How long do you go between sessions?

When I first exited the hospital in 2008 after starting on clozapine, I was seeing my therapist once to twice per week. Eventually this developed into a meeting every two weeks and then every month. Now I am on a frequency of every 6 to 8 weeks for seeing my therapist. During this time post 2008 I saw my psyche doctor every month or every two months. Now I see him every 3 months for meds management.

It is important to note that these elongated timeframes happened for me after years of work with my therapist and with my meds. It feels good to move to longer timeframes between visits, but it is true that pre-2008 I used to “play mind games” with myself regarding my psyche visits. I would deliberately schedule doctor’s visits every three months out to tell myself I was doing “fine” when in retrospect this should have been monthly. I was not doing fine and I was on a drug that wasn’t working. In part, this was because I was not maintaining the proper dosage of the meds.

I feel like today I am honest with my therapist and my psyche doc about how frequently I need appointments. I used to have to have a therapy appointment lined up for the next time when I completed a session so as to be able to “see” what was upcoming on the horizon. Now I basically see how I am progressing and schedule a session every 6 to 8 weeks or so as needed.

Any thoughts on your session frequency with the therapist or the MD?

Do you experience inertia surrounding your to-do list for the day?

There are days when I feel like getting things done and there are days when I don’t really feel up to doing much. This post is about the days when I don’t feel like doing much of anything.

I am a planner so I always have a list of things to get done each day more or less. Some days are busier than others. Some days are more motivated than others. This post is about the days that I don’t feel particularly motivated and/or may also feel that I am just not up to the task of going to the grocery or fixing a home-cooked meal that day.

So I am assuming we all know what inertia looks like on those days when the to-do list is not a source of help for organizing the day. Inertia looks like: I don’t feel like doing anything other than the most rudimentary things like caring for the dog or taking a bath or shower and maybe not even these items. Additional items on the to-do list are just more a source of stress than anything else. It is as if there is a pile-up accident on the highway up ahead and I am just caught in a huge traffic snarl and cannot get through the pile-up of vehicles (to-do items) up ahead on the highway. In other words, I just don’t feel like getting things done.

So what is it that can help with all this inertia and being caught in a multi-car pile-up (metaphorically speaking)? I have found that there is not a cure for this inertia. It rears its ugly head from time to time and does not truly disappear. I am certain it is a by-product of depression associated with my bipolar condition. But there are some ways of managing this inertia or countering it.

I find that if I can muster the energy to do just one small thing on my to-do list for the day like the simple act of emptying the dishwasher, I am all of a sudden ready to tackle another thing that is important but may or may not be on my to-do list for that day. And the trend continues to a third or maybe even fourth item on the list (or off). The key appears to be true to the idea of inertia. If I set my body in motion (by acting on the dishwasher) I have a tendency to keep moving forward (by either doing another item on my to-do list or some other task that may be equally important).

This also means being flexible with the items on my to-do list. I may be motivated to do items not on that list and need to be aware that doing these items is progress even if those items are not on the original list for the day.

Inertia exists in both directions. A body will stay at rest if it is put to rest. A body will be set in motion if there is movement. This idea of setting a body in motion really helps me get over the hump in my day and move onto the next item on my to-do list. It is a matter of changing the force of inertia for the day from a resting place to a movement place.

For example, I did not feel like doing much today and did not feel like going to the grocery store at all. I was able to get the dishwasher unloaded and felt afterward good about writing this blogpost and did. In the meantime my husband went for a short grocery run and I was somehow able to plan and prep for a nice home-cooked meal of marinated salmon steaks, couscous and cabbage. My day went from standstill to pretty busy and fairly fulfilling.

Does this inertia metaphor ring true for anyone else? What helps you to pick up your to-do items when you are not motivated to do so?

Anxiety and High Blood Pressure

Does anyone with anxiety also experience high blood pressure? When I was pregnant in 2003 I had pre-eclampsia which is high blood pressure associated with being pregnant. After my daughter’s birth, I continued to have high blood pressure. It has been 18 years since and I am still on high blood pressure medicine along with my psyche meds. I recently have had to go up on that blood pressure medicine – metoprolol.

I am wondering out loud if other people who have chronic anxiety as I do associated with bipolar illness also have need of high blood pressure medicine. It makes sense to me that the anxiety could either cause high blood pressure and/or exist correlatively (not causally) with it.

