What even is reality?
November 2, 2023 9:39 PM Subscribe
I'm diagnosed bipolar II, CPTSD, ADHD, and autism, and am on medical treatment for most of the above (well not the autism obviously). I also have a major fear of my life/reality actually being a hallucination and that I'm actually on a hospital bed having a psychotic episode this whole time, or that I have dementia and I'm actually imaging what my life used to be like, etc etc. How do you know if you're having an episode?
The fear isn't debilitating, but it does crop up from time to time, especially when I'm very very emotionally/psychologically vulnerable. I have a therapist but I don't know if "so what does psychosis feel like?" is a viable thing to ask her. My life gets pretty weird and sometimes I'm just like "did that really happen or did I make that up???"
I've had moments of mania - for some reason, I turn into the Most Responsible Adult Ever, and only realise it's mania when I come down and feel a particular sort of brain tired. But I'm not sure if or how I'm supposed to tell if any given situation is a psychotic episode or not.
Like from this link from the Blue, there's someone who believes she's a M15 spy on a mission. Do they physically see things that seem very tangible to them but no one else can see them? Is it a case of reading too much into something that others can see but take at face value?
Or someone with dementia who thinks they're still with a long lost loved one and they're much younger than they really are. I saw a TV drama years ago that had this as a plot point and they basically portrayed this as though the person's soul went time travelling and entered the body of their younger self in that earlier timespan. Is that what it actually feels like? Do things around you resemble the past?
I know this is a sensitive subject and I apologise for my inelegance. If you'd rather answer privately, I can be reached at me(@)[my metafilter username].com
The fear isn't debilitating, but it does crop up from time to time, especially when I'm very very emotionally/psychologically vulnerable. I have a therapist but I don't know if "so what does psychosis feel like?" is a viable thing to ask her. My life gets pretty weird and sometimes I'm just like "did that really happen or did I make that up???"
I've had moments of mania - for some reason, I turn into the Most Responsible Adult Ever, and only realise it's mania when I come down and feel a particular sort of brain tired. But I'm not sure if or how I'm supposed to tell if any given situation is a psychotic episode or not.
Like from this link from the Blue, there's someone who believes she's a M15 spy on a mission. Do they physically see things that seem very tangible to them but no one else can see them? Is it a case of reading too much into something that others can see but take at face value?
Or someone with dementia who thinks they're still with a long lost loved one and they're much younger than they really are. I saw a TV drama years ago that had this as a plot point and they basically portrayed this as though the person's soul went time travelling and entered the body of their younger self in that earlier timespan. Is that what it actually feels like? Do things around you resemble the past?
I know this is a sensitive subject and I apologise for my inelegance. If you'd rather answer privately, I can be reached at me(@)[my metafilter username].com
I have a therapist but I don't know if "so what does psychosis feel like?" is a viable thing to ask her. My life gets pretty weird and sometimes I'm just like "did that really happen or did I make that up???"
Everything is a viable thing to ask your therapist. DUMP IT OUT. IN WHATEVER ORDER IT COMES. If it's in the form of language, you aren't likely to freak them out or exceed their ability to help you make sense of all of this (and even so...). Even the worst therapist I had was a trained professional who I respected, and for what it's worth I could always say anything. He was just the worst because that's the furthest anything went with him. He was old as dirt and probably just cruising until he decided to retire. ANYWAY, I digress, but sometimes a therapist is just a Woody Allen-type talk talk talk and in a lot of cases I bet recognizing that is a sign it's time to switch to a new one.
My current and awesome therapist told me just yesterday, "anxiety wants answers." There may not be any, though, and ironically with an upside: things in the future are open to be answered by you and your sensibilities.
posted by rhizome at 10:51 PM on November 2, 2023 [5 favorites]
Everything is a viable thing to ask your therapist. DUMP IT OUT. IN WHATEVER ORDER IT COMES. If it's in the form of language, you aren't likely to freak them out or exceed their ability to help you make sense of all of this (and even so...). Even the worst therapist I had was a trained professional who I respected, and for what it's worth I could always say anything. He was just the worst because that's the furthest anything went with him. He was old as dirt and probably just cruising until he decided to retire. ANYWAY, I digress, but sometimes a therapist is just a Woody Allen-type talk talk talk and in a lot of cases I bet recognizing that is a sign it's time to switch to a new one.
My current and awesome therapist told me just yesterday, "anxiety wants answers." There may not be any, though, and ironically with an upside: things in the future are open to be answered by you and your sensibilities.
posted by rhizome at 10:51 PM on November 2, 2023 [5 favorites]
Best answer: Have you read nonfiction by Esme Weijun Wang? She has an essay maybe called "Perdition Days" on Cotard's syndrome that might answer some questions.
posted by knucklebones at 11:10 PM on November 2, 2023 [2 favorites]
posted by knucklebones at 11:10 PM on November 2, 2023 [2 favorites]
Best answer: As someone with serious depression, anxiety and autism, I have had a lot of weird experiences but I'm pretty confident about what is and is not real. I used to have audio hallucinations pretty often as a kid and frequently experience very confusing touch and body sensations, but once I realized that they were coming from inside my brain I learned how to deal with them. I frequently feel a vague sense that "something is wrong" with reality and I feel like that is something that could turn into paranoia for some people. But for me it's just another confusing sensory thing that I can deal with by applying a simple version of the scientific method to my own experiences. I sometimes have dissociative episodes where I lose my sense of self but am able to solve problems and make decisions just fine. I often second guess my own experiences and assume things must be worse than they actually are, which you might be doing here.
My understanding is that psychotic episodes are generally when people lose contact with reality but are still quite confident that they are experiencing reality. "Something really weird is happening, but I am responsible and in control of my actions" is not a psychotic episode. One thing to keep in mind is that human brains are ALWAYS struggling to make sense of the confusing world around using a complicated series of electrical signals and it's kind of a miracle that the world makes sense to us in the first place. Everyone is always a little out of touch with reality, and psychosis is when people start spiraling away from it. Learning about cognitive psychology and basic neuroscience gave me a lot more confidence about what is and is not real.
This is definitely something you can talk to a therapist about, I have had similar conversations and they went just fine. From all the reading I've done there are no hard divisions between psychotic episodes, dissociative episodes, and autistic shutdowns because they are all distortions of consciousness and we don't know exactly what is happening inside the brain. Unless you suddenly become very confident that you are really experiencing something that is impossible, I would not assume that you are psychotic when there are more likely explanations related to your other diagnoses.
posted by JZig at 11:15 PM on November 2, 2023 [11 favorites]
My understanding is that psychotic episodes are generally when people lose contact with reality but are still quite confident that they are experiencing reality. "Something really weird is happening, but I am responsible and in control of my actions" is not a psychotic episode. One thing to keep in mind is that human brains are ALWAYS struggling to make sense of the confusing world around using a complicated series of electrical signals and it's kind of a miracle that the world makes sense to us in the first place. Everyone is always a little out of touch with reality, and psychosis is when people start spiraling away from it. Learning about cognitive psychology and basic neuroscience gave me a lot more confidence about what is and is not real.
