Sunday, August 21, 2022
Saturday, August 20, 2022
Monday, January 24, 2022
Take care and hope you have a great weekend!
Coping Skills for Bipolar Disorder
- Find a good doctor
- Become an expert
- Manage your illness
- mood charting - what it is and why it's helpful
- managing medications
- a healthy lifestyle helps recovery
- Plan for a crisis
- Find a community
- United States Support Organizations
- Online Support Groups and Newsgroups
- International Support Organizations
- Practical matters - work, school, and federal aid issues
- Other Resources - coping with mania, depression, and life with bipolar disorder
When we give lists of symptoms and medications for people with bipolar disorder, the entire thing can seem disarmingly simple. But anyone who has been there knows that there is nothing simple about accepting and living with a chronic illness, and it's just as important to address the emotional and practical issues of bipolar as it is to know the diagnostic criteria and treatment guidelines. Those with other chronic diseases like diabetes, cystic fibrosis, or multiple sclerosis go through a similar process of grieving, accepting, learning, and adapting - and through this, begin healing and recovery.
A helpful outline to guide a healing and recovery journey is described in the acronym TEAR:
T = to accept the reality of loss. There are things that will be different after a diagnosis of bipolar, and it's important to recognize these things rather than denying or hiding them.
E = experience the pain of the loss. You are allowed to grieve what you feel has been lost with the onset of this disease, both from your own life and the lives of others. You are allowed to mourn previous goals and aspirations that must be altered to this new reality.
A = adjust to the new environment without what was lost. Whatever was lost with your diagnosis doesn't constitute the whole of your person. The core of you is still the same, and knowing about your illness now allows you to re-adapt to this new context of life.
R = reinvest in the new reality. Explore, create, engage, and live as the person you are, managing your own life and your illness as part of that life.
Below are some articles and resources that we hope will help you in your own life.
Even if you already have your diagnosis, your doctor will be your ally and partner in treatment and recovery. It's important to have a doctor you can speak openly with, who will listen to you as an equal and acknowledge your expertise on your own body, who will offer helpful suggestions and be invested in your recovery. Below are some resources on what to look for in a good psychiatrist and/or health care provider, and how to find one in your area.
- The Patient-Doctor Relationship: The Good, The Bad, and the Ugly - signs of each kind of relationship, and advice from someone who has experience as a psychiatric health care consumer.
- Mental Health Professionals: Who They Are and How to Find One - article provided by NAMI.
- Contact your local NAMI chapter or another support group, and ask people in the area who has provided quality care for them in the past. Ask family members, friends, other doctors, and anyone else who has had personal experience who they recommend as health care providers.
- A Bipolar Specialist Referral Database - provided and maintained by the Harvard Bipolar Research Program
- The Best U.S. Psychiatrists for Mood Disorders - names and contact info compiled (and kept current) by Dr. Ivan Goldberg, a psychiatrist and clinical psychopharmacologist in private practice in New York City.
Putting a name to what used to be a vague collection of debilitating symptoms puts you in control. Knowing your disease as intimately as you can gives you the tools to manage it effectively, rather than it managing you. It can also make your situation seem much less frightening when you can understand and recognize what is happening in your own body. Here are some resources to get you started.
- What Is Mental Illness? - it is not a choice, a weakness, a failing, or a sign of immorality. It is a biological disease based in the brain. This information from the American Psychiatric Association gives an introductory look.
- Manic Depressive Disorders and Schizophrenia are Diseases of the Brain - an introduction to the evidence, with references.
- Guide to Depression and Bipolar Disorder (PDF) - an easy-to-read pamphlet provided by the Depression and Bipolar Support Alliance.
- Understanding Bipolar Disorder - a comprehensive, 24-page information booklet provided by NAMI.
- What Causes Mood Disorders? - a short, understandable explanation of the brain chemistry that underlies mood disorders.
- Excellent books - a list of essential reading about bipolar disorder and mental illness [coming soon].
