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.”
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?
This is not a product endorsement for CBD oil – only a recount of my experience. Please take this into consideration. Thank you.
I have started up with a low dosage of CBD oil again. I am still underwhelmed at the level of dosage information there is on packaging and in general available to consumers but I am trying to take the edge off my anxiety which is presenting with the end of my daughter’s high school career and the beginning of her college years. I have talked this through with my therapist at our last session and with my psychiatrist a year or two ago.
Does anyone have personal stories of CBD oil helping with anxiety? Other stories regarding CBD?
When I first exited the hospital in 2008 after starting on clozapine, I was seeing my therapist once to twice per week. Eventually this developed into a meeting every two weeks and then every month. Now I am on a frequency of every 6 to 8 weeks for seeing my therapist. During this time post 2008 I saw my psyche doctor every month or every two months. Now I see him every 3 months for meds management.
It is important to note that these elongated timeframes happened for me after years of work with my therapist and with my meds. It feels good to move to longer timeframes between visits, but it is true that pre-2008 I used to “play mind games” with myself regarding my psyche visits. I would deliberately schedule doctor’s visits every three months out to tell myself I was doing “fine” when in retrospect this should have been monthly. I was not doing fine and I was on a drug that wasn’t working. In part, this was because I was not maintaining the proper dosage of the meds.
I feel like today I am honest with my therapist and my psyche doc about how frequently I need appointments. I used to have to have a therapy appointment lined up for the next time when I completed a session so as to be able to “see” what was upcoming on the horizon. Now I basically see how I am progressing and schedule a session every 6 to 8 weeks or so as needed.
Any thoughts on your session frequency with the therapist or the MD?
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?
- 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.
- 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.
- 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.
- 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.
- 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.”
- 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.
- 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.
- 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.
- 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.
- 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?
Caution: this post involves the use of CBD oil. The post in no way suggests that CBD oil should be used for mental illness. Rather, the post suggests that the lack of prescription amount and dosage is a real problem that makes CBD oil unsafe or unreliable to use for most people.
About two years ago I started using CBD oil with buy-in from my therapist and my psyche doctor. It was very effective at reducing anxiety — my biggest problem remaining from the bipolar I have had since college. When I bought the CBD oil from a New Age Health Vitamin Store, they failed to tell me to shake the bottle with each dosage. So when I got to the last several doses particularly the last one, the CBD was so concentrated it did me in for a day.
After that episode I became somewhat suspicious of the process of selling and administering CBD oil. I later bought another bottle but I found myself to be too circumspect about the proper dosages for my condition. Even though the CBD oil had helped me there was no place to go for getting the right levels and the right amounts in my daily routine. While my therapist and MD said I could try CBD oil, they never prescribed a certain amount for my condition. This was not their purview.
Even though CBD was somewhat beneficial for me, my lack of trust with the process of buying and administering CBD won out. I have not used the new bottle – I am not even sure how that dosage compares to the dosage I took with that first bottle. There is concentrate information that varies from brand to brand and from bottle to bottle. For me, I need to be working with a professional to get the right dosages on a daily basis. Experimenting with the use of CBD oil is not something I am happy to do. Right now I don’t have that person in my life who could prescribe dosages.
Have you ever used CBD oil? Did the lack of information on dosages and strengths leave you feeling suspect about the process of using CBD oil? Do you wish there was more data about CBD oil including dosage information for people seeking its medicinal qualities? How do you think that additional dosage information might come about?
Compare thyself to others…..
My sister and her husband were in town for the Holidays and stayed with us for three nights along with my aging and memory-impaired mother. It is always great to be around my sister. She is active, fun to be with, helps out whenever necessary. In short you could not ask for a better big sis.
Big difference between my sister and me? She did not get the bipolar. But she has always been very supportive of me and actually used to take me into her home every six months for what I call mini-breaks when I lived up north.
My problem with my relationship with my sister is I try to compare myself to her in terms of her successes in managing relationships, her accomplishments at work, her steadfastness with her faith and just her innate ability to have fun. My therapist suggests using her as a role model rather than comparing myself to her because I will likely always come up short. My therapist did not say “come up short” but that is how I feel when I make the comparison.
A word of caution – it’s not the type of nice that rubs your face in it. My sister is really just a very good person who has not had a mental health diagnosis to deal with. But if I remember things honestly and correctly, my sister has had her share of hardships. One of her sons had a chronic disease growing up and almost did not graduate high school. Her other son is an artist who is extremely talented but not necessarily financially prepared for family life with a spouse and kids. (I am not sure he even wants that….).
So why do I gloss over these facts when I think about my sister’s lot in life? She has definitely had her share of hardships. She is just expert in getting past these. I think her strong faith is main reason why.
So do any of you compare yourself to siblings or cousins when you know you “should” not? What do you tell yourself when you are comparing self with others? Does resolving the comparison or downplaying it involve faith in any way?
I had a run-in with my therapist yesterday. I was talking about having a lot on my plate with a daughter going off to college soon, a Mom needing cataract surgery and me not knowing for a week or so about a brain tumor and whether that required follow-up with the neurologist. Thankfully it does not.
Where my therapist and I disagreed was whether I had a lot on my plate. It is true my daughter is a stellar student and good athlete. So she is likely to get into some if not several colleges of her choice. But, that does not mean my feelings on her behalf don’t include anxiety. I was diagnosed with bipolar while in college — so that makes me worry about her.
