Taking responsibility for managing bipolar episodes and symptoms: how much of my mental health is under my own control?
Q: “To effectively manage their condition, they need to vigilantly watch their thoughts, examine their thoughts, and challenge the reality of their thoughts and the emotions that follow. It’s imperative..It’s absolutely a martial art” : this deeply resonates with me but how do I establish this vigilance/form a container for living this way? Vipassana? Transcendental meditation? Journaling? Something else? (Am just coming off meds now).
This is a comment left in the comment stream of another article I wrote about bipolar disorder and spiritual enlightenment. While I am not a doctor and cannot give medical advice, I do have personal experience from being very close to several people who have been diagnosed with this unique mental pattern. Some of them have found ways to thrive, some are barely clinging on and at least one has died. So I’ve seen it go many different ways. What follows is some general advice that will be helpful whether you are on medications or not.
To the reader who asked the question, you mention you are just coming off your meds. Most psychiatrist don’t take people with bipolar disorder off their medications completely, so I am wondering under what conditions you are coming off your medications?
Some people believe that psychiatric medications are a mistake, and actually damage the brain. They assert that you should never take them. Most people, and most doctors, believe that a lifelong regimen of a carefully adjusted cocktail of medications is the only way to effectively treat bipolar disorder.
I’ve seen the medications stabilize people in extreme phases of mental illness who otherwise would have been committed or might have even died without it. I’ve also observed that the medications do not cure or heal, they often stop working and need to be changed or adjusted, and they all come with some very serious potential side effects. Furthermore, doctors don’t really know how they work, or what bipolar disorder is. Medications are blunt, unsophisticated tools used on a very delicate and mysterious mind/spirit/body system. Deciding to go on, stay on, or get off of medication is a serious decision. Going off of medications is dangerous and needs to be done slowly and under medical supervision. Whatever path you are taking, please take the utmost care. There are a few psychiatrists out there who are committed to helping their patients avoid psychiatric medications completely, but they are very rare.
Even if you are diligently taking your medications, you will still experience bipolar cycles. Taking these powerful medications usually just limits the height and depth of the cycle by some varying percentage. The following daily management suggestions will help you to limit them even further. Obviously this is just a brief and superficial sketch, because I could write a whole book about this easily. But hopefully it will give you some helpful ideas and direction.
What time of year is it?
One of the notable features of bipolar disorder is that cycles often follow a seasonal pattern. One person I knew became gripped with suicidal thoughts and compulsions all summer, every summer. As soon as autumn came, she could hardly even remember wanting to kill herself and would start swinging to the hypo-manic or mixed state part of her cycle through the holidays and until late spring. Every year, it was the same thing. Another person suffered from a paralyzing anxiety starting in spring, which moved to a leaden depression in the summer, which lifted into hypo-mania in the autumn and so on. Every year.
Pay attention to your own patterns and see how they correspond with seasons. Once you know what your tendency is, you can plan to initiate counter measures and get the correct kind of support during that time. Don’t forget to note the in-between times, which are transitions from one set of symptoms to another. Note times you suffer various symptoms, like anxiety, depression, paranoia, hypo-mania, aggression, and so on. Every one is different, and you need to know in as much detail as you can gather how it is for you. Become an expert on your particular seasonal pattern.
Mastering your own momentum
The primary mechanism of bipolar disorder is momentum. This is really important to understand. Your goal is to catch yourself as early as you can in your cycle (or episode, or whatever you’d like to call it) and enact countermeasures to keep from gaining momentum. It’s like a train: if you can catch it when it’s barely even started moving, you can stop it much more easily than if it’s reached full speed. The longer you allow yourself to gain momentum, the less presence and control you have. The more you allow it to run, the less free will you have to exert over it and the more consequences later. I’ve also noticed that the higher people go, the lower the snap back.
Really, all the other advice given is to help you stop the momentum. The momentum gathers speed, very quickly, so you can’t be lazy about it. You need to keep refining you knowledge and strategies so that you can catch it earlier and earlier.
Get to know your prodromal symptoms
One of the best ways to catch yourself earlier and earlier, before you’ve gathered more momentum, is to become an expert on your prodromal symptoms. If you don’t know what that means, please look it up. It is crucial.
Start keeping a journal of what changes take place as early in the cycle as you can. Things do change. Your feelings change, your interests and desires change, your tastes change. You might notice that two weeks before you start noticing depression creeping in, you start having a certain kind of recurring dream. Or you might suddenly crave junk food, alcohol, sugar, caffeine a couple of weeks before you start gaining momentum on the manic side.
Here are some areas to watch and become aware of changes that precede bipolar episodes: eating, sleeping, dreaming. Also become aware of changes in preference for being around certain people, wanting to listen to certain music, being drawn to certain kinds of media. There have been studies showing that people show a marked preference for certain colors (red spectrum) prior to a manic episode! It doesn’t just happen in a vacuum. But the warning signs very early on don’t seem very worrying at all, they are extremely subtle and can only be discovered through diligent observation.
I am a gourmet cook and used to make food for my family every day, unless we were eating out. One of my husband’s prodromal symptoms was a craving for total junk food, which he never ate otherwise. So when I told him we were having some lovely four course meal for dinner and he excused himself because he just really wanted Taco Bell, that was always a warning of a huge swing about to manifest.
Believe it or not, even a sudden upsurge in spiritual seeking behavior can be a prodromal symptom.
Get to know the lingo
The term bipolar would suggest that you are either up or down. In order to become an expert and thus master of your own energy, you will need to know and understand all the different ways that episodes can manifest. It is not up or down, but there are mixed states, paranoia, psychosis as well.
