What medication does not improve with bipolar disorder

in Daily Living / Ideas: Ways to Thrive  by May 2, 2011 0 comments

Many people believe that to treat bipolar disorder, you just have to get the right medication and the right balance.

That belief simply has never been true for me.

For me, medication prevents mania and prevents mania from getting worse…that is about it.

What follows is my experience of challenges that are consistently present when thriving with bipolar disorder.

Ruminating Thoughts

Ruminating thoughts are thoughts that repeat over and over again that are very difficult to stop.  Ruminating thoughts often occur during times of stress, excitement, uncertainty and insecurity.

When I have ruminating thoughts, not only can I not stop thinking about them, but it can be very hard to not stop talking about them as well.  The thoughts just sneak out of my mouth.  During these times, I do a lot more speaking before thinking.  When I experience ruminating thoughts, they often get expressed at inappropriate times, such as 5am or during a romantic dinner.

In all my years of struggling with ruminating thoughts, I cannot say I have “the solution”.  However, what helps me is the ability to recognize the “Aha!  I am having ruminating thoughts right now”.  By recognizing what I am experiencing, I may not be able to stop them, but I can contain them and better keep them from freely flowing out of my mouth.

Emotional Roller-Coasters

I get so sick and tired of emotional roller-coasters.  Preventing emotional roller-coasters is a consistent challenge that I face and manage.

I believe that I experience emotional roller-coasters during the same circumstances I experience ruminating thoughts – stress, excitement, uncertainty and insecurity.

What I’ve learned from emotional roller-coasters:

  • They start with a fantasy about what “could” happen or “may” be happening.
  • My imagination builds on that fantasy creating an entire story around what could happen.
  • My emotions don’t know or care what is real, they simply respond to my thoughts.
  • My emotions respond to my fantasy as though the story I am telling myself is actually happening right now.
  • The emotions then create their own thoughts based on how I am feeling about the fantasy.

As you can see, the journey of an emotional roller-coaster gets further and further from my reality with every thought.  Without this awareness of what my thoughts and emotions are doing to me, it is very easy to become delusional.

For many people living with bipolar disorder this can be so severe that they experience severe psychosis in the form of delusions and hallucinations.

Racing Thoughts

Even with medication, I still have difficulty expressing my thoughts at times.  Like with ruminating thoughts and emotional roller-coasters…when I am under stress, excitement, uncertainty or insecurity, my thoughts race or get jumbled.  During these times I have a difficult time expressing myself.  I have taught myself skills to cope with this, but those skills are effective maybe 50% of the time on a good day.

Following the Unspoken Social Rules

Unspoken social rules are my weakness. At times I feel like everyone except me has the “Social Rules Handbook” full of details of all the social rules full of boundaries and appropriateness when with acquaintances.  I do not naturally know what is appropriate dinner conversation. At times I feel like an alien watching people wondering “why don’t they just say what they mean or what they really feel?”

What comes naturally to me is to be honest about what I’m thinking and feeling. That does not work for people.  I’ve made plenty of people uncomfortable.  I truly believe that I am missing that part of my brain that just gets what is socially appropriate.

My research has taught me that my brain may have less mass (depletion) in the part of the brain responsible for picking up on and internalizing the unspoken social rules (anterior and posterior cingulates).

It takes effort to pay attention to how people interact to learn what is appropriate social behavior and what is not and no matter what I learn, it does not come naturally to me.

Thriving with bipolar disorder is not easy, but there is no other option.

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What is Bipolar Disorder?

in Information  by April 27, 2011 0 comments

Bipolar disorder is a highly misused name whose sole purpose is to describe common and shared experiences and behaviors that occur in a significant percentage of the global population.

To appropriately receive this name (or as it is often called, “label”) one must have evidence of the presence of one single manic (severe) or hypomanic (less severe) episode.

how do you recognize mania?

  1. a person must have a distinct period of at least 1 week in which they experience persistently elevated, expansive or irritable mood

  2. at least 3 of the following symptoms

  3. mood disturbance must be severe enough to cause impairment in ability to work, relationships, social activities

Mood

  • elated mood – ecstatically happy with or without reason; bouncing off the walls with happiness.
  • expansive mood – covering a wide area of mood; mood swings.
  • irritable mood – angry; easily lashing out

Notice if mood is abnormally elated, expansive or irritable from how mood normally is.  Mood may swing between the extremes of elated and irritable as well as other emotions. Mood  may shift without any situational triggers or circumstances.  Emotion may be expressed in an out of control way.

If a person exhibits these moods, it does not mean that a person should be diagnosed with bipolar disorder. However, it does mean that bipolar disorder could be a reasonable possibility.

Symptoms

During the period of mood distrurbance 3 or more of the following symptoms must be present to a significant degree

Inflated self-esteem or grandiosity

  • perception of self is not in touch with reality
    • exteme (significantly greater than normal) sense of self-importance and specialness
    • arrogance
    • It is common for people to believe that they are not from this planet or are chosen by God.

