By Tim Kuss, LADC, LMFT
It should come as no big surprise to those of us in recovery from chemical dependency that consistent, predictable contact with other people is a stabilizing force. For years as a counselor, I have been advising clients to find a “home” AA or NA group to attend on the same night at the same time every week and to meet with a sponsor for at least an hour a week outside of meetings. We have also recognized that support from spouses, parents, siblings and friends can be an important part of recovery. I have also advocated for finding “mentors”, respected “elders” like ministers, teachers, etc, not necessarily in recovery, to connect with regularly.
So when Ellen Frank suggested that social rhythm is important in managing bipolar disorder it seemed to make sense. As part of Interpersonal Social and Rhythm Therapy she suggests that we keep track of our contact with others, as well as other daily events. Her 5 item social metric asks people with bipolar disorder to track their time out of bed, first contact with another person, the start of work, school, or other activity, dinner time and bed time.
I have long recognized that structured, “meaningful” activity aids with stability, chemical or psychological. I have seen many clients start patterns of heavy drinking after retirement, while other elderly people seem to create a new structure in their lives that gives them things “to do”. Unfortunately, some clients with chemical and mental health problems are unable to work, or are, at least, temporarily out of work. I advise them to find volunteer work and to create a “busy” schedule at least 5 days a week, which can include social activities, like cards at the senior center, church activities, projects at home, visits to museums, libraries, etc. Most communities have community education programs that offer inexpensive classes. One of the main assets of a schedule could be spending time with and around other people.
Contact with others provides “grounding” and “reality testing”. It’s harder for our thinking to get off track if we are communicating with others. Also, we are more likely to experience a sense of well-being if we are in positive, supportive relationships. It is important for families to learn positive communication and conflict resolution skills. Sometimes family therapy is necessary for this. It is also possible for one person to learn better skills and to teach by example.
I think that individuals within a couple or family may each need their own support network to some degree. It is OK for men to go to a men’s group and to spend time with buddies and for women to have their own groups and friends It is also a good idea for the couple or family to have support as a unit. Churches, temples and synagogues used to provide predictable support for families. Unfortunately, we have increasingly busy lives and often do not think of the concepts of “self-care” and “nurturing”. Predictability and regularity count a lot in terms of mood stability.
So, the concept here is “Social rhythm”. The thing to think about is our amount, types and quality of human contact. If you experience episodes of mania or depression, whether mild or severe, it may be a good idea to look at your social rhythm and how it could be adjusted.
The first step in changing social rhythm is to notice our “routine” of social contact. When one is depressed it is generally a good idea to increase our contact with others. When one is manic it is a good idea to look at the quality of our connections with others and to be on the lookout for making too much of new relationships based on too little. The type of connection we need is consistent, predictable and nurturing.
Tuesday, November 2, 2010
Managing Anxiety
By Tim Kuss, LADC, LMFT
This assignment is for anyone who experiences anxiety, which includes worry and fear. You may or may not have a diagnosis of anxiety disorder.
1. Describe how you experience anxiety, fear or worry.
a. If you have fear, what are you afraid of?
b. If you worry, what do you worry about?
c. Obsessive compulsive behavior can be a sign of anxiety. If you have this behavior, what is it about?
d. Are there physical symptoms? How do you breath when anxious? What happens to your heart rate? Your blood pressure?
2. Dysfunctional behavior?
a. Did you use chemicals to feel better? If so, what kind of chemicals? What effect did they have? How did you feel when the chemicals wore off?
b. What other things did you do to try to feel better? Sex, gambling, spending? How did those things work?
3. Did you know that some medications can relieve anxiety?
a. Anti-depressant meds, specifically SSRI’s can help. Are you willing to try that?
b. Benzodiazepines, such as Valium, Xanax and Klonopin are NOT good ideas for people with chemical dependency.
4. Individual therapy could be helpful
a. If you are willing to try this, please ask the therapist if they have experience with working with people with anxiety.
b. Some group therapies, such as cognitive or rational-emotive therapy can help.
