Bipolar By Chance - The Bipolar Connection

The Parental Role and Bipolar Disorder

noreply@blogger.com (Donald Kern) — Mon, 07 Dec 2009 05:07:00 +0000

As a parent you learn to put your children’s needs before your own. Isn’t that the nature of the parental role, making certain children are safe and secure? But, what happens if the parent is ill? What occurs when a parent is bipolar and cannot deal adequately with a minor child’s need for guidance, for structure, for nurturing?

Illness typically has the focus of concern for the ill person. When you have a cold or the flu, your attention shifts from those outside yourself to you. You don’t feel well; you want to be taken care of. Yet, to be a parent is to shift the focus from you to your family.

When you’re mentally ill, it is all too easy to have your view be surrounded by your symptoms. This runs counter to taking responsibility for the care of those more vulnerable than you. Often you, the parent, are vulnerable, lacking common sense and the wisdom it takes to guide your children. All too often, the children become the parent. They take on at a young age the role of safety monitor for other siblings and may even assume the care of the ill parent. This is called a parentified child; a child who is caught between love for their parent and the too early assumption of adult roles, thereby cutting childhood short.

Even in families where there is a healthy parent attempting to deal adequately with child and spouse, there is an inability to connect with the partner to share the burden of responsibility. Families such as this often run afoul of an overtaxed partner living on the edge of a breakdown himself/herself. Caregiver burnout is often the result. It is at times like this that children fall through the cracks, into that dark world of negligence, unmet needs, and insufficient succor.

Mentally ill parents don’t purposely lead their children astray. Yet, at times, their vision of themselves and their children’s strengths is distorted by a desire to wish themselves well, denying their inability to look after and shelter others.

Mania’s grandiosity and depression’s lethargy can lead to inadequate parenting. When you’re up, everything goes along easily, or so you think. Lubricated by overblown desire for well-being, a mentally ill parent can ignore the threats to the safety of their children, or the taking care of their physical needs. We live in a world of all-expanding possibilities, deluding ourselves about our impairment. When depressed, all seems lost. The simplest action is often overwhelming. It is at those times of diminished adequacy that neglect can arise.

Parents, grandparents, and family friends need to keep an adequate eye out for relatives or friends who may be falling short of adequate parenting. Stepping in to assure children’s safety and the need-to-be-children may be necessary. Even when the most loving thing you can do is to be in touch with a social service agency to engage proper child supervision, don’t be filled with guilt or a competing desire not to be cast in the role of disciplinarian. Those less fortunate or inadequate to care for their own needs still require your help. If family can’t intercede, your local church or government agency may need to.

For those with mental illness, disabilities can get in the way if you’re unable to shoulder parenting. Sometimes it is just until you recover that social support is called for. Don’t be blind to your children’s needs. Let your love be for their nurturing.

Biploar Holidays Revisited

noreply@blogger.com (Donald Kern) — Sat, 14 Nov 2009 00:09:00 +0000

It’s that time of year again; time to get ready for the holidays. Gray skies, falling temperatures, daylight receding into night earlier. Time to take the holiday cheer out of the closet and bedeck the house with it. This is the season for gratitude.

Does this sound like too much of a cliché? We’ve all heard these well-worn platitudes before. For those struggling with mental illness, it can seem like pleas for thankfulness emitted from some goody- two-shoes view of reality. For what should someone with bipolar disorder feel blessed?

I ponder my reply to that last question. What should my response be? Is your medication working? Do you feel like you’re on a roller coaster of ever-changing moods? Do your moods shift between depressive lows and intermittent normalcy; normalcy, which is a reprieve from unending manic excess that gives no thought to the inevitable consequences of feeling too good tomorrow?

Do you have family and friends to gather with, or has your life become an isolated trek through the cold and gloom of a winter-night darkness? Is there any relief for what seems like glib attempts to squeeze one more drop out of a stale appeal for holiday solidarity? Is there an opportunity for genuine caring? My counsel for those afflicted with mental illness is—hope. Gratitude springs from the hope that things will be different, and the activity of that difference can bring change that is satisfying and healing. In short--to care. Too much time spent in expectation of better times with too little perceived results can cause burnout.

Perhaps the one true spirit of the season is to rededicate one’s self. Can we acknowledge what we hope is true? Can we have gratitude for the opportunity to hope anew that life has meaning and our struggle is redeeming? Attitude rules change for the mentally ill and their families who cling to the belief that no matter how fleeting or pervasive their circumstances are, these circumstances are not static, but constantly changing and yielding to the betterment of their lives. This belief puts us in a position to be thankful for what we have. Attitude defines the ability to change. The gains are there to see.

The holiday season can remind us of how much we, as people, have in common with one another, if we pull together. And that can be shared again and again throughout the year.
Happy holidays to all who read this, beginning with a thankful Thanksgiving.

Ten Suggestions for Holiday Survival

Focus on what you have, not what you don’t have.
Count your blessings; make a list of them.
Accept the limitations you currently have creating goals that apply year round.
Concentrate your caring outwardly, not inwardly.
Encourage an open attitude of tolerance.
Avoid isolation by gathering with others.
Refute negative thoughts.
Meditate on living in the present.
Avoid excessive alcohol use.
Practice random acts of kindness.

Women's Issues and Bipolar

noreply@blogger.com (Donald Kern) — Thu, 29 Oct 2009 16:49:00 +0000

Women’s issues, when it comes to bipolar disorder, are many; all focused on a sense of identity and autonomy. In the culture as a whole, females have a particular array of unique problems arising from the way society views them.

When lost in mania or depression, there is a difficulty connecting emotionally with others. While it is true for most females, seeking identity in relationships has special meaning for those caught in the polarization that comes from bipolar disorder. Sliding back and forth in mood is unique to this illness. Cycling makes it hard to deal with the shuffling between nurturing and maintaining one’s identity. This can impact a sense of self-control, leading some women to promiscuity in a vain attempt to be cared for and valued by their partner. Only a female can know the shame and sense of degradation that stems from trying to find worth in relationships.

Being supported versus financial independence can keep many women with mental illness bouncing back and forth in a never-ending loop of seeking their own sense of self-esteem and catering to a partner who has a narrow vision of their worth. Often this leads to identity confusion that can be magnified by manic distortion.

Flagrant bipolar disorder can handicap a woman when parenting her children. Dancing to mania’s allure can cause many to ignore their parenting responsibilities, only to be left bereft of dignity when they recover from a manic escapade.
Repercussions stemming from a mental illness make the struggle for recovery a special dilemma for women. Added to their already overburdened loss of personal power only adds to the stigma they experience.

All of this together lends to an urgency to heal. Yet, qualities unique to women can aid in a return to health, while the draw to connect with others can lead to emotional support. Women have the potential to be gatekeepers to recovery for themselves and their families When stable, their ability to nurture can save lives threatened by emotional instability. Whether it be their children, their partners, or the community at large, they have a unique corner on healing. It’s through their ability and strength that we all prosper emotionally. Women are caretakers by nature, but they need to learn to take care of themselves when mental illness strikes.

