Tearing Down Stigma To Understand Diagnoses With Compassion

in Ideas: Ways to Thrive / Information  by July 12, 2010 2 comments

In this blog I hope to create a better understanding and compassion for people living with the diagnoses bipolar disorder, schizoaffective disorder, and borderline personality disorder.

Often times society sees people living with bipolar disorder as people to be feared and are seen as dangerous. Society has no clue as to what schizoaffective disorder is. And often when people think of borderline personality disorder there is so much judgment and rejection that it can feel incredibly hopeless to the person experiencing it.

It’s important that I acknowledge that I do not have personal experience living with schizoaffective disorder or borderline personality disorder. I DO live with bipolar disorder and have a much greater understanding of how it affects people. Nonetheless, I hold a tremendous amount of compassion for anyone living with diagnoses that are incredibly stigmatized and misunderstood.

What I hope to give you in this blog:

  1. Shine a light that empowers you to be proactive in how you choose to live with the challenges caused by whatever conditions and circumstances you are dealt.
  2. I hope to remove the judgment and stigma and instead invite you to have compassion and understanding for these experiences.
  3. An awareness that any diagnosis is NOT who we are. Diagnoses are something we live with, we are in relationship with it. This means that it has the power to affect us and we have the power to affect it.

When professionals make a diagnosis we look at the following criteria and to what degree it affects one’s life:

  • Mood (defined as a temporary state of mind or feeling)
  • Behavior (defined as the way one acts or conducts one’s self, especially towards others) / Changes in Needs and Interests
  • Changes or Patterns in Thought Process
  • Sense of Self

In today’s blog we will explore the diagnoses bipolar disorder, schizoaffective disorder and borderline personality disorder from the criteria of Mood with compassion. Following blogs will cover the other criteria.

Mood

Bipolar Disorder:

It is important to note that bipolar disorder is defined by the presence of mania. The diagnosis is not dependent on the presence of depression. In this blog, we will only explore from the perspective of mania.

The mood component of mania is defined as a temporary state (at least a week or can be less) in which mood is:

  • Unusually elevated, euphoric or expansive

Experiencing these mood patterns can feel so incredibly good that it is hard to recognize that mania is present. They may be the superhero “I can fly” feelings that we dreamed about experiencing as children and now they are REAL feelings.

  • Unusually irritable

No one usually wants to take responsibility for their irritability. Irritability is one of those things that just doesn’t make sense. It’s not usually based on what’s happening right now. It’s based on what happened in the past. And it usually is from things we don’t address.

When irritability happens in the experience of mania in bipolar disorder it’s because bipolar disorder puts the pot of our emotions on a stove or in a pressure cooker. Our emotions boil over. Meanwhile, bipolar disorder is stirring the pot, mixing all of our emotions together without any regard to what’s taking place here and now. No matter what those emotions are, when this is happening to you, you’re going to be very irritable.

  • Often feels as though every possible human emotion is being expressed in the same time period.

To make sense of this from a brain perspective, see my blogs on the bipolar brain.

During this experience we are our most scared and at one of our most fragile times in which our life is at tremendous risk. This is a time when we feel completely out of control not only in our own minds, but also in our bodies. It is so hard to share that we are in danger with anyone because we are so afraid of what will happen to us. Often times its like we are having an out-of-body experience. We are watching ourselves be completely out of control, but there is nothing we can do about it. We know we are not crazy, but we are having a crazy experience and we can’t explain what’s happening and why.

  • Shifts in mood happen impulsively or swiftly with or without trigger

This is so painful because there are so many consequences. During these temporary times, our family and friends don’t know how to be around us and are scared of us. They are walking on egg shells. It’s hard to be a friend when people can’t feel safe with us. We feel so alone and so isolated. We don’t know how to repair what was broken when we were out of control. It is very easy for shame, blame and guilt to set in.

  • There is a loss of control in the mood shift, yet there is an awareness of the shift in mood

Often times people think that there is a lack of awareness when people are experiencing mania. I tend to disagree. I think people are so scared of what they are experiencing that there is an abundance of denial, fear and shame. I do not believe there is a lack of awareness. No one ever wants to feel completely out of control, let alone acknowledge it to other people who have no clue as to what its like.

