How Distorted Thinking Affects Bipolar - Part One

Distorted thinking happens to some degree in every human being. We all tend to get just a bit irrational at times. However, with mental illness, there are a few differences. In a life without mental illness, a person is generally able to correct their distorted thinking fairly quickly. A person may do something wrong, but they will realize it, process their feelings, correct them, and move on. A person with mental illness has a much harder time doing this. They dwell on their distorted thoughts. This is called rumination. Their thinking is their reality. It is usually negative thinking, although not always, and it is an unwelcome guest in their head that leads to or worsens depression. The other difference is more serious. A person with mental illness will have distorted thinking that falls further into far left or right field than normal. This makes the fact that it won't leave their head even worse. Where a person without mental illness may recognize they did something and feel bad (even terrible) about it, a person with mental illness will do something and feel the error is unforgiveable. They may feel the need to apologize for no reason. They may assume others are thinking negatively of them with no cause. They may think negatively of themselves for no reason. Both of these differences together leave us wondering, "Is this for real or am I having a bipolar thought and/or reaction?"

We are first going to define the different types of distorted thinking. I have compiled this list from many different sources, and from what I have learned during the two times I have been through out patient programs. You will notice that some are very similar and that can be confusing. I have included examples to try and help (since I get confused half the time myself).

TYPES OF DISTORTED THINKING
Mind Reading - we think we know what other people are thinking. When this happens, there is no concrete evidence that our assumption is true, but it becomes reality in our minds.
Examples:

• We see two people whispering and immediately we think they are talking about us.
• We don't get a response on a text message and assume we are being ignored or someone is mad at us.
• We may think anyone of the gender we prefer is attracted to us just because they say hello.

Fortune Telling - we predict the future, when in actuality, we have no way of knowing what is going to happen. We are going to tend to think that something will not work out. Or, we assume things will work out no matter what.
Examples:

• We have a presentation to give and assume we are going to perform poorly, or fail.
• We meet someone new and assume they will not like us.
• We have an idea we plan to turn into a project and assume everyone else is going to see how wonderful it is and want to buy into it.

Minimization - We shrink everything about ourselves to the nth degree, making things less important than they are. We fail to see or admit our successes. We minimize our good qualities. One negative detail will cloud our entire perspective of a situation, much like seeing a small stain on the carpet and focusing only on the stain.
Examples:

• We may have a good day, but one mistake would make us feel as if the day was unproductive or unsuccessful.
• Someone compliments how we look and our reply is that our outfit is old.
• We complete a project to specifications but don't feel it is good enough no matter what.

Catastrophizing - We magnify everything and blow things out of proportion. It is the inability to see anything but the worst possible outcome. This type of distorted thinking often produces fear or anxiety.
Examples:

• A boss criticizes us, constructively or otherwise, and we fear we are going to get fired.
• We fail one test and fear we are going to fail the entire class, or worse yet, school in general.
• We argue with our partner and fear they are going to leave us.

All Or Nothing  - Very close to catastrophizing but an even more distorted thinking process. Everything falls into a black or white category. We never see gray. With all or nothing distorted thinking, we tend to use words like “always”, “every” or “never”.
Examples:

• We lose a job and think we are a failure that will never be successful, will always be a poor provider, and a worthless person. 
• We feel we are always right, never wrong, and will argue every point that doesn't fall in line with our own.

Personalization - we hold ourselves personally responsible for an event that isn’t entirely under our control. We may take the blame for things no matter what has happened. Sometimes, we even take blame for things that have nothing to do with us.
Examples:

• We see our child struggle and feel like it is our fault.
• We get into an argument with a friend and feel like we are to blame for the argument and the friend has no blame.
• A child may assume their parents are arguing just because of them.

Emotional Reasoning - assuming just because we feel a certain way about ourselves, it must be true. We make assumptions and decisions based on how we feel rather than what is reality.
Examples:

• We say something to embarrass ourselves and think we must be an idiot.
• We have acne and feel we are ugly.
• We think our outfit makes us look fat and therefore we are fat.

Labeling - when we assign ourselves a label in general. A situation does not precede this. Usually "I am" statements.
Examples:

• I am a loser.
• I am worthless.
• I am useless.

Would, Could And Should - second guessing ourselves. We are never satisfied with a situation, or when we make a mistake we think about what we should have done differently in a vague sense and without a concrete plan to change the situation. This produces guilt, which can move into shame.
Examples:

• I should have tried harder.
• I could have not said that.
• I would have been happier if...

Distorted thinking is linked to low self esteem. It is a learned behavior. Research has shown that the more a person dwells on distorted thinking, the lower self esteem will be, and the smaller the trigger will be that leads to distorted thinking. In our next blog we are going to discuss some steps to overcoming distorted thinking.


To balanced and productive days my friends,

Laura

The Two Most Important Relationships With Bipolar - Part Two

Today we are going to talk about the second most important relationship you can have with bipolar disorder. We will discuss finding a psychiatrist. Psychiatry is not an exact science. There are no tests or physical exams to determine that you have bipolar (not yet at least). Your diagnosis is going to come from the symptoms you describe, and not just from one session, but over a period of time where the psychiatrist can get to know you (avoid one that wants to diagnose you in one session). This places more responsibility on you in finding a psychiatrist you can connect with.

A BRIEF HISTORY
There used to be a biological/psychological split in how psychiatrists were trained. Biological training involved teaching a psychiatrist to be a doctor that provided diagnosis, medication, and psychotherapy (usually psychodynamic oriented). As time has progressed, the emphasis has changed and is now focused on diagnosis and medication treatment. Many times a psychiatrist will work hand in hand with a therapist. Mine does. Personally, the best therapists and psychiatrists I have ever had have worked together.

