Healthy Ways to Manage Bipolar Swings

I have been getting more and more off over the last week, feeling tired, disconnected, angry, and depressed. There have been triggers, but also something (we are not sure what) that is making the triggers worse than usual. So the theme of this week has been: What can we do to interrupt the downward spiral, or at least lessen the magnitude of it?

Cleveland Metroparks. Copyright Jeff Norris.

Last weekend on a particularly depressed day, my husband and son took me for a walk in the Metroparks. I was really resistant to it and it took a good half hour before I started to feel some joy again. They made sure we walked, but also had time to just sit in nature and hear the water rushing down the river.
 
We also made sure that I exercised at CrossFit three times last week. On Friday I was so angry when I woke up, and normally I would not go out in public, but Jeff got me to go to CrossFit anyway. I did feel better after the workout and it allowed me to manage later triggers in the day better because my anger did not skyrocket thanks to the exercise. Now today I woke up even more angry and also feeling physically sick due to all the junk food I ate yesterday. I finally got to CrossFit, assuming the same thing would happen as last Friday, but even just into the warmup, I could tell all my muscles were like lead and everything was just so hard to do. I got part way through the workout and stopped. I was pretty upset about that, but Jeff reminded me that even part of a CrossFit workout is normally a full work out for most people, and that I actually got there on a day when I usually would have stayed in bed. So, it is progress even if it is not as much as I had wanted it to be.

Right after CrossFit though, I felt pretty bad about ending my workout and was just an angry mess when we got home. So, Jeff talked to me, and got me to let him do the meridian work on my feet. He said the angry energy was literally burning his arms during the energy work. It did calm me down though, after I was done trying to resist it working. Then Jeff got me some food and tea and had also emailed my therapist. So, by the time my therapist called, I was doing much better and we could look at the situation and find out why it might have happened and I am looking forward to my appointment tomorrow.

Today I will still be lounging around a lot. I will make sure I don't go anywhere on my own because I don't want to end up getting fast food and making myself even sicker. I will have Jeff hide all the car keys tonight so I do not try and go to Dunkin Donuts in the middle of the night.

To some people these tactics might sound extreme or weird, but there are so many illnesses where you have to manage the symptoms, where you have to intervene to lessen the effects. What I don't think we talk about enough in mental health is that there are many non-pharmacological things you can do to stop or lessen a downward spiral. We also need to realize that we need understanding and compassionate people to help us because sometimes we can not do it on our own. If Jeff had not sat holding my feet even when I was arguing with him, I would not have been able to calm down. It took about five minutes of me trying to say this was not going to work until it did work. Even my workout this morning, I waited it out to see if it would help. And it did, because it kept me committed to my healthy lifestyle, got me out of the house, got me some exercise, and made it easier for me to calm down later in the day. Now, if I can just get in some family time, and meditation or art practice today, I think things will go even better.

Depending on the severity of your illness, managing it can be a full time job at times. It is not fun. It is tiring for everyone involved. You wish you could be like everyone else, but we rarely realize that everyone else has their issues too, we just don't know about them.

One of the things that has really been helping us add in simple things to help me is Mariel Hemingway and Bobby Williams' book Running with Nature (formerly The WillingWay). I will write a review on it soon, but basically it has many suggestions of how to calm your mind and feed your spirit, such as taking the time to sit and listen to nature, or meditation techniques. The book has made us much more mindful of the options we have for helping all of us be happier and healthier. 

So, just try anything healthy in order to help yourself manage the hard times. Even if you don't want to do it. Tell yourself you will try it for just five minutes and see what happens.

Blessings,

Rev. Katie

The Messy Reality of Mania

I have decided to write a more vulnerable post than I usually do because I want people who do not understand mental illness to understand bipolar better and I want to let other people like me know they are not alone. Too often bipolar is portrayed as an illness of non-functional people and no one really knows what the illness is like for those of us who live and work with rest of world every day. Also, when those of us who write about having the illness are never honest about the darker sides of it, especially when we are in the midst of living it, we make other people with bipolar feel like what they are experiencing is abnormal. I hope this post helps raise awareness that in the midst of struggles like this, we still work to be contributing members of society. I also hope that others with mental illness feel held in a community of people who understand what they are going through.