Are there other folks out there who experience anxiety and high blood pressure simultaneously? Do you consider this causal or correlative?

Graphic Visualization of Moods: Does It Help?

It is helpful to me to have a graph of my moods for the day and for long-term.

For bipolar illness it is pretty common to visualize two parallel lines with moods going up and down between those parallel lines. So a person with no bipolar disorder has the same set of parallel lines but the lines are only say 6 points apart – 3 up from zero and 3 down from zero. If 6 units wide is a “normal” mood range, a person with bipolar illness might experience a range twice that wide at 12 units – this is 6 units up from zero and 6 units down from zero. As I have said before, this image of more accentuated mood swings is a pretty standard way of talking about the highs and lows of bipolar illness. Also it has been said that bipolar illness mood swings are similar to normal mood swings – it is only a matter of degree. I might contest that assertion in that bipolar mood swings may be accompanied by anxiety and/or psychotic experience.

So if bipolar mood swings are say twice as high and twice as low as regular normal mood experience, what does the graph look like on any given day? For me there is a pattern to most days that is helpful for me to visualize. Generally, the first moment I wake up is the most anxious. I would start this day’s curve on the high end. As I take my morning meds and wake up to face the day, my mood starts to level out. Late morning and early afternoon are when my day starts to become more productive and with that my anxiety tends to get more under control. Dinner is often a chore to get together but typically this is something I enjoy, so the anxiety seems to be at a low point at dinnertime. After dinnertime is usually my time to watch the news and part of a movie or a TV series. This time is spent with my husband and is generally very relaxing – my anxiety is at a low point in the day. Around 8:45 to 9:15 on a weeknight I go to bed early. On a weekend it may be a couple of hours later. It should be mentioned that this pattern is generally the same whether or not it is a weekday or a weekend.

So for a visualization, my anxiety starts at a peak in the morning when I awake and typically falls as the day progresses. Depending on the day there may be small dips here and there as the anxiety dissipates or spikes here and there as the anxiety surges. By and large this curve maps the moods of my day. If I am able to get something done on my todo list in the mid day to afternoon timeframe, my anxiety abates pretty regularly. It is as if I have to get past a small spike in anxiety in order for that anxiety to continue to drop as the afternoon and the day progresses.

This post would be that much better if I could provide readers with a picture of what I am talking about — so sorry that my blogging abilities do not incorporate importing a picture of parallel mood lines on the one hand and an anxiety curve dissipating generally as the day progresses on the other hand.

Does this graphic description seem relevant for others with bipolar and/or anxiety disorders? What is the same and what is different about your mood curves?

What Does It Look Like to Be in Mental Illness Maintenance Mode?

This is just a bit of musing on being in maintenance mode with bipolar illness. At times, I have called this maintenance mode being in mental illness remission. Due to the specifics about what is illness remission and what it is not, I am choosing today to talk about where I am in my history with bipolar illness as “maintenance.”

What does bipolar maintenance look like for me?

