Will I Pass on Bipolar Illness?

Please be advised that this post contains information that may trigger some persons’ reactions to nature versus nurture and bipolar illness or other psychiatric disorders.

” The available body of evidence suggests that environmental factors may either trigger or prevent the development of a psychiatric disorder. Moreover, there is some circumstantial evidence of an association between environmental factors and the clinical course of bipolar disorder.

Environmental factors, life events, and trauma in the course of …

https://www.ncbi.nlm.nih.gov › articles › PMC7167807

The data about the nature versus nurture of bipolar illness is mixed. I have seen data that suggests a 10% likelihood of bipolar illness in offspring of people with bipolar condition. But I have also seen more promising statistics that show environmental factors are extremely important in the prevalence and/or the prevention of bipolar illness diagnosis for second generation folks.

My therapist is one of those people who believes more on the nurture side of things rather than the nature side of things.

I grew up in a household where my infant brother had died before I was born. My parents also divorced in large part because of this when I was about ten years old. I felt like the replacement child that could not prevent her parents’ break-up. It is also extremely likely that I had some sort of traumatic event in my childhood like sexual abuse from a neighbor. (There also was no clear history in my family of bipolar or mental illness.)

All in all, my therapist believes I have sheltered my child from any of these occurrences and the likelihood of her developing bipolar is very low. This is incredibly reassuring to me for all the obvious reasons.

I imagine there are folks out there who believe in the nature side of things. For me the nature theory is real in that it heightens the probability of the illness occurring but does not guarantee it.

Anyone care to comment on nature versus nurture and psychiatric diagnoses?

Happy Easter Everyone!

Hello all. I hope you are having a great Easter Sunday or whatever holiday you observe (or don’t observe)! Today I am focusing on being grateful. Even though I have persistent anxiety from my bipolar illness I have lots and lots to be thankful for: my daughter’s health, my daughter’s achievements in school, my husband’s companionship, my Mom’s relatively good health, our new puppy, a psyche doctor and therapist who I trust and consider in my support circle , constant help and support from my sister, and the list goes on….

Can you find it in your heart to be thankful for something today? Even if it as simple as that cup of morning coffee? I hope so.

Have a super day!

What Does It Look Like to Be in Mental Illness Maintenance Mode?

This is just a bit of musing on being in maintenance mode with bipolar illness. At times, I have called this maintenance mode being in mental illness remission. Due to the specifics about what is illness remission and what it is not, I am choosing today to talk about where I am in my history with bipolar illness as “maintenance.”

What does bipolar maintenance look like for me?

