off the spectrum

I wrote previously that my new therapist asked me to do some research about autism, and see if I thought I might have it. I looked at multiple reputable sources, and after reading many lists of symptoms and presentations, I don’t seem to fit the overall autism profile. I suppose some of the criteria could apply to me, but it seems like two general patterns of autistic behavior are a lack of understanding of social norms, and difficulty with communication. I don’t feel like those two conditions apply to me at all, currently or in the past.

I know autism is a broad spectrum of different abilities and limitations, and it expresses itself in different ways with different people, but it just doesn’t feel right to me the way other diagnoses feel right. My actions and behaviors seem to be better explained by a combination of bipolar, ADHD, and personality changes resulting from years of emotional abuse in childhood. Even if my therapist and I decided I was a little bit autistic, what good would it do for me to have another label? There’s no treatment, and having that diagnosis doesn’t help me solve anything.

When I was diagnosed with bipolar, it explained everything that had happened up to that point in my life, and I finally got the treatment I needed. After being diagnosed with anxiety disorder, I am working on ways to finally deal with childhood traumas in order to help cope with my anxiety. I have also been diagnosed with avoidant personality disorder; I haven’t researched it extensively, but it seems to describe my thoughts and behaviors related to social interactions. My psychiatrist and I discussed OCD, and it seems to fit pretty well, but we didn’t really dive deep into that rabbit-hole. And although I haven’t been officially diagnosed with ADHD, I am very sure I meet almost all of the criteria for the inattentive type.

disorders on order

I feel like I’m being pulled in many different directions right now, like that Stretch Armstrong doll when I was a kid. I don’t have much time for myself, and I have to be “on” a lot. I’m often asked to solve the emergency of the day. I have to play different roles for different people, and it is really tiring right now. I need a break, but I don’t have time for a break. I have one vacation day remaining at work, and I need it for something fun in September.

I have so many unfinished tasks and projects, and it’s a trigger for anxiety. I can feel it closing in around the edges of my vision. I wish I had the motivation to finish a few things, or just to make progress, but I give up because I can’t break things down into manageable pieces. It’s all or nothing, and I know it is distorted thinking, but as a result I’m mentally paralyzed.

I have been officially diagnosed with social anxiety and general anxiety, and I’m certain I have ADD and some elements of OCD. I don’t know how likely it is that someone has all of these things going on, but here I am. My new therapist asked me to consider if I might be on the mild side of the autism spectrum. I’m skeptical, but I’m doing some research to see what I think. I don’t think I need another label at this time, so I will ask her to table that discussion and help me work on social anxiety (which currently seems to be my biggest problem).

the cost of bipolar

I’ve had bipolar disorder since I was a pre-teen, and the costs of my illness have been eye-opening. I have lost educational opportunities and had instability in my career, resulting in a loss of many tens of thousands of dollars over the years. There have been the financial costs due to unnecessary purchases and moving to different places. There are significant costs for ongoing mental health treatment. I have lost or damaged several important relationships, and I nearly lost my life on a few occasions.

There are also the physical health costs associated with bipolar disorder. There is the weight gain associated with the meds I take, which causes me problems such as high blood pressure, the potential for heart disease, and lack of mobility. I have sleep problems, decreased libido, and ongoing gastrointestinal problems, all of which decrease my quality of life. Bipolar medication may one day cost me my intellect, if the potential for early dementia becomes a reality (I wrote a previous post about memory problems).

My bipolar has inflicted harm on the family as well. My wife has stayed with me despite over 30 years of instability and unpredictability, and it has cost her emotionally, including unhappiness, fear, and anxiety. She had to be responsible for raising the kids while I was unable to help due to my illness. She has felt like she has to work harder to make more money to pay for the medical bills (she doesn’t at this time), so she continues to work at a physical job and often has debilitating aches and pains.

My son and daughter grew up in an unstable home where I wasn’t mentally present for long periods, which in my opinion caused ongoing mental health issues. My son has battled depression, but seems to have dealt with it pretty well. My daughter has been diagnosed with bipolar, schizoaffective disorder, and anxiety disorder. Her illness has cost her most of her friends, dreams of a normal life, two potential career paths, and many thousands of dollars in medical bills. She struggles with emotional issues in addition to her other physical and mental problems.

therapy 5.0

You might recall that I didn’t seem to connect very well with my previous therapist, who was intent on making me do mindfulness techniques despite my lack of enthusiasm. He then suddenly left the practice, and I declined his invitation to follow him to his new office. I thought I could work on my anxiety on my own. Yeah, right.

