Inversely proportional

I've encountered this term several times when I was still in school. It's used in physics. It's used in mathematics. And now, I realize, it can be used in my daily struggle with my mood and emotions.

I've been thinking a lot about this, and I have come to this conclusion: My highs are inversely proportional to my lows. I don't know how high my mood should be for it to be considered a manic or hypomanic episode. But all I know is if I'm not wallowing in despair, I talk loudly, spewing out witty and funny comments with an unbridled energy. It's as if I don't run out of jokes and witty retorts. I make people laugh, especially my housemates in the boarding house. I love being in this kind of state, although I wish I hadn't spilled water over one of my housemates the other day while I was spewing out these spiels and wanted to demonstrate something funny. 

But this state scares me, because I know that when the energy and laughter have died, it will be followed by a deep downswing. It can come hours after this high, or at times, minutes after this high. My mood will slide and before I know it, I've hit rock bottom. Again. For the nth time. 

And when I am in this state, everything is a struggle. Waking up is a struggle. Getting out of bed is a struggle. Doing anything is a struggle. I don't want to go out. I don't want to be around people. I just want to stay at the boarding house with my housemates or go see PM, my boyfriend. 

Then, my mood would lift, but it wouldn't last long. I would again exchange funny banters with my housemates. My energy would be at an all-time high. Then, my mind would be so active that I would work like a beast until the wee hours of the morning. 

When I work at night, I don't take my meds until I'm done. Maybe it's the reason why my mind becomes active and I feel that I can do anything and everything. There's nothing that can knock me down and sleep. I can go and be a machine. 

And then again, when all these is over after a few hours, I would plunge again. The higher my energy was during my active moments, the deeper I would sink into depression. 

Maybe this is what having a bipolar disorder really is about. My psychiatrist Dr. G once told me that she doesn't see me having manic or hypomanic episodes, but she thinks it's because I am taking medicines for bipolar disorder (Quetiapine and Lamotrigine). I think it's also because when I see her, I'm usually in a depressive episode. She doesn't see me every day. She doesn't see me talk loudly and expel jokes one after another. She doesn't see how noisy and energetic I am when I am not having a depressive episode. 

I am supposed to see her today, but she has to attend a conference, so I have to wait until my next scheduled appointment, which is on Nov. 9. I wish she didn't need to attend to that conference, because I want to see her. I want to report to her everything that has been happening to me. I want to know her thoughts on this. 

I have to hang on. I have no other choice, even if these daily ups and downs are driving me nuts. 

Alone

Do you feel this, too? You're surrounded by a lot of people, each of them in their respective circles, but you don't belong to any. You're able to talk to different people at different times, but when the small talk has died down, you're left on your own. Or you simply feel that you're not a part of a group you're supposed to be a part of.

This has been happening to me recently, and when I can't take it anymore, I ask myself, "Do I see and feel these things because of my psychiatric condition? Am I being too aware of my inner thoughts and emotions that I come up with different interpretations of certain events? But a friend of mine told me not to blame my condition. Some people are just like that--they live in an exclusive bubble.

I've been in this place before. I've experienced being an outcast in school, with only one or two friends. Back then, I endured all their parinig. I endured their whispering behind my back. I endured all the things they (some of teachers included) did to put me down. I was 12. Now, I'm 28, and I can't believe I am again experiencing how it is to not belong to anything.

Every day, I do my best to set aside this feeling and instead focus on my tasks, on what I am supposed to do. But sometimes, it becomes overwhelming that I find yourself crying at midnight and wishing I have someone to talk to but, unfortunately, all my friends are already asleep.

Last week, my therapy session went great. Again, I wasn't a disaster when I got out of the clinic. There was no crying, there was no meltdown. In fact, I felt proud of myself because I was able to identify recent events and thoughts as cognitive distortions and what I did about them. I thought things would get better. But then, as what usually happens, I'd be feeling great for maybe three to five days, then something would happen that would ruin everything, and I'd be back to zero. And I would be zero for weeks and it would go on and on and on, until the next three- to-five-day period of stability, and then I would go back to zero again.

