Conditional Conditions

I was having a fantastic time at Tang Soo Do class last night.  I excelled in techniques that were far above my level.  I was really doing well with jump kicks and then, POP!  I landed on my knee wrong, and here I am.

Mental health disorders with limitations are difficult enough on their own.  I find that I am unable to just go to the mall.  I have to plan, and take a Xanax or two well in advance.  The same is true for many other crowded public places.  Forget concerts, bars, clubs, and occasionally anywhere within Pittsburgh City Limits.  Even the idea of attending an event is overwhelming, fiercely bashing my panic button.  It’s enough of a deterrent on its own.

Phobias often limit places I go and events I attend.  Social anxiety often limits my capacity for meeting new people and maintaining friendships.  And bipolar disorder comes with it’s own special set of challenges.

Bipolar disorder has proven to globally stunt me, from the disorder itself preventing me from having stable relationships and jobs to the medication causing aphasia, making it difficult to express my own thoughts.  “My memory ain’t what it used to be,” although it was never stellar in the first place.  I find it challenging to create new short term memories and even sometimes long term memory is kind of foggy.

Depression and mania, in their own respects, both cripple my ability to function.  In depression, I have a tendency to isolate myself, causing my relationships to go sour quickly.  I find that the state of depression and the behaviors associated with it are generally a mystery to others.  Since it is so misunderstood, people may start attributing it to life events incorrectly.  And when the depression doesn’t subside, others become short with me, occasionally to the point of ignoring me.  No one likes a wet blanket, so to speak.

Depression also causes me to lose interest in activities I used to find enjoyable.  Worse, I become disinterested in work and start to have issues with the processing speed of my cognition.  I cannot focus on a particular task, and most situations become completely overwhelming.  In short, I feel like I am unable to handle my life any longer.

Mania is a horse of a different color.  In certain types of mania, I become overly social to the point of being overbearing, blunt, attention-seeking, and needy.  It puts an extreme burden on friends and family.  In euphoric mania, I will demand my impulses be satisfied without a thought to how it will affect anyone else.  Contrastingly, in dysphoric mania, I will become enraged at the slightest thing, real or imagined.  I have been known to become aggressive.

I have a tendency to become overly ambitious.  That would entail me taking on too many tasks at once, with the intent to finish them all, but with zero follow through.  This is especially detrimental to my work, seeing as how I find it next to impossible to sit still, or remain on one task for any significant duration of time.  I will demand immediate satisfaction, and have an inclination to become aggressive with co-workers.

With psychosis involved, there is a whole new ball game.  In psychosis, my grasp on reality starts to loosen.  I will insist that conversations took place that never actually did.  I will invent ulterior motives from suspicion generated by delusion.  Or, contrastingly, I will assert myself incorrectly by insisting I am infallible and all-knowing.  In the worst instances, I have had delusions of being a time traveler, not living in this reality but in an overlapping parallel reality.  Psychosis makes typical functioning next to impossible.

Mixed states provide a variety of issues drawing from both mania and depression, respectively, but also brings other unique symptoms and behaviors to the surface.  In mixed states, I often suffer from dissociation and splitting.  It’s as if my mind cannot handle the overload of external stimuli that provokes and emotional response, therefore I dissociate.  Occasionally, I have been prone to partial dissociative amnesia, where events that took place become only vague in my memory.  I have been known to have multiple personas, and in the most distressful of moments, my dominant persona becomes pushed into a partially conscious state as a disgruntled, passive observer to the actions and behaviors of the alternate persona.

As if these conditions are not serious enough on their own, they can be aggravated by a physical illness or injury.  I am experiencing a lot of emotional turbulence over this knee injury.  First, I am panicked that I did not receive professional medical attention.  I am wearing a brace from my last visit to the ER for a similar condition, but I obsessively worry that I may be using it incorrectly.  I am putting a small amount of weight on it, and it occasionally hurts pretty badly.  I worry that I am doing more harm than good.

Secondly, I am embarrassed over the injury that happened in the middle of class.  In short, I landed wrong during the jump kick and felt my knee give out.  I feel like a complete rookie, although I am only a white belt at this time.  As I am very sure that many people have gotten injured before, I still feel like it is maybe too big of a deal.

Next, I feel guilty that my husband had to spend his entire night driving back to 511, our old home, to retrieve my knee brace.  Why didn’t I have the presence of mind to bring that knee brace when I am well aware that I have life long knee problems?  It seemed like an entire night wasted, all over a silly injury I probably could have prevented, had I been more careful.

And lastly, I feel helpless.  I am responsible for supervising my child while my husband is off at work for nine or ten hours a day.  I am terrified that I am not going to be adequate to care for him properly.  I am unable to move around, therefore my function is limited.  Mostly, I will likely be confined to a sitting position for most of the day.  I am at the mercy of others.

