Feeling dodgy on the way to La-la land

Imagine you are juggling 3 balls comfortably, but then someone throws in an extra ball. It throws you off your step, but you manage to keep a hold. But then another ball gets thrown at you and you start to drop balls all over the place. This is what its like building up to a manic episode. Your tummy feels fluttery a lot of the time and you have a bubbling stream of weird excitement jogging along with you. You know its there but its like a lid is pushing down on it, and for now at least, it gently propels me along at a pace I can just about manage. I have a curious sensation of being attached by a wire to the body that is separating out in front of me. The body in front is the one that is rushy, taking at 100mph, taking on far too much work and generally being a bit loopy. The trailing body is the one that watches on in despair as it predicts the hideous crash that will inevitably happen, but feels completely powerless to intervene. The thread of connection becomes more stretched and tenuous the more I speed up.

I remember seeing my psychiatrist at the begining of May and telling him I didn't feel quite right. It was definately the odd before the storm. That little orange nylon covered chair that pushes up next to his desk is a comforting safe place. I wasn't keen on leaving after our 20 minutes, but he said, "If you have any problems before your next appointment, just telephone."  Famous last words.

So during May things start to pile up. I'm trying to organise a conference for approx. 100 people, using a whole new approach (the whole systems approach) and I keep having to have extra meetings with a woman we all fondly begin to call chlamydia because we can't pronounce her name correctly. People are going off sick too, or, being redirected to other work instead of helping me. I am under lots of scrutiny from up the 3 line whip and everything is feeling a little bit unmanageable. The stress also increases as I have 2 weeks holiday booked, which will parachute me back into the chaos 2 weeks before the conference actually happens. Oh yeah, and I'm meant to be doing a workshop for 25 people with my boss as well as attending meetings and mediating between the variety of tossers who think being a strategy manager is an easy job and involves doing nothing. I ask for extra help or for someone to keep an eye on my e-mails etc. in my absence. Every ones looks at me as though I just popped a shit biscuit in my mouth. I'm on my own.

Lets discuss the business of being busy

Now you may well be wondering why I haven't written so much about the actual bi-polar diagnosis yet, or even got to the point of diagnosis? Its for a reason. A diagnosis can be made on say, 2 episodes of mania in 2 years, or a few short bouts over an extended period of time. So it can actually take a while to capture a patient in a full blown episode and ensure that it is definitely mania and not just an over excited and gregarious disposition. Also mania doesn't always last that long, and some people actually love the feeling and choose to not take medication, advice or action. They stay in it and wait for it to pass. For most of us the hardest thing to cope with is the crippling depression. Saying this though, if you ask any of my friends or family, they will tell you that I am a high speed, energetic person, prone to days running around like the Duracell bunny.

From my initial referral interview with my CPN up until the end of my self esteem CBT course, I have regularly discussed my "rushy" episodes, when they happen and what happens. I kept a diary for a while and they were unpredictable, but significant enough to warrant attention. When my CPN and I first talked to the psychiatrist Darren about it, he dismissed it out of hand. He felt that it was probably a side effect of the high dose anti depressant or taking too many stimulants. In my case that means only coffee. I knocked booze and party drugs on the head a very long time ago. As I mentioned, the run in to my initial contact with psychiatric services involved me being 100mph in the head and verging on suicidal. Sadly the professionals didn't see me like this, all I could do was explain it after the event when I slowed down a bit. I talked to my new psychiatrist about it and he felt that it did need further scrutiny to see if there is a difference between my general upbeat, rather too bouncy and annoying self, versus something even more fast paced and detrimental to my well being. I'm not keen on the waiting game and to be honest, even though I am "well" I don't feel quite right.

So here is how the land lies. I'm doing CBT self esteem course, I am up to 3 days a week in the office, one day at home, taking my anti depressant medication and seeing my psychiatrist every 6 months. It seems ok but then things start to get a little stressful. As I said, something just didn't feel right and during the May things started to go a bit wrong.