Men's Issues and Bipolar

noreply@blogger.com (Donald Kern) — Wed, 14 Oct 2009 02:10:00 +0000

Why is it the tough guy always gets the girl? Is it because of that elusive quality we call “macho?” And, what is macho? To be sure it has an effect on the way men see the world. What happens when macho meets mania and depression?

To be macho is to be in control; masterful in all that a man does, confident. This sounds like a prescription for success. A man is aggressive, gets what he wants, and dominates. Of course all this is an illusion. Living in the real world is to be bombarded with doubts and struggles at every turn. Control, at best, is intermittent. Competition gives way to cooperativeness, but what happens if you end up a bipolar male? Mania thrives on control, the feeling of being invincible as long as you’re up. You can do anything, and quite often you can do it easily. All of this is fine until you cycle into depression. Then, there is no macho. The masculine imperative gets stuck. It’s then that shame moves in, the lack of having personal power. “You can’t get no respect,” as Rodney
Dangerfield used to lament. Talk about the image of the ineffectual man; he’s it.

Men often define themselves by the ability to do work. When their minds are muddled, it is hard to focus. The respect a man derives from his family as the breadwinner is threatened. The loss of leadership in a family or in a relationship gives way to shame. Often, conflict erupts and depression sets in.

So, what’s the option: seeking treatment, trying to regain lost masculinity, or coming to terms with your vulnerability? Sometimes men who have traveled the road of recovery come to find another power, the life of the spirit or spiritual. After the fall from grace, after recognizing the chaos mental illness can bring, comes a re-ordering or priorities. Learning to live with bipolar disorder is an education in humility, having gratitude for the calm that comes from facing an obstacle. One becomes a different sort of man. With the loss of macho comes the wisdom of acceptance, living in a world of physical limits and spiritual possibilities. To be strong ultimately, is to be strong emotionally, as well as mentally and to pass that wisdom on to others. To be a man is to teach what is from within.

Tools for Acceptance

Create a spiritual path within your life.
Seek skills that create calm for you.
Do physical exercise.
Join a church.
Learn to meditate
Seek a counselor to work with.
Take up a handcraft as a hobby.
Listen to music
Join a men’s support group.
Encourage others to share their stories & become a listener.
Join a 12-step group.

Bipolar Disorder – The Fifth Commandment

noreply@blogger.com (Donald Kern) — Tue, 22 Sep 2009 04:02:00 +0000

I never understood the fifth commandment, “Honor Thy Father and Mother,” never that is until my father died. I was not certain I understood what, “Honoring Thy Father,” meant. I loved and respected him, but wasn’t of like mindset and didn’t particularly share his view of life. In 1979, the year he died, I assumed that would be the end of our relationship. I couldn’t have been more wrong. Still, what does “honoring” mean? And why is that relevant to a blog post related to mental illness?

My mother, who lived to see my recovery from bipolar disorder, was instrumental to my recovery. She saw me marry, attain a master’s degree, and have a relationship with my stepdaughters. My father did not. He only knew me as mentally ill. While not contentious, there was a gap between my father and me. I never felt I understood him, what had driven him, or what his past looked like to him.

Having had a strong recovery since 1984, I often reflect on what my father would say if he saw me today, 25 years on meds without an episode, a successful mental health professional with a private practice, a 22 year marriage, and two grandsons. He would be proud. In the ensuing years since my stabilization, I have come to understand him through my own experience as an aging adult with a painful back that can make me feel irritable and silent, while trying to also ignore my pain and the struggles of self-employment in a time of a turndown in the economy.

My relationship with my father did not end when he died. He is with me when life’s markers are celebrated; he is with me when I wonder what his response would be to the success I am so proud of; he is with me when I make a difficult decision and choose wisely.

My father still continues to give wise counsel when I think of how he would see things. For me, my life struggle has been to recover and remain recovered from bipolar disorder. I know my father would be proud of my diligence to the task at hand.

Now stabilized, I am able to understand clearly the man my father was. I respect and appreciate him for the values he raised me with, and the tenacity and persistence I have gained from his example. I could not express my gratitude when in the throes of an episode. And so, I honor to the man my father was. To honor is to remember with gratitude

From the Wife of One Who is Bipolar

noreply@blogger.com (Donald Kern) — Wed, 09 Sep 2009 23:31:00 +0000

Aesop once said, “United we stand; Divided we fall.” I keep this quote in mind as I live each day with my spouse, who is bipolar. From the very beginning of our relationship, I knew he had a mental illness, which could manifest itself at any moment and yet; I took a chance. I have no regrets. There have been those times when I thought, “What have I gotten myself into,” but I made a commitment, and that commitment still stands.

I am fortunate; I have never seen my husband in a manic mode, although I have seen him depressed. We met after he began the meds that have kept him sane for the last 25 years. There have been those times when I have had to distinguish between what is normal and what is not. This has been difficult for me to determine. I have only witnessed a mild down period or extreme enthusiasm, which I have come to realize as his normal way of expressing heartfelt emotions. He is a sensitive soul. These feelings alert me, put me on notice and cause a fear of relapse despite 25 years of recovery. To counter this, I continuously educate myself on bipolar disorder, trying to read and learn as much as I can about this illness. Support groups such as National Alliance for the Mentally Ill have been a help, along with books and blogs on the subject.

There have been those unfortunate times I have lost my temper with my husband, usually over petty things and have been tempted to shout, “You’re nuts,” or “Stop acting crazy.” It is then I catch myself and refrain from saying words I will regret; words that are cruel and hurtful. It is very easy to blame his actions or moods on his illness. I have to remember that he has the same moods and emotions I do and that it is unkind to remind him of an illness, which is chemical and through no fault of his own. Because we are both totally open in our communication with one another, we are able to discuss our feelings about mental health issues.

Wanting to introduce myself as the wife of someone with bipolar illness, I am writing this article for my husband’s blog. I hope it will be helpful to readers.

Linda Kern – wife of Donald Kern

Ways to Work Together When One Spouse has Bipolar Disorder

Develop good sleep habits.
Help reduce stressor & triggers
Learn to forgive
Communicate your feelings
Educate yourself about the illness
Work together to promote health.
Promote a calm environment.

The Value of a Mental Health Support Group

noreply@blogger.com (Donald Kern) — Sat, 29 Aug 2009 16:13:00 +0000

Whether you are a consumer of mental health services or a family member of someone with a mental illness, support groups may be helpful. Coping with mental illness can be a challenge, leaving you feeling discouraged and overwhelmed.

The operative word in the term, “support group,” is support. Having the strength of others who have a similar issue can relieve that feeling of isolation, which often accompanies being confronted with issues that seem beyond our depth and capacity. Shouldering the burden of new and alien behaviors in a loved one, or attempting to understand what has happened in our own thinking, can be dealt with through the experience of those who have had the same path to follow.

