Tien Chiu

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Medical crises, mental illness, and patients’ rights

I’ve been pretty quiet for the last two weeks, mostly due to some serious medical drama – side effects of the lithium I was taking for bipolar disorder. It’s mostly resolved now, but I want to explain what happened, why I fired my psychiatrist, and how I’m approaching finding a better doctor. (Bonus: You get my personal “Bill of Rights” as a patient, particularly one with mental illness, who needs medical treatment.)

What happened to me

I wrote my previous blog post on the 29th, and went to bed feeling fine. In the middle of the night, I woke up feeling somewhat thirsty, so I drank a glass of water and went back to bed. This isn’t a huge thing; it happens to me fairly frequently.

But this time was different, because the thirst didn’t go away. In fact, I spent much of the rest of the night feeling horribly thirsty – I drank over half a gallon of water in four hours, and was still awake, tormented by thirst, the following morning.

I wasn’t sure if I had simply gotten dehydrated the night before, so I drank a bunch more water and went to the gym to work out. During a half-hour cardio workout, I drank half a gallon of water (with electrolytes) and still ran out of water before the end. And finished the workout feeling thirsty.

I still wasn’t sure what was going on, so I spent another day drinking water. Daytime wasn’t too bad, but night was excruciating. To make sure I didn’t get dehydrated, I drank 24 ounces of water before going to bed. I slept well for an hour, then woke up feeling thirsty. I drank another 24 ounces of water, and got back in bed. This time I couldn’t even get back to sleep, because my mouth was dry and my tongue felt like a stone in my mouth. I lay in bed for an hour waiting for all the water to rehydrate me, but it didn’t. Finally I got up, drank some more water, worked on the computer for an hour (still feeling thirsty), then abandoned all subtlety, guzzled down a quart of water, and got back into bed. And finally got to sleep, for about four hours. And woke up with a dry mouth, gritty eyes, and a burning thirst that would not go away.

After staggering out of bed and drinking another quart of water (no effect), I started Googling “extreme thirst”. I discovered that extreme thirst generally has two causes: diabetes mellitus and diabetes insipidus.

Diabetes mellitus (what most people mean when they say “diabetes”) causes thirst because your cells stop taking in insulin, your body can’t regulate blood glucose levels appropriately. This typically results in in overly high blood glucose levels. The kidneys then try to protect the body by excreting the excess glucose in urine. This requires a lot of water. So you have to drink like crazy to stay hydrated, because your kidneys are pouring the water out of your body as fast as you can pour it in.

Some more research suggested that this problem doesn’t happen until your blood glucose rises above 200 mg/dl. I had had my blood glucose levels tested six weeks earlier. (Because some of my bipolar medications impact various vital organs, I have a complete blood panel worked up every six months.) Anyway, my blood glucose had soared from prediabetic to diabetic since the previous month – but at the very low end of the diabetic range. Nowhere near 200 mg/dL. If it had soared up further, I was in serious trouble, both because of the immediate problem and because of the implications of swiftly rising glucose levels.

I went on reading.

Diabetes insipidus, the other culprit, is a condition where your kidneys can’t concentrate urine. They stop reabsorbing water as they filter out toxins. So – as in diabetes mellitus, but for different reasons – you generate urine at a frightening rate, and you have to guzzle water almost constantly to stay hydrated. The difference is that in diabetes mellitus, your urine contains lots of glucose, so it tastes sweet, and in diabetes insipidus, it doesn’t – in fact, it has no flavor whatsoever because it’s basically just water. And that’s how these two disorders got their names. “Diabetes mellitus” literally means “sweet urine,” and “diabetes insipidus” means “tasteless urine”. (Let’s skip thinking about how they diagnosed/distinguished these two disorders before modern medicine, OK?)

And what causes diabetes insipidus? Well, for people who are not pregnant, have not had head trauma, brain surgery, or pituitary cancer…the #1 cause is taking lithium carbonate. Which is generally prescribed to treat…surprise! Bipolar disorder.

Guess what medication I had switched to last year?

I kept reading.

It turns out that not only is lithium the most common cause of diabetes insipidus, but diabetes insipidus is one of the most common side effects of lithium. In fact, half of people who take lithium will eventually develop diabetes insipidus.

