by Richard Weingarten , M.A., CPRP
“How good can a day be if it begins with getting up in the morning?” Ed Flynn, Ph.D.
Getting out of bed and moving in the morning and then facing the day is a challenge for many of us, whether we have psychiatric illnesses or not. For people suffering from psychiatric illnesses, the early morning poses an even greater challenge, one that goes largely unnoticed because it is often linked to “hangovers” we experience from the psychotropic medications we have taken the night before. Because hangovers are often seen as unavoidable side effects of the medications, many consumers view them passively as one inevitable unchangeable side effect of their illness that they must accept. “This too shall pass” is often the refrain.
I accepted the early morning “hangovers” that bedeviled me for the last 17 years, although they weren’t the same. I woke up with tired, heavy, listless feelings that I associated with the psychotropic medications I took each night before bedtime. These feelings mirrored the feelings of dysthymia I experienced for 19 years prior to finding an anti-depressant that eliminated it. Unfortunately, the depressive hangover feelings were accompanied by intrusive thoughts about ways I had screwed up interactions and activities the day before. My mind replayed the previous day’s mistakes and miscues, second-guessed my actions, and offered “solutions” for the previous day’s perceived mistakes.
To get out of bed, stay out of bed and focus on something other than these intrusive thoughts, i.e. “I probably shouldn’t have sent her my article along with the e-mail,” I developed and followed an active morning routine. I shaved and showered, dressed, prepared and ate breakfast, read the morning paper, cleaned up the breakfast dishes and straightened up my apartment. The regimen worked up to a point. However, often when I got to work, the intrusive thoughts and tired feelings were still with me.
To keep my mind and body busy at work until the intrusive feelings and thoughts lifted, I retrieved my phone and e-mail messages, sent out routine messages, etc. I did not schedule anything important until 9:30 or 10:00 AM. By this time, I had focused my energy, my head cleared, and I could concentrate on the job at hand.
I learned quickly not to tell anyone about my slow start in the morning. In my first job as a mental health outreach worker, my supervisor found me thumbing through magazines early one morning and asked me what I was doing. “I’m a slow starter and this is the way I allow myself to come to,” I said. Her response was “We’re not paying you to thumb through magazines. You’re here to work.” I put the magazine aside. At the end of my contract, when I was offered another year’s contract, I turned down the offer, recalling my supervisor’s insensitivity. I learned in subsequent jobs to fake working the first hour or so.
With the belief that many other consumers found early mornings difficult, I surveyed several consumer friends, all of whom were in recovery, to determine if they had hangovers and how they coped with them.
- Jim, a devout Catholic, told me he wakes up with the hangover, gets down on his knees, prays and asks God for a good day. Then he meditates for a while, dresses and takes a long walk outside his apartment before he fixes breakfast for himself and goes to work–hangover-free.
- Patty, a clubhouse director, said that if she does not have a plan in place i.e., to be at her workplace at a particular time, she stays in bed, so overwhelming are her hangovers upon waking.
- Don, who works part-time for NAMI-CT, says he goes into work in the afternoons because his mornings are so difficult.
- Amy, an award-winning In Our Own Voice presenter, does behavioral therapy on herself to move into her day. Initially she coped with this problem by rewarding herself with Fruity Pebbles, a colorful cereal she has loved since childhood. More recently, she rewards herself for making it through the night in one piece by going to the YMCA at 5:00 AM for two hours of cardio-vascular exercise.
- Brian, a director of Consumer Affairs at a large public agency, takes his neuroleptic medications at dinner instead of bedtime and no longer experiences early morning hangovers.
- Tracy, a homemaker and mother of two, reported a more complex interaction with her morning hangover. For a long time, she woke up almost every morning discouraged and depressed. A spiritual person, she told me she became so exasperated one morning that she yelled out, “God, what is it?!!” Afterwards, she said she saw in her mind’s eye two figures sitting on her bedroom bureau—her mother, representing her discouragement and herself, representing her depression. Gradually the two figures disappeared, and she is no longer troubled by these dismal morning feelings, she told me.
Eliminating early morning hangovers was a little more complicated for me. I employed a set of coping techniques–cognitive therapy, journaling, meditation, self-affirmation and speaking aloud to effectively deal with my hangover problems. Actually, my use of these coping techniques followed three breakthroughs that came one after the other within a three-day period.
The first breakthrough came when I examined the obsessive thoughts and second-guessing, I experienced when someone did not immediately return my e-mail messages or phone calls. I looked at the relationships I had with these people and carefully wrote about them in my journal. Rationally, I knew that they were busy people and would get around to responding to me, but I was unable to be patient. Perhaps I was used to the immediate responses in today’s instant worldwide communications networks like the Internet, Twitter and texting. Perhaps I was being child-like or narcissistic, expecting people to drop what they were doing and respond immediately to me. My uncomfortable waits were filled with intrusive, self-incriminating thoughts about how inappropriate my message was or how I alienated the person, to whom I had emailed.
Then, thoughts that were more intrusive would seek to repair the “damage” I had done to these relationships. The thoughts would take on a life of their own and run through my mind day and night, and then would reappear, non-stop, in the early morning after I awoke. The breakthrough came when I identified the people who had not responded to me as parental figures. I wrote about all the people I placed in this category in my journal. I found that I had placed several people in my life on this parental pedestal, giving them huge power over me.
My second breakthrough came when I linked these parental figures to my father, with whom I had had a very difficult and complex relationship throughout my life. This relationship was marked by emotional and psychological abuse and neglect as well as dutiful love and material support.