Recently I have been noticing what I have to do to clean up after a night of mania, all the things required to be able to "present well." (Presenting well is what they say when those of us with mental illness are able to look ok on the outside and function just enough to get by.) This post-mania clean up and presenting well is one of the hardest parts of the illness and I wanted to share with you why with the story of a average day after mania.

After finally falling asleep at 7am, I wake up two hours later in a panic that I might have missed my alarm and I am late for a meeting. (I did not miss the alarm and now I am awake hours before I needed to be.) I think of the many tasks I still need to finish so my work does not fall behind, so I frantically lay in bed with my computer and get a few things done through the haze of sleep deprivation. I hope that everything I write sounds coherent. I have extreme stomach pain from everything I ate and drank last night in a binge eating episode.

I get out of bed and find that coming down from a mania and being extremely tired has made me quite dizzy, and I trip over my own feet and run into the side of the bathroom door. I barely brush my teeth and I shower, but don't wash my hair because that is too much work. I get dressed and try to pull up my pants without aggravating the now angry, red, and swollen cuts I made on my thighs and stomach. I know every step I take for the next few days will hurt. I make sure my son does not come into my room before I am fully dressed so he does not see the damage to my body. When I buckle my belt I realize my stomach is in fact two belt notches larger than it was yesterday thanks to everything I ate.

For me, this photo is a bit embarrassing, but real.

After I am dressed, my husband tries to get me to eat something for breakfast but I am full from various fast food items, the wrappers of which I now have to clean up. It is humbling and shocking to have to gather up the remains off all the things I ate since I don't really remember eating some of it. My husband has already cleaned up the shards from the dishes I broke in anger the night before. There is a lot of regret and questioning "What the heck did I do?" and "Was that even me?"

In order to not look like death warmed over, I sit in front of my extensive makeup collection doing everything I can to attempt to cover the huge red welts I have nervously scratched into my face. I put concealer under my eyes and curl my lashes to make me look less tired. A bit of light shimmer eyeshadow in the inner corner of the eye helps brighten the eyes as well.

At some point the night before or that morning I had sent my therapist an email saying I was not doing well, and he calls to help me look at what happened and see what triggered it. His call helps me realize the mania was not random, but a reaction to an event. This understanding stops me from falling into self-loathing, shame, and plunging into depression. Thank goodness for good therapists!

I try and interact with my son and husband, trying not to let the stomach pain and drowsiness make me too snappy. I fake a smile and hope my son has no idea how bad I am doing. I drag myself to meetings, with the pain of my stomach making me double over just a bit, and my brain being completely filled with what seems to be cotton. I can't really follow exactly what is going on so I smile appropriately and ask relevant questions, all the while knowing that while my body is in the chair, my mind is trapped somewhere else. I can see myself looking fairly presentable and not noticeably off to people who do not really know me, and yet I feel a million miles away trapped in a post-mania fog. I track the conversation while having a totally other conversation in my brain of how terrible I am and the agony that is life, which I have to live day after day.

I do all the things I have to do to "present well" and not cause too much alarm, and I go home. I get in bed and sleep, until my husband makes dinner and he and my son try and wake me up so we can eat together and we try to make tomorrow a better day.

Blessings,

Rev. Katie

FALSE: Bipolars Do Not Make Good Leaders

I recently read a blog post on PsychCentral by Dr. Yanni Malliaris called Bipolar Disorder: A First Rate Madness? His post is in response to a webinar he attended by Dr. Nassir Ghaemi who has researched the positive sides of bipolar disorder in his book A First-Rate Madness: Uncovering the Link Between Leadership and Mental Illness. In short, Dr. Ghaemi says people with bipolar disorder can make great leaders, especially in times of crisis. He also says depression can make you more realistic and mania makes you more creative. He adds that bipolars tend to have more empathy and are more intuitive than average.

Having not finished his book yet, I can't comment on his whole argument, but it does not seem new to me considering all the work Dr. Kay Redfield Jamison has done (a bipolar herself who has researched much about bipolars in leadership and creativity.) It also does not surprise me given how my bipolar disorder has helped me in my leadership abilities, especially in crisis.

