Can You Learn to Limit the Impact of Your Next Break?

This post was inspired by a recent post at SpeakingBipolar.com.

About 30 years ago I met a psyche doctor who told me the more often you have a break, the greater the likelihood of having a break again. This was directed at the highs and lows, and this doctor requested me to go off alcohol which I have for 30 years and caffeine (which I did for 12 years and then stopped). Knowing this propensity was a great motivator in seeking and obtaining good self care including meds and other forms of care over the years. I tend to call this managing risk. If I manage or minimize the risk of one break, in theory I am (or am I?) managing or minimizing the risk of that or a similar break occurring again in the future.

This seeking good self care and med management and risk management did not start immediately for me but did begin once I was on Clozapine in 2008. This was my bottom out low is as far as it goes time.

Using this logic if it is accurate means that in some respects if I can “learn” from a prior episode, I am more likely to be successful in staving off or managing severe bipolar symptoms the next time. One success begets more success.

So how do you get to the place where you are learning not to break from current or on-going trauma? How can managing a current break help to minimize the risk of a future break? These are steps that I take. They don’t always work 100% of the time but they do help me learn to go around an episode and/or lessen its impacts and/or avoid another one head-on that is so severe that hospitalization is required. This has been the case since 2008 — fourteen years.

  1. I keep a journal of thoughts and self care and regular activities and feelings on a daily basis. A quick sentence or two for each day is all that is needed. I share the journal with my therapist.
  2. I get psyche meds prescribed from a psyche doctor and stay with the regimen. (In the past I have not done this.)
  3. If the regimen is not working I negotiate a change with the doctor.
  4. I keep in regular contact with my therapist. I seek to be as transparent as possible. Secrets tend to create a life of their own.
  5. I read my journal back to myself and see if I am acknowledging and managing triggers or not. This requires knowing what my triggers are like poor sleep, taking too much on in the day, talking down to myself, limiting that internal critic and so forth.
  6. Also I give myself credit for making baby steps in my journal. Perhaps I did not walk 2 miles every day for a week but did walk 2 miles for 4 days last week. Tell myself how much progress this is. Give myself credit for baby steps instead of listening to the critic talk that I am not doing enough.
  7. I get as much exercise as my mental health will allow. I start with small steps like a half mile walk and gradually build up to 2 miles plus. Or practice yoga with a class or on my own.
  8. Tire out my body in order to tire out that mind.
  9. I reach out to my support circle and let them know how I am feeling. Sometimes just acknowledging how I feel tends to diffuse the tension. It helps me to know others are aware I am having an off day.
  10. Eat well if and when I can. Avoiding empty calories. This includes accepting body image impacts of taking meds – ie. weight gain.
  11. Reach out to a friend I haven’t talked to in a while. Arrange a time to meet and walk or just enjoy talking with that person over the phone.
  12. Remind myself that there are always those who are struggling as much if not more than I am. This does require being part of a community. A church community, a mental health community, an on-line mental health community, a neighborhood community? A community hit by hurricane Ida? I seek to reach out and make some sort of contribution to the communit(ies)I am a part of. It helps me to know I can be of help to others even when I am not at the top of my game.
  13. Finally, be kind to myself. It is not my fault I have bipolar disorder. It is not my fault that certain consequences and behaviors trend to follow that diagnosis. I have to learn to forgive myself for sometimes “crazy” or ill-conceived acts. Ill-conceived acts here refers literally to acts I have taken while ill. I seek to forgive myself as readily for those acts as I seek to forgive others.

What do you think? Do you think we have any control over the propensity to have a full-fledged breakdown over time? If we cannot entirely steer clear of it can we at least learn to experience less dramatic highs or lows? Does this argument erroneously assume that the patient has the power to learn a better outcome or is the outcome already set in stone?

OOOHHHH Final Exams!

My daughter is finishing up high school this month. You may have heard of the program — the International Baccalaureate or IB Diploma Program.

The program is insane – at least in my mind right now. It is testing kids on two sometimes three years of content. Most of these kids were out all of Sophomore and a good part of Junior Year due to COVID and still exams are marching on.

I find myself in a particularly strange spot. I should be providing undying support to my 18-year-old rather than getting her enmeshed in my anxiety. This is really hard for me as college years were the years I first experienced early signs of bipolar. So I worry about the same for her.

All in all, we have less than two weeks to go. So that is great! But it sure would be nice if the IB Diploma Program made some real concessions for studying and mastering content during a world-wide pandemic. I have reached out to the college counselor and he agrees it is an issue globally. So maybe they will give the kids a break?

My Sojourn through Bipolar Illness – Development of High Anxiety

In the years after I was first diagnosed with bipolar illness, I would have a break and go into the hospital about every six months.  Eventually with the right meds I got to the place where I would have mini-breaks every six months and stay with my sister Jane and her family rather than go into the hospital.  This was during the days of Mellaril, Ativan and Haldol.  I would leave my apartment and take the subway to my sister Jane’s house about 25 minutes away.  Oftentimes this ride was a huge challenge.  I would arrive at Jane’s house with an overnight bag and some meds and put my belongings in the basement where there was a guest room.  I would spend between three and seven nights at Jane’s house where she would help me with administering meds.  In those early days, the anxiety associated with waiting for the meds to kick-in was excruciating.  I often requested to hold Jane’s hand as we lay in the bed until the medication had had time to sink in and sedate me. 

At that time, the meds for bipolar illness were not very advanced.  Meds seemed at that time to treat the symptoms of the illness rather than seeking to manage the illness before the break-through of mini or grand episodes.  I am forever grateful to my sister for allowing me several years of staying with her and her family every six months or so and managing though those mini-episodes. When I was at her house and under the care of Mellaril, Ativan and Haldol, it would take about an hour for the impact of the meds to sink in.  During that hour of sheer hell I would sit and smoke cigarettes nonstop waiting for the meds to kick in.

Since those early days of a mini break every six months, I have been prone to high anxiety which is often at times consuming and sits sometimes in the background, as a nagging reminder that I continue to struggle with my moods every day.   Managing the anxiety associated with bipolar illness has developed into my greatest challenge besides the reversal of stigma.  Perhaps pairing the management of this anxiety with a willingness to explore potential abuse as a child will make an impact on this generalized anxiety – hopefully reducing it substantially. 

I also have more recently added an additional medication Trileptal to help with the anxiety and this appears to be making a difference for me.

As an aside based on commonplace discussions, I have been told that family intervention for people with behavioral health diagnoses is much more common in Europe than in the US.  Just like our propensity in the US is to care for the elderly in homes for the elderly, we tend in the US to care for people with psychiatric disorders in a hospital setting.  Personally, I feel that the more care that can be provided in the context of the family and the family home the better.

Once again, my illness has developed in phases.  Early in my diagnosis were “grand episodes” including hospitalizations.  These ”grand episodes” gradually gave way to more “mini episodes” managed in the home with a few exceptions. In my postpartum period, I was back to having “grand episodes” and being in the hospital again for those first three to four years. 

As I became more comfortable with managing my illness and being a Mom, I went back not to having “mini episodes” but to having a general level of anxiety to manage at all times.  Goals but not necessarily accomplishments include daily meditation, daily exercise goals including walking and yoga and a daily commitment toward transparency in my faith and my diagnosis.