Bipolar By Chance - The Bipolar Connection Blog

Manic Depression - Renewing Courage

noreply@blogger.com (Ruben) — Mon, 16 Jan 2012 02:24:00 +0000

Manic Depression affects its victims in insidious ways. It weakens resolve and undermines the spirit. It agitates the ability to concentrate and focuses the individual afflicted on the edge of social norms, a place where he is vulnerable to the loss of mental health. This is not particularly unique as many illnesses follow a similar course. So it is that many bouts with illness are universal. It is from this perspective that I offer the following: the struggle to maintain stability, the sensitivity of human dignity, and the drive for courage.

Courage, which is about living dreams daily, is not just about physical courage, but mental courage as well. It is about persistence, not taking no for an answer. Reaching a goal is a daily decision to pursue that goal. It is resisting intimidation and focusing quietly without fanfare.

We all hear stories of tenacity in the face of odds. They speak to us everyday: the businessman who strives to improve his business, the worker who works three jobs to support his family; the individuals with a serious illness who focus on life and refuse to be victims. They all display examples of courage.

Dana was deemed mentally retarded at a young age, five years old. His reactions were slower then other children his age. While being termed slow, he was not without grace. He had a way about him. He found comedy in everyday activities. When he made a mistake, he would laugh at himself. Though pensive about his performance at school or in a group activity, he would look back at the milestones in his life with a sense of wonderment: graduating high school or working his first job. While some collect stamps or baseball cards, Dana collected people, those who had helped him overcome the obstacles of life. Though he wouldn’t be able to define the word, Dana had gratitude. As an adult, he recollected stories of the help he received: the third grade teacher who taught him how to read, the coach who encouraged him to swim, the counselor who helped him choose a vocation, his parents who never let him feel disabled.

Today, Dana works at a major metropolitan hospital as an x-ray technician, a job he has held for over 20 years. He has also had a long-term relationship with a woman for twenty-six years. But Dana is not without his fears. A recent bout with anxiety had him question his ability to continue in his job. Over time this receded. Like all of us, his relationship sometimes has discord, which offers challenges to overcome. In spite of it all, Dana displays a resilience which could make all of us envious. He shows courage in the everyday sense of the word, perhaps not the physical heroics of the battlefield, but the daily struggle to fulfill a promise to himself to be the best at whatever he does, living out his goals one day at a time. Dana should be a lesson to us all. Life is a drama lived out on a stage.

For those with bipolar disorder, like many of my psychotherapy clients, Dana’s story is instructive. Never miss a chance to do your best. As for those out there who have never experienced a manic episode or a clinical depression, but struggle daily with their loved ones who have, take heart at the dramatic unfolding of a life lived and the small but not inconsequential victories achieved. What is already stated for a friend or loved applies to us all. Courage is about the attitude we bring to the things we do. It would seem that at some point we find common ground, both client and family alike. Sometimes, what is true for one is true for all.

Why Psychotherapy for Bipolar Disorder?

noreply@blogger.com (Donald Kern) — Fri, 06 May 2011 06:32:00 +0000

We’re often told the best treatment for bipolar disorder is a combination of medication and psychotherapy. For some, medication is acceptable, the logic being if bipolar disorder is an imbalance in the brain’s biochemistry, then taking medication to correct the imbalance would be sensible. While many diagnosed with the illness resist taking medication, it nonetheless is logical that if there is a discrepancy in neurotransmitters, some pharmaceutical agent would be helpful to restore the mood balance.

But what about psychotherapy? What contribution to mental wellness does talk therapy make to the overall treatment along with meds?

There is an argument going on about this beneath the surface. We, as a society, have a bias toward the technical and scientific outlook. Such a slant in perspective has us accepting a therapy that is in a physical form—a pill. This is not to say there isn’t a controversy over medication treatment in society today, a view natural substances or mind-over-matter thinking will bring relief. The mindset that pills are bad stems from a view we embrace attacking any ingestion of a foreign substance. At the heart of this is the suspicion we are being led down the garden path by labeling more and more behavior as pathological, losing sight of the varieties of human actions, which in the past we either put up with or kept behind closed doors.

