Posts tagged bipolar
Posts tagged bipolar
Missy Douglas: Visualizing bipolar disorder through art
By David Keller, BBC News
Fed up with keeping her mental health a secret, bipolar disorder sufferer Missy Douglas spent a year creating a painting each day to express her feelings. Controversially, she decided not to take her medication during this time, in the hope that paintings demonstrating her highs and lows would raise awareness of her condition.
Waking up each morning, Missy Douglas has no idea how the day will go. She may feel invincible, or she may be hit by a bout of depression.
Battling the emotional extremes in life has become second nature to the 37-year-old artist, who has lived with bipolar disorder for most of her adult life.
Last year she chose to do what she does best. Every day, for a year, she picked up her paintbrushes and painted exactly how she felt.
She decided to give up her medication while she carried out the project.
"I wanted it to be as pure a view of the disorder as possible," she said.
"Painting every day didn’t make me feel more stable or increase my sense of wellbeing," she said Douglas. "In fact, trying to look inside and express raw emotion or psychological distress everyday was very difficult.
"It sometimes exacerbated the depression or mania I was experiencing at the time. However, when I look back I can recognize the patterns and rhythms of my own ‘brand’ of the disorder."
Bipolar disorder brings about strong mood swings that can last for several weeks.
It can leave people unable to form relationships or cope with the day-to-day routine of work and - in extreme circumstances - lead to a feeling of worthlessness.
Douglas, who is originally from Northampton but now lives in New York, said living with the condition could be “extremely exhausting”.
An online platform that helps people with bipolar disorder self-administer therapy has proven to be successful in a small trial, with 92 percent of participants saying they found the content positive.
Nicholas Todd, a psychologist in clinical training at the NHS Trust, has developed the site as part of a project he’s running called Living with Bipolar.
In it, he asked 122 people to use a sort of e-learning environment that uses audiovisual models and worksheets, incorporating parts of cognitive behavioral therapy and psycho-education known to be effective in bipolar patients. There’s also a peer support forum, which is moderated by a member of Todd’s research team, and motivational emails were periodically sent to those on the trial.
"Service users were encouraged to access the intervention flexibly and use it as and when they felt appropriate," Todd told Wired.co.uk. That’s because, as he presents in a paper on the platform, for patients “recovery is defined as people living a fulfilling life alongside their condition”. As such, it needs to fit in around them, their lifestyle and their changing needs.
One participant comments: “….for me recovery is certainly not about being symptom free… it is about coping and having a reasonable quality of life, being able to work productively and enjoy things outside of work.”
Thus, Todd explains, “service users did not focus on a ‘cure’ as their desired outcome but instead personally defined recovery goals and improved quality of life.”
By the trial end, Todd found that on average, users who stayed till the end completed 60 percent of the program. Of the people that completed the whole thing — 15 modules — 74 percent took under three months to do so.
The platform took a year to develop, spent looking at the most effective components of psychological therapy for bipolar disorder. As this was narrowed down, the group carried out five focus groups and tested it online via a consultancy group.
The system gets users to identify their own mood using an established scale, the idea being they — and the system — can track their own ups and downs. “Service users would then receive information about the most appropriate modules, given their mood symptoms,” says Todd.
The forum, he says, played a key role in the project’s success. One participant commented, “…part of it [bipolar disorder] is feeling very alone… you don’t get that and I do think that the forum works extremely well with the intervention…” Todd explains how participants used it to support each other not only through the new intervention process, but through life events.
"A balance was struck between allowing participants to offload, and posts which encourage or talk about acts of suicide, self-harm, harm to others and are unhelpful to participants’ recovery." A total of 70 percent of the users signed up to the forum, and 1,927 posts on 130 topics were accumulated. "The participants who used the forum tended to complete more modules, and all participants who completed the entire program used the forum, albeit in different ways."
