Dealing with mental health issues as a nomad

October 17, 2016 10:28 AM

I lead, and love leading, a pretty nomadic lifestyle. I do seasonal, travel based work interspersed with backpacking around the world. I am told constantly I lead a dream lifestyle. I love it, and am proud of what I have created. However, it's also becoming clear to me that something is not ok with my current mental health situation (more details below). My lifestyle is 1) interfering with my ability to get help and 2) possibly aggravating it. How can I keep the life I love and still get help?

My apologies for the length, but I wanted to be thorough.
I think the problem has been going on for longer than I care to admit, but I have been in a bit of denial. It's now getting really really hard to ignore.
I'm not sure that I'm depressed, or what my problem is exactly (if anyone has ideas, I would love to hear them).
I'm not sad all the time. Not at all, but when I am, it's uncontrollable. When I am, I scare myself. When I get on a downward spiral, it can last a few days, or a few weeks, or, even once, a few months. I become de-motivated. Unable to feel excited about all the genuinely cool things I know I'm doing. I withdraw from everyone. Sometimes I just pass through things in a haze. Lately, I've been having these dissociative phases, where I feel like I'm having an out of body experience. I feel like I'm not even me. It's getting harder to ignore now, but when I look into the last 6 or 7 years of my life, I see a lot of problems. I have had phases of self harm, phases of reckless and unhealthy drinking and sexual behaviors, and phases of throwing myself into work and academia so hard I literally made myself sick.
I've been around mental health problems all my life, I was raised by a depressed, anxious, and paranoid mother. My sisters have struggled with severe depression and anxiety for years. Watching them has made me very aware of the signs that something is wrong, and made me want to get help. If I lived in one place, the answer would be easy, I'd go see a therapist, and start dealing with whatever is going on.
But, I travel pretty much full time. I just finished up a season leading road trips around the US, and am traveling internationally for a bit before road tripping with my boyfriend around the US and Mexico all winter. There's no end in sight, and I don't think I want there to be. But I also don't want to keep going like I am now (side note:it is also definitely affecting the first normal healthy relationship I've ever had with a really great guy).
I've also noticed that with some lifestyle changes, I feel better (a better diet, more walking, meditation), that said, I'm struggling to fit these things into my current lifestyle. I know that phone or web therapy is possible, but being free and with wifi at a particular scheduled time is also pretty difficult.
So basically--what can I do to get better? Do I need to settle down for a bit to make the changes I need to make? Sorry if this feels disjointed, I confess I'm a bit off right now.

posted by anonymous to Health & Fitness (20 answers total)

Can you speak with a therapist who is willing to do Skype sessions? I know people who travel quite a bit who have found therapists who have embraced remote sessions, so that may be something to explore.
posted by xingcat at 10:43 AM on October 17, 2016 [1 favorite]

Settling down a bit might be helpful. It would give you time for a good evaluation by a psychiatrist or other mental health worker. I don't know how you feel about medications but what you are describing sounds like it would help your symptoms a great deal and possibly enable you to continue the lifestyle that you seem to want. Good luck.
posted by cairnoflore at 10:45 AM on October 17, 2016

Along with therapy I'm going to urge you to get a medical check-up and improve your diet (vegetables, whole foods and not processed, probiotics - that sort of thing) because these sorts of things can really effect your mental health, believe it or not.
posted by jbenben at 10:47 AM on October 17, 2016 [1 favorite]

just wanted to throw in that this actually sounds quite positive. you've identified a problem, you're looking for solutions and you've got some good ideas. it's understandable you feel "a bit off" but it sounds like you're asking the right questions. so don't be too hard on yourself. it seems like you're heading in the right direction. good luck.
posted by andrewcooke at 10:51 AM on October 17, 2016 [9 favorites]

If one wanted to describe what could be a bipolar cycle you are doing fairly well--depression/flatness, overactive , depression/flatness, destructive sexual/drinking behavior, some dissociation etc. I would encourage you to settle down in one place long enough to see a psychiatrist that is highly recommended/regarded, get a thorough evaluation, possible treatment/medication and then stay long enough to evaluate if there is a general improvement and/or you like the "improvement". If you continue to then travel take your medical records and medication history with you as well as staying in contact with your psychiatrist. On the off chance you might have a moderate/low grade bipolar disorder please see an experienced psychiatrist for medication--the right combination and dosages can be tricky, or fortunately in some cases,very easy. The good news--bipolar is one the 'easiest manged" disorders around. Some times it is hard to give up the "throwing myself in to work/frenetic" phase. Best of outcomes for you. This is unlikely to significantly change on its own or by only talk therapies .
posted by rmhsinc at 11:06 AM on October 17, 2016 [3 favorites]

I've heard about this online therapy option, though I don't have any personal recommendation of it. https://www.talkspace.com/ (I heard about it from the Another Round podcast, you can get a $30 discount with the code ROUND.)