Three Sundays ago, I opened up to a friend about my insecurities and everything that I am experiencing. I was pleasantly surprised because even if we're not particularly close, he took time to listen to me and offer kind words. I felt that wow, there's an additional person out there who gets me. Yey! It is during these moments that I feel I am not alone, which is ironic. When I am surrounded by people, I feel alone because I am not part of their circle. When I am literally alone and I am talking to friends through FB messenger or text, that's when I feel that I have company.

Maybe I feel this way not because I have a psychiatric condition, but because I trust the wrong people. And I trust the wrong people because I think that they have even a small amount of empathy in their system. Apparently, some (if not all) of them have none. I guess it's hard to ask that of people.

Maybe the best thing for me to do is not to be so hard on myself and stop blaming myself for everything that I see and feel. I may have a psychiatric condition, but I have a fully functioning mind and heart. I am not making things up. People are just showing their true colors, and now, I am seeing them for what and who they really are.

What type are you?

A friend once told me that he didn't see me as the type who listens to Paramore (he didn't mean anything bad by this, by the way. It was just an honest observation :) ). He said he pegged me as more of a Taylor Swift fan. Well, I am a Taylor Swift fan, a Demi Lovato fan, AND a Paramore fan.

A classmate back in college once told me that she didn't think I am the type who throws and breaks things when angry. Well, I am. In a fit of rage, whenever my dad and I would fight, I would break almost anything that I touched. I had broken almost everything that was on my desk in my room at home. In a fit of rage, I even broke plastic storage boxes, which were supposed to be unbreakable. I once threw my cellphone across my room. Good thing it didn't break.

When another friend learned that I'm dealing with bipolar disorder and depression, she told me she didn't see me as the type who would have these struggles. For her, I am a jolly person. Which I am. I can exchange jokes with people. I can talk to people at events. I can introduce a friend to my other friends and professional contacts and make them talk to each other and exchange contact information. She meant it as a compliment, and I took it as such.

But looks, as they say, can be deceiving. Not everyone who wears a smile has rays of sunshine inside. In my case, I do wear a smile. I have sunny days. But I have a lot of rainy days, stormy days, days when everything feels like a tornado. Most of the time, my soul feels like it's in an eternal winter solstice--nights are long and dark while days are short. And on those nights, there's no moon or any star in sight. It's just plain, black darkness.

There are times when dark thoughts linger in my mind. Sometimes, these thoughts are about what it would be like when I'm gone from this world. And then, I'd feel scared because I'm afraid of death itself. I still want to live. But aside from this, other dark thoughts also linger in my mind, thoughts that aren't as dangerous as death but are just as powerful in pulling me down. When I think and feel that I am inadequate, when I think and feel that there's nothing "special" in what I do because everybody else can do it anyway, I feel down. It's as if I am not doing enough.

This plain, black darkness keeps me up at night. Without my meds, I won't be able to sleep. That's why it was I and my cousin (who was studying law and who was comfortable reading at night) who worked the "night shift" during our grandmother's wake. Our parents and aunts would sleep at night, while my cousin and I would stay awake. Then I would take my meds by 2 or 3 am when one of the grown-ups was ready to continue the "shift."

This is insomnia, and this is not healthy. Insomnia got me through college, when 24 hours isn't enough to finish all my academic requirements and things I had to do for my college org. I was able to survive with just four hours of sleep, or even less, daily. But this isn't a healthy way to live. And when you're dealing with psychiatric conditions, it is best to have a regular sleeping schedule, as advised by my boyfriend who is a doctor.

When I still wasn't seeking treatment, and dark and sad thoughts would occupy my mind, I would cry for no reason. This would probably come as no surprise to other people because it is pretty much an established fact that I am the type who cries a lot. I am the type who cries at movies even if the movie is a jolly, animated film. I am the type who cries when I feel cornered. I am the type who cries because I easily get hurt. I am the type who cries and breaks down when filled with overwhelming sadness or anger or rage. But people never saw me as the type who would have a psychiatric condition.