My therapist also reminded me that my sister is the point person for my Mom’s cataract surgery and there is very little for me to do there. From my point of view it is difficult to have my Mom age, it is difficult in having to set limits on how much I can help with her care because of the bipolar (like driving across town at 5:00/5:30am under heavy sedation with meds). It is also stressful for me to see my Mom as she insists until recently on driving herself and I don’t feel that is safe.
The MRI for a brain tumor was stressful because I did not know if I would need brain surgery – literally.
My admiration for my therapist is at a low point. Rather than acknowledging all these stressors, she basically said I did not have a lot on my plate and I should be doing better. She texted me that she thought I had enormous difficulty managing my own life and to stop trying to manage other people instead of managing my own struggles.
This is the first time in 13 plus years where my therapist in my view made the wrong call. If I were in a wheel chair, the doctors would not necessarily believe I should walk again but that I should be making the most of my life albeit in a wheelchair. For the first time in 13 years, I feel my therapist just “doesn’t get it.” I feel she doesn’t get it that anxiety can be really rough even if it looks like things on the outside are pretty much handled. The anxiety doesn’t necessarily go away when life’s challenges are getting managed one way or another.
Has anyone had this kind of fall-out with their therapist or their doctor? Any ideas on how best to move forward?
Dear reader I am writing to ask you a question. What happens after a person has had some reconciliation of the fact that he/she was very much abused as a small child? If this doesn’t pertain to you, please disregard this post.
I have just undergone gut-wrenching and extensive therapy since December 2020 which for me had its origins in treatment I received as a small child of about 6.
I have been clinging to the earth these last few weeks so as not to slip again into the abyss where for some extended period of time a portion of my psyche had been living.
According to my own assessment, I have successfully crawled and clawed my way out of a 100 foot deep pit with slippery mud sides.
Now that I am completely out of the pit ( I hope), I am wondering what to do with myself, what to work on, what to avoid, what to learn, what to enjoy. Take a shower and wash off the mud? Take into account exactly where the pit is so as not to fall into it again? Designate this exit from the abyss as my new “rock bottom” and be thankful for hitting it so as to get the $%^&* out of there? Allow myself to tell myself, I deserve happiness? I deserve good health and fitness?
As fodder for knowing I have exited the abyss, for the first time in 20 years I have been able to stick to an exercise routine composed of mostly yoga and some walking in the neighborhood. I have recorded a log which is two weeks long and growing which for me is super progress. In my youth I was very, very fit, so getting back to that place with mindfulness is huge for me.
So if anyone here or there has also climbed out of their own pit of abuse or anxiety or depression, I would love to hear your story as to what you decided to do next once you found yourself alongside the edge of that pit but no longer in it.
Of course I will talk my therapist about it, but I thought I would ask you dear reader in the meantime.
I have decided this cancellation from my therapist (see below) was all for the best. Rather than panic about not having a therapy visit for 8 weeks, I was able to talk myself through a period of not having a regular session with my therapist. When we did get in touch I learned s/he had a very painful illness but was not at a serious risk level. I feel proud of myself, if I can say so, about managing through this period. It has made me realize that in the 12 years of working with my therapist I have grown into a person who can handle a temporary lapse in therapy time if that occurs and/or as it occurs.
Here is the original post from a week or two ago:
After 12 years of work with my therapist with no interruptions and no cancellations, I got a call today cancelling/postponing our session for this month. In all the 12 years of work, my therapist has never missed or changed an appointment.
Funny how you rely on someone being there and expect there to be no gaps. Rationally, I know at some point people do get sick and have to call in sick, but it worries me when my therapist does/did this.
I guess you could say I am confronting my dependency on her. Should I have a back-up plan for when she is ill? She is into her 70’s as is my psyche doctor. Should I be thinking about someone younger just because?
When I got the news today about the cancellation I got somewhat anxious, so I called my psyche doctor and shared the news. We agreed I would go up on my meds if things felt too stressful.
Just out of curiosity, what do you do if your therapist is sick and cannot make a session? Does it stress you out? Do you move to Plan B? What is your Plan B?
I am not yet in the habit of giving thanks every day for my blessings. So here goes a try…..
I have a beautiful (inside and out) daughter. She is healthy, funny, smart, caring and resilient. I have a loving husband and understanding in-laws. He is non-judgmental and generally puts up with my anxiety that surfaces almost every day on some level. My in-laws also are not judgmental. I have a very good relationship with my Mom who is 83 though this has not always been the case. Now, she and I can talk pretty openly about events of the day including things that are hard emotionally or difficult because of my diagnosis. I have a solid rapport with my older sister who lives up North but continues to be a support for me every time I ask which is fairly often. I have a therapist I can trust and a doctor/ psycho-pharmacologist who I can talk to about raising or lowering meds depending on what’s going on with me. I have seen my therapist and my meds doctor since 2008 — there is little they don’t know about me and that is a blessing. I take meds that are largely therapeutic for me. I recently had a scare (this summer) with breast cancer but thankfully the mammogram, ultrasound and MRI were all benign / negative. I have strong bonds with my best friend from 1985 forward. She and I can talk to each other about everything and anything pretty much.
In writing this, I am noting that most of the things I am thankful for are relationships and health. Does any one else see a pattern in what you are thankful for?