One of the best coping strategies, suggested by professionals and patients alike, is using a mood chart to track your own episodes and symptoms. A mood chart can be a preventative tool to help identify early warning signs for relapse, a record for physicians and family to help assess the efficacy of different medications and treatments, and a therapeutic tool to organize a person's daily routine and improve awareness of the illness.
The simplest method of mood charting is rating your mood (at the same time each day) on a scale of 1-10, with one being very depressed and ten being absolutely elated. A good place to keep a record is on a wall calendar or in a daily diary. Other methods involve more elaborate charts, and a more detailed rating scale (see the links below). Some people work better with graphs, others with numbers, others with writing lists of words or paragraphs to describe their feelings. The overall goal of the charts is to have a reliable and consistent record of how greatly your moods flucuate over a period of time, so develop the method that is easiest for you to achieve this goal.
- Mood charting resources:
- Mood Charting for Children - the Child & Adolescent Bipolar Foundation provides examples and resources for charting your child's moods, and eventually helping him/her to track it themselves.
Another excellent coping strategy is learning how to manage your medications effectively. The first thing to do is know about what you are taking - ask your psychiatrist what symptoms your medication is treating, how long it might take to work, how much and how often you should take it, what you should do if you miss a dose, what side effects you might have and what you can do about them, and anything else that is on your mind. Keep track of your own medication information - names, dosages, how it makes you feel, what symptoms it makes better or worse - in a journal or diary. Having this information will help both you and your doctor find the medication regimen that works the best for you, and allow you to adjust it effectively as needed.
It can be an extremely frustrating trial-and-error process to finally find a medication that works for you. Please be patient and give the medications adequate time to do their job. Most people won't feel better right away - it can take four to six weeks for a drug to get into your system and start noticeably helping. In the meantime, you can help yourself by trying some of the suggestions on this page, or finding a support group to help you through difficult times. By all means work with your psychiatrist to switch medications if you are unhappy with your current one; however, try to be realistic about what medications can and can't do, and consider the relative benefits of staying on one versus trying to adjust to a brand-new one.
Simplify your medications as much as possible by putting them in separated daily pill boxes (you can purchase pill organizers with seven separate compartments, one for each day of the week), taking them at the same time each day, or taking them with a daily vitamin pill or something else that you do religiously. If you have a lot of trouble remembering, ask family members/roommates to help, or ask your doctor about the possibility of switching to long-acting injectable medications instead of pills.
Help your medication do their job by keeping healthy habits in your daily life.
- A reliable sleep routine is especially important for people with mood disorders - research shows that not getting enough sleep can bring on a manic episode.
- Making sure you get all your daily nutrients and vitamins - especially omega-3 fatty acids, which have been shown to help relieve the symptoms of psychiatric disorders - will keep you feeling better and more stable.
- Daily exercise will help your mood during a depression, will add structure to your day to help avoid mania, and will keep you looking and feeling better and healthier.
- More resources:
- Download Healthy Lifestyles (pdf file) - a brochure provided by the National Depressive and Manic-Depressive Association
- Bipolar Disorder Self Care - information on eating/sleeping/exercise habits, getting adequate nutrition, reducing stress, and avoiding relapse
- A Healthy Lifestyle Approach - tips and info from the Organization for Bipolar Affective Disorders Society (Canada)
Your mood charts (see above) will help you recognize what particular symptoms or behaviors tend to precede a manic or a depressive episode. Having a plan ready for relapse situations will help you get the care you need, and make sure other practical matters are taken care of, even if you are in a place where you can't effectively make decisions. One of the most difficult aspects of bipolar to deal with is the seductiveness of mania - many people don't seek help during a manic episode because they are feeling on top of the world. However, even though they can't recognize it, they still present a danger to themselves or others via reckless acts, excessive spending, uncontrollable behavior, etc.
You can take some precautionary steps while you are stable to help get through a crisis situation as smoothly as possible. Put the following information (along with anything else that might be helpful) into a "crisis plan" folder, and distribute it to your doctor, your family members, and other trusted people who can help you.
