On Being Bipolar(thewalrus.ca)
thewalrus.ca
On Being Bipolar
https://thewalrus.ca/on-being-bipolar/
92 comments
> Instead of me constantly bitching, we have code words for how I'm feeling. If I'm good, that makes I'm stable and relatively happy. If I'm okay, I'm probably depressed. It goes on from there. I'm able to talk about how I feel without getting into the details no one want to hear every day.
I want to mention how kind and empathetic this is. My mother had bipolar disorder and I’m very appreciative reading this comment from you.
I want to mention how kind and empathetic this is. My mother had bipolar disorder and I’m very appreciative reading this comment from you.
I'm glad you wrote about it! I'll add it to my TBR list. Which, coincidentally, includes a collection of stories you're in.
If no one really wanted to read that, then your comment wouldn’t be the first one on this thread. Thank you for sharing with us.
I'm very glad people want to read my story but I think this comment makes my point. It's at the top because I carefully wrote it and purposefully kept it short and digestible. The long details of my life experience are linked rather than written out. People opt in to read more.
From past experience, the long, rambling, barely coherent rants I start with aren't effective or well received. :)
Note: This comment was eight times longer and took about 8 minutes to reduce to what I have here. And I seriously considered deleting it because it doesn't add much to the conversation. Only 20% of the comments I write survive to be posted.
From past experience, the long, rambling, barely coherent rants I start with aren't effective or well received. :)
Note: This comment was eight times longer and took about 8 minutes to reduce to what I have here. And I seriously considered deleting it because it doesn't add much to the conversation. Only 20% of the comments I write survive to be posted.
Well... I think long rambling rants from people who have a diagnosed mental health condition are about as interesting as long, rambling rants from people who do not have a diagnosed mental health condition.
Well, most of the time.
Well, most of the time.
I can relate to that, I would say 50% of mine survive, I usually stop just before clicking the submit button. Anyways you have your reasons and I respect that.
And here I was thinking I must be the only person who deletes their comments instead of submitting them!
Thank you. I cannot tell you how relieved I am feeling right now.
Thank you. I cannot tell you how relieved I am feeling right now.
I have a lot of respect for your ability to make a blog about something that is already overwhelming enough to "just" be suffering.
Being both high functioning and with severe psychiatric issues is very weird when dealing with the world: you can sometimes drain your energy to almost have a "super" ability to do things (focus, make stuff, communicate, whatever it is), yet you're actually suffering immensely and it often doesn't help that you might get praised for the very same things that you should get help for. There's fear of losing some of those bits when you enter a path of medical treatments, there's immense energy spent doing inner work that people who are considered "healthy" never really have to be doing. It's like the neighbour is driving up a hill while you're hiking up a mountain with a broken leg.
So here's a hug.
Being both high functioning and with severe psychiatric issues is very weird when dealing with the world: you can sometimes drain your energy to almost have a "super" ability to do things (focus, make stuff, communicate, whatever it is), yet you're actually suffering immensely and it often doesn't help that you might get praised for the very same things that you should get help for. There's fear of losing some of those bits when you enter a path of medical treatments, there's immense energy spent doing inner work that people who are considered "healthy" never really have to be doing. It's like the neighbour is driving up a hill while you're hiking up a mountain with a broken leg.
So here's a hug.
"But no one really wants to read that and I don't want to write it again."
I have this same issue but with severe chronic pain that impacts my executive function greatly, worsened by physical activity further sensitizing my nervous system - so I depend on low activity routine to not make life even more intolerable for 2-3+ days it takes to recover to getting clear thought and mental function again - to be able to orient myself again; it doesn't make a difference if I do share it though either, even though there are still options I could try to reduce the pain - it's been difficult to find a doctor who's actually willing to work with me and so much time between appointments when exploring new potential avenues. The challenge I've found is mostly running into indoctrination, lack of critical thinking, lack of willingness to accommodate to read long-form explanations of what I write out for my experience to get doctors or professionals on the same page of understanding. I have mostly given up and am winding down my hopes or fantasy of a capable, productive, rewarding future now though - planning to return "home" to an unfinished, untidy, cluttered house that no one should live in, where my mother has been mostly alone the past 5 years since my father passed away horrifically - so I'm no longer paying rent anywhere nor have any obligations and will quietly disappear from the universe as barely anyone will know that I will be gone.
I have this same issue but with severe chronic pain that impacts my executive function greatly, worsened by physical activity further sensitizing my nervous system - so I depend on low activity routine to not make life even more intolerable for 2-3+ days it takes to recover to getting clear thought and mental function again - to be able to orient myself again; it doesn't make a difference if I do share it though either, even though there are still options I could try to reduce the pain - it's been difficult to find a doctor who's actually willing to work with me and so much time between appointments when exploring new potential avenues. The challenge I've found is mostly running into indoctrination, lack of critical thinking, lack of willingness to accommodate to read long-form explanations of what I write out for my experience to get doctors or professionals on the same page of understanding. I have mostly given up and am winding down my hopes or fantasy of a capable, productive, rewarding future now though - planning to return "home" to an unfinished, untidy, cluttered house that no one should live in, where my mother has been mostly alone the past 5 years since my father passed away horrifically - so I'm no longer paying rent anywhere nor have any obligations and will quietly disappear from the universe as barely anyone will know that I will be gone.
I encourage you to investigate your issue. I've heard countless cases of people going to countless doctors until they've found one that could pin down their issue. Look for ones interested in investigating your condition, it could be a journey. I had a number of issues giving me chronic headaches for years, and it took a while slowly removing variables and pinning things down until I got better; then it was like having a second life.
What were the causes if you don’t mind me asking?
I can understand the issue you describe with doctors not being willing to deviate from their standard training. It's exhausting when they don't listen ("right, right, you've read something on the internet, yes, yes... why don't you let me take a look at it first") or they only try their common approaches that have failed before and if you don't fit that mold, well, too bad.
I hope you find a way to manage (or better yet, get rid of) your pain. It's such a waste that, unless you're famous, rich or a rare, scientifically interesting case, the point of "sorry, there's nothing else I'm willing to do for you" comes rather quickly. It seems with most chronic problems, you need to become an expert and then find and convince somebody who is certified and can write a prescription.
I hope you find a way to manage (or better yet, get rid of) your pain. It's such a waste that, unless you're famous, rich or a rare, scientifically interesting case, the point of "sorry, there's nothing else I'm willing to do for you" comes rather quickly. It seems with most chronic problems, you need to become an expert and then find and convince somebody who is certified and can write a prescription.
Can I ask what ADA accommodations you were able to seek? My sister has type 1 and is currently in mania. She worked for me for the last 2 years because she is “unable to hold a regular job” but I won’t be able to continue employing her after this episode.
This is what I have documented:
- Intermittent FMLA. (1)
- Being able take extended breaks during the day and make up hours without using FMLA. (Flex time)
- Work from home when I need to.
- No on call. (Company has to respect my consistent sleep schedule.)
- No overtime. Maximum of 40 working hours per week.
- Ability to take extended leave for inpatient care.
My team knows I'm out occasionally for medical issues but they don't have an issue with it.
I really do work for a wonderful company that takes care of their employees. Having someone's kid interrupt a zoom meeting is common right now and no one except the parent gets annoyed by it. Even the CEO isn't immune from his kids interrupting an all hands meeting. He just laughs and sets the tone for the rest of the company. :)
1: Basically, I can take time off in 1 hour increments for any medical reason, any time.
- Intermittent FMLA. (1)
- Being able take extended breaks during the day and make up hours without using FMLA. (Flex time)
- Work from home when I need to.
- No on call. (Company has to respect my consistent sleep schedule.)
- No overtime. Maximum of 40 working hours per week.
- Ability to take extended leave for inpatient care.
My team knows I'm out occasionally for medical issues but they don't have an issue with it.
I really do work for a wonderful company that takes care of their employees. Having someone's kid interrupt a zoom meeting is common right now and no one except the parent gets annoyed by it. Even the CEO isn't immune from his kids interrupting an all hands meeting. He just laughs and sets the tone for the rest of the company. :)
1: Basically, I can take time off in 1 hour increments for any medical reason, any time.
Infinite respect to you for facing and surviving your experience of life.
I wish that society had a meaningful role for people who have had this experience that could make full use of their emotional depth in a way that was valuable to us all and allowed you to not feel like you have to hide your interior world.
Someday we, as a broad group, will get to that point, rather than stigmatizing and hiding it to your and everyone’s detriment.
Your effort to speak openly about all of this is heroic.
Thank you.
I wish that society had a meaningful role for people who have had this experience that could make full use of their emotional depth in a way that was valuable to us all and allowed you to not feel like you have to hide your interior world.
Someday we, as a broad group, will get to that point, rather than stigmatizing and hiding it to your and everyone’s detriment.
Your effort to speak openly about all of this is heroic.
Thank you.
> wish that society had a meaningful role
We kind of do. Storytellers. I write fiction. (And a few blog posts) A lot of my own experience with the extremes of the human emotion gets rolled into what I create.
We kind of do. Storytellers. I write fiction. (And a few blog posts) A lot of my own experience with the extremes of the human emotion gets rolled into what I create.
