One of the considerations that goes hand in hand with a diagnosis of bipolar disorder is the knowledge that it will be something one lives with for life. That can be a frightening prospect for a person with this illness and their friends and family. Diagnosis can often be traumatic and the pronouncement itself can be devastating, akin to being told to put one’s house in order and prepare to die. There is very often a social death that accompanies mental illness, with friends and family simply not wanting any part of it for whatever reason. Often the inadequacies of our approach to mental health in the UK means that simply obtaining the correct diagnosis itself can be a struggle of gargantuan proportions. It is not uncommon for bipolar disorder to be misdiagnosed as attention deficit hyperactivity disorder (ADHD) or as depression. This combined with the fact that once a correct diagnosis is received, there are several strains of the illness in question means that the prospect of a life lived as a mentally ill person can make for an extremely intimidating prospect. Beyond that, and let us be frank here, the label ‘mentally ill’ is likely to induce derision, laughter and hostility in many circles. How does one start to live a life that is fulfilled yet mindful of the illness and structured in such a way as to accommodate it? It is important to remember that, as is so often the case with a great many different conditions, there is no silver bullet. What works for one person will not work for another and the process of discovering what sort of lifestyle will help a person live with their illness is time consuming, emotionally painful and very often simply a matter of trial and error. As the saying goes, if you wish to learn to swim then you must jump in to the water.
I have developed my own way of living that has allowed me to live a productive and fulfilled life and I consider myself very fortunate to have not only the opportunity to do so, but also to have the understanding of my partner. I believe it is important to have a holistic approach to life with bipolar disorder. I do not mean the use of holistic medicine, rather that the changes in certain areas of life must be made with the goal of achieving happiness and fulfilment as a whole. Without a plan sufferers will often muddle through one episode to the next whereas planning and thought will go a long way to minimising the disruptive effect of bipolar disorder. I stress that it is important only to use medicine that has been prescribed by a trained mental health professional. Reliance on so-called holistic therapies, new age medicine, homeopathy and suchlike is a recipe for disaster. In this post I have decided to give you my recommendations for managing a fulfilled and happy life as someone with a diagnosis of bipolar disorder. I refer to this as therapeutic living. This is not a medical treatment and I am not a physician of any kind. If you are someone with bipolar disorder or you know someone who is and they are suffering in any way symptoms that are either undiagnosed or which represent an imminent danger to their person, lives or loved ones then you must seek out medical attention immediately, particularity if there is any suggestion of suicidal thinking or planning (also known as suicidal ideation). What I have decided to discuss here today is how a person with bipolar disorder might go about the everyday task of living a happy, fulfilled and productive life.
If you have family or friends in whom you have confided concerning your illness then it is very often a good idea to let them know that you are planning lifestyle adjustments in order to better deal with life. I am not suggesting that you ought to ask permission to do this, rather that they be made aware so that they can conduct themselves accordingly if necessary. For example, if you have decided to stop drinking then they will want to know so that they do not put you in the difficult position of being offered alcohol.
It is also important to decide ahead of time the things you would like to achieve, for example better awareness of moods or better strategies for when moods change. Once you decide what you like to achieve from a lifestyle point of view you can begin to measure the progress and effectiveness of the actions you have taken. Measuring outcomes is very important as it is the only way to determine the effectiveness of what you are doing. In addition to this it is also of critical importance to have an action plan in case there should ever be a point where emergency treatment and hospitalisation in necessary. The fewer things that are left to chance, the better the outcomes are likely to be.
Self-medication is something that many mentally ill people do regularly. It is generally the habit of using alcohol or drugs to deal with symptoms. You might say it is the act of dulling the pain of life. This can be a very dangerous thing to do. Not only are these substances bad for human health, this in itself a reason not to do it, but also the outcomes of self-medication can often be extremely unpredictable. If a physician prescribes medication then he or she does so anticipating positive outcomes and will closely measure and monitor those outcomes in order to ensure that the correct medication is being administered at the correct dosage and that adverse side effects can be minimised. This is not so with self-medication. Very often a person self-medicating will do so until in a stupor. It is not hard to see why this is extraordinarily dangerous with overdose or alcohol poisoning being a real possibility. It is also the case that a drug dealer, alcohol retailer or pub landlord is not giving you the medication with your best interests in mind. They care about profit and your health is of no concern to them. After spending a few years medicating myself without understanding that that is what I was doing I have opted for the discipline of teetotalism. I recommend that to all, not just the mentally ill, but remember this is about a regime that is right for you, not me. I personally do not see any good arising as a result of alcohol or drug use. There is also the worry that drugs and alcohol could make symptoms worse, sending a manic person into greater, more challenging symptoms, or, even worse, tipping a depressed person into a suicidal mood.