- Make a list of people you trust (close family members, friends in the area, etc) who know about your disease and are willing to help you. Have their names and phone numbers together on a "crisis alert list"
- List the names and contact info of your psychiatrist, general practitioner, case worker, or any other professional that helps you manage your illness.
- Write out the particular signs that indicate a manic or a depressive episode, to help others recognize when you need help. (See some of the early warning signs compiled by bipolarsurvivor.com to use as a guide in making your list).
- Make another list of all your medications, what dose you take, and what side effects you experience. Note any medications you are allergic to or do not want to take under whatever circumstances.
- Leave directions for the care of your house, your pets, your plants, etc., in case you are hospitalized.
- Write down your insurance plan information
- Leave the names and numbers of family members and/or employers that need to be contacted in case of an emergency or an extended hospital stay.
- Leave any detailed instructions of what kind of care you do and do not want to recieve if you are unable to make your own decisions (the legal document for this is called a psychiatric advanced directive).
Having a supportive community is important for anyone, but particularly for someone dealing with a chronic illness. A support group of friends and peers can relate to what you go through like no one else can, offer support or a sympathetic ear, and give practical advice and solutions for difficulties as they come up. For the times when you are not feeling particularly social, an online discussion group or chatroom is a great option to keep yourself connected with others.
- Depression and Bipolar Support Alliance - a comprehensive website w/ information, resources, advocacy materials, and a database of local chapters
- National Alliance for the Mentally Ill - free education programs and support groups in every state for patients and family members
- Children and Adolescent Bipolar Foundation - a comprehensive database with support orgs/chapters for every U.S. state. Also has online chatrooms and discussion boards
- Locate Regional Mental Health Services and Support Groups with a national database provided by the Substance Abuse and Mental Health Services Administration
- Manic Depression Fellowship - U.K. based support and services organization
- International Society for Bipolar Disorders - requires a membership fee to join, but has some info available for free as well
- Mood Disorders Associaton of Manitoba, Canada
- Balance: New Zealand Manic Depressive Network
- Dutch Association for Manic-Depressives (Netherlands) - site in Dutch only
- Fundacion de Bipolares de Argentina (FUBIPA) - Spanish support organization and website w/ thirteen regional groups in Argentina
- German Society for Bipolar Disorder - site in German only
- How does a mental illness affect the way I function at school?
- Documenting your disability for an educational institution - recieve the resources and support you are entitled to
- Disclosing your Disability to an Employer - this is a personal choice and NOT required by law. This article outlines the pros and cons of both options.
- Handling your Psychiatric Disability at Work and School - lots of articles and links from the Center for Psychiatric Rehabilitation in Boston.
- What is Supplemental Security Income (SSI)?
- FAQs, advices, and articles about disability benefits - lots of information for most every situation.
- Dealing Effectively with Manic-Depression (pdf) - an excellent pamphlet for patients from the Depression and Bipolar Support Alliance.
- How to avoid a manic episode
- 10 things to remember when you are manic
- 10 things to remember when you are depressed
- Should I take therapy or pills? - thoughts from someone with manic-depression
- Ideas for coping - advice from someone with manic-depression
- Myths about mental illness - good things for anyone to know, and occasionally remind themselves of.
My Coping Strategies:
4a. ExerciseCorrecting faulty thoughts patterns
Saturday, January 22, 2022
(These series 6 messages on "Depression and the Christian" are also available on .pdf, .mp3 and video formats which can be downloaded from the website of Sermon Audio )
DEPRESSION AND THE CHRISTIAN
BY DR. DAVID P MURRAY
(1) THE CRISIS
Perhaps you clicked on the link to this video out of desperation. Perhaps, like many Christians, you are secretly suffering with a mental illness – maybe depression, or maybe panic attacks – and you have tried many remedies but are growing no better, only worse. Or perhaps someone in your family is suffering in this way and you just don’t know how to respond or help. Or, maybe, you are a pastor who feels helpless when confronted with mental illness among the sheep of his flock.
Whatever your reason for clicking, I hope you will find something in this series of addresses which will either help you in your suffering, or which will help you in ministering to the suffering.