This is definitely something you can talk to a therapist about, I have had similar conversations and they went just fine. From all the reading I've done there are no hard divisions between psychotic episodes, dissociative episodes, and autistic shutdowns because they are all distortions of consciousness and we don't know exactly what is happening inside the brain. Unless you suddenly become very confident that you are really experiencing something that is impossible, I would not assume that you are psychotic when there are more likely explanations related to your other diagnoses.
posted by JZig at 11:15 PM on November 2, 2023 [11 favorites]
Best answer: A close family member has bipolar and thanks to medication is stable most of the time now, but they still have the occasional mood shift. From what they've described about their manic episodes it seems clear that the old saying "if you think you're mad, you're probably not" is relevant here.
One of the key issues in a serious manic episode is a loss of connection with reality. Crucially, you're not aware you've lost touch with reality though. Everything makes sense to you, and it's the world and all the people in it who are wrong and strange. So if you're asking yourself the question "is this real or am I having an episode?" the chances are good that you are not having a manic episode, because when you are having a manic episode you will be absolutely convinced that nothing is wrong.
That being said, having questions about what can we know? can we trust our senses? what is real? is perfectly normal human nature. Philosophers have been pondering this for millennia (you might find the Brain in a Vat thought experiment an interesting place to start).
A significant problem for people with a mental health issue which affects their perception is that you know your perception is not trustworthy, whereas most people have never had such a diagnosis and therefore trust their senses without thinking about it. So bipolar people (as one example out of many serious mental health issues) often have a layer of uncertainty about the world and their perception of it that bipolar people don't. That uncertainty can be debilitating, to say the least, and it can feel impossible to say to someone else "I'm not sure I trust what I see and feel" without feeling like you're also saying "I'm crazy". Not to mention the fundamental problem of literally not being able to be certain that what you see and hear and feel is in any way a match to objective reality. It's hard to be emotionally stable in such a rationally unstable situation.
You are not alone and you are not weird. You are asking questions which literally billions of humans have asked, and you're asking them from a position where they are fundamental to your ability to live your life, in a way that idle speculation about the "nature of things" is not. So your urgency is valid, understandable and, frankly, sensible. How can you live your life if you're struggling to distinguish when things are real or not? It's hard to think of a more basic, important question.
But this is exactly when your therapist should be the most value: they can hear all of these deepest fears without judgement and without letting you get into a shame spiral. Believe it or not, your questions make perfect sense in the context you find yourself in, and I've had this exact conversation with said family member many times. Any therapist with experience of working with people with perception-altering mental health issues will have had lots of conversations about this. You asking these questions is a sign you are a normal, sane human being.
I hope you find some answers and wish you luck.
posted by underclocked at 12:25 AM on November 3, 2023 [10 favorites]
One of the key issues in a serious manic episode is a loss of connection with reality. Crucially, you're not aware you've lost touch with reality though. Everything makes sense to you, and it's the world and all the people in it who are wrong and strange. So if you're asking yourself the question "is this real or am I having an episode?" the chances are good that you are not having a manic episode, because when you are having a manic episode you will be absolutely convinced that nothing is wrong.
That being said, having questions about what can we know? can we trust our senses? what is real? is perfectly normal human nature. Philosophers have been pondering this for millennia (you might find the Brain in a Vat thought experiment an interesting place to start).
A significant problem for people with a mental health issue which affects their perception is that you know your perception is not trustworthy, whereas most people have never had such a diagnosis and therefore trust their senses without thinking about it. So bipolar people (as one example out of many serious mental health issues) often have a layer of uncertainty about the world and their perception of it that bipolar people don't. That uncertainty can be debilitating, to say the least, and it can feel impossible to say to someone else "I'm not sure I trust what I see and feel" without feeling like you're also saying "I'm crazy". Not to mention the fundamental problem of literally not being able to be certain that what you see and hear and feel is in any way a match to objective reality. It's hard to be emotionally stable in such a rationally unstable situation.
You are not alone and you are not weird. You are asking questions which literally billions of humans have asked, and you're asking them from a position where they are fundamental to your ability to live your life, in a way that idle speculation about the "nature of things" is not. So your urgency is valid, understandable and, frankly, sensible. How can you live your life if you're struggling to distinguish when things are real or not? It's hard to think of a more basic, important question.
But this is exactly when your therapist should be the most value: they can hear all of these deepest fears without judgement and without letting you get into a shame spiral. Believe it or not, your questions make perfect sense in the context you find yourself in, and I've had this exact conversation with said family member many times. Any therapist with experience of working with people with perception-altering mental health issues will have had lots of conversations about this. You asking these questions is a sign you are a normal, sane human being.
I hope you find some answers and wish you luck.
posted by underclocked at 12:25 AM on November 3, 2023 [10 favorites]
Best answer: I also have a major fear of my life/reality actually being a hallucination and that I'm actually on a hospital bed having a psychotic episode this whole time
From my experience as somebody who has been simultaneously chemically and physically restrained in a hospital bed while a psychotic episode peaks, I don't think that's likely to be what you're doing.
The single most prominent feature of my psychosis was the feeling of absolute certainty. Every time I'd dream up some superficially plausible idea, the raw, irrefutable, revelatory truth of it would hit me with the force of an epiphany.
My physical experience became so much less relevant to my interests than the way the fundamental nature of reality kept on revealing itself to me that I paid it only the most cursory attention. It would never have occurred to me to wonder whether what I was experiencing was real or not; I simply had no time for that kind of question.
One of the best things to come out of having gone through and recovered from that has been developing a healthy skepticism. These days I'm far less inclined to embrace the kind of theoretical skepticism that proceeds from an inability to prove beyond doubt that one is not in fact a brain in a vat or a character in a simulation, and much more inclined to be skeptical about the intellectual competence of self-styled philosophers who seriously entertain that stuff.
I think that if the world is still capable of surprising you - if it keeps on presenting you with stuff that makes you go "that's weird, how could that actually happen? Lemme check" - then your cognitive relationship with it is probably essentially sound.
Another decent test is your ability to converse coherently with other people, which you're easily passing at present. I've been particularly impressed by the quality of your comments in the ongoing Hasan Minhaj thread, for one.
posted by flabdablet at 1:44 AM on November 3, 2023 [40 favorites]
From my experience as somebody who has been simultaneously chemically and physically restrained in a hospital bed while a psychotic episode peaks, I don't think that's likely to be what you're doing.
The single most prominent feature of my psychosis was the feeling of absolute certainty. Every time I'd dream up some superficially plausible idea, the raw, irrefutable, revelatory truth of it would hit me with the force of an epiphany.
My physical experience became so much less relevant to my interests than the way the fundamental nature of reality kept on revealing itself to me that I paid it only the most cursory attention. It would never have occurred to me to wonder whether what I was experiencing was real or not; I simply had no time for that kind of question.