  1. Being on a largely functional cocktail of meds that are monitored by a psyche professional. I adjust these meds slightly with the help of my doctor when I am going through extra stress or when stress is more manageable. I have been on the same basic meds since about 2008.
  2. Seeing that psycho-pharmacologist about every three months with monthly trips to the lab for bloodwork. It is important to me to be honest with my doctor and to have the type of relationship where I can work with him to adjust med levels when needed.
  3. Seeing the therapist about every 2 to 8 weeks. Every two weeks is if I am in a rough patch. Every 8 weeks if all is progressing well. Back in 2008, this was weekly. Mostly now it’s every 4 to 8 weeks.
  4. Not having to be admitted to the hospital for 2 plus years. For me this has been since fall 2008. I have been informed that not being hospitalized for a period of time, in and of itself, does not qualify as remission. But the stats seem important to me to include as at least one barometer of remission and/or maintenance.
  5. Having several activities like blogging, care of pets, walking or yoga routines that are by and large fulfilling if not enjoyable. I find that with the anxiety and depression that I experience with bipolar illness, my activities are sometimes fulfilling and sometimes not. Getting them done is what I count most. There is “enjoyment” or “satisfaction” in getting them done even if at the time, the activities themselves are not particularly “joyous.”
  6. Being able to manage day to day activities in the household. These for me include being supportive to my teen-age daughter, keeping my relationship with my husband current and vibrant, running the household, going to the grocery on a regular basis, getting a healthy dinner on the table each night, doing basic laundry and clean-up, caring for a new puppy. This does not require me to hold down a job which has been a struggle for me since 2005 or so or perhaps earlier.
  7. Seeking out regular contact with friends and contacts who are supportive of bipolar illness. I have had a neighbor who is close to me move about an hour away from where I live, so I could make some improvements in this area. We used to talk openly about stress and anxiety on regular walks. It would be great to resume this activity virtually if possible. Blogging also does help create a sense of community support. I have been blogging regularly for a couple of years and this is very fulfilling — both the reading and the writing of various posts.
  8. Doing something tangible to reduce stigma about mental illness. Instead of being the victim of mental illness stigma, I have found it empowering to write about stigma in my journaling and in my blogging. It is important to get out in front of the stigma and try to tackle it and talk about it before it becomes a big deal with big deal consequences. I have found it difficult to address stigma, but I also have found that talking about it and educating people who have no prior exposure to mental illness is important. I have just written a series of blogs about mental illness stigma and working as a project manager. Hopefully that perspective when shared may mean people who have no prior connection with mental illness can at least read about what it’s like to experience that stigma.
  9. Talking and educating people who have no connection to mental illness seems to be at the top of the list for me for stigma reduction. Stigma reduction does not happen immediately or overnight, more like a small, small drip into a large, large pond. Very small change but change nonetheless. Also to note, there is real danger of preaching to the choir about mental illness stigma. Most people who might follow my blog probably already think stigma is an issue. In stigma reduction, it is important to find ways of reaching people who are not yet educated on mental illness and its challenges.
  10. Finally, being in maintenance mode for me means being able to be kind to myself. This means forgiving myself for mistakes no matter how large or small. This means giving myself credit for accomplishments achieved no matter how small they may seem – like going grocery shopping for healthy food that day. This also means not comparing myself to others in a way that makes me feel “less than” or “more than.” Maintenance mode means being willing to accept constructive criticism from my support team even when that criticism is difficult to hear. It also means standing up for myself when the criticism may not be “spot on.”

Does anyone else care to share what mental illness maintenance might look like to them?

Working with Bipolar Illness – Lessons Learned

All in all, my work experience has taught me several things about working with bipolar illness.  In no particular order they are here:

  1. Working in the public sector may be more forgiving than working in the private sector when it comes to stigma and access to short and long-term disability (in the US).
  2. People who have a family member with mental illness are 100% more likely to accept mental illness in an employee and be willing to work with that person toward mitigation strategies to help reduce stress and stigma in the workplace and help alleviate mental illness. 
  3. Most people in the workplace do not have a family member with mental illness and in general do not have a clue how to respond or how to be of help.  Generally these people consider you a danger to yourself and others.
  4. Keeping a presence in the workplace is very important if you are taking care of your own health insurance.  If you are blessed to be on a family member’s insurance plan and/or your home country has universal healthcare, be thankful.
  5. Meds are sometimes difficult – finding the right one or the right combination of drugs.  It is helpful if you feel you can work with a psyche doc about finding the right combination for you.  It is preferred if you can have a partnership and a doctor who listens to you as to what is working and what is not.  This can be a struggle particularly if you are going to work every day.
  6. I believe that mental illness like addiction has a bottom out effect.  You will not start thriving and responding to meds and other interventions until you have hit rock bottom.  This involves a sense of honesty about your symptoms and your challenges for yourself, your family, your support community and your medical team.   It also involves honesty with self about what kind of jobs you are best suited for.  For me project management work was not the best fit, but it took me a while to figure that out.
  7. Working for yourself, if you can afford it, allows you to explore your strengths without over-taxing your brain or your illness.  You can set your own schedule and allow yourself breaks for med checks, labs, psyche appointments and so forth.
  8. Blogging is a good way to keep honest within yourself and with other people in your blogging community.  You can learn a lot from telling your story and listening to other people’s stories as well.
  9. All in all, remember that you are more than your accomplishments.  If you spend most of your time on self-care rather than in a career, you are still doing a great job and you still have a huge contribution to make.  Being paid for what you do is not the tell-tale sign of success.  Define success based on your own goals that you reach and setbacks that you overcome. 
  10. Finally, don’t compare yourself to others especially those who don’t have a mental illness challenge or have very mild symptoms.  Judge your progress in the workplace and in your educational endeavors based on your own realistic goals.  Don’t be hard on yourself if it takes you longer than your peers or your siblings to reach your goals.  Or if you don’t reach them at all.  There are likely other strengths that you have that these people don’t have.