That is one of the most insightful things I’ve read all year. Thanks!
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Interesting article. I've been diagnosed with bipolar type 1 myself. I still struggle with accepting having that particular mental illness for two reasons; the way it is depicted in media and popular culture, and it being seen as a lifelong thing you can't possible get rid of. This despite having a psychotic episode twice. You'd think these things are clear cut. But they're not.
The first part of the article is spot on, really. Even medical professionals have strong biases that are pretty visible even when you're institutionalized. Mentioning drug use is almost guaranteed to put you in a certain classification bucket. What's more, once a history is taken, while being psychotic or (hypo)manic, you are once again put into some kind of classification bucket, despite not being well enough to frame things properly.
I don't mean to be completely negative here. Once you are institutionalized, this is needed to get things back on track, start some kind of medication or figure out some first line treatment. However, the stigma afterwards is very real. GP's, psychologists, even surgeons take in this information after the fact, and its almost factual. And the effects the author mentions are very much there; imagined or not, they are there for the ill person. Being extra careful not to seem overly rash, overly emotional, too impulsive around doctors. Just because they have your best interests at heart, doesn't mean they're free from bias.
The first part of the article is spot on, really. Even medical professionals have strong biases that are pretty visible even when you're institutionalized. Mentioning drug use is almost guaranteed to put you in a certain classification bucket. What's more, once a history is taken, while being psychotic or (hypo)manic, you are once again put into some kind of classification bucket, despite not being well enough to frame things properly.
I don't mean to be completely negative here. Once you are institutionalized, this is needed to get things back on track, start some kind of medication or figure out some first line treatment. However, the stigma afterwards is very real. GP's, psychologists, even surgeons take in this information after the fact, and its almost factual. And the effects the author mentions are very much there; imagined or not, they are there for the ill person. Being extra careful not to seem overly rash, overly emotional, too impulsive around doctors. Just because they have your best interests at heart, doesn't mean they're free from bias.
One of the most fantastically positive things that happened to me on a journey for better mental health was to encounter a seasoned psychiatrist who did two amazing things:
(1) He didn't try to always resort to whatever is brand new but actually gave choices and explanations that include treatments considered "old" and misunderstood to be ineffective (for example in my case, going with MAOI/RIMA for depression instead of the ever-so-new fancy SSRI of the day - and that alone was a life-changer already).
(2) He actually had an open ear for my personal experiences with a (very) wide range of things in a "non-medical" environment, and used the input in a non-judgmental way to calibrate his understanding of my subjective reports and to find better treatment strategies - also including me in the process, therefore making me the main actor of my own healing process.
On the other hand, I've stepped into rooms with a psychologist and shared about experiences with a wide range of drugs (mainly focusing on empathogen-entactogen and psychedelics for the heavy experiences, but I've covered a wide range) and gotten the regressive "this is all shit/poison" rhetoric, thus solidly ensuring that I would mentally check out when they turn around and try to offer tools to address cognitive biases and practice mindfulness, both of which they can't even apply to their own selves.
(1) He didn't try to always resort to whatever is brand new but actually gave choices and explanations that include treatments considered "old" and misunderstood to be ineffective (for example in my case, going with MAOI/RIMA for depression instead of the ever-so-new fancy SSRI of the day - and that alone was a life-changer already).
(2) He actually had an open ear for my personal experiences with a (very) wide range of things in a "non-medical" environment, and used the input in a non-judgmental way to calibrate his understanding of my subjective reports and to find better treatment strategies - also including me in the process, therefore making me the main actor of my own healing process.
On the other hand, I've stepped into rooms with a psychologist and shared about experiences with a wide range of drugs (mainly focusing on empathogen-entactogen and psychedelics for the heavy experiences, but I've covered a wide range) and gotten the regressive "this is all shit/poison" rhetoric, thus solidly ensuring that I would mentally check out when they turn around and try to offer tools to address cognitive biases and practice mindfulness, both of which they can't even apply to their own selves.
Interesting. I have a negative bias towards psychiatrists myself. Experiences with psychologists weren't that great either until I went into therapy with an analytical psychologist. None of this mindfulness stuff, which I practiced myself for years already, but a complete focus on actually figuring things out and understanding why I see things the way I do.
I don't think there is a single answer for everyone (not implying that you think so). The psychologist doesn't really stop me from talking about experiences with drugs, but doesn't really see it as something helpful.
I currently see my illness as existing of two components; genetic and environmental triggers. Stress and drugs, together with past trauma interact with my genetic disposition towards psychosis/mania.
Drinking less coffee, sticking to a routine, no drugs (particularly psychedelics), and sorting through my internal web of views with a psychologist, it looks liek that's the solution for me. Medication is part of it, mainly to provide some stabilization while I sort things out. It doesn't really jive well with how psychiatrists go about things though, in my experience, since they seem to think I have to be on it til the end of time. I would love to have contact with a psychiatrist I trust, so I could make some sense out of the medication part of my healing process.
I currently see my illness as existing of two components; genetic and environmental triggers. Stress and drugs, together with past trauma interact with my genetic disposition towards psychosis/mania.
Drinking less coffee, sticking to a routine, no drugs (particularly psychedelics), and sorting through my internal web of views with a psychologist, it looks liek that's the solution for me. Medication is part of it, mainly to provide some stabilization while I sort things out. It doesn't really jive well with how psychiatrists go about things though, in my experience, since they seem to think I have to be on it til the end of time. I would love to have contact with a psychiatrist I trust, so I could make some sense out of the medication part of my healing process.
> In my experience, since they seem to think I have to be on it til the end of time.
Easily explained by survivorship bias. They only see the people who need to be on it for the rest of their lives.
There are people who will need to be on medication their entire lives. I'm probably one of them. My psychosis and primary insomnia hasn't been treatable with anything else.
Easily explained by survivorship bias. They only see the people who need to be on it for the rest of their lives.
There are people who will need to be on medication their entire lives. I'm probably one of them. My psychosis and primary insomnia hasn't been treatable with anything else.
Thanks for that perspective. That could explain it indeed. The psychiatrists I saw were the ones working the ward, not outpatients. So they really do see the worst of it. That being said, I really do admire the work they do, the people there are typically not easy to work with, at least not while they are on the ward.
I am lucky in that I'm on a low dose of not too strong medication (valproate acid, 600mg slow release daily). If I go off (I've weaned off it myself before) nothing really extreme seems to happen. Hope you are doing well with your medication.
I am lucky in that I'm on a low dose of not too strong medication (valproate acid, 600mg slow release daily). If I go off (I've weaned off it myself before) nothing really extreme seems to happen. Hope you are doing well with your medication.
Our stories have more in common than you might think. I've always had a focus on trying to understand things, but I've also encountered people who would throw pragmatism and logic out the window as soon as I'd get real.
For me, (recreational) drugs are not the solution at all but they've been a part of my life and they're part of an explanation of things, so any therapist who would dismiss the experience entirely also dismisses the nature of my approach to those experiences, and in doing so they create their own blind spot and less useful to me because they've already established that they're unwilling or incapable of looking at the big picture.
The psychiatrist I'm talking about never mentions drugs actively, never sings praises of any of those experiences or even makes any particularly positive comment about them, but he doesn't disparage them and he inquires about what the experiences were ("what pills? what dosage?" etc, usually when relevant - otherwise I'll volunteer what I think is relevant without fear). And he is willing to answer my questions ("what are the advantages/drawbacks when taking a little bit more than the nominal dose for this treatment?"), and is willing to try different approaches that we discuss and reflect on.
This builds a trust relationship that does more for treatment than people might think. I don't need to amplify the meds using doses of Abilify and whatnot, I don't need to deal with side-effects that go unadressed, etc. If there are issues, I can talk to someone who isn't prejudiced, who is willing to offer alternatives, willing to discuss the compromises related to those alternatives, and willing to devise a plan that is medically sound to get from A to B.
As for the psychiatric help, I'm glad that for you not taking coffee and doing sports is enough. I've mistakenly thought that for years (more vitamin D, "it's S.A.D", no coffee for months, more exercise, etc etc), but I had to hit a wall hard before I encountered the help that I realized I needed my whole life.
For people who relate to this thread (with BPD) or people with severe depression and other psychiatric issues, proper psychiatric help is not really an optional thing but much more like the knee surgery required to walk properly or the wheelchair that is required to be autonomous: whether temporary (former) or permanent (latter), it's an essential element that can enable some people to actually live, and live well.
For me, (recreational) drugs are not the solution at all but they've been a part of my life and they're part of an explanation of things, so any therapist who would dismiss the experience entirely also dismisses the nature of my approach to those experiences, and in doing so they create their own blind spot and less useful to me because they've already established that they're unwilling or incapable of looking at the big picture.
The psychiatrist I'm talking about never mentions drugs actively, never sings praises of any of those experiences or even makes any particularly positive comment about them, but he doesn't disparage them and he inquires about what the experiences were ("what pills? what dosage?" etc, usually when relevant - otherwise I'll volunteer what I think is relevant without fear). And he is willing to answer my questions ("what are the advantages/drawbacks when taking a little bit more than the nominal dose for this treatment?"), and is willing to try different approaches that we discuss and reflect on.
