Guest Blogger

Living with mental illness

Filed By Guest Blogger | December 10, 2009 1:00 PM | comments

Filed in: Living, Living
Tags: bipolar disorder, living with mental illness, mania, mental health, transgender

Editors' Note: Guest blogger Autumn Sandeen is a transgender activist living in San Diego. Autumn SandeenShe is a regular barista at Pam's House Blend.

Last Thursday was the International Day Of Persons With Disability. Many of the folk commenting in the thread for the Pam's House Blend diary Today Is International Day of Persons with Disabilities wrote about their intersections of LGBT and having mental health issues.

Well, I think I need to come out of the closet on this in ALL CAPS -- I too have a mental health condition. And, it's more than just the technicality of having Gender Identity Disorder (of having GID -- as all transsexuals are officially or unofficially diagnosed). Hey, I'm officially mentally disordered -- I was diagnosed as having Bipolar Disorder Type II quite a number of years ago.

To give an example of how I experience my bipolar condition, this past Thursday evening -- the same day as the International Day Of Persons With Disability -- I experienced a pretty severe bout of hypomania when covering a story form Los Angeles (that I'll be putting together in the next day or two). It was hypomania that ended in a something akin to a panic attack -- I experienced about 2/3's the symptoms of a classic panic attack; the bout began just before I left to go home to San Diego. I'm assuming it's a state that is, or is close to, what mania would (or maybe does) look like for me. This is only the third or fourth time in my life I've experienced that kind of severe panic/mania related symptoms, but these severe bouts have all occurred within the past two years. So, I think it's safe to say my bipolar condition is slowly worsening...even with treatment.

[More below the fold.]

Normally, I function well enough for day-to-day activity. I take a mood elevator for depression, and a mood stabilizer for the mood swings -- these generally keep me emotionally pretty flat.

Stressors can set off my mood swings. One trigger that has in the past has set my mood swings in motion is insufficient sleep, so I make sure I'm well rested, and keep regular hours as much as possible.

Stress is the other of my two main triggers for rapid hypomanic-depressive mood swings...especially extended periods of unresolved stress.

But, when it comes to impetuses behind the beginning of bipolar mood swings, sometimes there are just no known impetus I can point too -- sometimes these hypomanic-depressive mood swings just start up for no apparent reason. This happens to me about two or three times a year.

And too, the difficulty of having my mood swings includes very rapid cycling -- sometimes I cycle through what I would cal significant hypomanic and depressive moods several times in single day.

So, I know I have bipolar mood swings, and I've had these mood swings frequently enough to recognize the symptoms relatively quickly after onset -- Well, what do I do about it? This is what the National Institute For Mental Health (NIMH) says I should do these things if I know I'm bipolar:

How can I help myself if I have bipolar disorder?

It may be very hard to take that first step to help yourself. It may take time, but you can get better with treatment.

To help yourself:

  • Talk to your doctor about treatment options and progress

  • Keep a regular routine, such as eating meals at the same time every day and going to sleep at the same time every night

  • Try to get enough sleep

  • Stay on your medication

  • Learn about warning signs signaling a shift into depression or mania

  • Expect your symptoms to improve gradually, not immediately.

Yeah, I've learned spot my symptoms. As I'm writing this, I'm entering "the zone" -- I'm experiencing the start of a hypomanic bout. If you read the link on hypomania you'd have learned that bipolar people in a hypomanic state are often in their most productive place. I know when I'm feeling just a bit hypomanic, that's where I'm personally in one of my productive places.

So, with or without symptoms of my mental illness expressing, there is a treatment plan for my Bipolar Type II Disorder that I follow. I eat the pills to stave of the mood swings and depression; I talk and talk -- going to talk therapy helps keep my stress levels low. I try to keep routines -- which is when I say "I don't travel well," you can read into that the breaking of routines. I also have two "kats" -- pets aren't on the list, but connecting with them has been extremely helpful in releasing stress...finding warmth and comfort in day-to-day life.

Another of the things I intentionally do is keep my stress levels artificially low. Just normal work stresses have set of those rapid hypomanic-depressive mood swings when I was working (which is why I'm retired at 50), and even before the panic/mania related symptoms started showing up, those mood swings were debilitating -- those mood swings left me only intermittently functional as a member of employed society. So, I try not to take on responsibilities I may not be able to follow through with.

