My new skill

If anyone read my posts last May or whenever I began writing for Depressed Academics, you would know I was having a really hard time emotionally. Here I am a year later and I have to congratulate myself on something in particular: my new skill of sitting with uncomfortable feelings without being destructive or resorting to some form of escapism.

Truth be told, I am having a pretty hard day today. I've been experiencing mixed states-- a combination of an elevated/anxious mood and symptoms of depression: crying, isolation, etc. Mixed states are probably my least favorite mood state(s) because they can be so unpredictable. The last several days, I was in a hypomanic state-- which was pleasant initially. However, underlying the pleasantness was the knowledge that at any time, I could tip into a more severe manic form. I had been monitoring my moods carefully, ensuring not to get too overstimulated either by drinking too much caffeine or being around too many people as these things can definitely heighten my mood. Making sure I got my sleep, doing my deep breathing. The basics.

I noticed my mood shifting earlier today, however, due to family stuff, I had to keep myself composed. Be strong. Be the rock. After all, some members of my family are having their own issues-- whether its financial or emotional. So I was there for them as they had been for me when I was going through my breakdown last spring and summer. The problem with "being strong" when you feel like crumbling is that at some point, you have to release those feelings. Alternately, you can avoid them or overeat or oversleep or drink a beer or a lot of beer and forget. These things are what constitute escapism.

I released my mania last spring when I went crazy in the city of 2. I was in a similar situation I as I am now. Living at home with family and in a hypomanic state. I have a tendency to "let loose" emotionally in environments and people I'm most familiar with. So when I was invited to visit my friends in the city of 2-- a place I had lived for several years before moving in with family -- I decided to go even though I had a feeling it might disrupt my moods. In fact, I went because it would disrupt my mood. Let me explain. Physically, I felt I had to release all the built up energy and neglected emotions. This wasn't my cognitive process- but rather something like muscle memory. In other words, I knew (somewhere inside of me) I was about to go crazy and I needed a safe space to do so. So I chose my safe space to be with my two closest friends at the time. However, since this wasn't a cognitive process, I didn't think that they might not be equipped to handle my emotional state. And that's when things got complicated.

Back to my new skill. I am feeling really shaky in the sense that at any moment I could teeter on over to mania's side or worse, a severe mixed episode. But instead of indulging in that drink or another destructive behavior, I've been sitting with my feelings. Figuratively and literally. For instance, I've been communicating with my family and being assertive about my needs. Earlier I told them I needed to stay home to unwind, relax. When I was back at the house, I ended up calling a friend and talking out what's been bothering me. But instead of completely "letting loose" with my friend, I kept the conversation to a specified length and told her that if she had to go at any time, to let me know. By establishing those boundaries, I didn't overwhelm my friend. Additionally, I have been invited to visit the city of 2 recently--invitations I've rejected for the simple reason that I actually do not want to disrupt my moods this time, intentionally or not.

The good news in all of this is that I see my psych doctor later today. The other day I wrote out a list of all my questions relating to my my anxiety, irritability and elevated mood. I do have some speculation as to what triggered this emotional state so I'll be bringing up those concerns and issues as well. Just knowing I see my psych doc is comforting and reassuring. Because I've gone through this before, I know the drill and I'm prepared. Despite this difficult and painful state to deal with, at least I know that I do have resources here to help.

Before signing off, there's an adage that just seems too fitting not to reiterate. I feel like people with a mood disorder know this one best: this too shall pass. If I had a penny for every time I heard someone say that in response to a difficult situation! But what I'm trying to say is that if I could sum up all my lessons into one remark about the malleable nature of moods, that adage would be it.

I'll keep you updated.

The face of my depression or facing my depression?

There are many faces that a bipolar person has: the face of depression, mania and even of a mixed state. Sometimes we can conceal a depressed or manic face so that even our loved ones can't tell. Other times the face of despair and hopelessness is realized by others through dark circles under the eyes, a constant frown, tears. The lighted face of mania--wild eyed and flushed--can draw attention from even strangers. The most difficult part about this, however, is not what other people notice. But what we see when we are standing alone in front of a mirror, honestly looking at ourselves. Honestly looking into ourselves.

And because looking at ourselves at our most vulnerable is a very personal thing, I'll switch to the first person now....

