by Peter J. Dorsen, M.D., LADC
I thought this response to my challenges with Billy would be interesting counterpoint to my own thoughts on anger in someone with bipolar disorder.
Dr Gove Hambidge, an unique psychoanalyst who prefers to go in depth with his clients, emphasizes that it is crucial for Billy to "self discover." He further adds that there is implicit danger if you " give instructions"(as I seem to have done with Billy); that he "might think you incompetent." However, “preferably, if he discovers the fact( call it truth) himself, it becomes self-fulfilling."
In his opinion, however, in respect to a relationship between Billy’s explosive anger and his bipolar disorder, "they are always linked.” This “ social organization”, as it were, is part of him: anger-mania-hypomania.
"But Billy is a good learner." In answer to my question why Billy’s mother is calling canceling her son's appointment is that it could represent "a power struggle you are having (with the mother). " You are like a pair of boxers in the ring and she can win by canceling the appointment."
"Keep in mind, it's his job to discover. Be subtle. Empathize. Invite him to look at his behavior (like the incident hitting the door recently." Dr Hambidge added, " He's certainly pissed at his mother. It is for him to look and say "intolerable"-- that's why I recommend self-discovery."
"I suspect you have been suckered into the role of giving instruction. Instead, hand power over to the client/patient.
But the good thing, is that you are (now) more familiar with the family dynamics."
Sometimes, it just seems like such a painful way to learn!
Definitely insightul!
Sunday, May 29, 2011
Tuesday, May 24, 2011
Bipolar Visions: What About explosive Anger?
It has frequently come to my attention that people who happen to have bipolar disorder get “accused” more often than not of having a often inaccurate “bipolar moment.” However, I must be one of those splitters rather than lumpers and think such unfortunates have an independent entity called Intermittent Explosive Disorder(IED).
What I have consistently come to believe is that what we are witnessing, especially in someone diagnosed with bipolar disorder (especially Type 1 more frequently than Type 2), is what the Diagnostic and Statistical Manual of Mental Disorders (DSMIV) has categorized as 312.34, under the broad umbrella of impulse-control disorders(not elsewhere classified.
Here is a case from my practice:
Billy, age 17, enrolled in a special school and additionally carefully supervised there for his bipolar disorder(not otherwise specified, 296.80), is currently participating in a specially tailored weekly outpatient CD program with me, biofeedback and therapy from a mental health counselor, and obtains in-depth psychotherapy and medications(Depakote) from a psychiatrist. He has \demonstrated rapid alterations(over days) between manic and depressive symptoms that meet symptom threshold criteria but not minimal duration criteria for manic, hypomanic, or major depressive episodes.
Billy entered the legal system as a minor at 16 and received probation after totaling his parents’ car while under the influence and discovered carrying an illegal amount of marijuana a week later at school(a possession charge). He also has suffered chronically from anxiety and panic attacks for which his PMD prescribes a long acting anxiolytic(Valium) which is monitored. He endures an abusive dependent relationship with a schoolmate and accepts victimization.’
A week ago, his girlfriend called him out of class while he was on a short break enlisting another girl in a dialogue over a rumor that they were breaking up. He violently and uncontrollably punched the door behind the girl several times and immediately screamed four-letter epithets how she should stay the F out of his business. An xray was taken of his hand that was suspicious of a hairline fracture. In our conversation he admitted regret what he had done but said he could not control himself.. His girlfriend was suspended for 10 days for instigating the incident.
I believe this case is illustrative for demonstrating impulsive aggression (that) is unpremeditated and so characteristic of IED. Curiously, IED belongs to the larger family of Axis I impulse control disorders such as kleptomania, pyromania, and pathological gambling. By definition, it is a “disproportionate reaction to any provocation, real or perceived.” Keep in mind that, prior to the incident, my client was sitting quietly in chair in a “comfi” chair in a short break from a class movie.
It comes as no surprise to me that “the disorder itself is not easily characterized and often exhibits comorbidity with other mood disorders, particularly bipolar disorder or, as I am inclined to say, “true-true, but not related. Here’s where I’m in the “splitters” camp. I believe the two are separate entities.