The idea behind the platform is to help bridge those periods between appointments, or those appointments that a patient misses. As with depression, health services can be known to administer solely medication to help alleviate symptoms. More and more, the NHS is striving to ensure psychological therapy is integrated alongside a prescription for mood stabilizers, such as lithium. “However, severe inequalities in access to psychological interventions for bipolar disorder currently exist in the NHS,” Todd says. “This intervention aims to increase access to psychological intervention.”
Todd tells us the NHS is actively training more staff to deliver psychological therapy, to plug the gap. For now, that initiative is being piloted for severe mental health conditions. “This intervention may fit as part of this initiative in giving service users with bipolar disorder greater access to psychological therapy.
"Computerized interventions are not about replacing face-to-face interventions, but giving someone another option to receive psychological support. In fact, some people prefer accessing psychological support in this way as it fits better with their lives."
For one woman in particular the experience has been, in her words, “life changing”.
She said: “I have encountered insights in the modules that have significantly helped me to survive the blackest moments. I cannot measure the value of this, as it has contributed to their difference between life and death. My husband and I are sincerely grateful for the immeasurable impact this has had on our family.”
Loser! You messed this up again! You should have known better!
It’s that know-it-all, bullying, mean-spirited committee in your head. Don’t you wish they would just shut up already?
We all have voices inside our heads commenting on our moment-to-moment experiences, the quality of our past decisions, mistakes we could have avoided, and what we should have done differently. For some people, these voices are really mean and make a bad situation infinitely worse. Rather than empathize with our suffering, they criticize, disparage and beat us down even more. The voices are often very salient, have a familiar ring to them and convey an emotional urgency that demands our attention. These voices are automatic, fear-based “rules for living” that act like inner bullies, keeping us stuck in the same old cycles and hampering our spontaneous enjoyment of life and our ability to live and love freely.
Some psychologists believe these are residues of childhood experiences—automatic patterns of neural firing stored in our brains that are dissociated from the memory of the events they are trying to protect us from. While having fear-based self-protective and self-disciplining rules probably made sense and helped us to survive when we were helpless kids at the mercy of our parents’ moods, whims and psychological conflicts, they may no longer be appropriate to our lives as adults. As adults, we have more ability to walk away from unhealthy situations and make conscious choices about our lives and relationships based on our own feelings, needs and interests. Yet, in many cases, we’re so used to living by these rules we don’t even notice or question them. We unconsciously distort our view of things so they seem to be necessary and true. Like prisoners with Stockholm Syndrome, we have bonded with our captors.
If left unchecked, the committees in our heads will take charge of our lives and keep us stuck in mental and behavioral prisons of our own making. Like typical abusers, they scare us into believing that the outside world is dangerous and that we need to obey their rules for living in order to survive and avoid pain. By following (or rigidly disobeying) these rules, we don’t allow ourselves to adapt our responses to experiences as they unfold. Our behavior and emotional responses become more a reflection of yesterday’s reality than what is happening today. And we never seem to escape our dysfunctional childhoods.
The Schema Therapy Approach
Psychologist Jeffrey Young and his colleagues call these rigid rules of living and views of the world made by the committee in our heads “schemas.” Based on our earliest experiences with caregivers, schemas contain information about our own abilities to survive independently, how others will treat us, what outcomes we deserve in life, and how safe or dangerous the world is. They are also responsible for derailing intimate relationships.
Young suggests that schemas limit our lives and relationships in several ways:
A woman we will call Diana has a schema of “Abandonment.” When she was five years old, her father ran off with his secretary and disappeared from her life, not returning until she was a teenager. The pain of being abandoned was so devastating for young Diana that some part of her brain determined she would live her life in such a way as to never again feel this amount of pain. Also, as many children do, she felt deep down that she was to blame: she wasn’t lovable enough, or else her father would have stuck around; a type of “Defectiveness” schema.
Once Diana developed this schema, she became very sensitive to rejection, seeing the normal ups and downs of children’s friendships and teenage dating as further proof that she was unlovable and her destiny was to be abandoned. She also tried desperately to cover up for her perceived inadequacies by focusing on pleasing her romantic partners and making them need her so much that they would never leave her. She felt a special chemistry for distant, commitment-phobic men. When she attracted a partner who was open and authentic, she became so controlling, insecure and needy that, tired of not being believed or trusted, he eventually gave up on the relationship.
