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In the midst of the chaos that has shaken up my life recently, I’m still working hard to keep even just a basic level of structure in my every-day life. Structure, stability, and routines are some of the core strategies for keeping bipolar under control. It’s probably the most recommended strategy I’ve been given by specialists and therapists, and whereever you read about treatment, it’s there. It’s quite obvious why; when you have bipolar, the goal of most – if not all – treatments are to remain stable, avoiding the highs and the lows that can essentially destroy you. However, when your surroundings are incredibly unstable and chaotic, it makes it very difficult to remain any kind of structure. This continues to be one of my biggest struggles.
I have now been on sick leave for more than a year, which is so strange to think about. It’s surreal for me that it’s been a year and a half since I finished my BA, and that I haven’t had a paid job since… well, fall 2015, I suppose. I finished an internship while studying, and am currently doing another internship, as I’ve talked about in previous posts. I’m on a break this month, though, and starting again in August.
This internship is part of something called “jobafklaringsforløb”, which is the next step of a sick leave if your doctor, after about six months, can’t conclude that you will be able to return to the work force within a certain time period. My psychiatrist obviously couldn’t do that, so the job centre decided to put me in “jobafklaring” instead. It basically means that we (my team and case worker) have to figure out how much I’m able to work, and what kind of work I’m able to do. So doing an internship is meant to test my limits. So far, because of everything that has happened, it hasn’t been possible for me to truly spend time and effort on this process. Hopefully that will change when I start again in August.
My disorder has affected my cognitive skills significantly. Every other person with bipolar that I have met have similar problems. I can’t concentrate for very long, and my memory has gotten worse (it was already pretty bad to begin with; the disorder and the meds have just made it a lot worse). One of the causes of bipolar has to do with brain chemistry, and that will affect certain parts of your brain, one example being the amygdala.
The amygdala is responsible for the perception of emotions such as anger, fear, and sadness, as well as the controlling of aggression. The amygdala helps to store memories of events and emotions so that an individual may be able to recognize similar events in the future. For example, if you have ever suffered a dog bite, then the amygdalae may help in processing that event and, therefore, increase your fear or alertness around dogs. The size of the amygdala is positively correlated with increased aggression and physical behavior.
The amygdala in humans also plays a role in sexual activity and libido, or sex drive.
As well as the hippocampus:
The researchers discovered that the study participants with bipolar disorder had volume reduction in certain parts of their hippocampus. The portion of the tail, two cellular layers, and subfield 4 of the cornu ammonis all displayed lower volumes. The reduced volume was more pronounced in subjects with bipolar I disorder than those with other mood disorders.
Additionally, the researchers found that patients with bipolar I disorder displayed lower volumes of certain hippocampus areas the longer the period of their illness became. Volumes of other CA areas and hippocampal tail, on the other hand, decreased more in subjects with more manic episodes.
The entirety of the study can be found in the journal Molecular Psychiatry.
Another researcher specifies it this way:
The bipolar states of mania and depression have a clear impact on cognitive function. The clinical criteria for mania include distractibility, inappropriate speech and behavior, increased goal-directed behavior, and a tendency to make decisions associated with potential painful consequences.1 The depressive state is also characterized by cognitive changes, including a lack of concentration, difficulty making decisions, motor slowing, and changes in memory.
On top of all this, adding medication into the mix can, in addition to help control the chemistry in the brain, also contribute to further screwing with your cognitive skills. In my case, as previously mentioned, bipolar has had an immense effect on my cognitive abilities. I used to devour volumes and volumes of books, concentrating for hours on end. Now I can barely get through a chapter of a novel without feeling distracted and unfocused. I can barely get through an episode of a tv-series without checking my phone. I can manage to read a blog post or watch a short YouTube video without pausing, but if the video is more than 6-8 minutes long, more often than not I find myself clicking pause, and either move on to another video or checking my e-mail, Facebook etc.
Memory, however, is probably my biggest issue. I have to keep a very detailed daily calender that I often have to check in order to recall what I did just the other day. I’d always bring it to therapy sessions when we were to talk about how I had been doing, and what I had been up to. Without it, I wouldn’t have been able to remember half of it.
My calendar plays a significant role when trying to create structure in my life. It sort of keeps me grounded in a way, helping me keep track of where I’m supposed to be and when. It’s gotten to the point where I have to check it many times a day, yet there are times where I still mess up times and dates. Luckily, I always end up being super early, which is much better than showing up late for important appointments, such as meetings with my case worker, practitioners, etc.
Since I don’t have a regular job, only going to my internship 2-3 times a week for 2-3 hours per day, I struggle to create steady routines. An example could be getting up in the morning. If I don’t have something that requires me to get up at the same time every day, like I would if I had a full-time job, it’s hard to get up. I do my best to schedule appointments early in the day when I’m able to choose the time myself, like physiotherapy and therapy sessions with my psychiatrist. When my case worker asks what time in the day that would work best for me, I always try to get in as early as I can.
On the days where I don’t have official/medical appointments or internship, I try to meet up with friends or family, or spend hours doing chores, like cleaning or doing laundry. However, filling out my days is quite a challenge for me.
Do any of you experience the same struggles, and do you have any other strategies to share? I don’t have a dog that needs walks, or a garden to tend to. Other suggestions would be greatly appreciated!
Hope you’ve had a wonderful weekend. Ciao!
The Elephants in the Room 