5. Even if you take meds and go to therapy, it’s still a good idea to learn other COPING SKILLS for managing anxiety
a. Mindfulness skills include deep breathing and progressive muscle relaxation, including imagery and affirmations.
b. Yoga, acupuncture, or meditation may also be helpful
c. Cognitive restructuring is another positive method. This means noticing your negative self-talk, and learning to challenge and change it.
d. Distraction can help. This means doing activities like tv, reading, video games, housework, walking, work, etc,
e. Have a support network and connect with them on a regular basis
For example, find at least one person who you can share your worries or fears with and talk with them at least once a week. You can tell them that you don’t need advice and just need someone to listen. Or you can ask for suggestions some times.
6. Be involved in healthy activities that help you prevent anxiety
a. exercise for at least 15 minutes 3 to 4 times a week.
b. maintain a healthy diet. See your doctor if you need a plan for this
c. sleep 6 to 10 hours a day, depending on personal need
d. Have a daily schedule go to bed and get up about the same time every day
eat meals about the same time every day
e. Do fun stuff every day. Set aside time to do fun stuff for 1 to 3 hours at a time every week.
f. Connect with people who care about you regularly. Put it on your schedule.
7. Take a daily inventory of your anxiety, fear and worry
a. Make a plan to use coping skills to manage each one.
Questions:
What new things did you learn about anxiety, fear and worry?
What coping skills and/or strategies do you plan to use in the next week?
What skills or strategies do you plan to improve, or to develop through practice?
Read pp 12-15: Overcoming Major Anxiety Disorders and Addiction by Ihson M. Solloum, MD, MPH and Dennis Daley, MSW to get more ideas.
This assignment is for anyone who experiences anxiety, which includes worry and fear. You may or may not have a diagnosis of anxiety disorder.
1. Describe how you experience anxiety, fear or worry.
a. If you have fear, what are you afraid of?
b. If you worry, what do you worry about?
c. Obsessive compulsive behavior can be a sign of anxiety. If you have this behavior, what is it about?
d. Are there physical symptoms? How do you breath when anxious? What happens to your heart rate? Your blood pressure?
2. Dysfunctional behavior?
a. Did you use chemicals to feel better? If so, what kind of chemicals? What effect did they have? How did you feel when the chemicals wore off?
b. What other things did you do to try to feel better? Sex, gambling, spending? How did those things work?
3. Did you know that some medications can relieve anxiety?
a. Anti-depressant meds, specifically SSRI’s can help. Are you willing to try that?
b. Benzodiazepines, such as Valium, Xanax and Klonopin are NOT good ideas for people with chemical dependency.
4. Individual therapy could be helpful
a. If you are willing to try this, please ask the therapist if they have experience with working with people with anxiety.
b. Some group therapies, such as cognitive or rational-emotive therapy can help.
5. Even if you take meds and go to therapy, it’s still a good idea to learn other COPING SKILLS for managing anxiety
a. Mindfulness skills include deep breathing and progressive muscle relaxation, including imagery and affirmations.
b. Yoga, acupuncture, or meditation may also be helpful
c. Cognitive restructuring is another positive method. This means noticing your negative self-talk, and learning to challenge and change it.
d. Distraction can help. This means doing activities like tv, reading, video games, housework, walking, work, etc,
e. Have a support network and connect with them on a regular basis
For example, find at least one person who you can share your worries or fears with and talk with them at least once a week. You can tell them that you don’t need advice and just need someone to listen. Or you can ask for suggestions some times.
6. Be involved in healthy activities that help you prevent anxiety
a. exercise for at least 15 minutes 3 to 4 times a week.
b. maintain a healthy diet. See your doctor if you need a plan for this
c. sleep 6 to 10 hours a day, depending on personal need
d. Have a daily schedule go to bed and get up about the same time every day
eat meals about the same time every day
e. Do fun stuff every day. Set aside time to do fun stuff for 1 to 3 hours at a time every week.
f. Connect with people who care about you regularly. Put it on your schedule.
7. Take a daily inventory of your anxiety, fear and worry
a. Make a plan to use coping skills to manage each one.
Questions:
What new things did you learn about anxiety, fear and worry?
What coping skills and/or strategies do you plan to use in the next week?
What skills or strategies do you plan to improve, or to develop through practice?