What I saw today when I looked at myself was so subtle that I doubt anyone would know anything was wrong. It only took one glance into the side mirror of a car for me to tell that something was terribly wrong. Of course I knew my mood hadn't been great. But for the first time in a long while I saw hopelessness, disappointment, fear. I was seeing the face of my depression (again!).

Excuse me though as I try to catch you up briefly. My last post was end of June so there's obviously going to be pieces missing, but these are the big events since my last post:

• End of July: Moved across country to find a place to live for the upcoming semester.
• Mid-Late August: Began first semester of PhD.
• Early September: Made some poor choices.
• Risky sex.
• Drug use --> Mania-like symptoms.
• Irregular sleeping.
• Missing class --> Fell behind in school.
• Mid October: Was kicked out of house by druggie landlord in the middle of the night.
• October 22: Turned in paperwork for medical withdrawal from my university.

So the ugly face of depression has reappeared. As of today, I have withdrawn from my university, and I am wondering what the hell is next. I sort of have a plan in place and that means facing my depression instead of just staring at it helplessly.

The plan:

• Return to the basics.
• Sleep regulation
• Exercise & healthy eating
• Medication and supplement management
• Attend therapy.
• Mindfulness practice in between
• Mood-tracking and sending charts to both my doctor and therapist

Yeah so that's that. Oh, and also, I can still return to school (when I'm ready). I have to show documentation of improvement before I can be readmitted. But I'll think of that when it comes...

The process

Note: Hopefully this is not too scattered. I tried writing this out earlier but due to a Klonopin fog, I became confused. Also, the opinions I have about medication usage are mine and mine alone. I respect your views if you respect mine.

May 2013 (yes, I know the month and year, but maybe not the exact date ha)

Victory moods don't last long. It turns to absolute suckage. Sucakge meaning stigma in my own circle of f. I have been documenting my mental health. On recordings. On notes, receipts, folders. I forget you see. I forget everything I say and don't say. Actions too. Not impulsive ones but movements. I've been moving slow. It takes a good deal of time to write this NOT just because of the klonipin.

I am termed "hyper verbal" "hyper observant" YET and there's always a yet, I am not aware. I am confused, scared....  The partial hospital care I am going to now knows I am doing well because:

1. I am high functioning
2. I can spell world backwards (in an amount of time) -- mostly a joke about this being why I am in partial care and NOT a hospital hospital (Note: there is nothing wrong with a hospital, only not for me at this time)
3. I can recite my medications like nobody's business
5. The higher anti anxiety meds help.
6. I am lowering (doctor's orders) my antidepressant--- This causes mania in me. I am coming out again as a manic-depressive. But manic right now.

Anyhow, some other observations/comments/helpful tid bits:

1. I check with my f & f. I ask "Did I just tell you that?"
2.  The partial care program is great. The doctor is fantastic super fabulous. She is lowering my antidepressant-- because I am too hyper/wound up.
3. Pets are great!
4. Art therapy is great except for when they want to stunt my artistic ability (I use to draw dinosaurs in  grade school)-- person might have been surprised by my art, not because it was great or anything but because it had literary references and said I am not schizo on it or something to that affect. I don't know if I have schizo. I do write a lot and in circles. Memory is returning!
5. Alpha-stim has helped me tremendously: with anxiety, depression, mixed states. I have it on all the time because it is safe to do so. Fine motor skills are coming back too. So is relaxation.

May 30, 2013 (I know the date, the Klon-fog has cleared)

I was admitted into a partial hospitalization program last week due to extreme anxiety, social phobia, paranoia and bursts of panic attacks. Ironically, my note on my art piece about not being schizo might not be entirely accurate; I have acquired a new illness apparently......

Schizoaffective bipolar. 

The result of this partial hospitalization was no one's fault. Not mine--though I sometimes believe that. Just a series of unfortunate occurrences. My usual pscyh doctor was not available over the weekend (which one I don't know). So I became worried and scared. I called everyone. And I mean every mental health resource center until I landed at a prestigious center in 2, and it was awful. I mean stressful, intense, nerve-wracking. For the first time in my life, I did not want to be in a hospital. In the past, hospitals were my safe places. But this time, they did not understand when I told them about my hard-to-find veins and my tardive dyskinesia on my left side so of course, I freaked out when they poked and could not find my vein in my left arm. Needless to say, they released me on the condition I would take Klonopin to "kick out" the mania and they upped my mood stabilizer. The one doctor was amazing and very understanding of my concerns about the hospital, too.