Diana’s unspoken rule was that it was not safe to trust intimate partners and let relationships naturally unfold; she believed that if she relaxed her vigilance for a moment, her partner would leave. In an effort to rebel against her schema, she also acted in ways that were opposite to how she felt; encouraging her partner to stay after work to hang out with his friends, in an attempt to convince herself (and him) that she was ultra-independent. This led to chronic anger and dissatisfaction with her partner.
Diana did not understand her own role in this cycle. Diana (and her partner) needed to understand how her schemas resulted in ways of relating to herself and others that are repetitive, automatic, rigid, and dysfunctional. By acknowledging and connecting with her unresolved fears and unmet needs, Diana could become more flexible and allow her partner more freedom without feeling so threatened.
The schema concept helps us understand how early childhood events continue to influence adult relationships and mental health issues, that we need to recognize their influence and (with professional help, if necessary), begin to free ourselves.
Six Things You Can Do Right Now
The tools and tips below will help you begin to identify your core schemas and take some corrective actions.
2. In close relationships, think about your partner’s background, beliefs and behaviors to see whether they fit into one of the schema patterns identified here. Think about the times when your communication gets derailed and you both get angry or defensive. What schemas may each of you be bringing to the table and how may they be setting each other off. For example, a partner who has an Entitlement schema may act in needy and demanding ways that trigger the partner with an Emotional Deprivation schema to feel uncared for.
3. Pay attention to when you or your partner are getting triggered. You may notice feelings of anger or helplessness, thoughts that contain the words “always” or “never,” and feelings of tension or discomfort in your body. You may feel reactive and tempted to withdraw or say something impulsively.
4. Practice the STOP technique when you are triggered during a conversation with your partner. This is a practice from the Mindfulness-Based Stress Reduction course developed by John Kabat-Zinn. STOP what you are doing, TAKE a breath, OBSERVE what you are doing, thinking, feeling and what your partner is doing, thinking, feeling. Think about whether your schema is calling the shots and if you would like to change tracks. Then PROCEED with a more mindful response.
5. At a time when you are both calm, sit down with your partner and try to figure out the cycle that happens when both you and your partner get reactive to your schemas. Decide how to communicate that this is happening in the moment and call a break.
6. Train yourself in the skill of cognitive flexibility. Deliberately think about other ways to interpret your partner’s behavior that are not consistent with your schema? Perhaps he is withdrawn because he had a hard day at work. Are you personalizing things too much?
Schemas are more likely to be triggered when your emotional needs are not being met. Take some time alone to reflect on what these needs might be. Then practice some healthy ways of taking care of your own needs for love, security, comfort and so on. Harness your inner “Healthy Adult” to proactively take care of yourself so you’re less likely to feel deprived and reactive.
Is it melancholy to think that a world that Robin Williams can’t live in must be broken? To tie this sad event to the overarching misery of our times?
– Russell Brand, comedian/actor
Like millions, I am sitting with the fact that one of the funniest people to grace the planet has died by his own hand. Robin Williams’ death has hit people of my generation, Generation X, especially hard. After all, his face flashed often across our childhood screens. Mork and Mindy episodes were a source of solace for me as a little girl, as I bounced around between foster homes and family members’ homes, while my single mother cycled in and out of the state mental hospital, fighting to survive. I could laugh and say “nanu, nanu – shazbot” and “KO” and do the silly hand sign and forget for just a little while about living a life I didn’t ask for.
“You’re only given one little spark of madness. You mustn’t lose it,” may become one of Robin Williams’ most famous quotes. I was always struck by how he moved so seamlessly between wacky comedy and the most intense dramas. He was so magnificently able to capture the human experience in all its extremes. He threw all that intensity right into our faces, undeniable, raw, frenetic. He showed us our own naked vulnerability and sparks of madness and gave us permission to laugh in the face of all that is wrong in this world.