Read pp 12-15: Overcoming Major Anxiety Disorders and Addiction by Ihson M. Solloum, MD, MPH and Dennis Daley, MSW to get more ideas.
Understanding Depression
By Tim Kuss, LADC, LMFT
I am suggesting a bio-psycho-social approach to understanding and coping with depression. The biological component comes in as we have noticed that mood disorders, such as depression, bipolar disorder and anxiety disorder tend to be found in successive generations of a family. As with alcoholism, what is inherited is a genetic predisposition to mood disorders. That means, if you have a parent, grandparent or other family member with a mood disorder, you are more likely than others to have one. It might not even be the SAME mood disorder. For example, someone’s grandmother may have had Major Depressive Disorder (depression) and that person may have bipolar disorder. We have learned that people with depression and bipolar disorder have a chemical imbalance. Medications can allow our bodies to work properly and maintain the right balance of neurotransmitters.
SSRI’s and other chemicals work as antidepressants, while lithium and certain anticonvulsants work as mood stabilizers to help manage bipolar disorder. Taking medications consistently can help us avoid episodes of depression.
The biological approach for managing depression intersects with the behavioral approach in that behaviors such as regular exercise, proper nutrition and sleep hygiene help us to avoid or cope with episodes of depression. Exposure to the sun or artificial sunlight also helps our body relieve depression.
The best psychological approach for managing depression is Cognitive Behavioral Therapy(CBT). In their book, Depression:Causes and Treatment, Aaron Beck and Brad Alford state that major depression is the leading cause of disability worldwide. They note that studies have shown changes in thyroid hormone levels in response to cognitive therapy, showing that our bodies and minds are linked. They say that depression results in a complex pattern of deviation in feelings, thoughts and behavior.
Symptoms of depression include low mood, pessimism, self-criticism, agitation, problems with memory and concentration, and physical complaints such as pain. There may be a loss of gratification with activities that starts with a few areas and expands. Activities that involve responsibility, obligation or effort become less satisfying and there is greater satisfaction in passive pursuits, including recreation, relaxation and rest..
People with depression begin to distort reality, They become preoccupied with continuous, repetitive negative thoughts(perseveration). There is often a contrast between a depressed person’s image of themselves and the objective facts. They dwell on mistakes, imperfections and inabilities, convinced that others will reject them, and that they will lose jobs, relationships, and friendships. They continue to think in themes of deprivation and defectiveness
Depression seems to be a reversal of human nature, of the survival instinct to eat and sleep and the desire to experience pleasure. Others need to respond with concern, empathy and acceptance and to be aware of the client’s difficulty in concentration and in formulating thoughts. People with depression are hypersensitive to rejection and discouragement.
The cognitive approach to managing depression involves recognizing the negative thoughts or negative self-talk that continues and increases depression. We can learn to challenge the negative thinking and replace it with neutral or positive thinking. For example, if I notice that I’m not functioning as well as normally at work, I can encourage myself to do the best I can. Instead of thinking that “I can’t do anything right” or “I’m doing so badly, that I might as well quit”, I can realize that this thinking doesn’t help the situation, and pay more attention to what I am doing well and think about what I can do today to improve the situation.
The behavioral approach involves doing things that help relieve depression. A depressed person is likely to withdraw from emotional attachments and tends to isolate from others. We can notice this and purposely spend time with others. If necessary, we can ask others to just let us be there without demanding conversation or interaction. Depression includes lethargy, but it is better to be active. Daily rituals such as walking the dog, biking, walking or swimming several times a week can be helpful.
Routine and structure can provide relief from nagging negative thoughts and feelings, so it is best to go to work or school, or to do volunteer work, or be involved in group activities, like crafts or sports. A person with depression needs to “push the envelope” in terms of involvement and activity, striving to get beyond his or her comfort zone. It’s best to start with a few small steps and keep expanding.
There is no reason why we shouldn’t pay attention to our biology, our thoughts and our behavior during the same time frame. There is no shame in taking medication for depression. We wouldn’t hesitate to take an antibiotic regardless of what people might think of us. We need to pay attention to seasonal changes including the amount of sunlight we are getting, healthy sleep habits, proper nutrition and exercising. We need to avoid isolation and too much unstructured time. We need to adjust our thinking to encourage ourselves to do all of these healthy things. Depression IS treatable. We are the prime agents in our own recovery!