This week, I started seeing my fifth therapist, who works at my psychiatrist’s office. The first appointment is always difficult, especially for someone like me who feels awkward talking about myself, to a stranger, trying to summarize my dumpster-fire life in an hour. I started out very nervous, like it was a test I had not prepared for; she actually offered me some fidget toys if they would help. I passed on the toys, but I calmed down a little while we talked.

She seems like a good listener; even though she was typing notes as fast as I was talking, she asked the right questions when necessary. She appears to be quite young, but I don’t have any problem with that. Her personality would be good with children, but she didn’t treat me like a child. Overall I got a good feeling from the visit.

After the short life history (which I struggled to keep short), she asked what the most important things were to discuss. I told her that I have already written a “field guide” to my many mental health problems, but maybe we could start with my social anxiety and general anxiety. She was interested in reading my lists, so I will print that out for next time.

I’m guessing that starting with a new therapist is as difficult for everyone else as it is for me. I am forced to immediately allow her within my “trusted circle” rather than getting to know her slowly, which is quite unnerving. This is a place where only a few people are allowed, and yet here is a stranger I am telling things usually only reserved for my blog friends. At the same time, I have to remember she is a professional, paid to listen and help me solve problems, and we’re not going out for coffee afterward.

mind reader

I hate having to be a psychic, but I do it all the time. How else would I find out what horrible things my friends and loved ones feel about me, let alone what the barbarians in public think? It’s all about me of course, and while people won’t tell me what they’re actually thinking, with just a glance I can read people’s minds and know how they really feel about me.

This is ludicrous, of course. While I can pick up on non-verbal communication as well as the next person, there’s no way I know what they are thinking. What I’m really doing is making an assumption based on my interpretation of what is said and those non-verbal cues, and usually my assumption is incorrect.

I define my self-worth based in part on what I believe others think about me, because it is difficult for me to believe that I am worthy of someone’s love or friendship. I am constantly trying to get a real-time gauge on where I stand with a person, which is impossible if the person isn’t explicitly telling me their honest feelings. People very rarely do that of course; sometimes they filter their thoughts, sometimes they lie, and sometimes they say nothing.

I assume the worst when people don’t speak to me, whether due to physical distance (I’m too far away to hear), social norms (people don’t often speak to strangers), or by choice (someone could speak but is choosing to ignore me). In each of those cases, I feel like I have to fill in the blanks with what I believe their thoughts are at a given moment. Then I interpret those invented thoughts through the “I’m not worthy” filter, and reach the illogical conclusion that everyone is thinking negatively toward me in some way. This black-and-white thinking is clearly distorted, but I fall into the trap every time.

When I can look at things logically, I can see things from a less judgemental perspective. Strangers are probably not thinking about me very often, and possibly not at all. Acquaintances may have a nuanced opinion about me, while friends apparently like me despite my flaws. Loved ones care about me for my positive qualities. I don’t have to be on-guard against others’ negative thoughts all the time; that’s just an artificial defense mechanism that I learned during childhood.

However, thinking logically is difficult when your spouse is giving you the silent treatment, and you can’t figure out why. It’s easy to be emotionally insecure when a social interaction doesn’t go as you think it should. Fears of rejection, awkwardness around people, and feelings of inadequacy cause me to fall back into the pattern of self-centered, black-and-white thinking. I spend a lot of mental energy in this way, and it detracts from my well-being.

rear view

I was looking back at my posts from early 2021 that followed the arc of a long manic episode. The posts from that time aren’t scary like some of the deep depression posts from the old blog, but they are interesting to me.

My episode started with the side effects of starting on Latuda in November of 2020; I felt pretty good for a few weeks, but I started climbing the hill in December. By January 2021, I was frequently staying up in the middle of the night, my anxiety was climbing, and my OCD symptoms became overwhelming. I couldn’t concentrate at home or at work, I was having panic attacks, and I almost left my job out of frustration. After quitting Latuda and returning to Abilify, there was a long downslope where my symptoms were decreasing steadily, but were still there. I was afraid something had permanently changed in my brain. It wasn’t until May when a solo mini-vacation brought some relief from the storm.

