Life on Speed

CrackheadSay No to Drugs.  That’s been my mantra for the past five years.  After trying every psychotropic pharmacology had to offer, which either had no effect or made my bipolar symptoms worse, I chose to manage my illness drug-free.  I take a sleep-aide when insomnia pops up, because that can mess me up fast and hard, but that’s it.  I had to get over my dream of a Magic Pill.

A year or so ago, I also gave up the dream of losing weight.  I’d used every kind of diet and non-diet, mindfulness training and behavior modification, but compulsive eating always won in the end.  I felt it was time to shake hands with that old nemesis and accept it in the pantheon of players.  Better to accept all of me, I thought, than keep bullying the parts that didn’t behave well.

I’d never talked about my compulsive eating with the nurse practitioner at my psych clinic, but this spring I did.  It was part of my bi-annual check-in, a commentary on my relationship with myself.  But she had a different take on it.  Sarah said I was a poster child for Binge Eating Disorder, and that there was a drug that might help.

Was I leery?  Yes.  Skeptical? Of course.  One of the things I love about Sarah, though, is how conservative she is about medication.  She’s my loudest cheerleader, and our brief sessions usually consist of her grilling me on what new tools I’m using to manage drug-free.  I know to keep an open mind when Sarah makes a suggestion.  So, we talked about Vyvanse being a “clean” drug—it’s in your system or it’s not, no lingering effects, no weaning on or off it like the psychotropics.  Any side effects should present themselves right away.  We would start with the lowest dose and work our way up to find a level that would (ideally) curb the compulsion without throwing me into mania or insomnia.  I said, yes, let’s give it a try.

I tried not to have any expectations.  I turned down the volume on The Song of the Magic Pill.  I didn’t want to set myself up for another round of disappointment and failure.  Sarah encouraged me to focus on changes in the compulsive thinking and my feelings, not weight.  I created a chart for the back of my journal to keep track of those parameters.  I was ready.

Three weeks in and I’m cautiously, furtively whispering, It’s a miracle.

The first thing I noticed was the sensation of fullness.  I never felt full when I ate, not even after bingeing for hours at a time.  What allowed me to stop was a weird click in my head, like a timer that said I was done.  Feeling full was a totally alien concept, and I was astonished at the minuscule amount of food that produced the effect.

I also noticed when the Vyvanse wore off and the compulsion returned.  It was like fire ants scuttling over my brain, a swarm of nattering food-thought—What do I want? What do I need? Where? When? How much? What else?—that hadn’t been there a moment before.  It was fascinating.  And it helped me identify the compulsion more clearly.  I could see the difference between the frenzied drive and habit.

Habits are the things normal people deal with—popcorn at the movies, a snack with TV, a trip to Dairy Queen to celebrate.  I found that without the engine of compulsion pushing my habits, I could brush them aside.  I spent a couple of hours reading without eating.  I watched a movie without a snack.  Habit carries its own power, so I have to be intentional and mindful, but now mindfulness actually works.  I still overeat and make crappy choices otherwise.

With time and attention, habits can be changed.  This is my hope.  I went to Starbucks the other day and stopped before I ordered.  I thought my regular Venti latte might make my stomach uncomfortably full.  I was perfectly satisfied with the Grande I ordered instead.  I can’t adequately express how weird and wonderful that little triumph felt.  With nary a fire ant in sight.

I’m on an Adventure.

The Price of Insight

I'm OK A prominent feature of  schizophrenia and bipolar disorder is anosognosia, a sick person’s unawareness that he is sick. — Algis Valiunas, New Atlantis, Winter 2009.

No one really understands why those of us with serious mental illness struggle with insight.  Current medical theory holds that it’s actually a core feature of our neurobiology.  It’s not that we’re in denial or stubborn—we simply can’t see.

This seems ridiculous to those observing from the outside as our behavior becomes more risky and disjointed.  But those are the times when our insight is most impaired, because anosognosia is also a symptom. We lose insight just when we need it most.

Lack of insight is relative.  It fluctuates as the illness fluctuates.  When we are in remission or in a more stable state, we can often see that we were ill.

Lack of insight is listed as the leading cause of non-compliance with medication (I’m not sick, so why should I take these drugs that make me feel lousy), and in another paradox, compliance with one’s medication regime can improve insight in some cases.

Aggression and violent behavior are also linked to lack of insight.

So, if insight is important to recovery and functionality, what can we do to foster it?  Unfortunately (and not really a surprise), the mental health delivery system has little to offer:  Take your meds.  Go to therapy.