  • profound sense of spirituality, ability and purpose

    • sense of invincibility, omnipotence, mastery and control
    • incredibly heightened intellectual and overall brain activity due to changes in the brain during mania
    • connection to the world around them; believing they can change the world by doing ________________.
    • perception of having special powers, gifts and abilities

This (and the ability to persist towards goals) is often the reason why people do not want to take medication.

Not needing to sleep (or unable to sleep)

  • significant decrease in need for sleep.
  • Difficulty falling asleep and staying asleep.

If a person is having difficulty sleeping and/or does not have the need for sleep, this is an early warning sign of mania for a person living with bipolar disorder.

Medical problems must be ruled out when a person is experiencing sleep difficulties. This symptom alone cannot result in the diagnosis of mania. However, it is a very important symptom that must be monitored.

Can’t stop talking

  • pressure to talk
  • more talkative than usual

This is not about a person’s need to talk about themselves or be the center of attention.  They are simply flooded with so many ideas that they can’t stop talking.

Obsessed with a goal (goal-directed activity)…unable to stop.

  • unable to stop persisting on a goal (work, school, sexually)
  • neglect things like eating, showering, sleeping, family, friends etc to work on a goal

This is not Type A personality. This behavior is significantly different from how a person normally behaves.

Excessive involvement in pleasurable activities (impulsivity)

  • high potential for  painful consequences
  • often times impulsivity is expressed by spending lots of money frivolously (trinkets, clothes and unnecessary items) and goal oriented ways (investments, business, homes etc); however the investments are often not things that would be chosen by them normally.
  • sexual impulsivity – it is very common for people experiencing mania to have an intense and often insatiable sex drive

There is a difference between impulsive personalities and mania. A person experiencing mania is acting impulsively in extreme ways that they would not normally behave otherwise.

Flight of ideas or racing thoughts

  • these are thoughts that move so fast that they cannot be expressed or only make sense to you.
  • it is often having multiple thoughts at once that get jumbled together
  • these thoughts can be obsessive. You just can’t stop thinking them.

These racing thoughts often exist in people with bipolar disorder even when they are not experiencing mania.  Mania exacerbates them.

Easily Distractable (particularly by ideas or tangents,  this symptom is related to racing thoughts)

  • attention is easily grabbed by unimportant and irrelevant external stimulus

Similar to ADHD, yet ADHD does not have the mood component and distractibility occurs during the manic episode unless it is also a diagnoses.

Psychosis

can occur during mania and depression

  • delusions – refusal to accept that their perception and experience is not real to other people in spite of evidence that contradicts their perception and experience.
  • hallucinations – having sensory experiences (seeing, hearing, feeling, tasting) things that is not real to other people and rejecting that possibility in spite of evidence that contradicts their sensory experience.

Psychosis that takes place within a manic episode is common for mania.

However, when psychosis occurs outside of a manic episode, the diagnoses is schizoaffective disorder.

Note: Symptoms are not due to substance use or a medical condition. Medical conditions should be ruled out by a physician.

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How To Break-Up With Depression

in Actions / Ideas About Depression / Ideas: Ways to Thrive  by April 25, 2011 0 comments

Have you ever had a friend who was in a relationship with a boyfriend or girlfriend that did their best to try to control them or change them or tell them, “You will never be…….I am the best you will ever have”?

Have you ever had a friend who was in a relationship with someone who did not want them to be around their family and friends or do any of their interests and wanted to keep them all to themselves?

Have you ever friend who was in a relationship with someone who did not want them to be happy, period, EVER?

If you were in this relationship, would you want to break-up as soon as possible?


This description is the relationship people have with Depression.

Depression is the unhealthy relationship who wants to control you.  Depression wants to change you in ways that will serve it’s purpose. Depression tells you, “You will never be……I am all there is.”  Depression wants to isolate you from all of your friends and family.  Depression wants to steal any pleasure and interest you have in your life.

Why is it so hard to break-up with Depression?

Just like in an unhealthy relationship, Depression convinces you that the problem is “YOU”.  Depression convinces “There’s something wrong with you.” “You are bad.”  “You are worthless.” “You don’t deserve to be happy.”  “No one cares.” “You can’t be…” “You will never feel happiness again.”

By believing this it causes you to own it.  It is like marrying Depression.  When you believe the fear that Depression feeds you, you are making a commitment to it.

How to break-up with Depression

[Note: these ideas will not be effective with all forms of depression.  Severe depression requires medical help and the monitoring of psychiatric and psychotherapeutic professionals.]

Breaking-up with Depression is a lot like ending an unhealthy relationship.  HARD!

  • Recognize and Identify Depression in Your Life.

Just like in the first step of ending an unhealthy relationship, you have to recognize that you are in a relationship with Depression, that the relationship is unhealthy and that it is not what you want for yourself and who you choose to be.

In order to identify Depression in your life, you have to be able to recognize what is YOU and what is NOT YOU.  For instance, is it YOU who doesn’t care about anything and chooses to stay in bed all day or is it Depression?  Is it you that finds no pleasure in things that are normally pleasurable or is it Depression?

