Showing posts with label bipolar. Show all posts
Showing posts with label bipolar. Show all posts

Why Am I Still Sick? Mental Illness, Faith, and the Love of God

Rumor has it, I'm going to start preaching again. My brain functions a lot better than it used to. But it still functions slowly. So to give myself plenty of time, I have been looking ahead to the scriptures that are coming up in the lectionary.

[In the Episcopal Church, among others, we preachers don't pick and choose our favorite bits of the Bible. We get confronted by and have to deal with what is assigned.]

That's how I came across Matthew 9:18-26, one of the texts for early June. Jesus is on his way to heal a young girl when a woman with an issue of blood reaches out surreptitiously to touch him. He feels the power go out of him and turns to confront her. Then he says:

Take heart, daughter; your faith has made you well.

Ah, here it comes -- the faith question of every person with a chronic or fatal illness, every person who prays and has people praying for us.

Don't I have faith? Don't I have enough faith to get my healing?

Many years ago in one of my darkest times, I met a young woman. She was part of a mission group who had come from Mexico to Costa Rica. On behalf of a local church, she and others would be going door to door, sharing their witness.

She asked me what I was doing in Costa Rica. So I told her that I had depression and was writing a book about it.

Without missing a beat, she answered, If you give your life to Jesus, he will heal you, and you won't have depression anymore.

She described her life in her teens, a life of indulgence, as she put it. She was a smoker. But then she gave her life to Jesus and he turned her around. He took away her addiction to cigarettes

Oh, honey.

She and I had met at the church that was sponsoring the mission. The worship service had gone long. I was tired. And I didn't have enough Spanish to get into it with her.

So I didn't tell her that 

  • I fell in love with Jesus when I was eight and was baptized
  • I took Jesus as my Lord and Savior when I was eighteen at college
  • I gave my life to Jesus when I entered seminary at twenty-five
  • I vowed to . . . pattern my life in accordance with the teachings of Christ, so that I may be a wholesome example to my people when I was ordained a priest at twenty-nine
  • I . . . well, you get the idea.

The thing is, I have a brain that works differently, and sometimes not very well. Living a life in Christ has not protected me from the symptoms of bipolar disorder, nor even from feeling suicidal at its worst.

Bipolar disorder has been around for millennia. People had it before the coming of Christ. And people have had it since. Faith in Jesus really has nothing to do with it.

I am glad that Jesus took away her addiction to cigarettes. I am glad that Jesus healed the woman with an issue of blood, that he freed the Gerasene man who had been possessed, that he raised Lazarus from the dead.

But he hasn't healed me. At least, he hasn't taken away my bipolar.

Why not?

No, don't answer that question. I don't want an explanation. I especially don't want God to explain to me how He -- and I use that pronoun on purpose -- how He is using my suffering to some greater end. To help you, I suppose.

I don't want a God who manipulates people who are suffering, moves us around on some chessboard as part of His grand design.

For God's sake, don't tell me to have faith.

What a cruel notion that if you just believe hard enough you will be healed.

The first preaching I will do after an absence of a few years will be for a man who was one of the most faith-filled people I know. He died after waiting for years for a lung transplant, while people around the world prayed for him. As people have prayed for me.

Why am I still sick? I think that's the wrong question to address to God. I think that question posits the existence of the kind of God that we want, a God who will answer our questions and give us certainty and make us feel good.

A God that exists only in our desires and our imaginations.

Whoa! Did the preacher say that God doesn't exist? No, the preacher said that the God that does exist is not small enough to fit inside the box of our desires.

Who is the God who does exist? I am a very smart person. Nevertheless, that question is beyond my bandwidth. I have my own desires about God. But I no longer expect that God will satisfy them.

However, reading all those stories of healings year after year, over forty years of preaching on them, there is something that I have noticed. In almost every one of them, part of the healing is a return to community.

The woman who had had an issue of blood for fifteen years (endometriosis?) would have been unclean on that account. Nobody would have touched her. For fifteen years. Now she could take a neighbor's hand.

The Gerasene man who was possessed (schizophrenia?) lived in chains outside the city of Gerasa. When he was restored to his right mind, Jesus sent him home.

Lazarus -- dead and in the tomb. Jesus returned him to his sisters.