A CONSIDERATION

In 2007, a study was done between psychiatrists, nurses, and patients. Each was asked to rate the most important keys to a successful relationship between psychiatrist and patient. Almost 50% of psychiatrists felt that "ability of the patient to communicate" was the most important key. Around 40% of patients felt "being a good listener" was the most important key. This brings us to our first point.

YOUR RESPONSIBILITES
The more information you are armed with about your symptoms and management, the better. Educate yourself. Keep a mood log. Make a list of questions and/or concerns. Be ready to discuss how you have been since your last visit with your psychiatrist. Learn as much about bipolar as possible. There is no one definite place to research the symptoms of bipolar. I would suggest starting with NAMI and NIMH. This will give you a general idea. Remember that each person has their own journey with bipolar. For me, I quickly lose the ability to sleep whether I am in a hypomanic or depressive state. Many people report that when in a depressive state, they want to do nothing but sleep. So, because psychiatry is not an exact science, the psychiatrist needs meaningful communication from you. Help them help you.

There are a few other ways to help your psychiatrist help you:

• Stay medicine compliant - this means taking your meds every single day, at as close to the same time as you can manage.
• Be willing to make healthy lifestyle changes - diet, exercise, and sleep, etc.
• Be reasonable and expect reasonable outcomes - because psychiatry is complex a combination of evaluation and treatment, and the choosing and monitoring of medications, it may take months to find a med set that works for you. Patience may be something you will have to have.
• Be punctual and prepared - most likely after your initial office visit or diagnosis, your psychiatrist will manage your visit into 15 minute time blocks. They need to treat efficiently to be affective. Having a list of questions and/or concerns, along with your mood log, is a good way to help that happen.

A FEW ASSUMPTIONS
If everything is right, there are two things in your favor:

• Location
• Insurance/Finances

If you are missing either of these key advantages that allow you to have the freedom of choice, finding your psychiatrist match will be difficult. You may be left with choosing the best you can find even if it isn't the best match. If insurance/ finances are an issue, contact your local NAMI chapter or your local mental health center. They will help point you in the right direction. Unfortunately, most psychiatrists will not work on a sliding pay scale.


CHOOSING A PSYCHIATRIST

• Referrals - ask your family doctor. Ask your therapist. Call your insurance company and find out who is in your network. Use Psychology Today to find a psychiatrist close to you.
• Specialty/Focus - if you have bipolar disorder and a psychiatrist doesn't specialize in mood disorders, you will not accomplish anything. Make sure the psychiatrist treats your age group.
• Experience - I like the saying, "practice makes better". While this won't guarantee a better psychiatrist, someone who has experience in practicing has had the opportunity to have worked with all kinds of individuals.
• Availability - Is the psychiatrist available during off hours for emergencies and crisis's? Some psychiatrists belong to a group of psychiatrist that share on call duties. If they don't, your only option in a crisis will be 911 or a crisis hotline.
• Shop Around - Nothing says you have to stay with the first (or even subsequent) psychiatrist you choose. If you educate yourself about bipolar, you probably have a gut feeling on what you need to manage it when your mood is relatively balanced. You deserve to work with the best person possible for yourself. Be your own advocate for self care. A good psychiatrist will strike a balance between making sure you are on the right medications, but not too many or too few. I have been through quite a few psychiatrists. I was diagnosed with PTSD in December of 2014. After a few months, my psychiatrist looked at me and told me I was "going to have to get over it". He never offered medicinal help for the violent nightmares I was experiencing. I didn't even have any idea there was anything out there for PTSD nightmares until June of this year. I now see a different psychiatrist. You are most likely willing to shop around for the best buy on something you want. Don't be afraid to shop around for the right psychiatrist, also.

A GOOD FIT

Around 40% of you reported finding a good listener was the most important factor in a successful relationship with a psychiatrist. So, you are going to see that a few times below in the suggestions because it is important. A good listener will listen without interrupting. They will also ask questions relevant to what you say. Find a good listener. If your responsibility is to communicate, then the psychiatrist's responsibility is to listen. They should be able to repeat, or paraphrase what you say. In fact, ask the psychiatrist to tell you what they heard so you make sure you and he or she are on the same page. That may seem uncomfortable, but it is part of being your own self care advocate. Here are some suggestions on finding the right one for you:

• Bedside Manner - Are you comfortable speaking to your psychiatrist? Do they display empathy and compassion? They should have good listening & observation skills. They should spend time educating you. They will listen to your concerns, input, perspective, opinion, questions, and are willing to discuss any and all of those with you. You should feel like you are a partner to your psychiatrist and not simply expected to do what they say. It is important that you are heard if you disagree with their observations or treatment decisions. An excellent psychiatrist will even ask your opinion, collaborating with you and coming up with plans that work for both of you.  If you see a psychiatrist that seems rigid, intimidating or disrespectful towards you when speak up, it may be time to seek someone else out.
• Method - Most psychiatrists are going to meet with you for an hour on your initial visit and then schedule you for 15 minutes appointments after that. Stay away from psychiatrists that meet with you for less than an hour on your initial visit. It will take time to get to know you to treat you most effectively. They shouldn't be in a hurry. Neither should you. If you feel the psychiatrist doesn't have enough information about you after the initial visit, speak up! You have to be your own mental illness advocate. A psychiatrist should also see you once a month at first, gradually weaning you to every three months. The psychiatrist should be willing to see you in between times if you think you need to. Some psychiatrists will not hesitate to write a prescription, and some think less is more. Regardless of their method, they should be following you closely and listening to your questions, observations, and concerns.
• Knowledge -  Psychiatric diagnoses are complex. The symptoms you have often overlap between different disorders. Even if a psychiatrist thinks they know what disorder you have, they will consider a broad range of possibilities. This is where your knowledge can be an advantage and can (secretly) test how knowledgeable your psychiatrist is. I do it all the time, but I am careful in how I approach it because, of course, my knowledge is layman at best. This will also tell you how well you will partner with your psychiatrist. The same about knowledge can be said when it comes to your treatment. There isn't one set of medications that work to manage bipolar. Your psychiatrist should discuss a variety of treatment solutions with you.
• Ethics - unless you live in a very rural area, do not enter into a relationship with a psychiatrist that treats a family member. You shouldn't even use a psychiatrist that treats a friend. This potentially compromises the psychiatrist's ethical responsibility and could skew their treatment.