This builds a trust relationship that does more for treatment than people might think. I don't need to amplify the meds using doses of Abilify and whatnot, I don't need to deal with side-effects that go unadressed, etc. If there are issues, I can talk to someone who isn't prejudiced, who is willing to offer alternatives, willing to discuss the compromises related to those alternatives, and willing to devise a plan that is medically sound to get from A to B.
As for the psychiatric help, I'm glad that for you not taking coffee and doing sports is enough. I've mistakenly thought that for years (more vitamin D, "it's S.A.D", no coffee for months, more exercise, etc etc), but I had to hit a wall hard before I encountered the help that I realized I needed my whole life.
For people who relate to this thread (with BPD) or people with severe depression and other psychiatric issues, proper psychiatric help is not really an optional thing but much more like the knee surgery required to walk properly or the wheelchair that is required to be autonomous: whether temporary (former) or permanent (latter), it's an essential element that can enable some people to actually live, and live well.
> As for the psychiatric help, I'm glad that for you not taking coffee and doing sports is enough. I've mistakenly thought that for years (more vitamin D, "it's S.A.D", no coffee for months, more exercise, etc etc), but I had to hit a wall hard before I encountered the help that I realized I needed my whole life.
This is actually what I'm afraid of. I haven't confirmed it yet, I'm still on my medication now. I might be developing some kidney problems (VPA is hard on kidneys and liver), so who knows. Based on your experience, and what others have mentioned, I might look for a psychiatrist I trust as an out-patient and see what my options are. I'm still not convinced the medication is stopping any psychosis either, but I'd rather not find that out the hard way.
This is actually what I'm afraid of. I haven't confirmed it yet, I'm still on my medication now. I might be developing some kidney problems (VPA is hard on kidneys and liver), so who knows. Based on your experience, and what others have mentioned, I might look for a psychiatrist I trust as an out-patient and see what my options are. I'm still not convinced the medication is stopping any psychosis either, but I'd rather not find that out the hard way.
One thing you should make sure to retain is some trust in yourself. A fitting psychiatrist might help, but any random psychiatrist might not. Trying out stuff might take some time and be a delicate balance, but all this can get difficult if there isn't a two-way relationship of trust and respect with the doctor.
The first psychiatrists I met diagnosed me with the wrong condition and prescribed completely ineffective meds (I'm talking an entirely different category of meds altogether, entirely useless stuff that I still took just to show them that I am trying). I then met a better psychiatrist who was definitely more on the money when it comes to the diagnosis but was still inexperienced and not really interested in developing any kind of relationship of trust, so he prescribed to me whatever was at the top of his checklist and pretty much disregarded feedback, trying to double-down on the inefficiency of treatment with MORE treatment and without reasonable explanations when I asked "what about alternatives?".
After a good 6 months of that, I had started to talk in parallel with the person I've praised in my first message, and he agreed to take me on as a patient if I wanted. I politely moved on from the previous experience, pretty much immediately started changing the prescription to something that came out naturally out of a more in-depth and non-judgmental discussion with my new psychiatrist, and since then I've basically been stable. Every follow-up since has been about fine-tuning things, discussing potential alternatives if any side-effect would become difficult or the positive effects of the meds would wear off, and what tradeoffs different approaches could have from a medical standpoint but also with personal logistics (including cost).
To the first ones I met, I was barely a line on a piece of paper, and their own confirmation bias made them prescribe what they had on the shelf in their office.
To the second one, I was a person but "the whole thing" was still a blur and he "stuck with the script", correctly diagnosing things but not deviating from what his textbooks probably indicate to be the go-tos.
The last one saw me as a person, established right away that he was open to my input and very much no-bullshit, pragmatic and digging into a longer history of psychiatry and interactions with patients. I'm not there to make a friend, I'm not there to get free meds, I'm there to figure out how to not constantly suffer as much and what proportion of that can be to an extent carried through medication (until I can do without, if/whenever possible).
I stopped trying to die already at the second one, but I only started living with that third one. And that makes a world of difference. I hope that whatever journey you're on, you get to alleviate the pain in your way.
The first psychiatrists I met diagnosed me with the wrong condition and prescribed completely ineffective meds (I'm talking an entirely different category of meds altogether, entirely useless stuff that I still took just to show them that I am trying). I then met a better psychiatrist who was definitely more on the money when it comes to the diagnosis but was still inexperienced and not really interested in developing any kind of relationship of trust, so he prescribed to me whatever was at the top of his checklist and pretty much disregarded feedback, trying to double-down on the inefficiency of treatment with MORE treatment and without reasonable explanations when I asked "what about alternatives?".
After a good 6 months of that, I had started to talk in parallel with the person I've praised in my first message, and he agreed to take me on as a patient if I wanted. I politely moved on from the previous experience, pretty much immediately started changing the prescription to something that came out naturally out of a more in-depth and non-judgmental discussion with my new psychiatrist, and since then I've basically been stable. Every follow-up since has been about fine-tuning things, discussing potential alternatives if any side-effect would become difficult or the positive effects of the meds would wear off, and what tradeoffs different approaches could have from a medical standpoint but also with personal logistics (including cost).
To the first ones I met, I was barely a line on a piece of paper, and their own confirmation bias made them prescribe what they had on the shelf in their office.
To the second one, I was a person but "the whole thing" was still a blur and he "stuck with the script", correctly diagnosing things but not deviating from what his textbooks probably indicate to be the go-tos.
The last one saw me as a person, established right away that he was open to my input and very much no-bullshit, pragmatic and digging into a longer history of psychiatry and interactions with patients. I'm not there to make a friend, I'm not there to get free meds, I'm there to figure out how to not constantly suffer as much and what proportion of that can be to an extent carried through medication (until I can do without, if/whenever possible).
I stopped trying to die already at the second one, but I only started living with that third one. And that makes a world of difference. I hope that whatever journey you're on, you get to alleviate the pain in your way.
I recognize what you're saying about trusting yourself. Part of having experienced psychosis is regaining trust in my own mind, afraid of 'the bottom falling out'. I feel I'm doing well there.
I'm also wondering if they have diagnosed me correctly. I pretty much haven't had any depressive symptoms for at least five years now, it stopped a long time before I ever had a psychotic episode. In fact, the depression was in line with my living conditions, it was something that made perfect sense at the time. Sounds like a question for a psychiatrist.
Unfortunately, like you experienced too, part of the healthcare industry still has a parent-child relationship between doctor and patient. I notice that the doctors which worked out, never really had that aspect, but treated me as someone with valid input. Especially for me, I like to understand things, dive into them, see what the mechanics of medication, disease and diagnosis are all about. It doesn't really work well with a doctor that just wants to prescribe whatever they think is right. I'm sure you can relate to that.
Thanks for the well wishes. I can say that I've been pretty much completely symptom free for a year now, and it does feel like I've only now started to really explore myself, and find out what I want out of life. All the best to you as well.
Unfortunately, like you experienced too, part of the healthcare industry still has a parent-child relationship between doctor and patient. I notice that the doctors which worked out, never really had that aspect, but treated me as someone with valid input. Especially for me, I like to understand things, dive into them, see what the mechanics of medication, disease and diagnosis are all about. It doesn't really work well with a doctor that just wants to prescribe whatever they think is right. I'm sure you can relate to that.
Thanks for the well wishes. I can say that I've been pretty much completely symptom free for a year now, and it does feel like I've only now started to really explore myself, and find out what I want out of life. All the best to you as well.
I have to second your two points on finding a seasoned psychiatrist. I also found an extremely good therapist who didn't case judgement on my experiences.
Between the two of them, I was able to take charge of my own treatment and be able to help myself instead of being backed into a corner.
Poor mental health treatment just makes things worse. I have friends who badly need therapy and coping skill but can't get over a therapist who hurt them in the past.
Between the two of them, I was able to take charge of my own treatment and be able to help myself instead of being backed into a corner.
Poor mental health treatment just makes things worse. I have friends who badly need therapy and coping skill but can't get over a therapist who hurt them in the past.
Meanwhile, I know of a practicing therapist in my community who stops just short of encouraging patients to experiment with hallucinogenics. (She's also fairly vocally anti-vaccine.)
The range of attitudes within the profession just astounds me.
The range of attitudes within the profession just astounds me.
The precariousness the author describes is real, at least in my experience. I'm 20 years into a career that many would find enviable except strangely devoid of any tenures longer than about 30 months, because that's the longest I've been able to surf my bipolar swings before imploding. Those meltdowns traditionally resulted in me running away from work to fall into a boozy depressive mess for six months, them returning once the mania kicked in again.
This year, a low coincided with the onset of COVID lockdown and I put myself in the hospital. Not checked myself in: I tried to hurt myself badly enough to be in the ER, ICU, and then inpatient psych care.
Even there, I was the "eloquent, self-reflective" model patient, much like I've been (in the manic times) the persuasive, thoughtful, creative employee that people couldn't wait to hire and promote.
After a couple of months of medical leave I went back to my previous job instead of quitting. It was driven largely by financial insecurity, as I had burned through my savings after not working at all in 2019...once again, due to being in a low phase _and_ getting sober and having no bandwidth left for anything else.
