Bipolar and the Treatment Team

 
Bipolar is an illness with many fronts:
 

• The illness itself, its symptoms and treatment.
• Possible blood pressure problems.
• Possible blood sugar problems.
• Diabetes concerns.
• Heart disease awareness.
• Weight issues.

Working closely with a doctor means all of the present and potential problems are on the table and are being addressed. A positive, close working relationship with a psychiatrist is basic, of course, but let’s not forget the important roles that families and caregivers play. And therapists, spiritual coaches and support groups can also prove quite helpful in remission and the probability of continuing recovery, both mental and physical.

Relationships are vital in the recovery process and they need to be built on solid trust. Spotty, irregular or infrequent visits to the doctor and other members of the treatment team are not very effective and of minimal help in recovery.

Having a brain illness is serious, so giving it our wholehearted attention and care is required to achieve maximum benefits such as long-term remission.

Taking a half-hearted approach may be more foolish than one realizes. It can forestall recovery and make someone more vulnerable to a number of additional problems--problems that may not only exacerbate the bipolar disorder but also raise the chances of exposure to risks on several additional fronts.

The smart thing to do is be an active and involved member of the treatment team, and look to a trusted psychiatrist as the captain of that team.

Be Careful of Misdiagnosis

Depression is a serious illness which can be quite disabling if it is not properly treated. The good news is that when accurately diagnosed and an appropriate treatment plan is implemented and followed, the severity of the symptoms of depression can be significantly reduced and the likelihood of future relapse minimized if not even prevented. The bad news is that depression can be difficult to accurately diagnose. All too often the illness is misdiagnosed and improperly treated, making an already challenging situation even worse.

Misdiagnosis sometimes occurs because symptoms of the depressive phase of bipolar disorder share a number of similarities to those of severe depression. Fortunately, most psychiatrists are fully aware of these similarities and understand how critical it is to conduct a thorough medical history before making a diagnosis and developing a treatment program. The treatment plans for persons who have severe depression are very different than those that are developed for persons in the depressive phase of a bipolar disorder.

Psychiatrists know this. It is the specialty in which they are board certified.

Non-psychiatrists do not know this. It is not their specialty. They may be general or family practitioners, internists, cardiologists or psychologists, but they are rarely board certified psychiatrists, as well. They do not know how to accurately diagnose patients with brain illnesses.

Avoid the serious problems of misdiagnosis. Make sure the physician doing the diagnosis is a psychiatrist. Accept no substitute.

Knowing Our Limits

Something all of us experience at one time or another are the challenges that can occur when we take on more than we’re able to handle. While these are often viewed as disappointments if not defeats, they may also be great teachers. Discovering and recognizing our limits can mean the difference between going out too far (and needing help to get back) or remaining on solid ground and keeping our sure footing (to be able to do whatever may be required).

Knowing our limitations helps us to focus on what we know we can do and gather the energy we need at the place and time it‘s needed. With our capabilities very much in mind, we may then:

• Examine the situation or challenge and thoroughly think the matter through
• Plan for the possibilities of unknown occurrences
• Expect the unexpected and prepare for them
• Do our very best…always
• Exceed our expectations

For those of us caring for someone with bipolar or depression, it is important that we stay in good health. Our loved ones need us and may look to us to provide needed guidance and support when the challenges of their recovery become overwhelming. It’s vital that we’re able to provide the needed guidance and leadership whenever and wherever it is needed. Taking proper care of ourselves and respecting our own limits should be the goal of every companion. We never know when we’re going to be called upon, so always be ready to help.

Knowing our limits and staying grounded in our role of an effective and successful family member, caregiver or companion will help us to be ready for whatever’s next, regardless of what that may be.

Choosing the Positive

People who have mood disorders are on the receiving end of a lot of negative energy in their lives. Things like criticism, disagreement, discord, faultfinding, judgment and nitpicking are seldom strangers to someone who has depression or bipolar. Sometimes the negative feedback comes directly from the person themself. All too often they are their own worst critic, and this steady stream of negative feedback can make problems even worse:

• It deepens discouragement that may trigger additional stress.
• It usually adds to a loved one’s shame, guilt and already low self-esteem.
• It makes difficult situations even more difficult.
• It can cause a loved one to lose hope, give up and adopt a “what’s the use?” mentality.
• It may eventually lead to suicide ideation, or even worse.

Something they don’t often get enough of is understanding and compassion, and this is so unfortunate. When we as companions, family members or caregivers are able to provide compassionate understanding of our loved one’s behavior, however irrational or inappropriate that behavior may be, we have the potential of gaining the following:

• Greater insight of what our loved one is dealing with and how their illness is interfering with their ability to make healthy choices.
• Identifying and prioritizing our loved one’s needs (medical care, therapy, support groups, nutrition, stress reduction, shelter, etc.)
• Discovering and implementing recovery tools that help motivate our loved one toward achieving managed stability.
• Establishing mutually agreed upon realistic goals (“small steps”) and avoiding pressurized unrealistic goals (“huge steps”), and then achieving those goals.