I have found people living with bipolar disorder to have incredible sensitivity and self-awareness.

Note: If someone has lived with bipolar disorder untreated for a long time, it is possible for them to feel as though it is their personality. And maybe it is, I believe it is possible to have a manic personality and it is possible to have rapid and consistent temporary mood changes. Anything is possible.

Schizoaffective Disorder:

Same as bipolar disorder or major depressive disorder (depression without mania) or any other mood disorder.

The key difference between schizoaffective disorder and other mood disorders is that the delusions and hallucinations take place during times when mania or depression are not taking place. This means that psychosis occurs beyond mood disorder episodes as well as during them. If you are suffering from something similar, then it might be a good idea for you to seek help. You could always check out an inpatient facility like Honey Lake Clinic that can help support you through this disorder. However, the decision is up to you.

In my opinion, this may be the most difficult and painful mood disorder that people experience. I can only imagine how scary it would be to not only have to live with mania and depression, but to also experience delusions and hallucinations during the times when mania and depression are not present. Nonetheless, I am confident that there are gifts and beauty in every experience. I trust that we don’t get to hear about the goodness that comes through these experiences because as a society we silence that. (For example, prophetic wisdom and vision.)

Borderline Personality Disorder:

Here’s where people often get confused. It is quite confusing to recognize the difference between someone experiencing bipolar disorder and borderline personality disorder.

People living with bipolar disorder can also live with borderline personality disorder.

The reason why it is considered a personality disorder versus a mood disorder is because here mood shows up as character traits that are consistently unstable possibly on a daily basis that can last anywhere from a few hours to a few days. It gets very confusing with rapid cycling bipolar disorder. So keep reading to better understand.

It is important to understand that borderline personality disorder appears to have a very strong nurture / environmental components that are often found to be passed on from one generation to another.

Research has shown that people experiencing borderline personality disorder often did not grow up in an environment / family that offered them stability and predictability.

Their environment may be one that lacked defined and consistent boundaries.

In fact, people nurtured in this way often grow up in an environment where they never really know if and when they will have their needs met. This is incredibly traumatic to a person.

A key component that people share with this diagnosis is the experience of emotional abandonment from their primary caregivers / parents. The response to these experiences are a persistent fear that they will be abandoned emotionally or physically in any relationship.

Anyone living in these nurture / environmental conditions would experience tremendous pain and fear. When your primary caregivers abandoned you emotionally and/or physically or you lived with the fear that they would, relationships may be so difficult and frightening. It makes sense of how someone could live with such a deep need to belong, to be loved and to have their needs met.

It has been described to me by a client in this way, “Its like going through life walking on glass and you get so used to it that it provides the comfort of a blanket.”

This does not mean that all people living in this type of environment will grow up to live with borderline personality disorder, it simply makes them vulnerable to having the following response in life.

These following MOOD characteristics are a response to growing up in this type of environment:

  • Intense dissatisfaction with life
  • Irritability or anxiety
  • Intense anger and/or difficulty controlling anger
  • Intense fear of abandonment
  • Consistent idealizing and devaluing of others
  • May have consistent suicidal ideation

Note: We are only discussing characteristics of mood, this is not a complete diagnosis.

A key difference from bipolar disorder is that people living with borderline personality disorder do not experience elevated, euphoric and expansive mood. They don’t feel invincible and on top of the world.

In Part Two we will explore this from the perspective of Behavior and Changes in Needs and Interests.

Part Three will cover Thought Processes and Sense of Self

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5 Sensitivities That Affect People Living With Bipolar Disorder

in Information  by June 25, 2010 4 comments

The earth & all life are sensitive to the moon

Everyone living with bipolar disorder experiences and is affected by bipolar disorder differently.

However, we all share specific sensitivities that can cause us to be more symptomatic or less symptomatic.

1. We are all affected by changes in our circadian rhythms.

Circadian rhythms are the natural rhythm that occurs in our body that tells us things like when its time to eat, sleep, when to wake-up, time to be active, have sex, rest etc.

Everyone has these rhythms. With us living with bipolar disorder, our brains and bodies are more sensitive to changes in these rhythms.