Does anyone care to add to the list of lessons they have learned about the workplace and mental illness? I am sure I have missed a bunch….

Managing Bipolar Illness in College and in Graduate School

Graduate school from 1992 to 1994 was a time when my bipolar illness appeared to be getting more manageable.  Again, this was before the time of becoming a Project Management Professional or PMP-certified in 2002.  The mini-breaks began to subside in or around 1994, though I was still managing bipolar symptoms.  During this time my awareness of the importance of the sleep cycle developed.  If I had two nights of really bad sleep in a row, there were warning signs that instability was around the corner.  This two-night sleep rule continues with me today.  Now I can generally manage a one-night sleep deprivation but not two.  In addition to the new sleep hygiene, I gave up caffeine and alcohol at this time (though later resumed my use of caffeine only).

When I was enrolled in my master’s program, I was taking a Finance class and was having difficulty with bipolar symptoms.  The date for dropping or adding a course had already passed.  But I knew that I was not going to pass this Finance course.  I simply could not get the concepts the way the professor was teaching them.  So I reached out to the professor and asked if he could make an exception for the drop/add rule due to the fact that I was experiencing bipolar symptoms.  He reluctantly agreed but agreed nevertheless.

Later that summer I took a finance class from a different professor whose method of teaching “I got.”  I had no problems taking the course and passing it with this new professor.

This experience in academia also harkens back to a time during my undergraduate career.  I was able to drop a course associated with writing my thesis around the time I had my first break.  The college was accommodating in this regard, but did not provide any disciplinary action for the professor associated with that thesis who was engaged in trying to get me to come with him on a trip to New York.  My experience is that he was engaging in very inappropriate behavior – trying to get me to go to New York with him as well as providing cocaine to a group of undergrad students.  I have written several blogposts surrounding this experience as an undergrad so I will not go into detail about it at this time.

All in all, academia has been pretty tolerant of special needs associated with school requirements and my bipolar symptoms.  I would say though that there is still a long way to go in clarifying what type of behavior is appropriate for a college professor towards his or her students.  At the time in 1984 and 1985 there was absolutely no guidance from academia and academic ethics in this regard.

Stigma Resistance and Existence in the Project Management Workplace:

I have found in my 35-year career mostly doing project management work that the company you work for is only as accepting as the people who make it up.  When I have experienced a supporting atmosphere for my bipolar illness (which is extremely rare), my mentor or my boss has come from a place where mental illness was in their family.  One a husband, one an aunt.  This was volunteered information to me from them.  I find the ability of the workplace to be supportive is in direct correlation to the boss or mentor having first-hand experience with mental illness.  For all intents and purposes, the individual and not the company is the determinant of a supportive environment for working with a mental health condition.

It should not be this way.  The company as a unit in and of itself should be able to show understanding and support for mental health challenges particularly with such advances as the Americans with Disabilities Act. 

In my experience, the company is more prone to act out of fear or out of ignorance and assume someone with a mental health condition is dangerous to themselves and to others around them.  There is a tendency to criminalize people with mental health diagnoses in the workplace when that mental health diagnosis is exposed. 

Not uncommon is the ushering out of the office by building security when the mental illness surfaces.  Is this ever done when you have diabetes?  Or a brain tumor?  Or cancer?  No, you are not humiliated and meant to feel you are criminal just for being ill.  These other illnesses are accepted as part of the risk profile for managing employees.  People are given support for their illness by co-workers and by management for these other non-mental illness profiles, while for mental illness profiles the employee is considered an immediate and unsurmountable threat and treated as a criminal.

Again, I would hope in the US the Americans with Disabilities Act would change this criminalization of people with mental health diagnoses in the workplace, but in my experience it has not.  That sounds out as a sad state of affairs for employment for people with mental health diagnoses.

Have you ever been treated poorly at the office because of a mental health diagnosis or break-through event? Have you ever been treated well for the same? What causes some employers to act in a way that is supportive and others not?