Stigma, particularly self-stigma, is a constant companion when mental illness surfaces. Being with others normalizes our experience and leaves us with the feeling our illness is not quite so onerous that we cannot deal with it. The sense of shame attached to a mental disorder, that scary image that is conjured up when we think of “mental,” is reduced when we think it is reduced to a tolerable level. The idea is, “If they can do it, so can I.”

When I was newly diagnosed, I attended a consumer support group at the day treatment center I was enrolled in. Hearing others’ stories of their disrupted lives made me think my situation wasn’t too bad. Their support helped promote a new vision of what my life would become, and I could cope with what had seemed an impossible quandary. As well, I made new friends

Going to that group became a weekly vigil, which helped offer structure to my life at a time when I didn’t have a lot happening. Seeing a therapist, checking in with my psychiatrist, and attending support group meetings was all I had to fill my weeks. Feeling stale, under-challenged, and bored, I was happy just having that group meeting to anchor me to a place where my isolation was being displaced by activity with others.

Support groups are not for everyone. Some people are disturbed by seeing those who share their diagnosis. Hearing members talk about their symptoms can fill one with dread that their condition may worsen. Getting too much information can fan the flames of fear and alarm at what seems a barrage of emotions set loose by the difficulties of others. Sometimes it is too much information. If this is you, keep in mind the group experience may be something to come back to when you are further along the path to recovery. Individual therapy with a mental health professional may be a better alternative.

Support group attendance may also be a gateway to further action in the community as an advocate for mental illness; fighting the fight to reduce stigma and to normalize and educate others. Support groups give support to everyone: the mentally ill, a loved one, and the community-at-large.

Organizations That Offer Mental Illness Support Groups and/or Support

NAMI
Bipolar Support Alliance
Mental Health America (The Mental Health Association)
Recovery Inc.
Your local community Department of Mental Health
Twelve step programs
Local hospitals
Private therapists who work with the mentally ill
Your local church and clergy
Phone help lines that offer referral information

Precursors to Mental Illness

noreply@blogger.com (Donald Kern) — Tue, 18 Aug 2009 22:18:00 +0000

Often, when patients are newly diagnosed, they reflect on when it became clear they had a mental illness. Behaviors, which recently became the “stuff” of mental illness, were identified as pathological and were the rightful subject of clarification and treatment. Sometimes though, behaviors and moods can be seen earlier in life, long before a diagnosis and long before it seems to be necessary for an intervention. I am not talking here of childhood bipolar as much as I am precursors to an adult (young adult) onset of bipolar disorder. My own case is a good illustration of what I mean:

Diagnosed as the surfacing of bipolar disorder when in my mid- twenties, I can recall having mood swings in high school. I remember thinking when I had an up mood, to enjoy it while I could because I would be down by the next day at that time. Even then, it was clear to me my moods alternated and more often than not stayed in the dysphoric or melancholy range much of the time. Being a teenager, I just figured this was part of who I was. A thoughtful, sensitive young boy as well as teenager, I tended to be a loner. I spent long periods entertaining myself. Looking back on it, I displayed isolating behavior, another depression forerunner. I was shy and had difficulty mixing with other children. As well, I was super-sensitive to a slight. Children were sometimes unintentional tormentors. Because of this sensitivity to others, the societal imperative placed on correct social behaviors was difficult for me. At the time I simply saw myself as odd, my solitude counter to the accepted social norms. The issue that stems from this is: what is an extreme, and what are normal childhood issues?

Looking back, what may have been precursors to bipolar disorder in childhood and adolescence were often displaced as being normal. Not acknowledging differences in childhood behaviors may be due to wanting to see a child as normal; with social behaviors and parental expectations lived up to. This can lead a child to hide their moods, not reporting them to a parent because of a perceived expectation to the contrary, that they act normal. Not wanting to appear odd or different can motivate a child or teenager to fulfill an expectation of health or normalcy despite what is actually going on.

We know that mood changes are normal for teenagers and this makes it difficult to identify what is ill and what is normal adolescent angst. Certainly abnormal behavior can’t be laid at the door of parents simply because they failed to pick up on what may be illness. Should you as a parent see behaviors and mood swings in your child, it is important to educate yourself in order to pick up on what could be an opportunity that could aid earlier recognition, and if appropriate, treatment. Listening to and not just talking to your children is the first step.

Behaviors That Can Be Red Flags

Depressed mood
Social isolation
Extreme shyness
Excessive tearfulness
Acting out; sudden flare-ups of temper
Mood swings in excess of what would be deemed normal
Hiding feelings from a parent
A “flat line mood,” one which remains instant (does not differ over time)
Non-communication with a parent for a sustained period
Expressed thoughts of alienation or meaninglessness
Hyper behavior or insomnia
Poor grooming
Erratic behavior
Changes in appetite
Sudden weight loss or gain

Should any combination of these red flags arise, it would be good to discuss them with your family doctor or a mental health professional.

Answer to Request for Bipolar Information

noreply@blogger.com (Donald Kern) — Mon, 03 Aug 2009 04:00:00 +0000

I recently received an email request from an individual outside of the United States, asking for help regarding treatment for bipolar disorder beyond medication. I am publishing my reply and hope that it will be of assistance to others who are similarly interested:

Dear Ruben:

I received your email and am hoping I can be of some assistance to you.

As you may know, the medication taken for bipolar disorder is critical to recovery. While there are co-existing treatments that stabilize biochemistry, I believe medication is essential.

As well, "talk" therapy is helpful in sorting out the issues which arise from having a mood disorder. Breakdown in communication with friends and loved ones can occur in the midst of an episode, and we must learn to confront and take responsibility for the consequences of our behavior at those times.

My not knowing the culture in your country is a drawback because I am not able to assess the amount of stigma there may be in seeking psychological therapy and whether that is an option for you. Regardless, going for counseling is also an important therapy.

Support groups may be helpful in maintaining self-esteem. Being with others who share your diagnosis can be helpful and relaxing to the tension which can surround a diagnosis. Often, the feedback of others can reduce stigma and help you feel connected and less isolated.

One organization you can contact in the U.S. is the National Alliance for the Mentally Ill, or Nami as it is called. They may be able to put you in touch with treatment options closer to you. Their website address is: www.nami.org.

Also, the Depression and Bipolar Support Alliance (DBSA) is a helpful organization for those with bipolar disorder. You can contact them at: DBSAlliance.org. for information about the illness, its treatment, and referral to professionals who can help. They may have more information about treatment.

Cognitive-Behavioral Therapy has been found to be helpful as a psychotherapy for bipolar disorder. Doing a search of the internet will give you more information on this. It is the type of therapy that stresses our mind's ability to control our behavior.

As well, educating yourself about your illness is the most important thing you can do to help treat it. Learning what you are up against, and dispelling untruths about mental illness can be one of the key things you can do to empower yourself to persist in recovery.

Websites like PsyhcCentral, FinkShrink, and StableMoods are but a few of many sites that can increase and expand your knowledge and sense of well-being.

Lastly, don't be discouraged. With persistence, you can have a life and maybe someday help others to learn more, maybe even start your own support group in your own country.