The consistent pattern of this illness is that outbursts are brief( less than a half hour) and, certainly in our patient, often associated with panic and anxiety. There is an association as well with chest tightness, twitching and palpitations, somatic experiences. One of the comments my client volunteered was, “ I could never hit a woman.” She very quickly scurried off to class immediately after this encounter. He said he wished he had been capable of reacting differently. It was all so instantaneous. It was as if he had explained, “The Devil made me do it!”
Except for known and diagnosed bipolar disorder, my patient lacks other possibilities for his behavior: an antisocial personality disorder. He is not borderline, and does not have ADHD. I am unaware of prior brain injury and he has four months of sobriety from all illicit drugs verified by negative regular and random urine screens. He has had witnessed consumption of Depakote, his mood stabilizer, although admittedly he has not had a level drawn and has requested increasing his dose from 250 twice a day to 500mg twice a day. “I feel better on the higher dose.”
Certainly, there are some exotic theories for an etiology for IED such as a low brain serotonin turnover rate(low 5-HIAA) in the CSF as well as an increased insulin secretion. I am personally aware how volatile any of us can become with low blood sugar certainly a consequence of elevations of insulin.
It is important to address treatment issues for IED. In Billy’s case, we are utilizing the aforementioned interdisciplinary approach to our patient’s documented polysubstance addiction problems. Our method includes addressing mental and physical health issues. Unquestionably, a concern for family dynamics as well as Billy’s difficult dependent relationship with his girlfriend are important in our focus. We are treating him for bipolar disorder as well as endeavoring to find the best anxiolytic because so much of his challenge has been his own self-medicating with marijuana, MDX, alcohol, and opiates.
It is my opinion that Billy definitely has issues with bipolar disorder which we are in the process of stabilizing. We are working with his family as well as generating as much cooperation from Billy who I want to begin assuming more and more responsibility for his treatment as well as his behavior. As with other issues like cursing out his mother, I am trying to help Billy create better alternatives. Cognitive behavior therapy(CBT) is one of the mainstays of therapy. I like to think ours is eclectic and may as a result be even more successful. I am not so quick to incriminate Billy’s primary illness, bipolar disorder as what instigates his IED.
My plan is to approach Billy’s IED both independently and simultaneously with his bipolar disorder and addiction to relearn “uncontrollable” responses to frustration. I would like to see him divert impulsive and disproportionate rage reactions elsewhere or help him anticipate ways of avoiding potential trigger events like the one described he had at school.
In this event, I am attempting to assist Billy prepare by avoiding any potential for such an reoccurrence. I advised developing preventive skills. There is no way I can guarantee we can fully eliminate IED in our client. However, I believe it helps to view IED as an independent entity with its own combustion point that can be anticipated and hopefully modulated.
What I have consistently come to believe is that what we are witnessing, especially in someone diagnosed with bipolar disorder (especially Type 1 more frequently than Type 2), is what the Diagnostic and Statistical Manual of Mental Disorders (DSMIV) has categorized as 312.34, under the broad umbrella of impulse-control disorders(not elsewhere classified.
Here is a case from my practice:
Billy, age 17, enrolled in a special school and additionally carefully supervised there for his bipolar disorder(not otherwise specified, 296.80), is currently participating in a specially tailored weekly outpatient CD program with me, biofeedback and therapy from a mental health counselor, and obtains in-depth psychotherapy and medications(Depakote) from a psychiatrist. He has \demonstrated rapid alterations(over days) between manic and depressive symptoms that meet symptom threshold criteria but not minimal duration criteria for manic, hypomanic, or major depressive episodes.
Billy entered the legal system as a minor at 16 and received probation after totaling his parents’ car while under the influence and discovered carrying an illegal amount of marijuana a week later at school(a possession charge). He also has suffered chronically from anxiety and panic attacks for which his PMD prescribes a long acting anxiolytic(Valium) which is monitored. He endures an abusive dependent relationship with a schoolmate and accepts victimization.’