Thinking bias, mood contamination and my dodgy internal barometre

So, I've been talking about my inner beliefs about myself, and as well as these low self esteem thoughts I get additional body states, behaviours and emotions that go with it. You know like emotional fatigue, headaches, over eating; perfectionism, people pleasing; fearfulness and anxiety, hopelessness, depression. Low self esteem is not a pleasant state of being. I'm already at war with the depression and it appears that I also sabotage my life by wrong thinking. This is what I mean by thinking bias. My mind has made up its own little rule book of how to interpret information and eradicate low self esteem.Unfortunately, my mind has actually got it all wrong, and what its really doing is keeping me enslaved to the folly that is my bottom line thought - you know the "I am no good" thought. This is only one of a series of bottom lines that I have - I have a low self esteem broad sheet newspaper going on in my head as well as me being its biggest critic! Its very noisy up there in my grey matter.Maybe I am a twin stuck in one body, and the child that is trapped is resentful and won't shut up!

Here are a few thought biases/wrong thoughts that i have:

• I get given 99 positive comments and 1 bad - I only hear the bad (Filtering)
• If I am not good at badminton it means I am bad at everything (Labelling)
• I missed a payment on my credit card; this means we'll get bad credit, lose all credit options, we won't get a new mortgage, my husband will be mad so we'll end up divorced (Catastrophic thinking)
• My friend cancels lunch, which in my head means she doesn't like me I must have done something wrong (personalization and blaming of self) 

I know it's awful isn't it. Thank god you're not me eh?

Thankfully because all of this stuff is just opinions in my head, apparently it can be changed. Ironically all of the group members feel so rubbish about themselves, none of us actually believe that we can change, which is a representation of a bottom line that we all share which is, "Its one rule for everyone else, but it'll never work for me". It becomes a bit of a group joke throughout the course when anyone goes a bit off track or makes a sarcastic or self deprecating comment we all chant in sing-song voice, "That'll be your bottom line!"  The excellent thing about group working is that you can see so much of yourself in others and the mirror never lies.

At this juncture, I will not go into a blistering tirade about a crap childhood, trauma or or self inflicted horrors but what I will say is that my low self esteem has been around for a very long time. The more I explore my behaviour I begin to accept that I need to unpick the massive rug of protection measures I've been stitching together, unravel the wool, and make it into a snug cardigan that keeps me warm and held. I must start to focus on my strengths and not my weakness. I've been looking down the wrong end of the telescope and I really need a reality check. God bless me - it's at times like this I wonder how many other people are walking around with this type of dialogue going on in their head.We are all our own little universes, bobbing around and knocking into each other, and  we never truly understand one another. It's rare to meet other brutally honest people who will actually tell you the truth. Many a time when someone has asked me how I feel and reply, "Shit actually", they look at me aghast or fall about laughing. Honesty is very underrated you know, and sometimes I'm sure people think you are saying it just to raise a laugh. Many people can't tell these days if I'm being honest or funny. Openness, directness and frankness are more akin to presents for Jesus than traits of character I swear.

I suggest you go out and try it one night. Go on - Do a CBT experiment I dare you. Be blunt but not vicious.I assure you, it will be a very interesting experiment. People will think you've had some kind of mental episode, which is the paradox really isn't it. Normally we'd be all submissive and polite or lie, which is actually dishonest. Lets hope you're friends are understanding though. They might just think you've lost it. Welcome to my world.

Keeping a lid on it

If I stand still for just a minute and take stock of my situation, I am baffled as to how I keep it together sometimes. I don't know whether its because I am stubborn, courageous or just plain stupid, but I keep plugging away even when an episode of doom lurks over the horizon. I have a vision in my head, and it doesn't include not being able to work, going to hospital, needing additional help to look after myself or abandoning my current life as I know it. This may well be misjudged or unrealistic but it is how I am currently managing my life.

I think I see my illness as the enemy. If you make friends with it you keep it close and always have one eye on it. Its a constant power struggle, where I perpetually realign myself with what comes on any particular day. I have to give myself little milestones as markers to see if I am on top of the game. The hardest thing I think, is trying not to state out loud the whole time, "I am finding everything difficult. Please give me 5 minutes to chill out and catch up."  The irony in this is when I am hyper manic, I feel like shouting, "Catch up for goodness sake! You're all going to slow". Balance and mundanity are not something I am familiar with.