In this introductory address we shall consider the question, “Why study depression?” In the second, we will ask “How should we study depression?” Thirdly, we will look at “What is depression?”. And, in subsequent addresses we will begin to look in detail at the different approaches to helping people with depression. We will look at what the sufferer can do, what the carers can do, and what the Church can do.
Before we go on, perhaps you are asking yourself what qualifies me to speak on this subject. That is a valid question, which I will answer in four ways.
Firstly, let me make clear that I am not a medical doctor. I have, however, checked all the contents of these addresses with an experienced medical doctor who has first-hand experience in treating many patients with mental illness.
Secondly, I have been a pastor for 11 years in the North West of Scotland, both in Wester Ross and the Outer Hebrides, areas with some of the highest rates of mental illness in the world. While I do not consider myself to be an expert, I have had multiple contacts with people who suffer from mental illnesses. This also means that my motivation in making these videos, and my methodology in producing them, is not academic but is highly practical. I desperately want to help sufferers and those who minister to them.
Thirdly, I have had close and painful experience of depression, anxiety and panic attacks among friends and some of those I love most in this world.
Fourthly, I believe that God has given me a burden to speak on this subject, a burden which I cannot ignore any longer. And, I trust, with the God-given burden will come the God-given wisdom to speak in such a way that will minister to God’s suffering people.
WHY STUDY DEPRESSION?
Mental illness is a term that covers a large number of complex conditions. So, before we proceed any further, I would like to state what aspects of mental illness I am going to focus on in this series of addresses. The area I am particularly concerned with is the most common mental illness – depression. As anxiety and panic attacks are also very commonly associated with depression (so much so that doctors are increasingly using the term “depression-anxiety” when referring to depression), we will look at these distressing conditions also.
But firstly, why should we study this subject, depression? Here are eight reasons. 1. Because the Bible speaks about it
There are numerous Bible verses which refer to depression and severe anxiety – its causes, its consequences, and its cures. The Bible does not address every cause, every consequence or provide every cure. But, as we shall see in later addresses, it does have an important role to play in the treatment of Christians who are suffering from depression and anxiety.
It must be admitted that the Bible never states that “Bible Character X had mental illness,” or “Bible Character Y was depressed.” However, it does frequently describe men and women who manifested many of the symptoms of depression and anxiety. In some cases, it is not clear whether these symptoms reflect long-term mental illness or simply a temporary dip in the person’s mental health, which everyone goes through from time to time. For example, symptoms of depression/anxiety can be seen in Moses (Num.11:14), Hannah (1 Sam.1:7,16), and Jeremiah (Jer.20:14-18; Lam.3:1-6). In these cases it is difficult to say whether the symptoms reflect a depression or a dip. Martin Lloyd-Jones argues from biblical evidence that Timothy suffered from near-paralysing anxiety. A more persuasive case for depressive illness can be made for Elijah (1 Kings 17:7-24), Job (Job.6:2-3, 14, 7:11), and various Psalmists (Ps.42:1-3, 9a; Ps.88).
“The Psalms treat depression more realistically than many of today's popular books on Christianity and psychology. David and other psalmists often found themselves deeply depressed for various reasons. They did not, however, apologize for what they were feeling, nor did they confess it as sin. It was a legitimate part of their relationship with God. They interacted with Him through the context of their depression.”
Another significant verse is Proverbs 18:14, “The spirit of a man will sustain his infirmity; but a wounded spirit who can bear?” The human spirit can help people through all kinds of sickness. However, when the healing mechanism is what needs healing, then even more serious problems arise.
2. Because it is so common
1 in 5 people experience depression, and 1 in 10 experience a panic attack, at one stage in their lives. An estimated 121 million people suffer from depression. 5.8 % of men and 9.5% of women will experience a depressive episode in any given year. Suicide, often the end result of depression, is the leading cause of violent deaths worldwide, accounting for 49.1% of all violent deaths compared with 18.6% in war and 31.3% by homicide.