  1. Being on a largely functional cocktail of meds that are monitored by a psyche professional. I adjust these meds slightly with the help of my doctor when I am going through extra stress or when stress is more manageable. I have been on the same basic meds since about 2008.
  2. Seeing that psycho-pharmacologist about every three months with monthly trips to the lab for bloodwork. It is important to me to be honest with my doctor and to have the type of relationship where I can work with him to adjust med levels when needed.
  3. Seeing the therapist about every 2 to 8 weeks. Every two weeks is if I am in a rough patch. Every 8 weeks if all is progressing well. Back in 2008, this was weekly. Mostly now it’s every 4 to 8 weeks.
  4. Not having to be admitted to the hospital for 2 plus years. For me this has been since fall 2008. I have been informed that not being hospitalized for a period of time, in and of itself, does not qualify as remission. But the stats seem important to me to include as at least one barometer of remission and/or maintenance.
  5. Having several activities like blogging, care of pets, walking or yoga routines that are by and large fulfilling if not enjoyable. I find that with the anxiety and depression that I experience with bipolar illness, my activities are sometimes fulfilling and sometimes not. Getting them done is what I count most. There is “enjoyment” or “satisfaction” in getting them done even if at the time, the activities themselves are not particularly “joyous.”
  6. Being able to manage day to day activities in the household. These for me include being supportive to my teen-age daughter, keeping my relationship with my husband current and vibrant, running the household, going to the grocery on a regular basis, getting a healthy dinner on the table each night, doing basic laundry and clean-up, caring for a new puppy. This does not require me to hold down a job which has been a struggle for me since 2005 or so or perhaps earlier.
  7. Seeking out regular contact with friends and contacts who are supportive of bipolar illness. I have had a neighbor who is close to me move about an hour away from where I live, so I could make some improvements in this area. We used to talk openly about stress and anxiety on regular walks. It would be great to resume this activity virtually if possible. Blogging also does help create a sense of community support. I have been blogging regularly for a couple of years and this is very fulfilling — both the reading and the writing of various posts.
  8. Doing something tangible to reduce stigma about mental illness. Instead of being the victim of mental illness stigma, I have found it empowering to write about stigma in my journaling and in my blogging. It is important to get out in front of the stigma and try to tackle it and talk about it before it becomes a big deal with big deal consequences. I have found it difficult to address stigma, but I also have found that talking about it and educating people who have no prior exposure to mental illness is important. I have just written a series of blogs about mental illness stigma and working as a project manager. Hopefully that perspective when shared may mean people who have no prior connection with mental illness can at least read about what it’s like to experience that stigma.
  9. Talking and educating people who have no connection to mental illness seems to be at the top of the list for me for stigma reduction. Stigma reduction does not happen immediately or overnight, more like a small, small drip into a large, large pond. Very small change but change nonetheless. Also to note, there is real danger of preaching to the choir about mental illness stigma. Most people who might follow my blog probably already think stigma is an issue. In stigma reduction, it is important to find ways of reaching people who are not yet educated on mental illness and its challenges.
  10. Finally, being in maintenance mode for me means being able to be kind to myself. This means forgiving myself for mistakes no matter how large or small. This means giving myself credit for accomplishments achieved no matter how small they may seem – like going grocery shopping for healthy food that day. This also means not comparing myself to others in a way that makes me feel “less than” or “more than.” Maintenance mode means being willing to accept constructive criticism from my support team even when that criticism is difficult to hear. It also means standing up for myself when the criticism may not be “spot on.”

Does anyone else care to share what mental illness maintenance might look like to them?

Working with Bipolar Illness – Lessons Learned

All in all, my work experience has taught me several things about working with bipolar illness.  In no particular order they are here:

  1. Working in the public sector may be more forgiving than working in the private sector when it comes to stigma and access to short and long-term disability (in the US).
  2. People who have a family member with mental illness are 100% more likely to accept mental illness in an employee and be willing to work with that person toward mitigation strategies to help reduce stress and stigma in the workplace and help alleviate mental illness. 
  3. Most people in the workplace do not have a family member with mental illness and in general do not have a clue how to respond or how to be of help.  Generally these people consider you a danger to yourself and others.
  4. Keeping a presence in the workplace is very important if you are taking care of your own health insurance.  If you are blessed to be on a family member’s insurance plan and/or your home country has universal healthcare, be thankful.
  5. Meds are sometimes difficult – finding the right one or the right combination of drugs.  It is helpful if you feel you can work with a psyche doc about finding the right combination for you.  It is preferred if you can have a partnership and a doctor who listens to you as to what is working and what is not.  This can be a struggle particularly if you are going to work every day.
  6. I believe that mental illness like addiction has a bottom out effect.  You will not start thriving and responding to meds and other interventions until you have hit rock bottom.  This involves a sense of honesty about your symptoms and your challenges for yourself, your family, your support community and your medical team.   It also involves honesty with self about what kind of jobs you are best suited for.  For me project management work was not the best fit, but it took me a while to figure that out.
  7. Working for yourself, if you can afford it, allows you to explore your strengths without over-taxing your brain or your illness.  You can set your own schedule and allow yourself breaks for med checks, labs, psyche appointments and so forth.
  8. Blogging is a good way to keep honest within yourself and with other people in your blogging community.  You can learn a lot from telling your story and listening to other people’s stories as well.
  9. All in all, remember that you are more than your accomplishments.  If you spend most of your time on self-care rather than in a career, you are still doing a great job and you still have a huge contribution to make.  Being paid for what you do is not the tell-tale sign of success.  Define success based on your own goals that you reach and setbacks that you overcome. 
  10. Finally, don’t compare yourself to others especially those who don’t have a mental illness challenge or have very mild symptoms.  Judge your progress in the workplace and in your educational endeavors based on your own realistic goals.  Don’t be hard on yourself if it takes you longer than your peers or your siblings to reach your goals.  Or if you don’t reach them at all.  There are likely other strengths that you have that these people don’t have.

