In my last blog post, I discussed some future plans I had for wanting to push my body of advocacy work to a new level. The type of feedback I received on that post could be neatly fit into two categories; encouragement and “are you manic?” On the first point, I appreciate the kind words and encouragement that many people gave me.
On the second point, I’m a Type 2 Bipolar. I don’t experience mania, I experience hypomania. I realize that most people use the two interchangeably, but they are different things. Mania requires psychosis. Hypomania does not. Technically, I’m not manic. Also technically, I’m not hypomanic either.
How do I know that? Doubt and self-doubt.
Understanding the way unwellness manifests gives us a great tool for identifying when Bipolar Disorder or Depression is trying to drive our thought processes. In my case, hypomania brings with it arrogance, impatience, and anger. The thought that I could be making a bad decision never crosses my mind because Bipolar Disorder just shoves my brain ahead at 1000 miles an hour without any consideration for consequences.
The ideas and thoughts I shared on pushing towards forming a venture of my own are not an overnight creation. It’s something I’ve been thinking about for the past two years, off and on. The list of doubts and cons is about the same length as the list of ideas and pros.
That is a good thing, because it heavily infers that I’m not now or have been escalated. A major decision like that is an almost guaranteed unwell cycle trigger. That doesn’t mean that I will or have triggered, it’s just that the potential is there. Anything that can bring major stress or incite passionate emotion should be counted as a potential trigger. That means increasing the amount of self-assessment that I would normally do to ensure that I pick up on any shift towards unwellness before it becomes a major problem.
Awareness gives me the power to unwind the unwell cycle before it really gets going. My methods of management are derived from personal reflection and strategy learned through Cognitive Behavioral Therapy.
These points are something that anyone can learn to be aware of. It may sound exhausting to need to think about mental state on a daily basis, but it really is the best way to keep a firm grasp on potential unwellness. Though it is kind of annoying at the start, regular practice and effort turned it into a thing that I just do without actively thinking about it.
That leads me to one of the more common misconceptions about Bipolar Disorder. Just because we’re not unwell at the moment does not mean that Bipolar Disorder is not lurking, waiting. An unwell cycle can trigger from anything and come out of nowhere.
The only way to head those unwell cycles off is to treat Bipolar Disorder like it is a companion that is always walking beside us: not behind us, not sitting at home on the couch, not as that thing in our past. Even when we’re medicated we need to keep a close eye on it to make sure it does not run ahead and away.
Even though my doubts have been strong, I view them as a good thing. Doubt means I’m sane and balanced. Doubt means I’m thinking critically of my choices. Doubt means I’m still in control of the Disorder, it is not in control of me.
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11 replies on “About Doubt and Mood Disorder Management”
No real question here – just wanted to comment:
What a great posting Dennis. I have a friend who is bipolar and I wish he had the opportunity to practice more cognitive behavioral therapy. He is low-income and on disability and I am under the impression that his assigned therapist doesn’t do much other than listen to him and just agree with him. Every time he has an appointment with her (once every month or so ONLY), he seems to have changed his mind about what he should be doing.
He only sees his psychiatrist every three months and that’s about a 10 minute meeting regarding his meds.
It’s hell to be poor, for sure.
I am under the impression that his therapist would rather my friend not do anything at all, given his instability. I can’t help but think that he should be working, step-by-step, to overcome the fears and anxiety that go hand-in-hand with EVERY decision and even the smallest life changes that he encounters.
But he seems really alone – without any professional assistance. It’s hard for me to know (I live in a different state) how much is it due to lack of good counseling and how much of it is his denial. He swears he accepts his illness, but he always makes excuses why he doesn’t go to sleep early, why he’s not eating regular meals, etc.
On the other hand, my friend may be worse off than most – he experiences psychosis – he hears voices – he says that angels are talking to him and demons are screaming at him. He worries that people are right outside his door, waiting to harm him.
When he’s manic, he doesn’t wander around or think he’s God or anything you see on TV – he just thinks he can do a lot more than he is capable of doing (volunteers for all sorts of church activities), and gives his money away (last time, he gave his name and address out to street people, telling them to come to him for anything). When he’s depressed, he’s paranoid, exhausted, and becomes very religious and thinks about joining a monastery or someplace where he can disappear from the world.
But the voices are there – whether he is in a manic phase or depressive phase.
He gets resentful if anyone suggests that the voices might not be real – he’s lived with them since he was 9 or 10 years old. I’ve told him that some of the voices might be real but that he should realize that all of them are probably not – that he MUST investigate this possibility.
I’m not sure what his therapist does with all of this – but it does not seem like much. While he and I have known each other for over 20 years, it’s only been the last 6 or 7 that we’ve been in close contact. In these past 6 years, I’ve seen him steadily decline. Part of that is probably age, but I also think he’s not getting the care he should be getting.
Did I say it’s hell to be poor?
Hello, Houstonia. Thanks for taking the time to read my work and comment.
You’re right in that being in another state and not actually involved in his processes doesn’t give you a clear picture of what’s actually going on. It’s hard to infer because we also don’t know what he actually communicates to his medical professionals. They only have a limited amount of time to really analyze and make decisions surrounding the people they deal with. So, it’s also possible that he doesn’t tell them everything either.