I’ve been told by most of the professionals I’ve worked with that I have a high level of insight.  Even when my symptoms are at their worst, I retain some awareness, though it becomes harder to access and trust.  But very few of those therapists and psychiatrists ever asked me if I do anything to strengthen my awareness.  The fact is I work very hard at it.

I started meditating and working on mindfulness years before I was diagnosed with bipolar disorder, and those practices continue to help me “wake up” in the middle of an episode.  Meditation is the only “exercise” I know that builds the muscle of insight.  And like any muscle, the more it’s worked, the stronger it becomes.  We can build insight by using insight.

It’s not for weenies, this practice.  Ask any neuro-normal who sits meditation or suddenly realizes he’s projecting his fears into the future instead of living in the Now.  Most people are asleep.  To be anything else requires dedication, courage and sweat.  It also requires forgiveness, tenderness and a willingness to observe rigid beliefs with gentle curiosity.  Even then, moments of awareness are fleeting.

Insight is a Big Ticket item, and most people would rather spend their hard-earned psychic cash elsewhere.  I get that.  I’ve taught meditation for fifteen years, and most people don’t stick with it.  Sitting with oneself can be uncomfortable.  It can be frightening.  Why not practice golf instead?  At least that’s fun.

That’s been my experience with neuro-normals.  Now I’ve been asked to teach meditation to folks like me with serious mental illness.  I’ll introduce it gently next week, then see if anyone wants to continue.

Because these are people who will recognize the price tag.  And they might decide it’s worth it.

Give Me a Reason

It’s been a bad day.

It’s one of those days when thoughts of death and fantasies of how seep through the cracks.  It’s one of those days that demand a reason—any reason—to keep on going.

Like the push of a kitty’s paws against my side as he settles me for a nap.

Or a job that needs to be finished.

So, I left Emmett to sleep under the covers and finished a project—cards for the people retiring this year from our school district.


This is the third year I’ve been hired to make these cards.  When I think about it, even though I ended up in partial hospitalization the last two years, I still got the cards made.  They nudge me toward life, these pieces of gratitude.  My hands remember beauty even if I can’t at the moment.  As I work the sun swings around to my westward-facing window, giving Henry his chance to bask.

Another day nearly done.  And I made it to the other side.

Kind, Gentle and Generous

Give Him the Moon

Earlier this year I set a goal to stay out of the hospital or a hospital program this spring.  Three out of the last five years, I’ve ended up there.  It’s a good thing, really, to know when to make that call.  Lots of folks with mental illness aren’t able to do that for themselves, so I feel lucky and proud of the work I do to hang onto a little insight during the worst of times.

However, the program I’ve used in the past was eliminated, like many of the behavioral health programs across the state, because psychiatrists fled Iowa like rats on a sinking ship (some problem with Medicare reimbursement).  If I needed serious help now, I’d have to drive across the state and admit myself into one of the few psych wards left.  I’d rather not, really.

I needed to change things up—not just my perspective, but what I do to manage this transition from winter to summer.  I found some new resources this year to help—Intensive Psychiatric Rehabilitation (IPR) and Integrated Health Services (IHS).  Both are new state programs trying to fill the gaps left by the psych docs.  Also, with my mom’s passing last summer, I now live frugally instead of crushed by poverty.  It’s a huge difference.

So, with this new net under me, I started to address the critical and disapproving voice in my head.  I started to wonder if my drive to do more and be more was actually another facet of that mean voice.  I watched how I withheld comfort, left no room for rest or rejuvenation, and squeaked by on the least.

I wondered how it might feel to do the opposite—to be kind and gentle in my self-appraisal, to be generous with my time and money.  I wondered how that voice might sound.  I wondered, for instance, what my grandma might say to me when rapid cycling ruined all my plans for the day.  Or what my friend, Lily, might say about me going to Ireland next year.

Whenever I started to hate on myself, or rail against the unfairness of living with bipolar disorder, or scold myself for going to Des Moines twice in one week, I tried to stop and conjure the people who love me.  Their kind and gentle voices filled my mind.  Their immediate generosity helped me breathe.

Over the course of the spring, I’ve tried to make those voices strong in my mind.  This is some of the hardest work I’ve ever done.  I’m steeped in self-violence.  Recognizing the lie in that voice when it slithers into my thoughts takes time.  Then, countering it with petal-soft, open-armed sweetness is like speaking a foreign language.  But, I’ve learned a few words.  And my vocabulary is growing.

Being kind, gentle and generous to myself doesn’t alter the course of my bipolarity.  Rapid cycling fogs my brain and leaves me exhausted.  Emotions flip and tumble like Olympians.  Chores overwhelm me.  But, today, I have hope that I can navigate the hard road through Spring.  In my mind, I’m holding a warm, gentle hand.  It fits perfectly in mine.  Because it is mine.