One of the best things to come out of having gone through and recovered from that has been developing a healthy skepticism. These days I'm far less inclined to embrace the kind of theoretical skepticism that proceeds from an inability to prove beyond doubt that one is not in fact a brain in a vat or a character in a simulation, and much more inclined to be skeptical about the intellectual competence of self-styled philosophers who seriously entertain that stuff.
I think that if the world is still capable of surprising you - if it keeps on presenting you with stuff that makes you go "that's weird, how could that actually happen? Lemme check" - then your cognitive relationship with it is probably essentially sound.
Another decent test is your ability to converse coherently with other people, which you're easily passing at present. I've been particularly impressed by the quality of your comments in the ongoing Hasan Minhaj thread, for one.
posted by flabdablet at 1:44 AM on November 3, 2023 [40 favorites]
I am diagnosed with bipolar, I have had psychotic episodes, I'm also having an autism assessment in a couple of weeks.
It is valid to take your question to your therapist. In fact assuming they are half way decent I think it would be the best thing you can do. Some manifestations of mental illness require the kind of "reality testing" you're trying to do here, but others require uncertainty tolerance, and your therapist would be MUCH better placed than strangers to know what kind of guidance you need. They can clarify, for instance, whether your questions might be anxious rumination (in which case getting reassurance from peers might be ineffective or even exacerbate things).
People can have self insight during pro drome, and even in the midst of an episode they may do a degree of what psychiatrists call "double bookkeeping" which muddies the waters. I do not think you sound psychotic (the point about coherent conversation is important) but I do think your therapist is better placed than us to understand how your fears relate to your risks of an episode, and you should get advice from someone with that context.
posted by Ballad of Peckham Rye at 2:33 AM on November 3, 2023 [8 favorites]
It is valid to take your question to your therapist. In fact assuming they are half way decent I think it would be the best thing you can do. Some manifestations of mental illness require the kind of "reality testing" you're trying to do here, but others require uncertainty tolerance, and your therapist would be MUCH better placed than strangers to know what kind of guidance you need. They can clarify, for instance, whether your questions might be anxious rumination (in which case getting reassurance from peers might be ineffective or even exacerbate things).
People can have self insight during pro drome, and even in the midst of an episode they may do a degree of what psychiatrists call "double bookkeeping" which muddies the waters. I do not think you sound psychotic (the point about coherent conversation is important) but I do think your therapist is better placed than us to understand how your fears relate to your risks of an episode, and you should get advice from someone with that context.
posted by Ballad of Peckham Rye at 2:33 AM on November 3, 2023 [8 favorites]
Best answer: I've had moments of mania
If they had been diagnosed as mania you would not be considered Bipolar II. Mania is specific to Bipolar I. From your description, hypomania seems more likely.
I saw a TV drama
With rare exception depictions of mental illness in film or TV are misleading or simply wrong. Between misinformation and creative license they’re not a good place to get an understanding of this topic.
I don't know if "so what does psychosis feel like?" is a viable thing to ask her
It’s a good thing to ask and really not that unusual. People sometimes think they’re going crazy and a good therapist can help them work with it.
I also have a major fear of my life/reality actually being a hallucination
There is an entire philosophical realm called Solipsism that deals with the possibility and implications of your entire life experience being an hallucination. It doesn’t directly address the hospital bed scenario, but a lot of very rational people have been considering this question for a very long time. You’re not alone in wondering.
How do you know if you're having an episode?
I’ve only had minor episodes, but the common thread I’ve picked out talking to friends and relatives is that at the time it is happening everything makes sense — not just the audio and/or visual hallucinations, but everything in their lives feels accounted for. Unlike the reality of day to day life, things are very clear. This is also a symptom of paranoia.
For at least two of them, a sense that they understand everything is a warning sign that they need to be extra careful. Their hallucinations are not particularly unpleasant but they can be socially awkward, and in particular they should never drive while experiencing them. Others say they would never recognize an episode when they’re having one but in retrospect they see similarities. This is a very small sample though. YMMV.
To sum up, life is extremely confusing and made even more so when you can’t rely on your sense of reality. When everything starts to seem perfectly clear is the time to worry.
posted by Tell Me No Lies at 7:33 AM on November 3, 2023 [2 favorites]
If they had been diagnosed as mania you would not be considered Bipolar II. Mania is specific to Bipolar I. From your description, hypomania seems more likely.
I saw a TV drama
With rare exception depictions of mental illness in film or TV are misleading or simply wrong. Between misinformation and creative license they’re not a good place to get an understanding of this topic.
I don't know if "so what does psychosis feel like?" is a viable thing to ask her
It’s a good thing to ask and really not that unusual. People sometimes think they’re going crazy and a good therapist can help them work with it.
I also have a major fear of my life/reality actually being a hallucination
There is an entire philosophical realm called Solipsism that deals with the possibility and implications of your entire life experience being an hallucination. It doesn’t directly address the hospital bed scenario, but a lot of very rational people have been considering this question for a very long time. You’re not alone in wondering.
How do you know if you're having an episode?
I’ve only had minor episodes, but the common thread I’ve picked out talking to friends and relatives is that at the time it is happening everything makes sense — not just the audio and/or visual hallucinations, but everything in their lives feels accounted for. Unlike the reality of day to day life, things are very clear. This is also a symptom of paranoia.
For at least two of them, a sense that they understand everything is a warning sign that they need to be extra careful. Their hallucinations are not particularly unpleasant but they can be socially awkward, and in particular they should never drive while experiencing them. Others say they would never recognize an episode when they’re having one but in retrospect they see similarities. This is a very small sample though. YMMV.
To sum up, life is extremely confusing and made even more so when you can’t rely on your sense of reality. When everything starts to seem perfectly clear is the time to worry.
posted by Tell Me No Lies at 7:33 AM on November 3, 2023 [2 favorites]
Mod note: One comment removed. This is all very sensitive and fraught, so please don't try to diagnosis the OP!
posted by Brandon Blatcher (staff) at 7:35 AM on November 3, 2023 [2 favorites]
posted by Brandon Blatcher (staff) at 7:35 AM on November 3, 2023 [2 favorites]
Best answer: I sometimes hallucinate when very sleep deprived or feverish and I can tell that my hallucinations are hallucinations because they are impossible and no one else reacts to them, e.g., when my cat was walking around on my hospital bed I knew it was a hallucination because my cat had no means to get to the hospital (he can't even drive) and the nurses were not shooing him off.
I basically just compare the probability of the thing being real to the probability that my brain is malfunctioning. Brains malfunction and perceive things that aren't actually there quite often, even in "sane" people. I don't stress about it because I'm not arrogant enough to assume that my brain is always correct.
So my advice would be to just accept that sometimes your brain is wrong. Ask other people if they see/hear that too, or consider how realistic is it that this thing would actually be happen?
Like I'll probably be fucked if anything truly wild ever happens, e.g. aliens invade, since I'll assume I'm hallucinating, but the probability of that happening is so very small that I'm fine with erring on the side of assuming that wild shit is actually just a hallucination from my brain glitching out.
