Tuesday, September 2, 2008

Spectrum of various Experiences, Treatment and Coping Means helpful for Bipolar Disorder (manic-depressive illness)

In my first Mission 4 Monday post yesterday, I republished an excerpt "Trust during rough times" from my friend, Marja's book "A Firm Place to Stand."

I am thankful to my friends who took time to stop by, read my post and share your thoughts. One of my readers, Rob, wrote a comment which I would like to share in this post. Rob has bipolar disorder. Thankfully his condition is stable and he is able to go off medication now.

Bipolar Disorder or previously known as manic-depressive illness is a mood disorder with extreme mood swings ie. manic/hypomanic and depression.

Rob wrote on 2nd September 2008,

Hi Nancie,

Let me share a very weird, but also very interesting and I hope illuminating experience I had recently. In a way, although I am not a believer (nor a 100% complete disbeliever), this anecdote will, I hope, be interesting to you and your regular readers, and will be supportive of your theme today.

It has now been almost 2 years since I began reducing lithium, and more than a year and a half since I stopped it completely. I'm proud that I am totally drug-free for the first time in my adult life, but I am also very aware that my good fortune could end at any time. Anyway, I had a physical exam (after more than 2 years), and then a week or so later, I had a visit to my psychiatrist, for the very first time since stopping all drugs. I really like my psychiatrist, and I do not fault him on any decision he (and I) made over the years. I went there hoping to perhaps thank him for his efforts, and to show him that I'd had a clean physical checkup and was feeling "great" (no, not *that* great :-)). My family doctor sent my report to my psychiatrist. I like the fact that they work closely together, and they share information about me. All the minor complaints I'd had seemed to have pretty much disappeared, though there is much more than just a lack of lithium to credit for that.
My family doctor is cynical about psychiatry, and has always wondered why I was clinging to lithium, in spite of all my minor physical complaints, that seemed to just be getting worse as I aged.

Anyway, I entered my psychiatrist's interview room (after waiting one hour). I felt a bit sorry for him because he is now aged 72, and has not retired yet. I wanted to say something to the effect of "thanks for your efforts over the years". He first apologized for making me wait, and I said "oh it's nothing" or something like that. Then, to my total surprise, he acted like no other time in my entire 30 year history with him. Rather than having our usual calm, peaceful, friendly discussion, with him saying not too much, but encouraging me to speak my mind, it was the TOTAL OPPOSITE! I didn't know what to make of it. He was acting extremely hypomanic, while I was trying to stick to my agenda, of asking a few practical tips regarding sleeping, new drugs I might possibly take, etc. in the future etc. He wouldn't shut up. Even when he opened the door of the office to show me out (after 15 minutes), he kept talking and talking, even with other people listening! He made no mention of lithium, and no mention of when I might see him again. I finally managed to squeeze in "I guess I might pop in to see you again in a year or so", to which he didn't answer. He kept on talking about trivial stuff like tennis hurting knee joints or some such nonsense. He was also suggesting that "Oh, I guess you know everything now, and don't need your family doctor or me", to which I replied, "no, not at all". My wife was in the waiting room, and I said he could talk to her if he wanted, but he said he wasn't interested. Finally my wife and I left, both of us scratching our heads...

I later thought, Oh, I get it. He was just doing his job as my doctor. He's not really my friend. He was pulling out all the stops to try to destabilize me and "prove" that I was actually manic, and he was obviously failing to do so, so the end result was to make me somewhat more confident. Good. I feel better... But, I don't completely accept that theory either. A more cynical theory would say:
1. He is worried about a malpractice lawsuit
2. He is going to lose income without me
3. He is embarassed that he finally "lost" the argument with my family doctor
4. He worries that he might retire "in shame" at having kept someone on drugs needlessly, for almost their entire adult life
5. Just before seeing me, I think he took someone else who seemed to be in bad condition, and perhaps that rattled his nerves (I think he may have actually bumped me, in favor of that other person, who my wife later told me, looked quite sick.
6. I partly went to him because I tried to get a prescription for Stelazine filled (as a safety precaution) and it got held up at the pharmacy, because he happened to be on vacation. I then checked if my family doctor could fix that for me. I also then took some Stelazine, with my wife's knowledge, because I'd had some poor sleep recently, and I wanted to verify if I could count on Stelazine to fix that (minor) sleeping issue that had dragged on for a few days, for various reasons
7. Who knows what? Your guess is as good as mine. It just doesn't completely make sense. I still like the guy, but I wanted to share this with other sufferers of mental disorders.