Finding a good psychiatrist is trickier than finding a good therapist. More than anything, they need to be wiling to listen and partner with you. You need to communicate and speak up for yourself. With those things together, you will be able to find a good fit.


To balanced and productive days my friends,

Laura

The Two Most Important Relationships With Bipolar - Part One

Everyone's life is full of relationships. Some are more important than others. If I was to ask you what relationship was most important to you, who would you reply with? Family? Friends? You may think they are, but I would like to approach this from a different perperspective. Today, we are going to talk about the first of two of the most important relationships you need to have in your life with bipolar. Both of the relationships mentioned above are, indeed, very important. However, the two relationships we will begin talking about today are not either of the above. The ones we discuss are going to help you succeed and draw closer to all other relationships in your life.

The two most important relationships are your therapist and your psychiatrist. Meaningful and successful relationships with each of these will touch your life in every aspect, including how you interact with your loved ones. Today we will discuss a therapist.

THERAPIES AVAILABLE
There are two types of therapies currently in practice by therapists. I'll include a brief overview of both, although if you would like to go much deeper into either, there is plenty of information available via your friendly Google search. They are:

• Cognitive Behavioral Therapy
• Psychodynamic/Psychoanalytical Therapy

Most therapists today will actually sometimes blend the two and practice either based on your needs. Find out which of the two therapies your therapist uses, and/or if they use them both.

Cognitive Behavioral Therapy:
Also known as CBT, cognitive behavioral therapy focuses on the role of thinking about how you feel and, in turn, what your reactions or behaviors are. It focuses on you in the present. There are several approaches to CBT. The general idea behind each is that your feelings cause you to think and behave in a certain way. Thoughts, feelings and behaviors all work together. Irrational thoughts and feelings result in irrational behavior and poor coping skills. By focusing on improving irrational feelings and thoughts, you can change how you react to situations (stress at a job, personal relationships, life challenges). You will learn rational, self soothing skills, based on thinking through situations factually instead of emotionally.

All of us have problems, so the therapist's goal is to help you feel and think rationally through those problems. With irrational thinking and feelings, not only do you have a problem, but you also have an unproductive and irrational reaction to that problem. Your CBT therapist will teach you how to respond to problems in a calm manner. The role of your therapist will not be to tell you what you should feel. Their role is to listen, teach, and encourage you how to feel. Your role is to express yourself and your feelings, learn, and then implement what you learn.

CBT is less time consuming than psychodynamic/psychoanalytical therapy and can produce results faster. It follows a highly instructive manner and normally has homework between sessions to reinforce what you learn. It's model is based on a scientifically supported assumption that your emotions, feelings, and actions are learned. The goal is to unlearn irrational and unwanted behaviors and to learn a more rational way of thinking and reacting.

Psychodynamic/Psychoanalytical Therapy:
Originally called psychoanalysis, it was created as a set of theories and techniques by Austrian physician Sigmund Freud and is rarely used as the primary focus for therapy. It has been revised and has developed in different directions, resulting in the predominantly used term of psychodynamic. There are 5 basic principles behind psychodynamic therapy:

1. a person's development is determined by often forgotten events in early childhood besides inherited traits
2. human attitude, mannerism, experience, and thought is largely influenced by irrational drives that are rooted in the unconscious
3. it is necessary to bypass psychological resistance in the form of defense mechanisms when bringing drives into awareness
4. conflicts between the conscious and the unconscious can materialize in the form of mental or emotional disturbances, for example: neurosis, neurotic traits, anxiety, depression, etc.
5. liberating the elements of the unconscious is achieved through bringing this material into the conscious mind (via e.g. skilled guidance, i.e. therapeutic intervention).

With psychodynamic therapy, you are encouraged to express your thoughts, fantasies, and dreams. The therapist infers what they think are unconscious conflicts and interprets them for you, giving you insight into how to resolve your problems. The therapist focuses on, and confronts, what they feel are your defenses, wishes and guilt. They will hypothesize how you may be your own worst enemy and rely on the concept that it is only after having a healing experience will you be cured and/or aided.

Psychodynamic therapy has been criticized as having no scientific basis. Because of it's approach, psychodynamic therapy can take years for results. It's focus is on the past and it's role in your development, rather than CBT, which focuses on your now self and how to learn new thinking.

A FEW ASSUMPTIONS
If everything is right, there are two things in your favor:

• Location
• Insurance/Finances

If you are missing either of these key advantages that allow you to have the freedom of choice, finding your therapist match will be difficult. You may be left with choosing the best you can find even if it isn't the best match. If location is an issue, ask a therapist if they are willing to Skype or conduct sessions over the phone. Mine does. If lack of insurance/finances is an issue, ask a therapist if they will make an exception and work on a sliding pay scale.