My Sojourn through Bipolar Illness – Clothing then and now (reposted)

As a note before this repost, I have successfully maneuvered getting 10 to 13 pounds off (and stayed off) in the last several months. This has largely been due to introducing daily exercise into my day – walking and/or yoga. This is the first time I have been able to stick to such a routine in 17 years. Oddly, my evening snacking has not made the weight gain disappear but it does tell me that I could get another 7 to 10 pounds off if I could just stop the snacking / stress eating in the evening after dinner. The repost is below:

I have continued to have some sort of fixation with clothes and clothing – not only the color in which they appear but also the “privacy” of the label.  Sometimes this label is not private and is emblazoned on the back pocket of the jeans as in Calvin Klein jeans from the 1970’s or even the Levi’s name tag on that ever so timeless brand of clothing.  I am unsure what this fixation on clothing entails exactly.  I do know that it is tied with some body image issues that get complicated because of my need to take regular meds for my bipolar condition. 

Throughout high school and college I remained a size 6 to 8 when I perhaps should have been a size ten.  After meds were introduced in my life I was almost always a size 8 to 10.  After bearing a child and substantially increasing my meds, I have been more a size 12 to 14.  My goal at this juncture in life is to be back at that size 12.  Perhaps my obsession with clothing is in parallel to my own body image issues, perhaps not. 

In any case, the preoccupation with clothing seems to have something also to so with pattern recognition.  If four people out of ten wear red to the office that day, I notice it.   If black was worn by person A on day one and by persons B, C, D, and E, I notice it. Not that I really ever did anything with the information, it was just a layer of the type of perceptions I would have – extraneous and meaningless maybe or maybe not.  Definitely with a focus on color patterns and patterning.

In my teens, I spent hours shopping for the right clothing.  Today, I abhor shopping for clothes largely because I am two sizes bigger than I would like to be.  The preoccupation with clothes at an early age is probably all wrapped up in image.  I have very little to say in that regard today as Ego is largely drained from my daily events.  I tend today to wear the same make of clothes all the time and often repeat the same outfit once a week.  In fact, I do not care about clothing at all.  It is a chore to buy clothes and it is a chore to pick out clothes for any given day.

While being diagnosed with an eating disorder is something I have considered as relevant to my mental health, I feel that my weight gain issues center more on body image issues and medication use.  For years, I bought into the fashion magazine mindset that you were not beautiful unless you were a size 6 or size 8.  For years throughout high school and college and into my twenties, I ate and exercised in order to maintain a size 6 or a size 8 figure.  Often this meant running three to five miles several times a week and counting caloric intake to be about 1000 calories a day.  When I became pregnant at age 38 I was about a size ten. After giving birth to my daughter, I have stayed at a size twelve if not a size fourteen.  I currently have very little discipline in the food and exercise realm largely in my own view because I feel I am reacting to years of over-exercising and over-dieting. 

So it is that my size in clothes has moved from a size 6 in high school to a size 14 in married life and after child-birth.  This continues to be a goal of mine to return again to size 12 through a combination of exercise and food monitoring.  However, it is something admittedly that until quite recently has fallen off the radar screen.  Some of this frustration and back-pedaling about eating and exercise may include the fact that meds are often associated with weight gain.  In my mind, I tell myself it is better to have an extra twenty pounds on while taking medicine than it is to be a at a model’s weight with little or no mental stability.  This is particularly true when I start to be honest with myself that fasting from breakfast time through lunchtime is associated with mood issues since blood sugar levels are not being addressed.

My Sojourn through Bipolar Illness – Fear of Flying (reposted)

I am reposting chapters of the book I wrote a few years ago in hopes of catching some more recent readers. Thank you in advance for your readership. These posts provide a graphic account of a life with bipolar illness. Please avoid these posts if that is a trigger for you.

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Note – several names and places have been changed throughout this text in order to keep my story somewhat private. Thanks for understanding that need.

Although I had had no prior fear of flying, my first episode of bipolar illness was in a tiny airport near my Ivy League college (hereafter known as Ivy College).  While I was waiting for the plane to get ready to taxi off the runway and take me to my first interview for a job after college in advertising, I was consumed by runaway thoughts.  My thoughts were anywhere but on my interview for an Account Executive position at Chicago Avenue Advertisers.  I had no specific directions for my fears but I took out some papers I was working on for my undergraduate thesis at Ivy College and was writing and writing furiously in and around the margins of the pages of the papers I previously had written.  The thoughts seemed to co-mingle with the characters in the fiction as well as characters or people I knew in real life.  The writing was fast and furious until I finally heard the flight that I was to take to Chicago on the puddle-jumper called.