Once, when I bought my meds at one of the leading drugstores in the country, the pharmacy assistant told me that I didn't look like I am taking those meds. He probably meant it as a compliment, but anger and disappointment and sadness did cartwheels in my mind so fast that I wasn't able to process what I was really feeling at that moment. I just smiled and let out a short "haha" then left. Because really, what is someone who's dealing with psychiatric issues supposed to look like? Who or what is the type who has these conditions? And when you're a pharmacy assistant handing out medicines to anyone who's afflicted with any kind of illness, shouldn't you just keep these types of opinions to yourself?

This made me realize that we really have a lot of work to do to raise awareness about mental health issues. It's still a taboo. We can't talk about it openly. A lot of people are still afraid to step forward and tell a friend or someone else that they're dealing with something invisible, something dark, something that cannot be explained. Even I didn't tell a soul when I first sought treatment. Then slowly, I opened up to a few people, until I started writing about it here in my blog last November.

This is the type of issue that we should be talking about. It's not the type of issue that we can just sweep under the rug and pretend that it doesn't exist. It's not the type of issue that only a few people should care about.

So the next time someone tells me that I am not the type who has a psychiatric condition, I'll politely tell that person that psychiatric conditions don't have a particular face. They have no specific look. But we can do something specific about them, and that is to seek professional help.

My purple journal

When my therapy session last week was about to end, I handed my personal journal to Dr. G. It was the journal that I kept when I was still under the care of Dr. B (my former psychiatrist) and was still not undergoing Cognitive Behavioral Therapy (CBT). I was just under medications back then. Writing on my journal was my way of releasing...whatever it was that I needed to release. My anger, anxiety, things that make me upset, things that make me sad, Z whom I'm so insecure of, how Z (or should I say, thoughts of Z) has the power to pull me into a deep, dark, downward spiral--all these are on the pages of my journal which, coincidentally, is purple and has a metal elephant ornament in front. "Oh it's an elephant, and it's purple," Dr. G said when I handed her the journal. My purple elephant. My symbolic purple elephant, which I wrote about here.

I stopped writing on that journal when Dr. G told me to keep a thought journal wherein I would write situations, my moods, and emotions and images that came to mind in those situations. This is the CBT format. My purple journal doesn't follow any format. It's all me. I'll resume writing on my purple journal when I'm done with CBT.

I decided to lend my purple journal because I wanted to let Dr. G see how I was before I started seeing her. I wanted her to see what plagued me when I was still not undergoing CBT. I wanted to give her a peek into my chaotic mind so she can help me deal with my present troubles, which are a continuation of my past troubles. I wanted her to get to know me better so she will know the story behind every tear I shed during therapy.

My purple journal is my private, personal journal. The journal itself is a gift from PM (my boyfriend), which he got for me during his trip to Thailand. He told me that when he saw that journal, he knew he had to get it from me. And the moment I saw that journal being handed to me, I knew I was meant to have that journal. It's now my purple journal, and written on its pages are my purple elephants.

I let PM read my entries once in a while. I'm not sure if I've allowed him to read everything, but every time I want him to read an entry or two, he would gladly oblige. He is the only person who has access to that journal, and even then, he doesn't touch it unless I ask him to. Now, it's with Dr. G. I'm practically letting her dig deep into my soul. I'm practically introducing her to my demons. This is difficult. No wonder a psychiatrist's professional fee is steep. It's because he or she helps the patient fight demons that the patient cannot fight alone. And these demons cannot be seen, but they are there.

I've been seeing a psychiatrist for a year and five months already. It has been a long journey but the road ahead is still long. Dr. G and I are processing everything one at a time. Every negative thought, every emotion, every trigger--we're dealing with them one at a time. CBT is usually finished after ten sessions, but I think I would have to extend. I don't think everything that plagues me can be resolved in my remaining three or four sessions.

On a more positive note, I always look forward to my CBT sessions with Dr. G. I get upset when I have to skip a session because of work or other matters. I feel safe in her clinic. For me, it is a place where I am free to talk and cry and then talk again. It is a place where I am away from all my demons and ghosts, from all my triggers. It's a place where I am away from Z, where Z cannot hurt me.