Being back to work at a place that has seen me swing from "A+ performer, definite strong leadership/promotion track, etc." to "can I keep a job, any job here? Ideally one that won't demand more than 40 hours a week of my time?" is far harder than jumping into an impossible workload while manic. Grinding out yet another week full of stand-ups and PRs when I have zero confidence is gut-wrenching, and on top of it all I have to be there and stable and not a depressive mess for my family, because I can't let them take care of me while the world outside is on fire.
All I want to do is get on my bike and ride for six hours a day, then cook dinner for my family, then do a little programming and writing before I go to bed. Literally, that's it.
Unfortunately, that's not a lifestyle I can sustain, even if I suspect it might be the thing that would keep me alive past 40. So it's back to work, taking my meds every day, and lying through my teeth when folks ask how I'm doing.
This year, a low coincided with the onset of COVID lockdown and I put myself in the hospital. Not checked myself in: I tried to hurt myself badly enough to be in the ER, ICU, and then inpatient psych care.
Even there, I was the "eloquent, self-reflective" model patient, much like I've been (in the manic times) the persuasive, thoughtful, creative employee that people couldn't wait to hire and promote.
After a couple of months of medical leave I went back to my previous job instead of quitting. It was driven largely by financial insecurity, as I had burned through my savings after not working at all in 2019...once again, due to being in a low phase _and_ getting sober and having no bandwidth left for anything else.
Being back to work at a place that has seen me swing from "A+ performer, definite strong leadership/promotion track, etc." to "can I keep a job, any job here? Ideally one that won't demand more than 40 hours a week of my time?" is far harder than jumping into an impossible workload while manic. Grinding out yet another week full of stand-ups and PRs when I have zero confidence is gut-wrenching, and on top of it all I have to be there and stable and not a depressive mess for my family, because I can't let them take care of me while the world outside is on fire.
All I want to do is get on my bike and ride for six hours a day, then cook dinner for my family, then do a little programming and writing before I go to bed. Literally, that's it.
Unfortunately, that's not a lifestyle I can sustain, even if I suspect it might be the thing that would keep me alive past 40. So it's back to work, taking my meds every day, and lying through my teeth when folks ask how I'm doing.
I knew someone with BPD.
She might have been the hardest-working person I've known. She also couldn't hold down a job to save her life.
She's the reason I can't ever see eye to eye with anyone who wants to cut our social safety nets or who sees welfare recipients as somehow subhuman.
She might have been the hardest-working person I've known. She also couldn't hold down a job to save her life.
She's the reason I can't ever see eye to eye with anyone who wants to cut our social safety nets or who sees welfare recipients as somehow subhuman.
> She might have been the hardest-working person I've known. She also couldn't hold down a job to save her life.
A bipolar patient in a hypomanic phase can feel strong energy, motivation, creativity, and euphoria. These people can be fun to be around and work with for a short while, at least before the downsides of compromised judgment, inappropriate social disinhibition, and other downsides become problematic. Hypomanic people can work themselves into greater responsibilities at the office, which quickly comes crumbling down when they switch to a depressive episode and can't get anything done. Or they can progress to a full manic episode, where extremely compromised judgment, delusions of grandeur, inappropriate risk taking, inability to concentrate on one task, and other negative effects take over.
One of the unique challenges of dealing with bipolar individuals is that they might actually enjoy their hypomanic phases, despite the obvious negative consequences. It's some times difficult to convince them to give up the hypomanic weeks for the sake of arriving at a stable baseline. They might become convinced that their hypomanic phase is actually their "normal" self, as they're often blinded to the negatives of their behavior during these periods.
> She's the reason I can't ever see eye to eye with anyone who wants to cut our social safety nets or who sees welfare recipients as somehow subhuman.
I fully agree that robust social safety nets are important for our society and that welfare recipients should not be looked down upon.
However, it's more of a bridge than a long-term solution. The best path forward for most patients is to be treated with stabilizing medication and to return to the structure and accountability of having a job, ideally. Bipolar patients tend to struggle with unlimited free time, unstructured days, and no accountability to their work peers. The key is robust and ongoing medical treatment and monitoring.
Again, to be clear, I'm not disagreeing that social safety nets are a bad thing or that welfare recipients should be looked down upon.
A bipolar patient in a hypomanic phase can feel strong energy, motivation, creativity, and euphoria. These people can be fun to be around and work with for a short while, at least before the downsides of compromised judgment, inappropriate social disinhibition, and other downsides become problematic. Hypomanic people can work themselves into greater responsibilities at the office, which quickly comes crumbling down when they switch to a depressive episode and can't get anything done. Or they can progress to a full manic episode, where extremely compromised judgment, delusions of grandeur, inappropriate risk taking, inability to concentrate on one task, and other negative effects take over.
One of the unique challenges of dealing with bipolar individuals is that they might actually enjoy their hypomanic phases, despite the obvious negative consequences. It's some times difficult to convince them to give up the hypomanic weeks for the sake of arriving at a stable baseline. They might become convinced that their hypomanic phase is actually their "normal" self, as they're often blinded to the negatives of their behavior during these periods.
> She's the reason I can't ever see eye to eye with anyone who wants to cut our social safety nets or who sees welfare recipients as somehow subhuman.
I fully agree that robust social safety nets are important for our society and that welfare recipients should not be looked down upon.
However, it's more of a bridge than a long-term solution. The best path forward for most patients is to be treated with stabilizing medication and to return to the structure and accountability of having a job, ideally. Bipolar patients tend to struggle with unlimited free time, unstructured days, and no accountability to their work peers. The key is robust and ongoing medical treatment and monitoring.
Again, to be clear, I'm not disagreeing that social safety nets are a bad thing or that welfare recipients should be looked down upon.
> Bipolar patients tend to struggle with unlimited free time, unstructured days, and no accountability to their work peers.
I was thinking more broadly in terms of people with disabilities when I made the remark about social safety nets.
In the specific case of bipolar disorder, I have no reason to disagree with you.
I was thinking more broadly in terms of people with disabilities when I made the remark about social safety nets.
In the specific case of bipolar disorder, I have no reason to disagree with you.
Something something neurodiversity, evolutionary traits, situational advantages.
Something something society labeling as a dis-order anything which doesn't suit the order.
Something something choosing between no treatment and risk of involuntary commitment, overmedication, and life-long stigmai if diagnosed on paper.
Something something society labeling as a dis-order anything which doesn't suit the order.
Something something choosing between no treatment and risk of involuntary commitment, overmedication, and life-long stigmai if diagnosed on paper.
Can you please not post flamewar-style comments to HN? We're trying for something rather different here.
https://news.ycombinator.com/newsguidelines.html
https://news.ycombinator.com/newsguidelines.html
I apologize, I did not intend that as flames at all.
I'll pay more attention. Thank you.
I'll pay more attention. Thank you.
As someone who is also on the border between "good mentally ill" and "bad mentally ill," this is a really accurate portrayal of what it's like. The feeling that you're holding it together now, just barely doing the right things and making yourself seem normal enough, but that in the past you couldn't and the fear that in the future you won't be able to. I can't understate how much economic worry there is. Even for a software developer who is now doing pretty well financially, I can't help but wonder if I'll slip into another crushing depression where my brain works at 1/3 the speed and clarity and I can barely make it through a work day before collapsing on the couch. To anybody who sincerely wants to help, you can help by supporting strong social safety nets so that people don't have to shoulder the anxiety of being out on the street in addition to whatever else they're going through, and can also access affordable therapy. You can also support flexible or shorter work weeks.
Edit:
I would estimate that at least for me personally, at least half of the disease burden has been from second-order effects -- from economic anxiety, anxiety about stigma, and working through illness at an unsustainable pace.
Edit:
I would estimate that at least for me personally, at least half of the disease burden has been from second-order effects -- from economic anxiety, anxiety about stigma, and working through illness at an unsustainable pace.
In the US, ADA may help. Bipolar is a recognized disability. https://www.eeoc.gov/publications/ada-your-employment-rights...
I've listed my accommodations on another comment posted earlier: https://news.ycombinator.com/item?id=24680004
I've listed my accommodations on another comment posted earlier: https://news.ycombinator.com/item?id=24680004
> Sometimes, I dream about how wealthy I would need to be to take a break from feeling the fear that propels me to remain stable.
This is something I've felt but more so because it's incredibly difficult to access ketamine treatment. If your doctor loses his license or a pandemic happens you're left in the lurch.
This is something I've felt but more so because it's incredibly difficult to access ketamine treatment. If your doctor loses his license or a pandemic happens you're left in the lurch.
I have an illness on the schizophrenia spectrum and a lot of what is said rings true to me. My own therapist even doubts my diagnosis because he doesn't believe someone with my disorder should be able to hold down a job.
I don't bring it up to anyone IRL because I know what people will think of me- a danger to them, subhuman, a monster. I'm even uncomfortable to be within the spheres of supposedly accepting groups- neurodivergent advocacy groups, mental health advocacy, etc. People with less stigmatized disorders will treat me just as subhuman as a neurotypical.
I don't bring it up to anyone IRL because I know what people will think of me- a danger to them, subhuman, a monster. I'm even uncomfortable to be within the spheres of supposedly accepting groups- neurodivergent advocacy groups, mental health advocacy, etc. People with less stigmatized disorders will treat me just as subhuman as a neurotypical.