This is the hardest part of the break-up with Depression and an unhealthy relationship. 

People struggle the most with this because Depression has them convinced that they are the problem and has them believe that they are Depression.

Once you are able to see that Depression is not who you are, it is separate from you, you can learn how it works.

  • Understand What Depression Needs to Thrive.

Depression may be a chemical imbalance in our brains, yet it behaves just like every other living organism.

Depression needs energy to survive.  And just like every other living organism on this planet, it needs to receive energy from someone or something else that is living.

Depression gets it’s energy by consuming energy from the people it inhabits.  Depression has a lot in common with a parasite, virus or bacteria that need a living host in order to survive.

As human beings, we generate and use the most energy by being active.  We do the most activity doing things that bring us pleasure, interest or reward.  Because we are human, we also receive energy by being connected to other people.

Therefore, it makes sense that Depression would consume our energy by inhibiting people from experiencing pleasure and interest…and by keeping people isolated.

  • Interrupt and Shut Down Depression’s Control.

Like an unhealthy relationship, Depression needs to be in control.  An unhealthy relationship needs to control your self-esteem and self-worth, so does Depression.  An unhealthy relationship controls what you do and keeps you isolated, so does depression.

Take a stand!  Depression does not want you to be active, find a way to be active anyway! Even if it is as simple as taking a shower and getting dressed.  It does not matter how big or little you do.  Simply do something.

Depression wants you to be alone.  Connect with people or pets!  I know this is hard to do.  Being around people when you are experiencing depression can make you feel worse, especially if they are trying to make you feel better.  However, if you don’t want to talk, don’t talk.  Ask a loved one to just sit beside you and hold your hand.  You don’t need words to connect and you don’t need to feel better.  You simply need to connect.

Don’t expect to feel pleasure during this stage of the break up with depression.  All of the actions you do during this time are  a part of the break up process.

  • Consistently Be Active and Stay Connected

Now that you know what Depression needs and how it is getting it, stop giving it to Depression as best you can.

This is difficult to do because depression has consumed your energy and made you feeling tired, sore and/or achy.  Nonetheless, your body still works, it can do more than Depression wants you to believe it can.   It is very difficult to not let your body stop you and Depression knows this and uses this knowledge against you.

I know it is hard.  Nevertheless, breaking up with depression means that you have to go against what your own body wants.   This is very similar to when you are in love and you have to force your heart to let go.

By no means is breaking up with Depression easy.  It is hard, yet it sounds simple “do something and connect”.  Breaking up with Depression and moving on is worth your effort.

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Good Stress vs. Bad Stress: How stress can trigger a bipolar episode

in Daily Living / Ideas About Depression / Ideas About Mania / Ideas: Ways to Thrive  by April 15, 2011 5 comments

In the news lately,  Catherine Zeta Jones has openly shared her story of being treated for bipolar disorder that may have been caused by the stress of her husband, Michael Douglas, struggling with cancer.

People are wondering about stress and its relationship with bipolar disorder.  By no means do I believe I have “the answer”.  However, I do have a perspective that comes from my own experience that may shed some light on the types of stress that trigger an episode.

Good Stress vs. Bad Stress

Good stress comes from the combination of responsibility, goals and purpose with having a plan and structure to manage it.

Good stress is external, meaning it comes from doing something in the world.

Good stress may not cause a bipolar manic or depressive episode.

An example of good stress is, “I want to be successful in life.  In order to be successful I need to develop my abilities to do something that is meaningful to me.  In order to develop my abilities I need to learn information and develop the skills to apply them.  To learn information and develop skills I need experience.  In order to get experience, I need to get educated.  In order to get educated I need to study.  In order to study I need to pay attention in to my teachers and learn. etc…”

This example is full of stress and one that we all go through.  In my opinion, the stress of having to do these things is not what causes an episode for someone living with bipolar disorder.

This is productive stress that is goal oriented and task based.  This stress is emotion contained by a plan of action.

Bad stress is caused by internal pressures in response to overwhelm, urgency and fear.

It is caused by thoughts and feelings playing on each other without a plan of action.

Bad stress welcomes and ignites episodes of bipolar disorder.

BAD STRESS can take on multiple forms that build upon themselves:

  • Overwhelm

Overwhelm is a temporary state that occurs when we simply don’t have the interpersonal resources and information to achieve a goal.

In the example of good stress, there was a plan of how to reach a goal.  With bad stress there is no plan of how to achieve a goal.  As a result, a person may experience so much overwhelm that mania or depression gets invited as a coping mechanism.  Mania takes action or depression shuts you down.

Overwhelm is simply shouting, “I don’t know what I’m doing!” “This is too much!”  “I can’t handle this right now!”

So mania kicks in and the brain says, “Yay! I can do anything!” And it’s thoughts race a million miles a minute causing a person to focus on a goal for 20 hours straight using all of their brain power, even if the result makes no sense.

