Secrets Keep You Sick:


My journey down this path of mental illness began in earnest about 21 years ago, when at the age of 19, I was a student down at the University of Illinois in Champaign-Urbana. (I say in earnest, because these days I suspect that my journey with depression and addiction began at a significantly younger age, perhaps even as young as 10 or 11 years old.) I had graduated high school in 3 years—in spite of using and abusing drugs and alcohol the whole time—as a result of some additional summer school and credits for taking German at the high school while I was in junior high.


One of my favorite memories of my father came as a result of this, when the high school decided they were going to refuse to give me credit for some German language courses I had taken at the high school during seventh and eighth grade. My Dad and I went to a meeting with the high school’s principal. The principal had his book of state laws out and everything; but my Dad was a pretty tough character, and also well-prepared. After the principal showed my Dad the law in the book prohibiting anyone from receiving high school credits prior to being enrolled in high school, my Dad promptly produced the letter (on the high school’s letterhead) that read that I would receive credit for the high school courses I took while in junior high upon enrolling in high school. And that was that. The principal didn’t argue any further, and I was allowed to graduate high school in 3 years at 17 years old.


I felt that I was ready for college, and maybe a part of me was. Another part of me wonders what might have been different if I had done the full 4 years of high school, but that path was never traveled. I was pretty arrogant as an adolescent, incorrectly assuming that I knew better than everyone else, including of course, most of my high school teachers. From an academic standpoint I believed I was ready for college-level coursework and responsibilities. I very badly wanted it to be up to me to go to classes, do assignments, and study for and take tests, not be forced to do it by some institution’s requirements. Having missed the application deadline for the University of Illinois Champaign-Urbana, I ended up going to a small school not too far from home, the College. The College could appropriately be described as a wanna-be Ivy League school, or at least that might be the impression one would get by interviewing the typical student—a prep school graduate from the East coast somewhere. In other words, a lot of rich kids concentrated in one of the most upscale neighborhoods north of the Chicago land area. My parents did OK, but we were not rich. With the amount of money my parents were spending on my college education I definitely felt obligated to give it my best shot, hence my halfway decent work ethic in school, and my decision to ultimately double major. (I was already there, so why not pick up the second major!)


 

The Importance of Stability

I think the goal of bipolar disorder is to become and remain stable. I think that this enables a much more fulfilling and deeper sense of the world as you are able to take your observations as someone with bipolar disorder and actually use them instead of just experience them. Now, experience is more important than using them of course, but there’s a lot of pain that can be in that experience. And I guess you could say I’m for the nullification of that pain.


The kinda pain so deep that you would kill yourself if you had lived with that for the rest of your life. You wouldn’t want to live with that, you couldn’t live with it. But with medication, both pharmaceutical and herbal, people like us are able to remain stable, remain happy and be consciously aware of ourselves and our environment. Instead of just running through it like we are trying to escape something were actually able to stop and enjoy it and then repeat the process again reliably and tell others about it. That’s what I think the major benefit of stability is; the ability to participate in your own way. Not having to play games with people just to coexist.


You know what I mean, having to maneuver your way through the people landscape just to survive. Once stability is reached, and that does not necessarily imply becoming a zombie, in my experience it is implies that I can love again, I can be patient with myself and that the notion of what is urgent and what’s not has greatly shifted as well. I feel more myself being stable.


And this is the new frontier for us; what to do with our bipolar once we have it under control. And by “under control” I mean to imply, “harmony”. And there is no wrong way to get to true stability. I think that the definition of what is true is different from person-to-person. The point is that to get to stability, to become stable, you have to do it you have to do.


But I think there are a universal rule that works towards all stability. That is you don’t do harm to yourself or to others. Because once harm is introduced it’s definitely no longer stable and harm can mean mania or depression. Now don’t take me wrong, I’m not saying that it isn’t okay to be manic or depressed. I thrive with my hypomania. But instead I mean the kind of experience that begins to hurt you. The kind of mania where you end up in jail because you did something really stupid. The kind of depression where you can’t see the light and a flame of void burns in your body.


Stability is critical because it brings you to a place where you can do with yourself what you want instead of being done unto by what you don’t want. So, I see stability as the ultimate objective and how you get there is really as unique as you are. And the only rule is to do harm. That’s the big ticket winner right there.

