I'm sad all the time. I'm miserable. I'm caught in a well of darkness and depression -- all the time. Now, not everyone who is depressed experiences this. Some people who are depressed experience persistent sadness bouts, yes, but they aren't necessarily constant. Depression can also be characterized by diminished interest or pleasure instead of a depressed mood. In other words, being sad all the time is not required for a diagnosis of major depressive disorder; but it sure seems to be required by my major depressive disorder (that occurs because of bipolar disorder). And the trouble with all of this is that being sad all the time is just too heavy a burden to bear.

What Being Sad All the Time Feels Like

People's feelings of sadness and depression vary, but for me, I feel sad, yes, but also, almost anything can make me more miserable. If I see anything even mildly sad around me, that will do it, obviously, but things that aren't sad will make me sadder too. For example, you see a happy family walking down the street with one kid bouncing around like a monkey and another in a stroller and parents enmeshed in conversion -- that upsets the heck out of me and makes me sadder. All I can think of when I look at that scene is how I don't have those things and never will. (This is a way of looking at things that is driven by depression, but it's also very real.) 

The sadness really does feel like a ball-and-chain I'm shackled to. It really does feel like a lead weight bearing down on my back, creating a stoop that would suggest a 105-year-old body. It really does feel like this tremendous burden that goes everywhere with me all the time. Most people have no idea what it's like to carry that heavy a load. Aren't they lucky?

Being Sad All the Time and Hiding It

I've written about the importance of fake smiles in bipolar disorder. I've written about what it costs to appear "normal." And nowhere is that more painful than when it comes to unending sadness. The sadness is trying to break me every second of the day, and every second of the day, I have to fight it while simultaneously convincing everyone around me I'm fine. Every bit of my energy is taken up managing the sadness, yet I have to find more to fake smiles, modulate my speaking tone, and exhibit correct body language. These things are a burden to bear on top of the sadness. 

I'm worn out the moment I wake up in the morning.

If You're Sad All the Time, Try This

If you are sad all the time, there are ways to get through it. Try these things:

• Try to take time alone where you're not faking anything. Just let yourself feel sad. Pushing it down all the time will not help and will likely hurt you.
• Try to take time with people in front of whom you can be sad. I know I said I hide everything in front of people, and I mostly do, but there are select people in front of whom I can actually express my sadness. These people are angels on earth. These people help let just a tich of the sadness out to make room for something else.
• Try to get hugs. Hugs -- real hugs -- ones that aren't perfunctory or obligatory can absolutely be healing. Go ask for some.
• Distract yourself from your sadness. While I think it's important to express your sorrow sometimes, it's also important to try to distract yourself from it sometimes. It doesn't mean it will go away, but it does momentarily mean that your focus will be elsewhere. Use any non-harmful method for distraction. Examples are reading, watching a favorite TV show, taking a nap under a heavy blanket, going for a walk, petting an animal, etc.
• Express your sadness in therapy. Therapists will not be freaked out no matter what you're feeling, so be open with them. (This can work with your doctor, too, if your doctor does therapy and there's time.)
• Know that you will get through this. I can't promise the sadness will lift after reading this. I can't promise the sadness will lift after reading my book or every other self-help book in existence. What I can promise is that over time things will change. The constant in life is change, and that change will come for your sadness, too, even though waiting for it can be excruciating.

I do all the above when I can, but the most important is the last point -- knowing that I will get through this. Endless sadness isn't really endless, even though it feels that way. It feels like you will be stuck in the mire for all eternity. But you won't. Things will change, I promise. And when they do, you're going to want to be around to see them. 

I'm writing this just a few minutes removed from a morning run, which I hated almost every second. I'm not like the runners you see in the movies who gracefully jog with their camera-ready smiles; my face is usually fixed in a mask of focused despair, disguising not at all how distasteful I find the whole situation. This run was no different—my feet hurt, my heart pounded quicker than it wanted to, and my respiration struggled to keep pace. In short, the run absolutely, unmistakably, irrevocably sucked. It was exactly what I'd hoped for. I was hoping to increase my distress tolerance.