CHOOSING A THERAPIST

• Referrals - ask your family doctor. Ask your psychiatrist. Call your insurance company and find out who is in your network. Use Psychology Today to find a therapist close to you.
• Licensing - Unfortunately, anyone can call themselves a therapist. So, the letters behind your therapist's name are important. Look for "LPC" ( licensed professional counselor), "LPPC" (licensed professional clinical counselor), or "LISW" (licensed social worker). Different states use different wording and different acronyms. If not sure, ask! Ask them what their training is and where it is from. There are counselors out there certified to practice based on their own lived experience with mental illness. As a personal opinion, I would suggest using these as a compliment to a licensed therapist if you choose to do so. A certification is different than a license.
• Specialty - if you have bipolar disorder and a therapist doesn't specialize in mood disorders, you will not accomplish anything.
• Experience - I like the saying, "practice makes better". While this won't guarantee a better therapist, someone who has experience in practicing has had the opportunity to have worked with all kinds of individuals.
• Shop Around - Nothing says you have to stay with the first (or even subsequent) therapist you choose. This is your therapy! You deserve to work with the best person possible for yourself. You don't necessarily have to tell the therapist you are leaving them if that truly bothers you. Just do it. Be your own advocate for self care. I have been through many therapists. I had one who told me they couldn't help me when I brought up an issue. That was my last visit and I didn't tell them because I was uncomfortable stating it since I had seen them for a long time. I also know of someone who asked why their therapist always yawned, and was told they were always tired and sleepy from lack of sleep. You deserve better!!! You are most likely willing to shop around for the best buy on something you want. Don't think you have to like your therapist and be afraid to shop around for that, also.

A GOOD FIT

Can you say "relationship"? Good. Say it three times while tapping your heels together, and repeat after me. "There's no place like home, there's no place like home." Studies have proven the relationship between you and your therapist is the most important factor in successful therapy. Your therapist should feel like coming to a warm, accepting home where Mom and Dad still realistically expect the best from you. My therapist is gentle, yet doesn't let me get away with anything! If you can't talk about the ugliest parts of your life, you are with the wrong therapist. You have to feel comfortable enough to be painfully honest with your therapist. Here are some suggestions on finding the right one for you:

• Comfort and Connection - does your therapist make you feel comfortable? Can you make small talk? Can you talk about the things you find the most difficult to manage? I call this sharing the ugly. To have success in therapy you have to share the ugly and never lie to your therapist for any reason. Being real with your therapist is difficult because we all try to put on the face of being okay and you must let your therapist see that you need help. Having bipolar and the resulting mood swings is not easy. Find a therapist you feel comfortable sharing the ugly with. You deserve to be understood and guided to a better mentality. The way you connect with a therapist is important. Do they seem empathetic? Do they encourage you to share? Are they good listeners? Do you feel heard and understood when talking ugly? While you have an important part in this part of the relationship, a therapist has the job of making you feel comfortable to say what you need to say. You should have the kind of connection where your therapist is open to your feedback. Never be afraid to disagree or tell your therapist you don't understand. A good connection with your therapist will ensure that you speaking up will have them adjust to your needs and understanding. He or she should be open to feedback and to learning that something they said hurt or offended you. Good therapists are willing to look at themselves, to check their feelings, and to honestly and openly admit mistakes.
• A Plan - your therapist should present you with a plan for therapy so you have an idea of what they think you can accomplish together. After a few sessions, a therapist should even have an idea of how long therapy will be necessary. I want to note that for me personally, I have decided that my therapy is for life. All of this depends on how stable you remain in general. I need constant work!!!
• Approach - how do you feel your therapist approaches your therapy? You should feel their compassion. Ask them to describe themselves to you and how they approach therapy. Their answer will give you an idea of if you can connect with your therapist. Does your therapist seem to encourage dependence or independence? A therapist won't solve your problems. You will. They are simply there to guide you. And, therapy is hard work. Their approach shouldn't soothe you but encourage you to learn how to soothe yourself. If you find your therapist always providing you with what they think are the answers instead of encouraging you to come up with the answers yourself, you will become dependent on your therapist instead of yourself.
• Self Work - a therapist who has been in therapy has experience with both sides. If you ask a therapist if they have been in therapy, they should be willing to answer you. If they aren't, consider that a red flag. Most good therapists are wounded therapists.
• Ethics - unless you live in a very rural area, do not enter into therapy with a therapist that treats a family member. You shouldn't even use a therapist that treats a friend. This potentially compromises the therapist's ethical responsibility and could skew their treatment.

I can't express the importance of relationship. Do not be fooled. You don't need to feel like your therapist is your friend. You should feel like they are a trusted guide that accepts you. If this isn't the case, stop wasting your money and move on. You are spinning your wheels.

Next time we are going to discuss finding the right psychiatrist for you. You will find a good psychiatrist needs to have many of the same qualities as a therapist, but with a few differences in their approach.

To balanced and productive days my friends,

Laura

Grieving Over Your Bipolar Diagnosis - Part Two

In part one of "Grieving Over The Bipolar Diagnosis", we discussed the 5 stages of grief:

• Denial - It didn't happen. This is not me. It's not possible. I am numb.
• Anger - Why has my higher power let this happen to me?
• Bargaining - If I do this or that, it will go away or be okay.
• Depression - I can't take it. What is the point? I am worthless.
• Acceptance - It's going to be okay. I can live with this, no matter what.

