How honest do I want to get in these blogs and how much would anyone care to hear about my feelings? In the best of all worlds, I would be able to reveal some information about bipolar disorder while putting a face to the loss of my son. I truly believe that the words that touch our hearts are the words that penetrate and change behavior, so I will write what I feel and hope they are meaningful.It's never the day; it's the day after. That's what I've discovered. It's happened with each special day - I'm okay; I function and act somewhat normal as long as I'm busy and others are here. The next day, however, the sadness creeps in. You know how when you are anticipating a call, or a package, and you wait all day for it to come, and it never does? You feel suddenly let down and sullen. The joy of the expectation is erased and the day suddenly seems dull and lacking. That's what it's like for me. Take yesterday, for example. For the first time since Sean's passing, I made Thanksgiving dinner for the family that we have here. Now, anyone who knows me, or has been a part of holidays, knows that I am driven to produce a feast, with more food than can be consumed. We have traditional recipes for Thanksgiving, unlike Christmas, which is determined by popular vote each year. There was always one person whom I looked to for approval for the results of two or three days of preparation, and it was Sean. Like his mother, Sean loved to eat and cook, but he was a food critic, or at least a critic of anything I made. Thumbs up or thumbs down would be meted out without hesitation, and I secretly awaited his judgment. It's almost like everything I did was openly evaluated by him, and for some reason, above all others, I cherished his opinion. Was it because he was so discerning? Because he was blatantly honest? Or simply because I loved him so much that I wanted to please him? Probably, like all else in life, it was a combination of things, but I do know that I could attract Sean to sit and stay most often when food was involved. That's probably the crux of it. He moved on his own when he was 19; traveled extensively; had tons of friends and became part of each girlfriend's family - in other words, it was hard to get on his schedule, and living in the burbs which he disliked so, didn't help. But, when there was a feast and his sisters were going to be there, he came and stayed and ate and laughed and made us laugh.So yesterday, I did what I've done since I was 21 years old: I invited every family member and any other person without family to a dinner that included more options than could be consumed. Everything is made from scratch; the table is decorated for the season; the grandchildren have turkey placemats I bought for their first holiday; and, I act as if everything is normal. It's an act, but a convincing one. I've even seemed to convince myself.This Thanksgiving was particularly hard. Our beloved dog Sam died last week. Bridget is in London planning her own celebration. My Mom has deteriorated so much in the past months, that she is like a child. She is in a wheelchair, needs her food cut for her, and needs help with her most personal needs. She lives in a state of panic, anxiety so severe that we received no fewer than 15 calls to determine exactly when we would pick her up, although she had gotten the same answer for days. I ended up burning the tops of two dishes while I lifted her in and out of her chair in the urgent plea for help. I couldn't get her jacket off because her arms are unbending, and it's almost impossible to navigate with her, as she is panicked that she will fall. Funny, though, her personality comes through all the while: as someone who loves small children, she beams when she talks to our grandchildren; always one to pay her debts, she insists on knowing how much she owes Glenn for stamps; and, always self-conscious about her appearance, she asks repeatedly if her hair "looks okay." (I've always functioned as her hairdresser, as well.)What does all this have to do with anything? It's about depression and anxiety. My mother is from a generation where there weren't diagnoses for moods. At the same time, smoking (which helps with anxiety) was commonplace, and obsessive cleaning was a legitimate way for a woman to spend her day. Now, with these coping mechanisms gone, the death of her husband of over 50 years, the loss of her first born (and probably favorite) grandson, a daughter who has been her caretaker affected by the passing of her son, and the sadness of aging, she has legitimate reason to be depressed. She is unable to write because of shaking, can barely walk, and is unable to clean to busy her day away, and what is left is anxiety. Crippling anxiety.Sean, too, was plagued with anxiety and panic attacks. As a child, it was social anxiety. As an adult, he had both social and performance anxiety, as well as recurrent panic attacks. I have only suffered something like panic after Sean passed away, and it is a horrible feeling that cannot be wished away.I have since found out that the medications typically used for depression and anxiety make the symptoms of bipolar disorder worse. For depression and manic cycling, mood stabilizers have been fairly successful; however, for acute anxiety, there aren't good medication options. The things used for acute anxiety (Xanax, Klonopin, etc) are addictive in nature, and since many people with bipolar disorder also have issues with addictions, these are not medications of choice. So what is available for people who respond poorly to antidepressants and who have severe anxiety? From what I am told, there isn't much out there, and much research to be done.Of course, medications aren't the only answer. Cognitive Behavioral Therapy, a therapeutic method whereby you train yourself in ways to counter thoughts which lead to escalating anxiety, etc. has proven to be extremely valuable. Nonetheless, there are the typical issues: cost, availability, and in the case, of Sean, scheduling.One thing that is available on line is mood tracking (we have a link to a site on our web site resource page). It's your own personal journal of daily moods, while documenting factors such as medication compliance, sleep, and specific events of the day. I have begun using this tool myself. I am interested to see if sleep affects my mood, as there are days that sleep doesn't come early enough or last long enough. I'm also interested in the average mood that I'm in. If I record a day, and then the next, etc., I will be documenting exactly how I am feeling in the moment. If I were to try to recall it, I'm sure that I wouldn't be very exact, and certainly wouldn't be able to relate it to the time of year, amount of sleep, etc. I consider this to be an invaluable tool for both me and my providers when considering interventions. I highly recommend that anyone who seems to have recognized changes in moods that seem to be affecting their life, try this tool - it could prove to be enlightening.As for my Mom, there is so much that could be said. She lost Sean who was the one grandchild who was forthcoming with affection - it was just his way- and who lived nearby. She then lives near the only child (me) who has served as her support person most of her life, and that person is barely able to make it through her own day, never mind support someone who is increasingly in need. Given the level of her anxiety and the limitations of movement, there is no way for her to busy herself to diminish the feelings of loss and hopelessness. Finally, there is a dirth of knowledgeable practitioners in the field of geriatric psychiatry, as there seems to be in child psychiatry. How we can know so little about the function of the organ that controls every aspect of our body, and how there is so little evidenced based care, is astonishing to me. Maybe once we get past the Puritanical belief (ones that my father espoused, by the way) that we can think ourselves out of our mental challenges, we will carve a future for those who suffer without hope of relief.I think my Mom missed Sean yesterday. I know Glenn did - he could hardly come inside all day, and has been sleeping a lot. At the end of the dinner, my son-in-law talked about the elephant in the room, when he said: "This is a much smaller dinner than you usually have, isn't it?" Sean and he used to laugh all during dinners, and I'm sure he missed his spirit as well. Nonetheless, the obvious remains largely unspoken to try to make the most of what is, and at times, the attempt is successful.For me, it's today. The day that I know that Sean was absent (and that Bridget will be absent more and more as she deepens her commitment to the UK), and I know that I won't be able to tease him about what he's missed, or brag about my culinary talents. Today, I also know that my Mom wished that we should never have to suffer as she is now. These are two ends of the spectrum: a life prematurely shortened and a life with seemingly diminishing purpose. I know if Sean were here, he would have made my Mom laugh, and she would have felt important. I feel if she weren't such a prisoner of anxiety, I would have a Mom that I could lean on, instead of one I have to take care of (or maybe in addition to taking care of some of her needs). I just know that anxiety and depression are as lethal as any cancer, and can be more debilitating. You can face cancer and function if you have a healthy outlook; you can't face the smallest of challenges if you are depressed or paralyzed with fear.In my heart, did I give thanks anyway? Sure I did, for I have a lot to be thankful for. No one can take from me the memories of my son, or for that fact, my mother. Many people have come into my life because of Sean that I have become very fond of. I would be lying, however, if I said the hurt was less. It isn't. There isn't anyone who will take the place of Sean in my world. You may have know him as a musician, but you will find another's whose music moves you. You may have known him as a lover, but you will find another to love and fill that void. You may have known him as a friend, but new friends will make you laugh and fill your days. There is never someone who will be the son or brother that Sean was to his family. It's what keeps the hurt so much harder to hide and so personal. It's what makes resentment for the way that others move on so hard to keep at bay. It's what makes celebrations never the same, especially the day after when you wake up and realize that he's never coming.For the future of my Mom and others who are plagued with anxiety that defines their very existence, I pray for a better tomorrow and a crowded table with whom to give thanks.