2. We are highly sensitive to changes in our quality and amount of sleep.

When our bodies need less sleep we are highly vulnerable for mania or depression, possibly already in stages of mania or depression.

Quality sleep, deep sleep, is very important in maintaining our stability.

We ideally go through 4 cycles of sleep during the night. Our goal is to experience those complete cycles of sleep.

During our REM sleep (deep sleep in which we dream and have rapid eye movement, increased heart rate and blood pressure etc) all brains are both organizing and processing emotion, retaining memories and managing stress. By not getting the proper amount of REM sleep (4-5 cycles) our brains cannot do what they need to do to maintain emotional and mental and emotional control and stability.

3. We are very sensitive to light.

Our bodies are so sensitive to light that even if we try to go to sleep with a mask on our bodies can still be affected by the light around us and this will affect our quality of sleep.

We need our sleeping space to be as dark as possible to promote our best quality sleep.

Sometimes things like watching candle-light can promote falling asleep. However, that same light will wake us up out of deep sleep once we have achieved it and completed a cycle of sleep.

4. We are highly sensitive to our thoughts and emotions.

What we focus on grows incredibly fast.

Our sensitivity to our thoughts and emotions is so intense and rapid that we often do not have time to think about our thoughts and emotions to support them with evidence. Instead, we feel our thoughts and emotions incredibly deeply. We experience them in our mind and bodies in ways that cannot be put to words and easily understood from someone who is not living with bipolar disorder.

We live our thoughts and emotions, instead of thinking them. They are real to us until we take control, set our boundaries and define or make sense of them.

Our thoughts become feelings and actions impulsively. This process happens so fast that we often do not even think about it unless we know how. And even when we know how, it often will happen and we simply have to back-track and make corrections to our thinking and behavior.

5.  We are highly sensitive to stress.

We have the ability to face and conquer stress.  However, stress can easily throw us into an episode if we don’t know how to respond to it.

If we respond to stress with a sense of urgency or panic we are in trouble. We are asking for a manic episode.

Therefore, we need to learn and practice ways of responding to stress that do not invite the panic response.

We need to have a plan for responding to stress. One way of doing this is to plan for the stress that you know you are going to have in your daily life due to your responsibilities.  If you know that there are certain things that you have to do, then you have control over that stress and are able to respond to it without urgency or panic.

What tends to throw us through a loop are the stressors that we don’t plan for. When “shit happens” our goal is to plan that we’ll do the best we can with the resources we’ve got in that moment…and if it’s not perfect, so what!

Everyone we are dealing with under circumstances of stress is human…they’re not perfect too.

When you are living with bipolar disorder, it is not in your best interest to be a perfectionist. That’s just asking to be manic all the time.

Make space in your life and your relationships to make mistakes and be willing to own it and do your best to do better.

Take the stress off of yourself to be perfect.

It is so important that you know your own limitations and are willing and able to communicate them during times of stress. Don’t be afraid to ask for help or support.

There are some stressors like major loss, natural disasters, economic struggles etc that you just can’t plan for or do anything to control. During these times all you can do is grieve, feel a whole lot of pain, be angry, depressed…basically be just like everyone else during the worst times in their life…and get support, help and resources.

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“Newly Diagnosed With Bipolar Disorder Club” Topic #1: Complying & Coping With Medication

in Actions / Activities / Ideas: Ways to Thrive / Information  by May 14, 2010 1 comments

This blog series is dedicated to everyone Newly Diagnosed with Bipolar Disorder. Welcome to the club!  You have unwillingly joined an elite club in which some of the members are among the most brilliant, creative and talented in history.

Unfortunately there is no manual that comes with our bipolar disorder diagnoses when becoming a member of this club.

This blog will be followed by a series of blogs called “Newly Diagnosed With Bipolar Disorder Club”. Each blog will address issues that members have shared with me or issues I or clients I have worked with when newly diagnosed face.

Today’s topic is coping with medication and medication compliance.

Topics coming soon based on members’ request will include:

  • Building daily routine and structure
  • Developing sleep patterns

If you would like to make a request for this series, please contact me and I will be happy to address your concern.