Further reading didn’t turn up anything new. So I texted my psychiatrist to let him know about my symptoms, asking if it could be lithium-induced diabetes insipidus. A few minutes later (on a Saturday morning!), he called me to say that he was concerned that my blood glucose levels had soared dangerously high, and to get to urgent care as soon as I could.

I asked if it might be lithium-induced diabetes insipidus, and he said it probably wasn’t. He explained that normally diabetes inspidus comes on gradually, and since I hadn’t noticed symptoms earlier, and I was on a very low dose of lithium, it was much more likely to be diabetes mellitus. He suggested getting my blood sugar and kidney function tested, but urged me to go as quickly as possible because high blood sugar can be extremely dangerous.

So I headed straight to urgent care. They whisked me in, ran some tests, and determined that my blood sugar had actually dropped four points since the last time and was now only nine points into the diabetic zone – i.e. nowhere near the level needed for diabetes mellitus to be causing the problem. The labs also showed that my kidney and thyroid function were normal, and that my liver enzymes were unchanged.

I tried to schedule an appointment with my primary care doc, but the front desk wasn’t able to schedule me, and they didn’t know why.

So I texted my psychiatrist to tell him the test results, and that I couldn’t get an appointment with my primary care doc, and asked what to do next. He said, “I’m pretty sure it’s not lithium induced. I don’t know what it is. I think your primary care doc is on vacation, but someone should be covering for her, so call their front desk for an urgent appointment with whoever is covering for her.”

Ill spare you the details of the medical runaround that followed. But when I finally saw the endocrinologist, she snorted and explained that my psychiatrist was wrong. “Exposure to lithium is the driving factor, not the dosage, and since patients taking lithium tend to drink more anyway, it’s easy for it to sneak up on you. Why would you go looking for things like pituitary tumors when the #1 cause of the disorder is a medication you’re taking?”

I finally told my psychiatrist, “I don’t care whether you think the lithium is causing it. I think it’s causing it, and I want off.”

So we agreed to stop the lithium. That night, I was much less thirsty, and the following day the problem had mostly disappeared. Yay!

Which left me with a new problem. I had been taking the lithium to stave off the bipolar disorder. So in another day or two, when the lithium cleared out of my system, the bipolar disorder might start coming back. And some medications, including lithium, have a “rebound effect” – if you stop taking it abruptly, the mental illness comes back worse than when you started taking the medication. Given that my bipolar disorder manifests itself more or less continuously if I’m not taking medication, there was a pretty good chance that serious bipolar depression was barreling down on me and would arrive shortly. I had maybe 3-10 days to find another medication that worked.

I told my psychiatrist that I wanted to try a new med because I was worried about lithium’s rebound effect. He said, “Don’t worry – it doesn’t have a rebound effect. I don’t know why people say that, because it tapers naturally out of the body over about five days. How about we just discontinue the lithium, stay on the lamotrigine, and try something new if the symptoms start coming back?”

I said, “But we experimented last year and found out that the lamotrigine isn’t enough on its own. And I’ve read five research papers on the NIH website [the National Institute of Health funds a lot of U.S. medical research] – and they all say lithium has a rebound effect. So I’d like to go back onto the Abilify, for now.”

So that’s what we did. And, of course, I immediately started looking for a new psychiatrist.

Why mental illness can make it hard for patients to find and address a doctor’s errors

The moral of this story should be pretty clear. Doctors are medical professionals, and in general, they probably know more than you do, but don’t assume they’re right. Especially if you have a life-threatening medical condition. Because in every profession there are some who don’t communicate well, some incompetents, and some who are generally great doctors but just happen to be wrong in your particular case. Even good doctors can be wrong. If your condition is serious enough, their errors can have awful consequences.

This is particularly true for mental illness. Doctors can be arrogant and/or make mistakes in other fields, but for patients with mental illness, these mistakes can be much harder for patients to identify and correct. Because people with mental illness are typically considered to be intrinsically irrational – by their doctors, their family and friends, and themselves. It’s not totally without reason: Mental illness literally means there’s something wrong in your mind, and mental illnesses are notorious for distorting people’s thinking. As a result, if you have a mental illness, both you and the people around you are apt to think that your doctor knows better than you.