Or depression kicks in and the brain says, “I think and feel nothing.  I’m not getting out of bed. Lights are out, no one is home. Go away.”

  • Overwhelm + Urgency

Urgency is a real or imagined perception that something has to be done, RIGHT NOW.

This is a recipe for disaster for someone living with bipolar disorder because the imagined perception of urgency is a part of daily living.  Therefore, when it combines with overwhelm it can easily lead to mania or depression.

Overwhelm + Urgency are simply screaming, “I don’t know what I’m doing, but I have to do it RIGHT NOW!”

Mania kicks in and gets the job done or depression does nothing and simply shuts down.  Either way it is a coping mechanism to conquer overwhelm combined with urgency.

  • Overwhelm + Urgency + Fear

This is the worst.  Not only do you not know what you’re doing and it has to be done right now, but you have to deal with all of the “could’s”.

Example: “I could fail.”  “I could be humiliated.”  “I could disappoint everyone.”  “I could lose.” “I could lose the person I love the most in the world.”

When overwhelm, urgency and fear combine, which they tend to do eventually, you have the perfect storm for mania or depression.  It is a combination that is just asking for it in a person with bipolar disorder.

Bipolar disorder is interesting because it often causes many people to live with a sense of urgency regardless of an external source causing  urgency. 

In my own experience, I have to consciously remind myself that there is no external urgency in what I am doing.  I have to slow myself down.

The Hidden Stress

That doesn’t feel like stress at all

Excitement

When people think of excitement, they often don’t think of it as a stress response.  However, for a person living with bipolar disorder excitement is the match…or even easier a torch loaded with fuel.

People often ask me why that is…here’s what I believe.

We do not get excited about things that are familiar to us.

We do not get excited about things we know how to do well.

We do not get excited about things way off in the future.

Excitement is simply the really fun form of overwhelm and urgency.

Therefore, it is very common for people to experience excitement and have it lead to mania and possibly even depression.

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How to experience mania without it becoming a full on manic episode

in Actions / Daily Living / Ideas About Mania / My Stories  by April 13, 2011 5 comments

This is a dangerous topic if misused that should be explored with caution and should not be attempted without the support and accessibility of psychiatric professionals.

By no means do I encourage any person living with bipolar disorder discontinue taking their medication or change their dosage in order to experience self-management (especially if you have not been medically treated and stable for several years).  To suddenly discontinue medication has the potential to be life threatening.

However, it is important that people living with bipolar disorder (and those treating it) know that contained mania can be a gift in a person’s life and permit them to continue to feel like they have not lost themselves.

There are some psychiatrists who prescribe so much medication that the experience of genuine emotion is not possible for a person. I take a stand against over-medication.

I have been stable with bipolar disorder for fifteen years and am in the process of becoming a licensed psychotherapist, what follows is how I experience mania without it becoming a manic episode.

Step 1: The Trigger

You must know your triggers.  You learn what they are by paying close attention to your episodes. Not all triggers will be able to be controlled and contained.

I have three types of triggers:

  1. Stress: that I’ve broken down to be defined as anything that I don’t have the interpersonal resources or ability to handle at the moment.  The lack of a plan of action.
  2. Excitement: Stress with a specific goal, yet I still don’t know what I’m doing, but it is so much fun figuring out how I will reach the goal and having the burst of excited energy.
  3. Urgency: When I feel the pressure to have or be something right now.

When either trigger combines with URGENCY that is a dangerous mania that I must contain as soon as possible. This form of mania could exacerbate rapidly into an out of control mania that could lead to full-blown mania if I am not paying attention.

The safest trigger for me hands down is EXCITEMENT. However, it’s a catch-22 because if I do not pay attention and respond carefully to the excitement, URGENCY will get involved and then I am in the danger zone.

My least favorite trigger is STRESS because I have no clear goal and no plan of action. I simply don’t know what I’m doing so I’m completely overwhelmed.

URGENCY is so dangerous because it causes us to ACT and those actions can change our lives permanently.  URGENCY also causes us to lose control on every level and mania takes over.

I cannot stress this enough.  The key is to pay attention. Keep an eye out for URGENCY.

Step 2: The Mania

I only allow myself to experience mania that comes from excitement.  Any form of mania that comes with URGENCY is dangerous to me and must be contained right away (see below).

My Actions of Mania:

I think about, research or work on a project or goal for several hours straight (significantly beyond 9 hours a day).  I become so obsessed on my goal that I can think about nothing else.  Key: I am unable to stop thinking about my project or goal and I cannot stop working towards my goal. I am obsessed.

How do I know when I am in trouble:

I am not able to sleep.  I stay up all night with both ruminating thoughts and new ideas.  I sneak out of bed to do research or keep working.  I do not disclose to people about what I’ve been doing all day because I don’t want them to know how obsessed I am.

How I keep URGENCY away:

Urgency is really hard to keep away.  It has taken me years of practice.  What it comes down to is throwing away the time-line for when my goal has to be achieved or the project I’m working on must be completed.  It requires the will and ability to put down and put away what ever it is that I am working on.