I can't overstate the importance of treating my symptoms systematically, and compliantly within my treatment schema. In the worst of my hypomanic and depressive states, I've had suicidal ideation. Most people think that bipolar people are most susceptible to committing suicide during the depressive state -- The actuality is that bipolar people often commit suicide in the hypomanic/manic side of the mood swings. This is because one tends to be in "the zone" and connecting thoughts; one can tend to be hypercritical of oneself in a hypomanic or manic state. Suicide can follow that hypercritical take on oneself.

I've also found not pulling into my shell -- not "turtling up" emotionally -- and letting my close friends know when I'm having mood swings. Spending time with my friends helps. I know that my bipolar symptoms pass, yet sometimes working through the mood swings is making sure I keep in mind I'm not alone; others care. I spent this past Saturday with my friends Vicki and Lynda, in part because I love my friends, partially because my friends love me, and partially because I need to especially make sure I'm not alone when I'm having mood swings -- that I'm connecting with people. This is for my own long term survival.

People who deal with clinical depression often "turtle up," thinking that they are alone, and no one else is going through, or has gone through, what they're going through. I know very, very few trans people who haven't gone through clinical depression as part of their coming out process. And, as Jos at Feministing reminds us about studies of trans youth and young adults and trans people:

The number of trans folks who have attempted suicide ranges from about 30 percent to over 50 percent in studies. One study found that 83 percent of trans folks have considered suicide.

I don't know what the suicide and suicide contemplation rates are for trans adults are, but I'm sure the rates are very high.

And, of course, what was one of the stressors that has left me feeling personally distressed these past few weeks? Mike Penner's (a.k.a. Christine Daniels') apparent completed suicide.

I've missed the Christine I knew for quite a long time. As many of you know, I've missed Mike since he stopped talking to me in December of 2007; I mentioned the personal pain I felt upon hearing of the detransition from Christine Daniels back to Mike Penner. His passing from an apparent completed suicide has been incredibly stressful for me.

I thought of Mike as my friend; my eyes have welled with tears several times a day as I mourn his passing. Some days I sob. I suspect that his death had much to do with the internal stressors he felt in large part from having a gender identity that didn't match his natal sex. However, I've heard nothing concrete that confirms that suspicion, and not knowing is a hard thing for me to take.

That said, I can't help but think about Mike's apparent completed suicide and his trans experience are connected; and even if it wasn't connected, depression almost assuredly was connected.

And, this is the hard part -- I've been diagnosed with a propensity for depression; depression that's connected to my bipolar condition. Can you see the dots my brain are connecting Mike's life experiences and my life experiences? And, I can assure you there's more similarities between Mike and I that I haven't highlighted in this diary...

So, I talk to my friends; I talk to my therapist. I sleep. I keep a routine. I've had my medications adjusted just this past week; I take the pills. I remember that I've been through this before, and I'll make it through this again. And, sometime soon I'll be back to being as fully functional as I usually am; many if not most people who live with depression or bipolar conditions can and do lead productive lives. I'm not so special as to be an exception to that capability for productivity.

And now, I'm sharing this with my lesbian, gay, bisexual, and transgender peers. When I've written in the recent past about the intersections of disability and the LGBT community, I'm one of the folks where these intersect. And too, if you met me in person, you'd likely not be able to tell I'm disabled -- my disabilities are invisible to the naked eye. My life experience is an example of being invisibly disabled.

So, do you think less of me now? There is stigma associated with being mentally ill, no matter how functional one is in society. I can tell you my personal experience is that my being trans seems to have less stigma to it than my being mentally ill.

Now you know the main reason why I've a Veterans Administration Disability Rating of 100%. And since my bipolar condition was diagnosed in late 1996 -- four years before I retired from the U.S. Navy -- my disability is considered service connected.

And there, I'll leave it -- it's something for y'all to think about.

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Autumn, I've followed you and read your work for some time now, and I have to say I've always admired your courage and spirit. Coming out as Bipolar is extremely brave and I thank and congratulate you! BIG HUGS!

So much to say, but it comes down to this: You are not alone.
Many of our LGBTIQ persons have mental health issues and are either unaware of it or are simply so used to dealing with the added stress of being queer, that they don't know what normal is. We self-medicate, we hurt ourselves, we attempt suicide. You have shown another way, and this is a hopeful sign to me- the beginning of the end of mental health stigma in our communit(ies).