A week ago, his girlfriend called him out of class while he was on a short break enlisting another girl in a dialogue over a rumor that they were breaking up. He violently and uncontrollably punched the door behind the girl several times and immediately screamed four-letter epithets how she should stay the F out of his business. An xray was taken of his hand that was suspicious of a hairline fracture. In our conversation he admitted regret what he had done but said he could not control himself.. His girlfriend was suspended for 10 days for instigating the incident.
I believe this case is illustrative for demonstrating impulsive aggression (that) is unpremeditated and so characteristic of IED. Curiously, IED belongs to the larger family of Axis I impulse control disorders such as kleptomania, pyromania, and pathological gambling. By definition, it is a “disproportionate reaction to any provocation, real or perceived.” Keep in mind that, prior to the incident, my client was sitting quietly in chair in a “comfi” chair in a short break from a class movie.
It comes as no surprise to me that “the disorder itself is not easily characterized and often exhibits comorbidity with other mood disorders, particularly bipolar disorder or, as I am inclined to say, “true-true, but not related. Here’s where I’m in the “splitters” camp. I believe the two are separate entities.
The consistent pattern of this illness is that outbursts are brief( less than a half hour) and, certainly in our patient, often associated with panic and anxiety. There is an association as well with chest tightness, twitching and palpitations, somatic experiences. One of the comments my client volunteered was, “ I could never hit a woman.” She very quickly scurried off to class immediately after this encounter. He said he wished he had been capable of reacting differently. It was all so instantaneous. It was as if he had explained, “The Devil made me do it!”
Except for known and diagnosed bipolar disorder, my patient lacks other possibilities for his behavior: an antisocial personality disorder. He is not borderline, and does not have ADHD. I am unaware of prior brain injury and he has four months of sobriety from all illicit drugs verified by negative regular and random urine screens. He has had witnessed consumption of Depakote, his mood stabilizer, although admittedly he has not had a level drawn and has requested increasing his dose from 250 twice a day to 500mg twice a day. “I feel better on the higher dose.”
Certainly, there are some exotic theories for an etiology for IED such as a low brain serotonin turnover rate(low 5-HIAA) in the CSF as well as an increased insulin secretion. I am personally aware how volatile any of us can become with low blood sugar certainly a consequence of elevations of insulin.
It is important to address treatment issues for IED. In Billy’s case, we are utilizing the aforementioned interdisciplinary approach to our patient’s documented polysubstance addiction problems. Our method includes addressing mental and physical health issues. Unquestionably, a concern for family dynamics as well as Billy’s difficult dependent relationship with his girlfriend are important in our focus. We are treating him for bipolar disorder as well as endeavoring to find the best anxiolytic because so much of his challenge has been his own self-medicating with marijuana, MDX, alcohol, and opiates.
It is my opinion that Billy definitely has issues with bipolar disorder which we are in the process of stabilizing. We are working with his family as well as generating as much cooperation from Billy who I want to begin assuming more and more responsibility for his treatment as well as his behavior. As with other issues like cursing out his mother, I am trying to help Billy create better alternatives. Cognitive behavior therapy(CBT) is one of the mainstays of therapy. I like to think ours is eclectic and may as a result be even more successful. I am not so quick to incriminate Billy’s primary illness, bipolar disorder as what instigates his IED.
My plan is to approach Billy’s IED both independently and simultaneously with his bipolar disorder and addiction to relearn “uncontrollable” responses to frustration. I would like to see him divert impulsive and disproportionate rage reactions elsewhere or help him anticipate ways of avoiding potential trigger events like the one described he had at school.
In this event, I am attempting to assist Billy prepare by avoiding any potential for such an reoccurrence. I advised developing preventive skills. There is no way I can guarantee we can fully eliminate IED in our client. However, I believe it helps to view IED as an independent entity with its own combustion point that can be anticipated and hopefully modulated.
Saturday, January 29, 2011
Taking Step 1 with Bipolar Disorder
Timothy Kuss, LADC, LMFT
I am in recovery from bipolar disorder and chemical dependency. I also currently work as a CD counselor and family therapist in outpatient and residential CD treatment. I believe that taking step 1 for Bipolar Disorder is a lot like taking step 1 for our addiction. Many of us go through a period of denial. People in our family also go through a period of denial about our bipolar disorder.