And me with my bipolar -- that is the kind of healing I have experienced. When I was newly disabled and not leaving my second floor condo except to go to the doctor, I joined NAMI -- National Alliance on Mental Illness. I went a Peer to Peer class, where people with mental illness teach other people with mental illness how to navigate our lives.

I discovered people who didn't care whether I had faith or not. They didn't need for me to be healed to confirm their own faith. They expected I wouldn't be. And they loved me. They invited me in. They were my new community.

Romans 8 -- that's what I believe. When I don't believe in God -- I really don't believe in the God who withholds healing based on my puny wounded capacity for faith -- I do believe this:

I am sure that neither death, nor life, [nor feeling suicidal], nor angels, nor principalities, [nor health insurance companies], nor height, nor depth, [nor the personal hell of side effects], nor anything else in all creation will be able to separate us from the love of God in Christ Jesus our Lord.

I am not healed. But I am loved.

That's a kind of healing. And it is enough.


photo by Nevit Dilman, used under the creative commons license.

World Bipolar Day: What the Heck Happened to my Brain?

Prozac Monologues is a book within a book. Its original form was a series of monologues written in an unrecognized hypomanic state. The rest of the story is what I learned about bipolar disorder after I learned that I have it.

In Balancing Act -- The Science Chapter, I answer the question, How did I get into this mess anyway? I compare it to another question, Why did the roof collapse? Both answers are to be found in a process that begins with something a little wonky and develops into a systemic mess.


The following excerpt skips the charming roof collapse explanation (inspired by true events during one Central Oregon snowmaggedon in 2017). Buy the book for that story! It goes straight to the science part. Let me know in the comments what you think.

Interpersonal Social Rhythms Therapy: Good, Bad, and Ugly (Mostly Good)

Following #bipolar on Twitter for the last few years, I am often dismayed. So many people seem to spend so much time struggling with their medications and so little time focused on anything else that could help.

Don't get me wrong. Medication is an important tool for managing bipolar disorder. But it can't do the whole job. Education and life style changes are crucial for getting off the roller coaster of constant med adjustments to address the episode du jour.

I decided it was time to revisit my 2011 review of Ellen Frank's Treating Bipolar DisorderIt was a four-part review. The last three posts describe the treatment itself, Interpersonal Social Rhythms Therapy, IPSRT.

Part I laid the educational foundation, describing the relationship between circadian rhythms (our interior physiological clocks) and mood disorders.

Part II outlined Frank's Social Zeitgeber Theory and the treatment that proceeds logically from it, a process of establishing regular daily rhythms that set our interior clocks and keep them running on time. (Zeitgeber means timekeeper.)

Part III explained how work on interpersonal issues helps people reduce stressors and prevent disruptions to their social rhythms.

This last post will pull together my appreciation, my reservations and my hopes for future directions.

Social Zeitgeber Theory


How Does Interpersonal Therapy Help People with Bipolar Disorder?

Ellen Frank - Treating Bipolar Disorder, Part 3

Lately I have been reposting my 2011 review of Treating Bipolar Disorder by Ellen Frank. It was originally recommended to me by a friend who was researching hypomania. Part I described the basis of Interpersonal Social Rhythms Therapy (IPSRT) in circadian rhythms that control the many physiological symptoms of mood disorders. Part II outlined the Social Zeitgeber Theory and described the early stages of the therapy process, history taking and stabilizing social rhythms. Today I pick up with the later stages, interpersonal therapy and maintenance.


Interpersonal Social Rhythms Therapy came to Ellen Frank in an epiphany on her birthday, July 14, 1990. Personally, I like that. I especially like that it was the day that she participated in a conference for people with bipolar, and listened to them.

Frank and her colleagues were already using interpersonal therapy for people with recurrent unipolar depression. Their theory was that certain life events, particularly losses could result in lost social zeitgebers, (timekeepers), with subsequent disruption of circadian rhythms, leading to eventual relapse into another episode of depression.

IPSRT took up from there as an adaptation specifically for people with bipolar disorder, integrating the work on issues (as in, you've got issues) with greater focus on behavioral changes to achieve and maintain daily rhythms, time of rising, time of first human contact, work, main meal, etc. The purpose of IPSRT is to help people achieve stability and then to avoid relapses into either depression or mania/hypomania.

Why Do People Relapse?