Looking back from a year later, I am reminded how much I was struggling. This manic episode seems odd because on one level I knew what was happening and how dangerous it was, but at the same time I was very much caught in its uncontrollable grip. I didn’t think I could fly, but I believed that my life would be better if I tore everything down at work and at home. Had I followed through with my late-night schemes, it could have damaged my family relationships, cost me tens of thousands of dollars, and jeopardized the continued treatment for myself and for Nicole. I think I escaped the episode just in time, because I don’t know what I would have done if I had remained manic for a longer period.

My bipolar experience has been mostly depression, with very brief manias or mixed episodes followed by a deep spiral. This episode was different in that it had a long buildup and a long letdown, and I didn’t crash in the same way I had in the past. Since that time I have had no mania and a few depressions, and not with the abruptness and intensity as in the past. I know mania will happen again in the future, but I think having been through this most recent episode makes me better equipped to deal with it.

black box warning

Relationships should be a positive thing, but I feel like they cause pressure and bring a sense of obligation to be an equal partner in the relationship.

It’s not being selfish when I don’t fully participate in the give-and-take, but it is being protective of my own psyche. Sometimes I just don’t have enough spoons for anyone besides myself. I don’t always have the mental or emotional capability to give everything that is expected of me, and I feel guilty because I’m not contributing enough.

If I were single right now, there is no way I would try to develop a romantic relationship with someone. I wouldn’t want to spare enough mental energy to put the effort into being a good partner. In addition, the other person would find too many faults and would run away as fast as they could. I guess this says something about my wife’s love for me, as well as her loyalty and perseverance. This also is an indicator of my being unable to see myself as worthy of someone’s love.

I guess it has become a thing to give out personal business cards when meeting other people. People like me should have a black-box warning on the back of the card:

WARNING: This person is damaged, and will disappoint you in myriad ways.

underwater

I’m not doing well. This is the first real depression episode I’ve had while on the new drug. I don’t think this is a chemical depression; it is more emotional in nature. There is a deep, pervasive hopelessness right now, and nothing is able to rescue me for more than a fleeting moment.

There seems to be no break from the negativity. I might socialize with people at work, but it’s all fake. Music may calm me temporarily, but I know after the last note I will be depressed again. Food might please me briefly, but I know every bite is bad for me.

[Insert 400 words of self-wallowing drivel here. I don’t want to write it, and you don’t want to read it.]

inadequate

I don’t feel like I’m good enough for anyone – not as a husband, a father, a son, a friend, or a worker. I’m not good enough for my own standards of what I want my life to be. I feel like I let everyone down on a consistent basis, and that I’m not trying hard enough. I’m just a substitute until the right person comes to replace me, and they will do everything better.

I define my self-worth by how useful or helpful I am to others, and right now it seems like I’m not useful or helpful to anyone.

Sometimes you just have to face reality, and my reality is that no matter what meds I take, they can’t change the fact that I’m just not wired to be a happy, successful person. I want to be that guy, but I can only fake being that guy until I can’t fool anyone anymore.

dermatillomania

I have been picking at my fingers since I was a kid, but until recently I didn’t know there was an actual name for this. Dermatillomania is a real disorder in the DSM-5, and is diagnosed when someone causes repetitive injury to the skin through scratching, picking, or biting that results in an injury, with an inability to stop. It is related to OCD, but differs in that people with OCD perform compulsive actions to relieve anxious thoughts, but skin-picking is often more pleasure or sensory-based. [Link]

Picking at my fingers is something I feel the need to do despite the pain, blood, and embarrassment. I find visible or perceived imperfections and have the urge to pick the target area. I also look for fingers that seem “too perfect”. I pick at and mutilate my fingers and cuticles, usually with a fingernail, my teeth, or tools like tweezers or a push pin. There is never a time when my fingers don’t have some level of injury, and I have permanently damaged a couple of fingernails due to the repeated picking.

It’s an uncontrollable compulsion that is always present; in the moment I know what I am doing, and I know I should stop, but it feels good to remove that imperfect piece of skin. However I can’t always remove just the imperfection, and I make the problem worse. I know when it is going to hurt and bleed, but I follow through anyway. I do it even though I know my fingers will look horrible to anyone who notices. Sometimes it is bad enough that I have to use band-aids to stop the bleeding or to help heal the raw areas. When I take the band-aid off, the skin is moist and pliable, and sometimes I go right back to picking in that spot.