I was a month ago diagnosed with bipolar type 2, together with ASS. I experience sleep problems.
Some feelings in this article are familiar. To me, it was the feeling of being excluded for life from people.
Also I am going through work problems. I find myself at a difficult place in life now...
My wife has bipolar and I've got ASS. Remember that you're your own person in the first place, period. You're not your label, you merely /have/ a label. TFA makes this mistake from the outset in the title. It should've read "having" not "being".
There's no cure for these labels, but one can recover. To quote Patricia Deegan:
Recovery does not refer to an end product or result. It does not mean that one is “cured”. In fact, recovery is marked by an ever-deepening acceptance of our limitations. But now, rather than being an occasion for despair, we find that our personal limitations are the ground from which spring our own unique possibilities. This is the paradox of recovery i.e., that in accepting what we cannot do or be, we begin to discover who we can be and what we can do. Thus, recovery is a process. It is a way of life. It is an attitude and a way of approaching the day’s challenges. It is not a perfectly linear process. Like the sea rose, recovery has its seasons, its time of downward growth into the darkness to secure new roots and then the times of breaking out into the sunlight. But most of all recovery is a slow, deliberate process that occurs by poking through one little grain of sand at a time.
Only you are the expert of you. That said, there exist recovery colleges that can provide peer support. You're not alone.
There's no cure for these labels, but one can recover. To quote Patricia Deegan:
Recovery does not refer to an end product or result. It does not mean that one is “cured”. In fact, recovery is marked by an ever-deepening acceptance of our limitations. But now, rather than being an occasion for despair, we find that our personal limitations are the ground from which spring our own unique possibilities. This is the paradox of recovery i.e., that in accepting what we cannot do or be, we begin to discover who we can be and what we can do. Thus, recovery is a process. It is a way of life. It is an attitude and a way of approaching the day’s challenges. It is not a perfectly linear process. Like the sea rose, recovery has its seasons, its time of downward growth into the darkness to secure new roots and then the times of breaking out into the sunlight. But most of all recovery is a slow, deliberate process that occurs by poking through one little grain of sand at a time.
Only you are the expert of you. That said, there exist recovery colleges that can provide peer support. You're not alone.
I apologize for not knowing this, but what is ASS?
I am sorry. I meant Autism Spectrum Disorder. ASS is the acronym in my native language, I mixed it up.
So we're both Dutch then? In Dutch, recovery is "herstel" and a recovery college is either just that, or a "huis van herstel".
I can definitely recommend the HWG, which stands for "Herstel Werk Groep". Consult your SPV for this, as various GGZ services offer this free of charge.
I can definitely recommend the HWG, which stands for "Herstel Werk Groep". Consult your SPV for this, as various GGZ services offer this free of charge.
Does anyone who is bi-polar feel that they are able to navigate their down time well enough that it is not crippling? For myself, I believe it was more inline with seasonal depression, and after 30+ years of living in the northeast, where winters are longgggg and exgtremely cold, I moved to a place that this wasn't the case. I don't know if I have it, but when I am feeling down, I tend to read more, and just try to focus on the fact that I will come out of it and feel better shortly.
> is that the segment of your audience that doesn’t share the diagnosis runs the risk of essentializing your disorder
> I don’t associate mania with creativity, or fun, or clarity; I associate it with an abundance of energy that seems like it needs no fuel but that will end up using me for its fuel.
It's all consuming. It's highly misunderstood. It's trivialized at best.
It's confusing. The lack of stability does wonders to your understanding of the world.
Mania is a weird and strange experience. The energy is overwhelming.
When it comes to programming, it's different.
> I don’t associate mania with creativity, or fun, or clarity; I associate it with an abundance of energy that seems like it needs no fuel but that will end up using me for its fuel.
It's all consuming. It's highly misunderstood. It's trivialized at best.
It's confusing. The lack of stability does wonders to your understanding of the world.
Mania is a weird and strange experience. The energy is overwhelming.
When it comes to programming, it's different.
Hm reminds me of a traumatic but illuminating acid trip and the continual guessing about "physical brain damage".
Has anyone with natural psychosis also had simultaneous acid induced psychosis, and if so what happened?
Has anyone with natural psychosis also had simultaneous acid induced psychosis, and if so what happened?
LSD induced psychosis is stronger and pretty much overrides any bipolar psychosis I've ever had. My bipolar visual hallucinations typically lasted seconds to minutes, typically only happened during deep anxiety, and could be shooken off. LSD hallucinations last multiple hours, are very strong, happen in any mental state, and can't be shooken off.
Bipolar psychosis is a lot weaker, feels more like religion, can last many weeks. The scariest types of psychosis are the ones that are hard to distinguish from the real world. Talking to trees while in psychosis is easy to talk yourself through. Believing someone wants to marry you is a much harder psychosis to reason through, and can result in badly damaged friendships if you don't figure it out in time.
LSD psychosis is strong and warped and pretty much always dispelled easily as soon as you are in a calm frame of mind.
I've found that in the weeks following a trip, bipolar cycles are much more tame and manageable.
I know other bipolar individuals who also found similar relief in LSD.
Bipolar psychosis is a lot weaker, feels more like religion, can last many weeks. The scariest types of psychosis are the ones that are hard to distinguish from the real world. Talking to trees while in psychosis is easy to talk yourself through. Believing someone wants to marry you is a much harder psychosis to reason through, and can result in badly damaged friendships if you don't figure it out in time.
LSD psychosis is strong and warped and pretty much always dispelled easily as soon as you are in a calm frame of mind.
I've found that in the weeks following a trip, bipolar cycles are much more tame and manageable.
I know other bipolar individuals who also found similar relief in LSD.
That's very interesting. So the LSD psychosis shows you how intense it can be and makes normal psychosis feel that much milder?
It's not that it makes normal psychosis feel milder, it's that after trips my mood is more stable and I simply don't have as much bipolar psychosis.
I know other psychedelics (MDMA, Ketamine) can have this impact on depression, where one dose will stabilize a patient for many weeks after and I imagine its similar, though it's not as well studied.
I know other psychedelics (MDMA, Ketamine) can have this impact on depression, where one dose will stabilize a patient for many weeks after and I imagine its similar, though it's not as well studied.
I’ve read similar stories. I wish they were chronicled in medical journals.
Ketamine is being studied as a treatment for depression and bipolar.
Just venting out:
I remember the exact day and moment that, for the first time I felt that my mind was clear as crystal water, silent, and could be used at command without any effort. 0 anxiety, the inner voice in my head disappeared.
At the time i was unemployed just reading/watching math/philosophy/CS books/videos, I was stuck understanding concepts for months, just reading things without really digesting them, just to pass time. but at that second, everything started to make sense, without any effort, I started to make connections between concepts and applications, recalled that day as one of my best days of my life and changed my way of thinking in a good way, forever. i was just laying in bed completely immersed and exploring a new world in my mind. my memory was like it was a movie that could be rewinded,paused and analyzed at will.
The next Monday i visited my doctor at the time (i was been treated for ADD), I said - thanks you!, when i entered his office, thanks you for curing me!. I explained what happened and how i felt, he looked at me, took a paper and sign my definitive diagnosis : bipolar 2. he cut my antidepressant and prescribed my new treatment, and he told me, that how i feel was not going to last, and the way down could be really hard, and indeed, it was really hard for me to think that this was going to go away, I remember every morning of that month waking up and checking my thoughts. over the course of 2 months, i went back to the 'normal chaos', also i just landed a new job (which i quit 2 months later), so my worries intensified. I still have the false hope that I was the real me during those months and that sometime in the future I would be that way forever. I really want to feel normal, sociable , logical, assertive and articulate as I am during my states of hypomania , which are no longer than a week, very frequents, but not as high as that episode 2 years ago.
Life treated me well,i had extremely good luck with my understanding partner, my friends/colleagues and family, they know how to turn my weirdness and chaotic mind into something useful and productive. I still have no monetary stability and I feel I'am at one catastrophic disease/event to be on the streets or dead, I have been broke several times in my life, but as an 'above average' IT guy in a third world country with a simple life style, it was easy to find a job and shine for a while and get the money to get back on track and then throw it all and repeat.
Now, Im 'stable', under quetiapine/concerta, unemployed and with zero will to work ever again in something with a boss or teams, resisting the urge to engage and get exited with projects with other people, because i know ill disappoint at some time. Im feeling frustrated that i cant do anything valuable with what i know, i simply don't have the discipline nor the stamina to do something that matters and it is slowly eating me from inside. I dream of having a little opensource projects that involve everything I enjoy from math/cs/art, all my "projects" , code , ideas that i wrote get deleted in the next system reinstall. I don't know how/where to get more valuable help, i had tried a lot of things (mindfulness meditation, exercise, drugs, prescription meds, charity, collaboration on OS projects,diets...), things that at sometime seems to be doing the right thing on me but, they stop working or my energy just vanish, so i dismissed the effects as a placebo, which leads me to believe that is the only effect that works on me.