How the Social Zeitgeber Theory Works, for Good or Ill - IPSRT

This -- this system is the gift I wish I could give to the people I meet on Twitter who struggle with their bipolar, who are in endless rounds of medication adjustments and medication failures and medication despair. Medication isn't the only thing you can do. I'm not saying quit your meds. I'm saying, add social rhythms therapy. Originally posted in 2011:

Ellen Frank - Treating Bipolar Disorder, Part 2

So you have bipolar. You know you have bipolar. You are way past the denial stage. You are into the pulling out your hair, screaming with frustration stage. Or maybe moved on to despair stage. Because:


  1. The medication sucks.
  2. You keep getting sick again anyway.

But contrary to what everybody has been telling you, medication is not the only thing that works. It may be essential to your recovery and continued functioning. But you can do better if you do more. From my last post:

IPSRT [Interpersonal Social Rhythms Therapy] is one of three psychotherapies tested by the National Institute on Mental Health in its recent major study of best practices for treatment of bipolar disorder. The Systematic Treatment Enhancement Program for Bipolar Disorder, STEP-BD discovered that Patients taking medications to treat bipolar disorder are more likely to get well faster and stay well if they receive intensive psychotherapy.

Do I have your attention? Today we continue with Ellen Frank's Treating Bipolar Disorderin which she describes this therapy of her invention.

What Happens In IPSRT

Do Your Meds Work? There's More You Can Do to Treat Bipolar

Ellen Frank: Treating Bipolar Disorder - A Review

Ellen Frank changed my life. When I was diagnosed on the bipolar spectrum, and hadn't found a medication regime that I could tolerate, her Interpersonal and Social Rhythms Therapy gave me a way to get a handle on my wildly fluctuating condition.

She and I corresponded in 2011, as I was writing a four-part review of her book and her therapy. I published with her assurance that I got it right.

I was over the moon when she agreed to endorse Prozac Monologues: A Voice from the Edge. She wrote:

Brilliantly written, engaging from the first page, Prozac Monologues is a bit like a great evening at a first-rate comedy club…except that it is deadly serious.  Goodfellow’s painful and all too common journey to finding the right treatment for her bipolar disorder points her to the ultimate realization that doing well with this illness requires the right medication, the right psychotherapy, and the specific lifestyle modifications that support wellness.

Ellen Frank, Ph.D.Distinguished Professor Emeritus of Psychiatry, 

University of Pittsburg School of Medicine

Pretty cool, huh! She even wrote privately to her listserv to recommend it.

So many people I read on Twitter struggle to manage their bipolar disorder. I figure it's time to bring this four part series out again. So here is Part 1 - from April 4, 2011.

Medication And Mental Illness


Medication for mental illness is just like medication for anything else. It works better when you don't ask it to do all the work itself.

In the case of bipolar, once lithium and the chemical imbalance theory came along, the thinking was that medication was the only thing that worked. Therapy by itself certainly didn't. I wonder if therapists, worn out by their bipolar patients, were simply relieved to believe that medication was the only thing that worked. I wonder if therapists today, worn out by their recurrent depression patients, are secretly relieved to terminate when the diagnosis changes to bipolar, because medication is the only thing that works.

Frankly, there is a lot of wishful thinking out there in pharmacotherapy land. If only our brains were a chemical stew and the illnesses of the brain could be treated by adjusting the recipe. If only.

But people with mental illness, especially people with bipolar, can't afford the wishful thinking behind the better living through chemistry fantasy. Sometimes the medications do work. But not as well nor as often as your doctor would like to think.

I have a friend who is a psychiatrist. He challenges his colleagues who keep trying to solve this noncompliance issue, to get their patients to comply. He reminds them, if the medication (antidepressants, in this example) worked for 40% of those who took it in the trial, and the placebo worked for 30%, that means only one out of ten people benefit from the medication itself. So what's the big deal about nine who quit?

He says they just look at him funny.

Treating Bipolar Disorder by Ellen Frank


This same friend, God bless him, loaned me a book about a psychotherapy designed specifically for bipolar disorder titled, appropriately enough, Treating Bipolar Disorder. The author Ellen Frank, professor of psychiatry and psychology at the University of Pittsburgh School of Medicine and director of the Depression and Manic Depression Prevention program at Western Psychiatric Institute and Clinic, and her colleagues invented Interpersonal Social Rhythms Therapy (IPSRT), a kind of mash-up between talk therapy and regulating circadian rhythms.  It gets my next few posts.