It’s also easy to become intimidated by your mental health professionals because, unlike other doctors, your psychiatrist and therapist have the legal power to lock you up against your will, if they feel you’re being both irrational and dangerous. (The legal standard is “if you are a danger to yourself and others”.)

This undermining of your confidence and intimidation by your doctor’s powers can be dangerous. I gained forty pounds over ten years because – despite bugging me for a decade about the need to lose weight – my psychiatrist didn’t tell me that one of my medications had a weight gain side effect. 40 pounds of additional fat on a 140-pound woman is a LOT of fat. That 40 pounds of fat is almost certainly why I now have Type II diabetes and the beginnings of fatty liver disease. And yes, I probably should have investigated earlier, but I trusted my doctor to recognize and inform me if my medications were causing health problems, and he didn’t. I spent over a week suffering from tormenting thirst because he didn’t think it could be caused by lithium, and narrowly sidestepped a rebound effect he didn’t think existed. His errors could have killed me – especially if my mental illness weren’t well-controlled enough for me to be confident of my perceptions and choices.

So if you have a mental illness, please make certain you have the information you need,and don’t trust your doctor unconditionally. Ask your friends or family to support you. If you have a friend or family member who is willing to help, ask them to help research anything you aren’t comfortable with. If you aren’t confident of your own mental judgment and perceptions, ask them for their opinions and observations about your mood. While you should be able to trust your doctor, that trust should not be unconditional – get input and information from others if you can, so you can make an informed decision.

(When I am having mood issues, the first thing I do is tell all my friends, especially the ones who see me regularly, and ask them to look for any mood or behavioral changes. It’s not just a safety net; it’s an opportunity to cross-check my own perceptions and what my doctor is telling me.)

Finding a new doctor

As a result of all the medical drama, I’ve fired the psychiatrist I was seeing, and have signed up with a new one. This psychiatrist is an expert on bipolar disorder. At least, he’d better be, because he heads up the Bipolar Clinic at Stanford, has published 62 peer-reviewed papers about bipolar disorder, and wrote several chapters of the American Psychiatric Association’s Handbook of Diagnosis and Treatment of Bipolar Disorders, which is their manual for doctors.

I trust his expertise. But before starting with him, I’m writing up three documents. The first is a patient history that includes not just medications and bipolar disorder flare-ups, but also my experience with various treatments/doctors, and the overall impact that bipolar disorder has had on my life. I want him to have the most complete information possible before making a diagnosis,and that’s more than symptoms and medications.

The second document explains my goals. There’s the obvious one, getting treatment for my bipolar disorder. But I also want to educate myself about bipolar disorder, at least as it relates to my case and treatment. I could probably see a psychiatrist with far less impressive credentials and find a medication combo that works. But I want someone who knows what’s going on in the research world, and can not only explain things to me at a higher level, but who can point me at research papers that might be useful to me as I educate myself as a patient.

My expectations from a doctor

The third document is a set of working agreements. He gave me a list of his expectations from a patient, which is great. I’m going to give him a list of my expectations of a doctor, and I intend to start our intake appointment next week by discussing those expectations. They’re pretty straightforward.

  1. Explain things to me logically and provide references/other information sources if I ask for them. Don’t talk down to me, and don’t get offended if I sometimes question what you tell me, based on reputable sources from my own research. I don’t think I’m a doctor, but even experts can be ignorant in one particular area, and this is my health and my life we’re talking about. I’d be irresponsible if I didn’t cross-check.
  2. If you aren’t sure about something, tell me you’re not sure. I don’t expect you to be an expert in everything, but I need to know where I can have full confidence and where I might want to verify with other resources. 
  3. Respect my agency in making decisions. Give me your analysis of the situation and let me decide what to do. Don’t withhold information, intentionally or otherwise, because your job is to provide me with the information I need to choose the right course of treatment. I value your opinion, but the choice is mine, not yours, and I need full information to make that informed choice.
  4. Work and communicate proactively with the rest of my care team.
  5. Don’t drop me just because you think I’m going to kill myself.

I consider this a basic patient bill of rights. You would think this list would be obvious, but so many doctors and medical professionals don’t follow these practices. (#5 actually happened to me once, believe it or not, and it almost killed me.) With the exception of the last one, the psychiatrists who have treated me have all (eventually) failed this very basic test.

