who was a little freaked out to learn that I had bipolar disorder. The main reason was that she believed her father had had bipolar disorder, though he was never diagnosed, much less treated, and who created a very chaotic family environment. (Her assessment was retrospective and based on reading the DSM-IV criteria, which she said he fit in textbook fashion.)

At any rate, for a couple of days I engaged with her on the assumption that it might be a healing experience for her to be able to talk candidly and at length with someone who had bipolar disorder. She was still dubious about my claim to be able to manage the disorder effectively.

Then I discovered she’d been married three times, had once taken off on impulse with a man she described as a sociopath (and who bilked her out of thousands of dollars), and considered every relationship she’d had with a man to have been abusive. My therapist pointed out how chaotic was the life the woman had created for herself, and thought her skepticism about my ability to handle bipolar disorder was a classic case of projection.

And come to think of it, the people with the most confidence in my ability to handle the illness have been those with the highest degree of self-possession. It’s an interesting insight.

Saturday, February 17, 2007

Mood Watch - 33

I’ve let too much time go by between entries, but generally speaking my mood has been on an even keel from a biochemical standpoint. Any alterations have been pretty clearly due to circumstances or, in one case, a sudden opening of ancient wounds that have yet to heal.

Since my last entry I met with an undergraduate who’d experienced a depressive spell and just wanted to talk it over with someone who’d been there. (Of course, a lot of people have been there; most just refuse to acknowledge the fact.) Anyway, I wound up playing Polonius and offering a lot of advice about forestalling depressions when possible and rolling with the punches when one does occur. Recently got an appreciative email. The student has actually implemented most of my suggestions, and says that they have helped.

Sunday, January 21, 2007

Mood Watch - 32

Little or no change since the last Mood Watch post, except that I am back on a sleep schedule that runs from about 10-11 p.m. to 6-7 a.m.

Wednesday, January 10, 2007

Mood Watch - 31

Since my last Mood Watch post I’ve been feeling about as “normal” as I can imagine. Oddly enough, that’s been more or less despite new circumstances that might reasonably be expected to make me feel anxious or depressed. On the other hand, some of them have put me under increased pressure and even created a sort of crisis mode. I usually do well in such situations, probably because they characterized my early life. It’s when things are okay that I tend not to do as well.

I’m sleeping fine: getting roughly 6-7 hours per night. Although I’m generally a night owl, in recent days I’ve conked out around 7 p.m. and got up around 2 a.m. It’s actually almost an optimum schedule because I get a lot accomplished between 2 a.m. and 7 a.m.

I still get emails from people in trouble, most recently from a grad student who struggled last quarter with bipolar disorder and another individual who has recently been diagnosed with the disorder and feels a little freaked out by it. I get a lot of satisfaction out of being able to help.

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