It was very easy to write those sentences, but very difficult to do in real life.  It takes me tremendous will power to prevent urgency.

Step 3: Containing Mania

I cannot say it enough how important learning how to pay attention is!

I allow myself usually only one day to experience mania because that is safest for me.  In the past I allowed myself a week and I really paid for it.  It took me months to recover and feel like myself again.

By giving myself only one day of mania, I notice that the recovery time only a few days and there are minimal consequences in my life.

Here is how I contain my mania:

  1. I get support.  I let everyone close to me in my life know that I am experiencing mania and ask for their support.
  2. I give myself permission to experience mania from when I wake up in the morning (which is really early since I was probably up all night being obsessed) until 5pm.
  3. I force myself to stop working on my goal in order to eat and shower.  This is not always easy to do.
  4. At 5pm, I have to completely remove myself from the situation.  I disconnect myself from whatever it is that was fueling my mania…the excitement. I do not give myself access to what excites me. If I am not able to do it, I ask for help from my support system.
  5. I eat dinner and usually with some form of prescribed sleeping aid, I take my lithium and go to sleep for about 10 hours.  Otherwise, my mind will not stop thinking.

When I wake up in the morning, often it is as though a reset button has been pushed; however, the manic energy is still somewhat present, but in a weakened form.

With the remaining mania, I do not allow myself to even get close to working on the goal that triggered the mania. Instead, I put it to work in some other productive way (like cleaning etc).

I spend the day doing self-care practices that include both exercise and repetition because it has a calming effect on me.

I continue my self-care practices until I notice that I am no longer triggered and that the fuel that fed the mania has been consumed.

I continue working on my project or goal once the excitement of it has worn off and it becomes “work” again.

This is my story for how to experience mania without it becoming a full on manic episode.  I hope this is useful to you.

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Uncovering loving ways for doing an intervention

in Actions / Ideas: Ways to Thrive / Relationships Effected By Bipolar Disorder / Taking A Stand  by April 5, 2011 2 comments

In my years of helping people develop their ability to thrive with bipolar disorder, I have heard horror stories about interventions that were done on them.  As a therapist, I help teach people loving ways for doing interventions.

Out of love and desperation, people often do some very hurtful things to get someone to get help.


INTERVENTIONS GONE WRONG: Words that hurt someone you love when trying to get them help.

“Something is wrong with you.”

“You scare me.”

“I am ashamed of you.”

“You embarrass me.”

“You are crazy.”

“You are bad.”

“I don’t believe you.”

“You are bipolar.”

It does not matter what words follow after these sentences.  The damage has already been done.

It is highly unlikely that a person will want to seek help, when the person trying to help them is hurting them.

Loving ways to do an intervention:

  1. Use “I” Statements.
  2. Focus on specific behaviors that you are concerned about.
  3. Asking your loved one to receive help.

“I” Statements:

“I am concerned that…”

“It hurts me when…”

“I get scared when…”

“When this (behavior) happens, I feel…”

“I don’t know what to do when…”

These types of “I” statements are effective because:

  • They do not blame or shame.
  • They do not judge a person.
  • They do not label a person.
  • The person sharing these statements is expressing how something affects them…they are owning it.

Focusing on specific behaviors:  (that are not normal for the person)

Examples:

“When you don’t sleep at night, I fear that…”

“You’ve been speaking so fast lately that I can’t understand you.”

“The way you drove today, really scared me.  I felt we were going to get into a bad car accident.”

“When you purchased _________ on a whim, I didn’t feel we could afford it and I don’t know what to do about that.”

“Your emotions have been so powerful lately. It scares me and I don’t know how to respond.”

“You haven’t stopped working on ___________ (goal) in four days.  You haven’t eaten, showered, changed clothes, slept or left the house.  This is not how you normally are. I am concerned.”

What makes it effective:

  • You are separating the person from the problem = not shaming, blaming and judging your loved one.
  • You are expressing your response to their behavior without labeling or diagnosing the behavior.
  • Your concern is NOT that there is something wrong with your loved one, but that their behavior is significantly different from how they usually are.
  • You bring awareness to the behavior.

Asking your loved one to receive help

The goal here is to:

  • Not make yourself an expert or “know-it-all”.  You do not want your loved one to have to defend their behavior.  Therefore, you acknowledge that you don’t know what it’s like to experience what they are experiencing. (Unless you too are living with bipolar disorder…then it is different.)
  • Acknowledge that you believe that their behavior could be beyond their control; therefore, it is worthy of receiving help and not a reflection of who they are.
  • Ask them if they are willing to receive help.  If their behaviors do not put them at harm to themselves and others, it is best to willingly choose to receive help.

Example:

“I don’t know what it is like for you to not be able to sleep and to have such powerful emotions (or whatever behaviors you are noticing), but it appears that what is happening may be beyond your control.  Are you willing to receive help?”