In the wake of his death, many people are understandably jumping to identify causes. Depending on who you talk to, Robin Williams’ suicide was caused by depression, it was caused by bipolar disorder, it was caused by the drugs, prescription or otherwise. We just don’t know.
As a suicide attempt survivor myself, I can attest that it’s not that easy to find any single cause for the urge to die. It’s true that along with street drugs, SSRI antidepressants and other psych drugs can certainly increase suicide risk in some people. A decade ago, I was one of many who fought and won to get to the FDA to put a black box warning on SSRIs to warn the public of these very real risks. While a drug, legal or illegal, may give us the impetus we wouldn’t otherwise have had to act on suicidal thoughts, for some of us it’s more complex than that.
Our reasons for wanting to die are as varied as our reasons for wanting to live. That, I believe, is the great mystery of suicide.
But I invite us all not to fear the mystery; not to be struck hopeless by it. We can save each other’s lives; better yet, we can find and share reasons to keep on living. If we have 20 seconds, we can share information about a hotline or a warmline. But if we want to really see this horrific epidemic end, we all have to get more involved.
As someone who has looked into the void and longed for it more than once, I can attest that anyone who reaches out in those darkest of times is truly remarkable. It is, tragically, when I am most distressed and most in need of love and acceptance, that I have the hardest time reaching out. This is not an absolution of personal responsibility, because we all must accept some measure of that; rather a recognition that we shouldn’t put the full onus on a suicidal person to “reach out” and “ask for help.” We need to reach out and help. I have written about the problems with the master narrative of suicide prevention, and how punitive and dehumanizing much of the “help” out there currently is. This blog isn’t about that. I’m talking about help that heals.
My point is that we must change the way we relate to ourselves and one another. In revolutionary ways. We must wake up to the fact that we have been socialized since birth to hide the fullness of who we really are. Robin Williams got to act it all out and the world loved him for it. He expressed the madness, the wildness, that we have been conditioned to hide. We are generally chastised for laughing too hard or crying too loud or being too sensitive. We have been trained to put on a proper face and act like all is well. If for some reason we can’t naturally do that (and most of us can’t), we devise ways to cope with the awful unbearableness of it all. They may be fairly innocuous, like binge watching Orange is the New Black in bed all weekend long. Or we may seek to stop the pain in innumerable ways that we know will kill us in the end — from binge eating to chain smoking to staring down a bottle of whiskey or pills.
If we only realized just how many people walked around carrying heavy burdens that are invisible to the world, and were doing every fucking thing possible to keep from cracking under the weight, we would stop feeling so alone and isolated carrying our own. We could put down our burdens and rest, in the all-encompassing field of our human vulnerability and strength.
“Be kind, for everyone you know is fighting a hard battle,” said theologian Ian MacLaren. I am struck by the imperative need for us all to take up the challenge to be kinder to ourselves and others. There is so much suffering in the world. How often do we ask ourselves, in the midst of responding to Facebook posts, Tweets, and emails: how can I relieve suffering? At the very least, how do I not add to it?
No one person can fix this mess we have gotten ourselves into as a species, but we can each be a part of bringing more compassion and acceptance into the world. First, we have to learn to practice it with ourselves. We can be the antidote to the fear and sorrow that exists within us, in other people, and in the world “out there.” Kindness is dismissed as bullshit in a world that values power over others. But as mindfulness teacher Sharon Salzberg reminds us, kindness is a “force.” If unleashed in vast quantities, it could literally reverse the cycle of misery on this planet.
When will we stop walking around in these miraculous, vulnerable human bodies seeing ourselves as separate? What will it take for us to realize our interconnectedness; to act from a deep understanding that suicidal people are not to be feared and judged, but to be embraced and held in the light of understanding and true empathy? Empathy sees that we are all connected, and thus demands well-being for all.