I am suggesting a bio-psycho-social approach to understanding and coping with depression. The biological component comes in as we have noticed that mood disorders, such as depression, bipolar disorder and anxiety disorder tend to be found in successive generations of a family. As with alcoholism, what is inherited is a genetic predisposition to mood disorders. That means, if you have a parent, grandparent or other family member with a mood disorder, you are more likely than others to have one. It might not even be the SAME mood disorder. For example, someone’s grandmother may have had Major Depressive Disorder (depression) and that person may have bipolar disorder. We have learned that people with depression and bipolar disorder have a chemical imbalance. Medications can allow our bodies to work properly and maintain the right balance of neurotransmitters.
SSRI’s and other chemicals work as antidepressants, while lithium and certain anticonvulsants work as mood stabilizers to help manage bipolar disorder. Taking medications consistently can help us avoid episodes of depression.
The biological approach for managing depression intersects with the behavioral approach in that behaviors such as regular exercise, proper nutrition and sleep hygiene help us to avoid or cope with episodes of depression. Exposure to the sun or artificial sunlight also helps our body relieve depression.
The best psychological approach for managing depression is Cognitive Behavioral Therapy(CBT). In their book, Depression:Causes and Treatment, Aaron Beck and Brad Alford state that major depression is the leading cause of disability worldwide. They note that studies have shown changes in thyroid hormone levels in response to cognitive therapy, showing that our bodies and minds are linked. They say that depression results in a complex pattern of deviation in feelings, thoughts and behavior.
Symptoms of depression include low mood, pessimism, self-criticism, agitation, problems with memory and concentration, and physical complaints such as pain. There may be a loss of gratification with activities that starts with a few areas and expands. Activities that involve responsibility, obligation or effort become less satisfying and there is greater satisfaction in passive pursuits, including recreation, relaxation and rest..
People with depression begin to distort reality, They become preoccupied with continuous, repetitive negative thoughts(perseveration). There is often a contrast between a depressed person’s image of themselves and the objective facts. They dwell on mistakes, imperfections and inabilities, convinced that others will reject them, and that they will lose jobs, relationships, and friendships. They continue to think in themes of deprivation and defectiveness
Depression seems to be a reversal of human nature, of the survival instinct to eat and sleep and the desire to experience pleasure. Others need to respond with concern, empathy and acceptance and to be aware of the client’s difficulty in concentration and in formulating thoughts. People with depression are hypersensitive to rejection and discouragement.
The cognitive approach to managing depression involves recognizing the negative thoughts or negative self-talk that continues and increases depression. We can learn to challenge the negative thinking and replace it with neutral or positive thinking. For example, if I notice that I’m not functioning as well as normally at work, I can encourage myself to do the best I can. Instead of thinking that “I can’t do anything right” or “I’m doing so badly, that I might as well quit”, I can realize that this thinking doesn’t help the situation, and pay more attention to what I am doing well and think about what I can do today to improve the situation.
The behavioral approach involves doing things that help relieve depression. A depressed person is likely to withdraw from emotional attachments and tends to isolate from others. We can notice this and purposely spend time with others. If necessary, we can ask others to just let us be there without demanding conversation or interaction. Depression includes lethargy, but it is better to be active. Daily rituals such as walking the dog, biking, walking or swimming several times a week can be helpful.
Routine and structure can provide relief from nagging negative thoughts and feelings, so it is best to go to work or school, or to do volunteer work, or be involved in group activities, like crafts or sports. A person with depression needs to “push the envelope” in terms of involvement and activity, striving to get beyond his or her comfort zone. It’s best to start with a few small steps and keep expanding.
There is no reason why we shouldn’t pay attention to our biology, our thoughts and our behavior during the same time frame. There is no shame in taking medication for depression. We wouldn’t hesitate to take an antibiotic regardless of what people might think of us. We need to pay attention to seasonal changes including the amount of sunlight we are getting, healthy sleep habits, proper nutrition and exercising. We need to avoid isolation and too much unstructured time. We need to adjust our thinking to encourage ourselves to do all of these healthy things. Depression IS treatable. We are the prime agents in our own recovery!