By the way, I'm beginning to seriously believe that peaceful meditation actually works better for me than Stelazine, and has *zero side-effects!*

This is something you might want to consider (briefly), when you decide where to put your "faith".

Thanks for listening -- a slightly puzzled, but still doing OK Rob

I am thankful to Rob for writing in to share his experiences and thoughts with me and my readers. I am thankful that Rob makes time to come by every now and then, and I greatly value his friendship.

As I do have my own personal experiences and opinions pertaining to what Rob has shared, I have decided to write a separate post in answer to Rob. So here's my response to Rob:

Hi Rob,

Thank you for your 2 comments! I delayed in publishing your first comment because I needed time to digest what you wrote and also to think of an appropriate response :-) Thanks for writing again. I have decided to publish your first comment here as a separate post so that I can response and share my personal experiences and opinions too.

Your recent experience with your psychiatrist is truly rather weird :-) I am thankful that you are able to be medicine free and I hope you continue to stay stable!

In my personal opinion, I think there is actually a rather wide spectrum of experiences for those who suffer from bipolar disorder and therefore a wide spectrum of wellness or coping means that suits different individuals.

In my own personal experiences, I have found that Finding a Good Doctor/Psychiatrist is very crucial for me. I am thankful that God has provided a very good and helpful psychiatrist for me. I am newly diagnosed with bipolar disorder last March and still very new on the journey of understanding and managing bipolar disorder. My Doctor's help has been invaluable in my recovery journey!

I have come across several very different experiences among my fellow bloggers.

I know of people who are being helped my medication just like myself. Our mood-stabilisers helped to stabilise our moods in longer run. Some of us are on anti-psychotic medications which helps to manage our manic/hypomanic and sometimes we need anti-depressants to lift us up to a functional level when we have a relapse of depression. So medication does help some of us to be more functional. It would be wonderful to be so stable and functional one day that some of us can be off medication eventually! But that is a case by case basis.

Some of us may have to be on life-long maintenance medication for the sake of stabilising our mood. Medication however is only a part of our treatment and recovery plan. Medicine helps to lift us up to a functional level when we are depressed or helps to calm us down to a functional level when we are too manic, but we also needs to live a balance lifestyle that will contribute to our mental stability and physical as well as spiritual well-being. We need to know what may trigger off relapses, how to recognize early symptoms and what we can do to get better or prevent our conditions from deteriorating. Depending on our makeup and our bipolar condition, what works for us may differ one from another.

I have also known of others who are medicine resistant and who suffer more side effects than benefits from their medications. These have suffered much throughout the years due to unsuitable medications. Some have found help now through alternative medicine or therapy. There are some who have learned to manage their condition so well that they do not need medication at all. Perhaps their condition are also milder than some others. I also have some friends who benefited from ECT treatments when nothing else is helpful and their sufferings were relentless. Thank God for providing something that helps these friends. But again ECT may not be suitable for everyone. I think it is a case by case basis. It may take time to find out our own conditions and what is best to help us maintain stability and enable us to be functional and of maximum benefit to our family and society.

I have shared about some of My Coping Strategies in my previous posts. Personally, I benefitted from Medical Help and Medications. Anti-depressant medication helps to lift me up to a functional level when I am depressed and anti-psychotic medication helps to calm me down to a functional level when I am too manic/hypomanic.