Good Luck,

Donald Kern, MFT
email: info@kerntherapy.com
Author: Mind Gone Awry
website: kerntherapy.com
blog: bipolarbychance.blogspot.com

Ten Questions to Ask When Determining A Bipolar Diagnosis

noreply@blogger.com (Donald Kern) — Wed, 22 Jul 2009 18:02:00 +0000

Searching for a diagnosis takes persistence and determination. It is not always easy and implies the need for a professional’s help in pulling together a picture of an illness. Pieces of information from the client are fit with one another like pieces of a jigsaw puzzle, each impression a unique piece of the puzzle taken together and creating a unified whole that presents one image, the diagnosis. These images are symptoms.

You can help your doctor by providing information about what you experience. While your doctor knows what questions to ask, you can help the process by being aware beforehand what he will want to know during your appointment. You have already come to the conclusion there is something wrong or you would not have made an appointment to begin with. By thinking about your concerns ahead of time, you can begin to identify what seems odd or unusual about your behavior. If you have a notion what kind of symptoms to look for, you can help narrow down the data that will make a diagnosis.

Here are ten questions your doctor needs answered in order to make a diagnosis:

Are you motivated or anxious more than usual?
Do you have a lot of excess energy?
How are your sleeping patterns – increased or decreased?
Are you irritated or agitated?
Are you blue or in a funk; do you feel depressed?
Do you gain pleasure from your activities?
Are you experiencing behavioral changes?
Have you had any recent conflicts that are out of the ordinary?
Has your appetite changed?
Are you drinking alcohol more than usual?

Acquainting yourself with these questions can help your doctor or therapist get a clearer picture of your mental state and how your mind and feelings are being affected. They may not seem related to your initial complaint, but remember that changes in mood are accompanied by physical and behavioral changes. Pinpointing a specific diagnosis relies on ruling out or taking in factors and providing a beginning point.

The doctor may ask questions designed more to access your reaction in the here and now than the actual data requested. The important piece to remember is that you are seeking help to gain closure, to get treatment following a correct diagnosis. The mental health professional can be an ally in that quest. Give her the benefit of the doubt and trust her expertise to help guide you. You and your doctor are a team. Asking the right questions and giving accurate responses will help forge a bond.

Mental Illness - Living with Consequences

noreply@blogger.com (Donald Kern) — Thu, 09 Jul 2009 21:58:00 +0000

Recently, I was part of a panel of consumers of mental health services and family members, talking about their firsthand experiences with mental illness. Speaking about both my past manias and subsequent work with the mentally ill, I sat raptly at attention and listened to a couple who were sharing their experience dealing with a mentally ill son. They told their story of a son who had turned mean, threatened physical violence, and spent days locked in his room This couple was on the verge of being terrified in their own home, even to the point of putting a lock on their bedroom door. As I listened, I was filled with concern and dismay. “My gosh,” I thought. “They’re prisoners in their own home. They have to take back their lives.”

As I reflected on their plight, I was drawn to speak to them and repeated my thought of their need to take back their lives. Their response was one of agreement. I went on to suggest a disciplined, tough-love stance. They responded in a murmuring tone, of past attempts to set boundaries gone astray. They were clearly overwhelmed, feeling defeated, and my suggestions of resolute sternness brought out hopeless irritation on their part. They’d been there and were loath to return to that place of helplessness. They were not ready to put their son out, despite their struggle. I recognized a lack of positive response to my counsel as parental regard, mixed with frustration and defeat. I thought to regroup my remarks and was about to speak when a family caregiver next to me on the panel interjected. What she said was concise and to the point.

“Despite suggestions of tough love, you have to be able to live with yourself. No matter how difficult it may be to live with your son, and while it’s true you have to find some way to intercede with him, you have to be ready to accept the consequences.”

Because I knew this family caregiver and her story, I knew what she was saying was true. She’d lost a bipolar young adult son to suicide and another to paralysis after an unsuccessful suicide attempt. She’d been ready to put her son out of the home if he wouldn’t stay compliant with medication. Now, she was caring for a quadriplegic who was mentally ill. She had been ready to follow through with tough love and expressed no regrets. But, she was able to reach out to that couple with wise counsel in a way that I could not. She taught me something. You have to be able to live with your decisions, and when you are ready, you will do the right thing.

Tough Love and Bipolar Disorder

noreply@blogger.com (Donald Kern) — Sun, 14 Jun 2009 16:53:00 +0000

Tough love isn’t always tough. It also isn’t always love. How do you decide to take a tough stance with a loved one who suffers from mental illness?

There is usually a history of dysfunction before a family member or loved one decides he needs to take a firm stance with another family member. Lapsing into a mood of despair and broken promises, a parent may have to confront a mentally ill adult child about his behavior before the household deteriorates into a pattern of chaos and disorder. How do families regain their composure in the face of a loved one who loses all sense of boundaries? What do you do when a household is impacted by irregular sleep hours, isolating behavior, staying behind closed doors for days at a time, or becoming belligerent when confronted? How do parents present a firm stand against losses of personal hygiene, or threats of violence that threaten the normal functioning of the family? It is at times like these, especially after reported incidents, that family members must consider the prospect of taking a stand. This is no easy decision.

So what is tough love and does it work? Tough love comes into play quite often after a family has repeatedly attempted to resort to a moderate approach of reasoning with their loved one, with poor or no results. The household is close to being held hostage to the erratic and/or aggressive pronouncements of a family member who is out of control, firmly in denial, and may have lost a grip on reality.

Tough love is a response to the non-response of a loved one to recognize the need for treatment and acceptance that they are ill, mentally ill. It is about forcing a loved one with little or no insight into facing their situation. Sometimes it means giving an ultimatum of going for treatment or leaving the family home. It is often a last desperate attempt to reaffirm family normalcy and to bring balance back into the household. It is anguish for the family member seeking to regain boundaries.

Does it work? The prospect of turning out a child from the home is a heartrending decision a family naturally shrinks away from. It is only a last resort after repeated steps to get the mentally ill member to seek treatment. Often, tough love begins by making it clear they must see a doctor, take medication, and go into counseling. There are consequences for non-compliance. This is a long way from the assumption the loved one can no longer live with family or have touch with loved ones. Tough love is saying, “We’re not going to pretend any longer that there is not a problem.” It is taking the tough stand that you won’t allow denial to go on, and that there has to be a resolution. You know they need treatment, and you must take the loving action of forcing them to get better. It’s not a cure-all; it’s a beginning

BIPOLAR AND PSYCHOTHERAPY: The Other Part of Recovery

noreply@blogger.com (Donald Kern) — Sat, 06 Jun 2009 03:05:00 +0000

Taking a pill is not the only solution to bipolar disorder. Though the need for biochemical treatment to offset the imbalance of human chemistry is key, it does not alone insure a complete resolution of symptoms. Acceptance of a mental disability and attention to the social consequences of bipolar dysfunction is critical to living a life impacted by manic and depressive impulses.

