Monday, July 12, 2010

The Outer Limits

Once we have a psychiatric diagnosis, and we have admitted to ourselves that life is going to be different, one of the most valuable things we can do is learn what our new limitations are. As with any serious chronic illness, there will be things to avoid and things we cannot safely do anymore.

First, there is the delicate task of finding out exactly what medicines we need, in exactly what combinations and dosages. This can take years to get just right, and also has to be periodically adjusted. Meanwhile, there are other things we have to figure out.

Can we work? And if so, at what jobs and for how many days a week, how many hours? I knew right away that I couldn't sustain a 40+ hour work week any more. I'd been keeping it up only by means of alcohol, lots of it, daily. So that had to go. It turned out eventually that 19 hours a week was my new maximum, and these could not be 8 hour days. One doctor finally told me, "I don't want you working more than 5 hours at a time. You can tell 'em I said so." This was an enormous help. Most of us have to figure it out the hard way.

The rest depends on careful self-observation.

A key area is pacing. I believe many people with special chemistry could benefit greatly from simply slowing down. The breakneck pace of modern life is stressful, in case you hadn't noticed. Rushing all the time is stressful. Running from one activity to another without a pause is stressful. I soon learned that if I wanted to keep going without coming unglued, I needed at least a small break between activities to breathe and get grounded again.

And I found the sheer number of tasks I would tackle in one day had to come down. Two appointments in a day was enough. Three was pushing it. Four was major symptom time. You of course will have to find out what your own numbers are. But my experience is that the to-do list should be relatively short and basic. Stick to what really matters. Your sanity is more important than any chore on earth.

I learned most of my limitations by 20-20 hindsight, so to speak. After I had calmed down from a nasty episode, maybe the next day, I'd look at it with detachment and ask, What happened here? What was the sequence before I came to pieces? Who was I with? What was I doing? When did it start to feel bad? What was going on then? What would have helped at that point? Over time, certain patterns emerged. I found that for me, too much external stimulation is a trigger: too much traffic, too much noise, too many people, too many new impressions without a chance to absorb them, too much light and heat. Yes, even weather can be a factor. Many people are aware of Seasonal Affective Disorder in winter, but have you thought of the effects of high temperatures? They can do strange things to your brain, something to be aware of this summer. There is a good reason homicide rates rise during heat waves! And it's a little known fact that mental hospitalization rates also rise in the summer months.

Observe yourself, next time things go wrong in your head. Go over it later. What was the last time you felt OK? What was the point when you lost it? Were there any clues that your mind or behavior was going South? How did your body feel? What was going on with your stomach, with your neck? What were the emotions? If you keep observing this way, you may eventually come up with a list of 'triggers': situations or sensations to avoid. Too much hunger or too little sleep, for instance. You may turn out to have a sort of expiry date for efficiency, like my five hour limit. Gradually, you will have a picture of what you can and cannot reasonably tolerate.

The real beauty of this is that you can then learn to head off many attacks at the pass. Maybe not all of them, but quite a few. You can learn to say, "This doesn't feel good, I'm stopping now." Or, "I've had enough. I need to go home." You can say, for example, "No, I won't take that ten-hour bus tour with twenty strangers - that would be way too much!"

Gradually you will find that you have fewer scenes and bad patches. You will hurt fewer people, embarrass yourself in public less often, and just generally feel better about yourself. You have learned to have a modicum of control over what happens to you. It is possible to pre-empt that monkey in our brains, and live in relative peace.