I am learning to use Mood Diary to track my moods and learn to recognize early symptoms of possible relapses or impending relapses or worsening symptoms. I work closely with my psychiatrist on how best to troubleshoot and manage my condition. I hope to share more about this in future post.

I have found that getting enough sleep and sleeping at regular hours is very crucial. Insufficient sleep can cause my relapses or may be symptoms that I am going through relapses.

For some months last year I benefited from several counseling sessions with a lady Christian counselor who uses Cognitive Behavioural Therapy(CBT) to help me identify and correct some faulty thinking patterns. I do have some faulty thinking patterns that can either trigger off my relapses or worsened my condition. In particular I learn to understand some of the myths and facts on mental illness so that I have a more realistic view of my condition. Learning to coping with false guilt during depression is also very crucial to me as there is still such a terrible stigma associated with mental illness even among Christians.

I also found reducing stress and learning to manage stress to be very crucial in my own management of my condition. From past experiences, I am discovering that mismanagement of stress or excessive stress will trigger off my relapses. So I am now prayerfully learning to recognize signs that I am getting stressed up or overly stress, and how best to reduce it to a level I can manage. I learn to pray and commit things to God, and seek His wisdom to manage the various challenges in my life. I also learn to share with my family and friends when I am troubled, stressed or perplexed. In the multitude of counselors there is safety (proverbs)! I find brain-storming and discussing with family and friends helped me to see things from a better perspective and learn to manage the various challenges in my life better.

I am also aware that one of the great source of stress I often experience actually comes from myself! I am some kind of a perfectionist. So in some ways my expectation of myself and others can at times be rather high and unrealistic. The problem is I am not always conscious of this. But this can cause much stress and harm to me in my own life as well as my relationships with others or my works. So I am learning now to be more aware of my unrealistic expectations of myself, of others or of the world in general. I am learning to be kinder to myself :-) and to others :-)

In other words, I am learning to me more aware of my limitations! The problem with bipolar disorder is that whenever I am well, I am a little hypomanic. So I have more energy, more creativity and tend to want to do more things. I tend to take on more projects that I can manage without realizing it. I also tend to want to help as many people as possible without realizing that I am over-stretching myself and trying to do too much! That is why I often suffer burn-out and then clinical depression. The tricky thing for me now is to learn how to estimate how much I can do or I should do. There seemed to be 101 things that I think I should do or I can do! But in reality this is not the case :-) So I am still learning now to pace myself more moderately and prayerfully.

Personally I do not practice meditation. I have a friend whose sister is bipolar and found it put her in a dissociative state whenever she practiced meditation.

For me meditating on God's Words help me. My quiet times in the mornings and evenings are most precious to me. I am learning to pray and commit each day unto God. I spend the time in prayer, reading of the Bible, singing of Psalms and journalling. I find that writing down my thoughts and experiences help me to see things from a more realistic perspective. Prayers help me to unburden and cast my cares on God. As I pray and commit all things to God, I find peace in knowing that He will guide me in the paths He wants me to go. Though God may not always answer my prayers according to my desires, I am learning to submit to His will which is always the best, because He is sovereign, mighty and all-knowing, and He loves me. I find much comfort, direction and encouragements from God's Words daily. I learn to wait upon God to speak to me through His Words and providence, and He is faithful to answer my prayers daily. Filling my mind with the Word of God and meditating on these precious Truths gives me peace, comforts and directions. God's Words strengthens me and help me to cope with various challenges in my life in association with bipolar as well as other aspects of my life. For me this works very well. And this quiet time becomes a very important recovery tool as well as in my management of my condition.

I found that one good way of reducing stress is to be more organized. I have the tendency to want to do too many things at one time. Now I find that if I list down the things I need to do and plan on how to break them down into manageable tasks, I can cut down on stress and get more things done. So now I use a Diary to plan my days.