Today”s Topic:

The #1 problem that people have when joining this club is coping with medication and medication compliance.

There are not many people in a club like ours where the medication completely changes your experience of yourself.

Our medications may change:

  • Our energy and exuberance level
  • Our ability to feel the rich emotion of emotion
  • How we think
  • How we express ourselves
  • Our creativity and innovation
  • Our memory
  • Our weight
  • Our ability to be super productive and goal-focused

*Note: Not all medications cause these effects, but all medications are mood stabilizers which function to reduce emotional extremes.

Nobody would want to take medication if it did changed who they are AND keeps them from feeling like themselves and maybe weird or slightly off at first.

This is why we, the members of this club, are so strong and courageous. Each one of us has a different reason for why we are willing to sacrifice the amount of some these of these things. I made this sacrifice because I was willing to do anything I possibly could to prevent myself from experiencing the peak of full-blown mania and feeling like I am dead in depression. Some of the people I’ve had the privilege of working with shared with me that they made this sacrifice because medication made their quality of life so much better. They got to experience stability for the first time. It improved their abilities to function at work and improved their quality of relationships.

Most often, the consequences of not making the sacrifice are far more painful than what there is to gain by taking medication.

It’s a hard choice to make, but something we remember by taking our medication every day at the same time.

Before continuing on to an activity, take a moment and ask yourself what has you committed to being on medication.


Now that we understand why we are committed to being on medication, let’s explore how to cope with the losses:

The loss you experience is a death because it is that significant of a loss therefore in order to cope, I invite you to mourn the loss for a specific set amount of time before taking actions to explore your new life.

Ways to take action and help mourn the loss of your manic and depressive self:

1.  Write down the qualities you miss.
Examples: creativity, exuberance, productivity, passion, emotion etc

2.  Write down what you miss about each quality.

3.  How did it affect your life?

4.  How did you feel when you experienced it?

5.  What did you tell yourself about yourself when you experienced it?

6.  What abilities did each quality give you?

7.  What qualities or parts of qualities did you get to keep?

8.  What new abilities do you have because of being on medication?

9.  What action are you willing to take to further develop these abilities?

* This is an activity that could be very useful done in therapy if it feels overwhelming to do on your own.

Here’s one example put in action from my life.

1.  Write down the qualities you miss.

I miss my exuberance that was expressed through passion and an energy that completely filled the room.

2.  Write down what you miss about each quality.

I miss the feeling I had when I walked into the room and the affect my presence had on people. I felt special. I felt wanted. It felt so good to make people smile. (I wasn’t aware of how uncomfortable it made some people until I was in graduate school.)

3.  How did it affect your life?

People relied on my presence to make them feel good. I relied on my presence as a way to not be vulnerable because I always had a smile on my face and was a burst of energy. It made it easy for me to meet people and engage groups of people.

4.  How did you feel when you experienced it?

Wanted. My presence made people’s day. I felt passionate and alive. I felt seen.  At times insecure because with age, I could feel that it made people uncomfortable.

5.  What did you tell yourself about yourself when you experienced it?

People like me. People want me around. My presence matters and makes a difference. I make people’s days better.

6.  What abilities did each quality give you?

The ability to be free and break social rules (which I didn’t inherently know what they were anyway).  I could get away with so much because I did everything with a smile on my face.

7.  What qualities or parts of qualities did you get to keep?

I still have my passion and exuberance, but it has changed form. Now I’m a light in the room, instead of completely filling the room. I am not overwhelming. My energy is more relaxed and channeled, yet still very passionate. My energy isn’t as anxious and manic, except when I go to the doctor.

8.  What new abilities do you have because of being on medication?

I am able to feel peace and centered. I don’t feel the need to be “on” or performing all the time. Instead, I feel more genuine because I don’t always have to have a permanent smile on my face.  I’m able to use the abilities I’ve always had with more ease. I could go on and on…it has been tremendous.

9.  What actions are you willing to take to further develop these abilities?

Focus on my breathing during to increase my feelings of peace and centered. Continue to be transparent about what I’m thinking and feeling and continue being honest when I’m not able to be what people expect from me.