I don’t want it to happen again, and I figure that I am much more likely to be treated the way I want if I make my expectations clear upfront. If a doctor has problems with this, that’s great, because I learned it upfront without wasting my money and risking my health and my life. If it isn’t an emergency, I’d rather have a bunch of doctors decline to treat me than wind up with someone I don’t want to see.

I’m pretty sure my new psychiatrist will be fine with this, but I’m writing my goals and expectations documents up and sending them to him a week in advance. I’m going to ask him to read both documents well before our first meeting, so we can cancel our appointment if this isn’t okay with him. I don’t want to waste my money on an expensive expert that I can’t work with.

Fundamentally, this is all about one basic principle: Your doctor works for you. A lot of people find medical professionals to be intimidating and feel that they have to do what their doctor tells them to, because the doctor is an expert and you’re not. But the doctor is your employee. You’re the one calling the shots, even if someone else is paying their salary. So if you are able to change doctors, and if you are not satisfied with your doctor – fire him or her, and find a better one. (Though if you want to be tactful, say “I’d like to switch providers” rather than “You’re fired!”)

Your doctor is an expert you’re paying to make recommendations, but you’re the one making the decisions, and you’re the one in charge of your treatment program. If your doctor doesn’t recognize this…find another doctor.

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I’m the daughter of two refugees. Asylum matters.

There’s been a lot of discussion about refugees seeking asylum recently. So I have run into quite a few people who feel the need to explain to me that refugees are faking their need for asylum – that they’re just trying to get here for the economic opportunities, that they might be terrorists, and that they’re unskilled foreigners who will take jobs away from American workers. And so on.

I sit and watch them until they run down. Then I say, “You do know that my parents were refugees, right?”

My parents did not arrive destitute, like many other refugees. But they were fleeing the Chinese civil war, the beginning of Mao’s dictatorship, and they would almost certainly have been executed had they stayed. (My father’s older brother, in fact, was arrested and “committed suicide” while in police custody. My grandfather immediately sent his two remaining sons to the U.S., fearing they too might be murdered.)

The only reason my parents survived, and that I exist at all, is that sixty years ago, the US was willing to take in people fleeing violence, war, or repressive regimes in their home countries. I am alive because, when my parents came, the U.S was willing to grant asylum to those who needed it.

But this is about more than just me, or my family. It’s about my entire community.

I grew up in the Washington, DC area. Most of my classmates were white, but there was also a thriving Chinese-American community. So I grew up with a lot of Chinese-American friends. Virtually none of our parents spoke English as their first language. (Though they were pretty much all fluent in English: My mom sounded a lot more like Manhattan than Shanghai. And her score on the SAT-V practice test when I suggested she take one blew most American-born high school seniors’ scores away.)

My Chinese-American classmates’ parents weren’t native English speakers for the same reason mine weren’t: Every single one of their parents had fled China during the Communist revolution. We were all children of refugees.

So if the US hadn’t accepted refugees seeking asylum, not only would my entire family have died, but the families of every Chinese American kid that I knew would also have died. The weekend Chinese school that we all hated going to would have been completely empty. All the teachers would have been murdered, and the kids would never have been born.

So when I hear people talk about turning away refugees who ask for asylum, that’s what I think of: The entire Chinese American community I grew up with, wiped out. Every last one of us.

And I think it would have been a huge loss to the US, too. We kids were more or less indistinguishable from other middle class American kids (except maybe that our parents pushed us more). Like other middle-class American kids, most of us went to college and into various professional careers. My family was composed of scientists and academics – my dad is a well known astrophysicist (with his own Wikipedia page!), my mom was an X-ray crystallographer, one uncle was a well known international law professor and another a top-notch engineer. China is poorer for having lost my parents and the other Chinese parents in my community. America is richer for having them.

War doesn’t care who it uproots – in fact, it’s the brave and resourceful, and the people who had the skills and education to save enough money to flee, who are most likely to be able to escape. These are the people you want to have.

Current political discourse focuses on the refugees who are arriving today. Many people think of today’s refugees as desperate people from foreign countries, a land where many people (or even the government) are hostile to America. They see that today’s refugees come from radically different cultures, speak different languages, and may not speak even one word of English.

And yes. That’s true. All of it.

But it’s unfair to look at people only in the moment they cross the border. Or even to judge them by what they were in their home countries: Business owners, doctors, auto mechanics – whatever they were before war wiped out their past.