It is also common in Christians. Indeed, these days there would appear to be an epidemic of depression, anxiety, and panic attacks among Christians – both young and old. This is at least partly because of the depressing state of the Church and of the Nation. Every few days there is discouraging news about Church splits or problems, and Christians backsliding or falling into temptation. Then there is the secular and anti-Christian direction of the Government as it continues to dismantle the Judeo-Christian laws and standards that our civilisation was built upon, and as it attacks and undermines family life. On top of this, there is the relentless audio-visual misrepresentation and persecution of Christians through the print and broadcast media. To top it all there seems to be an unceasing diet of bad news on the international stage, with wars, terrorism, and “natural” disasters ever before us.
In these conditions, it is therefore little wonder that Christians react adversely, and get depressed and anxious about themselves, their families, their Church, and the world they live in.
3. Because it impacts our spiritual life
We might say that there are three main elements in our make-up that affect our overall well-being: our body, our soul, and our mind (our thoughts). These are not three watertight and disconnected entities. There is considerable overlap and connectivity. When our body breaks down, it affects our spiritual life and our thinking processes. When our spiritual life is in poor condition, our thoughts are affected, and often our bodily health and functions also. It is therefore no surprise that when our mental health is poor, when our thinking processes go awry, that there are detrimental physical and spiritual consequences.
The depressed believer cannot concentrate to read or pray. He doesn’t want to meet people and so may avoid church and fellowships. He often feels God has abandoned him.
Moreover, it is often the case that faith, instead of being a help, can actually cause extra problems in dealing with depression. There is, for instance, the false guilt associated with the false conclusion, “Real Christians don’t get depressed.” There is also the usually mistaken tendency to locate the cause of mental illness in our spiritual life, our relationship with God, which also increases false guilt and feelings of worthlessness.
4. Because it may be prevented or mitigated
Many people have a genetic pre-disposition to depression, perhaps traceable to their parents’ genes, which increases the likelihood of suffering it themselves. However, even in these cases, knowledge of some of the other factors which may be involved in causing depression can sometimes help prevent it, or at least mitigate and shorten it. Others, with no genetic pre-disposition to depression can also fall into it, often as a reaction to traumatic life-events. And, again, having some knowledge of mental health strategies and techniques can be especially useful in preventing or mitigating and shortening the illness.
One great benefit of having some knowledge about depression is that it will prevent the dangerous and damaging misunderstanding which often leads people, especially Christians, to view medication as a rejection of God and His grace, rather than a provision of God and His grace.
5. Because it will open doors of usefulness
Increased understanding of depression will make us more sympathetic and useful to people suffering from it. This is taught by the converse truth in Proverbs 25:20, “As he that taketh away a garment in cold weather, and as vinegar upon nitre, so is he that singeth songs to an heavy heart.” If we saw someone fighting for life in the midst of a freezing blizzard, the last thing we would do is take his coat away. Such an action would be cruel and heartless, and could easily lead to death. But, says the Bible, similar dangerous heartlessness is displayed by the person who tries to help their depressed friend with superficial humor and insensitive exhortations to “Cheer up!”
In later videos we shall look in more detail at what friends and carers should say and do for those suffering with depression and anxiety. However, the general rule is that those who listen most and speak least will be the most useful to sufferers.
6. Because it is so misunderstood
“Being depressed is bad enough in itself, but being a depressed Christian is worse. And being a depressed Christian in a church full of people who do not understand depression is like a little taste of hell.”
As we all know there is a terrible stigma attached to mental illness. This is the result of widespread misunderstanding about its causes, its symptoms, and the “cures” available. Some of the misunderstanding is understandable. Unlike cancer or heart disease or arthritis, there is no scan or test which can visibly demonstrate the existence of depression/anxiety. It is a largely “invisible” disease. We want to be able to point to something and say, “There’s the problem!” When we can’t, we often wrongly conclude, “There is no problem!” Or, if we are Christians, we may, usually wrongly, conclude, “My spiritual life is the problem!”