Reading that last statement, you might mistake me for a masochist. It's true that part of the benefit of running, for me, is how much I dislike it, but this isn't because I find pleasure in pain. It's because I find pleasure in growth, and whether I like it or not, all growth happens in the uncomfortable margins. 

A thousand and one metaphors speak to the importance of leaving your comfort zone for the sake of your own evolution, and unfortunately, they're all true. In exercise physiology, this phenomenon is referred to as progressive overload: the process of challenging your muscles slightly beyond what they are used to in order to create the necessary circumstances for an increase in strength, speed, or stamina. In philosophical terms, this can be viewed through the lens of the Hegelian dialectic. Take an existing precept, challenge it with new information, and watch a higher truth emerge from the conflict. No matter how you cut it, growth has a price. What does it cost? Does it cost discomfort?

Distress Tolerance 101

Discomfort is something that most people spend oodles of time, energy, and money trying to avoid. It's one thing to be forced to undergo an uncomfortable physical or emotional situation; it's another thing entirely to seek one out. If it's a positive change—otherwise known as growth—that you're looking for, though, you need to get good with discomfort. 

The proper jargon for this is "distress tolerance," the ability to withstand the disagreeable. This capacity is the first and foremost prerequisite for growth of any kind. The higher a distress tolerance a person has, the higher their ceiling for growth is. Distress tolerance is what kept me putting one foot in front of the other this morning faster than my body would've preferred because the only way to build a distress tolerance is to tolerate distress. 

This can't be a thought experiment. To build your distress tolerance, you need to pursue things you find uncomfortable and grit them out. Start small. Building this ability is a form of growth like anything else, and sustainable growth takes time. Rome wasn't built in a day, nor was the mightiest distress tolerance. Build discomfort into your day in tiny doses. Get your heart rate pumping for two minutes here, or talk to your obnoxious neighbor for 10 minutes there. Reclassify anything and everything you find distasteful as an opportunity to practice and increase your distress tolerance. 

The only way out is through. I didn't come up with that, but it's such an obvious statement that it goes without citing (although Robert Frost said something akin to it in his poem "Servant of Servants"). Everything you want to become, accomplish, or experience is on the other side of something unpleasant. So seek out the unpleasant and learn to love it as the way forward.  

Being the victim of verbal abuse can create vulnerabilities in several areas of life. I know that I still experience negative feelings of vulnerability even though I am no longer in an abusive situation. Thankfully, I am learning how to properly be vulnerable without making myself a target for further abuse. 

Vulnerability Is Common 

Because abusers tend to do everything they can to maintain continuous control over their victims, feelings of vulnerability are common. Even after the abuse stops, individuals may not know how to move past these negative emotions without using effective healing strategies.

For many victims, this vulnerability is easy for abusers to detect and can attract similar circumstances later in life. Unfortunately, this situation was common for me as I bounced from one abusive relationship to another, believing there was no possibility of a healthy dynamic. 

I had years where I tried to hide my vulnerability so I would not attract similar relationships. During this phase of my life, without seeking help, I believed that avoiding vulnerability would be the best way to protect myself. 

Vulnerability Can Be Healthy for Abuse Victims

Of course, vulnerability is not always bad. This emotional state can help individuals connect with others and is a sign of strength and good mental health in the right circumstances. Although in some abuse cases, it can seem like a sign of weakness, victims can turn it around and allow their vulnerable state to work to their benefit. 

Being vulnerable to my close friends and family members helped me process my abusive past and move forward on my healing journey. I felt less alone in my situation and connected with others who had similar circumstances. 

It took me years of therapy and learning how to use several strategies to accept vulnerability as a positive aspect of my life rather than a negative dynamic. One source that helped me dive deeper into this subject was Brene Brown's book, The Power of Vulnerability: Teachings of Authenticity, Connection, and Courage.​​​​​

Reading this book opened my eyes to a world I didn't know existed, and I began the search for learning about healthy vulnerability with my therapist. However, finding a healthy balance in your life may not come from reading a book; however, knowing that resources and information are available for you can kickstart your healing journey into a better emotional state after suffering verbal abuse. 