Every time I sit on that sofa at Dr. G's clinic, I do not want to leave. I do not want to be back to the "real world." But of course, the next patient is waiting, someone who maybe has the same demons as mine.

I hope Dr. G has the time to read everything in my purple journal. But she's busy. Maybe she would scan them and maybe read the entries that stand out. I don't know. I don't know what her reaction would be. Maybe I'll find out on my next session.

Cognitive Distortion No. 1: Catastrophizing

Last Wednesday, after my therapy session, I didn't come out of Dr. G's clinic a disaster. And that, I think, is an achievement, so I treated myself to a glass of chocolate cream frappuccino and a sausage roll from Starbucks. I deserved the treat.

I now feel that everything that Dr. G has been telling me in our therapy sessions is starting to make sense. In my mind, they're no longer theories. Dr. G has been telling me that one of our goals in doing CBT (Cognitive Behavioral Therapy) is to deal with my destructive thinking patterns and "fix" them. My session last Wednesday couldn't have come at a better time.

Last Tuesday, I made a REALLY BIG mistake at work. It was really a big deal. It was a stupid and avoidable mistake. Of course, I got flak for it. I was so embarrassed that I felt I couldn't face anyone at work anymore. I slept last Tuesday night hating myself--as in REALLY hating myself--and telling myself repeatedly that I was so stupid. Stupid, stupid, stupid. And irresponsible. Irresponsible, irresponsible, irresponsible.

And when Wednesday came, it was still fresh in my mind, so I told Dr. G about it, aside from all the things that happened to me the past month. Dr. G told me that the incident at work is a perfect example of why we're doing CBT. We focused on this thought: I am stupid and irresponsible. From that thought, she asked me what is my basis for saying that I'm stupid and irresponsible. And so I told her. She then asked me how many times I've made this mistake in the past seven years (I've been working in this publishing company for seven years). I said one, followed up by, "But I also made other mistakes in the past." She then asked me to share them, and I obliged, and she wrote them down.

After this, she asked me what my basis is for saying that an employee is responsible, and in my seven years of working, what are the things that I've done that make me responsible. And so I told her all that I could remember--all the good things that I did, articles that I wrote beautifully, positive feedback from some of the people whom I've interviewed for my articles, writing for other magazines published by the company once in a while, and representing our team during events. She wrote everything down.

Then, when I was done talking, she told me to look at the things she wrote. I made a mistake, yes, but in my seven years of working, I've done good things, too. One mistake doesn't make me irresponsible. And that, I felt, is how CBT helps.

One of the cognitive distortions I am guilty of having is the tendency to catastrophize things. One mistake, and I feel that I've summoned a catastrophe. One mistake, and I already feel that I'm stupid and irresponsible. One mistake, and I feel as if I've committed a crime against humanity. One mistake, and I can't forgive myself for it.

This isn't my first time to catastrophize. Last February, I've done this, and I think that was my worst case of catastrophizing so far. It was when I tried to reach out to Z to make sure everything is okay between us. But then, she said that it only made things awkward, and I didn't take it well. I beat myself for it, attempted to overdose on tranquilizers (Alprazolam) not to die but to fall into a deep sleep, and I made cuts on my left arm. I wrote about it here and here.

Now, cognitive distortions and CBT are starting to make sense to me. Catastrophizing isn't the only cognitive distortion I'm guilty of having. I'll write about them in my succeeding entries. For now, Dr. G's homework for me is to do at least one pleasurable activity per day. Activities that make me happy, which she had me list down during our session. I listed down fifteen activities, but she told me that I am free to add more. That is my homework. And I'm going to do it, being the good student that I was (some XX years ago) and being the good patient that I am.

My never-ending battle with insecurity

Nothing could trigger my depressive episodes really hard than bouts of insecurity. And there's this particular girl that I am so, so, so insecure of. In my previous entry, I called her Z. From then on, let's call her Z in all my related entries.