Mental illness carries quite a stigma and is often seen as untreatable. Sometimes it is seen as a permanent disability, especially if we’ve seen family members or acquaintances suffering long hospitalizations and recurring tragedy related to episodes over the course of decades. Most people don’t understand that with today’s medications and therapy, hospitalizations can be avoided fewer, or at least briefer. Tragedies can be averted and clients can lead relatively normal lives and have careers and families.
My own Step 1 with bipolar disorder was delayed due to a series of misdiagnoses of Schizophrenia. Bipolar disorder, unfortunately, shares a typical age of onset with schizophrenia of 20 as well as the potential for psychosis during manic episodes. My experience with delusional thoughts was probably heightened by the fact that I had used LSD and other hallucinogens frequently. I was hospitalized and treated for an incorrect diagnosis with anti-psychotics such as Thorazine and Haldol, which made me feel and look like a zombie. Such an error in diagnosis served to make me deny my mental illness. However, fortunately this resulted in volunteering myself for long-term chemical dependency treatment.
Twenty-five years later while continuing my sobriety I had a series of manic episodes resulting in short hospital stays and finally got the diagnosis of bipolar disorder. My reaction was one of relief. They finally got it right! As I learned more about the symptoms of bipolar disorder, I was finally able to understand what had been happening to me. As a professional I have encountered many clients with the same reaction of gratitude after finally getting the right diagnosis. Many have had co-occurring addiction and mental illness.
Unfortunately, many of us struggle with the need to take medications to treat our Bipolar Disorder. I tried to wean myself off them at first, just as I had done with those incorrectly prescribed antipsychotics. Today, I understand that my mood-stabilizing meds do not have any negative side effects. They are my insurance policy. They keep me out of the psych wards and out of potentially life-threatening situations that seem to predictably occur when I get psychotic. During my last psychiatric hospitalization I spent 3 days in intensive care due to high blood pressure that resisted medical efforts to bring it down. I have also put myself in dangerous situations when manic, like when I wandered outside in the dead of winter with no clothing and only a sleeping bag and tennis shoes for cover. Another time, I became paranoid of aliens trying to kill my daughter and almost put her in grave danger.
OUR step 1 includes recognition of some “crazy” behavior and thinking. Others also with bipolar disorder can laugh with us about these old episodes just like other drunks can laugh with us about our crazy earlier drinking episodes. Accepting unmanageability comes with accepting that reality is different from our delusions. We were powerless as individuals to cope with our illness. But together and with help we can be in recovery. Step 2!
In summary, Step 1 of our dual recovery includes recognition that our chemical use increased our mental health dysfunction(symptoms). This is different than saying that the chemical use caused the symptoms. I proved after 25 years of sobriety that I can STILL have symptoms WITHOUT using. I can see, however, a constant stream of clients entering the doors of our MI-CD program because their chemical use led to repeated hospitalizations for psychosis. I’m pretty sure that I wouldn’t have struggled with 5 years of psychiatric admissions if someone had helped me understand that I had to stop using chemicals.
As a family therapist I have seen many co-dependents struggle with accepting the reality of the dual diagnosis of a loved one. To help them with their fears I have done my best to help them understand how addiction and mental illness coexist. Besides referring them to Alanon or Naranon I also refer them to NAMI, the National Alliance for the Mentally Ill, which has both education and support groups for clients and family members. In dual recovery just as with following the twelve steps of alcoholism or other addictions, we all need to practice recovery one day at a time.
I do.
I am in recovery from bipolar disorder and chemical dependency. I also currently work as a CD counselor and family therapist in outpatient and residential CD treatment. I believe that taking step 1 for Bipolar Disorder is a lot like taking step 1 for our addiction. Many of us go through a period of denial. People in our family also go through a period of denial about our bipolar disorder.
Mental illness carries quite a stigma and is often seen as untreatable. Sometimes it is seen as a permanent disability, especially if we’ve seen family members or acquaintances suffering long hospitalizations and recurring tragedy related to episodes over the course of decades. Most people don’t understand that with today’s medications and therapy, hospitalizations can be avoided fewer, or at least briefer. Tragedies can be averted and clients can lead relatively normal lives and have careers and families.