 

Seeing The World As I Do

So much of my life I have assumed other people knew more than me. In fact I assumed that I was always wrong. But as I’ve gotten older I realize that most people are ill informed and carry out haphazardly. I would like to think that I see opportunity in a different way. I would like to think that I am courageous and willing to bend steel with my hands. But, that’s probably just grandiosity.


The problem was that as someone who has bipolar disorder and as someone who has always been generally confused in most the critical way (relating to the American school system), socially, I failed to see my on strength. I thought I was useless. And it’s not far from what I was told.


Today I see myself in a much different light, I see myself as a growing man. In fact I haven’t seen this clearly ever. And it’s not some isolated manic event either, it feels like a general trend in moving towards different awareness. I feel like not that I know or can do special things, but that I am more perceptive or quick.


See, the real talent isn’t knowing everything it’s being able to spot it when you see it. Did you ever play those games in the car as a kid, like the “I spy with my naked eye” games? I was really good at those games. And as that manifests today in a much different form I see a lot of different things. Mostly, the feeling I get is like a lot of light switches are flipped in the off position. Now when I say that, I’m referring to people, not the constructions of people. I’m talking about the condition of people’s minds.


I’ve said before that I’m a pretty sensitive person, always have been. I’ve always been able to see the big picture of what’s happening versus expertise in the minute. And as I see people in the off position I wonder if what I’m seeing is only in contrast myself. Am I just much more intense or excited than most people; you better believe it. Yet, I don’t think that puts my perspective or my observations at a disadvantage and therefore skewing them. No, instead I think it gives me a unique advantage.


This is an advantage that is innate to many people with bipolar disorder. We are able to get sort of a sixth sense for what’s happening. Many times it happens when we are panicking, but that’s really a different story. So here’s the point, I feel like I’m growing up and as I’m growing up and learning to speak my truth I feel that my ability to perceive the world around me is improving. Terence McKenna was right, “The world is made of language.”



 

Bipolar Rap – Dignity

These words I speak are the names of drugs

 

Some are friendly just like hugs

 

But others are dangerous, bad for you

 

Turning your brain into a goo

 

Prescription, Illegal, the dance it goes

 

Deciding which one, no one knows

 

Why some are on the shelf

 

While others get you prison wealth

 

The refined nature of science it is

 

Hard to break for many kids

 

Drugged to oblivion

 

Turning off the river in

 

The mind’s eye

 

Sky high

 

Choosing a medication, whether it self or official

 

Boils down to chewing the gristle

 

Baring the brunt of the bipolar impact

 

Doing what we need to stay intact

 

Some seek to punish us for what he do

 

I say to them, I pity you.

 

I seek solace from my pains

 

But these that I pity wish to keep me in reins

 

That’s the struggle and balance we fight

 

Only sometimes knowing what’s right

 

For so many of us, we are lost and at the mercy

 

Of something apathetic and dangerously thirsty

 

But on we go as bipolar folk

 

Off with our burdens, away from the yoke

 

Destined for the stars are all of us inside

 

Too many starry nights have a I cried

 

To forget my destiny

 

To be the best of me

 

 Bipolar Dx in Mom Makes Pregnancy Risky

 

Action Points

This study found that untreated pregnant women with bipolar disorder had a number of complications compared with women without the disorder.

Note, however, that treated bipolar disorder in women during pregnancy also was associated with increased risks of adverse pregnancy outcomes.

Women with bipolar disorder had a significantly increased risk of adverse outcomes in pregnancy, regardless of whether the psychiatric condition was treated, investigators reported.

 

Bipolar was associated with almost a twofold increase in the frequency of induced or planned C-section and a 50% higher risk of preterm birth, according to Robert Bodén, MD, of Uppsala University in Sweden, and co-authors.

 

Microencephaly, small for gestational age, and neonatal hypoglycemia all occurred more often among infants whose mothers had bipolar disorder, they reported online in BMJ.

 

"Our findings of increased risks for several of the investigated outcomes also in the untreated women suggest that mood-stabilizing treatment is probably not the sole reason for the increased risk of adverse pregnancy and birth outcomes," the authors wrote in conclusion.