Remember that the stages of grief do not happen in any particular order. They also do not last for any certain amount of time. Although women typically experience all stages, you may or may not. Stages can happen simultaneously, and they may happen more than once. To get through today's discussion we are going to start with a few quotes:

'The tasks of grief are TEARS:

• To accept the reality of the loss of your mental health you must
• Experience and allow yourself to experience the pain of the loss for as long as it takes, then
• Adjust, in your own timeframe, to the new life you will live; physically, mentally, spiritually, emotionally, and medically. Finally, you will
• Reinvest in the new reality of living with mental illness' - Adapted from J. W. Worden, "Grief Counselling And Grief Therapy: A Handbook For The Mental Health Practitioner

"Grief is itself a medicine" - William Cowper

"The only way to get to the other side is to go through the door" - Helen Keller

CONSIDER THIS...
If you scape your knee, it is impossible to change the amount of time it takes to heal unless you care for it. Raw, overwhelmingly painful, and scary emotions are part of grief. Give yourself permission to feel the pain and loss of your mental health. You must experience the full impact of losing your mental health; of losing yourself and what you thought life could be. Let it wash over you at will. Follow it and the journey. Cry when you want. Scream into your pillow. Don't try and suppress your emotions. Surrender to your grief! And, don't let anyone take away your right to grieve. Do not listen to anyone else's idea of how you should or shouldn't be grieving. It is your grief, not theirs! Steer clear of those people. Listening to someone else's ideas will add guilt to your grief. Everyone has their own unique way of expressing and experiencing grief. As painful as grief is, it is your friend and will guide you eventually into the acceptance stage. Allow yourself to grieve fully, for as long as it takes. Do not avoid it nor try to limit how long it lasts.

A CAUTION ABOUT THE DEPRESSION STAGE
Because our loss is one of mental health, the depression stage is one that we need to watch closely. Our brain is diseased. Therefore, it limits our rational thinking. Rational thinking is needed through all stages. This bears discussion.

There are three kinds of depression with bipolar disorder:

• Situational
• Clinical/Chemical
• A Depressive State

Situational depression is what you will feel while going through the depression stage of grieving. Those with bipolar struggle with clinical depression that is regulated with anti-depressant medications.  Mood stabilizing medications are added to try to even out the manic, hypomanic, and depressive episodes. But, changes in clinical depression and/or depressive episodes happen. Therefore, it is critical that while in the depression stage, you are regularly communicating and discussing your depression with your therapist and/or psychiatrist. Situational grief during the depression stage is fluid, always changing, and "all over the map". You will feel up, then down, changing over time. Clinical depression and depressive states are much more pervasive, suffocating, steady, dull, and constant. Remember, a depressive state is marked by length and a profound lack of self esteem that doesn't improve over a period of time, along with a host of other pervasive symptoms. It is an exacerbated clinical depression that takes you to extreme lows. Because each stage of grief can vary in the amount of time you spend in it, the depression stage is the one to pay closest attention to in regards to your mental health. You may need a med tweak for worsening clinical depression and/or a depressive stage.

WORKING THROUGH THE STAGES
The only way to reach the acceptance stage is to experience the other stages. There are no short cuts. You don't just "get over" losing your mental health. I promise, the grieving process will help create change in your life that allows you to gradually accept you can live with mental illness. And I promise this is possible after a relapse. Experiencing the stages will help you refocus your energies towards the future. Grief is not about "returning to normal". You know the old saying. "Normal is a setting on your blow dryer." You will accept that you will never be what you were, but will find a new energy and direction for life. I don't like the word "normal", but you will find a new balance for yourself.

There are several strategies for working through the stages of grief. Some are simple. Some are habits you will adopt for a lifetime. Some will take some work and research on your part. With all these strategies, stick to your daily routines as much as possible.

Cry: You have permission to cry. Cry as much as you want. It is a natural stress reliever. Washington Irving is quoted as saying, "There is a sacredness in tears. They are not the mark of weakness, but of power."

Be Gentle To Yourself: Be patient. It will take time. Some days will be better than others. Don't tell yourself, "I should be over this." Don't tell yourself, "I will be alright." Tell yourself, "I am a fighter and I will survive!"

Get Creative: Start a grief journal. Talk to your grief through the journal. Tell it anything that you think of, no matter how absurd you may feel in writing it down. While going through the anger and depression stage, try writing yourself a letter about your grief. Have a ceremony where you rid yourself of the letter to symbolize ridding yourself of anger or depression. You can tear the letter up, burn it, or roll it up tightly and stick it into a balloon before letting someone fill it with helium so you can release it. Try your hand at poetry about your grieving feelings. Nobody ever has to read it but you.

Watch Your Diet: This is required with bipolar disorder. A regular, healthy diet will help maintain your mental health. Grieving expands an enormous amount of energy. And grieving can manifest physically. If you have an upset stomach, clear broths, fruits, cheeses, and yogurts are easy on the stomach. You may even want to change your meal regimen to eating small, frequent meals to aid in digestion. Do not be tempted to try to avoid any stage of grief with alcohol. Do not abuse your prescribed medications. Fixes like this not only delay the inevitable stages you will go through, but they add to your problems. You don't want to invite a whole new problem into your life.

Sleep: This is another must with bipolar disorder. Regular sleep habits help maintain your mental health. During sleep, your mind works to process what you have been through during the day. Allowing yourself to deviate from your regular sleep habits will render your mind incapable of helping you through your grief. You can try meditation or yoga to help you sleep. You can also try soothing music or a warm bath and/or shower. Some swear by a glass of warm milk to aid in sleeping. If you are already doing this and you are still unable to maintain regular sleep habits, discuss it with your psychiatrist. You may need medication or a med tweak to help you. The addition or change doesn't need to be permanent. Work closely with your psychiatrist and therapist to know when to wean off or cut back again.