So far the only suspected hallucinations that turned out to be real are odd smells, e.g., I have hypersomia to the point where a dried up petal from a flower arrangement from a year ago falling behind the baseboard heater is enough to make me perceive someone is spraying floral perfume around my apartment. I'd assumed I'd been hallucinating the smell of perfume until I finally found the damn petal. But so far all suspected auditory and visual hallucinations were indeed just hallucinations, or at least whatever the real thing was disappeared before I could get a witness.
posted by Jacqueline at 9:03 AM on November 3, 2023 [5 favorites]
I basically just compare the probability of the thing being real to the probability that my brain is malfunctioning. Brains malfunction and perceive things that aren't actually there quite often, even in "sane" people. I don't stress about it because I'm not arrogant enough to assume that my brain is always correct.
So my advice would be to just accept that sometimes your brain is wrong. Ask other people if they see/hear that too, or consider how realistic is it that this thing would actually be happen?
Like I'll probably be fucked if anything truly wild ever happens, e.g. aliens invade, since I'll assume I'm hallucinating, but the probability of that happening is so very small that I'm fine with erring on the side of assuming that wild shit is actually just a hallucination from my brain glitching out.
So far the only suspected hallucinations that turned out to be real are odd smells, e.g., I have hypersomia to the point where a dried up petal from a flower arrangement from a year ago falling behind the baseboard heater is enough to make me perceive someone is spraying floral perfume around my apartment. I'd assumed I'd been hallucinating the smell of perfume until I finally found the damn petal. But so far all suspected auditory and visual hallucinations were indeed just hallucinations, or at least whatever the real thing was disappeared before I could get a witness.
posted by Jacqueline at 9:03 AM on November 3, 2023 [5 favorites]
Best answer: I'm trying to think of how to better articulate my internal diagnostics process because I do think it would help you. I used to get really freaked out by similar worries as yours until I learned a lot about brains and how everyone is basically always hallucinating a bit at all times because our brains cannot perfectly perceive and model sensory data.
We get a ton of imperfect info from our eyes, ears, nose, skin, inner ear, etc. -- way more data than we can process -- and our brains model it as best they can. But our brains are always wrong. Sometimes they are less wrong, but even at our most sane, lucid, alert, etc. out brains are still wrong.
I think if you change your baseline starting point from "I can accurately perceive reality" or "sane people can accurate perceive reality" to the more scientifically accurate "literally no one is ever accurately perceiving reality" then it is a lot less stressful because now you've got a margin of error to work with. The stakes are no longer "any hallucination = I'm crazy" but instead "hmm we seem to be having an usually high number of quality control issues today, let's investigate and recalibrate."
The process is very similar to figuring out if you are having an emotion because of something that happened, or if the emotion came first and your brain went looking for an explanation. Like when you're really angry and you think it's because X, Y, and Z but it turns out you were just hungry. The emotion came entirely from that internal physical process and not the external events of X, Y, Z, but if you didn't stop to think about it and run through a list of other things that could cause that emotion then you would assume that it was something external pissing you off.
In my experience, the more you practice metacognition, the easier it gets to debug your own code. So spend more time thinking about your thinking and analyzing why you might think, feel, or perceive something instead of just accepting whatever you think, feel, and perceive at face value.
If you are constantly doing that all the time, it serves as a built-in error checking process, e.g., why am I always seeing the hat man and the shadow people? They disappear when I get up to go look directly at where I saw them. It is physically impossible for someone to teleport away like that, so I know it is a hallucination. I analyze the circumstances under which I have this hallucination and realize that it is always when my bed or desk is oriented in a particular way to the doorway. So it seems there's a particular spot in my peripheral vision that my brain likes to populate with hallucinations. When I reorient my bed and desk so that a plain nearby wall occupies that spot instead of an open doorway, I no longer get startled by shadowy figures wandering down the hall. Sorted.
posted by Jacqueline at 9:37 AM on November 3, 2023 [10 favorites]
We get a ton of imperfect info from our eyes, ears, nose, skin, inner ear, etc. -- way more data than we can process -- and our brains model it as best they can. But our brains are always wrong. Sometimes they are less wrong, but even at our most sane, lucid, alert, etc. out brains are still wrong.
I think if you change your baseline starting point from "I can accurately perceive reality" or "sane people can accurate perceive reality" to the more scientifically accurate "literally no one is ever accurately perceiving reality" then it is a lot less stressful because now you've got a margin of error to work with. The stakes are no longer "any hallucination = I'm crazy" but instead "hmm we seem to be having an usually high number of quality control issues today, let's investigate and recalibrate."
The process is very similar to figuring out if you are having an emotion because of something that happened, or if the emotion came first and your brain went looking for an explanation. Like when you're really angry and you think it's because X, Y, and Z but it turns out you were just hungry. The emotion came entirely from that internal physical process and not the external events of X, Y, Z, but if you didn't stop to think about it and run through a list of other things that could cause that emotion then you would assume that it was something external pissing you off.
In my experience, the more you practice metacognition, the easier it gets to debug your own code. So spend more time thinking about your thinking and analyzing why you might think, feel, or perceive something instead of just accepting whatever you think, feel, and perceive at face value.
If you are constantly doing that all the time, it serves as a built-in error checking process, e.g., why am I always seeing the hat man and the shadow people? They disappear when I get up to go look directly at where I saw them. It is physically impossible for someone to teleport away like that, so I know it is a hallucination. I analyze the circumstances under which I have this hallucination and realize that it is always when my bed or desk is oriented in a particular way to the doorway. So it seems there's a particular spot in my peripheral vision that my brain likes to populate with hallucinations. When I reorient my bed and desk so that a plain nearby wall occupies that spot instead of an open doorway, I no longer get startled by shadowy figures wandering down the hall. Sorted.
posted by Jacqueline at 9:37 AM on November 3, 2023 [10 favorites]
I do not have the same experience, but I do have anxiety attacks, and sometimes panic attacks. Vagus nerve stimulation helps a lot. One form of vagus nerve stimulation is a very wet, cold washcloth on the face, or splashing cold water; this has a physiological effect, the mammalian dive reflex, and it reduces anxiety. Psychology Today has a bunch of articles.
I have ADHD and sometimes get manic when life starts to fall apart and I think I can keep 12 plates spinning, and I've learned by experience that when I start trying to fix things by running faster, the best thing to do is to focus on 1 solvable event.
Your awareness is a great asset.
posted by theora55 at 10:27 AM on November 3, 2023
I have ADHD and sometimes get manic when life starts to fall apart and I think I can keep 12 plates spinning, and I've learned by experience that when I start trying to fix things by running faster, the best thing to do is to focus on 1 solvable event.
