Bipolar By Chance - The Bipolar Connection Blog

Anger Mania

noreply@blogger.com (Ruben) — Fri, 18 Jan 2013 18:40:00 +0000

My wife and I were recently talking about my anger outbursts. Yes, I was over it but my wife was not. Sometimes, it leaves a scar.

I’m not an angry person. I’m normally a nice guy, a caring guy. My wife often says, "You’re a wonderful husband," then after a short pause adds, "most of the time."

I grew up in a loud family. My father discussed things at 125 decibels. I was always fearful of his occasional outbursts, as they made me feel small and afraid. I learned at an early age that the power of control and speaking over someone were ways to attain my point in a discussion or argument. I used that loud voice for effect and advantage until one day when I tried to end an argument with my sister by shouting. She suddenly burst into tears, "Please don’t yell at me, Don. It upsets me." That message was received clearly. I made a conscious decision to no longer use my voice for control.

But it didn’t stop there. It dwells in my marriage of 25 years. It resonates when I discipline my grandsons. "Stop yelling at me," my wife says. I am quick to reply. "I’m not yelling at you. I’m just raising my voice." The best defense is a good offense, or so I believe.

I love my grandsons. I am a proud grandfather. There are, however, times I have to discipline them; sometimes out of frustration from their misbehavior. At those times I yell at them to stop. They are immediately fearful. The six year old may break into tears and will say to me. "Poppy, it makes me feel sad when you yell at me.” Initially, I regarded his statement as a manipulation to avoid being reprimanded, but I have come to understand he is expressing a genuine feeling of hurt and fear. I now try to keep my voice calm when I need to teach him a correct behavior. I want him to love me and enjoy our time together, not be fearful and on guard.

Being bipolar doesn’t make any of this easier. Rather, it only complicates matters when I raise my voice. I am left in a quandary the likes of which brings up a question disturbing in nature. Is my yelling anger? Is it an episode? Is it a symptom of bipolar disorder? Or is it simply normal? In fact, where does normal leave off, and manic excess begin? I hope to answer that question in future posts, or at least shed some light on the matter.

Bipolar Rage

noreply@blogger.com (Ruben) — Wed, 12 Dec 2012 03:13:00 +0000

Sometimes, we want to do the right thing, but don’t know how. Sometimes, not knowing alternatives keeps us engaged in unhealthy behaviors. The list below is a collection of possibilities how to redirect behavior when an outburst of anger looms imminent. These ideas are a jumping off point for you to release angry energy. Can you think of others? Share your knowledge. I will print your suggestions on my blog, if you would care to pass them along my way.

Decrease stress: Learn your limits:
When you become aware of what sets you off, you can avoid those circumstances which result in losing your temper and create a breakdown in understanding.

Journal the outburst, write it out:
When you feel yourself beginning to lose control, being able to channel your frustration into words on paper (or electronically) can reduce the emotional charge and help to regain your calm. Reading something, writing it down, is a cooler means of communication and helps maintain composure.

Keep a rubber band around your wrist:
Snapping a rubber band whenever you feel anger rising can be a good preventative, a reminder to maintain your cool in avoiding an anger outburst.

Learn your physiological cues of anger to avoid outbursts before they occur:
We don’t exist in a vacuum. Long before we have an outburst of anger, our bodies register the rising tides, of frustration and temper. Studying our responses to anger will help head off dangerous emotions before they occur. Whether it is an increase in heartbeat, sweat breaking out on your forehead, or a rush of heat, these and other physical sensations can offer a clue to what’s coming before you lose control.

Take time out:
Removing yourself from the presence of agitation can go a long way in helping yourself regain a sense of calm. Whenever you find the sense your rational mind is slipping into emotional excess, step away from the source of your mounting rage until a cooler mind returns.

Calm yourself through exercise:
One way to get your mind off a troubling encounter is to shift attention. Doing so with exercise can cut through a potential outburst. Moving the mind off its mental focus by physical demand moves concentration onto our bodies, relieving tension and releasing endorphins, the body’s natural tranquilizers. Triggering a mind-body relaxation response by exercising re-establishes clarity and calm.

These are some thoughts to keep you cool in the fray when you find yourself losing control to manic excess. Use these feelings as an opportunity to make a fresh start. As is true of any technique or strategy, it is only as good as what you actually put into practice. It takes work to take back your calm. but you need not be controlled by bipolar rage. Choose wisely, choose health.