Have your sisters had any success or progress with their own mental health issues? Can you talk to them about it? For instance, if either of them has had success with a particular anti-depressant or style of therapy, it could be that it could help you too. A psychiatrist told me there is definitely something to be said for the potential genetic connection of: if a particular medication helps a family member with X, it could help you with X too.

Is there any chance your nomadic lifestyle is a symptom (i.e. running from your problems)?

It's really positive that you've recognized a problem and want to do something about it. I wish you the best of luck.
posted by purple_bird at 11:15 AM on October 17, 2016 [3 favorites]

I can identify with this! For me, I needed to settle down a bit, and have a routine and responsibility, but that's far from an all-or-nothing thing. I now work online part-time (I teach English, mostly) which gives me some commitments to stick to, but lets me move around often and be more flexible with my time and location than traditional jobs. I try to change cities every month, instead of every 3 days and that really helps with eating right and getting enough exercise.

I would be picky about the mental health professionals you trust, if you choose to go that route. Unfortunately, my experience has been that there are many in that industry who are quick to pathologize lifestyles that are uncommon or that they can't personally relate to. There are some therapists and coaches that are living as "digital nomads" themselves and those might be folks to reach out to.

Good luck and feel free to inbox me if you'd like talk!
posted by horizons at 11:19 AM on October 17, 2016 [4 favorites]

I would definitely vote for getting a comprehensive medical workup if at all possible, with the normal "yearly physical" bloodwork plus anything the doctor recommends based on the locations where you have traveled in the past 5-10 years. Being nomadic or transient often means a lot of brief exposure to pathogens that might stand out more if you were in one place for long enough to know about the local whateveritis that's been going around, and being free-range in a big chunk of the US now also means exposure to Lyme disease (and then there's Zika too) that can present in neurological symptoms you might mistake for strictly mental health issues if you had no reason to suspect a biological component. (And low-grade infections, we now know, can cause startling personality/perception/cognitive changes.)

This probably does at least mean at least holing up in one place for two weeks near a Planned Parenthood or county clinic so you can arrange the bloodwork and wait for results and figure out next steps.

You should at least rule out physical causes, and address any issues there, as part of a holistic approach. All the therapy in the world is only going to help partially if your thyroid is also crapping out.

Once you have a better bead on the state of your physical health, you might be able to better assess whether you need to try getting off the road for a while or if you can manage your health fine while traveling.
posted by Lyn Never at 11:46 AM on October 17, 2016 [5 favorites]

I could have written this exact question last year. It sounds like you could use a bit of a break. It's easy to ignore problems when you're on the road all the time. So much of your attention gets pulled into exploring a new place, meeting new people, figuring out where to stay and where to buy groceries, etc etc etc, that you just end up pushing all other issues to the back of your mind, where they creep into your life in weird subtle (or not subtle) ways, without revealing to you WHY you feel the way you do.

Is there a city or town that you like, where you have good friends and can stay for a while? Find a therapist, really commit to your healthy lifestyle changes, and enjoy the support and comfort that comes from being around people who know you well and care about you.

As much as I love being a nomad, and as much of a "dream lifestyle" that it is, ultimately I decided to settle for a while in a city where I had a social network to see if I could get my mental health back on track. It felt stifling at first, but as I started therapy and some temporary medication, I was able to really turn things around. I think a lot of people don't understand how hard a nomadic lifestyle can be, since they have next to no context for the realities of it, and are mostly fantasizing about some vacation that never ends. You and I both know that's not really what it's like.

Living here, I realized that as much as I hate routine, it is much easier to eat healthy and exercise when I know where I can go to take care of those things, and having a consistent social group helped with feeling stable and part of a community. Now when I do decide to get back on the road, I feel like I'll have a better handle on how to maintain my self-care and when to settle down for a while to reconnect with my tribe.