I am not against medication. In fact, I think medication can be an effective treatment. But I also think there are other alternatives that we should consider for our mental health care. I will address this when I am less tired.

The last moments of May 2013 & the start of June

There is more to tell, more to share. But I can say this: The depakote increase (back to my original dosage before a trip to Country Y) is hm, interesting. Doc says it will take four days to be back to my stable self since the other meds did not pull through. What I think? Can I have an opinion Expert Doctors?

I think medications are covering up something. Now this could very well be the paranoia. But there is something to memory loss. I am just beginning to figure it out.

The process: therapy. Therapy in every sense of the word. I am trying my hardest to do every possible thing for myself. CBT (with a DBT concentration). Sunshine. Exercise. Nourishing Food. Sleep regulation (no naps). Connecting to self and others (in safe and harmonious ways).

It is past May now. It is a new day. If the etymology of June is correct, if I believe in those signs (which I do and don't) -- then I can say this: I have a chance to be young again. To believe in the possibilities. To be my own version of a goddess.

I do have hope. Thank you so much for reading.

The Secret Life of the Manic Depressive (BBC 4)

Stephen Fry produced a 2h documentary miniseries for BBC 4 exploring with his own bipolar disorder by talking about his own experiences, and talking with friends, experts, fellow sufferers and relatives about bipolar disorder.

Part 1: http://www.youtube.com/watch?v=y8SVQDKIt3s
Part 2: http://www.youtube.com/watch?v=WeKIm2dUb94

Bipolar and work output

The other week I had a regularly scheduled developmental chat with my boss. It was surprisingly pleasant and good — I learned a lot about how she sees my role in the lab, my performance, and what she is doing to enhance my productivity, situation and activities.

I was surprised to hear that she really appreciates having me around.
That she thinks I'm doing a really good job.

I suspect the fact that I am so surprised is tied more to my depression worldview than to anything remotely similar to objective reality.

Aaaaaanyway.

The point I wanted to talk about was how my boss brought up how she's gotten herself to get used to how I tend to work in waves: I'll have a very low output for some time, and then work frantically for some time, producing immense amounts of work, and then have a down time again.

I wonder how tightly connected these habits are to my underlying bipolar issues? I know my paper writing episode last fall, when I produced most of “Sketches of a Platypus”, happened in what felt like an essentially dysphoric light hypomania. I was energized and had to get this thing written and done, and worked every waking hour at producing text, sleeping less than usual, and pushing onwards even though it often didn't feel very pleasant.

And my down times, my improductive times, usually come with a growing despair at how as much as I try to do work, I seem to only surf the web and play games. And do nothing but.

In the end, my improductive periods provide my bad self-esteem with enough fodder to feed the self-image of myself as lazy, unworthy and improductive that it drowns out my high output periods when I try to build my own self-image.

To medicate or not to medicate

I woke up this morning to find the following exchange waiting for me on twitter:

1. 
   
   
   

   7hMeredith L Patterson ‏@maradydd

   RT @Sheeeela People say meds are a crutch. So is a crutch, but you wouldn't take it away from someone with a broken leg#depression #stigma

   Expand
2. 2hDieter Schuldt ‏@LeSabot

   @maradydd @Sheeeela I am seriously concerned that meds will stop me from being productive. Successful research is all I have to hope for.

   Expand

2hMeredith L Patterson ‏@maradydd

@LeSabot @Sheeeela This is a concern I've heard many researchers express. @michiexile, you want to help field this one?

I started medicating early January. I was worried when I started whether medicating would remain sensible, what with my intense reliance on my brain and my creativity for my work, exactly like LeSabot here worries.

For me, with a history of manic-spectrum issues in addition to my depression, there is the additional worry that SSRIs may actually trigger manias if you are unlucky enough.

So I went into medication with a pretty vigilant mind. On the lookout for Things That Might Change Me. I figured that in the worst case scenario — drugs are actively counter-productive — it's worth losing, say, 3-4 months to find out whether they could have worked or not. And the best case scenario removes so much sadness, anguish, and problems that investing in this test is worthwhile doing.

I have been at it for a bit over a month now, and finally the side-effects are starting to wane. First month on meds was kinda shitty — I still had bad moods, but I ended up having a very flat, apathetic approach to both my moods and everything else. I have not had any significant mania-spectrum events. 

