Friday, July 16, 2010

Mood Charts -- Why Bother?


Last week I discussed two barriers to using mood charts, the complexity of some charts and the life styles of those with mood disorders.  I also suggested strategies to overcome these barriers.  Perhaps today's post should have come first.  Given the difficulties -- why bother?

The chart I use is here, the same destination linked to Mood Charting on the left side of the blog, under RESOURCES ON MENTAL ILLNESS.  The second page puts my remarks in context.  The first page was written for doctors.  This post will make all that verbage user friendly.

So let me tell you about my experience and why I am still at it.

The essential point is to understand your illness better, so you can manage it better.  These are things I have learned from my chart:

First, my cycles have a certain shape, and not the one I might expect from the information out there.  The typical description of Bipolar I and Bipolar II suggest a few weeks or so of high, followed by a few months or so of low, and a break between of whatever length your meds promise you, until the cycle begins again.

Me -- I go through two or three cycles a month.  They call that rapid cycling, or rather ultrarapid cycling.  And within these cycles, I ricochet several times a day between high energy anxiety/urgency and medium to severe depression, followed by a few days of mild depression, and then repeat -- with seldom a break.  They call that ultradian cycling (within the day.)

Bipolar II is not diagnosed properly if it initially presents with ultradian cycling.  Prozac, et al sped up my cycles.  We did finally piece together earlier, longer periods of hypomania that confirmed the diagnosis -- so I started being treated for the right disease!  (Bipolar II is seldom diagnosed until after antidepressants make it worse.)  I have kept track on my chart and confirmed the pattern.  It is clearly a cycle, with cycles within the cycle.

Now when I am cycling so fast that I need a helmet, I can reassure myself that a break is coming within days, not months.  Okay, the break is still depression, but not whale shit on the bottom of the ocean depression, which is an improvement.  Plus, now I can describe the course of my disease to my therapist and psychiatrist, and whether the last adjustment of meds changed anything.  Instead of treating the symptom du jour, they can address the pattern.  Ditto with side effects -- when I record them, I have evidence, not just impressions about whether they are subsiding or getting worse.

The chart also helps with my experiments.  By tracking a particular self-care strategy in relation to a particular symptom over time, I observe patterns and detect what really works.  Does alcohol or abstinence from it affect my mood?  Is my consumption changing with the trend of my mood?  Does exercise affect my sleep?  My anxiety?

We have so little control of brains that cannot self-regulate and regularly puts us on the roller coaster.  We have only some control over our exposure to whatever sets us on the ride.  We can control our self care strategies, like, don't eat a chili dog, tub of popcorn, fried dill pickle on a stick and funnel cake before getting on that roller coaster.

Perfection is not necessary, and its pursuit is probably harmful.  But relative consistency over time will tell us if a particular strategy works.  If it does, then it is worth the effort to maintain it.  My current experiment with alcohol tells me that my usual half a beer at lunch doesn't seem to matter, while a double martini at night is a disaster that night and into the next day.   I am trying to work up courage to try abstinence from sugar.  I'm not sure I want to know the results.

Of course, during your experiment you have to maintain your regular self care behaviors.  If you trade your daily beer for double hot fudge sundaes, you contaminate the results.  Not to mention your body.

One more why bother mood chart issue -- relevance.  Does it make sense for your own version of your mood disorder?

Early on I realized that my chart was missing something.  It didn't fit the way I experience my moods.  The foundation of the chart is high and low moods.  So the chart assumes the popular perception, that bipolar means that people have times when they feel great, and do crazy things because they feel too great. 

That is euphoric mania or hypomania.  And I used to have that.  We finally figured out I don't have recurrent depression by teasing out past euphoric episodes.  I used to be charming, the spark of the room.  I got crazy amounts of work done between my whale shit episodes.  My mind jumped from one thing to another, connecting more dots than anybody else in the state ever even saw.  It was fabulous.  I did not complain to my doctor.

I miss euphoric hypomania.  I thought I was in the zone.  Turns out it was a rip tide.

Dysphoric hypomania is the ugly stepsister in my story.  Nasty, nasty, nasty.  All the dots that my mind connects point to impending doom.  My highs are irritation, on edge, walking down the street trying the shake the anxiety out through my hands, scratching my arms to distract my racing mind.  Nasty, nasty, nasty.

See, I don't call that high.

So I have changed my chart.  I still track mood, because my meds are designed to deal more with depression than with mania, and depression is a mood.  But now I also keep track of high and low energy.  High energy can cover the loud, animated, notstop conversation with my seatmate in the plane, the desperation to do some task that won't let me sleep at night while I go over and over and over the exact order of the steps I need to take, and what my wife calls spinning, when I rush so fast from room to room, trying to do so many things that I can't do any of them, to be followed hard by frustration and shame.

I sure would like to get a handle on those symptoms.  The first step is to track them  Then I can construct my experiments.  When I get my new chart converted into a visual (with up and down lines) I'll post it under MENTAL HEALTH RESOURCES.

So that's why I record my moods on a chart that I keep as a bookmark by my bedside: to convince myself that what I think about my disease really is true, to supply better information to my care providers, and to do experiments on self care strategies and symptoms, so that I can manage this thing better.  Not cure it, but manage it.  Because I want to live with it, and by that I mean, live.

photo by Lotus Head and modified, permission is granted
to copy this document under the terms of
the GNU Free Documentation License, Version 1.2

t-shirt designs by Jerod Poore and available for purchase
 in a variety of colors, styles and sentiments at
I urge you to support Jerod by your purchase.

No comments:

Post a Comment