The Bipolar Therapist: Speaking Out About Speaking Up

noreply@blogger.com (Ruben) — Fri, 07 Sep 2012 21:13:00 +0000

I have used a variety of therapeutic orientations in my psychotherapy practice behavioral, cognitive, brief, client-centered, psychodynamic, humanistic, and family systems. The list goes on, spanning more years than I care to admit. In helping clients to deal with difficult issues, I have added self-disclosure to this list. This serves to underscore that someone else has experienced what they are going through and encourages empathy between the client and therapist. The client feels understood without feeling “one down.

To some in the field of psychotherapy, the idea of equality and therapist self-disclosure is antithetical to good treatment. I know, because in the past I numbered myself among those who believed this to be true.

The latest evolution in my thinking, therefore, came as a complete surprise to me. As a wounded healer with a history of manic depression going back 30 years, as I became more comfortable with my recovery, I was able to bring this area of expertise to the treatment of others who also have mental illness. I recognize, and clients confirm, the helpfulness of working with a therapist who has been through what they have been through. It is one thing to understand how psychotic thinking impacts one’s ability to make rational decisions; it is quite another to know how the thought impacts one’s logical thinking.

Recently, I was asked by a client to speak to a court evaluator regarding the client’s visitation rights with his children. The client needed a place to sort out mixed feelings about his ex-wife and his role as a father. At one point the evaluator asked if we were doing any “deep work.” I had difficulty expressing that the client needed a place to sort out mixed feelings, not to delve into the deep recesses of his unconscious mind. I felt intimidated by the expression, “deep work.” Because we as therapists cannot seem to move past the status quo and the “tried and true,” I felt uncomfortable with my belief that wider self-disclosure and equality between therapist and client benefits treatment. Today, as described in the following case, my discomfort at self-disclosure has disappeared:

John, age 32, has had anxiety most of his life. He was acutely shy and would be diagnosed today with social phobia. In his early 20’s John began to experience panic attacks and became phobic to most social gatherings. He had few friends and was becoming increasingly isolated. We began therapy by cultivating a conversational dialogue. Though mundane, reporting daily details helped John to talk about himself in a manner that was non-threatening. As he became more comfortable, he gradually began to share feelings of how he felt about himself and his difficulty living in this world, shut off from others. I shared with him my own confrontations with myself at a younger age, my self-consciousness at social encounters, and the discomfort of trying to engage in and maintain conversations. I expressed to John several ways I had confronted my anxiety, suggesting he might find ways of his own to do the same, as we delved deeper into his emotional life and the beginnings of his difficulty with anxiety. My honest input of similarities between us dovetailed with his growing need to understand what happens in others so afflicted. He came to understand there are those who experience life in the same way as he and still find ways to cope. Our relationship began to signify his resolve to venture into the world on his own.

Today, John has been able to conquer his demons. Being able to share with him not only my past history, but my emotional experiences as well, has enabled him to let go of his fears. He realizes his fears are only as big as he has allowed them to be.

Self-disclosure and equality, along with a sense of connection and oneness, merge to create change. If allowed to emerge, clients bloom in an atmosphere of mutual give and take.

I get something from these relationships as well. I am transported to a mindset that is uplifting and satisfying. I feel fulfilled. This is not only important to my personal well-being, but it enhances my work as well. I have learned that as therapists, we listen. The question is, how do we respond?

When Moods Change Dramatically

noreply@blogger.com (Ruben) — Wed, 22 Aug 2012 00:12:00 +0000

He sat there, propped up on one elbow, slouched in his seat. He looked like a deflated elf, his round eyes sunken in their sockets, his skin a gray pallor. “I don’t know what happened”, he said. “Two months ago I was on top of the world. There was nothing I couldn’t do. My wife says she can’t understand how I was able to function on three hours sleep and still have boundless energy. I never felt so good in my life. Now, it all seems beyond me. I feel stuck like I’m on a roller coaster, and I’ve become glued to the bottom of a high ride, a bottom I can’t seem to shake. I’d rather not be alive if it means living with this sense of hopelessness and futility. What’s wrong with me? I can’t stop crying.”

I hear this story in various degrees and shades of emotion all too often. My client is talking about mood changes that seem to have a life of their own. They stem from no particular losses or grievances, which might explain his sense of acute melancholia. What further complicates this picture is the alternation of moods, the ever irrepressible highs of boundless energy, the sharp drop into apathy. What is happening here?

There are several variations and explanations through which we can understand dramatic mood changes. Are we, for instance, talking about a swing in mood from our normal, everyday “OK”state into a depressive state? Or, is there also the presence of sharp spikes in energy characterized at its extreme by a grandiose, inflated sense of self? As well, there are degrees of intensity to take into account.