Terminal uniqueness is a concept I first learned about in eating disorder residential treatment. At the time, my restless, irritable teenage brain had no interest in the phrase. But over the years since, I've come to realize that terminal uniqueness is a common barrier to eating disorder recovery. In fact, it's not a unique or rare phenomenon at all—ironically enough. So what does terminal uniqueness mean, and how can it affect recovery? Let's unpack this further.  

Terminal Uniqueness and Eating Disorder Recovery

Terminal uniqueness is the deep—albeit mistaken—belief that whatever circumstances someone might experience are entirely different from the circumstances everyone else is familiar with.¹ In the context of eating disorders or other mental health issues, a person with terminal uniqueness will often assume that no one can relate to their specific brand of suffering because no one has faced anything like it before. That's a detrimental assumption for a couple of reasons. 

On the one hand, terminal uniqueness can stoke an impression that one is extraordinary or even superior to others. On the flip side, it can also cause feelings of shame, isolation, and torment as the person becomes convinced that healing is unattainable or they are unreachable because nobody else knows how to help them. Ultimately, this reinforces their view of being special—however, broken beyond repair. Therefore, terminal uniqueness stands as a common barrier to eating disorder recovery. I can attest since I have experienced it.

My Own Experience Dealing with Terminal Uniqueness

For as long as I can remember, I've had a fixation with individuality. I think it stems from being a twin. I used to seethe with resentment whenever someone referred to my sister and me as "the twins," a nameless package deal. Whatever their intention, the subtext I perceived was clear: These two are indistinguishable from each other, basically one and the same.

As a result, I spent much of my childhood in frantic pursuit of individual exceptionalism. I latched onto eclectic hobbies (Archery, fencing, violin, or ceramics, anyone?). I wore clothes that I called "bohemian" and my peers called "uncool." I poured over the dictionary, looking for obscure words to casually use in conversation. I took pride in being seen as different, but at the core of all this, I just wanted a sense of identity—something that was mine.

It seemed like I finally achieved that with my eating disorder. Now, this was an area I excelled in. This was a level of discipline and control I could tap into, which no one else around me knew how to access. Of course,  I had no clue that eating disorder behaviors are alarmingly prevalent. I was unaware that nearly 30 million Americans deal with the illness at some point in their lifetime.² I just relished the satisfaction of finding my ticket to individuality.

Combat Terminal Uniqueness in Eating Disorder Recovery  

When I began to understand that other humans could empathize with the pain I felt inside, that's when I started to recover. The defensive walls I had built to protect and insulate myself from rejection no longer seemed necessary, so I let them crumble. I realized that, in my lifelong pursuit of terminal uniqueness, I had become closed off to real connections. I was tired of all the loneliness—I was ready to belong.

I've since learned that even if the particulars of a circumstance are unique, suffering itself is a universal experience—as is healing. So if I invite someone else into those tender, vulnerable places within me, we can identify our similarities, then treat our wounds together. We can support, encourage, and share each other's loads. Terminal uniqueness is a common barrier to eating disorder recovery, but authentic human connection makes the entire healing process feel so much more attainable. 

Sources

1. Hull, M. (2022, May 31). Terminal Uniqueness and Recovery. The Recovery Village. https://www.therecoveryvillage.com/drug-addiction/terminal-uniqueness/
2. Report: Economic Costs of Eating Disorders. (2021, September 27). STRIPED. https://www.hsph.harvard.edu/striped/report-economic-costs-of-eating-disorders/

If you hurt yourself when you fail at something, know you're not alone. Other people, myself included, have struggled with this urge—and have since found better ways to cope.

Why I Hurt Myself When I Failed

For me, self-harm was always tangled up with feelings like shame and guilt. As such, self-injury was more than my emotional vent—it was also my self-inflicted punishment. By hurting myself when I failed, I felt some measure of catharsis in telling myself that this was how I should pay for the mistakes I made—a transaction that benefited no one and ultimately left me emotionally destitute.

It didn't matter what I failed at or how often. What did matter what how much importance I placed on the situation. The more I needed to succeed, the more it hurt when I failed—and the more likely it was that I would turn to self-harm for both punishment and relief.