I think of the people who report walking to the bridge and said to themselves, “if one person smiles at me or talks to me, I won’t jump.” Lately I try to go out of my way to smile at people, to talk to people, even if they look at me funny because they aren’t used to random strangers smiling at them or talking to them. Come to think of it, I think talking to strangers is definitely a symptom of some severe mental disorder in the DSM-V.
But seriously, folks. It strikes me that breaking down our collective walls of isolation, of chiseling away our carefully constructed masks, of taking care of ourselves and each other, of judging less and loving more, may be among the most important things we can do with our lives. We can simply value people, not for what they do or what they achieve in the world, but because they are alive on this planet with us, right now, sharing these troubled, turbulent and painfully beautiful times.
In the end, we are stunningly diverse, yet there are basic human needs that we all have in common. The ancient practice of lovingkindness exhorts us to wish for ourselves and all beings to be safe, to be healthy, to be free, to live with ease. How can we create a world where these universal human needs are met? I think this is one of the primary questions we should all be asking ourselves right now, and figuring out the answers together.
I don’t claim that smiling at the person who makes your coffee or talking to a stranger on the metro will save the planet. What I do believe is that if we all made human connection, safety, and a sense of shared belonging among our top priorities, if we all tried in ways large and small to end our collective isolation and suffering, this world would be a safer place to be human. And a lot of people might not be eager to leave so soon.
Nanu, nanu, Robin Williams. Rest in peace.
For seven years, mental illness has been a major part of Elizabeth’s life – but she bravely battles on. She shares her story.
Manic moods controlled Elizabeth’s life until she picked up the phone and asked for help.
She had suicidal thoughts and tried to kill herself. She went to see her doctor.
“I knew I was ill,” said the 50-year-old from Derby. “How I was feeling was not right.
“There’s nothing normal about staying awake all night chatting on the phone to a friend and at the same time, manically cleaning your house from top to bottom.
“There is nothing normal about feeling so low and depressed that you can’t even find the energy to change out of your nightwear and keep it on all day.”
For years, Elizabeth coped the best way she could. She endured several stays in hospital and took a concoction of drugs to try to stabilise her moods.
Then she was diagnosed as being bipolar – a serious medical condition that causes shifts in moods, energy and ability to function. Since then, life has been a whole lot better.
“I suppose once I was told that I had bipolar, I began to realise why I had been feeling the way I had. In 2011, I was in hospital for 11 weeks and that was a long time but, in that period, the doctors worked hard to work out what was wrong and now I know what I’ve got, I can deal with it.
‘‘I am learning to live with it. I am finding room in my life for this condition.”
Elizabeth does not want to be identified. She says the stigma attached to mental health is too big and she is afraid to be labelled.
While she battles to lead a normal life, she says she does not want to be discriminated against. And in her community, like many others, it is simply never discussed.
But at the same time, she wants to speak out about mental illness and highlight how hard it.
“People don’t talk about mental illness,” she said.
“It is something people hide away and keep close to them. I don’t feel ready to tell everyone that I am bipolar.
“Life is hard enough for me. But day by day, I get more strength and I know, with the right medication, I can survive this.”
Elizabeth was only diagnosed with bipolar two years ago. Her mental illness first started to show itself in 2007.
But, before then, life was normal for the mum-of-one.
“I had a job, a house and a husband,” said Elizabeth.
“I worked in the caring industry and everything was fine. My daughter was all grown up and had her own place and I thought I had been a good mum.
“Looking back, I think things started to spiral out of control when my marriage failed. It was 2005. I literally lost the house and was made bankrupt.
“I started feeling paranoid and my mood dropped. I struggled to sleep because of the paranoia. I was worried about my future and what was going to happen. I think this was the start of it.
“I stopped sleeping and eating. I was worried about my life and that’s when the depression kicked in.”
Elizabeth went to see her GP and was put in touch with the team at Derbyshire Healthcare NHS Foundation Trust. She was assigned a lead nurse. It was life-saving, says Elizabeth.
“To be honest, my nurse has been fantastic,” said Elizabeth.
“When I’ve felt like I’m losing it, I have picked up the phone and called her.