Along with the ravages of personal dysfunction, which is a hallmark of bipolar disorder, there are the aftershocks of behavior that are often tumultuous for personal relationships. Hypersexuality, which can be a consequence of a manic excess, affects your relationship with your partner and/or your image of yourself. Guilt and embarrassment follow in the aftermath. So, too, financial misbehavior affects your functioning, sometimes for years to come. Grandiosity, when finally brought to ground, disrupts the connection we have with others close to us. In short, there is a need for mending fences with those near to us, as well as ourselves. Simply rebalancing the biochemistry is not going to address what we do now to reclaim our lives. That is where counseling and psychotherapy come into the picture.

Sitting down with a therapist and sorting out our feelings about having a mental illness can go a long way toward reducing the stigma we often experience within ourselves and from others. Clearing away the debris of a life lived without restraint, unleashed and unapologetic, can only be addressed by a thoughtful coming to terms with our excesses in a therapeutic environment.

Support from a friend or family member is helpful to recovery. Often, however, the deeper feelings of self-loathing and regret for episodic excess can only be addressed with someone trained in the art of listening objectively and offering perspective untainted by personal biases. This is true of both depressive and manic occurrences.

A therapist at his best is an ally and advocate, someone who can be there for you. Whether education, support, or analysis is called for, a therapist can pave the way for your acceptance and understanding. He can also be a bridge between dysfunction and redeeming your life.

Sometimes we need a guiding hand. Psychotherapy is that step-up. Along with medication it is our strongest antidote to the confusion and chaos that often results from an illness gone awry. Reach out for a fuller recovery for yourself and your loved ones. You needn’t be alone as you traverse the road to recovery. Sometimes you need an honest broker to hold up a mirror to yourself; sometimes you need a caring listener to set your fears at rest; and sometimes you need the support of an ally to walk with you for awhile, someone who can help you find the answers to your inner turmoil and confusion. As a friend of mine once said, “Don’t be afraid to call the doctor if there’s nobody else at home.”

To Accept or Not to Accept a Bipolar Diagosis

noreply@blogger.com (Donald Kern) — Sun, 17 May 2009 22:50:00 +0000

I recently became aware of a commentary that made reference to an article I had posted on my blog. The author found me in agreement with one thesis, yet differed in another, namely that medication compliance is impacted by the acceptance of diagnosis. While I respect a difference in view (the idea that acceptance doesn’t necessarily bring compliance), it occurred to me that the difference might be more a question of semantics than thrust.

Acquiescence to my diagnosis of bipolar disorder and adherence to an ongoing medication regimen was a long, 12 year process and not a simple or logical shift over a short duration of time.

My clinical opinion as a therapist is that it takes a significant period before those with bipolar disorder are able to accept the illness as a factor that is lifelong and incurable, without ambivalence. Many patients are in process of gaining insight and accept compliance, yet after each episode, hope it is a fluke and won’t happen again. They may verbalize compliance, but subconsciously deny any consequences their behavior and actions may bring. It is only at the end of this ambivalence that true acknowledgment comes. I am not certain the author of the initial commentary and I are of different opinions, as might seem at first blush.

I would not in most cases dispute the point that buying into one’s diagnosis is sufficient to result in medication being taken on a regular ongoing basis. There is another compelling issue and that is duration. Suffering with a mental illness for a decade, for example, is more likely to result in taking medication regularly than a year or two. Exceptions permitting, attitude shifts with time.

Having arrived at the point where expectation of healing has given way to hopelessness that yields frustration, that frustration over lack of regaining one’s prior level of mental health can yield to having a second chance. Resignation gives way to a more realistic evaluation of the desire for a medication alternative to treatment, an attitude which is more likely to accept side effects in favor of the relief meds can bring.

The thrust of the post that today’s social context gives accusations of paternalism and condescension toward clinicians, I heartily agree with. This perspective all too often sabotages treatment. Socially induced resistance trumps insight, even insight gained from the passage of time.

It is gratifying, however, to know that some will sustain a recovery long-term by persistence of a self-realized perception that there is no alternative. It would appear that medication is quite often the only game in town other than living with the roller coaster of emotion and mood that mania and depression bring, and the terrible cost in human suffering resulting.

A Work Ethic for the Recovering Manic Depressive

noreply@blogger.com (Donald Kern) — Sat, 09 May 2009 03:01:00 +0000

There is much lost in initiative when one is struck with mental illness. Drive dries up like autumn leaves cast adrift by the wind. Caught in a mental maelstrom, one is often imprisoned in the world of the mind. The enduring quality of mental aberration often leads to a paralysis of activity and action. The best-trained and raised with an attitude of productivity often become enmeshed in a net of mental stricture which leaves one immobile and uninspired. Stamina is lost.

Recovery takes work, and success takes tenacity. How do you cultivate an ethic of work that will carry you through the successes and failures of creating a life, when motivation seems to have left you behind? Not only is mental illness fraught with inaction and faintness of heart, but its course over time leads to a loss of vitality and a lack of impulse to act. With this in mind, here are some ideas to help carry you through:

Never take no for an answer. When in treatment, don’t be discouraged by early failures. Turn frustration into persistence.

Angry at the rejection of a job application? Allow your anger to be channeled into positive action. Depressed at the daily lack of routine? Allow your melancholy to form a response. Shy and withdrawn after an episode of mania leaves you unsure of yourself?

Sit and let the discouragement wash over you. Use it as an expression of impotence. When you get done with feeling sorry for yourself, make a resolution to fight back. You are not a failure.

Read books and attend lectures that promote hope and a positive image. Take your life one day at a time. Make a list of daily tasks to complete, and do your best to complete them. Gauge your ability to persist as you go through your list. Acknowledge that your ability to persist will vary from day to day. Over time, your ability to pursue a goal will fluctuate. Accept this as you accept the need to push yourself.

Though anxiety may be your opponent, never let it define you. Learn from your struggle with depression and anxiety. Know you are more than your illness and don’t let others (professionals included) define you. When all seems lost, rest. Rest as long as you need.

When you lose hope, allow time for hope to return. In the end, motivation will surface, perhaps slowly and in small pieces. Let it move you. Eventually it will come.

Like a muscle atrophied after disuse, hope and tenacity must be toned and retrained. Be patient with yourself. Know you are more than your illness. The ethic of work is in your attitude. It is to that you must apply yourself. And so, a work ethic is born or recovered.

Bipolar Bereavement

noreply@blogger.com (Donald Kern) — Sat, 25 Apr 2009 23:15:00 +0000

Although my father died in 1979, he still lives on in my memory. Our relationship has survived across the years. Often a stormy, resistant interplay between us when he was alive, has given way to an understanding I could only have gained over time. My strongest regret is that he never saw me recover from a florid manic depression. He never saw me recover my sanity, go to graduate school, get married, or start a successful private practice as a psychotherapist. I have much to mourn.

Though I have much to mourn, I also have much to celebrate. One of my memories of my father is that of a father proud of a son seeking to find his place in the world. A stern man at times, he dealt with my mental illness with persistence in seeing me get into treatment. We both, at times, grew impatient with my inability to return to a traditional, middle-class way of life.