Regardless of our personal opinions as to the efficacy of having an increase in conditions labeled aberrant, there are still illnesses we are coming to understand in biological, brain-centered maladies. Therefore, it is no great wonder acceptance of medication as treatment for bipolar disorder is seen as making sense. But what do we gain from talk therapy? What is so important about it that it is put before us as an equal to meds and stands as part of a two-pronged approach, a best scenario for success in a return to normalcy?

Many believe talk is hardly a treatment. The primary and predominant view often held by the public is that bipolar disorder has brought about dysfunctional, harmful behaviors, which have led to aberrant acting out. What does talking do to alleviate this? The answer is simple. Psychotherapy can help bring insight. It is an opportunity to think through and take responsibility for what we have done, finally coming to terms with ourselves as the flawed beings we are. Often this foray into healthy introspection makes it possible to identify those we have hurt, damage done to our social lives, and careers harmed in the course of an episode. How can all of this take place simply by engaging in a conversation, albeit a therapeutic conversation?

Opening up to ourselves about our greatest fears is the narrowest of beginnings to mend the tentative, long-sought and struggled for acceptance of psychotherapy by those from all stratas of our culture. There is still much work to be done to gain far-reaching acceptance for psychological treatment.

Today, there is not just one psychotherapy, there are many. They can be relied upon to reduce symptoms and correct harmful mood effects. Psychotherapy helps to clear the cobwebs in our thoughts. In the beginning, it may consist of keeping on track with medication before we are ready to confront our illness and face living life with a mental illness diagnosis.

A pill can return you to biochemical balance, but only therapy can help sort out the repercussions of a manic episode or depressive slide. How to deal with, how to sift through, how to make amends; these are all the province of psychotherapy.

How often is one who is diagnosed bipolar brought back to sanity by medication only to be overwhelmed by actions taken in a mood swing of major proportion? Perplexed how to explain to others the lies, financial malfeasance, infidelities, substance abuse, job loss or debt, there is more here than a person can likely handle alone. To understand, to think through, to gain acceptance and guidance is the work to be done with a mental health professional. In short, talk can heal.

Thoughts on "Next to Normal" - A Play Most Extraordinaire

noreply@blogger.com (Donald Kern) — Mon, 25 Apr 2011 14:13:00 +0000

At times we are confronted with something so powerful, it takes us by storm, an experience so demanding, it forces us to listen and absorb it without choice. Such is the performance of, “Next to Normal,” a play I recently saw. Whether it is the driving beat of the music, crystal clear vocals that capture us, or the message it sends about mental illness, “Next to Normal,” confronts its audience with the issue of stigma.

It is difficult to know where to begin a discussion of this play; there are so many facets it brings to mind. It is an honest portrayal of bipolar disorder and what the illness does to a family. As others besides the individual with the illness are affected, there is the devastation it reins down on loved ones and the feelings of calm frustration it brings to the professionals who treat it.

As a consumer who has the illness, and as well, a mental health professional who treats it, “Next to Normal,” offered me a slice of life rarely seen outside of the treatment center. Where to begin critiquing this musical montage dedicated to mental illness comes hard to me. Perhaps it is with its lively and “right on” portrayal of the players.

The play begins in a light enough way, as the principals interact in the tangential and scattered way a family would who revolve around the skittish, disordered manners and habits of a bipolar family member--- the mother. It gives way to doubts, fears, and frustrations; as they attempt to steer a course around her mania and try to lead a normal life in the midst of abnormality.