If this is helpful, feel free to contact me with interests for future blogs.

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The Bipolar Brain-Part 2: The Fight For Domination…When the Right hemisphere is winning.

in Information  by May 11, 2010 1 comments

In our last post we explored that mania may be caused by the left hemisphere dominating the brain and specific areas of the brain being flooded with energy in the form of neurotransmitters or chemicals in the brain.

Now we will explore how depression may be caused by the right hemisphere dominating the brain. In this case,  specific areas of the brain may receive too much or not enough energy in the form of neurotransmitters or chemicals because the right hemisphere needs that energy to dominate the left.

An interesting theory to note is that the left hemisphere of the brain is responsible for more positive thoughts and emotions, which is why some stages of mania may be a very positive experience (except when the left hemisphere is fighting really hard).  Meanwhile, the right side of the brain is more responsible for negative or fear based thoughts and emotions. Keep this in mind as you read about the brain structures affected by the right hemisphere of the brain dominating the the left hemisphere.

Mood

Just like in mania, mood  appears to be caused by the Orbitofrontal Cortex. The orbitofrontal cortex is responsible for things like decision-making and is sensitive to reward and punishment.  When the right side of the brain dominates the left hemisphere it may use all of this energy to punish us because it is teamed up with the amygdala (see Emotion below).  Therefore, we may experience feeling very negative emotions and a loss of interests because our brain is flooded with negative chemicals carrying negative messages. At the same time, because of this battle our brain doesn’t have the resources from the left hemisphere that has more neurons that have chemicals that make us feel good and interested in things.

Emotion

The seat of emotion and our brains response to fear is in the Amygdala. Some studies have found that the amygdala is larger in the right hemisphere and smaller in the left.  This means the right hemisphere is more receptive to fear based emotions. Therefore, during the battle when the right hemisphere is winning, the amygdala is producing huge amounts of negative fear-based emotions that flood our conscious mind in the pre-frontal cortex which we shall soon explore.

Memory

The Hippocampus may be highly inhibited or even not functioning when the right hemisphere takes over. The Hippocampus is responsible for forming, storing and retrieving memory. This part of the brain may be completely cut off from resources during the battle and may even break down because of it.

When are thoughts are moving so slow that we can’t even form sentences…or we can’t think at all…

The structure called the Pre-Frontal Cortex is being inhibited during the battle and lacks the energy and resources to function. The pre-frontal cortex is responsible for analytical thinking, problem solving and all other forms of rational thinking.

Hallucinations and Delusions

This may be very similar as to what takes place during mania. This may be the point where the battle between the hemispheres becomes so intense that it jumbles each message between the messengers called neurotransmitters. The message becomes so chaotic that they are not easy to decode. As a result, the brain can’t see what the eyes see or hear what the ears hear.

The Right Hemisphere can only dominate the left for so long…

If the left hemisphere has energy when it takes control of the right hemisphere in its final battle….we go shooting up into mania or usually hypomania (a milder version of mania.) Then the story of the left hemisphere dominating the right begins all over again.

When Neither Hemisphere is Dominant: Understanding Mixed Episodes

A mixed episode may be what we experience when the left hemisphere and right hemisphere are battling. In the moments the left hemisphere is dominant of energy/chemicals and resources we experience mania. As soon as the right hemisphere gains dominance of energy/chemicals and resources we experience depression. This may take place very rapidly in the brain until one side or the other gains full dominance.  Sometimes the dominance does not happen at all and we just experience the battle until the brain exhausts itself from the fight.

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The Bipolar Brain: The Fight For Domination…when the left cerebral hemisphere is winning

in Information  by May 10, 2010 15 comments

One question I often get is, “What’s happening in the brain during a manic and depressive episode?”

The truth is that scientists don’t fully know. Scientists are finding common evidence, but the brain is so complex that nothing we know about it can not be considered fact that will apply to everyone.

Therefore, I am going to share with you my ideas that are based on both my current research and my own experience of my brain in action.

A Balanced Brain – (No brain is truly balance, but let’s pretend)

A balanced brain does its best to equally disperse resources. Therefore there is no competition for resources. Both hemispheres have what they need, the layers of cortex (where our higher functioning takes place) have what they need. The limbic system (the seat of our emotions) has what its needs. Everything is basically working together and there’s harmony.