You have to look at them in the future, too. I can tell you that my parents, and my Chinese-American friends’ parents, passed through Ellis Island looking not too different from today’s asylum seekers – citizens of a hostile country, from a totally different culture, with few assets, speaking minimal English. And I can tell you what they became. They became scientists and law professors and engineers. They started businesses, worked as nurses, became real estate agents, became office managers. They became parents. And they became me and almost all the other Chinese-American kids of my generation.

If you are dealing with someone my age who is of Chinese ancestry, the odds are very good that they’re the children of Chinese refugees. They might be your doctor, your waiter, your coworker, your boss. They might be software engineers, nurses, or vintners (that’s my brother!). They speak English like they were born here (because they were!), and they’re fluent in American culture, because they were born here, grew up here, and know no other country.

To see the future of today’s refugees, look at my past. Because I am the daughter of two refugees, and I can tell you exactly what I am, and what we are. We’re Americans.

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Cat meets self-driving mouse

In November 2014, I helped fund a Kickstarter project to develop Mousr, an autonomous mouse (the cat toy kind). I didn’t seriously expect that the project would succeed in producing a non-lame cat toy, but what the heck, it sounded interesting, so I contributed enough to get one.

(I was hoping it would get me out of my One Job, which is entertaining Tigress in the mornings. We play “chase the birdie” with the feather toy every morning, but because we play on a big padded cat playground, aka our bed, we don’t play until after Mike gets up. Predictably, we have arrived at a situation where 2.5 nanoseconds after Mike gets up, there is a cat in my study glaring at me and meowing loudly and continuously to explain that it is time to play and why am I not doing my One Job, unworthy human?? While I am generally cheerful about my state of abject servitude (I mean, why else would anyone have cats?), it can occasionally be frustrating to get interrupted in the middle of something by a cat who knows her rights and is demanding to play NOW!! Especially since she won’t shut up until she gets what she wants, even if it means meowing for fifteen minutes straight.)

We’ve tried all sorts of automated cat toys but she’s never been interested in a toy unless there is a human on the other end.

Tigress hunting (with human)
Tigress hunting (with human)

Well, 3.6 years went by, punctuated by occasional updates from the Mousr designers, but the end result is impressive: Tigress likes it! She’s fascinated and will play with it. Which is amazing since she generally yawns at automated cat toys.

Fritz, whose cat toy philosophy is “I’m a lover, not a hunter,” is not as impressed but will also play with it, especially once Tigress stops monopolizing it. Also very unusual!

Tigress and Fritz meet Mousr
Tigress and Fritz meet Mousr

Alas, while the cats find Mousr intriguing and fun, it is still not as fun as hunting a toy that has a human at the other end. (Probably because inconveniencing a human is half the fun.) So 30 seconds after we turned off Mousr, Tigress was bugging me (loudly and continuously) about playing with her.

So, while the autonomous robot mouse is a hit, no worries: No humans were automated out of their One Job by the self-driving mouse!

Here’s a video of Tigress meeting Mousr:

And if you want a Mousr of your very own? Trundle over to Petronics to order one. Warning: they’re not cheap. But they are cool. (I got mine for less because I backed the Kickstarter. And they even threw in the deluxe 5-tail bundle, which includes the catnip tail!)

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Choose your outrage wisely

Last week, I decided to read social media only once a day, so I wouldn’t have twenty strangers’ voices in my head while trying to create.

Yesterday, I went one step further. I installed the FB Purity browser extension, and set it to filter out all posts containing the words “Trump,” “Republican,” and “Democrat”.

Presto! The political vitriol that was dominating my news feed is almost entirely gone,and I can read about the cool stuff my friends are doing/seeing/writing again.

Do I feel bad about “sticking my head in the sand” about vitally important information? Don’t I feel the need to stay up on current events?

Nope. Here’s why.

First, the world contains an infinite number of horrible things. Child abuse, environmental destruction, animal cruelty, pharmaceutical greed, excruciating poverty, rape, drug addiction – any of those should provoke outrage in any decent person. And that’s just the tip of the iceberg. These are all terrible issues; they need to be addressed.

But not by me. Nor, for the most part, do I want to hear about them, unless one of my friends needs me to listen.