Does anyone care to add to the list of lessons they have learned about the workplace and mental illness? I am sure I have missed a bunch….

Worklife after Postpartum Depression

There are several stories to share about working as a project manager after the postpartum depression associated with the birth of my daughter.  Most are rather distressing to me as I was unable to hold down a job for any real length of time. 

 This includes work at:

               – a local planning and environmental company in 2004/2005

               – a major telecommunications company in 2007/2008

               – a non-profit environmental organization in 2010 and 2011

               – a health services company in 2013

               – a nonprofit management services company in 2014.    

Work at the local planning firm built upon prior work I did in the community for naturalizing the stream near my home. I served to facilitate the steering committee that was all-volunteer and dedicated to this stream restoration project.  My health at this time was still impacted by the postpartum depression.  The job was cut short when the principal developed lung cancer and retired and shortly after passed away. Generally speaking, working in the environmental sector proved less stressful than in telecommunications information technology.

A year or two after completing the job at the environmental planner and program manager job, I decided to go back into project management work at the telecommunications company.  This was a mistake.  The job was highly stressful.  At one point I was asked to work over a 70-hour workweek.  This was the death knell for my health.  Shortly after being up all night with a computer software launch, I began having break-through bipolar symptoms.  Within a day, this was full blown mania.  I wrote an incoherent email and forwarded it up the chain of command.  I was a contractor at the time.  My contract was immediately terminated and I was escorted from the building.  I was not even given the opportunity to retrieve my belongings.  The representative from the contracting agency retrieved my personal belongings and brought them to my house a few days later.  The treatment I received there made me feel like I was a criminal and/or dangerous to my colleagues.  There was absolutely no understanding of mental illness and/or bipolar symptoms.

Later that year, I was hospitalized for an extended period of time and started on a new regime of meds called Clozaril or Clozapine.  It was discussed at that hospitalization that I would perhaps not be able to work again.  After an extended stay in the hospital, I began weekly therapy visits and participated in CBT and other talk-therapy protocols.  My daughter by this time was almost five years old.

After a two-year stint away from the workplace, I landed a part-time job with a local environmental non-profit. I started working there 20 hours a week and eventually was promoted to 30 hours a week.  At this juncture, I was completely upfront with my boss about having bipolar illness.  My boss was more understanding than most people.  It appeared she was somewhat familiar with the illness.  During this time I made many contributions as project manager to this environmental start-up.  In addition to making strides on various environmental projects, I helped with the sale of one program to a national management non-profit organization.  I continued to work here for about two years but found that interpersonal relations with my boss were such that I wished to leave this place of work.  And I did.

From here the story tends to repeat itself.  I was hired in 2013 to do software development project management work. This contract lasted two months or less.  In 2014, I was hired to do project management in the certifications and educational departments for two non-profit agencies at a non-profit management company.  This job lasted about 6 months.

All in all, I found that project management work was too stressful for me.  I was not able to divide my time between two major projects I was asked to work on simultaneously.  I would tend to work on one major project and let the other slip.  Once in 2013 and then again in 2014, I resigned from each position in the project management information technology space within the period of several months.  Basically since I started on Clozaril or Clozapine in 2008, I have not been able to stay at a job for longer than two years.  And that was part-time work.

From here picking myself up in 2017, I resumed my work as a volunteer in the town where I live.  I was appointed to the local environmental sustainability board in the spring of 2017 and served on that board, chairing one committee for a time, until the end of 2020.

All in all, my work history after the extended postpartum period in 2004 has been very inconsistent.  I have had to re-orient myself as to what is productive behavior and what is not.  I have been very accomplished at volunteering locally and at researching and writing papers that were or have been presented in national and/or international settings.  But this work has not been “paid.”  I have had to re-direct feelings of being “less than” because I have been unable to keep a paying job. 