The Healing Time

Finally on my way to yesStrange & Terrible Sights

I bump into

all the places

where I said no

to my life

all the untended wounds

the red and purple scars

those hieroglyphs of pain

carved into my skin,

my bones,

those coded messages

that send me down

the wrong street

again and again

where I find them

the old wounds

the old misdirections

and I lift them

one by one

close to my heart

and I say    holy


© Pesha Joyce Gertler

Trust the Next Breath

Trust the Next Breath

May all your endings turn into beginnings.


Saw the Legs


Don’t mess with me today.  Really.


Reteach Loveliness

My grandpa and his horse with a glass eye.

F*ck Bipolar

(Warning: F Bomb Minefield Ahead)

I woke up furious this morning.  It happens sometimes.  When I start to shift out of a long siege of depression, there’s no telling what form the sudden influx of energy will take.  Anger is a safe bet.

I could see what a wet washrag of a life I’ve had the last two months, and that lit me up.  So much hard work just to stand in place.  I railed against the shittiness of dragging around a mental illness.  I slammed into my car, grabbed coffee and journaled to bleed out the fury.

Fuckit!  Fuck being a GOOD GIRL because THAT really works for me.  Fuck being the poster girl for crazy.  [A friend] asked me yesterday if I had a goal.  The only one I could think of was “Stay Out of the Hospital.”  What kind of FUCKING goal is that?!  Is that the best this putrid hump of a life can give me?  Staying out of the hospital, being miserable, and telling myself that’s OKAY?

I’m so sick of myself and my fucking compulsions and Mom’s voice in my head and constantly PUSHINGPUSHINGPUSHING to Do the Right Thing.  Take Care of Myself.  Fuck this shadow life.  FUCK BIPOLAR!

It went on for a few more pages before I started to wind down.  You get the picture.  When I left Panera to see my therapist, I was still furious, but had a plan about how to use all that hot energy.  I decided to make some Fuck Bipolar cards (see below).

I want to give these away, so if you have bipolar disorder or love someone who rages against it, let me know.  Put your name and address in a comment (I won’t publicize it), and if you have a preference for either the boy or the girl.  I’ll send you one, because I’m making lots.

Because Fuck Bipolar.


F Bipolar Girl


F Bipolar Boy

March Madness

TumbleweedPhew!  February is behind us.  Enough, now, of the darkness and bitter cold and on to mud below and sun above.  Historically, March is the time I rouse from my mental hibernation and blink at the mess I’ve made while thrashing around in the dark.  I spend too much money when I’m brain-sick.  I eat compulsively.  Fat and broke, I usually overreact.  Last year and the year before, I put myself on strict money and food diets… and I ended up in partial hospitalization.  Hmmm.  Maybe this is a pattern I need to address in IPR.

The mission of IPR (Intensive Psychiatric Rehabilitation) is to help those of us with mental illness succeed at a goal we choose.  My goal is to keep living in my apartment, not taking sabbaticals in the hospital, so my caseworker, Aly, and I look at any skills needed to do that.

Partial hospitalization gives me structured support, a place to do the hard work of managing my illness when it’s overwhelming, and accountability to professionals who understand me.  One of my new skills is to seek out more structured support outside the hospital setting.

Seeing my therapist and participating in IPR every week are two kinds of structured support.  Recently, I added a weekly meeting with my Peer at Integrated Health Services (where I worked for a time last summer).  Allison and I sit for an hour and talk about doing the hard work of recovery.  The more I can get this kind of help, the less likely another hospitalization.  And since the Partial Hospitalization Program closed its doors last year, my only option now is full admission to a psych ward.  To me, that’s not an option.

So, it’s also important to look at this pattern of deprivation in the early spring.  As Aly and I talked through this, it seemed so simple.  Now is not the time to white-knuckle anything—not my budget, not my diet, not an out-dated version of myself as responsible and in control.  If there was ever a time for my Kinder, Gentler practice to kick in, it’s in March.  Now is the time to acknowledge how ill I’ve been and how well I’ve coped.  Now is the time to gently come back to cooking at home when the depression lifts enough to allow it.  Now is the time to remember that this is what my savings is for—to pay the bills my illness created over the winter and to give me space to breathe.  I’ll be able to live within my means again, but not right now.

This whole idea is radical—not clamping down to pay off my Visa bill or repaying the money I took from savings.  The idea that I can do those things later, should do them later, boggles my mind.  So simple.  So very Kind and Gentle.  It’s lovely to be my own best friend.

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