This is not because I don’t care. Quite the reverse. I don’t want to hear about them because I do care. I agree that these things are horrible. And hearing about them makes me angry.

Anger is a funny thing. It can be a powerful force for good, or it can be horrendously destructive. If anger prods you to action, you can change the world. But living in a state of continuous outrage – as Facebook encourages you to do – can quickly lead to feeling overwhelmed and helpless. And that can lead to hate.

I spent a lot of time in my twenties volunteering with organizations that worked with sexual abuse, rape, and domestic violence survivors. Every day, I would hear about a different horror. There was the woman whose fiancé had deliberately infected her with AIDS, then abandoned her. Another woman had been sexually abused and beaten by her entire family; when she went to a priest to ask for help, the priest molested her, too. The domestic violence survivor whose husband had battered her until her jaw collapsed and all her teeth fell out. The other survivor whose husband, a doctor, not only broke her bones, but wouldn’t let her use birth control because he enjoyed performing abortions on her.

The outrage I felt – every day – was so intense, so horrifying, that I had to find some way to come to terms with it. Because these atrocities were happening every single day, to thousands of innocent people, and I felt totally helpless in the face of all those stories. It’s one thing to know intellectually that terrible things happen; it’s another to look into the eyes of someone who has been beaten, abused, or raped, and hear her tell the story of her assault. It becomes personal, visceral.

I struggled hard with this. How do you hear this over and over without dying of outrage? How can you hear all these stories of cruelty, torture, and abuse without starting to hate?

Then one of my fellow volunteers told me the starfish story:

A man was walking along a beach, picking up starfish stranded by the tide and flinging them back into the ocean, one by one.

Another beachcomber walked by, and, seeing what the man was doing, said, “Why are you doing that? There are thousands of starfish washed up on this beach, and thousands more will wash up in the next tide! You’ll never make any difference!”

The man stopped and thought for a moment. Then he reached down, picked up another starfish, and threw it into the ocean.

“Made a difference to that one,” he said.

And that, to me, is the answer to outrage. Surviving outrage requires focusing not on the terrible things you can’t change, but on the positive steps you can take to improve the situation. I can’t stop all domestic violence, but I can tell the woman in front of me that she does not deserve abuse, and that her partner’s violence will almost certainly get worse. And I can connect her to resources. I can make a difference in her life.

But listening to all those horrifying stories without taking positive action doesn’t work. If you do that, you will drown in a sea of outrage. That doesn’t help you, and it doesn’t help the world. The only thing that helps the world is the positive actions you take.

That’s why I’m not interested in reading all the outrage on Facebook. It isn’t that I don’t care about these issues; it’s that I don’t have the time/energy/money to take positive action on them. My volunteer resources right now are entirely devoted to supporting the San Jose Museum of Quilts and Textiles. I’m the President of the Board there, which is a great privilege, but also a great responsibility. About half my time/attention is consistently focused on the Museum. So I’m maxed out. Any additional outrage won’t prompt me to positive action; it’s just going to make me feel angry, stressed, and helpless.

No, I don’t want to hear about the latest outrage. Not because I don’t care, but because I do care – but I’m not in a position to change things. The only thing that hearing about the latest outrage will do is make me angry, and further destroy my creative life.

So I’m opting out.

Outrage is great if it prods you to action. But choose your outrage wisely.

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Social media and creative work: Who’s chattering in your head?

When I did my time log a few weeks ago, one of the first things I realized was that I was spending too much time on social media. The first day I logged, I spent nearly three hours on Facebook and Ravelry! So I immediately cut that back, deciding that I would spend less time on the sites, and stop writing long posts and comments there. The next few days I spent only 30-60 minutes on social media sites, mailing lists, etc.

Predictably, my productivity went up. But not by much. Which I found a bit puzzling: I had gotten 2.5 hours back per day – huge! – but I still wasn’t able to get much more done. Why?

XKCD, as usual, has the answer:

XKCD, “Duty Calls”

The problem with social media – and all social interaction, for that matter – is that the brain processes events by mulling them over throughout the day, thinking through alternative outcomes, what you could have done better, what you should do in the future, and so on. The stronger your feelings about the event, the more time the brain spends processing them. And humans are wired to care – a lot – about what other humans think. As a result, when you interact with another person, that interaction – and that person – stays in your head for minutes, hours, or days, depending on how upsetting the interaction was.