For some reason I did not feel safe in myself enough to board the plane once the flight was called and I came to the conclusion that the plane was going to crash.  I did not communicate this fear with anyone.  Instead I determined that I did not want to get on a plane that was going to crash, so I got my suitcase together and asked the airplane attendant if I could check my bags on the plane but not board the plane myself.  For some unknown reason, the contents of my suitcase were of paramount importance.  I recall a navy suit that I had packed and feeling like that suit should reach a friend who I was going to see in Chicago.   The label on the suit became extremely important at the time – it was an Evan Picone double-breasted navy wool suit.  The airport personnel immediately got suspicious and asked me why I was putting my suitcase on the plan and asked me to move away from the plane with them.  When I refused, the safety patrol man exerted more force and tried to get me to go with him.  In my fears, I turned to run down the runway away from the scene of the fears and ran completely down the airport runway up into a stand of pines, one shoe flying off in the process and resting in the snowy runway.  I recall exactly what I was wearing – a plaid pleated wool skirt in muted tones, a long sleeve silk blouse and a double breasted woolen gray or taupe sweater.  I don’t recall a coat or over-coat.   The safety patrolmen at the airport followed me into the woods with snow all around and made a chair with their arms for me to sit on.  I was in some stage of delirium and thought they were providing me some sort of throne to safety. 

Instead the next thing I knew I was being handcuffed to the backseat of a patrol car with the patrol lights flashing blue and white and was being escorted to the police station down the road.  When I arrived at the police station I kept telling the police that I was a Senior and straight A student at Ivy College and they must have made some mistake.  On the walls there were pictures of wanted criminals – I kept trying to figure out what the pictures meant.  There were three pictures:  a young woman who I thought looked like Ayn Rand, a man with a long beard who looked in my state to be like a long-haired Jesus and one other picture of a youngish man whose face I cannot recall.  What I do recall is feeling like a criminal and being treated like a criminal until a kind policeman named Michael started to ask me questions.  Once I started to talk with Michael I began to calm down.

After what felt like days of swirling and runaway thoughts and a myriad of questions, the police finally called my family and called the school clinic and I was escorted there.  Soon after, several of my college roommates arrived to be with me while the admission process continued.  After talking briefly with the clinic staff, I was transferred to the local hospital’s Psychiatric Unit. 

Within the next few hours my parents arrived in town and tried to begin to make sense of what had happened.  I recall my parents visiting me in the hospital mostly my Dad whose anxiety I could sense was through the roof.  Within a couple of days, we made arrangements to go back home to Augusta, Georgia.  I unenrolled from classes and moved back home to live with my parents for the spring and summer of 1985.  No one was sure yet if this was a temporary reaction to stress as a Senior and as a Senior thesis writer or the beginning of a lifelong behavioral health diagnosis and challenge.

Question for You?

** This post deals with paranoid thoughts and experiencing them**

We have all been told that paranoid thoughts do not have any value whatsoever. They are thoughts not grounded in reality and therefore something to forget or ignore or get past as well as we are able.

I have been prone to paranoid thoughts off and on since the onset of my bipolar illness in 1984 / 1985. Most times this paranoid thought is confusing, upsetting and painful. However, I am wondering whether to write a blog post that talks about the potential that there may be a small or very small kernel of truth in paranoid thought however hidden or misshapen particularly when paranoid thoughts from several people about the same topic are considered at one time.

For example consider that someone is paranoid about the water quality in the town where he lives and reports that to police. In that same week, police get reports from 5 different people that there has been a suspicious character near the water works for that town and 2 to 3 neighboring towns. These reports each taken by themselves these might be examples of paranoid thought but taken together might hint that there is a potential risk with the water supply in a nearby town.

The key is that there would need to be some independent entity that is recording the paranoid thoughts from individuals and looking for trends in them, then verifying whether the trends are grounded in reality or not.