Managing Depression
By Tim Kuss, LADC, LMFT
Several things influence the development of depression. Some people inherit depression. This means that their body does not work properly and they will probably need to use medications to stop their depression. Things that happen to us also influence depression. People who have bad things happen to them as children may continue to feel sad about these things long after they have grown up. The good news is that we can move beyond these effects by changing our behaviors and our thoughts. Things that happen to us and around us today also influence depression. The good news is that we can learn to cope with life events in positive ways and reduce the sadness and other negative feelings we experience.
Let’s try this.
1. What is one thing that happened or is happening to you that you feel sad about?
2. What do you think about what happened.
3. How have you acted related to what happened?
4. What have been the consequences of your thoughts and actions?
5. What can you do about the situation?
6. How can you think differently about the situation?
Would you consider taking anti-depressant medication? Why?
Would you consider going to individual therapy?
Complete pages 12 to 17 and 20,22,23 from UNDERSTANDING DEPRESSION AND ADDICTION by Daley and Thase
What are 5 ways to improve your mood?
Coping with depression:
People with depression often don’t want to get out of bed. However, getting out of bed and getting active is healthy for us. We also tend to want to stay in the house. It is better to get out of the house. Fresh air and sunshine work against depression. Activity, including exercise and work raise the level of endorphins so that we feel better. We may not want to eat, but a healthy breakfast will give us energy. It is also a good idea to set short-term achievable goals. Having daily goals that are measurable and that we can accomplish will provide encouragement and raise self-esteem. Practicing morning rituals will give us a good start to our day. Our habits can provide good structure for those days when we have low mood and aren’t sure what we want to do or if we want to do anything. Washing your hands and face, brushing your teeth and styling your hair can all provide positive feelings, while lounging around unkempt can contribute to negative thoughts and feelings about yourself.
When depressed we tend to want to isolate. We might think that we don’t measure up to other people, or that they don’t have anything to offer us. In this case we need to challenge the negative thoughts and practice positive behavior. Feel free to comment with your own positive skills for managing depression.
Several things influence the development of depression. Some people inherit depression. This means that their body does not work properly and they will probably need to use medications to stop their depression. Things that happen to us also influence depression. People who have bad things happen to them as children may continue to feel sad about these things long after they have grown up. The good news is that we can move beyond these effects by changing our behaviors and our thoughts. Things that happen to us and around us today also influence depression. The good news is that we can learn to cope with life events in positive ways and reduce the sadness and other negative feelings we experience.
Let’s try this.
1. What is one thing that happened or is happening to you that you feel sad about?
2. What do you think about what happened.
3. How have you acted related to what happened?
4. What have been the consequences of your thoughts and actions?
5. What can you do about the situation?
6. How can you think differently about the situation?
Would you consider taking anti-depressant medication? Why?
Would you consider going to individual therapy?
Complete pages 12 to 17 and 20,22,23 from UNDERSTANDING DEPRESSION AND ADDICTION by Daley and Thase
What are 5 ways to improve your mood?
Coping with depression:
People with depression often don’t want to get out of bed. However, getting out of bed and getting active is healthy for us. We also tend to want to stay in the house. It is better to get out of the house. Fresh air and sunshine work against depression. Activity, including exercise and work raise the level of endorphins so that we feel better. We may not want to eat, but a healthy breakfast will give us energy. It is also a good idea to set short-term achievable goals. Having daily goals that are measurable and that we can accomplish will provide encouragement and raise self-esteem. Practicing morning rituals will give us a good start to our day. Our habits can provide good structure for those days when we have low mood and aren’t sure what we want to do or if we want to do anything. Washing your hands and face, brushing your teeth and styling your hair can all provide positive feelings, while lounging around unkempt can contribute to negative thoughts and feelings about yourself.
When depressed we tend to want to isolate. We might think that we don’t measure up to other people, or that they don’t have anything to offer us. In this case we need to challenge the negative thoughts and practice positive behavior. Feel free to comment with your own positive skills for managing depression.