 

"The role of treatment is, however, still unclear as the overall analyses of variation in outcomes generally did not support a significant difference between treated and untreated women. The possibility of an anabolic drug effect with increased risks of gestational diabetes and reduced risks of fetal growth restriction should be noted."

 

Bipolar disorder has been associated with a small increase in the risk of pregnancy complications, preterm birth, and delivery of small-for-gestational-age infants. Previous studies had not separated the effects of the condition from potential effects of treatment for bipolar disorder, the authors noted in their introduction.

 

Mood stabilizers remain a cornerstone of therapy for many patients with bipolar disorder. Knowledge about these drugs' effects during pregnancy is limited. In particular, studies have yielded inconclusive results regarding the effects of antipsychotics during pregnancy.

 

The limited information and its lack of consistency provided a rationale for exploring the relationship between treated and untreated bipolar disorder and adverse pregnancy and birth outcomes.

 

Bodén and colleagues analyzed data from Swedish national registries for prescription drugs, birth data, and patient information. Data from the drug and birth registries encompassed the period 2005 to 2009, whereas the patient information registry provided information from 1997 to 2009.

 

The analysis included 332,137 women who had an estimated last menstrual period after July 1, 2005 and gave birth to a single child by Dec. 31, 2009. The study population included 320 women with treated bipolar disorder and 554 with untreated bipolar disorder.

 

Women with bipolar disorder more often smoked, were overweight, and more likely to have a history of alcohol or substance misuse. In the subgroup 0f patients treated for bipolar disorder, the most commonly used agents during pregnancy were lamotrigine (40%), lithium (40%), and antipsychotic drugs (39%).

 

The proportion of women ever admitted to a psychiatric hospital was substantially greater in the subgroup of patients with treated versus untreated bipolar disorder (67.5% versus 48.0%), as was admission to a psychiatric hospital within the past year (31.5% versus 9.8%), and admission during pregnancy (2.7% versus 0.7%).

 

As compared with patients who did not have the psychiatric condition, women with bipolar disorder had increased odds for:

Instrumental delivery -- 24.7% (no bipolar), 33.0% (untreated bipolar), 34.1% (treated bipolar), P<0.001

 C-section -- 16.8%, 23.5%, 25.6%, P<0.001

 Nonspontaneous start of delivery -- 20.7%, 30.9%, 37.5%, P<0.001

 Preterm (<37 weeks) birth -- 4.8%, 7.6%, 8.1%, P=0.03

 Apgar <7 at 5 minutes -- 1.1%, 2.0%, 1.3%, NS

 Neonatal hypoglycemia -- 2.5%, 4.3%, 3.4%, NS

 Small for gestational age -- 2.3%, 3.4%, 2.5%, NS

 

 

While information has gotten much better, many misconceptions still exist and endure.

Below, you’ll find five persistent myths about bipolar disorder

 

1. Myth: Bipolar disorder and depression are completely different diagnoses.

Fact: Bipolar disorder and depression — also known as unipolar depression — are not completely different illnesses, according to Francis Mondimore, MD, associate clinical director of the Department of Psychiatry at Johns Hopkins. In fact, he believes this is one of the most misunderstood ideas about bipolar disorder. (He blames psychiatrists for the misconception.)


Patients who believe this myth may oppose the diagnosis “if they don’t have the full-blown ‘manic-depressive’ picture and also resist taking “bipolar” medications like lithium,” said Dr. Mondimore, also author of Bipolar Disorder: A Guide for Patients and Families.


It’s more accurate to think of bipolar disorder and depression as “probably represent[ing] two ends of a spectrum of illnesses,” he said. “The designation ‘bipolar II’ has helped crack this a bit, but this is why the term ‘bipolar spectrum disorder’ continues to gain ground,” he said.


2. Myth: People with bipolar disorder experience dramatic mood swings followed by complete remission of symptoms.

Fact: Some people with bipolar disorder experience this pattern, Mondimore said. (Lithium is typically very effective for these individuals, he said.) However, “Many patients have periods of residual symptoms and less severe but still significant mood fluctuations between episodes of more severe symptoms,” he said. This is especially common if people don’t engage in healthy habits to manage the illness.