I'm not the type who's insecure about looks; modesty aside, I think I'm not lacking in that department. What I'm insecure about Z are her brains and her talent. She's incredibly smart. She's a doctor. And she can sing--not very well though, but still, she can sing. Ever since I got to know these things about her, I felt so down and inadequate, even if we're not being pitted against each other.

The fact that she can sing is probably the biggest and heaviest boulder thrown at me. She's incredibly smart and she's a doctor, and I'm neither. Sure, people say I'm smart, and I'm happy about that. But the thing is, I sing, too. I love to sing. And it pulls me down knowing that she can do this, too. It's as if she can do everything that I do, but I can't do what she does.

I've never considered science, math, medicine, and law to be superior fields, reigning over the arts, languages, and communication. That's why we have multiple intelligences, right? But when I got to know Z and the things that she can do, I felt so small. I felt that being a writer "doesn't count." I felt that I'm in a "lesser" industry. What's writing compared with saving lives? It's as if she's doing something great for humanity, while I'm just here, typing my articles.

Months passed but this feeling didn't go away. And as the day that I'd get to meet her drew near, my anxiety level shot up, one level at a time, every single day. When I was already at the venue (it was a dinner party), I couldn't eat because I knew she would arrive at any moment. My stomach was in knots. I felt like throwing up. My pasta tasted bland--either it was really bland or I couldn't taste anything anymore. I wasn't able to eat. And when she arrived, I didn't know what to do. I managed to smile and shake her hand when we got introduced, but I knew I wasn't in a "safe place." I managed to interact with the other people at that dinner party, and somehow, those interactions helped calm my panicking self. But those interactions didn't change the fact that I wasn't feeling well. Seeing her around made my heart beat faster and pound in my chest really hard.

After that dinner, I broke down and cried. I couldn't take it anymore. I couldn't pull myself together anymore. I just cried, even if I knew I wasn't making sense, nor was I being rational.

A couple of months after that dinner, I thought I was already feeling better. I thought I was ready to put everything behind. I thought that if, by some reason, we bump into each other, I wouldn't be awkward with her, and I didn't want her to be awkward with me. And so with all these good intentions, I tried to get in touch with her to tell her how I felt. But it didn't turn out well. She said it made things awkward. I felt that wow, there I was, trying to rectify the situation. But I made things worse. Even with good intentions, I made things worse. I failed.

Because of this, the more I got pulled into this downward spiral. I got even more insecure of her. And the worst part? SHE HAS NO FREAKIN' IDEA about all these. She doesn't know that she has this effect on me. And why should she care anyway? It's not her fault that I am insecure.

I am insecure. I wish I wasn't. But it's not something you just get over with. It's not something you put in a box and stash in your storage room (we call it bodega here in the Philippines). It's not something you throw in the wastebasket. It's not something you wash off. It's part of you. It's part of me. I wish it wasn't.

And so I'm here, dealing with my insecurity. I'm already on my seventh session of Cognitive Behavioral Therapy (CBT). My psychiatrist Dr. G has really been so nice and patient. Throughout those seven sessions, we always touch on my insecurity. And what happens next is always the same: I break down and cry. My makeup gets ruined. My eyes get red. My nose gets clogged. And all these because I'm insecure of Z. Because I feel so small. Because I feel inadequate.

This isn't something that my medicines can fix. That's why I'm going through therapy, hoping to get equipped with the right skills to cope with it. I can't go through life feeling like this, feeling small, feeling like my achievements don't count because someone out there is saving lives or whatever. I'm tired of all these. I'm so tired of being insecure.

Don't compare yourself with others. It's easy to say that. I've told myself the same thing countless times. And yet, here I am, still insecure.

I can't wait for the time when all these--my insecurity, my depressive episodes, my unpredictable moods--will be over. I can't wait. But like my psychiatrist who's patient with me, I need to be patient with myself, too. And I should stop punishing myself for feeling this way. I didn't want to be like this. I'm sure no one wants to be like this. But what can I do? These are the cards I am dealt with. I have no other choice but to play this right and recover.