Best of luck. PM me if you want to talk.
posted by ananci at 11:48 AM on October 17, 2016 [3 favorites]

If you drink alcohol or use any other substances that get you high/numb the pain try to cut down, like maybe down to nothing, as they can exacerbate any depressive tendencies. Make sure you get plenty of sleep, regardless of where you are. Try to get 45 to 60 minutes a day of aerobic exercise like walking, running, swimming, rowing. Try to get plenty of sunlight. If you're not one already, become a morning person. Spend quiet time in nature. (Early morning walks outdoors check all of those!) Strengthen your ties with people you care about and who care about you, even if you cannot spend much time with them. Use Skype to connect. Read stuff that takes you somewhere else, whatever works for you.

Getting a physical sounds like a good idea too.

I hope you feel less disjointed soon.
posted by mareli at 11:52 AM on October 17, 2016 [1 favorite]

I have a nomad friend, and while he loves the lifestyle, it can be a little overwhelming.

You have gotten some great advice here. In addition, have you considered using coworking spaces? They're everywhere on the planet, and many are open 24 hours. For a (usually pretty reasonable) fee, you get space at a desk with other people who are nomads or work independently, and there's usually coffee etc available. It's a good way to make friends, create a kind of stability, and separate your work life from your personal life.

My friend is prone to overworking, so he keeps regular office hours and leaves the work there so as not to overdo it, and otherwise stays unplugged. He's also started taking vacations, which has been really helpful for him.
posted by mochapickle at 11:53 AM on October 17, 2016 [1 favorite]

You might find an online based therapist (like talkspace) helpful. Good luck!
posted by heavenknows at 1:11 PM on October 17, 2016

Anonymous--when one uses the words "downward spiral", "going on for a long time", "days/weeks/months of depression/haze", "dissociative phases", "reckless and unhealthy drinking/sexual behaviors" a "family history of mental illness", history of denial" , "throwing myself into work to the point of sickness" and disruptions of a good relationship I hope you take this seriously and not singularly a reaction to a nomadic life style. There is certainly a probability that while your nomadic life style can be, in itself, destabilizing that the nomadic lifestyle ls also the consequence of of your own unique chemistry/wiring. There his much useful advise here but I do think this calls for a period of settling and assessing what is going on. If I am preaching I apologize but take the time to reread your own words. Wishing and planning on the best for you
posted by rmhsinc at 2:18 PM on October 17, 2016 [1 favorite]

I can't say I've ever been a real nomad in the way you are but I can relate to some of the psychological problems you are experiencing. While being a nomad in the present sense of the word seems attractive, it has little connection to our ancestral behavior as actual nomads. We lived in tribes of under 150 people or less, so had intense and ongoing connection to a group we had known all our lives. We migrated around areas that were part of a pattern of travel so nomads frequently encountered known landmarks and places they recognized and were part of the tribe's territory. Not to continue too far down this path but your life is fragmented in the extreme compared to an actual nomad's life.

You could put your problems in the realm of the psychological professional, who will medicate you or put you into some model they have in a textbook. You could also create a narrative about your family history being responsible for your current state. You could also think about the very real challenges facing a tribe-less and rootless human in a big, fast moving technologically based world and what you could do to be a whole person with a grounded stability and wellness that can transcend your particular set of challenges.

Your daily algorithm has to encompass the tasks and behaviors that can support your life as you choose to live it, meaning you need extra bandwidth if you're going to carry this load. Good luck and hopefully if I make it to a nomadic lifestyle I can do the same.
posted by diode at 2:31 PM on October 17, 2016 [3 favorites]

I think you need to prioritize seeing a psychiatrist, not just a talk therapist. Is there a kind of seasonal work that you enjoy that's not located far from a big city where you could get a job for the other half of the year? (For example, something like working at a ski resort near Denver for part of the year and then something in town for the other part.) That would let you establish some continuity in your medical care. Then in a year or two once you know what's going on with your mental health you could always pick the more nomadic lifestyle back up.
posted by MsMolly at 5:01 PM on October 17, 2016

I'm a nomad too (yay nomads!). It gain be an amazing lifestyle for those of us who are called to it, whether for a year or for decades. So many new experiences, always something diverting, lots of potential risks ... it can also really appeal to those of us with bipolar disorder.

I'd strongly suggest settling down for a little while (it's not permanent!). Find somewhere you can work for a few months, rent a place, and talk to both a therapist and a psychiatrist (medical doctor). It's worth the money. It's worth the time away from being a vagabond. It's not forever.