I think the urge to pick increases during stress or anxiety episodes, or during a hypo or mixed mood, but I pick when I am feeling well also. I keep score of how many fingers are bloody at a given moment, and it correlates directly to my anxiety level. Today my score is a 6, but tomorrow it could be 7 if there’s a nice juicy cuticle that needs picking. Sometimes I can temporarily will myself to stop picking, or put off the urge, but eventually I will do it anyway.

It’s not a harmless habit, but in the big picture it is a minor problem. In the moment I enjoy the picking, but later I regret doing it. Having people see my bloody and mutilated fingers is occasionally embarrassing, and covering multiple fingers with band-aids is noticeable, but I don’t seem to obsess on that thought.

I searched for ways to help stop this behavior; several resources focus on combinations of therapy (sometimes CBT) and stress reduction using mindfulness (oh fuck, not that again). The Cleveland Clinic even suggests substituting different behaviors such as going for a walk. One, I can pick my fingers while walking; and two, if I could substitute another less harmful behavior, I would already do it. I’ve thought about wearing a rubber band on my wrist and giving myself a good snap, but that would be less satisfying.

stressed but not depressed

It’s been a few months since I had a true depressive mood swing. I have been a little melancholy a few times, my concentration is terrible, and I have had anxiety issues. However, my overall mood has been pretty even since December. I’m almost not sure what to do without having the feeling of the dark cloud following me. It’s easier to accomplish things and make decisions when you don’t think your world is going to end tomorrow.

I have been stressed, however, because it’s been rather busy lately:

      • We successfully found a new psychiatrist for my daughter; the doctor has plans for treating her ADHD along with the bipolar-or-maybe-schizoaffective disorder. I hope the doctor will be responsive to messages or phone calls in case things change or don’t work well.
      • We had roof leaks probably caused by ice dams on the roof. We had contractors and insurance people here last week, which was the easy part. The hard part was dealing with the three very loud fans which operated for about 5 days straight to dry out the ceiling. The three of us and the cats almost went nuts.
      • Our dishwasher died, so during the middle of the leak mitigation we had a new dishwasher installed. Actually, the second dishwasher was successfully installed; the first one was 1/2 inch too tall for the cabinet space. We bought from a local small business, so it was easier to work with them than it would have been with the orange big-box hardware store.
      • We have airline credits that expire at the end of March because we canceled a vacation due to Covid in 2020, but a major airline (starts with A) will not extend the date to use the credits. We really had no plans of going anywhere, and during spring break time it would cost more to stay somewhere fun than it would to just lose the credits. Instead, we are going to visit my mother for a few days. I haven’t seen her in over 4 years (since the Butterfly Incident), and she would be happy.

Anyway, off to work (at home), where I will fight boredom and struggle to stay focused on tasks. Yay.

don’t talk about it

When I was a kid, life at home was pretty messed up, and I was aware of it from about age 8 or 9. I didn’t want anyone to know what my home life was like, and I never talked about home to any of my friends. I never invited any kids over to my house, even though I wanted to. I always went to other kids’ houses instead so no one would know what it was like in my home. I was ashamed of my life, and for not being able to deal with it; this was the start of my depression.

Fear and suspicion of other people was drilled into me from an early age. What went on at home was “none of their business”, they being people at church, teachers, kids at school, the government, or the neighbor lady who listened in on the telephone party line. School counselors were off limits because they might tell someone else who would interfere in “our business”. I would feel immense guilt if I wanted to talk to anyone I knew about my problems. There was no safe place for me to vent. I didn’t know what a hotline was or that you could call to talk to someone anonymously.

I was taught to avoid all forms of outside help. Counselors and therapists and shrinks were not to be trusted. I was depressed all the time, and most of the time I felt like I needed to fake being okay. I felt like a fraud, and like I was divided between two existences. On the outside I had to pretend that everything was fine, and on the inside I suffered. I knew things weren’t right, but I had been taught that admitting mental illness meant you were weak and vulnerable and stupid, and I couldn’t admit those things to myself or anyone else.

I didn’t feel like any of my friendships meant anything, so I pushed everyone out to the farthest circle of my defenses as if they would hurt me like so many people had before. I was being fake with them because I couldn’t trust anyone. By 7th grade I had no real friends, just acquaintances who thought they were friends.