All in all, I feel like a major component of my checkered job history is due to the fact that bipolar illness carries such a stigma with it.  I either have been asked to leave employment because of it or I have left employment early because I was unable to manage bipolar symptoms and worklife at the same time.  If there had been some sort of support for mental illness like referring me to a less stressful job, perhaps I could have made a go of it.  As it stands now, I have basically given up working at a for-pay job.  I spend my time focused on managing homelife and illness and doing volunteer work including my blogging.  I also am striving to see if I can get published with my story of bipolar illness.  So far the only publishing options available to me are self-publishing. 

Working as a PM During the Birth of My Daughter

I was working as a project manager for a major telecommunications firm during the time I was pregnant with my daughter and during the time of her birth.  After my daughter’s birth, I took time off as I was experiencing debilitating postpartum depression.

Oddly enough, I did not experience any pushback in the workplace associated with seeing the OBGyn every month when I was pregnant.  There was no stigma to deal with – everybody can relate to being pregnant, right?  So taking a few hours off once a month to go to the doctor was no big deal.  In fact, I had support from my project management peers as well as from my program manager.

However, after the birth of my daughter, I experienced crippling postpartum depression.  This was not so readily accepted by my management at the telecomm agency.  There seemed to be suspicion as to whether I was ill or not and what kind of work I was capable of doing.  During this time I took short-term disability to deal with the postpartum depression.  I did not believe at the time that the project management work I had been doing in the telecomm space made sense for me going forward.  It was just too stressful.  As it happened during the time I was on short-term disability leave, the principal of a local environmental and planning agency approached me to offer me a job in environmental project/program management.  I thought at that time that work in the environmental sector would be less stressful than work in telecommunications project management. 

So I accepted the environmental job while I was out on disability and began that work when my daughter was not quite a year old. That job was very rewarding in some respects. In some respects the postpartum depression was still an issue.  What came to pass is that my boss developed lung cancer and within a year or so had retired and shortly after had passed.  There was very little room for exploring this employment opportunity long-term.  So once again I was preparing for a sea change in my career. 

Working for Myself as a Project Manager / Circumnavigating Stigma but Forfeiting Income

For two distinct periods in my career which includes the present day, I became a self-employed project manager so as to be able to manage both work and illness (bipolar illness).  During these times, I dedicated / have dedicated myself mostly to environmentally based volunteer work in my community.  In later years this often has translated to work in new measures for the environment and new measures in health.  Work also includes a period of service on the mayor’s environmental board in the town where I live.  In earlier years, I submitted grants for environmental development on behalf of my community.  In later years, I began to write papers that were accepted for presentation at the US government and at academic institutions in the US and abroad, including two acceptances from overseas groups.  This work includes being published by one overseas organization dedicated to sustainable development.

During both of these periods, I was able to put my health first and manage whatever bipolar symptoms or needs presented such as therapy appointments, psyche doctor appointments, meds management, or lab tests.  I also did not experience stigma in the workplace as I was working for myself. The first period was 1998 to 2001 and the second period was 2005 to the present with 5 plus jobs in the marketplace scattered among the second volunteer period and duration.  (I will recount the stories of these jobs at a later date.)  The downside of these two periods is that I was not able to make any income associated with these many accomplishments.  Work was volunteer in the community or involved publishing/posting papers that I developed on my own time. 

During this first juncture as a volunteer in my neighborhood, I was able to make important contributions to my community.  One effort resulted in a near million-dollar creek clean-up and naturalization effort about ten minutes from my house.  Another effort resulted in a survey-based community development plan for an in-town neighborhood including such priorities as walkability and economic development. I also developed three community-based sustainability grant applications to the United States Department of Agriculture recommending an environmental approach for managing agricultural waste and converting it into biofuels. 

During my later juncture of self-employment as a member of a city sustainability board, I worked on a variety of environmental agendae items including climate change.  I chaired one of the four subcommittees for a time.  This subcommittee worked on recommendations for the local tree ordinance, storm water management, and reforestation and trails development at a near-by park that was newly acquired by the city. 