I'm on meds and very stable and still on the road. You can do this---make it a priority!
posted by mkuhnell at 6:19 PM on October 17, 2016 [1 favorite]

Ok, this is going to be a long post. Standard disclaimer that I am not a doctor and this is not medical advice. I'm stating that not just for legal reasons, but because I think it's important to keep in mind when hearing this kind of advice. I'm including some of my own personal experiences, anecdotes about friends who have been through similar things, and some general observations about the mental health system from a friend who works in that field. But, the guidance given to me or my friends by professionals my not be anything like what they would say to you, even if our symptoms were identical, as we are all different people. So take this all with a grain of salt.

Finding a professional to talk to sounds like a great idea. If you can stand to settle down for a year or two, that would be ideal. Maybe you could work leading some kind of tour trips while living based out of a town somewhere. You might even find you liked it. If that's not an option now, finding a therapist who will do regular Skype sessions could still be really helpful.

As someone noted above, you may encounter a therapist with the attitude that your lifestyle is indicative of mental illness (and theoretically it could be, but it isn't necessarily). Becoming a psychologist or psychiatrist takes years of ordered, disciplined work, jumping through hoops for authority, at the end of which they are rewarded for that stability and sacrifice with a well paid, high status career in their chosen vocation. And I'm not putting that down in any way. It just means that a lot of them cannot relate to someone having a very non-conventional lifestyle, and being a healthy functioning adult. I'm not trying to steer you away from going to see such a professional, from what you're describing it sounds like an excellent idea, and they can be amazingly helpful. It's just something to be prepared for.

There is a psychologist named Bruce Levine who has written several books that might appeal to you. One of his specialties is helping people who, for whatever reason, aren't finding much help from the established mental health system. One of his books is specifically for full time political activists, to address the stresses of that kind of work. Some psychologists see full time activism as either a symptom or cause of mental illness, and in some cases it may be, but if it is the life passion of the client and they're unwilling to give that activism up, they can run into a brick wall trying to get mental health care from professionals who see it that way. His books are amazing, and there are several videos of him speaking on youtube. I'm a big fan.

Even when you're living in the same place, consistently seeing a therapist can be difficult with your symptoms. When you're feeling really good, you don't feel like there's any point in going (any may be distracted by all the other activities you're engaged in), and when you're feeling low, it can be hard to drag yourself across town to see anyone. But seeing them regularly is really important. So, even if you weren't a nomad, something like a weekly or twice monthly Skype session could really be useful, so the therapist can really see your full range of what you're experiencing. Maybe you could get a moblie wifi hotspot, so you don't have to rely on road internet or be Skyping about personal stuff from cafes. Keep in mind that even with Skype you'll have to consistently be "on time" for appointments, and will want privacy, so you'll have to factor that into your travel plans.

I'm seconding what the poster above said about the modern 'nomad' lifestyle being very different from the traditional variety (where you would be a member of an entire community that would move around together). Being a modern nomad can be extremely socially isolating (though if you are always traveling with a supportive partner that could help offset the isolation).

Here's my personal story: A while back I began to seriously wonder if I was bi-polar. I had done some reading and thought I might be bi-polar II (the milder version). So I found a psychologist that I liked and started seeing her regularly. She listened to my story and said that it would take some time for her to make a diagnosis. She said that it was her professional opinion that bipolar tool a long time to properly diagnose. One of the things she had me do was start keeping a journal. She had me keep track of some specific things, such as how I was feeling, what my sleep schedule was like (specifically how many hours I was sleeping), any drug or alcohol use, my libido, what events were happening in my life, work, etc. After nearly 2 years of keeping these reports, and having regular sessions with her, she said that I was not bipolar. She wondered at one point if I had something called "cyclothymia," kind of a milder form of bipolar II, but ruled that out as well. She essentially said that I was just very sensitive to events in my life: very happy and energetic when things were good, and very depressed and unmotivated when I was down. Her suggested treatment was a combination of CBT, switching to a steady low-stress job (rather then the freelancing I was doing at the time), maintaining a regular sleep schedule (very hard for me to do), maintaining good nutrition and regular exercise, eliminating or at least minimizing any recreational drug use (particularly alcohol), avoiding periods of social isolation, and trying out meditation. This really wasn't what I wanted to hear. I was already starting to eat better, minimize alcohol, and exercise, for health reasons, but the rest sounded restrictive and constraining and super boring to me. But I gradually implimented the suggestions, and it made an incredible positive difference in my life. I still have the occasional wild weekend, the occasional indulgence of staying up all night working on a project, and I still love to travel. But my life has a lot more routine now (a word I used to loathe), and it's really been therapeutic. I'm so glad I tried it.