All it takes it one spark.

A Spectrum of Depression

Blank.

Each time I go to write, I get a blank.  Is it a blank, because I feel as if I don’t have anything important to say.  Or is it a blank, because if I make a certain statement, then it is real.  It becomes something tangible in this world, not only for me, but for others, and I will eventually have to come nose to nose with it.

I’ve grappled with this before.  Making certain admissions.  I do not lie as much as I turn a blind eye.  I rationalize.  I attempt to will it out of existence.  But, it is just not that easy.

Simply – I am in the midst of a depressive episode.

Why was that so hard?

There is a certain hesitation for me to use the word depression.  It is not a word that I use loosely; others use it as a part of their regular vernacular to describe sadness.  Depression is not sadness.  Depression has a depth beyond that of sadness, loneliness, isolation, self-loathing, or any other word.  No amount of words arranged in any way can accurately depict depression, and do it any kind of justice.

The hesitation to term it as depression stems from the idea that, if it doesn’t feel like the worst I’ve ever felt, then it’s not depression.  I have faced more gruesome depressions than this one.  With the admission comes a certain fear.  If I am to term it as a depressive episode, then it really will be such, in the worst sense of that word.  It could worsen the episode itself by acknowledging it.

Blank.  Again.

I have found it so interesting that Bipolar Disorder has this grandiose spectrum to encompass so many different types and symptoms.  However, they are exclusive to mania.  Depression is just depression, and it by itself is MDD, or unipolar depression.  Except, now psychologists are starting to recognize symptoms that are related to atypical depression.  However, by reading through these symptoms, it seems as if it may be exclusive to unipolar depression.

How much research has been done to distinguish unipolar depression from bipolar depression?  So far, the only thing that separates the two is the existence of hypomania / mania.  In theory, there wouldn’t be a difference.  I get the feeling that there is, and it is significant enough to have a separation between the two.

So far, the mood spectrum looks like this:

But, I really think that’s being too broad about it.  I fall smack dab in the middle of Bipolar II, no full on psychosis equals no full on mania, even if I have delusions.  I wouldn’t even suspect that I have full on mania, anyway.  Even with delusional thinking, I can honestly say that there has never been a time where I have been hypomanic where I lost touch with reality.

People with mood disorders are familiar with the depressive symptoms.  But, I’ll sum them up:

Sadness, anxiety, irritability,  Loss of energy,  Feelings of guilt, hopelessness, or worthlessness,  Loss of interest or enjoyment from things that were once pleasurable,  Difficulty concentrating,  Uncontrollable crying,  Difficulty making decisions,  Increased need for sleep,  Insomnia, Change in appetite causing weight loss or gain, Suicidal ideation, and / or Attempting suicide.

Symptoms of atypical depression:

Increased appetite, Unintentional weight gain. Increased desire to sleep. Heavy, leaden feeling in the arms and legs, Sensitivity to rejection or criticism that interferes with your social life or job, Relationship conflicts. Trouble maintaining long-lasting relationships, Fear of rejection that leads to avoiding relationships, Having depression that temporarily lifts with good news or positive events but returns later

These are all familiar.  I’ve bolded the ones that I’m experiencing at the moment.  It seems that I’m bordering on the more atypical part of depression.  This is the kind of depression that no one really tells you about.

I had mentioned my diagnosis of Bipolar II, resulting from non-psychotic “manias” clinically termed “hypomania”.  Fair enough.  Let me put a question out there.  Has anyone ever experienced a psychotic depressive episode?

I have.  And I have mentioned this to doctors on several occasions.  I will have breaks with reality when I am depressed.  I have severe delusions, almost completely the opposite of delusions of grandeur.  I will have severe paranoid episodes – in fact, I just had one.  I can have myself convinced that everyone hates me and is out to destroy my life.  It makes me combative.  I will sometimes invent conversations that never happened, just because my brain contorts a criticism.

Mayo Clinic appended this in fine print below their list of classical depressive symptoms:

When a person with psychosis is depressed, there may be delusions of guilt or worthlessness — perhaps there is an inaccurate belief of being ruined and penniless, or having committed a terrible crime.

Perhaps?  I’m nearly positive that exists because not enough research on bipolar depression versus unipolar depression exists to accurately differentiate between the two.

There are a few questions that remain.  Again, not to just the bipolar population but the unipolar population as well, have you ever experienced a psychotic depressive episode?  Is this more commonly found in MDD, BP II, or BP I?

Because if this is common amongst all populations, then the mood spectrum should look more like this:

Perhaps a more accurate model