Your awareness is a great asset.
posted by theora55 at 10:27 AM on November 3, 2023
You might also ask your therapist about Depersonalization or Derealization, which may match what you're experiencing closer than psychosis. (Reasonably okay description here: https://www.verywellmind.com/derealization-2671582)
posted by lapis at 10:27 AM on November 3, 2023 [4 favorites]
posted by lapis at 10:27 AM on November 3, 2023 [4 favorites]
Seconding Lapis! I used to have similar feelings / recurring thoughts and it was because of depersonalization from cptsd. It's a very uncomfortable feeling to me! After a lot of talk therapy focusing on the trauma, plus EMDR, and lots of personal mental health care habits, I rarely have those thoughts anymore. If they pop up, grounding exercises can help me (some examples here)
posted by Uncle Glendinning at 11:38 AM on November 3, 2023 [1 favorite]
posted by Uncle Glendinning at 11:38 AM on November 3, 2023 [1 favorite]
Best answer: Having experienced psychosis and been involuntarily hospitalised for it, I agree with everything flabdablet said re certainty and skepticism. If you’re able to question whether what’s happening is real, that’s a good thing. If you’re coming up against thoughts that don’t seem likely to be true (ie they seem to follow logic that would only make sense in a TV show, including ‘this character is hospitalised and imagining all this’ type TV plot lines) and you’re able to question whether that seems likely to be true or not, that’s also a good sign.
I also agree that talking to your therapist about this is the way forward. They may be able to suggest some CBT techniques for interrupting this thought train, for example, or some reassurance. Or, if you are currently experiencing some degree of mania or psychosis then they may be able to help you get treatment that doesn’t involve hospitalisation.
posted by chives at 12:24 PM on November 3, 2023 [3 favorites]
I also agree that talking to your therapist about this is the way forward. They may be able to suggest some CBT techniques for interrupting this thought train, for example, or some reassurance. Or, if you are currently experiencing some degree of mania or psychosis then they may be able to help you get treatment that doesn’t involve hospitalisation.
posted by chives at 12:24 PM on November 3, 2023 [3 favorites]
Best answer: Also, re-reading, your question sounds more like ‘what does a psychotic episode feel like?’ than ‘Am I having a psychotic episode’ - in which case my answer is that for me it kind of felt like a waking nightmare, or a very weird very long dream. Sometimes I knew what was happening, sometimes I didn’t. No one around me could understand what I was saying. It wasn’t like everything was perfectly normal and I was living a whole life except secretly I was in the hospital, like that one terrible episode of Buffy. It may be that your experience is closer to derealisation as described above, and this thought about psychosis is an anxious rumination you’re having, which would be good to discuss with your therapist.
posted by chives at 12:32 PM on November 3, 2023 [3 favorites]
posted by chives at 12:32 PM on November 3, 2023 [3 favorites]
I think autistic people experience this a lot. Things can be internally consistent for us, but maybe not make sense from an external view, and years of feedback from people who aren't autistic can cause real harm.
Sorta like the Home Video thread on toxic masculinity? A sorta forced masking, where when we don't, it's viewed as mentally ill, instead of just a different way of processing...
We can become attuned to, and over sensitive to "ok boomer" like reactions in other people (not being a boomer) and doubt ourselves and experiences.
This is a type of harm autistic people can feel, and even mental health professionals can cause this by looking at the behaviors through a mental health instead of autistic paradigm.
My therapist who specializes in this and the harm I've experienced, focuses very much on how internally consistent my behavior is, even if it's different from neuotypical responses.
Ironically, she's helped me to stop policing myself based on neuotypical standards, and to stop calling actions "being bipolar" or "OCD" or "reactive" or "crazy" because they are congruent within me, and my doubt is a sign of harm others caused me.
I know I repeated myself. I haven't had to say this out loud before. Maybe instead of looking at the article, as "proof people and maybe me are outside of reality and being catered to" ... What about... "Huh, neurotypical people once again learned divergent people can do some things differently, and still get by, without it being necessary to pathologize them"
posted by bindr at 1:03 PM on November 3, 2023 [2 favorites]
Sorta like the Home Video thread on toxic masculinity? A sorta forced masking, where when we don't, it's viewed as mentally ill, instead of just a different way of processing...
We can become attuned to, and over sensitive to "ok boomer" like reactions in other people (not being a boomer) and doubt ourselves and experiences.
This is a type of harm autistic people can feel, and even mental health professionals can cause this by looking at the behaviors through a mental health instead of autistic paradigm.
My therapist who specializes in this and the harm I've experienced, focuses very much on how internally consistent my behavior is, even if it's different from neuotypical responses.
Ironically, she's helped me to stop policing myself based on neuotypical standards, and to stop calling actions "being bipolar" or "OCD" or "reactive" or "crazy" because they are congruent within me, and my doubt is a sign of harm others caused me.
I know I repeated myself. I haven't had to say this out loud before. Maybe instead of looking at the article, as "proof people and maybe me are outside of reality and being catered to" ... What about... "Huh, neurotypical people once again learned divergent people can do some things differently, and still get by, without it being necessary to pathologize them"
posted by bindr at 1:03 PM on November 3, 2023 [2 favorites]
Response by poster: Thank you all, I appreciate the support and frankness!
To answer some questions:
1. I haven't been hospitalized for psychosis per se. I was hospitalised for what turned out to be panic attacks when I was 16 - I'd never had a panic attack before and wasn't diagnosed with anything mental health related before that, so as far as my family and I knew it was some physical malady. Got diagnosed with panic disorder and depression after that, but the diagnosis shifted to what it is now over time. I also spent some time in emergency after coming off a med (in a controlled monitored way) backfired and I felt VERY ANGRY suddenly, but I managed to get on track.
2. That damn Buffy episode with the hospital was what gave me this phobia in the first place!!
3. The closest I could say I've gotten to psychosis was when (for various reasons) I suddenly ran out of meds, and after a few days cold turkey the whole "I am hallucinating everything" vision set in FULLY. Long story short, we managed to find some kind of emergency mental health support the next day and I got back on my meds.
4. You're right, it's hypomania sorry! I forgot the term when I wrote this. Although I'm still not always 100% certain when it's hypomania and when it's my executive functioning Functioning Super Effectively, especially given that the periods of hypomania I recognised as such involved me making very intense versions of adult decisions such as budgeting and life planning for a rescue plan or cleaning the entire apartment in one fell swoop with way too energy.
The points about this being similar to autism burnout is interesting - my autism diagnosis is only a couple of years old so I'm still learning. I'll try to remember to ask my therapist next time I see her and see what she says, she's been pretty good but a lot of our time has usually been related to Current Day Issue, not so much larger scale matters.
posted by creatrixtiara at 6:21 PM on November 3, 2023
To answer some questions:
1. I haven't been hospitalized for psychosis per se. I was hospitalised for what turned out to be panic attacks when I was 16 - I'd never had a panic attack before and wasn't diagnosed with anything mental health related before that, so as far as my family and I knew it was some physical malady. Got diagnosed with panic disorder and depression after that, but the diagnosis shifted to what it is now over time. I also spent some time in emergency after coming off a med (in a controlled monitored way) backfired and I felt VERY ANGRY suddenly, but I managed to get on track.