Keeping a journal is something that you can begin right away, before you even find a therapist. You might want to use online backup of your writing (text files or scans of your written journal, which you can do with most smartphone cameras now). You don't want to keep a journal for a year, and then loose that invaluable resource due to a travel mishap.

Psychologists do talk therapy, psychiatrists prescribe drugs. Often they will work together, with the psychologist doing the actual therapy part, and the psychiatrist handling drug therapy when it is needed and wanted. I have never known anyone who went to a psychiatrist who wasn't immediately diagnosed and prescribed multiple drugs. When all you have are hammers everything looks like a nail. I've known some friends with the issues you're describing who had terrible experiences with psychiatrists and meds, while others (after a bit of trial and error) eventually found a drug cocktail that changed their lives for the better, making them happier more functional people.

Mindfullness meditation can really help. It's hard to have the self discipline at first, and it can really take a few months to kick in, but if you can stick with it, it really balances out the peaks and valleys for a whole lot of people. I'm in no way suggesting this as a substitute for professional therapy, but it's something you can do on your own with audio CDs, and you can do it on the road. It is also an activity that helps build and maintain routine.

SSRI's can make mania worse in some cases, which can be very dangerous. In cases of bi polar diagnosis they are combined with Lithium or another mood stabilizer to counteract this. Any decent psychiatrist is going to be watching out for signs of issues when you first start a new med. But if you are always on the road it will be hard for them to monitor for this (another reason to consider taking a year or two off from nomadism). I would just make sure to bring it up with the doctor if you decide to take meds and are still traveling.

This is a lot more information than you asked for, but your story is a familiar one to me, and I wanted to give you all the information I had. Best of luck to you, enjoy your travels, feel free to message me if you have any further questions.
posted by ethical_caligula at 10:23 PM on October 17, 2016 [2 favorites]

PS - I just asked my psychologist friend about how Skype sessions work. He said that, in America, psychologists are legally allowed to have Skype clients with anyone who is a resident of the state they practice in. So, for example, if you have a CA driver's license, you need to find a CA psychologist, even if you'll be Skyping them from Oregon or Mexico or some island somewhere.
He said that most people who offer Skype sessions advertise this on their websites. But if you have trouble finding someone, you can always call or email a few and explain that you travel for a living, are a resident of their state, and are looking for online therapy. Even if it's not something they offer, they may be able to steer you in the right direction.
posted by ethical_caligula at 10:35 PM on October 17, 2016

Clinical psychologist here: (I am not your doctor, this is not medical advice, etc).

At first glance, sounds like you may have bipolar affective disorder aka "Manic Depression". I'm clueing into these diagnostic points:

* times of relatively (or completely) normal behavior
* times of abnormal negative behavior which involve reckless/impulsive/self-harm behavior
* times of abnormal positive behavior (working too much...)

My first guess would be Biploar II (hypomanic episodes, with full depressive episodes)

I would want to rule out some other possibilities: Borderline Personality Disorder (seems unlikely, but I'd want to know more about the derealization episodes and self harm - is it chronic or only during 'episodes') A psychotic-type of disorder (Schizophrenia, Schoziaffective disorder) - you sound too functional and aware for either one but I'd want to get more info. Major depression with Psychotic Features? Others too...

See a professional. It's possible you could get diagnosed in a week and find out you don't need any help; or maybe just medication. Your traveling lifestyle may not really get in the way of this.

It is super great that you are seeking for help - this is not a weakness but a strength. Keep at it!
posted by soylent00FF00 at 5:53 PM on October 18, 2016 [1 favorite]

Nthing see a professional. I'm a 7 Cups junkie, myself - there are message boards, chat rooms, and one-on-one chats with non-professionals, to offer sounding boards for you. There are also links to professional therapists who can help you out. One of the best resources there are the Self-Help Guides for various issues, including anxiety and bipolar.

Other things that might help: mindfulness in addition to your meditation; Acceptance & Commitment Therapy, which helps people accept their pain, decrease suffering, and move toward things that matter in life; and drinking more water, in addition to your other lifestyle changes.

Best of health to you.
posted by The Almighty Mommy Goddess at 8:54 AM on October 20, 2016