The sinking into despair is what is termed a clinical depression. It may occur in response to a crisis or significant life event, run its course over a matter of weeks or months, and in time recede into the past. Sometimes there may be no apparent stressor. What we have recently come to understand is that there may be a chemical imbalance triggered by some kind of stressful occurrence. Depression appears to run in families.

Of further concern is the fluctuating of mood between intense “highs”called manias along with a cycling into depression. This is termed manic depression or, bipolar disorder. In its extreme it can be highly debilitating and like depression, lethal. Mania can result in acute thought dysfunction, impairing a person’s ability to think logically. As well, one may become involved in highly questionable schemes, financial &/or personal, resulting in financial repercussions, promiscuity and brushes with the law.

There are milder versions of heightened mood fluctuations termed cyclothymia and hypomania. Cyclothymia is a fluctuation or cyclic alternation of mood, without the intensity of its more severe cousin, bipolar disorder. Hypomania is a heightened state of energy - filled expansiveness less severe then mania. It often feels enhancing with a sense of productiveness, while having less of a downside, at least on the surface. Mania and hypomania are quite seductive. They often involve such a sense of powerfulness and confidence, that one becomes caught in expansive well being, the abrupt deflation of which seems all the more cruel. Like other mood disorders, there appears to be a genetic link (it runs in families).

Our understanding of the causes and biochemical underpinnings of dramatic mood shifts has increased in the last 20 years. We know that once established, mood disorders are more likely to persist and grow worse. This is called “Kindling.” Studies show that the sooner a mood disorder is treated, the greater the chance for a complete recovery. Virtually,75% of those affected can be treated successfully, either with complete cessation of symptoms or a significant reduction.

What does one do when he finds himself in a dramatic mood change, or more commonly, when he sees a friend or family member in the throes of one? Mood disorders are often discounted by those afflicted. How do we come to know that what we are seeing is dysfunctional, and what do we do? Here are some thoughts on how you can help:

Recognize symptoms early on by noticing changes in sleep, appetite, grooming, belligerence and isolating behavior.

Maintain a supportive atmosphere. Avoid confrontation through speaking calmly in the face of agitation. Project an attitude of concern.

Fill in for the patient’s lack of emotional control by overcoming denial, yours and theirs. Often a family meeting is helpful. Be sure to point out strengths to help gain common ground.

Set boundaries and limits; it’s important to let a family member or friend know there is a structure, a support to make up for their lack of control. Reduce their sense of turmoil.

Join a support group. Being connected with others who share your concern helps normalize your situation. It also serves as a source of advice and knowledge, often from others who have trod the same road as you.

Seek treatment. Today there are medications and treatments that can dramatically change hopelessness into hopefulness. A combination of medication and psychotherapy has been found to be the most effective, successful combination in treating mood swings. Seeking treatment helps reduce isolation and a sense of stigma.

One final thought--thousands of people die from suicide every year. What is especially sad about this fact is that mood disorders are treatable. Don’t be a statistic. Be a survivor.

Negotiation and Mental Illness

noreply@blogger.com (Ruben) — Fri, 03 Aug 2012 00:09:00 +0000

For those with loved ones who suffer from mental illness, it is often difficult to communicate with them. Not only is there an adversarial role that occurs, but the lack of insight which mental illness fosters makes it difficult to discuss openly. A friend or family member may have concerns, yet be unable to open a dialogue. It is at these times a less personal approach can be helpful, utilizing techniques that often come from the business community. I am talking about negotiation, making a deal with a mentally ill loved one.

Principle negotiation is a process often used in situations where both parties seek to win their points of view. Unlike other forms of negotiation where one party wins and another loses, principle negotiation is designed so that both parties get what they want. This can be critical when discussing treatment or evaluation with an individual lacking critical thinking brought on by a biochemical imbalance.

A family member may have concerns over a recent change in the behavior of a loved one and sees a need for treatment, while at the same time the ill loved one may be quite happy and believes the concerned family member is the one who needs treatment. After all, she is the one who is upset. What can be done in a case like this? Here is where principle negotiation enters the picture.

Principle negotiation has four main steps:

First, we want to separate the person from the problem. Avoiding negative judgment helps to clear the way for an objective view and makes possible focusing on behavior and actions at issue. Although this may be difficult when someone is disturbing the family equilibrium, it is not helpful but corrosive to understanding, if stigma or past conflict colors perception. Anger and upset must be left in the “entry way.” Instead, address the issues. Ask yourself, “What is it about this person’s actions that is getting in the way of family harmony? What is it I am concerned about?”