I remember the exact day and moment that, for the first time I felt that my mind was clear as crystal water, silent, and could be used at command without any effort. 0 anxiety, the inner voice in my head disappeared.
At the time i was unemployed just reading/watching math/philosophy/CS books/videos, I was stuck understanding concepts for months, just reading things without really digesting them, just to pass time. but at that second, everything started to make sense, without any effort, I started to make connections between concepts and applications, recalled that day as one of my best days of my life and changed my way of thinking in a good way, forever. i was just laying in bed completely immersed and exploring a new world in my mind. my memory was like it was a movie that could be rewinded,paused and analyzed at will.
The next Monday i visited my doctor at the time (i was been treated for ADD), I said - thanks you!, when i entered his office, thanks you for curing me!. I explained what happened and how i felt, he looked at me, took a paper and sign my definitive diagnosis : bipolar 2. he cut my antidepressant and prescribed my new treatment, and he told me, that how i feel was not going to last, and the way down could be really hard, and indeed, it was really hard for me to think that this was going to go away, I remember every morning of that month waking up and checking my thoughts. over the course of 2 months, i went back to the 'normal chaos', also i just landed a new job (which i quit 2 months later), so my worries intensified. I still have the false hope that I was the real me during those months and that sometime in the future I would be that way forever. I really want to feel normal, sociable , logical, assertive and articulate as I am during my states of hypomania , which are no longer than a week, very frequents, but not as high as that episode 2 years ago.
Life treated me well,i had extremely good luck with my understanding partner, my friends/colleagues and family, they know how to turn my weirdness and chaotic mind into something useful and productive. I still have no monetary stability and I feel I'am at one catastrophic disease/event to be on the streets or dead, I have been broke several times in my life, but as an 'above average' IT guy in a third world country with a simple life style, it was easy to find a job and shine for a while and get the money to get back on track and then throw it all and repeat.
Now, Im 'stable', under quetiapine/concerta, unemployed and with zero will to work ever again in something with a boss or teams, resisting the urge to engage and get exited with projects with other people, because i know ill disappoint at some time. Im feeling frustrated that i cant do anything valuable with what i know, i simply don't have the discipline nor the stamina to do something that matters and it is slowly eating me from inside. I dream of having a little opensource projects that involve everything I enjoy from math/cs/art, all my "projects" , code , ideas that i wrote get deleted in the next system reinstall. I don't know how/where to get more valuable help, i had tried a lot of things (mindfulness meditation, exercise, drugs, prescription meds, charity, collaboration on OS projects,diets...), things that at sometime seems to be doing the right thing on me but, they stop working or my energy just vanish, so i dismissed the effects as a placebo, which leads me to believe that is the only effect that works on me.
> I started to make connections between concepts and applications, recalled that day as one of my best days of my life and changed my way of thinking in a good way, forever.
Interesting.
Did you continue to feel that way after the episode?
People with ADHD often get racing thoughts and are restless. Also it's possible that you had some insightful moments at the time.
When things connect or we're making progress, we tend to feel happy/euphoric. So what is the reason that the doctor recognized the above as bipolar type 2?
When does "feeling optimistic" end and where does "bipolar" start?
Interesting.
Did you continue to feel that way after the episode?
People with ADHD often get racing thoughts and are restless. Also it's possible that you had some insightful moments at the time.
When things connect or we're making progress, we tend to feel happy/euphoric. So what is the reason that the doctor recognized the above as bipolar type 2?
When does "feeling optimistic" end and where does "bipolar" start?
I'm adhd and bp2 and while I can tell some of my symptoms apart a bunch of them seem so similar (reading texts and comprehending nothing for weeks, executive function issues, racing thoughts, emotional outbursts) I'm constantly trying to pry them apart to know which one I'm experiencing.
And now adhd seems to be going more the executive function disorder route so when I read through /r/adhd I wonder if a lot of the people I'm reading about are bp or if I'm not even bp2 but I'm just adhd. I guess in the end it doesn't matter if I find a way to manage the symptoms instead of focusing on labeling them.
I'm glad for posts like this because I had the same issue where I refused to believe my dx because my bp mom is far more serious and media/tv portray it so far from what I have, what seems to be a fairly mild case. It wasn't until I started reading bp-in-tech/etc stories on here where I realized the spectrum range is so broad.
And now adhd seems to be going more the executive function disorder route so when I read through /r/adhd I wonder if a lot of the people I'm reading about are bp or if I'm not even bp2 but I'm just adhd. I guess in the end it doesn't matter if I find a way to manage the symptoms instead of focusing on labeling them.
I'm glad for posts like this because I had the same issue where I refused to believe my dx because my bp mom is far more serious and media/tv portray it so far from what I have, what seems to be a fairly mild case. It wasn't until I started reading bp-in-tech/etc stories on here where I realized the spectrum range is so broad.
[deleted]
> Did you continue to feel that way after the episode?
yes, but not without effort,its like that episode taught me how to make connections more easily, or be aware of them more consciously. I remember it wasn't rare to be told on my work: - how the hell did you know it was that? when i was asked to take a look into a problem/tools/frameworks even areas not related at all to what I was doing, my answer often was, i don't know. it happened to me so often that i thought that the information was there and the connections were made without being conscious.
Also happen that is extremely hard to express my self or explain things that i know i can handle in my mind, but i guess im just shy.
> When things connect or we're making progress, we tend to feel happy/euphoric. So what is the reason that the doctor recognized the above as bipolar type 2?
I guess i was very talky,remember commenting him that I memorized/learned a bunch of stuff and i was able to recall it at will, I was very exited, too much I guess. he told me "a little bit more.. and you are going to think you can fly and jump off a building", so he told me to call him every day that week to report, I was delusional. Also, the diagnosis made me think of the past, and saw a very clear pattern of ups and downs. I don't feel depressed when I'm down, I just become apathetic, bored, angry and results in frustration , the energy is there,and its too much, but I'm there paralyzed. also my ability to express ideas, opinions or just the use of the words degrade substantially.
> When does "feeling optimistic" end and where does "bipolar" start?
In my experience with states of hypomania: the optimism is just not proportional to the achievements I guess, but you aren't going to be aware of that. you become another person, your confidence go to the roof, and your anxiety to 0, you feel at the top of the world, you can easily become a con artist if you want. that is when you start to do things that puts you in danger, physically, monetary , sexually,etc...
*sorry for my English, not native speaker. edit: new line
yes, but not without effort,its like that episode taught me how to make connections more easily, or be aware of them more consciously. I remember it wasn't rare to be told on my work: - how the hell did you know it was that? when i was asked to take a look into a problem/tools/frameworks even areas not related at all to what I was doing, my answer often was, i don't know. it happened to me so often that i thought that the information was there and the connections were made without being conscious.
Also happen that is extremely hard to express my self or explain things that i know i can handle in my mind, but i guess im just shy.
> When things connect or we're making progress, we tend to feel happy/euphoric. So what is the reason that the doctor recognized the above as bipolar type 2?
I guess i was very talky,remember commenting him that I memorized/learned a bunch of stuff and i was able to recall it at will, I was very exited, too much I guess. he told me "a little bit more.. and you are going to think you can fly and jump off a building", so he told me to call him every day that week to report, I was delusional. Also, the diagnosis made me think of the past, and saw a very clear pattern of ups and downs. I don't feel depressed when I'm down, I just become apathetic, bored, angry and results in frustration , the energy is there,and its too much, but I'm there paralyzed. also my ability to express ideas, opinions or just the use of the words degrade substantially.
> When does "feeling optimistic" end and where does "bipolar" start?
In my experience with states of hypomania: the optimism is just not proportional to the achievements I guess, but you aren't going to be aware of that. you become another person, your confidence go to the roof, and your anxiety to 0, you feel at the top of the world, you can easily become a con artist if you want. that is when you start to do things that puts you in danger, physically, monetary , sexually,etc...
*sorry for my English, not native speaker. edit: new line
Type 1 bipolar with an unusual history here.
My dad was bipolar and committed suicide while I was a teenager. I had a 6 months long mixed episode ~15 years ago that got me diagnosed. High energy, racing thoughts, little to no sleep, mood going from euphoria to more painful thoughts, always very high in intensity, borderline delusional.
After months of denial I accepted the diagnosis and I ended up with lithium then lamotrigine because of side effects of the former, but neither were effective. I still had to take olanzapine to quell nascent manic bouts a few times a year. I was pretty traumatized by the fallout of my first episode (I destroyed or damaged quite a few relationships), making me want to never go back there if at all possible.
Luckily for me the racing thoughts and high energy always came before the mood and ego distortions, which gave me the opportunity to act. I soon realized that the earliest I took olanzapine the lower the dose I had to take to shut off the episode. 1.25mg or at worse 2.5mg were enough to stop it in its tracks most of the time (taking another 1.25mg dose after an hour if the first wasn't sufficient). Sometimes I had to re-iterate on the next day, and that was it.
I discovered this paper [1] a few years down the line, which describes how both the speed and the content of thoughts influence the mood level. This made me want to try and control the pace of my thoughts willfully.
My first naive attempts failed (I had to fall back on drugs), but then I tried to use mental imagery under self-hypnosis (which I had learned independently, mania is very conducive to hypnosis), with success. I had realized that I had a hard time thinking fast while walking slowly, and thus I projected myself lingering in a derelict and deserted landscape, where everyone I loved was dead.