In A Nutshell... 


IPSRT [is] a treatment that seeks to improve outcomes that are usually obtained with pharmacotherapy alone for patients suffering from bipolar I disorder by integrating efforts to regularize their social rhythms (in the hope of protecting their circadian rhythms from disruption) with efforts to improve the quality of their interpersonal relationships and social role functioning.

Why Writing Bar Tales of Costa Rica is Good for my Mental Health

Mindfulness


Mayo Clinic describes mindfulness as a type of meditation in which you focus on being intensely aware of what you are sensing and feeling in the moment, without interpretation or judgment. Practicing mindfulness involves breathing methods, guided imagery, and other practices to relax the body and mind and help reduce stress.

For some of us, these meditation exercises, "close your eyes, focus on your breath..." are difficult, frustrating, and stress inducing. Particularly for people with a trauma history or ADHD, mindfulness can be a land mine.

For others, the whole enterprise sounds like woo-woo mental health. Add some essential oils and affirmations - who needs therapy or, God forbid, medication?

But there's more to mindfulness than nonsense.

The same Mayo Clinic article identifies several mindfulness practices. Three could be taken as basic concepts:

  • Pay attention
  • Live in the moment
  • Accept yourself

How does that work out irl - in real life?

Let me tell you about my recent five week stay in Costa Rica. First, the back story:


Prozac Monologues

My first book, Prozac Monologues, began with a hypomanic episode during an earlier trip to Costa Rica. I wrote a series of comedic monologues in an effort to not be mindful. The monologues danced around the memory of a recent Prozac-induced traumatic experience. It began with a bizarre thought, and moved on to some other weird stuff: dissociation, thought broadcasting, paranoia, and the like. 

Years later, once I was correctly diagnosed with bipolar disorder, I added edgy essays about that experience and everything I learned about bipolar disorder while trying to figure out what the hell happened to my brain. Like many memoirs, Prozac Monologues is a hybrid of my story and my issue. Sheila Hamilton's podcast, Beyond Well, captures it. Here's the linkIt's also a great read and now available on audio.

Bar Tales of Costa Rica

So what about Bar Tales of Costa Rica? My second book is exactly what the title promises: the stories I heard while sitting in bars in Costa Rica. That sounds like a very different book. Am I a genre hopper?

Yes and no.

via GIPHY


Bar Tales is about a milieu, a place and the people in it. It is not about mental illness. There are passing references to my own. But that's not the point. No references to research. No descriptions of recovery strategies. Stories heard in bars - it's a very different book.

Still, it is a sequel. It picks up where the monologues left off. In the first book, my wife Helen and I thought about moving to Costa Rica. Several months later, we did buy a little house in Playas del Coco. Didn't quite move there, but we spend several weeks there every year.


That's where I continued to work on Prozac Monologues. It's also where I gathered my bar tales, most of them at my sister's hotel and restaurant, the Pato Loco, which means "crazy duck." Other sites included El Bohío (referenced in the first book), Pacifico Beach Club, Coco Palms, and Soda Navidad.

You could call the second book a segue to the first. I turn a corner. That would be a right turn that leads me out of my neighborhood Los Canales, on to the Boulevard de Iguanas, and over to a whole new cast of characters: Patricia, Bruce, Andy, Sydney, Monique and André. Bar Tales is about their stories.



So why is this book good for my mental health?

As I am polishing these tales for publication in the spring of 2024, I spent several weeks in Coco for research. Research.

I wasn't sitting in bars, gathering tales - though inevitably a couple got added to the collection. This time I was gathering sensations. Physical sensations.

Trauma and Sensations

Sensations - these are at the heart of my mindfulness technique.

  • The person who has experienced trauma sometimes gets stuck in the past, reliving a loop of troublesome sensations. And let me tell you - being suicidal, as I was, is traumatic.
  • Or, in the face of current strife and stress, that person might dissociate - disconnect from present anxiety by going numb.
  • Or, based on deeply rooted thought patterns about bad things that happened in the past, the person faces the future with dread, anticipating - and pre-experiencing - a repeat of negative experiences.

Each of these are ways that we lose or escape the here and now. I think of here and now as my worst subject.

The thing is - here and now is where joy lives.

Let me repeat that.

Here and now is where joy lives.

So my research, gathering sensations, experiences in the present, kept me anchored in here and now.