Alternatives to Hurting Yourself When You Fail

If you hurt yourself when you fail, the solution isn't to avoid failing at all costs. We are all only human, and we all fail from time to time. Yes, it hurts, and yes, it sucks, but it can also be a chance for us to learn and grow more resilient—even if all we learn is that we can survive more than we gave ourselves credit for. It's not a lesson we like learning, but it's a useful one nevertheless.

Of course, when you're used to turning to self-harm to punish yourself for your mistakes, it can be hard to let that go and seek out healthier alternatives. I can't tell you what alternatives will work best for you, but I can tell you this: healing begins with gaining some perspective.

It's entirely possible and even likely that you are blowing your mistakes out of proportion. I know how easy it is to fall into this trap; I used to do it all the time. Even if this is not the case, self-harm is never the only solution—nor the best. Instead, try:

• Creative exercises such as writing or art therapy can vent your feelings safely.
• Physical movement can affect your brain chemicals and help you gain a healthier outlook; it's easier to maintain perspective when you feel better physically.
• Cognitive behavioral therapy techniques can help you challenge negative thought patterns and, ultimately, break free of them.
• Talking to someone—ideally a medical professional or at least a trusted loved one—can help you identify distorted thoughts and see your options in a new light.
• Mindfulness techniques such as meditation or yoga can help regulate intense emotions and find clarity in a calmer outlook.

When you feel you've failed in a major way, it can be hard to forgive yourself and move on—but that's exactly what it's going to take for you to heal. It's not something you can master right away; however, it will take time, patience, and lots of practice. The sooner you begin practicing, the sooner you will be able to improve and begin to heal. You won't feel the urge to hurt yourself when you fail forever.

Welcome to a syndication of Snap Out of It! The Mental Illness in the Workplace Podcast with Natasha Tracy.

This week, Snap Out of It! talks to lawyer Julia Stephanides. She schools us on the rights people with mental illness have at work and how you can use those rights to better navigate working with a mental illness.

Learn things like:

• Are all mental illnesses really considered disabilities?
• Can an employer not promote you because of your mental illness?
• Do employers have to accommodate your needs because of a mental illness?
• What is a “reasonable accommodation” at work for a person with a mental illness?
• Do you have a right to paid medical leave?
• How do you best advocate for yourself at work?

Your Legal Rights as a Person with a Mental Illness at Work

Julia addresses all these questions and more. Plus, we take your questions. Don’t miss out on this valuable chance to know your rights.

Snap Out of It! is available across podcast platforms. For more on this podcast, check out http://snapoutofitpodcast.com.

When some people read about those of us dealing with the effects of schizophrenia, they feel the same way I do about some other chronic illnesses. How can we find joy when we can't trust our minds? How do we function when we have to go through psychosis or stay at a psychiatric hospital or treatment facility? How do we go on when we hear voices or have paranoia or delusions of one form or another? How do we form relationships, go to school, or, if we are fortunate, go to work? 

The Effects of Schizophrenia Might Terrify Some People

Living with schizophrenia is difficult, I'm not going to lie, but it is the diagnosis, illness, and effects of schizophrenia symptoms that I know. I'm familiar with it. While having schizophrenia might terrify some people, the idea of many other chronic illnesses scares me, and I read about people living with them (and thriving) every day.

I hate having a mental illness, but it is the foe that I know, and because there is no cure for it, I'll live with it for the rest of my life, just like some people live with chronic physical illnesses all of their lives. Generally, I'm not afraid of having schizophrenia because I have lived with it for over 20 years, and not all of those years, months, weeks, days, or hours have been bad or hard. I've experienced many successes and joys despite having a severe mental illness.  

Depending upon our illness's severity and ability to focus on other things, I think we get used to a set of circumstances (schizophrenia symptoms) we have to experience and eventually decide to make the best of it. The alternatives, like feeling sorry for ourselves (I occasionally do this) or becoming bitter, are not the way most want to go about our lives. Being symptom-free would be ideal, but because that isn't the reality for many of us, we do the best we can with what we have (like most people).

If I had a choice, I wouldn't choose to have schizophrenia. Still, since I have it, I try to (when I can) put schizophrenia out of my mind. I try to prioritize or notice other things when possible, especially things like kind, supportive people, people who love me, nectarines, peaches, bumble bees, a new journal, the smell of jasmine, the jacaranda trees when they are in bloom, tea, and coffee. The list goes without end if we are fortunate enough to take our focus off our illness and look around. 