I have also found exercise to be very crucial to me in my recovery process. I read that the good chemicals that are released during exercise helps with depression. Personally, I enjoy Brisk Walking and have found that it helps to strengthen my body and mind. I feel very refreshed after my exercise and my mood is lifted up. But I understand that not everyone is able to participate in exercise. We need to assess our health and our medical conditions. It is good to consult a physician first if we are unsure. This is to prevent unnecessary injuries and harm due to inappropriate exercises.

I am learning that relaxation and recreations are important to me in my management of bipolar disorder. I also have several therapeutic hobbies which I enjoy very much and helped me to relax. I derive much joy and satisfaction in Photography, Making Bookmarks, making homemade Calendar and Blogging.

I am learning to eat more healthy meals and I also benefit from Omega 3 Fish Oil Supplements.

I realize through this illness, the importance of having the support and prayers of my family and friends, besides professional helps from Doctors, Counsellors and Support Group. The people I love, and who love me, will see me at my best. When my symptoms reappear, they may see me at my worst.

Whenever possible, I will share with them my illness. I give them articles, pamphlets and books to read about bipolar disorder so that they will understand that my behaviour is not always under my control. It will also help them to understand why I am sometimes so different.

For me, I have found blogging to be therapeutic to me and is an important tools in my recovery. It has been a joy and privilege for me to be acquainted with many blogging friends who are suffering from depression, bipolar and other physical or mental conditions. To be able to share and support one another as we seek to learn to understand and manage our conditions has a great impact upon my life. I felt I have grown much over the last half year of blogging through my acquaintance with such dear friends and learning from various people's experiences. I am learning to understand my condition better and to manage it better. Ever since I joined Word-Filled Wednesday(WFW) and Thankful Thursday (TT), God has helped me to grow spiritually. I am greatly blessed by the many encouraging posts many friends shared on WFW and TT. And now that I newly joined Mission 4 Monday I am also greatly blessed and encouraged. I am so thankful that I can get to know you and so many others through blogging! But I am learning to pace myself moderately as I tend to get carried away with blogging as I enjoyed it so much and I can over strain myself unknowingly :-)

I am thankful to God that in this generation there are many resources and helps available to cope with depression, bipolar and other health conditions. I am still learning and discovering what is helpful for myself and how best to manage my condition. I am thankful to God that I can share helpful resources with my readers on this blog as I journey on.

As there is a wide spectrum to the experiences as well as treatment of bipolar disorder, I do not recommend my own coping strategies as the best for everyone. I think it is a case by case basis. I believe many of my coping strategies are those being used by many people and it is helping them. But others might not find them useful. I think we each need to take time to understand our condition and what is most helpful to keep us stable and functional. Most of us will need our physician's help or therapies or counselors help in understanding and managing our conditions.

For me personally, ultimately my faith is not in myself, anyone or anything, but in God and my Lord and Saviour Jesus Christ, Who can restore me using various means or without means. I have survived some 10 or more severe clinical depressive episodes over the last 20 years without medication because I didn't know that it is a medical condition. I realized that without medication I can still recover from clinical depression but with medication my sufferings have been lessened as well as shortened. Without medications, I used to endure at least 3 to 6 months of clinical depression or sometimes longer. Those were very difficult, painful and confusing time. Thank God for preserving and restoring me in those years. Now I am thankful that I am more functional and able to live a more productive life with medical and various other helps. Knowing that my depression is clinical and not due to weakness of my character or lack of faith in God, helps me to banish false guilt and seek medical and other helps. As my depression episodes have become more and more frequent and more and more severe in these recent years with terrible temptation of death, I appreciate the way medication and other helps are helping me. I know there are side-effects with any medication but I have prayed and weighed the matter. It is better for me at this point of time to bear whatever side-effects of medication so that I can be more functional rather than to risk dying from suicide during severe depression relapses. And besides medication, I prayerfully use as many of my other Coping Strategies as possible so that my medication is kept as minimum as necessary.