It is a fitting tribute to him that he was a frequent character in my psychotic delusions when I was still in the grip of manic episodes. My wish to control his obstinate urge to get me into treatment had me cast him in my delusion as the leader of a group of seniors I had put him in charge of. He was to organize the use of their soul energy for telepathic, peaceful use.

How do you deal with the loss of a loved one who was unable to experience your wellness when alive, and is now unable to join with you when you are better? There are no easy answers. For me, I imagine his joy at my attainment of the lifestyle he wanted for me, even when in the past, I didn’t always share his dream.

When recovery meant returning to the middle-class values I had rejected earlier in my life, I grew to appreciate the life he had created for himself in his own struggles. We then had a common bond, normalcy. When treatment dictated the need for structure and stability, it was to the model he had raised me with that I returned. It has been a bountiful fulfillment I later arrived at.

My father’s death before my recovery has now come to mean the continuation of that relationship through insight and aging. I don’t try to bring him back. I just recognize the universal truths of living in the modern era. I have finally let go of the judgments I made of him; the attitude that I would somehow surpass him in understanding my life. Instead, I have learned how much he had to teach me. We have much in common. So it is, he continues to inspire.

Five Ways to Deal with Bipolar Bereavement

Embrace a loving attitude.
Recognize your differences have ended with the passing of a loved one.
Remain open to understanding their hope for your recovery.
Maintain a spiritual frame of mind.
Allow your loved one to live on in your memory.

How have your dealt with bipolar bereavement of a loved one?

Medicating for Bipolar Disorder

noreply@blogger.com (Donald Kern) — Tue, 21 Apr 2009 02:55:00 +0000

When a patient is first admitted to a psychiatric unit, the treating psychiatrist must make a determination as to the administering of medication. There are two basic models the doctor can choose from. He can start from a zero medication format where he begins with a low, minimum dosage level and adds small incremental amounts of medication until a level is reached whereby the patient approximates a normal behavioral level; or he can flood the patient with a large dose of meds to quickly bring the patient to a non-symptom level and then reduce the meds until a normal behavioral level is achieved. Either method is an acceptable treatment, although many people who are uneducated about treatment believe over-medicating is a bad thing no matter the results.

We are not well-served by a knee-jerk reaction in judging a particular regimen. In the case of “flooding” someone with medication, a person in the throes of a flagrant manic attack would best be served by bringing them down from the manic heights as quickly as possible. There will be time enough to adjust the dosage once they have returned to a semblance of normalcy. In the event of a depressive slide into despondency, we may have the luxury of slowly increasing meds over time, although suicidality ramps up the need to respond with speed of action.

Dogmatic adherence clouds perception whatever the situation and enhances the prospects of not making the best decision. Many times education is the avenue to wise treatment. I went for years not understanding the principle of over-medicating, assuming keeping someone in a stupor was at all times bad for them. It was only several years ago that a cousin who is a physician explained to me the intricacies of dosage decisions in treatment. It is this I am trying to pass on to others.

The general public is not aware of some treatment factors such as those of medicating. It seems it is rarely explained to family or patients. The psychiatric community would be serving a public good if they were to be more explicit about the logic of their decisions. An educated public is the best treatment outcome.

My remarks are not out of a narrow finger-pointing toward clinicians who work long hours under pressure to make the right decision, but to bring an understanding to what goes into a medical decision. This is often not addressed due to lack of time. Treatment would be improved if families and patients were more enlightened.

Learning to Find Creativity After Medication for Bipolar

noreply@blogger.com (Donald Kern) — Fri, 03 Apr 2009 05:00:00 +0000

There are some creative individuals who are burdened by a mental disorder. For many, the issue of creativity is tied to mania. They deal with their finest displays of artistic fervor and accomplishment in their manic phase of a bipolar diagnosis. The flame of original thinking combined with an expansive self-confidence propels them into a productive frenzy. At these times, artistic, bipolar types revel in the quantity and endurance one needs to take on a project.

Mania is tied to the creative impulse. While prolific as one can be in mania, a mood shift dispels original thinking. When an episode has run its course, the artist finds himself in an odd position, yearning for creative release, but too depressed to reclaim it. The artist gives way to the patient. Medication comes with normalcy and life takes on a drab, passionless existence. The artistic, bipolar patient decries his situation, but inspiration is nowhere to be found.

A common complaint of bipolar clients is their level of creative expression. It comes as no surprise that many such persons choose their creative manias over medicated normalcy, while others give up, take their pills, and make the best out of a stale existence. When mania is suppressed, boredom steps in; or so goes the given wisdom. This is true in the short term, but not necessarily the long.

In the immediate, medication locks down the fountain of creative urge. The switch is flipped off abruptly as a fantasy life is replaced by the more immediate needs of everyday. Often there is the sense that life has been drained of its essence, and this state is all there is, a spiritual wasteland governed by the pills one must take for stability.

My experience of 35 years says otherwise. There is a creative life after medication. It just takes time and persistence to resurface. Inspiration reasserts itself a bit at a time and needs to be nurtured. Once a stable platform is rebuilt, thoughts turn from the mundane. While initially stability struggles with staleness, appreciation of the commonplace spawns shoots of possibility. This takes time, and patience is of primary value. One reacquaints oneself with a creative vision a piece at a time. Eventually, hope for the ridiculous and the sublime re-emerge. Medication cannot hold back the urge to a larger view of life.

Thirty five years of living with manic depression has taught me that even when I give up in despair, I keep on growing, although I am unaware of this at the time. Life grows at its own pace. Becoming aware and being thankful are accomplished in small steps.

Twenty five years ago when I was newly recovering, there was no urge to write, sing, make music, or shape metal. At the time, I simply wanted to get back my life. I wasn’t interested in anything else. It was difficult enough to discipline myself to get up and go to work everyday. Eventually, that learned, I progressed to venturing out to meet others, to engage in uncomfortable but pursuant conversation. It was five years before I picked up a pen to write. I had nothing to say before that. Eventually my ear for music returned, and learning to share myself with others began. All of this led to a vitality in my everyday life.

During this time, I was, as I still am, on medication. It’s about a regrowth of spirit that helps us reclaim our lives. Life is a verb. It’s about doing. Medication cannot teach us this, only a life lived can do that. It’s like being in a dark closet. You keep bumping into walls whichever way you turn as you feel the bruises form. Eventually, the pain goes away and some light creeps in. You find that the walls you bumped into were actually mirrors. The longer you look, the more light seeps in. You see yourself again and again, always in a new and different way. And so, creative endeavor emerges over time. Medication can’t take that away. In fact, it can help.

Creativity and Bipolar Disorder

noreply@blogger.com (Donald Kern) — Wed, 25 Mar 2009 02:34:00 +0000

As an adolescent I spent my free time writing songs. I loved to sing, and for a long time I was part of a combo consisting of several other musicians. Several years later, while making my living as a silversmith, I experienced my first manic episode. With all of this creativity, I fit the mold of those creative artists who have bipolar disorder. Because of a high correlation between the two, it is no surprise.