Supportive nutrition and dietary supplementation
It’s critical that you manage your blood sugar. Critical. That means no sugar or sugar substitutes, refined grains, alcohol, caffeine. That means limiting your carb intake. If you eat just a bowl of berries for breakfast, it may not be refined sugar, but it’s not supportive of keeping even blood sugar.
It’s not an on and off affair. It’s tempting to negotiate with yourself, but it’s really not worth it.
Learn about brain supportive nutrition. If you are taking medication, know that some meds interfere with the absorption of important nutrients. Most doctors know nothing about this, because most doctors are not trained in pharmacology or nutrition. You’ll have to do your own research and keep up to date with the latest findings. If you need to supplement, find good quality supplements and keep a journal over time of any changes.
You may be super sensitive to all kinds of chemicals, dyes, etc. Eat whole, unprocessed foods. Keep a journal of any mood shifts or shifts in energy or feelings of fogginess. Find out what you were eating just prior. Did you eat a certain food, at a certain restaurant? Food matters.
Thou Shalt Not Pass!
There are certain things you need to close the door to, period. If you don’t have clear and non-negotiable boundaries, there is always a chance that you will let yourself slip just once and find that you’ve passed into a very dark and unsavory place that is hard to get out of.
Illicit drugs, alcohol, nicotine…substances that are mood altering are not your friend. Substances that are hallucinogenic are not for you. Not even the ones that are touted as spiritual, like Ayahuasca. Diet pills, NO. Energy drinks, just this once? Never.
Aside from drugs, the list depends on your particular pathways of weakness: gambling, promiscuous or dangerous or inappropriate sex, shopping online, spending more than a certain amount in a day on your credit card, joining cults that seem like religious or spiritual or self help groups. What do you need to close the door to, period? Make a basic list and add to it as you find areas that need unassailable boundaries. When you find yourself in a place of weakness, you will be served by the many other times you respected your Zero Tolerance boundary.
This list might include people you need to leave behind for good and forever. No weekend visits, no spur of the moment texting, no facebook stalking, no cards just at Christmas or on birthdays. NO.
Write it down
One fascinating aspect of bipolar disorder is amnesia. It seems that the person who is doing the manic activities, thinking the paranoid thoughts, having the psychotic experiences or trying to kill themselves is so NOT YOU that once the episode is over you can’t even accurately recall what you did. Even if you get the big brush strokes, all the fine detail is lost. That information, as painful and messy as it might be, contains absolute life saving gold for you.
So you need to write it down. Write down the details. Write down your realizations, because when you shift into another cycle, you won’t recall them, no matter how mind blowing they were when you had them. Make sure your writing is always dated, so you can correspond it to an annual calendar. Just having it written in a journal is really not enough. You need to track out the cycles and symptoms on an actual calendar in order to really help yourself.
You can also write notes to yourself. If you know you are entering a paranoid phase, you can put a big note on your mirror reminding yourself that “It’s not real.” That sounds so simple, but if you write it when you are stable and not paranoid, then it’s a lifeline of sanity…not from someone else, but from the sane YOU. You are reaching through the fog to yourself. Write it down. Write notes to yourself that say, “if I start feeling like X….” You already have all the wisdom you need, and you can be a great and loving support to yourself in times of need. When you are stable, write short letters or notes to yourself that you can use when you are not clear.
Here are some topics to research:
Antidepressant-induced mania and cycle acceleration
Bipolar kindling rapid cycling
Bipolar mixed mania or bipolar mixed states
Bipolar + sugar / caffeine / alcohol
Bipolar without drugs
Some types of meditation can actually cause problems for people with bipolar disorder. That doesn’t mean that you can’t meditate, but be easy with it. Good meditations are ones that give you calm and peace, let you feel at ease. Simply breathing and staying with the breath, letting all thoughts come and go while not trying to stop or control them, and also not getting involved or attached to them, is good. All of the advice I’ve given you here is totally mundane, it is not particularly spiritual. Unless you have the mundane aspects well in hand, and you are living them all the time, it really doesn’t matter if you mediate or not…you are going to be cycling. You are going to gain momentum.
It’s appealing to think there is some great spiritual discipline that will change all this. No doubt there are practices or insights to be had that will benefit you. But they are not in place of doing these mundane, daily disciplines. The awareness that you will gain from doing them can actually lead to profound spiritual insights, but it’s not about skipping steps. You must keep your momentum to a minimum, maintain the boundaries that keep you safe and be stable. Doing this in the face of powerful illusions is itself a form of spiritual mastery.
Yes, you need to have iron clad boundaries, you need to be vigilant and dedicated, you need to practice this martial art of sanity every minute of every day. But does it have to be dour, does it have to be grim? NO! Do you need to feel broken or damaged or somehow less than? Absolutely not. I hate the terms mental illness and bipolar disorder. I only use them here so that everyone knows what we are talking about and so search engines can find this information. In my own mind I have replaced the term bipolar disorder with unique energy pattern. You have a unique energy pattern. You need to learn to master it.
If you think about it, all the advice I’ve given here is totally applicable and would be beneficial to most people, not just people who are dealing with bipolar disorder. With perhaps the exception of the cycling and having to keep everything on a calendar. Who couldn’t benefit from setting healthy unassailable boundaries, eating for maximum brain health and blood sugar stability, writing messages to themselves when they are strong to bolster themselves during times of weakness or lack of clarity? If you think about it, this is not some strange prescription meant for crazy people.
Be happy. Live well and fully. Never be ashamed or doubtful of your perfection and divinity.
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