Exercise: Yet another must with bipolar disorder and needed while grieving more than ever. Exercise releases stress and tension and aides in combatting depression. Get plenty of fresh air and sunshine along with a regular exercise program. Cardio exercises are best.

Professional Support Groups: Talking with and listening to people also dealing with mental illness can be powerful. You will find you are not alone, and although mental illness is different for each person, there are a couple of benefits to a professional support group. You will be surprised at what you share in common with others. You will hear their struggles and victories and learn from them. You will find you can discuss things in a way where you are understood because everyone in the group deals with mental illness also. You may even find a few, new friends! Finding a professional support group is not difficult. You can contact your local NAMI chapter. You can google for support groups in your area. You can contact your county's mental health organization.

Personal Support Groups: Experts state that the most important part of the grieving process is the support of other people. While professional support groups are important, you should also take advantage of persons in your life who understand and accept you for who you are. Choose carefully. Those that care about you and accept you will consider it an honor to help you. Leaning on a personal support group is an additional way to verbalize your grief. While they can't fully understand what it means to have a mental illness, they can give you the tender and loving care that you need. They can listen without trying to fix you. Tell them what you need. Don't hesitate to ask them to bring you dinner or help you get out of your home. Tell them you just need to talk or cry or get a hug. These people love you and want to be there for you.

Hopefully, we have been able to share good information together through this two part series. Never forget that you are allowed to grieve for a lifetime. Don't wallow in it. Use the above material to work through it. The more you actively work your grief, the longer you will find you remain in the acceptance stage.


To balanced and productive days my friends,

Laura

Grieving Over Your Bipolar Diagnosis - Part One

When I type the word 'GRIEF', what loss do you think of that would cause you to grieve? Did you think it was the death of a loved one? Most people do. Today, we are going to discuss a different kind of loss that causes us to grieve. The loss of our mental health.

You are your own loved one. You were forced to confront a life you didn't ask for and give up the idea of what you thought life could be. It is the death of what could have been. That, my friends, is something to grieve over. This blog will be a two part series. We are going to first discuss the stages. Then, we will discuss ways to work through the stages in the next blog post.

AN OVERVIEW
There are 5 to 7 stages of grief. The most commonly accepted is by author, Elisabeth Kubler-Ross, from her 1969 book, On Death And Dying. It is important to know a few facts about the stages of grief.

1. You may not experience each one, although studies show women normally experience all 5 to 7. 
2. They do not happen in any particular order. 
3. They can happen more than once. Just because you reach the final stage (acceptance) doesn't mean you won't revisit each again at different times in your life. Grieving over the loss of our mental health never goes away. We will be reminded of it, even while living in a relatively balanced state. 
4. Stages can happen simultaneously, and are sometimes closely related to each other, making you slip back and forth between them.

THE STAGES

• Denial - It didn't happen. This is not me. It's not possible. I am numb.
• Anger - Why has my higher power let this happen to me?
• Bargaining - If I do this or that, it will go away or be okay.
• Depression - I can't take it. What is the point? I am worthless.
• Acceptance - It's going to be okay. I can live with this, no matter what.

DENIAL
In 2007, my family doctor, who had been treating me for depression for years, asked me to see a psychiatrist. I am a little hazy on what happened. I just remember not being able to hear anything else once I heard the word bipolar, telling the psychiatrist he was full of it and walking out.

Denial is most commonly the first stage we hit, but it can hit at any time, especially during a manic/hypomanic episode. At diagnosis, we may be shocked and can't believe what we just heard. Impossible is our thought. Certainly, we can't be bipolar!!!

Denial manifests both physically and emotionally. Denial can cause us to bottle our emotions as we deny our diagnosis. Think of a high pressure water hose that has a weak spot (no, bipolar is not weak). Now think of stopping the flow of water and increasing the pressure. That is not healthy for the hose no matter which way you go about it. It can cause confusion, nausea, and physical bodily pain and illnezs. Denial can make treatment difficult. It can make us act out in ways that try to deny the disorder, one of them being anger, a very closely related stage. It can also cause depression, another stage. These all closely work with each other and feed off of each other.

ANGER
My first reaction, besides denial, was to get very angry. How dare he tell me I had bipolar disorder. The only thing I knew about it was a Lifetime movie I watched one time about a pregnant woman that went off of her meds to have a baby. It wasn't a very pretty movie. In my limited knowledge at the time regarding bipolar disorder, the psychiatrist was the one 'crazy'. It didn't last long, but I was really angry.

Fast forward to 2011 and my first time hospitalized. During outpatient group therapy one day, I got angry at the topic. I don't know what the topic was. I went home and suddenly found myself beating wooden cabinet doors over and over. I kept screaming as I beat the crap out those doors (they didn't suffer any consequences). I was suddenly so angry at every single thing that I had to live a life with bipolar. My higher power, my parents, my childhood, my kids, my cat. You name it, I was ANGRY. I beat so hard, that I bent bracelets. I had deep bruises on my wrists and palms for weeks that made it difficult for me to write. I even split a couple of knuckles. I faced the anger stage for years again after after accepting that I had been diagnosed. It lasted for a long time.

Anger works very closely with denial. You are going to get angry and blame everything. Your psychiatrist, your parents, anyone but you. Or maybe you will blame yourself. I have. It is infuriating that you have a disorder for the rest of your life without being given a choice in the matter.

BARGAINING
I find myself in this stage constantly. If I just take my medication, everything will be fine. Then I exacerbate it by refusing to change meds when they need a tweak. I think if I just hold on and try to 'get better' everything will return to 'normal'. I don't call my pyshciatrist until I have already sliiped into a depressive state. I bargain with my illness that if I am patient, everything will be fine.

