Symptom, Sin, Circumstance or Psychology: I lost the thread on the way out of the labyrinth.

I have been having a great deal of trouble with motivation lately. I can't seem to get past it and I'm not sure where it's coming from.

I first taught myself back in 2002 to like cleaning my house, which was a big leap for me. That was the same year that I started looking after my eating habits. Then in 2004 I finally got a handle on keeping my clothes tidy. I got television watching under control in 1999. I have long had good spending habits. I developed the discipline to finish sewing and knitting projects somewhere along the way, I think in 2004, maybe 2002. Perhaps it just took a couple of years for it to really take hold. I learned how to talk to people, that is to overcome my shyness - I still come off all wrong sometimes, in 1998 and again in 2003 and again in 2006. I made a good habit of timely bill paying in 2003. I learned how to keep up with schoolwork in 2005. I seem to be developing a new understanding of how to give and receive help as I write, which feels like the only thing I have going at the moment.

Everything else seems to have slipped out of control. I have piles of unsorted clothes on my closet floor. I have two outstanding bills. The television seems to have taken me over. I have one unfinished sewing project and one unfinished knitting project. I've gone all shy again and my spending habits need reform for the first time I can remember. I haven't been able to properly keep up with the housekeeping for a good six months now. I cannot keep up with the schoolwork nor feed myself properly.

It took me a long time to develop good habits, which is a bit embarrassing. Some of that is due to never having been prepared to look out for myself once I no longer lived at home. Some of it is due to the disproportionate anxiety due to the bipolar. There are assorted secondary reasons for it as well. But bit by bit I pushed myself past it.

Now I seem to have lost it all and that is very discouraging.

Part of the current problem is that I'm not sure what has brought it on. One possibility is that I need an additional 100mgs of Lamictal. Another is that my routine is so loosely scheduled that I can't use my time effectively because it feels like there will always be time tomorrow - acres of time in front of me. The possibility that worries me most is the dreaded akedia. (Also known as accedie and accedia but I have done too much Greek to bear with the badly pronounced Latinate form of the word: it grates.)

I've had some rather flummoxing moods lately, the kind I look back and fret about. It's odd, though, because I am by and large on an even keel. I have been since September 6. (I know the date because I keep somewhat meticulous track of these things. That was the first day I felt well since October 2006.) Now the eveness has lasted more than three months and I am beginning to trust that it will stick around. So where has this deep lack of motivation come from? Why do I abandon all these good habits now when I was able to keep them up while I was severely ill?

If I were to tell my case worker or therapist about this they would immediately be on my case, saying that I should go to the hospital. But I'm not ill, not in a way that a hospital can help. Going to the hospital when I did is one of the best decisions I have ever made: it helped me to find appropriate medication quickly; it got me away from friends who didn't understand what depression is and were doing their level best (one of them, anyway, whom I was sharing an apartment with at the time) to make me feel incredibly guilty for not being able to behave as they wished I would; it kept my family at a distance; it stopped me having to do things like cook my own meals; it cured my insomnia for a good five months; and it gave me a chance to be around a whole bunch of people who were going through the same problems, so that I no longer felt as weird and isolated. But there's no opportunity for sustained counselling there. It's not the appropriate place for me to get to the bottom of whatever it is that has demotivated me.

This is the difficulty with the psychiatry/psychology part of things: they read everything as a symptom and automatically assume that the sufferer is having an irrational reaction to external circumstance, an attitude that has been shown to be distinctly unhelpful in several well conducted studies over the past sixty-odd years. It seems more likely to me that the cause lies in some psychological difficulty that would require some time for discernment or in some reaction to external circumstance, neither of which would be solved by playing around with medication.

If only I could figure out how to start figuring this out! Any ideas?