Does this type of suggestion of trending paranoid thoughts interest you or cause you anxiety? I would like to write more about this potential hidden kernel of truth in paranoid thought but I don’t want to make you uncomfortable in any way. I also do not wish to glorify paranoid thoughts in any way since most of what paranoid thought is is confusing and upsetting. I am looking for your feedback as to whether this type of discussion would be helpful to you or not?

My Sojourn through Bipolar Illness – Intermixing with Police and First Responders

I am of the mindset that police and college campus police could do well with more training as to what constitutes a paranoid episode that is largely safe and what constitutes a paranoid episode that is largely unsafe.  I feel that the police serve in a hugely defining role as to whether someone experiencing an episode of bipolar illness should go the hospital or be incarcerated.  There is no such distinction for any other type of intervention that the police are called upon to mediate.  It takes a great amount of training about paranoia and how it operates particularly in the minds of our youth.  If psychiatrists are largely unable to determine when paranoia is linked with violence or not after days or months or years of working with that person, think what a challenge it is for a police man or woman intervening with no case history on the patient while being charged with the safety of that patient and all bystanders.  It is a huge responsibility that falls on the police and college police. 

I have worked through NAMI (the National Alliance on Mental Health) in their In Our Own Voice Program to talk with these First Responders and provide more insight into the patient’s point of view when these incidents occur.  I found the reception at that event quite welcoming as if the police or campus police had never had a conversation with someone prone to paranoia when that person was outside of that paranoia event.

In any case, I find the work of police and campus police to be a gargantuan task.  It almost requires the intervening police officer to be all-knowing and to be able to size up the situation in a matter of minutes as to whether the person before them is paranoid and a danger to others or paranoid, a danger to themselves and needing hospitalization.  I feel that additional training in differentiating these behavioral health outcomes should be mandatory both for crisis interventionists as well as medical and clinical professionals.  As a person who has experienced mania and being a danger to self and perhaps others, I readily do not see a clear line for police to follow from which to determine how best to intervene.  If I am unclear on that intervention after 30 plus years of managing (or trying to) the illness, I would imagine most police and campus police feel that they are overwhelmed and alone as First Responders in assessing the case of a behavioral health incident.

I feel for the police and the campus police and their courage in this line of work and believe that greater training like that of NAMI’s In Our Own Voice Program is extremely important.  I had one first responder come up to me at that In Our Own Voice presentation and thank me.  The officer had never talked to someone with a tendency toward paranoia when they were not in a paranoid state.  All he had ever seen was the patient at the height of a paranoid event – he must have assumed through no fault of his own that that state of paranoia was the norm for that person rather than a state that comes and goes and can be managed for the most part through medications and talk therapy.   

The First Responders should have some sort of script that allows them to assess if the danger is being directed internally toward the patient or if the danger is more generalized to people external to the person experiencing the breach of reality.  I do not claim to have the content to that script in full, but my current thoughts about how questions for this script might go is something like what follows.  This script below should be vetted by a team of first responders, therapists, doctors and other professionals and is only a “strawman” from the point of view of one patient.

 I am going to ask you a series of 20 questions.  I would like for you to respond to each question to the best of your ability. OK, are you ready?  First question: 

          1) What is your name?

2) Are you a student here?

3) Are you feeling OK?

4) What is the date today?

5) Are you feeling suicidal?                

6) Have you ever felt this way before? 

7) Do you have a mood disorder illness?   Have you ever been hospitalized for a mood disorder?

8) Are you hearing voices?

9) What are the voices saying?

10) Are the voices asking you or telling you to harm yourself?

11) Are the voices asking you or telling you to hurt anyone else?

12) Do you have a weapon?  Are you intending to use it? 

13) Where did you get it?  Have you had it on you for several days or just a few hours?

14) How long has it been since you took a shower?

15) How long has it been since you had a full meal?

16) Have you been using any mind-altering, recreational or prescription drugs?

17) If so, what are they?

18) Do you feel safer now that the paramedics are here and we are talking?

19) Is there someone in particular you would like to talk to? Your parent? Your friend? Your psychiatrist? Your therapist?

20) What do you need to feel more calm?    

If there had been such a script available for use by First Responders at the West Ferry airport back in 1985, perhaps my first episode would not have been so cataclysmic.  Perhaps I would not have been plagued by security concerns for several years after this first episode if that episode had been less threatening and less dramatic.