My friend Lisa was the first person I let myself get close to in a genuine way. She was caring, intelligent, wise for her years, and she valued me for myself rather than as the “smart kid”. I felt safe with her, like I didn’t have to pretend to be someone else. I finally allowed her inside my defenses and let her see into my life. I shared way too much of course, but she was supportive and comforting. She returned the favor, letting me know some of her secrets that she couldn’t share with other people.

Since that time I have grown emotionally, but I still struggle to trust anyone. It is difficult to be honest and genuine with people for fear they will hurt me somehow. I have several acquaintances, and a few next level “work friends”, but really only a few friendships that I value enough to where I can have some level of trust. Then I have you, my blog friends, who I trust with almost everything.

ending therapy

I received a letter from my therapist explaining that he is no longer practicing at my psychiatrist’s office, and my scheduled appointments are canceled. If I want to continue seeing him, I would need to visit him at his new location.

After some thought, I’ve decided I’m not going to continue therapy with him, or anyone else. I was thinking about ending our sessions anyway, as I wasn’t getting a lot of benefit out of them. His emphasis on mindfulness didn’t seem to work for me, and sometimes he appeared to not really have any alternatives. There were a couple uncomfortable moments where he would struggle to find something to talk about. He might be effective for someone else, but apparently not for me.

I’m not really emotionally affected by this. I know some people have a true connection to their therapist and see them as a lifeline to their continued mental health, but I never had that feeling. In the past I have had the idea that I “failed” therapy three different times. I don’t feel this was a failure for either me or the therapist, I think we just weren’t compatible or complimentary.

When I started seeing him, I wanted some techniques to work on the constantly increasing anxiety that I struggled with a year ago. I now think it was a physical effect of a long manic episode, because my anxiety slowly decreased when we got the medication right. I still have plenty of anxiety, but it has returned to a manageable level at this time. I don’t think I need individual assistance in dealing with my problems. I need strategies to work on my social anxiety, but I think I can do it on my own at this time.

thanks for the memories

My daughter and I both have memory problems, and I believe they are directly related to bipolar disorder. We were talking about this recently, and she said she has forgotten lots of things, but it also feels like she never made the memories at the time; there is simply nothing there to remember. I never thought about it that way, but when she said that, it completely made sense.

I’ve given this more thought since that conversation. Looking back at what I remember and what I’ve forgotten, it seems like my ability to make and retain memories correlates to how severe my bipolar mood swings were at the time, and the depressive moods in particular.

I remember some of the depression “highlights” over the years, but during the times I was severely depressed there seem to be large blank spaces in my mind. School happenings, kids’ milestones, and my own work life just blend into a grey fog. I also have some memorable manic or mixed moments, but I seem to remember mental images from those times rather than the context of what was happening on either side. These memory snapshots don’t do anything to help me remember the life events surrounding the moments I do remember.

The memory loss feels strange, but just as odd is my ability to retain many events from times when I was alone. For example, I can remember locations I delivered or picked up from while I was a truck driver. I can remember places I’ve been hiking or exploring or just driving around by myself. I can remember vivid details about places I visited many years ago. In addition, I can remember lots of useless information and trivia (people always told me I should try out for Jeopardy, but I never wanted to).

My memories are often triggered by something else, whether it is music, a photo, or a geographic location. If I can associate a moment in time with a particular song, I will remember it for many years. For example, I recently listened to some music by Wham! for the first time in a long time, and it triggered a memory of driving through the Sierras in the dark when I was 18. A Hall & Oates song reminds me of a railroad crossing on a main boulevard in San Jose. A Tears For Fears song reminds me of a girl I liked in 9th grade, but also specifically of one part of a highway in Sacramento when we were on a school trip together.

I guess the part that bothers me is that I don’t know what is normal and what is not in my bipolar-addled brain. I think most people make memory associations from photos or music. I realize that normal people don’t remember everything about their lives, and usually just the highlights are what they remember. But I don’t think people typically have long years of time where they forget virtually everything. People have told me I had a great memory because I can tell them obscure details from events long ago, but I feel like my memory is getting worse all the time. I don’t know if it is caused by bipolar brain chemistry, long-term effects of psychotropic drugs, or early dementia coming on.