2. That damn Buffy episode with the hospital was what gave me this phobia in the first place!!
3. The closest I could say I've gotten to psychosis was when (for various reasons) I suddenly ran out of meds, and after a few days cold turkey the whole "I am hallucinating everything" vision set in FULLY. Long story short, we managed to find some kind of emergency mental health support the next day and I got back on my meds.
4. You're right, it's hypomania sorry! I forgot the term when I wrote this. Although I'm still not always 100% certain when it's hypomania and when it's my executive functioning Functioning Super Effectively, especially given that the periods of hypomania I recognised as such involved me making very intense versions of adult decisions such as budgeting and life planning for a rescue plan or cleaning the entire apartment in one fell swoop with way too energy.
The points about this being similar to autism burnout is interesting - my autism diagnosis is only a couple of years old so I'm still learning. I'll try to remember to ask my therapist next time I see her and see what she says, she's been pretty good but a lot of our time has usually been related to Current Day Issue, not so much larger scale matters.
posted by creatrixtiara at 6:21 PM on November 3, 2023
Response by poster: And oh yeah I was aware that TV drama representations of health conditions aren't exactly authentic - it more so reminded me of other people talking about their experiences with loved ones with dementia who think they're back in time or something and I was curious to know what their internal world was like
posted by creatrixtiara at 6:22 PM on November 3, 2023
posted by creatrixtiara at 6:22 PM on November 3, 2023
I'm still not always 100% certain when it's hypomania and when it's my executive functioning Functioning Super Effectively
I'm completely unconvinced that there's a process difference between those two things.
It seems to me that we label the exact same set of internal behaviours and responses as one of those things or the other not on the basis of what we're actually doing and/or its underlying biochemistry, but on the nature of the larger purpose we're attempting to serve by doing it.
making very intense versions of adult decisions such as budgeting and life planning for a rescue plan or cleaning the entire apartment in one fell swoop
One of the epiphanic revelations of the bleedin' obvious that I had while psychotic was that being alive is, in broad conceptual terms, an essentially simple proposition:
(1) Do your best to respond to your circumstances accurately enough, and quickly enough, that you
(2) Don't get hit by a bus.
Unlike most of them, this one has stood the test of time. Obviously the bus is metaphorical as well as literal and can manifest in an arbitrarily large number of forms. The trick is to see it coming.
It seems to me that finding my way into an emotional/mental/physical state where I have a massive amount of energy to apply to activities that serve (1) or (2) or both is useful and good and absolutely welcome. Applying the same kind of energy to activities that serve neither, though, makes me a loose cannon and risks failure on point (2).
Responding accurately to our circumstances is much more easily done when we're working with an accurate model of them, and a first and necessary step in the acquisition of an accurate model is to avoid bullshitting ourselves about how things are. Which includes bullshitting ourselves about how we are. Figuring shit out is hard at the best of times but it's made much, much harder if we spend most of our time having to hack through a tangle of marketing lies.
All of us have features and characteristics that we can't help seeing as unfortunate or regrettable, and others that we think of as excellent and worth cultivating. Sometimes it's personal experience that teaches us those attitudes toward ourselves; sometimes we soak them up from other people. For the purposes of figuring shit out it doesn't really matter how we learned what's good about us and what isn't. What matters is how well we can predict our own behaviour on the basis of how we know we work.
If occasional bursts of hypomania/super-effectiveness are part and parcel of your existence, I recommend embracing that rather than fearing it or treating it as pathological. Do bear in mind, though, that personal super-effectiveness is rather like access to technology: it amplifies personal power without doing squat to amplify personal responsibility.
So rather than trying to "fix" "hypomania", you might find that your time is better spent on cultivating a responsible attitude toward its appropriate uses. That way, when the next burst of energy arrives you're much more likely to be riding that bus than having it mow you down in the street.
Finding yourself with a workable budget and a clean apartment off the back of an episode is a clear sign that you're already doing that, so I wouldn't worry too much if I were you.
posted by flabdablet at 10:31 PM on November 3, 2023 [1 favorite]
I'm completely unconvinced that there's a process difference between those two things.
It seems to me that we label the exact same set of internal behaviours and responses as one of those things or the other not on the basis of what we're actually doing and/or its underlying biochemistry, but on the nature of the larger purpose we're attempting to serve by doing it.
making very intense versions of adult decisions such as budgeting and life planning for a rescue plan or cleaning the entire apartment in one fell swoop
One of the epiphanic revelations of the bleedin' obvious that I had while psychotic was that being alive is, in broad conceptual terms, an essentially simple proposition:
(1) Do your best to respond to your circumstances accurately enough, and quickly enough, that you
(2) Don't get hit by a bus.
Unlike most of them, this one has stood the test of time. Obviously the bus is metaphorical as well as literal and can manifest in an arbitrarily large number of forms. The trick is to see it coming.
It seems to me that finding my way into an emotional/mental/physical state where I have a massive amount of energy to apply to activities that serve (1) or (2) or both is useful and good and absolutely welcome. Applying the same kind of energy to activities that serve neither, though, makes me a loose cannon and risks failure on point (2).
Responding accurately to our circumstances is much more easily done when we're working with an accurate model of them, and a first and necessary step in the acquisition of an accurate model is to avoid bullshitting ourselves about how things are. Which includes bullshitting ourselves about how we are. Figuring shit out is hard at the best of times but it's made much, much harder if we spend most of our time having to hack through a tangle of marketing lies.
All of us have features and characteristics that we can't help seeing as unfortunate or regrettable, and others that we think of as excellent and worth cultivating. Sometimes it's personal experience that teaches us those attitudes toward ourselves; sometimes we soak them up from other people. For the purposes of figuring shit out it doesn't really matter how we learned what's good about us and what isn't. What matters is how well we can predict our own behaviour on the basis of how we know we work.
If occasional bursts of hypomania/super-effectiveness are part and parcel of your existence, I recommend embracing that rather than fearing it or treating it as pathological. Do bear in mind, though, that personal super-effectiveness is rather like access to technology: it amplifies personal power without doing squat to amplify personal responsibility.
So rather than trying to "fix" "hypomania", you might find that your time is better spent on cultivating a responsible attitude toward its appropriate uses. That way, when the next burst of energy arrives you're much more likely to be riding that bus than having it mow you down in the street.
Finding yourself with a workable budget and a clean apartment off the back of an episode is a clear sign that you're already doing that, so I wouldn't worry too much if I were you.
posted by flabdablet at 10:31 PM on November 3, 2023 [1 favorite]
I sometimes hallucinate when very sleep deprived or feverish and I can tell that my hallucinations are hallucinations because they are impossible and no one else reacts to them
My own equanimity wrt hallucinations is quite robust because I've had enough experience with assorted psychedelics to leave me quite comfortable with Internal Special Effects.
Some people use psychedelics for the special effects, just visiting the interior IMAX for entertainment purposes. As a committed inner space cadet I've always been less concerned about the scenery than the obstacles, so while I was in my psychedelics experimentation phase I was much more interested in how they affected basic life skills like my ability to keep track of The Precious Object (my water bottle! Tripping while hiking is fabulous) than the pretty distractions in and of themselves. They sure are pretty, though.