So my day goes a little bit like this:

• Get up and check mood - get out of bed regardless
• Eat breakfast and try not to become overwhelmed with toddler chaos
• Practice laughing at my intrusive thoughts whilst making breakfast and cups of coffee
• Deliver children to nursery whilst being assertive but loving
• Drive to work, ignoring  internal dialogue which usually revolves around "I'm not good at my job, my boss regrets employing me, I must try harder" etc. Actively sing along to the radio to quiet mind noise
• Get into work and choose to be upbeat and engage with people, ignoring negativity and focusing on the positives
• Plan work around times when I am productive and energy levels are good
• Take a proper lunch break even though the office culture tends to promote a lunchless day and try really hard not to spend money compulsively on a load of rubbish whilst out and about
• Attend meetings and work really hard at externalising i.e: Count the windows, recite words from the page, actively listen if zoning out, disregard nasty high level managers attitude and practice taking reality snap shot (getting stuck in my head ruminating is not good for me)
• Have a caffeine break at 2-3 as my energy and mood dip at this time
• Finish off tasks if possible, but leave work if necessary (This is difficult as I am a conscientious worker and a perfectionist). Accept any constructive criticism and focus on accomplishments of the day
• Drive home without rerunning the whole day over and over again in my mind, and picking on the things I think I have done wrong
• Collect children and ensure positive praise and physical affection, even though I feel like curling up under my quilt for 3 hours first
• Arrive home and do some housework, including chemicals, knives, hot water and the like (More exposure therapy) and force myself to be loving and gentle because really I want to have a rant - my mood does not dictate my behaviour
• Put kids to bed, eat a meal and finally sit down
• Go to bed at my regular time, taking medication and respecting the sleep hygiene rules

Exhauting, isn't it.

Now this is my day in a very basic format, but what I am trying to show is that I have to work throughout the day to ensure I stay on top of my depression and symptoms. I also have to listen to my mind and body if things start to go off kilter. Now that is the really hard bit because most people have bad days, mood dips, react badly, make mistakes and get narked if someone tells them off. But at least I am living and not existing. I am not letting the beast drag me down. Oh yes, and actually I find out from my colleagues that the individuals I struggle with, the ones who are really horrid to be around, are actually resented and disliked by everyone else. Well thank god for that. I am not alone.

So where were we with the self esteem group?

I'm wearing my guts on the outside

When you have to be blisteringly honest about yourself in a room full of people, it really brings home to you how fragile and vulnerable you feel. After our first session I experience the emotional hangover from hell, and want to cry the whole time. It's like I've been filled up with cement and can't think straight I am wearing a suit with my guts on the outside all raw and exposed. I think that everyone can see my crippled soul.  Immediately I feel resistant to the change, and I can sense my inner voice telling me to run away. I'm caught between a rock and a hard place. I have to go through the pain otherwise I will always have low self esteem and this will exacerbate my depression. I 've got to put myself through this for another 9 weeks. Its going to be grueling. If I don't do it I'll stay in that horrid place of feeling bad about myself the whole time. I've got to grin and bear it as I desperately want to be well. I tell you this now, ignorance is bliss.

Starting any sort of recovery is like taking the lid off of Pandora's box. Once its off you cannot put it back on, and although you know the gratification of wellness and inner peace is only a CBT course away, its like chewing razor blades. When the first session is over, no one can make eye contact and we almost crawl on our knees back to the car park.

I try to pull on my behavioural activation techniques to stop my mood being contaminated, and attempt to do some basic things that involve activity and concentration. It's a disaster and I go home to my bed and a family bag of revels. Next time I need to prepare myself and really dig in, armour up with my hard bitch outfit and begin anew. It dawns on me why they get you to do the CBT course "Over coming depression and learning behavioural activation" first. If you don't have those little strategies you would want to go home and possibly do something silly! I get a distinct feeling that a few people are going to drop out of this course.

Oh yes, and during this I'm tying to hold down a really grown up job and introduce the new more assertive, esteem filled me to my well balanced and unsuspecting colleagues, god bless them! What a nightmare!