The most common form of bargaining when grieving over the loss of your mental health will be feeling if you do one certain thing, everything will be okay. This can even be closely related to denial if you think you can control your life and bipolar disorder without any help. This certainly is not the case. Bipolar is a fluid illness. It can't be controlled. It can, however, be successfully managed.

Another form of bargaining will come if you think can self medicate with alcohol. Alcohol is a downer and drinking will negate the effects of your medications.

DEPRESSION
Are we talking depression or a depressive episode? We are discussing both, because depression, which is part of having bipolar, can lead to a depressive state. Part of the grieving process will be facing depression at times specifically about having bipolar. After the initial diagnosis, you may find you spend the most time in this stage. Depression can last any length of time. There are times when I am depressed for just a few hours. It is closely related to anger. Who wants to live with bipolar? I don't. So I get sad and sometimes angry. I feel like I will never have a life I can be satisfied with.

With depression you are going to be asking why you had to be burdened with such an illness. There will be tears. You will lose sleep or you will sleep all the time. Your energy will be low. You will either not eat or overeat. You may feel worthless or like living life with bipolar is too hard, or not worth it. You will experience the typical symptoms of depression, but it will be in relation to your diagnosis. You will wonder how you are going to live life with bipolar. You won't want to, and that is a justified feeling.

Experiencing depression is a part of grief that you cannot avoid. Watch yourself for signs that your depression is becoming serious and turning into an episode. Are you starting to isolate yourself? Does the isolation become so bad that you are cutting your support group from your life and not allowing them to support you? That is an indication of a depressive state instead of experiencing the depression stage. Call your doctor immediately.

ACCEPTANCE
After storming out of the psychiatrist office in 2007, I went home and did the usual when presented with a problem I know nothing about. I googled. I read. I took tests (please know these tests are not reliable, but I didn't know that at the time). It was one of those AHA! moments. I fit everything I read about bipolar disorder to a 'T'. I read up on bipolar disorder at NAMI and NIHM. Use these sites to educate your support groups. The next day I scheduled myself another appointment at my psychiatrist's office, and yes, when I saw him, I apologized. I went through a brief time of denial thinking now that my behavior was named, I could be fine. That was denial also. I didn't realize how much work being 'fine' was always going to take.

With acceptance, you will realize a life with bipolar, is indeed possible. Satisfaction is possible. Happiness is possible! You can manage bipolar despite the ups and downs. This is challenging when going through episodes, but it is still possible. You will feel empowered. You will feel clear. You will find that you can prepare yourself for the battle. You will feel stable.

FINAL THOUGHTS
In our next blog, we will discuss ways you can move through the first four stages. We will discuss ways to stay in the acceptance stage longer and how to possibly maintain this stage through an episode.


To balanced and productive days my friends!

Laura

A Conversation About Suicide And Bipolar Disorder

Suicide attempts are a real concern for persons with bipolar disorder. It is estimated that of the suicide attempts in the United States by persons with mental illness, up to 70% suffer from major depression disorder and/or bipolar disorder. Not only is it, therefore, important to understand the warning signs preceding a suicide attempt, it is also important to know exactly how to handle the situation should you believe they are serious or they tell you they are going to commit suicide.

Why A Person May Want To Die
It is common opinion that committing suicide is a selfish act. In truth, this is true. Friends and family are left with overwhelming guilt and anger, wondering what they could have done differently to stop their loved one from such an act. Children with a parent that attempts or succeeds in committing suicide are two to three times more likely to attempt suicide themselves than other children. Marriages where a child succeeds in committing suicide often end in divorce.

Unfortunately, a person that attempts suicide can no longer see the act as selfish. For them, suicide becomes a last resort to escape what has become unbearable. They see no other option. Most suicides are an act of passion in the heat of the moment. Fewer are actually planned out, and usually by those that have attempted suicide before. However, the root cause is still one of two reasons.

A major traumatic event has occurred in a person's life such as financial ruin, loss of a loved one due to break-up, divorce or death, etc.

The constant struggle and pain of living with a difficult situation, such as bipolar disorder, has destroyed the mental capacity and reasoning of a person to a degree that they no longer want to live. They believe they are an unwelcome burden in other's lives and feel friends and family are better off without them. They actually are past the point of pain. They are mentally exhausted and numb, incapable of rational feeling.

Warning Signs
A person considering suicide is not likely to openly admit that fact. However, there are signs that this is where their thought process is headed, sometimes before they themselves realize or admit suicide is an option. The more signs a person shows, the more likely it is that they are considering suicide.

They may make comments such as, "You would be better off without me", "I just don't think I can do this anymore", "I am tired of living", "I feel trapped".

They may withdraw from you and/or activities they normally enjoy, isolating themselves. You may notice they begin to give vague answers when asked how they feel or suddenly stop talking or seeing you.

You may notice changes in their personal hygiene, no longer taking care of themselves as they become increasingly unconcerned with things around them.

They may attempt to give prized possessions away.

Their sleeping habits may change, either sleeping very little or too much.

They may begin to abuse alcohol or drugs.

They may express an interest in getting their affairs in order, or actually do it.

They may seem easily irritated or become more aggressive.

They may suddenly become calm and happy.

What To Say To A Person That May Be Suicidal

Let them know you care and you want to be there for them if they can or want to talk.

Let them know you are willing to listen without judgement and won't offer advice unless they ask.

Check up on them. A person considering suicide may not ask for help or call you as they get worse. They will take your silence as evidence that their reasons are valid.

Give them the National Suicide Hotline phone number - 800.273.8255 (800.799.4889 for deaf individuals). Encourage them to call so they can talk to someone else that is an objective, trained professional. Assure them they are still also welcome to talk to you.