Poignant is the mother’s endeavor to get treatment, the genuine confusion she has over trying to understand herself, and how treatment leaves her questioning the success of its outcome. The hopeful, ever upbeat patter of the father, is reminiscent of many family members caught in their loved one’s web of unmet needs and desire for normalcy, bringing the audience closer to the desperation they feel more than any book or lecture on mental illness could.

The daughter is another portrait that convincingly shows a teenager trying to connect with a mother who is so scattered, the daughter finds herself looking for connection outside the chaos, which is her family.

Seeing this play, was to come to terms with my own demons and dread of inadequate outcomes in my professional life. I saw myself as the treatment professional, removed and analytical as the emotional themes of the family portrait jumped out at me from the stage. I am reminded of those I see in a clinical setting, being the consummate, detached professional I am, even though I have spent most of my adult life personally with the shock and grandiosity of bipolar disorder. Reminded of my own need for authenticity in the treatment setting, and how through repetition and fear I lose that intensity of the wounded healer, I step back from the pain I am immersed in at those times.

This play represented, for me, a mirror of seeing myself and not liking what I see. How easy it is to detach, to lose the depth of pain my clients are going through. “Next to Normal,” has challenged me to be a better therapist, to care more, and to confront my own numbness. How easy it is to forget!

Educational information was delivered about mental illness in the treatment sequence, information I could give to new clients. This gave the production a ring of truth, as I saw a mirror of my own flatness, the persona of the psychotherapist as an uninvolved bystander. What became a lesson for me as I watched this play, was a technique that works for the non-professional, educating oneself about bipolar disorder. A precious commodity, openness to new ideas, was achieved.

I found myself captured by the driving beat of the music, carried along through issues of family, dysfunction, treatment, and pathology. I was compelled to listen to the music, which made this production believable in a way words alone could not. A genre often accused of lightness and fluff, in this play, the opposite was true. In the genius of lyrics set to music, a heavy subject was able to be put forth in a way the theater goer could accept.

Although I do not recommend this play for everyone, it is a reminder of the havoc mental illness brings to a family; it is not for the feint of heart. A powerful expression and honest statement, it bangs a fist against a door, which holds behind it stigma and shows us what we must accept: mental illness may live next door to us in our own community and work station. For those troubled by unvarnished truth, it may be difficult to take. Yet, “Next to Normal,” speaks volumes about having shut mental illness away behind a screen of darkness. It is time we opened it up to the light of day.

It isn’t easy, but it is also not without its charm and the ability to take a hard subject and make it palatable to be addressed. We all have our trials and travails. In that way we are no strangers to trauma and suffering. We wish for the strength to see our way through our struggles and problems that keep us divided from others. In this way, we are all, “Next to Normal.”

Having a Caring Social Community

noreply@blogger.com (Donald Kern) — Thu, 03 Mar 2011 17:10:00 +0000

Early in my treatment for bipolar disorder, my psychiatrist recommended I get involved in a social group. At first, I rejected the idea, tending to isolate instead. Not being comfortable in social situations, I had always had only one or two close friends at a time. One on one conversations were my strong suit, but even those were not happening. Social groups were out of the question for me. When my doctor brought up the subject at every session, I finally acquiesced.

It was difficult for me at first, and there were a lot of fits and starts before I found a group that both drew me in and challenged me to take part. Over the years as a member, I formed some good friendships and shared my bipolar diagnosis with those who befriended me.

I soon found a way to get beyond my inclination to sit alone and observe, and began to take part in discussions. I realized how much I enjoyed contributing to a lively interchange of ideas, as well as taming my sensitivity to being hurt by someone else’s vigorous rebuttal to an idea I was trying to put forth. Participating strengthened my social skills despite the sometime pain of being cutoff by someone else before I could develop a thought. My psychiatrist had given me good advice, and an experience that has led to further growth.

When I had a manic episode several years later, my social group of friends made an effort to call me daily to ask how I was doing and to offer support. I was touched by their reaching out. These caring calls made me rethink my sense of worthlessness. They helped me to accept that I had value as a human being. In turn, I reached out to them. Friendships are now an oasis for me when life feels like an endless desert.