In his blog post, Dr. Malliaris disagrees with Dr. Ghaemi's assertion that people with bipolar make good leaders. In fact he lists three reasons why he believes we are not. Dr. Malliaris says: "People with bipolar disorder cannot be great leaders at times of crisis." He says we actually do worse in crisis and don't handle it well because it can trigger cycling. He also says that when we have the more mild symptoms of depression and mania, that we are not more intuitive and creative, as Dr. Ghaemi suggests. Dr. Malliaris suggests instead of accessing the positive aspects of those times, we should be trying to get rid of the mild symptoms because they can lead to relapse. He also says that being goal-oriented is bad for people with bipolar disorder and that healthy bipolars need to work on being "lesser super-heroes."

I disagree with Dr. Malliaris but of course he is entitled to his opinion and what he sees from how he has helped his own patients. What I was very unhappy with in the blog post though was his condescending tone. He sounds overly critical and his argument is pretty soul-crushing to say that even trying to tap into anything good about our illness will only make us worse. I am sure he has helped many people, but to me is sounds like he still really does not know or understand people with bipolar disorder.

My bipolar disorder does make me a great leader during crisis. Sure it may drain me and I may need to adjust other parts of life to make sure I recharge and do not burn out, but that is part of managing the illness. I don't need to avoid crisis and leadership to manage my illness, actually working as a minister where you do deal with crisis, especially as a hospice chaplain, is extremely rewarding and energy giving to me. It allows me to see the positive aspects of my illness. In fact, the worse my illness is, the better it is for me to work. Work brings me joy and purpose in life and it's actually when I don't have enough work in my life that I get worse.

In my professional life, people have been very kind about the times when I need a bit more support when my illness is bad, which Dr. Malliaris seems to think is a negative thing (point 1 in his post.) However, I don't see it that way. Everyone, mentally ill or not, needs more support at certain times in their life. Community is about learning how to help each other so we can all bring our gifts into the world. 

Also, I am very creative, which is essential in my preaching, leadership, and work with people with dementia and mental illness. I know my creativity is part of the mania of bipolar disorder, but you can figure out how to use your creativity to do something good. And lastly, I don't know how I could ever be a minister if I was not intuitive and didn't have empathy for others.

He does give a quick note that there have been good leaders who also have bipolar, and does mention that we have to work twice as hard to be great leaders and manage the illness at the same time, but his post really seems to discourage people with bipolar from even trying to have leadership positions. That seems extremely sad to me.  

As I have written many times before, you do need to balance things and be aware of your triggers in order to manage your illness. But for Dr. Malliaris to say we really can't be good leaders is unrealistic to me. Managing bipolar disorder is figuring out your balance and learning to tap into what is great about yourself so you can have a happy, caring, and productive life. The idea that we have to get rid of all signs of our illness in order to be well seems wrong to me. I think it just promotes the idea that people with mental illness are scary, bad, and irresponsible. In my opinion, his post just increases the stigma against people with mental illness.

What do you think about Dr. Malliaris' assertion that "people with bipolar disorder can not be leaders in times of crisis?"

Blessings,

Rev. Katie

Rosie: Getting a Psychiatric Service Dog

A while ago we came across information about Psychiatric Service Dogs (PSD's). You are probably most used to service dogs such as Seeing Eye Dogs, but over the years they have found that dogs can be trained to assist with all kinds of disabilities.

Psychiatric Service Dogs assist people with whatever disability comes with their particular mental illness. For instance, people with schizophrenia who hear voices can train their dog to check rooms for them or alert them if someone else is around them. If the dog does not see or hear something, then the person (the dog's handler), knows that what they heard or saw was not real. PSD's can ground someone who has Post Traumatic Stress Disorder when they have a dissassociative flashback or can awaken them during night terrors. PSD's can stop people who self mutilate by pawing at them until they stop the behavior. Often psychiatric medications make you forgetful and if you don't take your medication you can have severe side effects so your dog can be trained to bring you your medication. Your dog can be trained to awaken you when you can't awaken due to medication side effects or deep depression. A PSD can ground you and provide tasks that decrease anxiety enough so that a person can have a job and function every day. PSD's can even alert you to a panic attack or manic episode before they happen. These are just a few of the things Psychiatric Service Dogs can do but basically, they help you live your life with your disability.