And what's most likely important to this discussion: so far, about a month into daily medication with fluoxetin, I have not noticed any change in my intellectual prowess. I pushed out two papers since medication started — one SIGGRAPH submission (which honestly was pretty punishing in stress levels and workloads) and one arXiv preprint — and more than anything, the medication frees up parts of my brain that were working on keeping my emotions in check.

I'm not sure whether I end up more productive now. But at the very least, I can say with confidence, SSRIs have certainly not made me less productive.

“But what are you so sad/upset about?”

This question has been on of the most difficult to encounter through all my problems and issues. It leads me on a merry goose chase to find some reason — any reason — why I might be feeling as I fell, and more often than not, I latch onto something correlated and trumpet that as the reason.

More often than not, it ends up blaming my wife.

More often than not, unjustly.

I meet the question all the time. It is one of the first my wife asks me when I am upset or anxious or sad. And the lack of a response is disconcerting. Can trigger an escalation for me on its own. It feels like there should be a reason, so when I can't produce one, something's clearly wrong with me.

And it kept re-surfacing during my psychiatrist interview last week. I had been talking to a psychologist for two meetings, going through things I felt, trying to describe — trying to even remember — what life is like outside the office we met in. Trying to capture the daily emotional crashes I'd had for months by that time. And then I meet the psychiatrist — who had read all the notes from these two preparatory meetings. I describe, over again, that I am getting emotional crashes, they come increasingly often. That I have a bipolar diagnosis and a treatment from about a decade ago, but I don't remember what they did (beyond giving me lamotrigin — back then it was experimental for mixed state bipolar), but that I want this to stop, somehow.

And the question comes: “But when you are upset, what is it you are upset about?”

And … I don't know. That, right there, is the clearest signal that there is something wrong with me that I can find. I get terribly upset. And I just don't know why. Had I known why, I could have tried to do something about it. If I knew that I am angry, or sad, or devastated, or afraid, of something in particular, I can tackle that source. Work on my scheduling if I know that it is stress. Ask colleagues for help if I am overworked. Figure out what the source is, and then do something about it. But that simply is not it.

I get upset. Sad. Angry. Afraid. Sometimes utterly terrified. And there is no reason. No causality. It just appears. And since I don't know why, nor from where, I can't see what I can do to prevent it.

Introducing myself

Ian started this place, and has linked to my text on my own problems.

But there's no substitute for your own voice in introducing yourself, so here goes. An introduction, and call to action, of sorts.

I am Mikael Vejdemo-Johansson. I am a mathematician — started out in homological algebra, and now I am most active in applied algebraic topology. Currently I am at the tail-end of a sequence of post-docs, searching for a long-term academic job before my research funding runs out.

I, and those around me, have been struggling with my affective disorders for years. Within a few months of us first hooking up, my wife told me I had to do something about my outbursts. Some time later, I managed to get in touch with a psychiatric care unit, and two years of medication and therapy later my outbursts had gone from several times weekly to several times a year.

Mixed State Bipolar Disorder.

In the last year or two, things have gotten worse again. I have been moving around a lot — postdoc will do that to you, and I had several stints of a few months up to a year with stable living situation before everything changed again chained up after each other. Stress triggers. I tried late spring to get in touch with a psychiatric care unit in Edinburgh. By the time I was scheduled, I was already moving. Now, finally, I am in touch with a care unit in Stockholm.

Mild Depression.

I am ambitious, successful, full of ideas and energy, and produce research at what I think is a decent rate. I am engaged in my community, take care of my peers, and play an active role in shaping my field of research. My disorders hide when I am with people I do not know very well. As Ian says, if I do not tell you, you probably do not know.

Outside of academia, I am also an active member of the hackerspace community. Close friends of mine are avid presenters and organizers of hacker cons. During the last three years, there has been three widely publicized and high-profile suicides within the hacker community: Ilya Zhitomirskiy, then Len Sassaman — married to one of my best friends, and now Aaron Swartz — close friend to another of my best friends. At times it seems I keep seeing friends of my friends vanishing off the face of the earth, and leaving wrecks behind.

The hacker community has had enough of this. They have started organizing. They have started speaking up about it. They founded BlueHackers. Several of my close friends participated in a panel on depression in hacker culture at 28c3 — the Chaos Communication Congress of 2011.

And I find myself wondering…
Why not us?
Why is a depressed academic so much more on their own than a depressed hacker?

Help us make it not so.