When a diagnosis of mental illness shocks us into despair of ever-finding some normalcy in our lives, it is those connections with others that can help us rebuild our sense of value. Friends offer a mirror which reflects back to us the idea we will recover from an episode and be able to see ourselves through their eyes until such time that we can again see ourselves anew. Friends can also help us accept a diagnosis we might otherwise reject or minimize.

Social situations are numerous and span a variety of topics and interests, such as NAMI (National Alliance for the Mentally Ill) or DBSA (Depression/Bipolar Support Alliance), which deal with mental illness. These also offer clubs, discussions, and/or social occasions.
There are also social groups exclusively for athletics, crafts, religion, politics, sports and just about any other interest you can name. The important thing to remember is that our humanity is most felt when it is connecting with others. While it might feel alien at first, taking the chance to connect can change our lives. Having support reduces our isolation.

Today, I am an avid socializer and debater on topics ranging from politics to professional issues. The advice my psychiatrist gave me thirty years ago has paid dividends I could never have imagined. Though I sometimes struggle with rare instances of random rudeness from those I meet, it cannot outweigh the joy I reap from the frequent pleasure of friendships. Be your own best friend by opening yourself up to those around you.

Bipolar Disorder: Not Letting Yourself Down

noreply@blogger.com (Donald Kern) — Thu, 16 Dec 2010 15:54:00 +0000

Recently I was watching a 10-part TV series about World War II, called, “Band of Brothers.” The series documented the experience of one company as it fought in the European Theatre of the war. At the beginning of each one-hour segment, there would be commentary by real-life veterans about different aspects of being a soldier in battle.

In one segment these veterans talked about fear and the various ways they dealt with it. Many spoke to the issue of not letting their comrades down. There was one sentiment that struck me. It was the statement, “I didn’t want to let myself down.” Not only was this man being loyal to his fellow soldiers, he was being loyal to himself.

This struck me as a stance one can take in any struggle, including recovery from mental illness. It was certainly true of mine. Though fearful at times when doing new things and facing down hospitalization, medication, and the anxiety and stress of the work world, I willed myself to move forward because I didn’t want to let myself down. Though filled with trepidation, I would not allow myself to settle for a limited existence. I couldn’t let go of myself as a whole, healthy person, despite the knowledge I have a disability that brings darkness which sows seeds of confusion and doubt.

For a long time I was uncertain which way to turn at various crossroads of my life. I made decisions I could not be sure were the right ones. Often, there was no clear marker to base a decision on. So, I proceeded into the unknown, fear of failing at life my constant companion. Over time my road became a little clearer until the time when I began to feel a small amount of confidence.

I was doing helpful things to recover. Little by little my terror subsided, and as I constantly pushed myself to be true to myself, I succeeded.

Many may now be in the same place I was when I began my recovery. Instead of recovering for the sake of those who hope for your return to mental health, do it for yourself. Believe in yourself and have faith in your ability to do the right thing. Like the soldier in E Company of “The Band of Brothers,” do something because you don’t want to let yourself down. It’s a value and ethic to live by. To address life’s struggles straight on is difficult, but to be true to oneself is its own reward. It also goes by the name of “having character,” and who can say, “ those with mental illness can’t have character.”

Ruminations of an Aging Manic Depressive

noreply@blogger.com (Donald Kern) — Thu, 04 Nov 2010 23:48:00 +0000

How we see ourselves yields what we expect. Changing our view of ourselves depends on what we see in the norms society reflects. This is how self-awareness changes. For example: I am a senior citizen and have behaviors and symptom that fall into a pre-existing group. Back pain, bursitis, and chronic illness impact me. As a late, middle-aged individual, I see the evidence stack up and realize I am newly arrived at being categorized as a senior citizen. In this way, my ideas have changed. Accepting a bipolar diagnosis also utilizes this same process. At first, no insight gives way to later insight that can then give way to recognition of a new definition of self.