Psychosis caught me unawares largely because of a complete lack of ISE: the cognitive failure was conceptual rather than perceptual. It wasn't about being presented with oddly misleading information about the world so much as becoming rapidly and increasingly unable to model it correctly while not caring about that in the slightest in a way that made the whole thing feed back on itself.
I'm lucky to have survived the ensuing antics, and I deeply regret the emotional distress they caused in all the people who care about me, but as an experience in and of itself it was an extraordinarily pleasant way to exist. The total absence of anxiety brought on by always being completely certain about everything was astonishingly good. Balm for the soul.
I often wonder whether deep religious faith amounts to a high-functioning variant of the same operating mode. If it does, I can fully understand why people value it.
posted by flabdablet at 11:22 PM on November 3, 2023 [1 favorite]
My own equanimity wrt hallucinations is quite robust because I've had enough experience with assorted psychedelics to leave me quite comfortable with Internal Special Effects.
Some people use psychedelics for the special effects, just visiting the interior IMAX for entertainment purposes. As a committed inner space cadet I've always been less concerned about the scenery than the obstacles, so while I was in my psychedelics experimentation phase I was much more interested in how they affected basic life skills like my ability to keep track of The Precious Object (my water bottle! Tripping while hiking is fabulous) than the pretty distractions in and of themselves. They sure are pretty, though.
Psychosis caught me unawares largely because of a complete lack of ISE: the cognitive failure was conceptual rather than perceptual. It wasn't about being presented with oddly misleading information about the world so much as becoming rapidly and increasingly unable to model it correctly while not caring about that in the slightest in a way that made the whole thing feed back on itself.
I'm lucky to have survived the ensuing antics, and I deeply regret the emotional distress they caused in all the people who care about me, but as an experience in and of itself it was an extraordinarily pleasant way to exist. The total absence of anxiety brought on by always being completely certain about everything was astonishingly good. Balm for the soul.
I often wonder whether deep religious faith amounts to a high-functioning variant of the same operating mode. If it does, I can fully understand why people value it.
posted by flabdablet at 11:22 PM on November 3, 2023 [1 favorite]
So... There have been extra demands on my executive functioning and emotional regulation lately, and I have not had the space necessary for self-care.
I'm getting irritable and angry, and carving out spaces for myself... And getting a lot of resistance for that ... Because my self-care can appear somewhat atypical. The push back makes me angrier, and if I had no clue what was going on, I could do easily burst into tears crying, panicking because I didn't know what was wrong with me, and walk away with a bipolar II dx of mixed state, with a nice new rx for a mood-stabizer...
Which could reinforce the idea that I'm unreliable , unstable and there's something wrong with me that means I can't trust myself, my perceptions or needs...
BUT... I also know that 4-6hrs or silence, to pick an or any activity of my own volition, and performance of a non-entrophic task will have me on even-keel and ready to face the world again... Faster than meds would work...
It's all very reasonable laid out like that... But there's a neurodivetgrnt vs neurotypical aspect to this...
My spouse (a mefite) is sick, and cranky. They know that with exception of the day I was in bed with a fever I haven't had time to myself in over 3 weeks, between his illness, my daughter's illnesses, days off from school, and a family friend needing respite care... They have no problem with me going for a walk, or meeting with friends, grabbing a coffee or getting a mani-pedi to relax. Neurotypical shit.
But I'm not neurotypical! So, there's a conflict of sorts, because they want to know WHY if I'm overwhelmed, tired and done, am I painting a room, cleaning out a closet, replacing a broken pane in our security door window, organizing toys, books, files.. It's very easy to take that on myself and wonder if I'm insane, especially because their frustration interfers with my stimming/regulating activities.
Working with my therapist whose well versed in autism, especially how it presents in women, has taught me to understand and be comfortable with what I'm doing and my needs, and over time to feel less like there's something seriously wrong with me, because my ideas don't align with a more neurotypical view.
I'm at the point I no longer doubt myself and my reasons, at least not in most situations, and I'm no longer feelings shaky inside, but not so far along that pathologizing my decisions around what self-care looks like for me, doesn't make me furious!!!
posted by bindr at 9:07 AM on November 4, 2023 [2 favorites]
I'm getting irritable and angry, and carving out spaces for myself... And getting a lot of resistance for that ... Because my self-care can appear somewhat atypical. The push back makes me angrier, and if I had no clue what was going on, I could do easily burst into tears crying, panicking because I didn't know what was wrong with me, and walk away with a bipolar II dx of mixed state, with a nice new rx for a mood-stabizer...
Which could reinforce the idea that I'm unreliable , unstable and there's something wrong with me that means I can't trust myself, my perceptions or needs...
BUT... I also know that 4-6hrs or silence, to pick an or any activity of my own volition, and performance of a non-entrophic task will have me on even-keel and ready to face the world again... Faster than meds would work...
It's all very reasonable laid out like that... But there's a neurodivetgrnt vs neurotypical aspect to this...
My spouse (a mefite) is sick, and cranky. They know that with exception of the day I was in bed with a fever I haven't had time to myself in over 3 weeks, between his illness, my daughter's illnesses, days off from school, and a family friend needing respite care... They have no problem with me going for a walk, or meeting with friends, grabbing a coffee or getting a mani-pedi to relax. Neurotypical shit.
But I'm not neurotypical! So, there's a conflict of sorts, because they want to know WHY if I'm overwhelmed, tired and done, am I painting a room, cleaning out a closet, replacing a broken pane in our security door window, organizing toys, books, files.. It's very easy to take that on myself and wonder if I'm insane, especially because their frustration interfers with my stimming/regulating activities.
Working with my therapist whose well versed in autism, especially how it presents in women, has taught me to understand and be comfortable with what I'm doing and my needs, and over time to feel less like there's something seriously wrong with me, because my ideas don't align with a more neurotypical view.
I'm at the point I no longer doubt myself and my reasons, at least not in most situations, and I'm no longer feelings shaky inside, but not so far along that pathologizing my decisions around what self-care looks like for me, doesn't make me furious!!!
posted by bindr at 9:07 AM on November 4, 2023 [2 favorites]
Suggesting to somebody else that they should - need to, even - stop doing what's clearly working for them, in order to do something else that would work for you if faced with their circumstances, is indeed fury-inducing.
It's not only a neurotypical vs neuroatypical thing, either. It can be a gender thing, or a culture thing, or a race thing, or a family thing, or a generational thing, and on and on and on.
The fundamental thing that makes it so enraging is that the person doing the ordering-about, whether or not they cover it with a fig leaf of well-meant advice, is displaying a complete failure of not only awareness but self-awareness while unjustifiably bigging themselves up along the way. They're so inordinately proud of their own coping skills as to act as if those are the only possible coping skills; the idea that their own history is every bit as random and contingent as anybody else's never seems to have occurred to them.
"This is working well for me, thanks all the same" is the script I'll generally use when assailed in this fashion.