This misunderstanding is addressed in the excellent book, I’m not supposed to feel like this (a book written by a Christian pastor, a Christian psychiatrist, and a Christian lecturer in psychiatry). Near the beginning of the book, they summarise what they believe and what they do not believe about depression:
“What we believe: We believe that all Christians can experience worry, fear, upset and depression. We also believe that being a Christian does not prevent us or our loved ones from experiencing upsetting and challenging problems such as illness, unemployment, or relationship and other practical difficulties.
What we do not believe; Although at times we all choose to act in ways that are wrong and this can lead to bad consequences for us and for others, we do not see anxiety and depression as always being the result of sin; neither do we
believe that mental health problems are the result of a lack of faith.”
It is absolutely vital for Christians to understand and accept that while mental illness usually has serious consequences for our spiritual life, mental illness is rarely caused by problems in our spiritual life.
7. Because it is a talent to be invested for God
Like all affliction in the lives of Christians, mental illness should be viewed as a “talent” (Matt.25:14ff) which can be invested in such a way that it brings benefit to us and others, as well as glory to God.
Dr James Dobson, the Christian psychologist, observed that “nothing is wasted in God’s economy.” That “nothing” includes mental illness.
Mind over Mood, while not written from a Christian perspective, illustrates the possible “benefits” of depression thus:
“An oyster creates a pearl out of a grain of sand. The grain of sand is an irritant to the oyster. In response to the discomfort, the oyster creates a smooth, protective coating that encases the sand and provides relief. The result is a beautiful pearl. For an oyster, an irritant becomes the seed for something new. Similarly, Mind Over Mood will help you develop something valuable from your current discomfort. The skills taught in this book will help you feel better and will continue to have value in your life long after your original problems are gone.”
It is usually broken people that God uses most. In Passion and Purity, Elisabeth Elliot
quoted Ruth Stull of Peru:
“If my life is broken when given to Jesus it is because pieces will feed a multitude, while a loaf will satisfy only a little lad.”
8. Because we can all improve our mental health
Most Christians try to take preventative (and curative) measures to enjoy good physical health and spiritual life. However, there is less consciousness of the similar effort required to maintain or recover mental health. There is much less awareness of the biblical strategies and sound mental techniques that can be used to achieve good mental health, which obviously has beneficial consequences for our bodies and our souls.
I have never been diagnosed with any kind of mental illness. However, like most people, and especially like most ministers, I have had low points in my life. My thinking processes have gone wrong, causing times of mild depression, and anxiety.
What I now know about improving and maintaining mental health, and what I hope to communicate in later addresses, would have greatly helped me in these low periods. What I have learned is helping me on a daily basis to overcome disappointment and handle stressful situations without my mental health suffering as much as before.
As I look around me, and especially as I look around the Church, I can see many people who have not been diagnosed with depression, and who are not disabled with it, but who are experiencing long-term, low-level depression/anxiety which is having its own knock-on effect on their bodily health and the spiritual lives.
I believe that it would not be too difficult for them to learn some sound strategies and techniques which will improve mental health, and consequently their bodily and spiritual health.
In the next video we will consider the attitude and spirit in which we should study depression.
Dr. David P Murray served as the Pastor of Lochcarron Free Church of Scotland from 1995 to 2000, and then of Stornoway Free Church of Scotland (continuing) from 2000 to 2007. In August 2007 he accepted a call to be the Professor of Old Testament and Practical Theology at Puritan Reformed Theological Seminary in Grand Rapids, Michigan.
 M Lloyd-Jones, Spiritual Depression, (London: Pickering & Inglis, 1965), 93ff.
 S & R Bloem, Broken Minds (Grand Rapids: Kregel, 2005), 204.
 J Lockley, A Practical Workbook for the Depressed Christian (Bucks: Authentic Media, 1991), 14.
 C Williams, P Richards, I Whitton, I’m not supposed to feel like this, (London: Hodder & Stoughton, 2002), 10.
 D Greenberger & C Padesky, Mind over Mood, (New York: Guilford, 1995), 1.
 E Elliot, Passion and Purity, Power Books (Old Tappan, NJ.: Revell, 1984).
All 6 articles on Depression and the Christian:My Coping Strategies:
4a. ExerciseCorrecting faulty thoughts patterns