I remember my initial reaction to mental illness. I was manic. I was pleased and infused with the grandiose ideas that filled my head. For weeks I was on a high that was all too much to discard. When weeks later I experienced a drop in mood, it was with reluctance and dread that the party ended. It was several years before I realized these episodes had a beginning, middle, and end. It took several more years to focus on and recognize there was something amiss. Only after years of many episodes was I able to grasp that when people referred to mental illness, they were talking about someone like me. It was at that point that my view began to change. Forced into making a choice between seeing myself as someone special in a positive way when spiritually high and as a mental patient seeing himself as someone special in a negative way when acutely depressed, I arrived at the conclusion I was in a category that inspired stigma.

After innumerable ejections from restaurants for talking out loud to myself, encounters with the police, cheap hotels, and six different therapists in just as many years, I had a rude awakening. With lots of jobs and broken relationships, I was side-lined by my aberrant behavior. When I ended up in a mental hospital, the last little chink in the strait jacket clicked in; and with it came a shift in attitude, the recognition of what I had long strived to avoid. I was mentally ill. Aging and attitudes can both change.

Becoming an elder is more than a number and bipolar is more than a collection of symptoms. Attitudes serve as our identity. We don’t arrive at a time of life by chance or at an acceptance of mental illness by accident; we experience events that add up over the years to the recognition that we have changed.

A Caregiver's Lament

noreply@blogger.com (Donald Kern) — Tue, 29 Jun 2010 23:27:00 +0000

As my client sat on the couch opposite me, her tone became tighter the more she spoke. As if in a trance, she talked about her years growing up and the relationship she had with her mother, now a point well-beyond her 40 years of dealing with a parent who was diagnosed bipolar for as long as my client could remember. Though her mother had good and bad days coping with approaching dementia, my client was cautious about discussing any of the past with her mother. She knew it could be dangerous emotionally.

Some things don’t change, and her mother’s clouded picture of the past caused her to attribute truth and certainty to events that bewildered my client, who saw them much differently. Her difficulty was due to a long period of chaos and tumult when dealing with her bipolar mom.

All is going well now, but she still remembers when her mother was delusional, and sees the past as part of her mother’s normalness, not allowing her daughter to let go of it, always a little on edge. Her mom sees her life as a “flatline,” all episodes in her life equal and part of a continuum with no insight. The daughter sees the bumps in the road and doesn’t want to go there, knowing that at some point the good times will end and my client will be forced to deal with dysfunction. As a caregiver, she has her mom well for now and enjoys being a daughter, going out to lunch or shopping together.

Lack of insight is dictated by the rule that all behavior is measured the same. To normal people, they see the extreme highs and lows and have to deal with them. On a good day, my client talks about memories with her mom, but all too often, there were bad days when her mother’s view was inflexible, seen through a prism of need and dysfunction, death by brain cell atrophy.

Now an adult child of a parent with bipolar disorder, what she goes through as her mother ages, adds to the already significant pile of lost episodes and tainted experiences. Her mother is now at the gateway to further dysfunction, senior onset dementia. When did it become so complicated my client laments? She has become a conservator of her mother’s dwindling financial resources and is making plans for how best to care for her as she ages.

We talk from a period of upswing for my client and her mother. Mom is having a period of lucidity during which they are able to connect with one another. For a sliver of their lifetime together, they can laugh and remember good times. My client’s children are also able to be a source of pleasure for their grandmother. “Don’t count the days too long, but enjoy the present,” is my client’s outlook.

Am I Crazy – the Bipolar Dilemma

noreply@blogger.com (Donald Kern) — Mon, 14 Jun 2010 21:11:00 +0000

Incorporating manic behavior into a recovery-belief system is a dilemma, perhaps the ultimate bipolar dilemma. What is good in our lives is often tinged with the excessive and grandiose things we think and believe that stay and linger long after an episode has us sidelined.