When to have a professional intervention

If you are not able to communicate with your loved one in a structured and constructive way, it may be a good option to have a therapist or specialist participate in the intervention to structure and guide the communication process.

However the role of the interventionist is not to diagnose your loved one, their role is simply to contain and structure the communication so that your loved one can have an opportunity to choose to receive help.

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Answering Readers Questions: March 23, 2011

in Daily Living / Information  by March 23, 2011 4 comments

I highly value curiosity and welcome questions that can be generalized to be helpful to a lot of people.

Every thing that I write here is my opinion based on two things, my personal experience of living with bipolar disorder and my experience of helping people live with bipolar disorder both professionally and through out my life.

Here are the questions I have received recently:

  • What do you mean by “I am living with bipolar disorder”?

  • What are an M.A. and MFTi? (The letters that come after my name)

  • Can you treat bipolar disorder with just medicine or do you need therapy as well?

  • What does lithium do?

What do you mean by, “I am living with bipolar disorder”?

CLEARING UP CONFUSION: I, Robin Mohilner, was diagnosed with bipolar disorder as a teenager. I do not write from the perspective of living in a home with someone diagnosed with bipolar disorder.

I do not own “bipolar disorder” as my identity.  It is not who I am.  I try to refrain from saying, “I am bipolar.” That gives bipolar disorder the upper hand in my life.

By having the attitude and mindset that “I am living with bipolar disorder.”, I have the upper-hand.

I am in a relationship with bipolar disorder. I experience it as separate from me.  It affects me and I affect it (powerfully).

It does not control me, but when I’m not paying attention to our relationship, it temporarily gets the upper hand and I lose my power and control.

When I’m not paying attention, bipolar disorder loves to take me on emotional rollercoasters.  It loves when I am nervous or uncomfortable because it gets the upper hand and off I go unknowingly breaking unspoken social rules and impulsively speaking before I think or it makes me think so fast that it’s difficult to get words out of my mouth.

On the other hand, I have spent fifteen years developing a strong upper hand.  I get how bipolar disorder works.  I know how to prevent and contain my episodes.  I know what bipolar disorder needs and wants.  I am skilled in the art of stealing its power and fuel so that it cannot control my life.  My passion is to develop this in others.

The key is that I exercise my “paying attention” muscle everyday.  This keeps me living with bipolar disorder instead of being bipolar.

What are an M.A. and MFTi?

This question addresses my professional credentials.

M.A. refers to the Master’s Degree that I have earned in psychology, specifically in Marriage & Family Therapy, with eligible certification as an Art Therapist.

I earned my Bacherlors degree from U.C. Berkeley in Psychology and my Masters Degree from Phillips Graduate Institute in Marriage and Family Therapy.

However, earning degrees does not make me a therapist.  I have spent years paying my dues, which will explain the MFTi.

MFTi stands for Marriage and Family Therapist Intern. For the past five years I have practiced as a therapist under the license of supervising therapists.

I have successfully completed all of the hours of experience that I need to become a licensed therapist; however, I am currently patiently waiting (it’s a long wait) for the state of California’s Board of Behavioral Science to approve my hours of experience and grant me permission to take two challenging exams.  When I pass these exams, I will be officially a Licensed Marriage & Family Therapist (LMFT).

Can you treat bipolar disorder with just medicine or do you need therapy as well?

You CAN do anything you want. Nonetheless, bipolar disorder is complex and it affects a person’s complete way of being in the world.

Bipolar disorder is a reflection of the way the brain functions. It affects both how people think (very fast), feel (passionately) and how people respond to things that cause excitement, stress, fear and basically any human emotion.  There are both profound strengths (example, many experience high levels of intelligence and creativity) and weaknesses (example, having no intuitive clue about what is socially appropriate).

Bipolar disorder affects people’s self-esteem, relationships and quality of life.  Medicine does not change that.

Medication only reduces depression and mania.  Bipolar disorder is more than just an episode.

Therapy helps one navigate through the complexity and develop their awareness of how they are affected by bipolar disorder and utilize their own strengths, abilities and skills to construct their preferred way of being.

What does lithium do?

Scientists still do not know how lithium works.

Nonetheless, they do believe they have found two ways that lithium affects the brain.

One way they believe the brain is affected is at the level of the axon in neurons. Neurons are the brain’s cells that do all of the communicating.  Scientists believe that lithium affects the myelin sheath on the axon (the part of the neuron that message travels down). It is believed that brain’s affected by bipolar disorder have deteriorated myelin sheath and lithium may help reconstruct it.

Another more recent finding on the effect of lithium is that scientists have found that lithium may build  brain structures that are deteriorated in people living with bipolar disorder. Some of these early findings show that scientists witness change in areas such as the amygdala (seat of emotions in the brain) anterior and posterior cingulates (seat of impulsivity, awareness of unspoken social rules, center of inhibition that are all diminished in people with bipolar disorder).

If this was helpful, feel free to send me general questions and I will do this on a more regular basis.