The case of the purple elephant

I've been wanting to write about my therapy session two weeks ago, but I've been really busy. Anyway, here I am, writing about it and giving you an update of what I've been going through.

As I've mentioned in my previous entry, my psychiatrist put me back on antidepressants (Escitalopram). So now, I'm back to taking three medicines: Escitalopram, Quetiapine (antipsychotic), and Lamotrigine (anticonvulsant). The cost has really hit my wallet so hard. Thank God I got extra money last payday for extra work I did before.

Last August 24, my psychiatrist and I touched on my insecurity once more. This, I think, is my biggest depression trigger. I've been really insecure of (and frankly, annoyed at) this person. Let's call her Z. And last February, when I sort of had a close encounter with Z (through Facebook), I really spiraled down. Down, down, down. I wrote about it here and here.

Ever since that February encounter with Z, I never go out without makeup. Before, I could go out with just moisturizer and powder on my face, especially if I wouldn't be out for long. But now, since February, I always wear makeup when I go out. When I'm with my boyfriend to watch a movie or just stroll at the mall around the area where he lives in, I make sure I wear makeup. First, it's because when I see that I look good, I feel good. And second, we might bump into Z (she lives in the same area), and I don't want to look plain when that happens. I want to look good, to be pretty when I bump into her. So far, it hasn't happened. Yet.

This insecurity of mine is spiraling out of control. It's one of the reasons why my psychiatrist (Dr. G) put me back on Escitalopram. I'm now taking 15mg of Escitalopram in addition to 300mg of Quetiapine and 150mg of Lamotrigine. This combination is making me very, very sleepy.

In my last session with Dr. G, she gave me the elephant exercise. She asked me what my favorite color is (it's purple), then she told me to close my eyes and think of a purple elephant. She asked if what I'm seeing is an adult or baby elephant; what's going on with its ears, trunk, and tail; and where I am seeing it, was it in a jungle, zoo, or somewhere else. When she told me to open my eyes, she asked me if I've seen a purple elephant in real life. I said no. She then went on to say that that is the power of our thoughts.

After her explanation, I asked, "Does it mean that I'm making it (my depressive episodes) all up?" She assured me that I'm not making anything up. The point of cognitive behavioral therapy (CBT) is not to put blame on me. It's to change my negative thought patterns. She then went on to say that our thoughts are influenced by our past experiences, like the way were brought up. These experiences affect how we think about and see things. None of these are imagined or made up. They're all products of our past.

My depressive episodes and panic attacks and my restless and noisy mind--from now on, I will see these things as one purple elephant. My purple elephant. It's not something I made up, of course, but something I saw because of my past experiences.

Dr. G also gave me a list of cognitive distortions (with explanations for each) and asked me to encircle what applies to me. Out of ten, I encircled eight. It's from David Burns's book Feeling Good Handbook (which I have yet to get my hands on). My destructive thinking patterns are destroying me and the way I see myself.

My latest destructive thought is that I'm afraid of getting fat (just to make it clear, I don't have anything against plump people). I've never been the type who's conscious about her weight or figure. I eat anything I want. I have a fairly fast metabolism, but I don't overeat. But lately, seeing a flat tummy when I look in the mirror makes me feel good even if it means I'm hungry because I haven't eaten breakfast yet. Then I will just have light snacks then eat lunch late. When I get to the office, I just want to work, with sugary food like cookies sustaining me before I eat a proper meal. It's not healthy. I shouldn't rely on sugar for energy--I must eat regular meals. But lately, my appetite is messed up. Z triggered my latest panic attack (and my subsequent plunge, as if my current depressive episode isn't drowning me enough) when I saw a photo of her on my Facebook timeline (FYI, I'm not friends with her on FB but some of my friends are). I got insecure for the nth time, hence this latest destructive thought: I don't want to gain weight because Z leans on the chubby side.

I'll see Dr. G again in two weeks (I'm supposed to see her this Wednesday but something came up at work so I had to reschedule). I'll bring all these up--my fear of gaining weight, my fear of being seen barefaced, my neverending depressive episodes. Maybe we'll have another exercise that could help me see things from a better perspective.