My own Step 1 with bipolar disorder was delayed due to a series of misdiagnoses of Schizophrenia. Bipolar disorder, unfortunately, shares a typical age of onset with schizophrenia of 20 as well as the potential for psychosis during manic episodes. My experience with delusional thoughts was probably heightened by the fact that I had used LSD and other hallucinogens frequently. I was hospitalized and treated for an incorrect diagnosis with anti-psychotics such as Thorazine and Haldol, which made me feel and look like a zombie. Such an error in diagnosis served to make me deny my mental illness. However, fortunately this resulted in volunteering myself for long-term chemical dependency treatment.
Twenty-five years later while continuing my sobriety I had a series of manic episodes resulting in short hospital stays and finally got the diagnosis of bipolar disorder. My reaction was one of relief. They finally got it right! As I learned more about the symptoms of bipolar disorder, I was finally able to understand what had been happening to me. As a professional I have encountered many clients with the same reaction of gratitude after finally getting the right diagnosis. Many have had co-occurring addiction and mental illness.
Unfortunately, many of us struggle with the need to take medications to treat our Bipolar Disorder. I tried to wean myself off them at first, just as I had done with those incorrectly prescribed antipsychotics. Today, I understand that my mood-stabilizing meds do not have any negative side effects. They are my insurance policy. They keep me out of the psych wards and out of potentially life-threatening situations that seem to predictably occur when I get psychotic. During my last psychiatric hospitalization I spent 3 days in intensive care due to high blood pressure that resisted medical efforts to bring it down. I have also put myself in dangerous situations when manic, like when I wandered outside in the dead of winter with no clothing and only a sleeping bag and tennis shoes for cover. Another time, I became paranoid of aliens trying to kill my daughter and almost put her in grave danger.
OUR step 1 includes recognition of some “crazy” behavior and thinking. Others also with bipolar disorder can laugh with us about these old episodes just like other drunks can laugh with us about our crazy earlier drinking episodes. Accepting unmanageability comes with accepting that reality is different from our delusions. We were powerless as individuals to cope with our illness. But together and with help we can be in recovery. Step 2!
In summary, Step 1 of our dual recovery includes recognition that our chemical use increased our mental health dysfunction(symptoms). This is different than saying that the chemical use caused the symptoms. I proved after 25 years of sobriety that I can STILL have symptoms WITHOUT using. I can see, however, a constant stream of clients entering the doors of our MI-CD program because their chemical use led to repeated hospitalizations for psychosis. I’m pretty sure that I wouldn’t have struggled with 5 years of psychiatric admissions if someone had helped me understand that I had to stop using chemicals.
As a family therapist I have seen many co-dependents struggle with accepting the reality of the dual diagnosis of a loved one. To help them with their fears I have done my best to help them understand how addiction and mental illness coexist. Besides referring them to Alanon or Naranon I also refer them to NAMI, the National Alliance for the Mentally Ill, which has both education and support groups for clients and family members. In dual recovery just as with following the twelve steps of alcoholism or other addictions, we all need to practice recovery one day at a time.
I do.