When our loved one uses poor judgment or makes an unhelpful or unhealthy choice, our choice should be to stay positive and remember that they may be doing the very best they can at the moment. Through compassionate understanding we and our loved one can continue to move in the direction of stability, regardless of how small the steps we are able to manage at the time.

Choosing positive directions is vital to recovery. Let’s try to always choose wisely.

　

The Habit of Healthy Choices

Many of us have heard the phrase, I have bipolar but bipolar doesn’t have me! (Or, sometimes, I have depression but depression doesn’t have me!)

This can be especially true for those of us with loved ones who are doing everything they possibly can to assure their own ongoing stability and the enjoyment that comes with managed recovery. As companions, family members and caregivers, we can all feel blessed when someone we care very much about is consistently highly functional and maintains a daily habit of making healthy choices. Choices like:

• Getting adequate sleep each night.
• Eating regular, nutritious and balanced meals while maintaining weight control.
• Following all aspects of their treatment plan and not deviating from the plan without first discussing any possible changes with their doctor.
• Staying sober--no alcohol or un-prescribed drugs…ever.
• Seeing their therapist…regularly.
• Attending a support group…regularly.
• Successfully avoiding all “triggers” (stressful situations, people, choices that can bring about anxiety and other emotional upsets).

Someone with a brain illness who is experiencing ongoing stability can see how recovering from a disabling mood disorder is always more successful when done with others in supportive roles. They also usually realize recovery is rarely successful when going it alone.

When our loved one has a mood disorder but their disorder doesn’t have them, we know it. And we know, too, it will never have us, either.

Being of Help

Those of us involved with the challenges of brain illnesses, whether the illness is challenging us or someone we are trying to help, may depend on how well we are able to help ourselves. Or love ourselves. Being of help, some of us have discovered, is really dependent on our being able to love.

Karen Armstrong, a widely respected author, religious historian and compassion activist, teaches that if we are ever going to be able to love others, we must first learn to love ourselves. If we can’t love ourselves, with all of our past shortcomings and present faults, then loving someone else simply is beyond our capability. The way to learning to love ourselves, Ms. Armstrong suggests, is through compassion--knowing ourselves…accepting ourselves…loving ourselves.
 
When there is something we know about us, something about ourselves that we are not able to accept that keeps us from loving ourselves, then it is up to us to change it. In fact, we must change it. We must love ourselves so we can learn to love others. There are no shortcuts. Learning to have compassion for ourselves allows us to have compassion for others. Aligned with this concept, I suggest, is that of being of help.

How can we expect to help others if we fall short of being able to help ourselves? Changing the things about ourselves that we don’t like and cannot accept is key. Why don’t we do that? For many of us, the answer is fear. Facing our shortcomings, and accepting them, fills us with so much fear that we avoid going there. That prevents our ever reaching a place of forgiveness.

But love casts out fear, doesn’t it? Yes, perfect love…the love of the fearless.

So this is the way to be of help: fearlessness. We owe it to ourselves and to those we want to help.

Thin Ice Twice

For some of us who have a mental illness, recovery may be like making our way across a lake in winter. The lake, its top a smooth surface of glistening ice, appears safe. At first we hesitate. Finally, we step out. Although the ice feels solid as we carefully step further away from shore, we can’t shake a fearful thought: in some places the surface may be too thin to safely support us, and at any time it could break and we’ll plunge down into a dark icy abyss from which we’re not likely to return.

For those of us supporting a loved one in recovery, the trip across the ice can be just as challenging. We’re afraid about the firmness of the ice, too. Will it prove to be reliable? What if we think we hear the ice start to crack--should we immediately pull our loved one back? We’re not even sure we should be out there with them. If they go down, what’s to prevent us from going down with them?

All of us involved in recovering from the affects of a brain illness, or supporting someone else who is, will have times when we have second thoughts and want to hold back. This is especially true when we’ve never been in this situation before, and we’re not sure that we will achieve the outcome we seek. We’re concerned about the risks involved.

One way to cross a lake in the dead of winter is to seek out others who have successfully crossed the same lake. They will have some experience about crossing safely and can make wise suggestions about where to cross and just how best to go about it. The same holds true for recovering from a mental illness. Others who have been involved in recovery and have experiences of what has worked successfully (or not) can pass on valuable information as well as provide insight and suggestions on what has worked for them (or what hasn’t worked).

Procrastinating from taking any action toward recovery is not helpful. It may even propel things to becoming worse, and possibly catastrophic. Doing nothing is probably our worst choice.

Action with movement toward recovery is essential. How do we do that while avoiding getting caught on thin ice?

Talk with your doctor and therapist. Attend a support group, regularly. Read as much as your can about successful methods of recovery. Learn as much as you can about the illness you’re involved with. Do all these things while you’re taking continuing action.
Stop thinking about it… just do it.