Once we found out what PSD's could do we decided that getting one would be a good option for me, especially since I have such a hard time with medications.

Getting and training a PSD is not all that easy. Typically with many other types of service dogs, you can get a dog who has already been trained from an organization. There are places that train service dogs such as Seeing Eye Dogs, Autism Service Dogs, and there are even organizations that provide Veterans with Post Traumatic Stress Disorder (PTSD) with PSD's but other than that, most Psychiatric Service Dogs are trained by their handler with the assistance of a dog trainer and someone who specializes in training dogs to do PSD tasks.

From my experience and with the resources we have, here are the basic steps to getting started with a PSD:

1. Talk to you Psychiatrist and/or Psychologist. As with all types of service dogs, you must have a disability in order for you to have a service dog. If you have a disability, your doctor will wright a letter stating that you have a disability and are in need of a service dog. You will keep this in your files, but you do not need to carry your doctors order with you as it is illegal to ask for proof that you need a service dog.
2. Find a basic dog trainer who uses positive reinforcement training, most often Clicker Training. Do NOT use a trainer who uses yelling, shock collars, or other forms of negative reinforcement. This trainer will help train the basics, socialization, and the Canine Good Citizen Class. 
3. Find someone in your area who does PSD task training or find online resources for PSD task training that your regular trainer can help you with. Make sure your trainer knows how to train a dog for all the basic service dog requirements like potty on command, tucking their tail while inside, how to sit under a chair or table, etc...
4. Find a dog.  There are many ways you can find a dog appropriate for a PSD but the best thing to do is have a dog temperament tested by a vet behaviorist. I would suggest finding a rescue dog that has gone through a basic training program and has passed Canine Good Citizen so you know they are trainable and they will be a bit older, past the puppy phase, which is really hard to handle. Just because the dog took well to basic training though does not mean the dog will be a good service dog so you need your trainer to check the dog out. For instance, we have a dog already who was trained in a prison program. She is a fantastic dog who learns really quickly but I could not use her as a service dog not only because she is too old already, but because she was abused and is very anxious. Her anxiety makes her very scared in certain public situations, causes her a lot of stress in the car, and when I am manic, she hides from me, so she would not be able to help me when I needed her.
5. Start training, realizing it will probably take two years and if it does not work you have made a commitment to still keep your dog as a member of your family. 
6. Love your dog and create a great relationship with him or her.

Rosie, Psychiatric Service Dog in Training

Blessings,

Rev. Katie

Depression: When It All Falls Apart

There are no words adequate to describe depression. Unless you have gone through it, you never know what it is like. And there are different kinds for different reasons. Many of us will go through situational depressions in our life that may even last a few years from an illness or grief from loss of a loved one. The depression I am talking about is the one that is a mental illness which just lasts and lasts your whole life. Where you go out in public and you look at other people and wonder how they look so normal. How do they get through their day? Why are they smiling? Is life so excruciatingly painful and hard for them as it is for you? Do they live every moment of every day doing only what they have to do to keep their jobs and not look like a freak? Do they count down the seconds and hours until they can go back to bed and stay there until their next required task comes around? Do they wish they enjoyed time with family and friends? Do they have no motivation to wake up in the morning because they know every day will be agonizing and joyless? Soulless almost?

It is sad to have depression because you wish you enjoyed all the things you love, like family, friends, and work. But when you are depressed you want to spend no time with anyone, doing anything. It can also make you mad that you are required to fake a smile and pretend to be happy just so you don't make other people uncomfortable.

Photo by Jeff Norris

It's also annoying because you do the right things and are still sick. I took the medication, which seemed to be working but the side effects were so bad I had to dramatically decrease the dose and see if I can build up more slowly. Any time you change a dose of medication, it can make your symptoms much worse and so my depression now is extremely bad. Also, my Mom has gotten worse and is now in hospice care so I am sure that is adding to my poor mental state. The problem is that normal sad or scary life events are different for people with mental illness. These events may or may not set off your illness and make it much worse. It is not like you can avoid those situations, but you may have to realize you will have months or years of fallout after stressful life events. Even good events like job change or marriage. And right now I have changed medications, changed jobs, and Mom is dying so I should expect that I will get worse, it's just that every time it happens, you have never quite prepared for it.