3. Myth: Medication is the only treatment for bipolar disorder.

Fact: Medication is an important part of managing bipolar disorder. But it’s not the only answer. Viewing medication as your only treatment option “can lead to fruitless reaches for the ‘right’ medication,” Mondimore said. And it can lead you to avoid making valuable lifestyle changes and seeking therapy, he said.


As Fast writes on her website, “Medications take care of half of the illness, the other half is management.”


Both Fast and Mondimore stressed the importance of leading a healthy lifestyle, including avoiding alcohol and drugs, cultivating good sleep habits, exercising and effectively coping with stress.


Fast includes medication and alternative therapies as part of her treatment plan. Still, she cautioned against thinking “that we can exercise, diet, meditate, walk and rethink our way out of this illness.” (In fact, this is another big myth that persists, Fast said.)


Think of bipolar disorder like any other long-term illness, such as diabetes and high blood pressure, Mondimore said: It requires commitment and comprehensive management.


4. Myth: After having a severe episode, people with bipolar disorder should be able to bounce back.

Fact: If a person with bipolar disorder experiences a severe episode — one that requires hospitalization, for instance — there’s an expectation that afterward they’ll be able to get back to their work and life, Fast said. However, she equated this scenario to people who’ve been in a car crash. You wouldn’t expect someone with broken bones simply to get up and start sprinting.


5. Myth: People with bipolar disorder aren’t trying hard enough.

Fact: People wonder why someone with bipolar disorder just doesn’t try harder. They think that if they exert more effort, they’d have the life they want. They wonder why everyone else who experiences mood swings can cope with them but someone with bipolar disorder can’t. Sometimes Fast has even wondered the same thing about herself.


 

Results with Treatments

What To Expect from Treatment


Treatment can consist of medication, psychotherapy or a combination of the two. Various practitioners, including psychologists, psychiatrists, licensed professional counselors and social workers, and primary care physicians can treat depression. Which professional and which treatment you choose is up to you.

“In our experience, fully half of patients can be managed exclusively in primary care. Many others would benefit from mental health consultation and some may need or prefer to be managed in mental health,” Dr. Dietrich said. Taking medication “can work on its own, is more accessible to many people and may require less frequent visits,” he said.

However, as Hollon points out, medication doesn’t correct the underlying propensity for depression or address the negative thinking and behavior. This can be especially problematic for patients with chronic depression.

Whatever the limits of medication and psychotherapy, each is effective in reducing depression symptoms. Some research has shown that a combination of the two is particularly powerful.

Psychotherapy


There are many types of psychotherapy; however, not all approaches are created equal. So it’s important to understand what approach your therapist is going to use. Whereas generic talk therapy has not been proven effective in treating depression, research consistently shows that cognitive-behavioral approaches and interpersonal therapy are successful.

“Depressed patients typically make specific errors in thinking and engage in unproductive behavioral patterns that lead to, maintain and can worsen depression,” said Oakley. When they walk in the door, clients typically have lots of evidence that they’ve screwed up in life and tend to blame themselves, said Hollon. It is these errors and evidence that cognitive behavioral approaches address.

Contrary to popular belief, these therapies don’t focus on the power of positive thinking. “I’d much rather see people be realistic instead of falsely optimistic,” said Hollon.

A large part of cognitive-behavioral approaches is investigating patients’ slew of negative evidence. “Patients learn how to examine the accuracy of their own beliefs, so they don’t get stuck with self-fulfilling prophecies,” said Hollon. For instance, instead of saying, “I didn’t get into college because I am stupid,” a patient examines the evidence and might realize that he didn’t get accepted because he only applied to one school or didn’t correctly complete the application.

Length of treatment ultimately depends on the severity of the depression, but cognitive-behavioral therapy (CBT) typically lasts from 12 to 24 sessions. “Patients can usually expect to see incremental changes in mood usually by the 12th session,” Oakley said.

In Hollon’s experience, patients typically start feeling better after a week or two, though the gains aren’t lasting. If Hollon doesn’t see “good improvement between four to six sessions” (if the depression isn’t severe or chronic), he wonders what’s missing. If you aren’t getting better, always ask why and don’t blame yourself, said Hollon. “It might be that your therapist isn’t pushing you forward.”