Identifying my low self esteem

What is really hideous is the fact that my self esteem is massively better than it ever was. Over the past 12 years I have worked hard at improving how I feel about myself and where I fit in the world. I try to be kind to myself and work hard at not letting other people treat me badly. Most people see me as confident, assertive and friendly. What they don't realise is that it takes loads of practice and its not actually how I feel.If you could read the mantra of my heart, you would see a different me.

The people that I know who suffer with low self esteem don't want to be that way. Its not false pride or martyrdom, but a genuine sense of just not being good enough. Its horrible really and fills you with a distrust of people and constantly attacks your confidence. You question yourself  and your abilities unceasingly, and its exhausting and demoralising. Here are some typical thoughts I have had about myself :

I'm just not good enough
People don't really like me, they just say that to be polite
I'm a crap parent
I am ugly and truly unlovable
People don't really love me, they say that to placate me
Everyone else is better than me
If I try harder maybe I'll be average

Now I could go on, but its not the best, looking at yourself in type and seeing how shite you feel about yourself. The thing is with low self esteem is that you create little rules for living that you hope in your heart, will stop the dreaded feeling happening. I am a perfectionist. I avoid conflict. I will constantly put myself down with self deprecating humour, but what it hides is a genuine dislike or lack of acceptance of self and stops you getting in there first. I'm a sad little git really, but lay off the pity as I'm taking a big bus ride away from the dammed internal dialogue, sprinting joyfully to the fields of glee where imperfection, failure and doing things half arsed is acceptable .

If  I now take a snap shot of my disordered and colourful life, the way I am put together is a bit like a ragdoll. I'm a mish-mash of bits, but although I'm a bit duff, I'm interesting to look at, good to cuddle and play with and a bit more unique than a cabbage patch doll. Yes, that means you normal people with your autonomy and moulded joints and matching outfits! Actually, that is just my perception. You know the one in which I see all the women who drop their kids off at school  as alpha parents who do absolutely everything right and are perfect. I am soon to learn that this is something that I do - its called wrong thinking. I generalise about situations, I filter what I hear, I categorise everything as black or white and I am hideously self punishing. I would LOVE to take a day off from being me - I really would.

Welcome to the CBT course on self esteem.

CBT is over - you're on your own

So I've managed the 12 weeks and I've learnt  loads of things that are actually very useful.  At the last weekly session, all of my mental club chums turn up looking as nervous and concerned as me. It's been lovely having somewhere to come each week and share about the madness. Now we have to go out into the world alone and practice our techniques and survive the world alone. The general feeling is one of fear as we won't have the group to fall back on, and most people are terrified of a depression relapse. The worst thing in the world is feeling well, then having your joy snatched away from you, not knowing when it will return. We all dread it on some level. There are no guarantees of wellness.

The therapist uses the analogy of doing your driving test. You have your block of 12 lessons, pass your test and then you have to go out and drive all on your own. You know intellectually that you can, but you're going solo and its a little bit scary to say the least. Its exactly the same as CBT. You have to go and put it into practice. Some poelple will have a car crash, some will have a few scrapes and some will drive aorund, blissfully unaware of any trouble whatsoever. Its a case of suck it and see.

I've done my score sheets that compare to my first week session feelings to my final week session, and they show that although I'm still depressed, my social functioning and anxiety are much improved. For me, this is fabulous as I know depression won't just go away, but I have a deep need to be able to function and get on with my life. Giving up is not an option. And I have been getting on with it. I am managing to juggle 3 days at work and 1 at home, looking after the kids, having more fun and generally being more involved in my own life and relationships. Its good news.

However, I now have to face another recovery hurdle which is deeply rooted and not easy to shift. Friends, I introduce you to low self esteem. "Low self-esteem means that you think you are a lesser person than others. It can often be traced back to early childhood experiences, such as heavy criticism, being abandoned, feeling unloved, or being ridiculed or abused. It can also be a symptom of depression." (www.thesite.org) In short, whether or not I am depressed, happy or otherwise, generally I think of myself as the dirt, which is on the turd on your shoe. And I am going to do another course which will help me to overcome this. Its going to be uncomfortable (which really means excruciating) , last 10 weeks (A bloody lifetime), but it will help (yeah right, but not for me, which I'm told is a typical low self esteem remark!).

Welcome to hell.