Am I crazy, or is there a place in our lives for a variation of what is often viewed as a delusion or fading vision of positive afterthought? Often, it is the stigma of being deemed crazy that forces us to let go of our more upbeat selves. How can we hang onto what feels at the time of an episode like a fairy tale existence, yet has the underbelly of manic excess, which ultimately drags us down? Is it possible to sustain some semblance of hope and acceptance, or am I just plain crazy?

As every stereotype has the value of truth captured within it, so grandiosity and seduction have their valued qualities. Often, black and white thinking, the antithesis of open examination, has us discard our more creative selves in favor of stability and survival. Do we need to discard it all for the sake of sanity? A lot depends on regaining some
self-respect after an episode leaves us hollow and bereft.

There is a recovery period after an episode, a time when we may question ourselves or find it difficult to understand how we could have followed a line of thought and action to such an excess. Eventually, we come to a place of balance, recognizing what’s gained from “a brilliant madness.” Recovery is about second chances. Leaving the door of insight and openness ajar can help us retain what has value from even the most extreme and chaotic impulses.

The next time you are ready to throw away every grit and particle of an experience because of remorse over letting yourself go emotionally and intellectually, remember to glean from your memory the biochemical facts of your diagnosis. Gather in what felt true and what touched your heart. There is no need to judge yourself harshly. Be kind to yourself and from that place evaluate your extremes. Discern what mania offered you in the light of day and embrace those elements of true caring. Question what you cannot sort out and put it aside for the time being. Fullness of thought sometimes only comes with time.

Learning to live with only partial understanding can lead us to fuller insight at a later time. From mania can evolve a fuller recovery, and THAT’S NOT CRAZY.

Sensitivity and Acceptance of a Bipolar Diagnosis

noreply@blogger.com (Donald Kern) — Sat, 20 Feb 2010 16:05:00 +0000

With the telephone pressed firmly to my ear, I was talking to a potential new client, a lady in her sixties with a five- year diagnosis of bipolar disorder that came after a lifetime of dealing with clinical depression. As she was relaying her story to me, I was using the self-disclosure of my own bipolar history to form a sense of rapport. At one point, I expressed my belief that my wife of 22 years had been a major help to me in recovering from a mental illness to the degree that I had. I wondered whether I had shared too much when the woman on the phone broke into tears. As I heard her begin to sob, I was moved by her struggle, angry with myself at being so clueless. This woman had spent her whole life single. Her entire meaning or purpose in life, her reason to exist, was to take care of her two dogs.

I reflected on the issue of those we have in our lives that make a difference in our quality of life and who ultimately lead to the amount of pleasure we draw from our existence. While I count the support I have had as the central fixture in my struggle to move forward, others have different things that supply the emotional nutrients we need in order to flourish as human beings. For my potential client, her dogs provided her emotional nurture.

Initially, I was struck dumb by this woman’s emotional outpouring at my sharing. In the moment, I castigated myself for not having more sensitivity to her aloneness. But, I was corrected in this by the speaker, as she recovered from her tears and went on to talk about all the things that helped her get through life. They were numerous: a job, friends, and the nursing staff at the hospital she had been to.

She assured me that her struggle had been shared by many, despite her not having been married. It was then I remembered a central truth. We all have our burdens and our high points in the course of living a life. It is what we draw on, the attitude we bring to our issues that counts in the long run. This client had lived a lifetime with depression, but did not live an empty one devoid of meaning. My disclosure was not what moved her to crying. It was her memory of struggles fought, and those who had accompanied her. We broke through the silence and touched in that moment on such things as relationships forged and medicine for the spirit.

One Aspect on the Road to Bipolar Recovery

noreply@blogger.com (Donald Kern) — Tue, 05 Jan 2010 00:57:00 +0000

Recently, while speaking with my sister, the topic of conversation was my adult niece who has bipolar disorder. She needs to get into therapy, my sister said, but she keeps avoiding the diagnosis.