And it filled me with joy.

What color are the rooster's feathers? - bronze head and breast, black legs, wings of teal and red.

What sound do the geckos make? - chk, chk, chk. How about the howler monkey? muffler dragging on concrete!

What do mangoes smell like when they are sitting in the field near my house in the hot sun? - like a fortified sweet wine.

What does carne en salsa taste like? Beef stewed in a rich vegetable sauce with hints of smoke when Juan cooks it all day in an iron pot over a wood fire under the mango tree.

What does it feel like to walk in the surf? Caressing waves, then grit in my sandals.

I walked around town with my phone in my hand, making voice memos, describing these sights, sounds, smells, tastes, and sensations. My mind fixed on the present, there was no room there for regrets about the past or anxiety about the future.

Health Benefits of Mindfulness

Mindful meditation has been demonstrated to reduce anxiety, depression, stress, pain, insomnia, and high blood pressure.

There are many ways to do mindfulness. A review of literature published in Clinical Psychology Review, Effects of Mindfulness on Psychological Health, summarizes the context of mindfulness practice in its Eastern and Western versions and its application in a variety of psychological treatments.

What I offer here is one simplified self-help practice for addressing panic and anxiety, a disciplined version of what I called my research:

Focus on your environment.

  • Name five things that you see right now
  • Name four sounds that you hear
  • Name three things that you feel
  • Name two things that you smell
  • Name one thing that you taste
Yeah, don't get hung up on remembering whether it's three feelings or three smells. I don't remember the order of the sensations and made it up.

The point is to redirect the catastrophizing brain, to pull it into the here and now. Remember - here and now is where joy lives.

This practice isn't the cure all to my mental health issues. And I doubt it will cure yours. But it gives our poor brains, exhausted by the three alarm fires that usually occupy them, a break. It turns down the temperature and lets a different input in.

And that's a good thing.

There's That Squirrel Again! How Do I Know if I Have ADHD?

There is a reason why I haven't posted in months. My latest diagnosis -- ADHD -- Attention Deficit Hyperactivity Syndrome -- the adult version.

I have a fistful of posts in my draft file that were never finished before they seemed beside the point. That is not an unusual state for me. Many years ago my brilliant brain was unable to write the doctoral thesis for which I had already conducted extensive field research and had a thorough outline. Periodically I would write whole chapters in my head. But when the laptop was in front of me...

via GIPHY

I was stuck.

We'll see how this post goes.

Diagnosis

Wait a minute. Don't I have bipolar disorder? Where did this new diagnosis come from? What are the chances a person could have both?

Beyond the DSM: Three Ways to Manage Other Issues of Bipolar Disorder

Medication is approved for a mental illness if it reduces symptoms, the symptoms listed in the Diagnostic and Statistical Manual (DSM).

Did you know that there is more to bipolar disorder than: 

an episode of depression 

elevated or irritated mood, inflated self-esteem, decreased need for sleep, pressure to keep talking, flight of ideas, distractibility, increase in goal-directed activity, psychomotor agitation, and excessive involvement in pleasurable or risky activities?

These are merely the outward and visible signs of what is happening inside the brain. These are how the doctor can tell that you have bipolar disorder.

But even after you suppress these symptoms, you still have a variety of neurological dysfunctions that affect your thinking, your energy metabolism, and your health.

Psych meds do not address all these other issues. They are a piece of treatment, an important piece. But suppressing symptoms, while it relieves the anxieties of those around you, does not fix your life.

Prejudice, Not Stigma: How People with Mental Illness Get Crap Health Care

Eight years ago I published an article titled Doctors' Prejudice Against Mental Illness. It lays out the reasons why it is so damn hard for doctors to learn. Here is a paragraph from that original rant:

Similarly, people with other mental illnesses as well often do not receive routine standard of care for a whole host of conditions, including screens for infections, dental care, metabolic syndrome, even blood pressure checks, even while receiving medications that put them at risk for all of these health complications. As a consequence, the death rate gap between people with mental illness and the rest of the population is growing.

The link in the second paragraph is to a World Psychology article, a review of the literature documenting the crap health care that people with serious mental illness receive, with the consequence that we die an average of ten years sooner than people without mental illness.

The difference in lifespan is only slightly due to suicide. For the most part we die of the same things everybody else dies of, heart disease, cancer, that sort of thing. We just die sooner because our heart disease and cancers are not detected as early, nor treated as aggressively, as everybody else's.

