My primary chronic illness is bipolar disorder. Most chronic illnesses, whether physical or mental, require the individual to take regular action to maintain the highest possible level of health. The illustration most commonly used is diabetes — people with diabetes must check their blood sugar regularly, follow a plan of diet and exercise, take oral or injectable medications, examine their feet often, and so forth. Failure to carry out any of these actions can lead to serious consequences including kidney failure, hypoglycemic coma, amputations, or even death.
Self-management of bipolar disorder also requires certain actions, but it is much more difficult to know just what these actions are when a mental illness is concerned than it is when it is a physical illness. The easiest action to discern is taking prescribed medications. Having gone off my meds several times in the past, including once for almost a year, I know very well what can happen. I know the insidious downward spiral of bipolar that can lead to the brink of death just as surely as a disease like diabetes can.
So taking meds is number one, but it is not the only habit I must develop. Here are some others that are equally important:
Therapy — For some reason, I’m having a problem doing this often enough.
Eating properly — Research suggests that the Mediterranean diet is the best for bipolar.
Exercising regularly — I have a shirt my mom bought me that says “Exercise? I thought you said ‘Extra fries!'” That is my usual attitude towards exercising, but I know that regular exercise, outside when possible, is crucial.
Spiritual practices — This is one I have lacked for a long time, but I am beginning to realize (not for the first time!) that I have to depend on God to help me with the symptoms of bipolar, especially my bad temper.
Having a routine — Although I enjoy visiting my daughter and my mom, the break in my routine that results can be very disruptive to my mental health. I need to keep my routine as much as possible even when I am away.
Laughter and relaxation — Laughter can definitely be a powerful medicine! If I don’t practice relaxation, I develop excessive anxiety.
Of course, there are others, but at present, I will address these. Where does holism come in? Many of these issues overlap. For example, I can keep up with all of them better in the context of a routine. Prayer and meditation are spiritual practices that help me relax; yoga is a relaxing type of exercise. A healthy diet gives me the strength to exercise and to think rationally. These are not independent bits of my life that are related only because I am the one doing them. Rather, they are strands of activity that are woven together to create the fabric of my days
I shall go into each one in future posts and then revisit how they work together.
I just read a post on Colline’s Blog in which she discussed her word for 2017, discipline. This is her theme for the year. She described how the word discipline relates to her goals for the year.
The idea intrigued me, so I looked inside myself for a word that could be my theme for the year. I thought of spirituality at first, but I finally decided on “holistic.”
I tend to focus on just one area of my life at a time, a habit which is probably related to my bipolar disorder. In spite of medication, I still have episodes of depression, hypomania, and mixed states. During these times I may obsess over my physical health, compulsively work on my writing, or ruminate about my relationships, to the exclusion of everything else.
In 2017, I want to keep in mind the “big picture.” All areas of my life are important: spirituality, physical and emotional health, family and friends, relaxation and leisure, writing, housework and cooking. I often feel overwhelmed when I think about doing all that! But part of the overwhelm is that I think of it as doing everything at once and doing it perfectly. I will need to remind myself that I am human and that’s okay. Trying to be aware of my whole self may feel like herding kittens sometimes, but I think it’s worth a try!
In the last post, I mentioned the poisonous thoughts that arise when I try to ask other people for help. I’ve been thinking about this idea. Are there Deadly Elements (e.g. grenades) in my brain that can get triggered by my thoughts, feelings, or actions? If so, how can I find and destroy those pockets while simultaneously employing the baby steps concept?
It is quite possible that I have social phobia or social anxiety disorder. On the other hand, maybe I am shy in a way that is completely normal. Either way, the difficulty I have being around people gets in the way of my enjoyment and happiness. Many days I don’t step foot outside of the house, even to get the mail. I just let my roommate get it when she comes home. I sometimes walk to the grocery store or the pharmacy where I get my meds (I don’t drive). I smile and say hello if someone speaks to me, but I am terrified that they might want to converse, so I leave as soon as possible. I don’t look over my grocery bill because if there is a wrong price I will have to take the item back. I would never ask a store worker where to find something, and I get embarrassed when they say, “Can I help you find something?”
Many people with mental health issues tend to go to extremes with their emotions because they are unable to regulate them successfully. When I go to extremes, I add another problem on top of the one I’m already dealing with. It’s not just the situation itself, it’s also the fact that my extreme emotions are running the show.