This let me cut the mania in its track, but let me sad for two days. Also, even in my mind, walking slowly was hard to maintain for long periods of time. So I tweaked the scenario, to a more pleasant and peaceful walk in the sea on a nice end of the summer day, with water above the knee. The imagined physical resistance of the water helped me keep the pace down, and the experience let me in a nice, agreeable mood. Practicing the scenario between manic episodes also helped getting there more easily.
Seven years ago, after a few years of not needing olanzapine, I tried stopping the lamotrigine as well, since it was not fully effective. The frequency and intensity of the episodes didn't worsen, and it even gradually went down to ~1 per year without any ill consequences. I've now reached a point where I don't even need the full self-hypnosis decorum to brake, sheer will is sometimes enough.
So this is how I got to mostly manage my condition and get rid of drugs. While unusual, this isn't unheard of [2]. Lewis Mehl-Medrona's approach with narrative analysis and imagery approach among native americans remains very marginal though (that paper has been cited once in 13 years, I discovered it this month).
I say "mostly manage", because there are still a few problems.
- Because of its long half-life, pseudoephedrine taken several days in a row is stronger than my own might, and self-hypnosis barely helps (sinusitis, fuck yeah).
- This summer, experiencing an epiphany while being in love pushed me over the edge into a slow but otherwise manic-like euphoric state, with a relentless, obsessive train of thoughts (not unlike a walking bass in an old jazz), and distorted thoughts patterns reminiscent of my initial episode. Without the usual warning sign (racing thoughts and high energy) it took me ~36 hours to realize something was amiss and come back down (I had watched a slow, contemplative movie without realizing it had a plot. This left me puzzled and I read about it on the Web the next day, discovering with dread that had just been out of my mind). I had ruined another relationship in the mean time. Conclusion: avoid thinking too hard while being in love (in that state, one's ability to think is badly impaired anyways).
2. https://www.researchgate.net/publication/45389079_Narrative_...
My dad was bipolar and committed suicide while I was a teenager. I had a 6 months long mixed episode ~15 years ago that got me diagnosed. High energy, racing thoughts, little to no sleep, mood going from euphoria to more painful thoughts, always very high in intensity, borderline delusional.
After months of denial I accepted the diagnosis and I ended up with lithium then lamotrigine because of side effects of the former, but neither were effective. I still had to take olanzapine to quell nascent manic bouts a few times a year. I was pretty traumatized by the fallout of my first episode (I destroyed or damaged quite a few relationships), making me want to never go back there if at all possible.
Luckily for me the racing thoughts and high energy always came before the mood and ego distortions, which gave me the opportunity to act. I soon realized that the earliest I took olanzapine the lower the dose I had to take to shut off the episode. 1.25mg or at worse 2.5mg were enough to stop it in its tracks most of the time (taking another 1.25mg dose after an hour if the first wasn't sufficient). Sometimes I had to re-iterate on the next day, and that was it.
I discovered this paper [1] a few years down the line, which describes how both the speed and the content of thoughts influence the mood level. This made me want to try and control the pace of my thoughts willfully.
My first naive attempts failed (I had to fall back on drugs), but then I tried to use mental imagery under self-hypnosis (which I had learned independently, mania is very conducive to hypnosis), with success. I had realized that I had a hard time thinking fast while walking slowly, and thus I projected myself lingering in a derelict and deserted landscape, where everyone I loved was dead.
This let me cut the mania in its track, but let me sad for two days. Also, even in my mind, walking slowly was hard to maintain for long periods of time. So I tweaked the scenario, to a more pleasant and peaceful walk in the sea on a nice end of the summer day, with water above the knee. The imagined physical resistance of the water helped me keep the pace down, and the experience let me in a nice, agreeable mood. Practicing the scenario between manic episodes also helped getting there more easily.
Seven years ago, after a few years of not needing olanzapine, I tried stopping the lamotrigine as well, since it was not fully effective. The frequency and intensity of the episodes didn't worsen, and it even gradually went down to ~1 per year without any ill consequences. I've now reached a point where I don't even need the full self-hypnosis decorum to brake, sheer will is sometimes enough.
So this is how I got to mostly manage my condition and get rid of drugs. While unusual, this isn't unheard of [2]. Lewis Mehl-Medrona's approach with narrative analysis and imagery approach among native americans remains very marginal though (that paper has been cited once in 13 years, I discovered it this month).
I say "mostly manage", because there are still a few problems.
- Because of its long half-life, pseudoephedrine taken several days in a row is stronger than my own might, and self-hypnosis barely helps (sinusitis, fuck yeah).
- This summer, experiencing an epiphany while being in love pushed me over the edge into a slow but otherwise manic-like euphoric state, with a relentless, obsessive train of thoughts (not unlike a walking bass in an old jazz), and distorted thoughts patterns reminiscent of my initial episode. Without the usual warning sign (racing thoughts and high energy) it took me ~36 hours to realize something was amiss and come back down (I had watched a slow, contemplative movie without realizing it had a plot. This left me puzzled and I read about it on the Web the next day, discovering with dread that had just been out of my mind). I had ruined another relationship in the mean time. Conclusion: avoid thinking too hard while being in love (in that state, one's ability to think is badly impaired anyways).
--------
2. https://www.researchgate.net/publication/45389079_Narrative_...
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This is an extremely good write-up.
Thanks for posting it!
Thanks for posting it!
Does anyone know unconventional ways to treat depression (or bipolar), that are not widely known, but are nevertheless supported by solid science?
RTMS, gaining traction, good efficacy, and no side effects like medication.
I read about keto diets being helpful in schizophrenia and such. It should be easy to find.
I don’t know if this qualifies as “unconventional” but I have had tremendous success increasing my physical exercise daily. I’m not entirely sure if it’s just daily exercise or goal setting (in my case it was the somewhat ambiguous ‘10k steps a day’) or maybe a mix of both, but it evened out my mood significantly and had a strong effect on my depression.
(Edit: studies associated) https://scholar.google.com/scholar?q=exercise+effect+on+depr...
(Edit: studies associated) https://scholar.google.com/scholar?q=exercise+effect+on+depr...
I find that daily exercise and keeping a steady schedule of 8~9 hours of sleep is critical to maintaining stability. Sleep is the one thing I can't skimp on. Exercise can slip for a day or two. Food is less critical as long as I'm getting proper nutrition and don't skip meals.
Due to my severity, insomnia (primary), and psychosis, I will likely always need medication but taking care of my body allows me to keep the dosages low enough that I still feel like myself.
Due to my severity, insomnia (primary), and psychosis, I will likely always need medication but taking care of my body allows me to keep the dosages low enough that I still feel like myself.
I feel like exercise is the standard advice from almost every medical professional for almost everything... but it is often helpful (I mean from the perspective of a type 2 bipolar), and it keeps away things like weight gain, inability to do physical activities, etc. which is usually pretty harmful. Sleep is also important.
In general, taking care of yourself physically (beyond sleep and exercise this includes things like taking showers, brushing teeth, etc., which can be difficult during a slump) makes it easier to take care of yourself mentally since you have more energy and don't need to deal with body problems.
In my experience this stuff is helpful, but not a silver bullet.
In general, taking care of yourself physically (beyond sleep and exercise this includes things like taking showers, brushing teeth, etc., which can be difficult during a slump) makes it easier to take care of yourself mentally since you have more energy and don't need to deal with body problems.
In my experience this stuff is helpful, but not a silver bullet.
Lithium as a supplement to antidepressants, for treating depression. It works very well.
All-meat diets with a high fat to protein ratio seem to be a panacea to many physical and mental ailments.
Amber O'Hearn is a famous personality and researcher in this space, there are a few accounts of her successful remission from bipolar type 2 with this regimen.
I can give other references and answer any related questions.
[Edit] I'm not aware of any science on all-meat diets and mental health, but there is scientific evidence supporting the role of nutrients in animal foods and brain health, as well as ketogenic metabolism VS glucose metabolism (notably as a treatment for epileptic seizures). Obviously what's good in calming epileptic brains is going to be good for calming all brains.
Amber O'Hearn is a famous personality and researcher in this space, there are a few accounts of her successful remission from bipolar type 2 with this regimen.
I can give other references and answer any related questions.
[Edit] I'm not aware of any science on all-meat diets and mental health, but there is scientific evidence supporting the role of nutrients in animal foods and brain health, as well as ketogenic metabolism VS glucose metabolism (notably as a treatment for epileptic seizures). Obviously what's good in calming epileptic brains is going to be good for calming all brains.
I heard somewhere that this was good if there is an auto-immune issue underlying the mental health problems - although I could be totally wrong about that. If no such auto-immune issue is present, is this still a valid therapy? Thanks.
This seems at least tangentially related to the psilocybin thread currently on the front page. I have read in journals that bipolar is a disease of neuroinflammation upregulated by cytokines etc. in the brain. My hypothesis is that this could be related to the gut microbiome which has been proven in studies to affect the brain directly. Maybe you really are what you eat?