Tuesday, January 18, 2011
Here's a Heads Up on Bipolar Options
Categorization of Bipolar Illness: DSM IV Resources: For Health Professionals
Mood Disorders
Major Depressive Episode: 2-weeks See Beck Inventory, Appendix A
Manic Episode: 1 week, elevated, expansive or irritable mood
Mixed Episode: Both manic and Major depressive Episode: 1-week
Hypomanic Episode: At least 4 days/No hospitalization required
Major Depressive Disorder(MDD). Single or Recurrent(2 Mo Int)
Dysthymic Disorder: Depressed Mood, at least 2 years
Depressive Disorder NOS, Not Otherwise Specified
Bipolar Disorders
Bipolar I Disorder
Single Manic: Presence of only one Manic Episode, no past MDE
Most Recent Episode Hypomanic*: At least one Manic Episode or
Mixed Episode
Most recent Episode Manic*( at least 1 Maj Dep Ep, Manic Ep, or
Mixed Ep
Most Recent Episode Mixed*
Most Recent Episode Depresssed*
Most Recent Episode Unspecified*
*Note: Any of these entities can be associated with rapid cycling
Bipolar II Disorder (recurrent major depressive Episodes With Hypomanic Episodes)*
One or more MDE, at least one hypomanic episode(no manic)
May be in partial or full remission
Note: May occur as rapid cycling
Cyclothymic Disorder
At least 2 years, hypomania, depressive symptoms(not
MDE). One year in children
Can see superimposed bipolar 1 or 2 after 2 years
Bipolar Disorder Not Otherwise Specified
Very rapid alternation (over days) between manic and depressive symptoms meeting symptom threshold criteria but not minimal duration criteria manic, hypomanic, or MDE. Also, the clinician may be unable to determine primary, medical, or substance induced.
Substance-Induced Mood Disorder
The problem developed within a month of substance use or withdrawal
Mood Disorders
Major Depressive Episode: 2-weeks See Beck Inventory, Appendix A
Manic Episode: 1 week, elevated, expansive or irritable mood
Mixed Episode: Both manic and Major depressive Episode: 1-week
Hypomanic Episode: At least 4 days/No hospitalization required
Major Depressive Disorder(MDD). Single or Recurrent(2 Mo Int)
Dysthymic Disorder: Depressed Mood, at least 2 years
Depressive Disorder NOS, Not Otherwise Specified
Bipolar Disorders
Bipolar I Disorder
Single Manic: Presence of only one Manic Episode, no past MDE
Most Recent Episode Hypomanic*: At least one Manic Episode or
Mixed Episode
Most recent Episode Manic*( at least 1 Maj Dep Ep, Manic Ep, or
Mixed Ep
Most Recent Episode Mixed*
Most Recent Episode Depresssed*
Most Recent Episode Unspecified*
*Note: Any of these entities can be associated with rapid cycling
Bipolar II Disorder (recurrent major depressive Episodes With Hypomanic Episodes)*
One or more MDE, at least one hypomanic episode(no manic)
May be in partial or full remission
Note: May occur as rapid cycling
Cyclothymic Disorder
At least 2 years, hypomania, depressive symptoms(not
MDE). One year in children
Can see superimposed bipolar 1 or 2 after 2 years
Bipolar Disorder Not Otherwise Specified
Very rapid alternation (over days) between manic and depressive symptoms meeting symptom threshold criteria but not minimal duration criteria manic, hypomanic, or MDE. Also, the clinician may be unable to determine primary, medical, or substance induced.
Substance-Induced Mood Disorder
The problem developed within a month of substance use or withdrawal
The Latest Info On Life As I Know It
It’s been a few years since my last entry to Crazy Doctor. I am no longer a practicing medical doctor. I surrendered my medical license in 2005. While I was in the transitional process, I became a licensed drug and alcohol counselor (LADC) and tried my hand albeit perhaps less than successfully at two drug treatment jobs. The first offered minimal opportunity to function as an actual bone fide CD counselor and the second left me unhappy both with my new milieu and I encountered insufficient help to unravel the mysteries of the new technology of charting.
So what’s a professional gonna do? I never considered some of the alternative potential of my degrees only recently discovering a teaching opportunity at a Twin Cities acupuncture and Oriental medicine academy teaching Western medicine. Way back then, at the demise of my career as I had known it for thirty years, my ever so tolerant wife had off handedly suggested Sam’s Club which, on a lark, I joined first as a greeter until later moving to their gas station where I quickly discovered how to write, read, and even grade papers on the sly.
My sojourn with “big box” retail has had its heads and tails but a steady paycheck has definitely helped supplement my meager Social Security check. Now too, my teaching stipend has also helped crawling out of credit card debt. Oh, the woes of bankruptcy, divorce, and professional demise.