Overcoming Common Obstacles in Psychotherapy


Various hurdles can hinder progress in therapy. Here’s how to overcome them.

•Be honest. Though it’s tough opening up to someone you don’t know about your innermost feelings, being honest with your therapist helps you make progress. If you aren’t comfortable disclosing information to your therapist, ask yourself why. If it’s the therapist who makes you uncomfortable, you might want to see someone else.

•Be willing. It’s important to enter therapy with an open mind. For instance, even though you might experience a loss of interest in all activities, your therapist will encourage you to experiment with “things that previously brought joy, a sense of meaning or accomplishment,” said Oakley. Be willing to try these and other activities.

•Remember you’re a team. Successful treatment involves both the patient and the therapist; it’s a collaborative process. “Patients assume an active participation in treatment, and assignments that are designed to build skills are an integral part of effective treatment,” said Oakley.

•Speak up. A common obstacle to CBT is when patients don’t complete their assignments between sessions. “If your therapist is suggesting homework that seems like too much, discuss this with your therapist, who will most likely be open to the feedback and will work with you to make the between-session work manageable,” said Martell.

•Consider your belief system. For some people, an ingrained belief system can impede treatment. For instance, an individual might feel that he’s doomed to a life of depression because of a family history of the disorder.

•Remove mood from the driver’s seat. A common trap for depressed individuals is that they aren’t motivated to participate in activities that improve their mood. They become inactive and withdrawn, which worsens and maintains their depression, Oakley said. This is where it’s key not to let your feelings dictate what you do, he added.

General Tips To Overcome Depression

In addition to medication and psychotherapy, there are many things you can do during and after your treatment to boost your results and prevent future episodes.

•Try doing the opposite. “If things aren’t going the way you want them to go, do the opposite,” said Hollon. He’s referring to Dr. Marsha Linehan’s concept of “opposite action,” part of dialectical behavior therapy, which teaches patients how to change their emotions. For instance, instead of isolating yourself because you’re feeling sad, call a friend, have dinner with a loved one or invite company over.

•Establish and maintain relationships. Build a social network and surround yourself with meaningful relationships.

•Practice good self-care. Many know that a healthy lifestyle — including eating well, exercising, getting enough sleep and resting — is important for our mental health. The same is true for discouraging depression. If these habits seem overwhelming at first, take it step by step. Think about small changes such as cutting out junk food, taking a 20-minute walk or aiming for an extra hour of sleep every night.

•Build your resilience. The APA defines resilience as “the process of adapting well in the face of adversity, trauma, tragedy, threats, or even significant sources of stress — such as family and relationship problems, serious health problems, or workplace and financial stressors. It means “bouncing back” from difficult experiences.”

The APA lists 10 ways to cultivate your resilience so you’re better prepared to bounce back after trying times. Some of these suggestions include changing how you view and respond to stressful events; developing realistic goals; finding opportunity in obstacles; and nurturing your confidence in solving problems.


•Help others. Whether it’s assisting at the food bank or reaching out to a loved one who’s going through a difficult time, it’s important to support others in addition to yourself.

•Put things into perspective. “Even when facing very painful things, look at the situation in a broader framework,” said Dorlen. Similarly, avoid catastrophizing, or anticipating that negative events will occur. This kind of thinking creates harmful self-fulfilling prophecies: If you think you’ll fail, you just might help yourself get there.

•Maintain a routine. “A routine gives life structure,” said Dorlen, who works with her patients to keep daily routines. For instance, your morning routine might consist of enjoying a brisk walk, reading the paper while you eat breakfast and taking a shower before you head to work.

•Have a psych checkup. People have regular medical and dental checkups, but a psychological checkup also is essential, Dorlen said. For instance, after having cancer treatment, a patient is never just sent on her way with a goodbye and good luck; she goes in for regular checkups, Dorlen said. You can conduct the check-up yourself. Consider how you’ve been feeling lately. Are you taking good care of yourself? Have you fallen into bad habits?

You can see a mental health professional for this if you prefer. It’s not uncommon for Dorlen to see her patients for an occasional “tuneup,” which typically lasts several sessions. By “keeping tabs on yourself, you don’t wait until it’s too late, till you’re lying in bed unable to do anything,” Dorlen said.