You are never prepared for how your illness with rear it's ugly head. For me it's how the depression, mania, anxiety, and eating disorder combine to create depths of despair and hell I didn't think were possible.

So, now when all of those things happen in your life, what do you do about it? You have mental illness and can't just "change your mind," "shake it off," "act happy," or "be different." But that does not mean you are lost. Here are a few tips and I know they are not easy to do, but once you do one, it gets easier and easier to do more:

1.  Remember that it is not always like this. It is not always this bad, there are good moments.
2. Ask for help when you need it and will accept it.
3. If you have not exercised, slept, or eaten correctly in weeks, do one of those things right one day, then two the next. Make one good decision every day that makes you feel better, no matter how small it seems.
4. Tell your illness and whatever other factors contribute to it that they won't win. (I would probably use some more colorful language around that to really be firm about that point.)
5. Write about what is going on, that usually diffuses the situation and helps you see things more clearly.
6. Know that you are loved by God or the Universe, whatever you see as greater than yourself. Get in touch with that Spirit of Love through church, prayer, nature, art, animals, meditation, the beauty of science- anything that gives you the "awe factor" and lets you know you are not alone.

Remember that managing mental illness is a process where you will get better and worse. You just can't give up, and that is the hardest part. You are too precious and too important to this world to give up on and you always need to remember that no matter what your illness makes you think or what other people tell you.

Blessings,

Rev. Katie

Why Do You Choose to Do That?

It must be eternally frustrating for people without mental illness to see those of us with it doing things that are bad for us. Even though we know all the reasons we shouldn't. Even though our loved one told us we shouldn't. Even though to them it seems like our life is perfect, or at least happy enough that we should not have a problem.

The only thing I can tell you is, that's how you know it's an illness.

When we do things that are detrimental, from eating bad food, to spending our savings, even to suicide, we do them because we really think we need to. We think it is the only way to end the extreme pain and suffering we feel.

I have no idea how to describe this to someone without mental illness. I know that being able to understand this would help end one of the biggest stigmas against this illness, which is people assume we choose to be this way and we are just being irresponsible.

Photo by tommychheng, Flickr Creative Commons

My husband still asks me "Why do you choose to do that?," especially when I eat poorly. As if I sat down and thought, "Yes, I know eating this doughnut will send me into a mania risking my health and the happiness of my family. I don't care about myself or anyone else. I would like bad things to happen so I'll eat the doughnut." That's not the way it happens. It's more like this: "I know eating this doughnut will make me worse and cause issues for my family but I am in so much pain that if I have to spend one more second like this I'll die. I am not that important to my family anyway." That doughnut will increase my serotonin and make me feel good, for an hour, before I get worse again.  But when you have a mental illness you often live your life second by second, hour by hour just trying to stay alive and ridiculous things seem rational at the time. Or like how in the middle of the night when my mania is mixed with my depression I truly, 100% believe my husband doesn't love me and we should separate. Seriously? In reality he loves me 110% and we are like Adelie penguins, together for life.

Photo by linpadgham, Flickr Creative Commons

That is just my experience of how my mind can be irrational. For other people with other illnesses, it will present different for them. For instance with manic spending the person may actually think they are invincible and running out of money is not realistically possible.

Expecting someone with a mental illness never to do detrimental things or irresponsible things is like asking someone with an amputated leg to walk. However, you could get the person an artificial leg which could help manage the issue they have and that is what I hope my blog helps people do, manage their illness. While it is essential that we understand mental illness, that does not mean the bad behavior is ok. Particularly if the person is emotionally or physically abusive. Understanding it means we can then discover appropriate ways to deal with it, not that you don't hold the person accountable for their actions.

Overall, I hope that much of my blog talks about ways in which to manage mental illness (please read some of my other posts for more on that), but I really want people to understand the fundamentals of it first. If we don't understand the true nature of the illness we will try the wrong management techniques and not be able to help our loved ones.

Blessings,

Rev. Katie