Surviving Heat Waves with Bipolar Disorder

Did you know that more people are murdered at 92 degrees Fahrenheit than any other temperature? I read an article once. Lower temperatures, people are easy-going, over 92 and it's too hot to move, but just 92, people get irritable.

That's what the sheriff said in an opening scene of It Came from Outer Space. Set in Arizona -- even in black and white, you could feel the heat rolling off the sand. And throughout the movie, they attributed people's reports of strange sightings to heat-induced lunacy.

As I read that quote from 1953, I think -- 92, if only!

Everybody is irritable right now in -- how shall we put this? -- the coolest summer we will experience for the rest of our lives. Everybody is exhausted. But some of us more than others.

via GIPHY

One Exciting Thing and One Ironic Thing About Prozac Monologues and Psychology Today

Last week Psychology Today posted Bipolar Disorder: How to Get Correctly Diagnosed, my interview with Monica Starkman, M.D. about Prozac Monologues: A Voice from the Edge. Its tag says, The average of seven years to receive accurate diagnosis is unacceptably high.

Damn straight it is! The article is about how to improve that rate, or at least to improve the odds for the people who follow its suggestions.

This popular journal chose to place the article in its Essential Reads section on its bipolar resource page. The article's key points include:

  • Bipolar disorder, particularly Type II, is often misdiagnosed.
  • People tend to spend much more time in a depressive state and often do not recognize mild or hypomanic symptoms.
  • The chance of getting properly diagnosed is increased by using online screening tools and bringing family/friends to doctor visits.

I spent a mere (!) five years misdiagnosed with major depression, two of them taking the antidepressants that threw me into mixed episodes and made me suicidal. A random conversation on an airplane led me to the Mood Disorder Questionnaire referenced in the Psychology Today article. Taking the MDQ was the first step to discovering my bipolar and, more importantly, getting on the road to recovery.

So the exciting thing is that this information will be accessible to a larger audience than those of us who go poking around medical journals. That is my mission. Contact me on my website if I can speak to your book club, church group, or fraternal organization about mental illness and recovery.

The ironic thing? -- The photo the magazine chose to accompany the article.

Does Music Therapy Help People with Bipolar Disorder? Maybe Not

Non-pharmaceutical approaches to mental illnesses are great. I mean, who wouldn't like to pop a pill without the side effects?

I eagerly clicked on the link: Music therapy for bipolar disorder: Can it help? from the newsletter, Medical News Today, hoping to find the playlist that would soothe the savage beast. The article reported on two studies, both pretty small, N<30. I guess music therapy doesn't attract the big bucks in research land. Spoiler alert: I did not find the magic playlist.

The first study compared people with bipolar in a euthymic state (stable, not depressed, not manic) with healthy controls. They listened to music that typically produces wonder and joy. The healthy controls felt wonder and joy. The bipolar participants felt... tense. The researchers surmised that the negative emotions in bipolar participants has to do with difficulties in emotional regulation, part of the executive dysfunction.

The music disrupted an equilibrium, perhaps, which healthy controls found exhilarating, but bipolar people found simply disruptive? -- That's my conjecture.

What is God Doing on World Bipolar Day?

It was not that this man sinned, nor his parents, but that the works of God might be made manifest in him. John 9:3, Revised Standard Version.

Or as The Message puts it: You're asking the wrong question. You're looking for someone to blame. There is no cause and effect here. Look instead for what God can do.

There's the text for World Bipolar Day.


In the Gospel, Jesus heals a man born blind. Presumably what God can do is made manifest by that healing. So, okay, Jesus, what about me?

What about me? How many people, with how many disabilities, wonder what God is doing, especially those of us surrounded by others who wonder, Who sinned, this one or the parents?

Five Good Books I Recommend for World Bipolar Day



Knowledge is the key to taming this beast we call bipolar disorder. The more you know about what is happening inside that beautiful brain of yours, the better you can avoid letting it bite you in the butt.

Alas, many people with bipolar think their doctors will tell them what they need to know. Most of the psychiatrists I have seen gave me an abbreviated (and sometimes disingenuous) description for potential side effects of the pills they prescribed. And that's it.

How do I actually live with this beast? Take my meds. What will it mean for my life? Not so much as a pamphlet.