Obligatory “I’m not a doctor or mental health professional so cannot/do not diagnose people.” That being said, the way he experiences those delusions is atypical for Bipolar Disorder. He may have Schizoaffective Disorder; which manifests as a combination of schizophrenic and mood disorder symptoms. It’s a relatively recently identified mental illness so it’s not something that’s well known by many professionals, in my limited experience. You may want to suggest to him to ask his therapist about it.
And you very correct, being poor is hell.
After his first manic episode back in his 20’s he was diagnosed schizo-effective and put onto Haldol which immediately sent him into a downward spiral of suicidal thoughts, attempts and depression. He had been working on his PhD, but the Haldol experience made him have to leave. He was re-hospitalized and diagnosed as bipolar and medicated for that. His therapist thinks he is schizophrenic and his psychiatrist thinks he is bipolar. Both of them tell him not to even bother with the raging OCD that actually is the most visible of his disorders and in some ways the most debilitating.
He says he suspects he has a combination of disorders which he will never recover from.
You know, I met him before the first manic episode and it is so heartbreaking to see what has happened to him as a result of all of this. The human body can repair itself from bone breaks, illnesses, some disease… but mental illness? It seems so much more difficult.
That is an extremely rough, unfortunate path. Mental health has a long way to go, really.
I can tell you the most likely rationalization though. OCD won’t cause him to kill himself or someone else. A bad break in Bipolar Disorder, Schizophrenia, or Schizoaffective Disorder could end in someone getting hurt; hence it’s the more imperative problem even though it may not seem that way on the surface.
It’s hard telling if he will recover or not. Given that mixture of mental illnesses it’s going to be a hard battle either way.
Mental illness doesn’t really repair itself. It just gets worse with age in a majority of cases because it accelerates volume loss in the sections of the brain it affects. Not every mental illness, but most that I know of anyways.
You have such self awareness and insight. I wish more people would know triggers and what to look for in order to keep their Bipolar symptoms managed. I love what you said about letting the illness walk alongside you and not ahead or behind. That allows you keep symptoms under control and not allow them to control you.
Best wishes always Dennis!
Thank you for the kind words, Cowboys. Part of the reason I write what and the way I do is to help other Bipolar people gain a better degree of control over their mental illness. It’s hard, but it’s not impossible. Glad you enjoyed my piece!
I really enjoy reading your blog. I am learning so much from you. I am betting that your book will be very successful. Thank you so much!
Thank you, Marsha. I’m happy you’re enjoying my work and appreciate your kind words!
First, I just want to tell you that this was like reading someone describe my own life. It’s good to know that someone else is going through the same thing I am. One of my biggest struggles with bipolar is how it seems all too common for people’s misunderstanding to cause me to doubt my own problems. I’ve actually wrote just today how I want to meet other people that share my diagnosis. Also, before I forget, I love your writing style; it flows nicely.
Take care!
~Jacob
Hello, Jacob. Thank you for taking the time to comment and for the kind words. I’m glad you enjoy my writing!
Trying to relate what it’s like to be mentally ill to people who are not mentally ill is difficult because they do not have the context to understand. Anything you try and relate to them they are going to try to relate to their own experiences and perspective to try to find common ground. To put it another way, you wouldn’t ask a man what it feels like to give birth. He may be able to form an intellectual guess based on third party information and what he thinks it might be like, but if you want to know you would ask a mother.
Same deal here. When you talk about the problems that Bipolar Disorder brings, or something like Depression, a person that has not experienced those things is going to equate them to whatever they’ve experienced in their own life that is similar. Now for a person who hasn’t experienced Depression, they will usually equate that to sadness and conclude it’s not that bad. So, you’re definitely right to seek out other people who share your diagnosis to relate to.
Some important points on doing so, though. A lot of mental health communities online are very toxic because they are crowded with the hopeless, toxic, trolls, and people who are gathering together to commiserate about their misery. No, mental illness is not fun and games or peaches and cream. But immersing yourself in that kind of negativity is a really good way to get sucked under yourself. You have to be wary of that.
Next, we all experience mental illness in slightly different ways, even if we are bound by a similar diagnosis. Many mentally ill people incorrectly conclude that everyone else experiences mental illness the same way that they do. Thus, they try to give advice or perspective based on their own personal experiences that are not necessarily relevant to you. In my own material, I work to combat that by clearly pointing out what was relevant to me, and aiming to provide lowest common denominator information that anyone can take, evaluate, and see if it will work for them.
Like I constantly say, my way is not the end all, be all. I am just trying to provide people a place to start and signposts through the gray, foggy areas of pursuing mental wellness.
Welcome to my site, I hope you enjoy your stay. If you have any specific questions or anything, feel free to email me at dennis@bipolarmanifesto.com
You make a great point about how important it can be to be aware of your mental state with any mood disorder. Knowing when you might be vulnerable can help ensure that you avoid over doing it on days where you will need extra mental strength to maintain balance. Knowing more about your condition can help you identify triggers and patterns, just like you mentioned, to better manage your well being. Thanks for sharing your experiences and insight.