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Lessons learned from UNCERTAINTY in the workplace

in Actions / Daily Living / Ideas: Ways to Thrive  by March 7, 2011 2 comments

Have you ever felt like everyone else, but you, was given a guide-book for proper etiquette in various  work and social circumstances?

Some people just intuitively pick up on social rules and know how to behave or have an inner critic that keeps them from saying or doing something inappropriate.

Well, I don’t have that guide-book and I often speak before I think and lack a strong inner critic that inhibits me from speaking my mind or doing what I feel is right.

This is very common for people living with bipolar disorder.  Our brains have a unique design.

Not having these qualities has the tendency to get me in trouble, especially at work.  Here’s some of what I’ve learned from the challenges of not having an intuitive guide and inner critic.

This is the beginning of a series to explore challenges people living with bipolar disorder my experience in the workplace.

Challenge: Uncertainty

What makes it a problem:

In my experience of living with bipolar disorder I have discovered that uncertainty is a key ingredient in inviting mania into my life. Uncertainty by itself will not trigger mania for me; however, uncertainty combined with the other ingredients of excitement and a sense of urgency…and I have the recipe for a manic episode.  (It does not guarantee a manic episode, but it makes me vulnerable to mania.)

Uncertainty is a problem in itself because it has the power to trigger my fear of being out of control within myself. The fear of being out of control within myself is rightfully my deepest fear because of my experiences of mania and depression.

This is not true for everyone.  Everyone experiences bipolar disorder differently.  This is solely my insight into my experience of it.

Here’s how I believe uncertainty gets it’s power:

The FEAR of uncertainty ( fear of what could happen) triggers insecurity.

Insecurity happily welcomes ruminating thoughts.

Ruminating thoughts partner up with strong emotional responses.

And poof…an emotional rollercoaster takes off at high-speed.

In my mind, my emotions were in control and taking me for a ride, even though nothing in my circumstances had changed.

 

How to recognize when the problem is uncertainty:

I worked in an environment that lacked structure and expectations for what I was supposed to be doing in order to be useful and effective.

All people benefit from having structure and clear expectations; however, for people living with bipolar disorder it is a MUST.

Because I did not know what I was supposed to be doing, when I started, I dove in, got creative and tried to participate in any and everything that I could.  I did this because I needed to create structure and expectations for myself, so that I could function effectively.  The alternative, an emotional rollercoaster,  is not beneficial for me or for business.

Unfortunately my effort to create my own structure and expectations was not appreciated by my colleagues and supervisors.  My efforts possibly appeared to be a lack of respect and arrogance on my part to come in and try to change their system to fit me.

 

What to do about uncertainty:

No one can make uncertainty go away.  We will all live life “not knowing” something.  However, how we respond to uncertainty is crucial in how it affects us.

My greatest lesson in regards to how to effectively respond to uncertainty for me, was learning how to sit with uncertainty.  It was hard for me to learn because I used to normally respond to uncertainty with impulsivity (which got me in trouble.)

Therefore, I had to try a different response, on that was not impulsive.  So I chose patience. Patience was a tough choice.  Patience was something that I really wasn’t all that good at.  I didn’t even know what patience really looked like.  To me it was like sitting on my hands in front of the cookie jar…that’s sort of being mean to myself.

Since that wasn’t working for me, I chose a new response…“observation”.  This time, when I experienced uncertainty, I took the following steps:

 

Observed my thoughts

I simply noticed what I was thinking.  I wouldn’t run with any of my thoughts (add emotion to them) or take action.  (That is impulsivity.)

 

Observed the situation and environment

This was easy, all I had to do was pay attention.  I didn’t get involved in anything happening, I simply watched the interactions taking place and tried to notice patterns and rhythms in how everything worked together.

 

Identified needs, roles, weaknesses and strengths and what I could do that would be valued.

This helped me to give myself a structure and create expectations for my role in work. It also empowered me to be able to anticipate needs and opportunities to be effective.

 

The funny thing about learning how to observe is that it taught me how to be patient.

In the next post, we will explore lessons learned from OFFICE POLITICS in the workplace.

 

 

 

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Compassion for Charlie Sheen: taking a stand for Charlie

in Taking A Stand  by March 1, 2011 7 comments

I am so thankful that I was not famous and incredibly wealthy when I had my worst full-blown out of control manic episode. I would not be where I am today and I would not be able to become a therapist that helps people thrive with bipolar disorder.

I am so lucky that full-blown mania came into my life at a time when I was able to overcome the consequences of self-destruction, public humiliation, loss and shame that mania causes.

I am so grateful that there was no one to document my actions and words besides my mother.

Therefore, I take a stand for Charlie Sheen because I believe his current words and actions may be those of mania and years of self-medicating drug abuse, not necessarily his character.

I am not treating Charlie Sheen, but in my opinion, the behavior he is expressing is quite NORMAL for someone experiencing full-blown mania and living with untreated bipolar disorder (even if never experiencing “traditional depression”).