One of the "doctors" who recently published research on "psychobiotics" was
later selling a brand of "clinically tested" probiotics tailored for mood disorders. Gut microbiome studies, at this point in time, need to be taken with a pinch of allum.
I'm bipolar. It is far more complex than "what you eat."
Forgive me for being slightly facetious with the saying, of course there are many more factors involved that require close and careful study.
From what I understand the etiology of bipolar is not well understood, with different correlations like dopamine dysregulation or the inflammatory markers you mention (which could indeed be influenced by the gut biome), but as with unipolar depression it's probably too simplistic an approach to try and reduce it to a single factor.
Almost all bipolar people have relatives that were bipolar. That points rather strongly to a genetic cause than an environmental one.
The complicating factor is that every disease/disorder/condition (both mental and physical) is a combination of genetics, environment, and the nonlinear interaction of genetics and environment. We can measure the genetic factors, and with somewhat more difficulty, the environmental factors. But that interaction term is extremely difficult to measure. It encompasses things like those mentioned in the article: the fact that "sick" people often don't appear sick unless there is an environmental stressor exacerbating their condition. This kind of conditional effect is very hard to measure scientifically.
Bipolar is one of the more heritable diseases. If one person has bipolar, every one of their direct relatives (children, bothers, parents) have a 10% chance of also having bipolar.
As part of my experience coming to terms with bp2, I did a family history and found out that almost everyone in my father's (high-functioning and accomplished) family had been institutionalized.
As part of my experience coming to terms with bp2, I did a family history and found out that almost everyone in my father's (high-functioning and accomplished) family had been institutionalized.
My understanding from the research is that the aetiology is not well understood at all, and that certain individuals are more susceptible to triggers. Note that although you may be genetically susceptible to a disease it does not mean that another cause (or organism!) might interact with those genes and result in said disease.
The problem is... "Maybe you really are what you eat?" seems to put the blame solely on the bipolar person for not eating properly.
I don't know about other bipolar people but I'm tired of being told it's my fault I'm bipolar.
I don't know about other bipolar people but I'm tired of being told it's my fault I'm bipolar.
This is not a good way to look at it, frankly.
The problem with "bipolar disorder is caused by diet" is that it's wrong. There's no evidence of it, plenty pointing in other directions, it's just a non-starter.
Which sucks, because if bipolar was caused by, I dunno, seed oils, great news! Just don't eat seed oils!
And if someone goes to the doctor and says "I'm bloated and gassy all the time and I feel terrible" and the doctor says "yeah you're lactose intolerant, avoid dairy and take these pills when you eat it", that's not blaming the person either.
I'm sure that there are people in your life who blame you for being the way that you are. I don't see this as a case of that. They probably read some woo-woo nutritional site with bad advice, and thought they were helping.
The problem with "bipolar disorder is caused by diet" is that it's wrong. There's no evidence of it, plenty pointing in other directions, it's just a non-starter.
Which sucks, because if bipolar was caused by, I dunno, seed oils, great news! Just don't eat seed oils!
And if someone goes to the doctor and says "I'm bloated and gassy all the time and I feel terrible" and the doctor says "yeah you're lactose intolerant, avoid dairy and take these pills when you eat it", that's not blaming the person either.
I'm sure that there are people in your life who blame you for being the way that you are. I don't see this as a case of that. They probably read some woo-woo nutritional site with bad advice, and thought they were helping.
Ah, that was not my intention at all. I know people with bipolar and would never suggest that it was their fault. It's a poorly understood and vastly complex disease and any clue as its possible origin and possible therapeutic targets would be good.
Also bipolar. Episodes often start with life-changing events. I highly doubt that food is to point a finger at here. My last episode was really triggered by me leaving my job and going jobless for the first time. I was eating well, fresh and self-cooked. Then during mania I could not eat a single thing. Also could not sleep. For 3 months straight.
The worst thing you can do here is to generalize.
The worst thing you can do here is to generalize.
Anecdotally the symptoms can already be present - but manageable - then severe trauma(s) trigger an extreme worsening of the cycle between the highs and the lows.
Getting back to a "manageable" state would be ideal however future (and even perhaps far more minor) trauma may prove to be a significant barrier and potentially trigger relapses resulting in quite a vicious cycle.
Certainly a very complex thing to explain to people and carries a lot of stigma.
Getting back to a "manageable" state would be ideal however future (and even perhaps far more minor) trauma may prove to be a significant barrier and potentially trigger relapses resulting in quite a vicious cycle.
Certainly a very complex thing to explain to people and carries a lot of stigma.
In my case, looking back, I think I have already lived through a handful of episodes of lower but still damaging intensity. I first really started recognizing this pattern when I had this sort of episode where it became clear to each and every person around you, that there is something off. It was like I was on cocaine 24/7, paired with extreme paranoia (I moved to a rather bad neighborhood in a big city two years before).
Ever since this initial awareness and diagnosis, I have stepped back from a lot of people, and many stepped away from me. I was left in a void where I had basically I social interaction.
While it was extremely depressing I have the feeling, at least in my case, that less communication can help to find a manageable state. Today it’s easier for me to manage, although still not perfect. I declined any medical treatment except for one dose of Haloperidol which I agreed to after I had freaked out and the police had to tie me down and send me to psychiatry. (As it happened I accidentally ran into a drug handover in the midst of my mania, I was afraid to die and started losing it completely)
Nobody really understands the hurricane of feelings one is going through, it doesn’t really make sense to try and explain it to people.
Ever since this initial awareness and diagnosis, I have stepped back from a lot of people, and many stepped away from me. I was left in a void where I had basically I social interaction.
While it was extremely depressing I have the feeling, at least in my case, that less communication can help to find a manageable state. Today it’s easier for me to manage, although still not perfect. I declined any medical treatment except for one dose of Haloperidol which I agreed to after I had freaked out and the police had to tie me down and send me to psychiatry. (As it happened I accidentally ran into a drug handover in the midst of my mania, I was afraid to die and started losing it completely)
Nobody really understands the hurricane of feelings one is going through, it doesn’t really make sense to try and explain it to people.
> Nobody really understands the hurricane of feelings one is going through, it doesn’t really make sense to try and explain it to people.
It can be done but it requires finding the points in a person's experience that mirror my own to some degree. Building on that, you can paint a picture they can understand.
I like the example of telling a person they need to keep eight words in their head all day long with no notes. Then they'll be quizzed about those words randomly throughout the day. If they fail, they have to sit quietly in a chair for the next hour.
Then I ask them how pissed off they'd be if they were interrupted in the middle of a task by me asking them to list the words in reverse alphabetical order by the fifth letter. Repeat several times an hour with different sorting and filtering criteria.
It can be done but it requires finding the points in a person's experience that mirror my own to some degree. Building on that, you can paint a picture they can understand.
I like the example of telling a person they need to keep eight words in their head all day long with no notes. Then they'll be quizzed about those words randomly throughout the day. If they fail, they have to sit quietly in a chair for the next hour.
Then I ask them how pissed off they'd be if they were interrupted in the middle of a task by me asking them to list the words in reverse alphabetical order by the fifth letter. Repeat several times an hour with different sorting and filtering criteria.
The closest thing I could make some people relate to was that it was like being on LSD, just that it comes in waves.
I also happen to have experimented with lots of psychedelics in the prior years and I’m not gonna deny that this may have intensified the symptoms. Mania felt like an acid flashback.
All this sudden energy and creativity, but also the scatteredness (not sure this is a word). It was too much to handle.
At the time I was programming up to 10h per day. I could not remember names of people I met the day before, also I had blackouts. My brain was not able to process. With your experiment I would have failed miserably because sitting still for an hour was not manageable.
I also happen to have experimented with lots of psychedelics in the prior years and I’m not gonna deny that this may have intensified the symptoms. Mania felt like an acid flashback.
All this sudden energy and creativity, but also the scatteredness (not sure this is a word). It was too much to handle.
At the time I was programming up to 10h per day. I could not remember names of people I met the day before, also I had blackouts. My brain was not able to process. With your experiment I would have failed miserably because sitting still for an hour was not manageable.
Feel free to link/create/sponsor/recommend clinical trials or research.
https://kayode.co/blog/4106/living-with-psychosis/
Hiding is what I've always done. It's exhausting having to appear normal all the time.
I'm fortunate to have understanding friends. Instead of me constantly bitching, we have code words for how I'm feeling. If I'm good, that makes I'm stable and relatively happy. If I'm okay, I'm probably depressed. It goes on from there. I'm able to talk about how I feel without getting into the details no one want to hear every day.
At work, I'm extremely fortunate to have a boss whose wife is bipolar. I've been able to get ADA accommodations that give me the flexibility and restrictions I need to go to work every week. This is the first job I've ever had this luxury.
And it really is a luxury. This is my first job where I've had any kind of accommodation. I've worked at places where I've pretended to have the flu just to take a day off for mental health.
Even now everyone, except my boss and friends, treats taking time off for mental health like vacations, because that's the experience for them. I've used so much PTO, I never get a vacation. Instead, I'm always at home on days off, dealing with a hell that my coworkers have never come close to experiencing.
I could go on a lot longer because there is no limit to how many things I have to deal with. But no one really wants to read that and I don't want to write it again.