I've been leaning into the practice of mindfulness lately, and the daily practice is helping me learn to accept my life situation at this moment as it is. Mindfulness helps me stay focused on what matters to me instead of slipping into eating disorder behavior when I am feeling sad, afraid, or angry. Mindfulness is helping me through binge eating disorder recovery.

What Does Mindfulness Have to Do with Binge Eating Disorder Recovery?

In my understanding, mindfulness is the practice of paying attention to your thoughts and feelings, on purpose, without judging or reacting to what you observe. I imagine that I am a constant, silent witness to my thoughts and emotions, and instead of labeling what I observe as good or bad, I try to remain alert and curious. 

But what does the practice of mindfulness have to do with binge eating disorder recovery?

When I observe my thoughts as if I were overhearing a conversation next to me, I have a choice of whether to act on my thoughts. Practicing mindfulness made me realize that I am separate from my thoughts, and I can choose whether to spiral down with them. This is a powerful tool in eating disorder recovery.

Our thoughts influence our emotions and how we behave. For example, after a difficult day, I notice my thoughts tend to focus on feeling stuck, depressed, and dissatisfied with life. If I'm not practicing mindfulness, these kinds of thoughts affect my appetite and make me more likely to binge to relieve myself of upsetting thoughts.

If I am being mindful, I am more likely to sit and be curious about why I feel the way I do. I'm able to understand what in my exterior life is causing the feelings of depression and either accept it or change what is going on.

Getting Started with Mindfulness

How do you practice observing your thoughts during the pace of daily life? Here are my tips for making mindfulness a part of your routine to help support your recovery process. 

• Practice mindfulness during everyday activities. You can practice mindfulness by picking one activity you do every day (brushing your teeth, taking a shower, making the bed, washing dishes, etc.) and observing your thoughts and feelings as you do that activity. If your thoughts pull you out of the present moment and into the past or the future, don't judge yourself. Celebrate that you noticed your mind wander and bring it gently back to the present moment. 
• Notice your breathing. We are constantly breathing, but most of the time, we don't notice our breathing if we are absorbed in our thoughts. Anytime in your day, you can practice taking three conscious breaths. I do this when I notice I'm feeling stressed out. You can repeat to yourself, "Breathing in, I am aware I am breathing in. Breathing out, I am aware I am breathing out."
• Make room for silence. If you usually listen to music or a podcast during your commute to work or while you complete your daily tasks, I challenge you to try doing these things in silence. Silence allows you to check in with your thoughts, emotions, and breathing.
• Check in with yourself before meals. When you're recovering from an eating disorder, food brings up a lot of thoughts and emotions. You can practice taking a brief pause before eating to notice how you're feeling and what you're thinking about. This is an opportunity to learn about yourself in the recovery process.

I hope these tips inspire you to try practicing mindfulness today. It's a challenging and worthwhile practice, so don't be discouraged if it is difficult to observe your thoughts, especially if you're trying to do it for the first time. Feel free to leave me a comment if you have thoughts and experience with this topic. 

In this month's video, I share more about how mindfulness helps with your recovery process.

I've been flitting in and out of a bipolar mixed mood for a while now, which leaves me trying to find the cause of my bipolar mixed mood. This is no mean feat. So many things can impact a bipolar mood state that narrowing it down to a single mixed mood cause is pretty tricky.

What Is a Bipolar Mixed Mood?

Mixed moods are actually a bit complicated. Essentially, a bipolar mixed mood episode is an episode wherein symptoms of bipolar polarities occur at once. In other words, a person would have symptoms of depression alongside symptoms of hypomania or mania.¹

So far, you're probably with me. 

But in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (which outlines mental illness diagnoses), they changed things a bit. They changed the designation of this mood state from a formal mood episode to a "specifier," which can be applied to any mood state.¹

In other words, you would be diagnosed with depression with mixed features, mania with mixed features, or hypomania with mixed features. (There are other specifiers like "with anxious features," too.)

All that complexity said, I just refer to them as mixed moods. And for me, that means that symptoms of depression and hypomania are occurring together. (As a side note, you may like to know that women get more mixed moods than men.²)

What Causes a Bipolar Mixed Mood?