•Use your tools. Rather than retiring the tools and concepts you’ve learned in treatment once you’re in remission, make sure to practice them regularly.

•Watch for signs. Similar to your psych checkup, “keep your eyes open to early symptoms to stave off a real serious episode,” Dorlen said.

•Purge your perfectionism. Originally, depression was defined as “anger directed inward,” said Dorlen, who commonly sees the devastating effects of self-criticism and perfectionism. Learning to be less critical and cutting yourself some slack tremendously helps individuals, she said.

Additional Resources


The MacArthur Initiative on Depression & Primary Care includes handouts about treatment for both clinicians and patients.

Families for Depression Awareness helps families recognize the warning signs of depressive disorders and manage them.

Depression Is Real aims to help people living with depression, their loved ones and the public understand the facts about depression.

National Alliance on Mental Illness focuses on support, education and advocacy in helping people with mental illness and their families.

Depression and Bipolar Support Alliance is a national organization that helps people with depression and bipolar disorders. It includes free educational materials on its site.

National Institute of Mental Health focuses on mental health research and contains the latest information on all mental disorders.

Challenge: Medication


“There is no ‘one size fits all’ medication that helps everyone with bipolar disorder,” Johnson said. Lithium is typically the first line of treatment. But for some people the side effects are especially troublesome, she said. Finding the right medication (or combination of medications) can seem like a daunting process.


Strategies: Learn as much as you can about mood-stabilizing medications, Johnson said, including their potential side effects. “Find a doctor who will work with you to make adjustments based on your experiences with the different medications,” she said. Expect that it might take several tries to figure out the best medications for you.


Many of the side effects dissipate after the first two weeks, Johnson said. Changing the dose schedule helps to minimize side effects. For instance, if you feel groggy, your doctor might suggest taking your medication in the evening, she said.


Support groups are another valuable tool, Johnson said. (She suggested looking at the Depression and Bipolar Support Alliance website for a group.) For instance, individuals in these groups are usually familiar with compassionate doctors in the area, she said.


Challenge: Relationships


Bipolar disorder is hard on relationships. The very symptoms – swinging moods, risky behaviors – often leave loved ones feeling confused, exhausted and like they’re walking on eggshells, Van Dijk said.


She also sees loved ones have difficulty distinguishing between the illness and the person. They might invalidate the person’s feelings and either blame everything on the illness or believe the person is making conscious choices when it is the illness.


Strategies: Bipolar disorder is difficult to understand, Van Dijk said. “Different affective episodes, [such as] depression versus hypomania, result in different symptoms, and one episode of depression or hypomania can be different from the next within the same person,” she said.


So it’s incredibly important for loved ones to get educated about the illness and how it functions. Individual therapy, family therapy and support groups can help. Refer loved ones to self-help resources and biographies or memoirs of people with bipolar disorder, Johnson said.


Getting a handle on your emotions also improves relationships, she said. Working on assertiveness is key, too, she said. Individuals with bipolar disorder tend to have a tough time being assertive. Therapy is a good place to learn assertiveness skills. But if you’d like to practice on your own, Van Dijk suggested using “I statements”: “ I feel _____ when you ______.” She gave the following example: “I feel scared and hurt when you threaten to leave me.”


 

By the book’s end, the reader gains a deeper understanding of how Livingston sees fear as well as courage. This analysis empowers readers to work at controlling their anxieties and strive toward more courageous and certainly more self-fulfilling actions.


In the early chapters, Livingston explains some working concepts to better understand fear. We’re all going to die and we know it, which worries us and causes us to avoid situations that put us at risk. Anxiety with its symptoms of a racing heart, sweaty brow, and general panic is related to fear. However, what triggers it remains a mystery. Both fear and anxiety can result in poor decision making, isolation, and failure to reach a person’s full potential.


“It is within ourselves, where we confront our deepest fear and insecurities, that we find our own forms of courage and cowardice,” writes Livingston. “Like any virtue, bravery is manifest in our habitual actions. Fidelity to an idea, risking ourselves to stand up for the powerless, refusing to crumble beneath the weight of time, all require a steadfastness that is uncommon in a culture dominated by glamor, celebrity, and instant gratification.”