I have been relatively as clear as anyone can be of problems at Sam’s and have persevered for over four years through heat, rain, snow, and cold. None of the potential problems or issues have arisen as my multiple psychometric testing suggested could. But we were warned, of course, of more intellectual or stressful situations I was told rather glibly. I have shown good judgment, been responsible with work assignments and almost always been timely and never had an unexcused absence ( although I continue to pursue personal diversionary opportunities at a brainless job).
I and a fellow CD counselor who is bipolar 1 also with an addiction history have taken a shot at speaking about bipolar disorder and co-occurring addiction, Tim on bipolar 1 and I on bipolar 2. His journey has been scarred with several hospitalizations for psychosis. Mine has been marked with failures personally and professionally. Together, we have established and manage the blog, Bipolarvisions.blogspot.com and mutually try to report on our experiences with the co-occurring challenges of addiction and mental disorder.
It is extremely comforting receiving consistent feedback from intimate friends of a positive transformation to a euthymic state show compared with an earlier emotional lability. People with bipolar disorder are known to wreak havoc with marriage. I know, I’m on my second and so is Tim. Although neither of us are ready to report a bliss state, gone are the impossible psychotic episodes or, in my case, explosive anger.
Those of us with this challenge, are known to change jobs frequently sometimes with the frequency “normies” change underwear. I have been at Sam’s over four years and am engaged in a monogamous relationship and marriage I must work at continually. Sure, I still make my share of mistakes, have my emotional ups and downs, trials and tribulations. I still cherish that I can be there to give what I can to this relatively new relationship. I often must struggle just to offer another adult presence for my wife’s four now-adult children. Sometimes, it is hard for me not to judge her children or to adjust to the lack of space in my new family environment.
It has been readily clear from the outset that my moods can certainly reflect conflicts or challenges dealing with stepchildren but only rarely with my new primary relationship. I show impatience dealing with stubborn post adolescents who very much deserve a mind of their own.
My medications, the anti seizure mood stabilizer, Depakote has no side effects other than lowering my platelet count. I have none of the tardive dyskinesia (TD) I experienced on Zyprexa with or without Abilify ( in my mind falsely advertised as an antidepressant). I am readying my two classes for next trimester and feeling comfortable with these challenges. My biggest challenge in one will be how to enliven the presentation to keep students awake.
Those in the Mankind Project (New Warriors), where I derive so much peer support, respect my “gold,” as we call our strengths or accomplishments for which we must take credit. My fellow “I” or “Integration” group partners with whom I meet for three hours biweekly, encourage me to risk change and seek greener pastures. I have grown increasingly disillusioned with cognitive behavioral therapy(CBT) and received recent strokes from a practicing octogenarian psychiatrist that I demonstrated an impressive gift for dynamic interactive therapy. He has offered to supervise me with any clients I should undertake to counsel. I am heartily prepared to go that direction. There are some delightful opportunities awaiting me just by opening up the myriad of possibilities that await me
So what’s a professional gonna do? I never considered some of the alternative potential of my degrees only recently discovering a teaching opportunity at a Twin Cities acupuncture and Oriental medicine academy teaching Western medicine. Way back then, at the demise of my career as I had known it for thirty years, my ever so tolerant wife had off handedly suggested Sam’s Club which, on a lark, I joined first as a greeter until later moving to their gas station where I quickly discovered how to write, read, and even grade papers on the sly.
My sojourn with “big box” retail has had its heads and tails but a steady paycheck has definitely helped supplement my meager Social Security check. Now too, my teaching stipend has also helped crawling out of credit card debt. Oh, the woes of bankruptcy, divorce, and professional demise.
I have been relatively as clear as anyone can be of problems at Sam’s and have persevered for over four years through heat, rain, snow, and cold. None of the potential problems or issues have arisen as my multiple psychometric testing suggested could. But we were warned, of course, of more intellectual or stressful situations I was told rather glibly. I have shown good judgment, been responsible with work assignments and almost always been timely and never had an unexcused absence ( although I continue to pursue personal diversionary opportunities at a brainless job).