The second step in the principle negotiation process involves negotiating interests, not positions. What this alludes to is reducing the role of the concerned family member as the party with power in the relationship, and the ill loved one as the subordinate. Instead of seeking the upper hand, family members are encouraged to focus on what their interests are. What is it each party wants?

The third step in principle negotiation is creating options for mutual gain by brainstorming ideas, which reflect gains or answers for both parties. This is what creates a win-win situation. No idea is too outlandish for consideration. In this step, decision-making with various scenarios should be presented. Parties to the negotiation process can brainstorm together or separate. It is important to keep in mind the mutuality of the outcome. The ideas created should strive to encompass answers for all parties to the negotiation. There are no winners and no losers, only satisfied participants. Principle negotiation can be used by any number of interested parties. The question you have to answer is, “What is the best solution for everyone?”

The fourth and final step of this problem-solving process is insisting on objective criteria. Know your facts; don’t attempt to complete resolution without them. If you are not sure of your position or the other party’s, put off reconciliation until you check your information. One way to do this would be to bring in a neutral third party as mediator; someone who doesn’t stand to gain from the final outcome. Most important—this negotiation process can be utilized with a mentally-ill loved one who is resisting treatment. Example to follow:

** PART II **

Isabella’s Story – An Example of Principle Negotiation

Isabella was 19 years old and lived at home with her parents and two older brothers. Though prone to depression, Isabella had recently been feeling unusually good. So much so that she felt a sense of confidence. She slept only two to three hours a night, yet had constant high energy. Walking around the house after her family had gone to bed and staying up listening to music with the volume cranked up high, she would isolate in her room for days, coming out only for food. Her personal hygiene, once a habit of pride, had now become intermittent. Sometimes she would leave the house for days at a time, never telling her family she was leaving, how long she would be gone, or when she would return.

Her family was disturbed by her behavior, fearful of her whereabouts when she would leave, and annoyed at being awoken by her erratic behavior in the middle of the night.

Vocal about their concern for her and at times harshly critical, they called her a “nut job” and took her to task for being an emotional drain on the family. They insisted she go for treatment, a topic Isabella refuted with anger. She told her family she liked her lifestyle and couldn’t understand what she took to be insensitivity. “If you are so unhappy, perhaps you should go for treatment,” she said.

Isabella’s parents decided they needed to speak to her about the situation and called a family meeting. Before Isabella’s parents and brothers could speak, Isabella rebuked them for the way in which they spoke to her, calling her a loser and a “nut case.” Her family quickly agreed that was a mistake, began to itemize the problems she evoked, and apologized for their behavior. Isabella responded by shouting them down. Her father tried to reprimand her, taking charge as head of the family, but Isabella would have no part in this. She felt she was an adult and should be shown some respect. Finally, her father asked the family to share their concerns about Isabella’s recent behavioral changes, how they impacted the family, and what they wanted from her. In return, they asked her for her concerns and what she wanted from them. The list of family interests was as follows:

Getting treatment for Isabella.
Return of family routine and stability.
Isabella’s desire to not be labeled a source of dissention.

Isabella’s brother Jeff pointed out the family concerns, but how does the family put their goals into action. As the family sat around the dining room table, they began to brainstorm, putting out ideas to one another as possible solutions. Soon there were a number of suggestions, some of which focused on satisfying the goals of everyone at the table, not only the family, but Isabella’s as well. The major options, which stood out, were these:

Isabella would agree to see a psychiatrist.
Isabella’s parents were willing to support her financially to satisfy her goal to return to college.
Set a list of house rules the entire family would create and adhere to.
Every family member would abide by a third party evaluator to resolve any lingering family dissention.

The family felt good about their brainstorming options for mutual gain. Only one thing remained. Who would be their third party mediator? Family members suggested relatives and family friends, but they were caught on the horns of a dilemma. They needed someone who would be neutral. That ruled out family friends and relatives. They agreed they needed someone who would take all the information the family had and be objective, using objective criteria. The family decided to put themselves in the hands of a psychiatrist who could evaluate Isabella’s mental state and offer a professional view on how they could best return to a state of normalcy. This turned out to be a win-win situation as Isabella got treatment without feeling harassed by the family, and the family regained a sense of goodwill. Eventually, with medication, Isabella was able to return to college and home life returned to normal. A sense of unity was rekindled for all concerned.