Don't be afraid to gently ask them if they are considering harming themselves. Assure them you are asking because you care.

Never accuse them of being dramatic or selfish. Don't engage in confrontational conversation. Don't ask them to promise they won't and expect them to follow that promise.

What To Do When A Person Tells You They Are Going To Commit Suicide

Never ignore what they say. Don't tell them they are being dramatic or selfish. Don't engage in confrontational conversation. Do not ask them to promise you they won't and expect them to follow that promise.

Do not try to handle the situation yourself. Call their local police department (call 911 and ask them for the person's local police department so you can report a potential suicide attempt). When calling, tell the police you need to request a mental health check due to threats of suicide. Ask the police department if they have officers trained in handling mental illness crisis and request those officers are the ones dispatched.

If possible, remain in contact with the person until officers arrive. There is no need to tell the person you called police. The officers will handle everything according to protocol once they arrive.

Tell the person what they mean to you and how it would effect you to lose them. Encourage them to talk to you about how they feel. Name people that love them and would miss them. Talk about anything to try to take up time while officers are on their way.

Final Thoughts
To a person that has never considered suicide, the thought of taking your own life will seem unfathomable. Try to understand that to the person who wants to end their life, continuing to live seems just as unfathomable.

Tools for Self Care: Writing a Letter to Yourself

A long time ago in a galaxy far, far away....one of the only forms of nonverbal communication we had was the hand written letter. People would sit down with paper and pen, take time to collect their thoughts, and write. Today, with the onslaught of communicating via email, text, and social media, letter writing has virtually become a lost and forgotten art. Communication is now a much more 'on the fly' event that continually invades our personal and professional space from every direction, instead of once a day from the local post office, and usually once a day when you get home from work.

Nevertheless, Steve Toepfer, a professor at Kent State, wondered if writing letters by hand would change how his students felt and behaved. His study, done in 2007, showed that hand written letters provide positive psychological benefits for the writer. Depression was lifted and relationships were strengthened, and that was just two of the outcomes. Other studies show that the receiver also gains benefits. Therefore, writing can be a twofold, valuable tool when used for self care while managing mental illness.

WHAT IS SELF CARE?
Take a few moments and think about owning a car. The better you take care of it, the greater it looks and operates, and the longer it lasts. You will need to keep it clean. It will consistently need gas. It will need tires rotated, balanced, and eventually replaced. You will need to take care of things like radiator fluid, oil, and wiper blades. There are many obligations, each different yet important. In order for it to run well, you must care for the car as long as you own it.

The same is true for you. You own your mind and body, and always will. Unfortunately, at least one study has shown persons with bipolar disorder can expect a shorter life span than those without. However, the World Health Organization (WHO) states good treatment, when followed, expands that life span. Self care is part of good treatment. Writing a letter can be just one of the ways you take care of yourself while living with mental illness. It's an easy form of self care because it doesn't require a scheduled event, like seeing your doctor or therapist. It's one that you can do when you feel up to it. And, takes less than an hour. All in all, it is a low maintenance effort with high benefit! Keep reading and give it a try!

WHAT YOU NEED

• About 30 minutes of uninterrupted time
• Paper
• Pen or pencil
• Envelopes
• Stamps
• Access to a copier
• One person that you can trust to follow your directions

THEME
Here are a few suggestions for themes. However, you can certainly write about anything that comes to mind!

• What would you say if you could talk to yourself as a small child
• What do you want to remind yourself to do when you experience hardships
• What are your strengths
• What are your goals
• What are your good qualities
• What are your passions
• Tell the story of a negative experience, what you did to overcome it, and what it meant to your life
• Why are you valuable as a person

WRITING THE LETTER
Decide upon a theme for your letter. Find a comfortable and quiet spot conducive to writing. Take a few minutes to clear your mind and prepare to let your heart dictate your thoughts. Do NOT skip these few minutes. Concentrate on the theme and what you feel. Then, write!!! Don't worry about neatness, spelling, grammar, or creating the next great literary work. Write what comes to mind. Remember, write only one  letter in your 30 minute time frame. When you are finished, you are ready to move on to the steps to send the letter.

SENDING THE LETTER
First, decide how many times you would like to receive this letter, and when. As an example, let's assume today is January 1. You decide you want to receive the letter three times, at one month (February 1st), two months (March 1st), and three months (April 1st).

Second, take the amount of envelopes that corresponds with the amount of times you want to receive your letter, and label the back of each envelope with the interval dates. Consult a calendar if needed. Using our example, you would write 'February 1st' on the back of the first envelope, 'March 1st' on the back of the second envelope, and 'April 1st' on the back of the third envelope.

Third, make photocopies of your letter so the total end amount of letters is the same amount of times you want to receive your letter. Using our example, you would make two photocopies so you have a total of three letters (two photocopies and the original).

Fourth, stuff your letter into the envelopes, add stamps, and seal (with a kiss is acceptable...after all, it is a labor of love!). Use your address in both places on each envelope. This ensures that as long as your postage is correct, you will receive your letter.

Finally, hand over and entrust your letters to a person you can depend on to follow your directions. The directions are not hard. Ask them to simply drop each letter in the mail on the date that you wrote on the back of the envelope! Have the person add the dates to their calendar, planner, and/or alarms so they don't forget.


Pen in hand,

Laura


THOUGHT FOR THE DAY!

TIP FOR THE DAY!
Mix it up! Write more than one letter. Follow all instructions except do not stuff your envelopes. Hand your letters and your envelopes to your friend and ask them to pick which letter you will receive on your chosen dates.