The flip side of that rage is watching people do things over and over and over in ways that are normal and standard and customary and ordinary but manifestly don't work and never have worked and never could work, then being required to put on a happy face while listening to them piss and moan about shit falling to pieces as the predictable and predicted result.
No, bossman, I'm not going to pop over and walk you through using that password manager again like I already spent an hour doing months after I first installed it for you, because if you were using it every fucking day like I've been nagging you to for fucking years instead of just starting now after your identity has already been fucking stolen, you'd already have it in muscle memory and you'd still have access to the bank account you're supposed to be paying me from. And don't get me started on people who flat refuse to take the whole idea of backups the slightest bit seriously and then crack the sads when twenty years of family photos just evaporate. Grrr.
What's normal practice is by no means always what's good, and many many many people have a grip on reality that's shaky at best.
posted by flabdablet at 10:06 AM on November 4, 2023
It's not only a neurotypical vs neuroatypical thing, either. It can be a gender thing, or a culture thing, or a race thing, or a family thing, or a generational thing, and on and on and on.
The fundamental thing that makes it so enraging is that the person doing the ordering-about, whether or not they cover it with a fig leaf of well-meant advice, is displaying a complete failure of not only awareness but self-awareness while unjustifiably bigging themselves up along the way. They're so inordinately proud of their own coping skills as to act as if those are the only possible coping skills; the idea that their own history is every bit as random and contingent as anybody else's never seems to have occurred to them.
"This is working well for me, thanks all the same" is the script I'll generally use when assailed in this fashion.
The flip side of that rage is watching people do things over and over and over in ways that are normal and standard and customary and ordinary but manifestly don't work and never have worked and never could work, then being required to put on a happy face while listening to them piss and moan about shit falling to pieces as the predictable and predicted result.
No, bossman, I'm not going to pop over and walk you through using that password manager again like I already spent an hour doing months after I first installed it for you, because if you were using it every fucking day like I've been nagging you to for fucking years instead of just starting now after your identity has already been fucking stolen, you'd already have it in muscle memory and you'd still have access to the bank account you're supposed to be paying me from. And don't get me started on people who flat refuse to take the whole idea of backups the slightest bit seriously and then crack the sads when twenty years of family photos just evaporate. Grrr.
What's normal practice is by no means always what's good, and many many many people have a grip on reality that's shaky at best.
posted by flabdablet at 10:06 AM on November 4, 2023
I'm still not always 100% certain when it's hypomania and when it's my executive functioning Functioning Super Effectively
Track your sleep, either with one of those smart watches or with your smartphone's built-in health app. The latter is actually just tracking when your phone is lying still and unused for several hours, so if you tend to go on multi-hour cleaning or other activity benders in which you don't touch your phone then you should probably get a smart watch or other sleep tracking device instead. (My own phone keeps trying to record long PC gaming sessions as sleep time because I'm not touching my phone while I play.)
Hypomania is almost always associated with sleeping significantly less than usual, so if you track your sleep over time and can retroactively recognize a hypomanic episode then you should be able to do some data analysis in Excel to figure out how much your sleep changes when you're hypomanic and then use that as a guideline going forward to help you recognize a hypomanic episode when it starts.
If you're able to track it accurately, hours of sleep per night is a nice objective metric to get insight into how you're doing when your subjective assessments can't be trusted. When I was very ill and hallucinating and went to the ER earlier this year, it turned out to be from severe sleep deprivation. I didn't know I hadn't been sleeping until the ER docs asked me about my sleep and I checked my phone's health app and discovered I'd been sleeping less than 2 hours/night for weeks. I'd developed a tolerance to Ambien so that it no longer functioned as a sleep aid but was still giving me the memory formation impairment side effect, so for a while all the Ambien had been doing was making me forget my insomnia.
Sleep deprivation exacerbates and triggers so many psychological issues that IMO it is very worth it for anyone with known psychological problems to invest the necessary time and money into collecting accurate sleep data. Even if you're unable to immediately fix whatever is causing the sleep deprivation, having an objective measurement that you're psychologically compromised right now is a great self-control tool for talking yourself down from extreme emotions. Like I have at least a few "am I suicidally depressed or just sleep deprived?" moments per year, and when I check my sleep history data on my phone the answer has been "sleep deprived" every time.
posted by Jacqueline at 10:37 AM on November 4, 2023 [4 favorites]
Track your sleep, either with one of those smart watches or with your smartphone's built-in health app. The latter is actually just tracking when your phone is lying still and unused for several hours, so if you tend to go on multi-hour cleaning or other activity benders in which you don't touch your phone then you should probably get a smart watch or other sleep tracking device instead. (My own phone keeps trying to record long PC gaming sessions as sleep time because I'm not touching my phone while I play.)
Hypomania is almost always associated with sleeping significantly less than usual, so if you track your sleep over time and can retroactively recognize a hypomanic episode then you should be able to do some data analysis in Excel to figure out how much your sleep changes when you're hypomanic and then use that as a guideline going forward to help you recognize a hypomanic episode when it starts.
If you're able to track it accurately, hours of sleep per night is a nice objective metric to get insight into how you're doing when your subjective assessments can't be trusted. When I was very ill and hallucinating and went to the ER earlier this year, it turned out to be from severe sleep deprivation. I didn't know I hadn't been sleeping until the ER docs asked me about my sleep and I checked my phone's health app and discovered I'd been sleeping less than 2 hours/night for weeks. I'd developed a tolerance to Ambien so that it no longer functioned as a sleep aid but was still giving me the memory formation impairment side effect, so for a while all the Ambien had been doing was making me forget my insomnia.
Sleep deprivation exacerbates and triggers so many psychological issues that IMO it is very worth it for anyone with known psychological problems to invest the necessary time and money into collecting accurate sleep data. Even if you're unable to immediately fix whatever is causing the sleep deprivation, having an objective measurement that you're psychologically compromised right now is a great self-control tool for talking yourself down from extreme emotions. Like I have at least a few "am I suicidally depressed or just sleep deprived?" moments per year, and when I check my sleep history data on my phone the answer has been "sleep deprived" every time.
posted by Jacqueline at 10:37 AM on November 4, 2023 [4 favorites]
This thread is closed to new comments.
You can ask your therapist anything. The more you ask, the more they can come to understand what you're dealing with, and the better positioned they will be to provide assistance.
You mentioned Bipolar II and psychotic episodes. Have you been hospitalized for such? My understanding is that a key distinction between Bipolar I and Bipolar II is that mania during the former can often lead to psychosis, but in the latter it either does not or does not happen as frequently. So, it can happen, but some (many?) people with Bipolar II will not have psychotic episodes, or not with the frequency or constancy that would lead to one being strapped to a hospital bed for a lifetime. Likewise, though it's true that a person with Bipolar II can be prescribed "anti-psychotics", it is not the case that everyone who gets prescribed those drugs is, or needs to be, one who enters into psychosis.
I think it's great you decided to reach out to AskMe for the hive's input. You've done nothing to be sorry for.
posted by jerome powell buys his sweatbands in bulk only at 10:38 PM on November 2, 2023 [2 favorites]