In-person interaction generally doesn’t produce strong emotional responses. That’s because people tend to be politer to someone who is standing in front of them, whose emotional distress is apt to be much more obvious (and may result in their punching you in the nose). A person standing in front of you also probably has friends within your social circle who may get pissed if you upset their friend too much. In other words, infuriating someone in the physical world has consequences, so people tend not to do it.

Online social media (not just Facebook, but other forums such as Ravelry, or mailing lists) doesn’t have that brake. It’s also a continuous conversation. At work, you might go hang out around the water cooler every couple hours on a coffee break. But you don’t go to the water cooler every fifteen minutes (unless you want to be fired, that is). With social media, it’s easy to flick over and check Facebook or your email every fifteen minutes. That doesn’t take more than a couple seconds…but it means that your brain is now processing all those social interactions, and all that new information, all day long. Continuously. And, because people are a lot less polite over the Internet, those social interactions are more likely to be offensive and/or provocative. So they linger longer, and are more disruptive.

So now you’re subconsciously carrying on a conversation with at least ten or twenty people in your head, the entire time you’re awake. And probably at least a few heated arguments. That produces a lot of mental clutter. It makes it hard to focus on other things.

If you’re cleaning the house, no big deal. You don’t need your entire brain for that. But creative work requires concentration and a clear head. Writing, in particular, requires internal silence, because you’re basically talking to an audience. You can’t do that if you have twenty people arguing in your head about something totally irrelevant. (Which is probably the big reason I haven’t been writing many blog posts for the last year!)

So I tried an experiment, and spent a few days reading social media only once a day. Wow! Suddenly I was doing a lot more creative work.

And then I went back to reading social media in snatches through the day. And my productivity tanked again. Surprise! I was right.

I don’t plan to abandon social media, for a variety of reasons. First, I have a professional interest in social media, particularly Facebook and Ravelry; it’s where I expect to “meet” most of my potential students. So I need a social media presence, like it or not.

But there’s more to it than that. Social media exists for a reason: it’s a great way to keep up to date on what your friends are doing, to interact with friends you don’t see every day, and find out about cool stuff from your friends. (I would never have heard about the Kubota exhibit, for example, if a friend in Canada hadn’t mentioned it on Facebook.) Plus, since I no longer have coworkers, it gives me a chance to socialize with interesting and/or like-minded people regularly, and I need some of that interaction. So turning off Facebook or Ravelry would be an overreaction (and stupid).

My compromise (at least for now) is to do social media, but only once a day – after the creative part of my day is over, and well before bedtime, so my brain has a few hours to process whatever comes up before bedtime. (And thus, doesn’t keep me up at night.)

In the same vein, I’ve also stopped fiddling with my phone at night. I used to play a relaxing game or two of Scrabble right before bed, just long enough to break off whatever stupid arguments were still bouncing around my head. That rapidly turned into an hour and a half of reading the New York Times, Facebook, Ravelry, and books about dye chemistry, tomato farming, etc. Which produced more mental clutter that kept me from getting to sleep, meaning I lost even more creative time the next morning.

This is not a rant about the evils of social media; social media provides a lot of great benefits, and I intend to keep using it. But I plan to use it more thoughtfully, so I can get the benefits without having other people’s chatter drowning out my own voice when I want to create.

Sherlock Holmes, in Sir Arthur Conan Doyle’s short story “A Study in Scarlet,” says

I consider that a man’s brain originally is like a little empty attic, and you have to stock it with such furniture as you choose. A fool takes in all the lumber of every sort that he comes across, so that the knowledge which might be useful to him gets crowded out, or at best is jumbled up with a lot of other things, so that he has a difficulty in laying his hands upon it. Now the skillful workman is very careful indeed as to what he takes into his brain-attic. He will have nothing but the tools which may help him in doing his work, but of these he has a large assortment, and all in the most perfect order.

Holmes was talking about learning facts generally. As an eclectic collector of information, and someone who likes mixing unrelated media, I disagree with him there. But in the hours you spend on creative work, I think he’s totally right. Silencing the external chatter, and clearing your mind of everything but the mental tools that foster your creativity, will make you much more joyful and productive in your quest to create.

So that’s what I’m doing. I’ll keep you posted on the results.