I and a fellow CD counselor who is bipolar 1 also with an addiction history have taken a shot at speaking about bipolar disorder and co-occurring addiction, Tim on bipolar 1 and I on bipolar 2. His journey has been scarred with several hospitalizations for psychosis. Mine has been marked with failures personally and professionally. Together, we have established and manage the blog, Bipolarvisions.blogspot.com and mutually try to report on our experiences with the co-occurring challenges of addiction and mental disorder.
It is extremely comforting receiving consistent feedback from intimate friends of a positive transformation to a euthymic state show compared with an earlier emotional lability. People with bipolar disorder are known to wreak havoc with marriage. I know, I’m on my second and so is Tim. Although neither of us are ready to report a bliss state, gone are the impossible psychotic episodes or, in my case, explosive anger.
Those of us with this challenge, are known to change jobs frequently sometimes with the frequency “normies” change underwear. I have been at Sam’s over four years and am engaged in a monogamous relationship and marriage I must work at continually. Sure, I still make my share of mistakes, have my emotional ups and downs, trials and tribulations. I still cherish that I can be there to give what I can to this relatively new relationship. I often must struggle just to offer another adult presence for my wife’s four now-adult children. Sometimes, it is hard for me not to judge her children or to adjust to the lack of space in my new family environment.
It has been readily clear from the outset that my moods can certainly reflect conflicts or challenges dealing with stepchildren but only rarely with my new primary relationship. I show impatience dealing with stubborn post adolescents who very much deserve a mind of their own.
My medications, the anti seizure mood stabilizer, Depakote has no side effects other than lowering my platelet count. I have none of the tardive dyskinesia (TD) I experienced on Zyprexa with or without Abilify ( in my mind falsely advertised as an antidepressant). I am readying my two classes for next trimester and feeling comfortable with these challenges. My biggest challenge in one will be how to enliven the presentation to keep students awake.
Those in the Mankind Project (New Warriors), where I derive so much peer support, respect my “gold,” as we call our strengths or accomplishments for which we must take credit. My fellow “I” or “Integration” group partners with whom I meet for three hours biweekly, encourage me to risk change and seek greener pastures. I have grown increasingly disillusioned with cognitive behavioral therapy(CBT) and received recent strokes from a practicing octogenarian psychiatrist that I demonstrated an impressive gift for dynamic interactive therapy. He has offered to supervise me with any clients I should undertake to counsel. I am heartily prepared to go that direction. There are some delightful opportunities awaiting me just by opening up the myriad of possibilities that await me
Sunday, December 12, 2010
Avoiding The Holiday Blues
By Tim Kuss, LADC, LMFT
As we approach the winter holidays it’s good to remember that they can be difficult to negotiate for some of us.
I remember, for example, visiting my parent’s home in a small town for a few days around Christmas. I became delusional and found myself driving around town in the middle of the night. I eventually wound up at the power plant because there were people there.
I was into my old “There’s something special for me” thinking. They eventually figured out who I was and called my parents.
One of my theories about holiday stress is that we have such high expectations. When we were kids it was a magical, miraculous time. As adults we may become aware of the loss of that magic. Now, our losses and our lack of accomplishments may loom large.
It may be best to keep our expectations down. Just plan to have an OK time for the holidays. Aim for comfortable get-togethers with your family and friends.
Forget about big presents!
Survive. If anything better happens then you’re ahead.
It’s hard to be disappointed if you don’t set yourself up for it.
As we approach the winter holidays it’s good to remember that they can be difficult to negotiate for some of us.
I remember, for example, visiting my parent’s home in a small town for a few days around Christmas. I became delusional and found myself driving around town in the middle of the night. I eventually wound up at the power plant because there were people there.
I was into my old “There’s something special for me” thinking. They eventually figured out who I was and called my parents.
One of my theories about holiday stress is that we have such high expectations. When we were kids it was a magical, miraculous time. As adults we may become aware of the loss of that magic. Now, our losses and our lack of accomplishments may loom large.
It may be best to keep our expectations down. Just plan to have an OK time for the holidays. Aim for comfortable get-togethers with your family and friends.
Forget about big presents!
Survive. If anything better happens then you’re ahead.
It’s hard to be disappointed if you don’t set yourself up for it.
Tuesday, November 2, 2010
Social Rhythm
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.
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.
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