It is often acknowledged that those with major mental illness have a creative side to their persona. A look at artists of any era reveals a high percentage of co-occurring mental illness, most often depression and mania. Studies reveal the incidence of creative talent is higher in those with bipolar disorder than the public at large. What can account for this? The answer is, we don’t know.

In my psychotherapy practice where I specialize in treating this mood disorder, I see a large proportion of artists and musicians who struggle with their creativity. In the wake of severe mood shifts these talented people have a difficult time balancing their personal lives with their mental health needs. Their dilemma in dealing with out of control, emotional fluctuations is eerily similar. How can they create in the face of mood shifts, which can either send them into a manic frenzy of racing thoughts and out of control emotions or into depressive lows that have them vacant of inspiration?

Added to this confusion is the issue of medication. Quite often the creative types I see value their manic side, where for them their inspiration comes in the throes of mania. Their dilemma is how to balance their need for creative expression with the need to deal with the everyday tasks of normal living. Often, this dilemma gets played out in their medication regimen. The common complaint is wanting to have enough medication to keep them stable, yet not so much that their inspiration is stifled. Some artists would rather live with the dysfunction mania brings than face the shut-off of emotion, which leaves them bored, depressed and vacant of the color and magnitude of boldness they need for self-expression.

There are no easy answers here. Out of control and without medication only leads to chaos, including crisis in relationships and other staples of a healthy life. Yet, stifling a creative side leads to a lack of zest and the feeling you cannot express a side of yourself that is a part of who you are .The common complaint is, “we only live half a life.” What’s to be done for people tormented with the inspiration of a creative vision, yet who are handicapped when they try to express it? Such is their struggle.

We assume those touched with creative expression are lucky to have talent and to lead a charmed life, able to bring forth new ides and new creations. Yet, often it is not so easy for them. In the wake of mental illness their lives are burdened by their talent. In the end, we are all a work in progress trying to find a balance. It is, however, doable.

Tips to Balance a Creative Lifestyle

Maintain a structured routine.
Get enough sleep.
Keep contact with a circle of friends.
Find a medication regimen that fills your needs.
Find a mental health professional who understands creativity.

Notable Quotables For Bipolar Inspiration #2

noreply@blogger.com (Donald Kern) — Sun, 08 Mar 2009 22:09:00 +0000

All problems become smaller if you don’t dodge them, but confront them. --- William Halsey
Let us not look back in anger, nor forward in fear, but around us in awareness. --- James Thurber
The greatest test of courage on earth is to bear defeat without losing heart. --- Robert G. Ingersoll
Always bear in mind that your own resolution to success is more important than any other one thing. --- Abraham Lincoln
Man does not live as he thinks; he thinks as he lives. --- Reverend Vaughan Quinn
Even if you’re on the right track, you’ll get run over if you just sit there. --- Will Rogers
So high you can’t get over it, so low you can’t get under it, so wide you can’t get around it, you gotta go through the door. --- Old folk song lyric
It ain’t over ‘till it’s over. --- Yogi Berra
There’s nothing that cleanses your soul like getting the hell kicked out of you. --- Woody Hayes
The highest courage is to dare to appear to be what one is. --- John Lancaster Spalding
He who loses wealth loses much; he who loses a friend loses more; but he who loses his courage loses all. --- Miguel de Cervantes
The rumors of my death have been greatly exaggerated. --- Mark Twain

HEALING BY FAITH - Resolving Mania

noreply@blogger.com (Donald Kern) — Tue, 03 Mar 2009 04:05:00 +0000

One grey, wintry day, as I sat by a window and looked out on my back porch, I pondered my fate after 14 years of manic depression, two of those in recovery. I had made much progress. I was working a professional job, had not had a manic episode in two years, and was managing a social life for the first time in ten. Still, I looked out on a life that had no great passion. The driving impulse of my manic episodes of the past had continued to elude me.

I reflected on what was missing from my life and the answer to a quandary I had yet to resolve. What was the nature of my psychotic, religious episodes? Though having shelved my inquiry into the meaning of God’s contact with me, I had to ask myself whether they were real or not. The evidence was overwhelming. I had a collection of episodes filled with the acts of spiritual oneness too numerous to count, which left me enchanted with the promise of sitting at God’s knee. I yearned for the mental state where I was certain of a destiny enshrined in a sense of the sacred.

I had experienced 14 years of vivid memories of living touched by God. They had filled my life with purpose. Yet, 14 years after this strange conveyance to the history of the universe I believed I was part of, I was once more relegated to a world where the immediacy of sacred purpose eluded me. I had spent the last two years out from under the shadow of God, filled with the early struggles of recovery, going to work everyday living in the mundane world, and fulfilling the boring tasks of existence. I felt bereft. The magic of life was missing. It was time to take those earlier experiences off the shelf that had put them there. Were they real or but delusions?

The answer was central to my recovery. If those manic highs were true, then I was part of world history, enshrined in the goings on of the eternal. Yet, after 14 years of being introduced to this cosmic existence and being locked out months later, I questioned their validity. Was I to be famous, or was I one more anonymous body of ordinary humanity? While my recovery had been significant, I had held back by not resolving this issue.

The answer came to me as I sat thinking. I imagined God speaking to me. There are those who can live in my presence in conscious awareness, but, after 14 years of trying to live in that state, perhaps you are not one of them. You have to take the same road most of humanity has, living in blind belief that there is a God. Like your ancestors who for thousands of years moved the belief in God step by step forward over a lifetime, you have to hand off God’s reality from one generation to the next. This was a powerful thought, and it made perfect sense.

In that moment, I had my answer. My psychotic, spiritual episodes were just that, psychotic and delusional. They were not to be sighted as proof of a sacred reality. I was set free in that moment. Finally, I could let go. A vision of clarity ensued. This epiphany would affect the rest of my life. I didn’t know it at the time, but I was healed.

Now, 25 years later, I can see my life rebuilt and full. My life has blossomed. I rely on the signposts of the familiar: religious observance, ethical dealings with others, and spiritual practice. We talk about religion as faith. “Take it on faith; what works is what’s real. Its proof is in the living.”

USING BIPOLAR AS AN EXCUSE Taking Responsibility for Your Actions

noreply@blogger.com (Donald Kern) — Sun, 22 Feb 2009 07:14:00 +0000

Joshua sat on the couch opposite me, the tension in the room growing by the moment. “I don’t owe her an apology; I was in the midst of a manic episode at the time. They told me when I was in impatient treatment that I have a chemical imbalance; so it’s not my fault I slapped her, and now she’s exaggerating the injury.”

Joshua by this time was angry, plenty angry. He couldn’t see the point I was making that while a chemical imbalance may have influenced his actions, his actions were regrettable, and he should acknowledge this. He finally agreed in a statement to me that his actions were, indeed, regrettable, and a reflex reaction to his ex-spouse’s provocative statement still carried the sting of unresolved anger. The trust between them, already strained, had grown worse.