A level playing field: an illusion?
by Peter J. Dorsen M.D., LADC
It’s been a fair amount of time since I have connected with the blog but am more than ready to do so. The last entry had to do with “ a level playing field,” and whether someone with bipolar disorder can ever return to a place they were at before they were diagnosed and adequately treated.
With a number of additional fiery accusations, I said categorically “yes.” But I have been mulling over my opinion almost continually since I entered my earlier opinion. Between then and now, I have experienced at least one bout of depression and may even have experienced at least one episode albeit brief of hypomania. I usually know about the depression. I actually get irritable. I discussed my emotional state with my psychiatrist and in a collaborative fashion, I began taking a higher dose of Depakote, the anti seizure medication for my bipolar 2 disorder that has served me well of late.
Things all settled back to emotions as usual and the constipation, probably the only physiological manifestation of my mental disarray, vaporized. My ability to deal with day-to-day challenges with my wife and her stepsons improved. Any issues with my sometimes testy students seemed to be of less consequence to them and to me. Perhaps I was showing more tolerance to everyday challenges on all fronts. I doubt this was La belle indifference but more that I was once again properly medicated.
I am not aloof how significant is my interaction with my loved ones or with the students whose tuition goes toward paying my salary. However, that I was once again subject to emotional “issues” even while properly medicated made me look more objectively at what I had written and almost believed as gospel. I don’t doubt that some of my opinions could well have been an element of denial:”I don’t really have a debilitating mental illness,” I insisted. How could I? It’s adequately treated and I am euthymic. Sure, in the same article, I had also taken a poke at psychiatrists in general as drug pushers perhaps even wagged dog-wise by a pharmaceutical industry anxious financially to get a return on their investment after developing all those designer psychotropics.
Recently, the mother of an often oppositional defiant young man still working through grief and PTSD after losing his father in his mid teens, told me an interesting story. Her son thinks anyone wanting to mentor him isn’t genuine. Likewise, he opines, any professional taking on the challenge wanting to guide him along “has to be” motivated by the financial aspect of such a relationship.
However, so much about our patient-therapist relationships get guarded by professionally mandated restraints. For instance, I cannot communicate with my psychiatrist by e-mail. I cannot talk to my psychiatrist directly. I must go through his nurse clinician if I have a problem or if I need medications earlier. This disturbs me. My psychotherapist, a well-meaning MSW therapist tried to categorically explain away this communication pattern as what happens when someone(me) is dealing with a system. My response was certainly testy, “ If we don’t question the system, we will be corrupted.”
There are certainly symptoms and signs that early mania or hypomania, the opposite emotional process to depression, is in motion: am I becoming hypermanic? Here is when taking an inventory by yourself or with the help of a loved one makes sense. How am I sleeping? Am I fairly abruptly needing dramatically less sleep? Am I more edgy with my wife or associates? Am I flying off the handle over seemingly smaller issues? There are co-occurring issues: did you resume drinking or drugging? Then there’s the angle of sexuality. Some is normal, inappropriately more is not.
This addition to the blog is not meant as an apology for what I have said previously but I want it to represent a dramatic reappraisal of how my disorder works. Bipolar disorder sneaks up on you. It wiles you into believing that you don’t own it. I am offering a different message today. We can hope for as level a playing field as compliance with effective medication will allow or by how much an uncontrollable and latent genie inside us will reemerge or fluctuate autonomously. Genuine cooperation with our treatment process may determine a pinnacle we can accomplish despite a chronic illness. I do not eliminate the value of questioning how care is delivered. The studies confirm that collaborative decisions about medications and psychotherapy improve outcome.
A “level playing field” may have some ruts and bumps as those of us with bipolar disorder reconnoiter our opportunities. So, I suppose, I must now say no to my earlier premise that now appears somewhat of an illusion. In my own case I sheepishly admit that all is not as smooth sailing in our perceived “recovery’ as I might have hoped. I have alluded to hints of reemerging depression. It is not unusual that mania and hypomania resurface. Perhaps, we can identify either end of the emotional yo-yo of our illness more quickly and with help collaboratively return to that illusory “level playing field” once again.