I relate this to what happens in the body when something irritates it — a splinter, a “scratch” on the inside of an artery, a bacterium such as N. meningitidis (meningococcus). The irritating factor is bad enough, but what happens next can be worse, as the body’s inflammatory responses kick in. The use of immunosuppressants such as steroid to treat bacterial meningitis is counterintuitive, but it works, because inflammation is part of the problem.
Researchers have identified the mechanism by which valproic acid controls epileptic seizures, and by doing so, also revealed an underlying factor of seizures.
The drug protects the flow of potassium between neurons which is called the m current. During a seizure, the m current is inhibited, which allow the neurons to become too excitable. A seizure is the result.
Many people with bipolar disorder (including myself) also take valproic acid (divalproex/Depakote). The new mechanism explains how the drug helps with manic episodes, when neurons are hyperexcitable. But what about depression?
If manic episodes result from too little m current, perhaps depressive episodes occur due to too much m current. In that case, Depakote would work by limiting the m current.
This may sound contradictory, but if it is true, it is just one more example of homeostasis in the human body. Most conditions of the body — sleep, temperature, heart rate, growth of new cells, availability of nutrients such as protein — are best kept within a range of values that is generally the same for all people. One can have too much vitamin A or too little. Body temperature can be too low or too high.
Bipolar disorder results when the underlying factors (such as the m current) are not kept in balance, but swing wildly from one extreme to another. Drugs that adjust those underlying factors are potential treatments for bipolar.
WARNING: MAY CONTAIN TRIGGERS
I don’t know if I was ever completely serious about taking my own life. I know I wanted to hurt myself, though. And some of the things I did to hurt myself could have killed me, whether I intended that or not.
I felt so miserable at those times. No matter which way I looked I felt pain — unending, mind-crushing pain. There seemed to be no way out. I believed that I was a bad person, a complete failure, and that I had no business being on this planet making other people unhappy.
Bipolar disorder is a strong risk factor for suicide. The rate of suicide for the general public is about 1%. For those with bipolar, it is 15-17%. Suicide is the leading cause of premature death for bipolar patients. It is more likely if the person is undiagnosed or untreated. By “untreated” I mean “not taking medication.” The person may have the medication but refuse to take it. This is a very common problem for bipolar individuals — because they feel so good when they become hypomanic or even the early stages of mania, they don’t want to take a drug which will prevent both downswings and upswings.
I wonder how many people with bipolar take their meds as prescribed? Do you take them properly, or do you go with the temptation to skip them sometimes?
… or at least a part of me has taken up acting like a puffer fish. They are those poisonous little fish that can go from little to big in a matter of seconds, by taking in water and sometimes air. It’s amazing how different they look!
Some puffer fish have smooth skin, while others have spikes, like this one:
When a “porcupine” puffer feels threatened, she inflates to look as large as possible and to push out her spikes. There might be times when something unfamiliar approaches and she puffs just to be cautious. Or if she sees something that is the same shape as a predator, out come those spikes. It may not actually be a predator –and that is the crux of the problem.
My “predators” — I call them triggers — make me puff too. They can be anything that causes me shame. I cooked the chicken too long and it dried out. I wasted too much time doing puzzles. I binged on Goldfish crackers. I did something in the past that destroyed relationships with other people (I’m a certified bridge-burner). I forgot to do something. Anything
All of these cause me shame, but I pretend I don’t feel it until it gets brought to my attention by someone around me. Immediately I inflate and jab the person with my spikes — irritability, sarcasm, rage, and other unpleasantries.
I don’t enjoy being this way. Puffing my spikes takes a lot of emotional energy, and oh yeah, it can ruin relationships, too. My next task is to find a way to short-circuit the puffer fish part of me and use that energy to actually solve the problem.
This is a documentary about what happens when mental illness and police intersect. This is the “weapon” we need, to fight ignorance by means of information and education.
My personal psychiatrist spends most of his time in prison. He is a prison psychiatrist. He tells me that roughly 50% of the prison population have a pre-existing psychiatric diagnosis–and he gives me a sardonic smile as he says, “And the rest are undiagnosed.”
Whether or not you agree with that, I’m sure you will agree that beating, shooting, tasering, and incarcerating people who may simply be disoriented, delusional, hallucinating, or displaying side effects of anti-psychotic medicines such as stiff gait and slurred speech, is not only inappropriate and inhumane, but criminal.
If you agree with the message of this film, I urge you to go to the authors’ website and see how you can…