“I have always been able to recognise the signs of my illness and I think that has actually saved my life.
“Instead of suffering in silence, I have asked for help.
“Instead of getting more and more unwell, I have moved quickly to get the right kind of support.”
Elizabeth is not proud to have spent time in Derby’s Radbourne Unit – a service dealing with mental health, learning disability or substance misuse.
She has been detained under the Mental Health Act. “People don’t know what it is like to have a mental health problem,” said Elizabeth.
“It can be tough.
“Most of the time, my moods are low. But I have experienced severe highs and that can be dangerous too.
“Once I went out shopping and spent far too much money. I severely overspent and got into debt.”
Despite feeling stable at the moment, Elizabeth still describes herself as ‘vulnerable’.
She takes medication and the tablets are keeping her well, but she does worry about her future. “People do take advantage of me,” she said.
“I was in a relationship and we got engaged. Then he started asking me for money and I gave it to him. Before I knew it, I had given him quite a lot. He said the money was for our future. In the end, that wasn’t the case at all. The relationship ended.
“I am vulnerable. I know I am. And when things like this happen, my moods can dip.”
Elizabeth lives on her own. She admits she struggles to get motivated but says she would like to get back into employment.
She says she needs a purpose in life. Getting up and getting out, she says, could help her. Volunteering is something Elizabeth is interested in.
“My daughter is a good support to me,” said Elizabeth. “And my mum, who is elderly now, talks to me on the phone. We ring each other every day.
“But I suppose it’s my daughter who keeps her eye on me. She comes over for a meal and that makes me get up and cook something nice.
“She’s the one who says ‘tidy up the house, mum’. I don’t like to think that she worries about me, but I guess she does. I worry about myself sometimes.”
THE DISORDER CAN BE A SEVERELY DISABLING CONDITION’
BIPOLAR disorder is a condition in which a person has periods of depression and periods of being extremely happy, cross or irritable.
It is also known as manic depressive illness. It is a serious medical condition and can leave sufferers unable to function.
Bipolar disorder is relatively common. It affects about one person in every 100.
It can occur at any age, although it typically develops between the ages of 18 and 24. Men and women from all backgrounds are equally likely to develop bipolar disorder.
The pattern of mood swings in bipolar disorder varies widely between people. Some people will only have a couple of bipolar episodes in their lifetime and will be stable in between, while others may experience many episodes.
The exact causes of bipolar disorder are not known. However, it is thought that several things can trigger an episode.
Extreme stress, overwhelming problems and life-changing events are often thought to contribute, as well as genetic and chemical factors.
The high and low phases of bipolar disorder are often so extreme that they interfere with everyday life.
Elizabeth’s lead nurse at Derbyshire Healthcare Foundation Trust, said: “Bipolar disorder can be a severely disabling medical condition. However, many individuals can live full and satisfying lives within their own homes with the use of regular doses of medication to stabilise their mood. Although bipolar disorder is usually a long-term condition, effective treatment combined with self-help techniques can limit its impact on everyday life. Staying active and maintaining a healthy diet are important. Exercise and taking up a new hobby can also help to reduce the symptoms, particularly depressive symptoms.
“To date there is no cure, but proper treatment helps most people with bipolar disorder gain better control of their mood swings and symptoms, because this is a lifelong and recurrent illness.
“People with the disorder need long-term treatment to maintain and control symptoms. An effective maintenance treatment plan includes medication and psychotherapy for preventing relapse and reducing symptoms.
“Not everyone responds to medication in the same way, therefore several different medications may need to be trialed before the preferred course of treatment is identified.
“Understanding the illness is key for the person with bipolar disorder, allowing them to gain insight into their condition and recognise relapse symptoms unique to them.
‘‘Should anyone feel they suffer with the above symptoms then your first port of contact should be your GP who will assess you and make a referral to mental health services if they feel this is necessary.”
For more information, visit www.nhs.uk/Conditions/Bipolar-disorder/Pages/Introduction.aspx