Although diagnosed in her twenties, she had been on again off again about taking medication, but at this point in time, she had finally come to terms with her illness; enough so that she now takes her meds regularly. It is the one concession she has made to her bipolar disorder diagnosis. If she would see a therapist also, my sister commented, she would at least get educated about her illness. My sister often laments my niece's lack of interest and curiosity about an illness that so pervades her life on an everyday basis. Our discussion carried me back to my earlier attitude then about my own bipolar diagnosis. It eerily rang similar to my niece’s attitude. This struck me as odd since I had read innumerable books on the subject and deal with the illness every day as a specialty in my psychotherapy practice.

Maybe she’s not ready for it, I told my sister.

But, isn’t that the preferred treatment, medication and psychotherapy? She isn’t taking care of herself and would be doing so much better if she’d just educate herself.

This same conversation reminded me of one I’d had with my wife early on in our marriage, more than 20 years ago. Upon asking me what I knew about my bipolar diagnosis, I answered, not much.

But, don’t you want to know more about something that impacts your life so profoundly?

I lived it for over twelve years, I said. I don’t care about learning, I just want to resume my life and be normal. That’s all I care about. I take my medication, and it works for me.

We now know medication and psychotherapy are the best combination for successful treatment of bipolar illness, and at the same time, I understand the reluctance to take meds and seek help, my niece’s stance, though it may conflict with my given wisdom.

Eventually, I did choose to seek education and treatment until today I have become an expert on the illness, writing and speaking publicly about it. Let me live my life; let me recover my bearings and move forward on the every day factors that mean the most: work, relationship, and social life. Let me just feel normal again. Stepping back from the abyss of mental illness and the chaos it brings, let me rejoin the world. Education can wait, until the first step in recovery — to feel human again. When the terror of life-long stigma and disability begins to subside, all things come in time. Patience, I counsel, Patience.

New Year Resolutions for the Bipolar

noreply@blogger.com (Donald Kern) — Fri, 18 Dec 2009 06:00:00 +0000

I have had a difficult time writing resolutions for the New Year. It is difficult to tell where bipolar leaves off and the rest of the population appears. So, I have decided to make lists for both. Sometimes the things we do make no sense to us until after we’ve experienced it. So it is for New Year resolutions. I’m more apt to react to what wasn’t in the picture in the prior year and address them for the New Year than I am for birthing new ideas never before considered. In the present moment lies a truth all too often forgotten in the rush of life. The present moment is the only certainty. As you read the following lists, keep in mind no mind is the goal. Respond to life as it presents itself. Less will put you in the present. In that way you are less reactive and experience (focused) more. Besides, it’s a great way to avoid racing thoughts!

Stay on my meds;
Continue to pursue anger management solutions.
Reduce my impatience responses; less irritability when interacting with others.
Accept feedback from others regarding mood shifts, as necessary.
Renew my commitment to maintaining structure in my life.
Sleep for 7-8 hours per night; get enough sleep.
Scrutinize my diet toward the goal of healthy nutrition.
Pursue more public speaking to educate about mental illness & reduce stigma.
Reduce and minimize ruminating – negative self-talk.
Maintain and enhance living in the present.
Accept what cannot be changed with less frustration and more acceptance.
Spend more time with my family.
Keep my priorities straight with family and loved ones: family first, work second.
Pay attention to symptoms of burnout. Reduce them through recreation.
Stay in touch with my feelings and moods.
Do something for myself every day, including sharing with others.

New Year Resolutions for Everyone

Learn something.
Teach something.
Listen openly.
Ask for help.
Address anxiety when it comes up.
Maintain an attitude of gratitude.
Let go of bad advice without rancor.
Give more freely and frequently.
Enjoy.
Trust more.
Hesitate less.
Live more in the present.

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.