I also believe that his lifestyle is quite NORMAL for someone living with untreated bipolar disorder who has fame and fortune.

When people have fame and fortune people are more readily willing to accept their manic “peculiarities” without calling it a diagnosis and without saying, “It’s not okay to treat me like this.” or “I think you have a problem and you need help.”

Charlie Sheen’s level of fame and wealth gives him access to the best drugs on the planet.  He can afford to make himself feel anything he wants to feel whenever he wants using drugs. I can understand why he would not see the value of a $10 bottle of Lithium that would make him feel more normal.

In my opinion, in order for him to want that $10 bottle of Lithium, he would have to experience the worst of the mania that many people never experience because intervention takes place before the mania peaks.

I probably wouldn’t be so committed to taking my lithium everyday if I had not experienced the peak of mania.

Where I believe Charlie Sheen is right now is in the best part of mania. Who wouldn’t want to truly feel omnipotent, divinely chosen and special and invincible?

Right now, to everyone else, Charlie looks out of control. However, my experience knows that he feels more in control of his life than ever before.

But I know what comes after that.  What came after that for me was so devastating and scary that I have not allowed myself to be fully manic since.

Every emotion I’ve ever had, came exploding out of me. All of my pain, rage and sadness exploded out of me uncontrollably.  I was haunted by delusions disguised as memories and obsessive paranoia that my family was trying to hurt me.  I used my words as knives to hurt people. Everything that was good in me, was gone.  All I could do was destroy my life.

This is why I take my medication everyday and do everything that it takes to remain stable with bipolar disorder.

Maybe Charlie Sheen needs to be in a safe environment. One in which he cannot harm himself and further destroy his life in order to hit rock bottom.  Maybe then, he can realize the priceless value of a $10 bottle of Lithium.

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Getting through “emotional rollercoasters” in relationships

in Actions / Ideas: Ways to Thrive / Relationships Effected By Bipolar Disorder  by February 1, 2011 0 comments

It doesn’t matter what you call it “emotional _______”: “…tide”, “…highs and lows”, “…rollercoaster”, “…waves”, “…rubberbanding”, “…disruption”, “…overwhelm”….we all go up and down or in and out in some way (even people without bipolar disorder).

So what do you do when you are in a relationship with someone and they are experiencing an “emotional…”?

Here are some of my ideas…

 

Common reasons for “emotional ______”:

Physical / Biological:

  • Hormonal changes
  • Sleep changes
  • Dietary or digestion changes
  • Lack of exercise
  • Chemical imbalance
  • Illness
  • Injury
  • Trauma

Emotional:

  • Stress
  • Fear
  • Uncertainty
  • Not enough connection / intimacy
  • Too much connection / intimacy
  • Need for independence / to be alone
  • Need for connection
  • Identity challenges
  • Financial stress / loss of income
  • You upset them / hurt their feelings
  • Self-doubt
  • Pain / Past emotional wounds
  • Self-worth
  • Trauma

These are just some possibilities.  The reality is that if you ask any person who is experiencing “emotional…”, they probably won’t be able to express this as they are experiencing it.

Why asking them WHY? doesn’t always help:

  • They don’t know.
  • Asking people “why” causes them to have to defend themselves.
  • Asking people “why” causes people to have to search for a problem and find one…that may not even be the problem at all.
  • It makes them feel worse when they are already feeling bad, overwhelmed or confused.

Ways to respond to your partner’s “emotional ______”

When someone we love is pushing away, withdrawing or pulling away, it is uncomfortable, scary and sad. Of course it is a natural instinct to want to be close. When they pull away it feels like we’re losing them, that we’re losing our relationship. It really hurts. “Emotional…’s” can be painful and a loss.

Often a mistake we make is to do the opposite of what they want.  We often smother them, lovingly of course.

Things to do instead of smothering:

  • Give your partner the space to experience their “emotional…”.

If they are pulling away, let them, and do so lovingly. Let them know that it is okay and that you love them, instead of panicking and feeling like the sky is falling down.

I know that this is hard and it is not easy to do at all, but in every “emotional…” there is a gift.  They may not always find it, but the gift is their own to be found.  You cannot give them that gift.  It is something they get to find within themselves.

  • Develop your awareness of your partners pattern or cycle for “emotional…” (and your own).

Ask yourself, “Is this a pattern?  How did it happen before?  What was the outcome? What did I learn?”

If you are able to see a pattern of emotion and behavior, then it is possible that what your own emotions and instincts are fearing may not be actually happening and it is simply an “emotional…”.

  • Do not take an “emotional…” personally.

(See the reasons above…almost all of them have nothing to do with you.)

  • Take good care of yourself.

Now is the time to focus on YOU.

What makes YOU happy?

What do you enjoy doing by yourself or with others that you may have not done in awhile?

What is something you want to try?

Give yourself love…

Don’t wait for anyone to bring you flowers, grow your own.

  • Therapy.

Therapy is both a vehicle and the developer of your own and your relationship’s tools and resources to better build the relationship you desire to be in.

 

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