Of course, we don't know what causes a bipolar mixed mood. Initially, psychiatry felt that mixed moods were more closely related to mania, so you could think of mixed moods being caused by similar things that may cause mania. 

Now, however, it's understood that hypomania, not just mania, can also be a component of mixed moods, so that complicates things.

In my experience, mixed moods come about when you're in one mod state and something strong is trying to poke through with the opposite mood. For example, I might be extremely depressed and then take a medication that is trying to improve my mood. Instead of gradually lifting my mood, there might be a period of mixed mood instead. And for me, medications are a major cause of mixed moods. (And I don't just mean psychiatric medications, either. Many kinds of medications, such as steroids, can profoundly affect mood.³)

In my experience, other causes of mixed moods might be time changes (watch out for our clocks "falling back" next week), good fortune that happens when you're depressed, major (or even minor) life changes, and many other things.

Figuring Out the Cause of a Bipolar Mixed Mood

I've said before, mixed moods are hell and possibly the most dangerous mood. So, of course, if I could figure out the cause of a bipolar mixed mood, I would work to avoid it. Thus, looking for bipolar mixed mood causes makes sense. So, if you're looking for your mixed mood cause, look for any changes or events that directly preceded the mood episode. 

However, it's important to realize that many times, there is no identifiable cause. Only your brain knows, and it's not sharing it with you. Don't make yourself crazy trying endlessly to find a specific bipolar mixed mood cause. You'll just go around and around, getting more anxious as you go.

Because the plain fact is this: we are not in control of the bipolar disorder. Yes, we can assert influence. Yes, we can develop good habits and take the correct medication. Yes, we can go to therapy and our psychiatry appointments. But even doing everything possible may not be enough to quell every upcoming mood episode. 

So, breathe in, breathe out, and realize that you're not in control of your brain disorder. And then do what you can to try to soften the bipolar mixed mood's effects. Talk to your doctor; talk to your therapist; use your coping skills. If you can't determine the cause, that's okay. You'll get through this one and the next one. 

Sources

1. Soreff, S., MD. (2022a, February 18). Bipolar Disorder Clinical Presentation: History, Physical Examination. https://emedicine.medscape.com/article/286342-clinical

2. Soreff, S., MD. (2022b, February 18). Bipolar Disorder: Practice Essentials, Background, Pathophysiology. https://emedicine.medscape.com/article/286342-overview

3. Cameron-Carter, H. A., Hopp, C., Wells, K., Hayes, K., & Mian, T. (2021, July 22). Misuse of Corticosteroids in a Patient With Bipolar Disorder and Secondary Adrenal Insufficiency. Psychiatrist.com. https://www.psychiatrist.com/pcc/bipolar/misuse-corticosteroids-patient-bipolar-disorder-secondary-adrenal-insufficiency/

Death is coming for us all. I don't mean that to be threatening; I mean it to be relieving. Encouraging. Enlightening.

Today is Halloween—no better day to broach this topic that most people find so deeply terrifying. The topic of death is avoided like the plague in modern Western society, but I'm of the utterly correct opinion that if you want to be happy in life, you need to be accepting of death. I don't put my foot down about a lot, but I put my foot down about this. There are plenty of roads that lead to Rome, but all of them have in common an acceptance of the inevitable: the end of all things. 

You Only Live Once: Don't Waste It

Life is precious. These are cloying, tired words, but when they're spoken in earnest, they mean something true. In our day-to-day, it's easy to forget that we're here only for a short while, bound on either side by an infinite nothingness. At first, this might seem macabre, but the more you ask your mind to settle into this initially uncomfortable notion, the more you can find yourself...free. If you're going to cease to be, what really matters? Not your bills, not your boss's opinion, not the weird way your mouth opens to the side when you talk (guilty as charged). Death clarifies your life like nothing else can. 

What's more, we owe all of life to death. Something can only exist in the presence of nothing, creation in the presence of obliteration. If you're at all thankful for your life, be thankful for your death, and for the death of everything that's preceded you and will follow. 

So this Halloween, celebrate your greatest fear. Your own impending death.