Thanks again for writing, Rob. I hope your condition continue to remain stable and you can continue to find wellness activities that helps you! You and your wife are in my thoughts and prayers. Take care and keep in touch.

With appreciation,

And thanks, friends and visitors, for stopping by. Do share your thoughts and opinions with me by leaving a comment, if you can. I will greatly appreciate it!

Take care and have a blessed day!


Anonymous said...

Blessings to you, and dear Rob.

Anonymous said...

Nancie...you have handled this like a true professional and your words are right on!!! What works for one may or may not work for the other! You have highlighted some major key points in staying well, coping and maintaining one's moods. You have emphasized from where your strength and healing comes from a faith that gives you this daily through Our Lord, His Word and journaling! Excellent coverage of all areas of treatment that are available for anyone hoping to walk victoriously!

Indeed it is clear from your words, that ALL of what you wrote works for you because your HOPE & FAITH is in Christ and you have support from others with like beliefs! God is there for each person and takes them right where they are and uses
all their life experiences to draw them closer to Him and their purpose for living! You reach out to all your blog friends in the love and compassion of Christ!

You share the positive attitude of what would Jesus do and you live your life on these principles! Your medical principles are sound, even though you are not a medical professional. You have researched and studied to aid yourself and many who pass this way!

This is for Rob, or Denise or Marja or I...God will make a way, where there seems to be no way. He works in ways we cannot see...He will make a way for me! He takes anything that may cause us harm and carefully molds us into His masterpiece! He is a gifted artist!
He knows what we can take and He tugs at our emptiness to fill us abundantly with His mercy, grace, strength, courage, and an everlasting, unconditional love. All we need to do is YIELD! Surrender all that we are doing that has not worked to follow what
He guides us to do as Our healer and Counselor! He gives us medical personnel and medicines to assist us in giving our lives control and stability. We are all human and as you pointed out, each with a unique
solution and experience! [Even a medical person can have an off day, Rob!I wouldn't wait a whole year if your life is not as it should be. If you know your signs and symptoms and can catch and control your moods, more power to you].

You pointed out everything Nancie and once more have blessed us with good information and inspiration!

Thank you and bless you for caring enough for others to share truthfully from your own experience. Very valuable!

Anonymous said...

Hi Denise, thanks for stopping by, and your encouragements. God bless you too!

Hi Peggy, Amen to your encouraging words! You are truly someone that understands me and I thank God for you! I am grateful for all your prayers and encouragements. I totally agree with you that God will make a way, where there seems to be no way. It has been my experiences in many situations in my life that God has worked His ways for me and through these I have come to know more and more of His love, mercies and goodness. Thank God that He is with us through all the changing scenes in life. Thanks for stopping by. Take care and God bless!

Anonymous said...

You've covered a lot here, Nancie, so very thoroughly. I too believe that there's a whole spectrum of bipolar disorders and everyone is different. Some can make it without medications, but I believe that most are like you and I and rely on good medications to help us live a relatively normal life.

Rob, I agree with Peggy. Your doctor might very well have had an off day. I wouldn't worry too much about his behavior. And I also agree that - should you need him sooner than a year from now - don't hesitate to go back for help. I wish you well on your medication-free journey. I wish you strength and stability.

I too place my trust in an almighty, loving God. There's nothing worse than fear to make us unwell. Fear worsens our condition. To believe in God means that I don't need to fear. I place everything into His care. And to be guided by the principles taught us by Jesus, spending quiet times with Him each day, can lead a person to an amazing life.

I'm 62 now and God has transformed me from a weak person, afraid to talk to people - someone who struggled so very much with my illness - to a person who speaks out publicly about stigma. God can do that for you if you learn to trust Him and place your life in His hands.

Rob, God is not about emptying myself, as in your form of meditation, He is about filling me up with good things. He fills my life with peace and joy and fulfillment.

Anonymous said...

Bless you both.

Anonymous said...

Just a note to say hello and thank you for another great post. Sharing your life and those of your friends help more people than you can imagine.