In treating bipolar disorder, this situation is not rare. Often, when volatile, those with a major mental illness diagnosis are confused and troubled by mild messages they receive from others. If a lack of knowing right from wrong at the time of a mental breakdown has been established, there is diminished capacity according to the law. What is lost in this logic is the damage done to the victims of angry outbursts. That is not to say a victim may not have fanned the flames of anger and has some responsibility for the eruption of verbal or physical attack. We do not live in such a pristine world of black and white, or all or none thinking. In the case of my client, his ex-spouse was not the perfect victim. But, in the aftermath of harsh words and/or physical assault, is clinging to the notion that a chemical imbalance is the culprit a fair release from culpability?

There is much work in healing the breakdown of civility which goes on with those in stressful situations. Even though you may be delusional, your actions may result in pain to another. Aren’t you then responsible for their pain? Too often one is loath to apologize, feeling it will only supply ammunition to an opponent and will weaken a claim to be the righteous one, the one wronged. This does not lead to understanding. It only increases the gulf already formed.

Setting the record straight implies acknowledging the damage done and can result in the beginning of a dialogue. “I’m sorry you were injured by my actions, or, what occurred between us is regrettable; let’s strive for a better understanding.”

But, the argument that a chemical imbalance is at the heart of a divide is an over-simplification and an easy way out. If you make a mess, then you have to clean it up. Sometimes it’s just what is needed.

Ten Ways to Take Responsibility

Be honest with yourself; admit your limitations.
Acknowledge your contribution to the misunderstanding.
Mentally exchange places with those you’ve harmed and
see the situation from their view.
See an outsider to mediate a dialogue.
Cool down before reacting.
Take time before trying to resolve an issue.
Recognize the futility of all or none thinking.
Seek understanding with goodwill.
Educate yourself on the difference between being reactive in the face of an altercation and looking at the aftermath for your opportunity to set things right.
Remain open.

Some Thoughts on Ethics for the Bipolar Job Seeker

noreply@blogger.com (Donald Kern) — Thu, 12 Feb 2009 06:01:00 +0000

I’ve discussed the dilemma before of looking for a job and the discomfort of bending the truth to gain employment. This is not an easy topic for those who sincerely subscribe to a moral and ethical code, whether it be religiously held or a personal philosophy of upright behavior. Toward the goal of trying to resolve this difficulty, I have created the following attempt to help you sort out where you fall on the continuum of ethics.

There are those who judge this issue in a black and white fashion, but for others the issue isn’t quite as clear. I believe a varied group of people will find help here, those with a strict code of right and wrong and those concerned with the nuances of right and wrong, the shades of ethics grey. Whichever way you are predisposed; here are some thoughts on ethics for the would-be-bipolar job seeker:

Living with virtue in an imperfect world.
You didn’t ask to be bipolar. Your aim is to live by virtue whenever possible.
Who is being hurt and who is being helped?
A job well-suited to you can create a win-win situation for the employer or employee. A less than perfect fit can spell trouble for either party or both.
Choose your battles wisely.
When is struggling on a job worth your while, and when are you in over your head? Creating a pro and con list can help evaluate potential gains and losses.
Prove yourself on a job.
Either suggest a trial period on a job or choose to disclose after, when you feel you’re in a better position to to make your case.
Evaluate your ability to withstand anxiety.
When is following your ethics the wise thing to do, and when do you choose to withdraw, only to live to fight another day? Perhaps you start out with less stressful jobs, building a job history of ever-increasing stress resistance.
Don’t allow fear to rule you.
Living heroically means standing up for the beliefs you have regardless of the discomfort. This has to be balanced with your state of recovery.
Discuss your dilemma with a trusted friend, therapist, or religious leader.
Sometimes it helps getting input in order to arrive at a decision.

Whichever way you happen to be predisposed, consider these suggestions food for thought.

The Dilemma of Disclosing Bipolar Illness

noreply@blogger.com (Donald Kern) — Fri, 06 Feb 2009 04:47:00 +0000

As I sat at the conference table, trying to collect my thoughts, I reflected on what to say. The words came out harshly. “I am bipolar.”

Here I was telling my colleagues, fellow mental health professionals, my secret. Once more, I was confirming the stigma of mental illness. In this instance, I was up against my own stigma: prejudice, fear of my illness, and anxiety over the judgment of others. What would they think of me? Would they lose respect? Would my bringing this out in the open cause others to look at me differently, as someone irreparably flawed? Would I lose friendships as a result? In that moment, my previous life of manic episodes flashed before my eyes. How could I expect others to understand what it is like to be manic?

After my disclosure, the room was quiet. Everyone’s eyes were either on me or glancing down. I wondered if they expected me to say more. The air felt heavy. Finally, someone broke the silence by saying, “I never knew.” Perplexed by my statement, slowly the atmosphere shifted from heaviness to quandary.

“Why did you tell us now?”

“I wanted you to know me,” I said.

Finally, one or two of them congratulated me on my honesty. I could tell that some of the others felt awkward and said nothing, but I could see they were looking at me with respect. In addition, an explanation of my difficulties in the last several months was explained: my silence, my lack of conversation, and my skittish interaction. I felt relieved, my opinion of myself, elevated.

It was at that staff meeting that I made the decision to write about my illness. I had come out in the open and for the first time and wanted to know more. It felt good. I was cleansed. The dirt and grit of my depression fell away, leaving me with hope.

I am still uncertain why I decided at that point in time, 1996 (23 years after my first manic episode), to go public with my mental illness; but I had clearly come to a crossroads in my life.

Caught on the Horns of a Bipolar Dilemma

noreply@blogger.com (Donald Kern) — Tue, 27 Jan 2009 14:56:00 +0000

Before becoming self-employed 10 years ago, I worked for employers. When applying for a job, I was confronted with the issue of my mental illness. Do I disclose my psychiatric history? How forthcoming should I be? I asked myself what the ethics were of being less than candid about my history in the face of certainty that my background would cause an obstacle to an employer. Therein lies the dilemma for people who are capable, but have a mental illness diagnosis.

In the earlier years of my recovery I did not think I was in a position to divulge my history. The truth was, I hadn’t even thought about this side of the bipolar issue before. Caught between competing values, I debated over what was the truest ethic to defer to. Should I be honest and put a job prospect in jeopardy, or should I just juggle my past history to gain a position? If I didn’t report my past history, would I live under a constant cloud of being found out? And would that prohibit me from being candid in my conversations with co-workers no matter how close to them I became? I was caught on the horns of a dilemma.

I believed that employers of companies who had a strong work stress component were unlikely to be understanding of a mental illness diagnosis no matter how sympathetic they may be personally. I knew I did not want to divulge this part of my life; I just wanted to work a professional job.

At that time, I wasn’t interested in learning the facts about bipolar disorder or the moral dilemmas it raised. I just wanted to put my life in order and resume it as one more citizen.

There are no easy answers to the question of disclosure. We all have to make that decision on our own. It is a subject that arises for those of us with mental illness sooner or later. It is best to think about this disclosure before it becomes an issue. To be prepared rather than being confronted with it prematurely is wisdom. It may also strengthen your resolve to deal with life head on.