Papers that I wrote and presented during the second timeframe focused on systems-based orientations to and measurements of environmental development.  The idea of much of the work at this time was that proposed adoption of systems-based measures in the Health, Energy and Food industries would correlate with simultaneous advances in all three industries.  Aligning measures for Health, Energy and Food advances means we can promote Energy work that allows for climate change concerns and we can promote Health work that allows for citizen well-being in the face of extreme weather events and the like.  This work and related work was presented and/or posted at a US government website in 2009, presented at a well-known public health university in the US in 2011, presented at a US academic non-profit geared to values in higher education (several submissions/presentations from 2010 forward), and submitted/presented/posted at two overseas non-profits dedicated to health economics and/or sustainability. 

Overall, my accomplishments during these two periods of self-employment are/were notable.  I am proud of these accomplishments, but I would not have been able to pursue this work if it had not been for support both financial and otherwise from my husband and my husband’s family.  Basically all this work in environmental development and new measures for the economy in terms of health economics and the like was financed by my family at that time.  This self-financing continues today with my blog writing and other work with which I am involved.

My First Job out of Graduate School – Compartmentalization

My first job out of graduate school was as a Business Analyst in the IT department of a local engineering and environmental management firm.  This position built upon my role in information management at the state cultural organization where I worked before graduate school.  Shortly after joining this firm as a Business Analyst I was promoted to a financial application services manager position and worked in that capacity for a couple of years.  The position used and developed project management skills but was more process oriented than project outcome focused. 

During this time I completely compartmentalized my bipolar illness.  I went to Psyche appointments on my lunch hour.  I went for lab work on Saturdays.  Basically, I provided no insight to my employer or my boss that I was managing bipolar symptoms.

Ironically, this seemed to work well for my career.  I was managing four programmer analysts and helping to manage and develop software systems.  It seemed to help that I was managing a team who had more technical know-how than myself.  So, I was just facilitating progress; I was not driving progress.  It also really helped that my boss trusted me implicitly to manage the software program assigned to me and was always available if I had an issue that needed to be escalated to her level or above.  It meant a lot to me and to my ability to function that this escalation window was always accessible to me. 

Within a relatively short period of time, I went from being at a reasonable paygrade to being at a somewhat high paygrade for the time.  There was definitely stress on the job but what seemed to make a big difference was that the team of four programmer analysts were first in line when there was a triage situation.  This occurred a lot since the application we were using was still in a beta test mode for all intents and purposes.  But when there was an emergency as there was about once a month or so, my programmer analyst team was first in line to answer the “distress page.”  (This was still the time of pagers and not smart phones.)  My role was more to manage the process when there was a software outage rather than come up with the solution myself.  I depended on the programmer analysts for that.

So my problem with having reduced sleep at night was not really a problem in this job due to the pager protocol and my team being first in line rather than me being first in line when there was an outage or some other problem with the software.  This idea of missing a night’s sleep to nurse the computer system back to health did not really start until I began work a few years later as a project manager for a large telecommunications agency. 

Looking back on it now, I did not necessarily have less stress at this financial software job, it was just that I did not have stress that was a trigger for the bipolar symptoms – mainly lack of sleep for one or more nights.  In addition, it meant a lot that I functioned more as a process manager than a formal project or program manager.  It was my job to ensure problems were resolved but not directly to resolve them.  As a certified project manager some years later, the job was to solve the problem directly with the team.  This may seem like there is not much difference between these two scenarios, but the bottom line is that it is different to be responsible for process rather than outcomes.  In the financial services job, I was focused on process.  Later in more formal project management jobs I was focused on outcomes or results.  Also, again, it really helped me to perform in this job knowing that there was a clear escalation process when issues arose that I was not qualified to address. 

In terms of mental health stigma at this job, there was really no disclosure of my bipolar illness so there was no “real stigma” to address unless of course you count the fact that I felt compelled not to share my diagnosis with anyone at work.  I had circumnavigated the stigma situation, but this was only for a few years of my career.  I often wonder if compartmentalizing my illness during this job should have served as an example to me in later project management jobs.  I believe I continued to try in later years in project management positions to continue with the compartmentalization, but as the stress of the work positions grew so did my inability to control my bipolar symptoms on the job and off.  The increase in stress of the job was coupled by the fact that the stress I was now experiencing was directly triggering my bipolar symptoms – largely the sleep deficit trigger. The compartmentalization was something like having a pressure cooker going all the time.  The pressure was there even if I was not acknowledging it.   At some point in each project management job I took, the top was bound to blow off.