Words are still difficult for me so I blog about "nothing" but I can always come to you for inspiration, words that I feel but can not express. I am so thankful we have a Lord who understands, then again, I do believe He spared my life to give me a great lesson on humility and on totally leaning on Him.

I know the amount of time and energy that you devote to your posts and I, for one, am very thankful :)

Bless you....and all your friends give you a BIG group hug!

Anonymous said...

Hi Marja, thanks for stopping by and your encouraging comment! Thanks for yours and Peggy's words of encouragements and best wishes to Rob. It is comforting that we can place everything into the care of a mighty loving God. This is my comfort daily. And it is so true that God is not about emptying ourselves but He is about filling us up with good things, He fills our life with peace and joy and fulfillment. Thank God for His love and goodness to us!

Hi Michelle, thanks for stopping by. May God bless you too!

Hi Darlene, thanks for stopping by! It is so good to hear from you. You are in my thoughts and prayers regularly. Thanks for your kinds words of encouragements and the BIG group hug! I love them :) They make my day :) I am so thankful too that we have a Lord who loves us and understands. Yes, He spared our life to draw us closer to Him and He wants to use us for His glory to share His love and goodness with others. May God continue to restore and strengthen you. May He continue to shower His love, mercies, grace and blessings upon you in many wonderful ways. May His love strengthen your heart daily as you live for Him! Take care!

Anonymous said...

Hi Nancie, and everyone else who has replied,

I thought, after Nancie's very lengthy, detailed, and very thoughtful reply, that I might have to make my own second reply, just to clarify things a bit, but I see that that is no longer necessary. You people "get it" even more than me! I was quite surprised. I even learned a new word, "dissociation".

I thank you all.
My wife thanks you all.

My (very clever) wife has just one comment: "Some people wonder if Rob has fully recovered OR is still a bit "crazy". The answer is "YES". That's why I married him! :-)

-- Rob (still scratching his head at his wife's "crazy" sense of computer programming logic...)

Anonymous said...

Hi Rob,

So good to hear from you again! Thanks for stopping by and leaving this note.

Actually, I too have a little bit of "craziness" in me :) Maybe that's part and parcel of our bipolar, or maybe everyone have some of it somehow :) That makes life more interesting :)

I do appreciate your last comment which in some ways give me an opportunity to share with my readers some of my own experiences and resources I have found useful. I am sorry that your experiences with psychiatrist was not a pleasant one that day. May as what Peggy and Marja noted, your psy has his off day on that day. I just wanted to share with my readers that to some of us, especially myself, finding a good doctor is very important and has made a significant difference in my recovery. I am glad now you are medicine free and I hope you will continue to stay that way. Should you ever need medical help in future, do not hesitate to seek it and I pray you will find good medical help in time of need.

I too hope that I can be medicine free one day but at this moment my medication is very important. They are crucial in my recovery and management of my condition. So I took the opportunity to share with my readers that I have benefited from medication and I may continue to need it for a period of time. But then medication is not the only treatment plan for me. There are many other coping means that I am learning to incorporate and use. I hope to share resources with my readers through my blog as I journey on.

My greatest comfort and strength comes from looking to God and relying on Him. It is God that gives me a reason to wake up each morning. I know He loves me and He is with me. When all my medication and coping means does not work, I can still turn to God and cast myself wholely upon Him. He is still the One that sustains and delivers me.

Like Marja, I too find that God fills me up with good things when I trust in Him. He fills my life with peace and joy and fulfillment despite my struggles with bipolar. I found that my life is meaningful when I have a relationship with God that is abiding and eternal. Though I may not understand a lot of things in life, I know He loves me and that takes care of everything.

I am thankful that God has provided you with a loving and supportive wife. I think the love and support of family and friends are so crucial and valuable. Please convey my warm regards to your wife. Hope to meet her one day at this blogging world too :)

Take care, Rob. Thanks again for stopping by and sharing your life and experiences with us. All the best to you and stay well :)