I could not, nor would I ever endorse the use of illegal substances, however if you are able to drink alcohol safely without the risk of engaging in self-medication then good for you. I am of the opinion that a person with bipolar disorder ought to examine his or her relationship with alcohol very carefully. It may be difficult to stay teetotal, however in my experience the boundary between responsible drinking use and alcohol based self-harm is very much closer than we think.
Exercise is recommended by many health professionals for the mentally ill, and with good reason. It is intrinsically good for a person to keep fit, no matter what their personal circumstances. It keeps blood pressure low, lengthens lifespan and strenuous exercise releases endorphins, the human ‘feel good’ chemicals in the brain. I am a keen cyclist, walker and swimmer. I run too, albeit less often. I generally tend to hammer my exercise routine as hard as I can. I work very hard in the swimming pool, I walk the school run whenever possible and when I need to commute I use my bicycle unless the weather is poor or the distance is prohibitive.
Aside from the health benefits I have outlined above, simply being outdoors and experiencing different scenery has its benefits. In my profession I am self employed and I work from home. The effect on my mood of sitting down all day at a computer screen without much stimulation can be very poor and exercise mitigates the effect it has upon me.
Managing one’s emotions is a real challenge for someone with a mood disorder and often severe cases require professional intervention. I stress again that whatever I am saying is not medical advice, nor should it ever replace whatever prescribed medication or treatment you receive and rely upon for wellness.
Managing moods is something that, in my experience, has several components. These include prevention through the identification and avoidance of triggers, recognising an abnormal mood and acting upon it, and dealing with the fallout from mood changes.
The word trigger is what I use to describe things that can have an adverse effect on an otherwise normal mood. It therefore follows that a trigger can only happen to somebody who is in the state of normal mood range. This state is known as euthymia. Obviously one is subject to normal mood swings whilst euthymic but not the extremes of mental illness. One of my worst periods of mental illness came when my mother passed away, very suddenly. The process of admittance to hospital with flu-like symptoms to death lasted less than twelve hours. You can imagine the emotional shock and trauma involved. For anyone, healthy or not, these times are the worst and most emotionally bruising experiences we will ever have. It is not unusual, even years later, to experience a song, smell or any number of stimuli that can be a reminder of darker times. Of course, anyone who has been bereaved will know that this is inevitable and over time black gives way to blue. The danger for those who suffer mental issues is that for us such stimuli can often be much more than a reminder. It can be the emotional trigger for a breakdown. The key to dealing with this is a threefold plan. Watch, record and look for patterns. Diligence and watchfulness can often result in a better understanding of what causes a particular state of mind and when triggers are identified they can be either prepared for or avoided.
How does a person recognise an abnormal mood state when they are immersed in it? Mania in particular is difficult to identify due to the fact that it is so easy and extremely desirable to be swept along with the waves of euphoria. It matters too because early intervention can prevent damage being done to persons or relationships. Here is where friends and family can help. They can, as an outsider, use their contrasting perspectives to identify mania. Depression can be a lot harder to spot. So many people smile their way through life whilst dying on the inside. That is why relationships are very important to maintain. Intimate knowledge of a person can allow close friends to spot subtle signs that all is not well.
It can be very difficult to emotionally detach oneself from the consequences of mental illness, especially as a friend or family member to a sufferer. They can often behave in ways that make others want to give up on them, or simply to avoid the drama. Obviously if steps one and two are adhered to then this step becomes less of a worry. It is very rare for a mentally ill person to look back at actions they took whilst in the grip of an episode and not feel bitter regret, yet at the same time we can feel very angry because we could not help it. All I can do here is appeal to those who live alongside a sufferer to be thick skinned and patient.
Monitoring and Self Expression
There is a lot to be said for keeping a mood diary or expressing oneself through some form of art, writing, music or similar pastime. The emergence of outsider art, a form that is often the work of those who simply cannot live without assistance and constant medical attention is well worth taking the time to investigate. Many people with mental illness use creative outlets to handle the highs and lows they experience and once a body of work is built up it can often be very revealing to look back and explore the moods expressed through whatever medium one might choose. This can often be a path to better understanding oneself and one’s illness.
Figuring Things Out
Ultimately the approach a person takes to their illness will be theirs and theirs alone. There will be a lot of trial and error and, inevitably, laughter and tears along the way. What is most important is that you work out the best thing for you. It is your head and you must live in it. Figure things out for yourself. That is the only real freedom any of us has anyway, and many of us neglect that. It is often easy to feel manipulated and controlled by those around you and I learned for myself that self-determination is very important and extremely liberating. Take ownership of your life and do not let anybody push you around. Being mentally ill makes you no less of a person than anyone else and you have as much right to live a life free from the malevolent influence of controlling or abusive people, and bullies. In my experience, though it can be emotionally difficult, getting rid of people who do you no good is very important. Life surrounded by positive people whose attitudes are healthy and who are not heavy-handed in their dealings with you is rewarding and the resulting quality of life is well worth the effort.