What I most wanted from my father was his approval, which he never gave me. This led to my third breakthrough. Yearning for approval that my father never gave me, I looked to my “parental figures” for satisfaction. Of course, their approval almost never came either, at least not the way I wanted or in my timeframe.
When I caught myself yearning for parental approval from those figures, I let go of them and the pedestal on which I had put them. I concluded that they were busy people and would get around to answering my e-mails and phone calls in their own good time.
When in the mornings I found myself ruminating over what I did or said wrong, I sat in my living room recliner and meditated, watching my breath go in and out for a few minutes until I was fully in the present, focusing on the TV set, boom box and bookshelves across the room. In time, I could reflect on what I was doing instead of being a prisoner of my thoughts. When I let go of these people as parental figures, I felt a void of sorts. To fill this void, I wrote in my journal of positive self-affirmations related to what I was doing that in many ways was/is the workbench of my recovery. For example, “I don’t need Ruth to tell me that I wrote a good article,” Or, “I can be a parent to myself,” or, “I am a worthy person whether I get an answer or not.” To give added emphasis to what I was doing, I would read the self-affirmations aloud as a kind of pep talk: “You don’t need his approval!” “You’ll be fine whether you hear from her or not!”
Amazingly, after using these coping methods for only a couple of days, the hangovers and intrusive thoughts stopped coming. I awoke with a clear head completely free of the obsessive thoughts and guilt-ridden feelings. I occasionally felt a mild heaviness due to the medication. However, this, too, soon evaporated as I moved into my day. I was surprised and relieved that I had reclaimed two additional hours of my day! I gave myself a great gift.
Not satisfied with overcoming this hurdle alone, I began to monitor myself in other similarly difficult situations in which I would have intrusive thoughts playing repeatedly in my mind. I knew that these disturbing thoughts were also related to my relationship with my father–going to sleep at night, having to be spontaneous, and spending money on myself.
After talking to my consumer friends, I believe that going to sleep at night is as common and intractable a problem as the early morning hangovers. At root, it requires being alone with and comfortable with oneself. I will pursue difficulties going to sleep in a future article.
I was surprised to discover that my early morning hangover was not totally the result of my psychotropic medication. I was equally surprised that I did not recall coming across others speaking of this problem before, not in WRAP classes that I led, not in peer support groups that I facilitated. I incorrectly thought that my morning routine dealt with the hangover adequately i.e. that I could still work with having it, while keeping it a secret from my supervisors and co-workers.
The consumer friends I talked with about their hangovers had each found strategies to cope with if not eliminate the problem. Their ingenuity and resilience was remarkable. While this is a universal problem – we all have to get up each morning and face the day – we consumers definitely have a higher hurdle to overcome. Nevertheless, jump, climb, crawl or fly over that hurdle, we can!!
Morning hangovers fall into a shadowy and often confusing area between hard-to-navigate, everyday problems and the medications and symptoms of our illnesses. In my case, I believed hangovers stemmed from the medications, not issues with my father. I kept it a secret because I did not want to advertise the fact that I was having difficulties from taking medication. I feared I might be stigmatized if I did. Like many difficult, illness-related choices we have to make, I found the morning hangover a difficult ocean to navigate. It falls into the category of everyday situations that cause consumers trouble. I think that focusing on these problematic everyday situations that we all face, and examining how they, too, create added problems for persons with psychiatric illnesses is a worthwhile pursuit for consumers and the people who work with them. If nothing else, they can lead to worthwhile discussions because all of us can relate to them.
Another advantage to looking at these common everyday situations is that they can lead to discussions about what is illness-related as opposed to what are everyday challenges common to everybody. In my daily recovery efforts, I have sometimes attributed feelings and situations to my psychiatric illness that were just heightened feelings most people would have in similar situations. I think the advanced recovery process is often a matter of separating the illness from the “normal” everyday aspects of life. When a person is used to seeing problems through the prism of the illness, he may miss seeing and dealing with them as a part of everyday life. An example would be teasing out normal feelings of sadness that at first seem like depression. A person can live with sadness more easily than depression.
A person’s self-image often changes radically and positively in recovery. However, when facing a stressful situation, a person retreats into an earlier lesser self-image. A friend once got angry at the way I presented myself in a group discussion. “You’re not anything like what you just said about yourself, “my friend told me.
In another case, while a person acquires strengths working on his recovery, he may not make use of those strengths or forget he has them. An example might be learning good public speaking skills while telling his recovery story. Then, in busy committee meetings, where strong personalities are vying to be heard, he may shy away from speaking up.
Life itself can be nearly as difficult and challenging as psychiatric illness. Fortunately, having learned to cope with symptoms, stigma, poverty, exclusion, marginalization and the many other difficulties brought on by mental illness, consumers are well equipped to master many of life’s challenges. My consumer friends and I have shown this by winning our bouts with morning hangovers.
Mary Ellen Copeland, PhD, developed Wellness Recovery Action Plan (WRAP) with a group of people with lived experience who were attending a mental health recovery workshop in 1997. She is the original author of the WRAP Red Book, as well as dozens of other WRAP books and materials. She has dedicated the last 30 years of her life to learning from people who have mental health issues; discovering the simple, safe, non-invasive ways they get well, stay well, and move forward in their lives; and then sharing what she has learned with others through keynote addresses, trainings, and the development of books, curriculums, and other resources. Now that she is retired, and that, as she intended, others are continuing to share what she has learned, she continues to learn from those who have mental health issues and those who support them. She is a frequent contributor to this site.