It’s been a fair amount of time since I have connected with the blog but am more than ready to do so. The last entry had to do with “ a level playing field,” and whether someone with bipolar disorder can ever return to a place they were at before they were diagnosed and adequately treated.
With a number of additional fiery accusations, I said categorically “yes.” But I have been mulling over my opinion almost continually since I entered my earlier opinion. Between then and now, I have experienced at least one bout of depression and may even have experienced at least one episode albeit brief of hypomania. I usually know about the depression. I actually get irritable. I discussed my emotional state with my psychiatrist and in a collaborative fashion, I began taking a higher dose of Depakote, the anti seizure medication for my bipolar 2 disorder that has served me well of late.
Things all settled back to emotions as usual and the constipation, probably the only physiological manifestation of my mental disarray, vaporized. My ability to deal with day-to-day challenges with my wife and her stepsons improved. Any issues with my sometimes testy students seemed to be of less consequence to them and to me. Perhaps I was showing more tolerance to everyday challenges on all fronts. I doubt this was La belle indifference but more that I was once again properly medicated.
I am not aloof how significant is my interaction with my loved ones or with the students whose tuition goes toward paying my salary. However, that I was once again subject to emotional “issues” even while properly medicated made me look more objectively at what I had written and almost believed as gospel. I don’t doubt that some of my opinions could well have been an element of denial:”I don’t really have a debilitating mental illness,” I insisted. How could I? It’s adequately treated and I am euthymic. Sure, in the same article, I had also taken a poke at psychiatrists in general as drug pushers perhaps even wagged dog-wise by a pharmaceutical industry anxious financially to get a return on their investment after developing all those designer psychotropics.
Recently, the mother of an often oppositional defiant young man still working through grief and PTSD after losing his father in his mid teens, told me an interesting story. Her son thinks anyone wanting to mentor him isn’t genuine. Likewise, he opines, any professional taking on the challenge wanting to guide him along “has to be” motivated by the financial aspect of such a relationship.
However, so much about our patient-therapist relationships get guarded by professionally mandated restraints. For instance, I cannot communicate with my psychiatrist by e-mail. I cannot talk to my psychiatrist directly. I must go through his nurse clinician if I have a problem or if I need medications earlier. This disturbs me. My psychotherapist, a well-meaning MSW therapist tried to categorically explain away this communication pattern as what happens when someone(me) is dealing with a system. My response was certainly testy, “ If we don’t question the system, we will be corrupted.”
There are certainly symptoms and signs that early mania or hypomania, the opposite emotional process to depression, is in motion: am I becoming hypermanic? Here is when taking an inventory by yourself or with the help of a loved one makes sense. How am I sleeping? Am I fairly abruptly needing dramatically less sleep? Am I more edgy with my wife or associates? Am I flying off the handle over seemingly smaller issues? There are co-occurring issues: did you resume drinking or drugging? Then there’s the angle of sexuality. Some is normal, inappropriately more is not.
This addition to the blog is not meant as an apology for what I have said previously but I want it to represent a dramatic reappraisal of how my disorder works. Bipolar disorder sneaks up on you. It wiles you into believing that you don’t own it. I am offering a different message today. We can hope for as level a playing field as compliance with effective medication will allow or by how much an uncontrollable and latent genie inside us will reemerge or fluctuate autonomously. Genuine cooperation with our treatment process may determine a pinnacle we can accomplish despite a chronic illness. I do not eliminate the value of questioning how care is delivered. The studies confirm that collaborative decisions about medications and psychotherapy improve outcome.
A “level playing field” may have some ruts and bumps as those of us with bipolar disorder reconnoiter our opportunities. So, I suppose, I must now say no to my earlier premise that now appears somewhat of an illusion. In my own case I sheepishly admit that all is not as smooth sailing in our perceived “recovery’ as I might have hoped. I have alluded to hints of reemerging depression. It is not unusual that mania and hypomania resurface. Perhaps, we can identify either end of the emotional yo-yo of our illness more quickly and with help collaboratively return to that illusory “level playing field” once again.
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