On a professional note, some of my bipolar clients have had amazing success incorporating meditation into their daily routine. Twenty minutes a day at least three times a week has been effective in lowering the frequency and severity of cycling in persons I have worked with, and is now being supported scientifically. It might be something that would work for you as well.

Regardless, I admire your honesty, your spirit and your generosity in sharing your experience with us. It really does make us all stronger.

Didn't know this, Autumn. Working with Bil for a few years has given me a crash course in bipolar. I'm surprised to hear you say that hypomanic means you're more productive... usually the most I hear of hypomanic is "Alex, I'm hypomanic today seriously I won't be around."

Thanks for sharing.

Actually, hypomanic is where I live most of the time - and when I get the most work done. It's when I hit mania that things turn ugly; I'm just lucky that my bouts don't last that long. Several people can go through weeks or months of mania at a time; I'm lucky to go a full week.

Some "zones" are better than others. Sometimes hypomania means for me I'm unproductive, but more often than not it means I'm at "110%."

Currently, hypomanic has been more unproductive, and I think it's the impetus -- Zoe has a point (below) about situational emotions. Situation-related emotions don't always trigger mood swings for me, but when situational stress does trigger my mood swings, these triggers influence how my hypomanic-depressive mood swings cognitively express.

But certainly, as Zoe says, it would be really surprising if Mike's completed suicide didn't impact me emotionally. As a human being who loved Mike, I should be pretty damn sad. It's just given my brain chemistry, sustained sad has often been a trigger for my bipolar mood swings, so this bout of mood swings was actually predictable.

Still, it suprrised me. My internalized ableism meant

I thought of Mike as my friend; my eyes have welled with tears several times a day as I mourn his passing. Some days I sob

Me too, Autumn. That's situational, not clinical.

Last time I lost it was yesterday, while talking with my GP. Christine's writings reflected more clearly than anything else our mutually shared experience. She got into our heads, and our hearts, and let us into hers.

Just a data point from someone who's not BiPolar, but is feeling exactly the same.

If you didn't feel this way, then I'd worry about you. There's such a thing as psychic numbness, when you get not just pain, but shock from mental damage. "I have become... comfortably numb".

Neither of us are in that place. We will survive, and heal. If only it didn't hurt so much....

I don't want to be Pollyanna-ish, but I think that when all the medical problems of transition are done with, the stress levels that seem to be causing your BPD condition to worsen will be gone. That may lead to not just remission, but actual cure. Or at least, reduction of symptoms so that medication isn't necessary.

I wouldn't claim that mental health problems don't exist — antidepressants have probably saved my life. But I think that there's a lot of pathologizing of variation these days. Life seems to be offering an increasingly narrow range of options, so now if we can't be happy sitting at a desk for eight hours a day (often in a windowless room) we're expected to get medicated.

And I think that those numbers about how many trans people have attempted suicide, or whatever, are basically complete fabrications. Nobody has any idea at all how many people have a transgender identity and never tell anyone in their whole lives. 83%? There's no way to know, and pseudo-precise numbers are pointless. It's hard being trans, and we don't need any made-up numbers to prove that.

Matthew Cross | December 14, 2009 11:21 AM

Thank you so much for sharing this.

I just discovered this thread, so I'm posting a bit late.

Ms. Sandeen, I support trans equality. As a bipolar survivor, I support and sympathize with you there.

I feel I should be frank & honest:
Over the past few months, Ms Sandeen, I've seen you become quite vindictive towards people with whom you disagree.
I can't help but wonder if you're in a manic state at those times. I ask in part because I've been there, done that, in the past when I was manic.

My bipolar is relatively mild, I'm well enough to work full time.
My meds have stopped by manic attacks.

But my former partner's bipolar is far more severe.
He now lives on SSI with an anti-gay conservative Christian family who use his disability as a control device.
When I turned to gay rights groups & activists for help in putting a stop to what these people are doing, I was laughed at.
Many of our "leaders" made fun of the fact that he & I are not together.

I have yet to get real help RE: the horrible things my ex's housemates have done, which include withholding his mail behind his back & getting him to sign falsified documents he cannot read.

I'm now wondering if the escalating mental health crisis among LGBT people is being fueled by the less than humane way we treat each other?