Psychoeducation for bipolar disorder has been shown to reduce recurrence of depressive, manic, and mixed episodes, all three, and to reduce hospitalization, as well. It includes information about the biological roots of the disorder, the rationale for medication, other treatment options, early warning signs of episodes, and common triggers. It aims to improve adherence to treatment plans. It usually is offered in a group setting.

It isn't offered often.

Are You Asking Your Meds to do All the Work?

Where is my magic pill? They say it takes a while to find the right medication, you just have to stick with it.

But for how long? How many chemistry experiments? When? WHEN will my bipolar get fixed?

This was me, resisting therapy, resisting exercise, resisting every other suggestion my doctor made. Alas, here are the pills that finally did the trick:

Pills are not enough.

What Happened to My Bipolar Brain and How Do I Fix It?

The most troublesome statement in Goodwin and Jamison's Manic Depressive Illness may be this: "Complete symptomatic remission does not ensure functional recovery." This is no small problem. For some 30% to 60% of patients with bipolar disorder, simply treating their mood symptoms is not enough to help them return to a full life.

There’s a third pole that needs to be addressed for that to happen: cognitive symptoms. These often persist even when patients are euthymic, and they range from problems with memory and attention to more subtle deficits such as picking up on social cues and making wise decisions. 

Chris Aiken's article, Eight Ways to Improve Cognition in Bipolar Disorder, opens with these paragraphs. Ironically, what Aiken calls troublesome, I find immensely reassuring. My experiences are real!

Bipolar Screening - People with Bipolar Know It When We See It

Psychiatrists and people with bipolar both have told me that my book captures what the manic experience is like.

Reviewers tend to say either, She must have written it when she was manic. Too bad her editor didn't fix it. One star. Or: She must have written it when she was manic. So glad her editor didn't fix it. Five stars.

Which gets me thinking: Doctors say bipolar is really hard to diagnose. But if people who have it know it when we see it, what if we wrote a screening tool? Bear with me here. I'm thinking something like this:

They say: A distinct period of abnormally and persistently elevated, expansive, or irritable mood.

What we hear is: Are you abnormal?

To which we answer: No. I mean, duh.


So what if they said: Has there ever been a time when everybody around you just didn't understand why the world was so great or why you felt so good? Or has there ever been a time when everybody around you was massively irritating?

Understanding Bipolar Disorder - A Review

On the one hand, bipolar disorder can sweep like a tornado through a family, disrupting every aspect of daily living and relationships.

On the other hand, family members can be one of the most significant resources for a person's recovery and stability.

In my own case, my wife is the one who described the symptoms that helped my psychiatrist recognize that I have bipolar, not major depression. But once that happened, what did she, as a family member, as the member of the team with day to day, hour to hour access, receive by way of help and guidance?

Nothing. Not a word. Butkus. Like, not even a pamphlet.

Nope, nothing. She worried. She worked from home to protect me at my sickest. She shouldered every responsibility. She thought through and recommitted to and excelled at "for better for worse, for richer for poorer.

Eventually she got to Family to Family, NAMI's program for education and support of people whose family members have a mental illness. And that helped. It gave her a skill set. It let her know she was not alone. It was more than a brochure.

What she needed was Aimee Daramus's new book Understanding Bipolar Disorder: The Essential Family Guide. Daramus, a clinical psychologist with over twenty years of experience in mental health, from psych units to private practice, has written the definitive guide for family members of people with bipolar. She takes you by the hand and leads you from a chaotic landscape to a steady path.

Diagnosing Bipolar - Doing Better to Prevent Suicide

How can I be a better psychiatrist for you?

Frankly, I was gobsmacked by that question. It came in response to reading my book, Prozac Monologues: A View from the Edge. The book is a comedic memoir of misdiagnosis and a self-help book for bipolar. It is both uproariously funny and brutally frank about my suicidal episodes, usually at the same time.

There are two directions to go with that question. This particular psychiatrist cares about both.

What kind of behaviors and qualities could he display that would make the relationship more helpful? Honestly, not all psychiatrists are interested in this question. I don't do relationships; I use psychopharmacology to treat psychiatric disorders, a psychiatrist once told me. Well, that had the benefit of clarifying things.

How can I improve my diagnostic skills? Nevertheless just about any psychiatrist wants to get the answer to the puzzle right, even the ones who treat patients as no more than a puzzle.

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