Yeah right! No brain works like this most of the time.

Bipolar brains just happen to be extreme.

A bipolar brain is a highly competitive brain, which is why many of us are so intelligent, inventive and creative. Different structures and hemispheres of our brain compete for resources to be able to do extreme things that require a lot of energy and brain power.

During Mania – Reminder this is not fact it is my theory

During Mania the left hemisphere of the brain is dominating the right hemisphere. But the right hemisphere isn’t turning it’s cheek, it is fighting back with all it’s got.  This is how the peak of mania and mixed episodes may come to be.

Mood – Mood Swings

This may be do to a structure in our brain called the Orbitofrontal Cortex getting too much energy and not enough energy as it gets pushed and pulled back and forth during the battle between the hemispheres. The Orbitofrontal Cortex is responsible for things like decision making and is sensitive to reward and punishment which may be a large factor in mood.

Memory

The structure in the brain called the Hippocampus (that is responsible for forming, sorting and storing memory) appears to be significantly inhibited during mania and/or depression. My experience was that it was incredibly inhibited when the right hemisphere took over and I went into depression, but not inhibited at all during mania.

When we are able to consume analytical information faster and easier than ever before, when our thoughts are racing, when we have multiple thoughts at once and when these thoughts get jumbled up because we cannot keep up with them….

This may be our left hemisphere, particularly in a structure called our Pre-Frontal Cortex, that is consuming so much energy and power that it has taken by dominating the right hemisphere that we cannot keep up with our brain’s ability to function and we cannot express ourselves because we cannot get it out fast enough.

They say that the average human being uses 7-10% of their brain power, well that’s a joke to someone who is manic!

When we are impulsive and take tremendous risks…

This may mean that two specific structures called the Anterior Cingulate (responsible for social inhibition)and Posterior Cingulate (responsible for being sensitive to risk) have been shut down by the lack of resources in the battle between the hemispheres. Research shows that these structures are somewhat depleted in bipolar brains to begin with, so during mania they may not be functioning.

When we feel invincible…

The battle in our brain may be taking a huge toll on our Amygdalas. The amygdalas are both responsible for emotional responses as well as our response to fear.  According to some studies, bipolar brains may have smaller amygdala in the left hemisphere and larger in the right. Therefore, when the left hemisphere is taking over during mania, the little amygdala is overloaded and may be depleted of its resources to appropriately respond to fear.

When we have a heightened sense of spirituality or oneness with all life…basically when we feel we are a god, prophets, higher being, aliens etc…

There is a part of the left hemisphere, whose name I do not know, that has been identified as the seat of spirituality. Some people have it, other people do not. During mania when the left hemisphere is consuming all of the brain’s resources this part of the brain soaks it up and runs with the energy until it is all burned up.

When we experience hallucinations or delusions…

Hallucinations and Delusions may be where the true battle between the left and right brain taking place. This may be where the right brain starts to win at times. This is all my theory from experience.

I believe that as the left and right hemispheres of the brain are battling the messages that get passed from neuron to neuron get disrupted or convoluted causing the message to change so extremely because the message gets changed by each neuron in the neural pathway.

It is basically like playing the telephone game, gone out of control.

When this happens our brain no longer sees what our eyes see and no longer hears what our ears hear. We are no longer able to be in touch with the world outside our our brain. Our brain is battling and doesn’t have the resources that moment to focus on getting accurate messages through.

During the Peak of Mania or a Mixed Episode- when all emotions explode out

This is the last fight. Mania gives the battle everything it’s got by exploding out positive feelings and emotion. But the left hemisphere has been exhausted by the right and doesn’t have many energy left.

The right hemisphere dominates with the power it has and explodes negative, ugly, nasty, horrible feelings and emotions. It does this until it exhausts itself.

During Depression – The Exhaustion

Both left and right hemispheres are depleted. They are done. Finished. And gave up the battle. Neither has any energy left to give.

Hence this is why we feel our brain is dead.

To learn about my theory about how the right brain dominates during depression, I welcome you to come back for more.

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