Isabella’s Story is an example of principle negotiation as it works in a family dispute. Family members were able to come together, grapple with an issue, and eventually heal. There is no magic here, but rather, an example of those making a commitment to stand by one another. It is not an instance of a technique that brings a family together, but rather, a story of a family dedicated to one another which used a technique, which worked for them.

If you want more information regarding principle negotiation, the book, which is a classic in this field is, “Getting to Yes, Negotiating Agreement Without Giving In,” by Fisher & Vry of the Harvard Negotiation Project. It’s a short book of exceptional worth. If you’re looking for hope in communicating with ill-loved ones, this straightforward book is a MUST.

Are the Mentally Ill More Prone to Violence?

noreply@blogger.com (Ruben) — Fri, 24 Feb 2012 18:17:00 +0000

We are bombarded today by news events, which portray those with mental illness as robbers, terrorists, and unbalanced individuals who become violent and commit acts of murder and mayhem. How true a picture is this of mental illness? How much does media focus slant our view, or is this simply painting the mentally ill with too broad a brush?

A bipolar client recently told me he was disturbed by thoughts of wanting violence to happen to random strangers as punishment for acts that in his estimation were foolish. However, he did not want to be the one to carry out this punishment, although his fear was that he would become the one to do so. He wanted to know how he could stop these angry thoughts.

How prevalent is violence in the mentally ill? The Los Angeles County Central Jail is the largest mental health facility in the United States. Many of the inmates held in this facility are not those held for aggressive violence, but the mentally ill homeless, a group prone to violence upon one another more for gain (food, clothing, shelter) rather than the desire to vent outrage.

A predisposition toward impulsive acts is a marker of mental illness, while more aggressive acts are thought out and planned. How much does medication address this impulsivity among the mentally ill and how do you get them to comply?

Those with mental illness, both violent and non-violent alike were once confined to hospitals. Society was protected until changes in the 1960’s in our mental health system occurred. At present, both the violent and non-violent are out among the community. While efforts are being made to screen the two groups, there are those who fall between the cracks. Since community treatment centers are largely under funded, the only place for many of the violent is on the streets, in jails, or incarcerated in state mental hospitals for the criminally insane. Instead of being in community clinics as was originally envisioned when the mental hospitals were emptied in the 1960’s, and the“wonder drug” Thorazine was thought to mold addled minds into functional human beings, we see these individuals on the streets where they garner more attention.

The media coverage of a violent act alters our perspective. In the past, violence wasn’t covered by the press as often as today. When we see violent images on our television screen, our inclination is to attribute more to it than it deserves because at that point it is in our faces. Numbers don’t count; numbers aren’t even part of the equation. Instead, we are appalled at what we are being presented with at that moment. A picture speaks 1000 words, and a 1000 words bespeaks a crisis. How do these acts of violence come to exist?

Violence is about frustration and discouragement. In the mentally ill, agitation surfaces unresolved and impulse is reborn as impulsivity and sometimes, aggression. This is not a process of those with mental illness alone. It is about being devoid of sanity; impatience personified by not having one’s basic needs met. Acting out violently on an impulse that cannot be entirely predicted and set against a family unschooled in identifying behaviors and stressors that are aberrant, an opportunity is missed to get treatment for a loved one before she acts out. Since aggressive and impulsive traits run in families, identification of these traits might be enhanced by the family identifying them early. At note here is to what extent are violent acts learned from siblings or parents, and to what extent is it simply bad bio-chemistry. What about the Hinckley’s and Columbines of our times? Is the family responsible? Are these just impulses, or violence planned?

PEI (prevention & early intervention) is one area at the forefront of current mental health outreach. The earlier we are able to identify and intervene, the greater the chance for recovery. At heart is educating the public to identify aberrant behavior while creating the desire to report these individuals. This is neither a blame game nor pointing the finger at the public, the family, or the mental health system. It is not about fault. It is more about the timidity of coming forward as a family member or friend to identify mental illness in our communities. Identification starts at the neighborhood level amongst people who know one another and who make their homes together, talking amongst themselves about mental health outreach programs and the necessity for public education whether private or through organizations such as the Alliance for the Mentally Ill (NAMI) or the Depression and Bipolar Support Alliance. Public institutions, school-based programs, or the media at large can create a knowledge-based community.

Perhaps we as citizens must rescue our mentally ill. How can we do this? By educating ourselves about mental illness and so intervene, we can make more enlightened choices about care. This will help to reduce aggression and violence. Some might call this paternalism. I call it, “Giving a damn.”

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.