Inigo,
Thanks for that wonderful description. A member of my family is bipolar II, and it is always useful to get another insight into what she is going through. And yes, she’s seeing a number of highly competent medical professionals whose prescriptions and counseling seem to help a lot.
Sometimes, yes they can. Other times it doesn’t take any outside stimuli. I can be running along on a great high, life is wonderful! I’m getting all kinds of things done! I love the world and the world loves me!! Then for absolutely no reason whatsoever my life sucks, is going nowhere and I hate everyone. That rage and hatred tends to quickly morph into depression and isolation. All the things that previously were wonderful and beautiful become horrible and ugly. Then I gradually sink through the depths until I hit a place where I am absolutely convinced that the world would be better without me in it. Then rinse and repeat.
Triggers…yeah, baby. My big one is anytime I get to thinking that, “Hey, maybe I’ll interview for that promotion.” or “Man, it’s been a long time since I put the moves on Mrs. Montoya…” and then one tiny little failure will flash through my mind and make me realize I am unworthy of any of that and away I go. And I went untreated long enough to develop a pretty thorough bank of minor, and not so minor, failures. So just about any time I feel like making any moves to do something positive or fun I’m screwed. But the drugs help in two ways. They keep that trigger from working and they keep me from needing to do anything positive or fun.
Q.N. Jones, I’m a junior facilitator with an anxiety self-help group based on CBT (you mention that your therapist helped you manage anxiety without pills - I would assume she used CBT for this), and we occasionally get bipolar people who also have anxiety coming to us for help. We’re kinda stumped on what to do for them - we know what to do with anxiety, but anxiety disorder is not bipolar disorder, and since we are just people trying to help other people, we don’t want to do more damage with bad advice. Should we treat bipolar people with anxiety the same way we treat people with “simple” anxiety? Should we advise them to go to a group that would have a better understanding of their particular struggles? Any advice for this?
Wow. Well, I can speak only from my own experience here, the experience of a few people I know who used the following techniques for their mood disorders, and the information given to me by a few therapists.
First, my regular therapist and most of the people I have seen have an approach that is either heavily CBT, or informed by it.
I was told by some of my therapists, and also in partial hospital, that dialectical behavioral therapy (DBT) is used with some people with depression, bipolar disorder, and anxiety to manage the stress they feel in times of crisis. My understanding is that a fair number of people with mood disorders have gone through the regular DBT training/therapy right alongside the folks it was developed for: people with borderline personality disorder and anxiety disorders. The people I know who did this did think that the regular DBT therapy was helpful to them.
My therapist did DBT-lite with me. I read the books, watched the videos, and discussed the lessons with my therapist. I found the coping mechanisms I learned really kept me from feeling totally overwhelmed and anxious during times of major pressures. It kept “times of high anxiety” from pushing me down into suicidal depression.
I can’t really say as a rule, “Oh yes, just use regular CBT on all bipolar people, it works!” because I don’t know what your program is like, or whether large groups of bipolar folks find CBT techniques helpful. All I know is that some people do, including me. I’m sorry, that’s not very helpful. 
Yes. Though this is probably a biological disorder of some kind, mood states are influenced by the environment. Specifically, a stressful environment tends to lead to more extreme mood states. Or can trigger a change.
The reason I asked the nosy question was that I was wondering if “foggy” just meant “boring.”
I find your experience sort of interesting because it’s nothing like the way my disease progressed, which was in a pretty textbook fashion. Oddly, I know this because I always studied psychology and had a pretty good idea of what was going on with me. As a high school student, I did a report on bipolar disorder and recognized myself, at that time, as probably being a cyclothyme. By the time I was in college, I was verging on being Bipolar II. But I still felt like I was pretty normal and functional.
Then, when I was in law school, at age 24, I had my first big break, where I got manic. It started out feeling pretty good, all positive and energetic and productive, but emotionally, somehow, it just all felt too big to handle, too big to be normal. After that, I basically felt like my brain was the enemy and was not functioning right, ever. I started having psychotic symptoms in my manias and depressions. I was never as clear or as able to focus as before. I just wanted to get back to normal, the way I was in college.
I like being on lithium. I feel close to normal. I like boring. My manias aren’t any fun anymore. Now all I get is all agitated and irritable, up all night, starting projects I can’t finish, ripping my house apart and scaring my cats. And I have a tendency toward paranoia and visual hallucinations. Like the time I saw Dick Cheney driving around Des Moines in a Suburban. And George Bush watching me at night from the shadows in my pillow. That’ll scare anyone into taking their pills.
I always turned myself in. I’m single, and my symptoms are pretty internalized. Nobody else ever had a clue that things were as bad as they were. Unlike some of the other folks described in this thread, I knew exactly what was going on and that it would drive my loved ones away if I didn’t get treatment. I’d heard all about it during my schooling.
Umm, what is CBT in this context?
What I know those initials as meaning really wouldn’t help with anxiety. :eek:
I must admit to knowing embarassingly little about how it manifests itself in others. I wonder if the “Childhood Onset-” prefix may have something to do with our different experiences? My son(8) has just started treating for the thing, and given a strong patrilineal history of it in my family it wouldn’t surprise me if I wasn’t just nutty as a kid and grew along with it?
Probably. You know, I see (but have not read) books on bipolar children in Borders and Barnes & Noble. I’m guessing you could probably find some pretty good descriptions or discussions if you looked, because it’s a hot field right now. I’m not interested in that stuff, so I just don’t know about it. And being bipolar as a child is not usually addressed in the “regular” literature because the classic profile is to manifest for the first time in the late teens or early 20s.
DBT is Dialectical-Behavioral Therapy, which is really just a kind of CBT.
I should add–
Angel of the Lord, I hope you will check in and let us know how you’re doing today!
Sorry for disappearing. I made it back to work today after my psychiatrist added Seroquel to my mix. My mood seems to have moderated a bit, though the drug is knocking the crap out of me. I’m freaking tired. Which of course makes my supervisory duties kind of interesting :).
Inigo, I defintely know how you feel on the meds. Right now, I just feel like I’m kind of “here,” and it’s a little disquieting. I know that in my case it’s because I just started on the new medication, but it’s still vaguely eerie. I thrive on being not the norm, on being outside the standards of “normal.” I’m just not keen on doing it with my brain chemistry anymore. To be fair, even when I’m stable, I’m far from normal, and I can do without that raw, keening pain I feel whenever I end up on a downslide.
As for triggers. . .I don’t know that I really have anything concrete that’ll trigger me, aside from the combination of cold medicine and caffeine. Together. Not separately. And, in the long run, I found that it was better to give up cold medicine than caffeine.
No, that is quite helpful. I have a theory that every person in North America could benefit from a good course of CBT; learning to go easy on yourself and not stress yourself, and learning how to deal with stress would benefit all of us. I think it is probably important for our group to still help bipolar people, but to make it very clear to them that we can’t do it all for them; that they are dealing with more than anxiety, and they need to find the rest of the help they need as well as our group to help their anxiety issues.
I haven’t heard of DBT, but I will look it up now. Thanks for the input.
No problem! I’m glad to hear you’re doing a little better. Take it easy and get back to us when you can.
Yeah, as time goes on, I find myself thinking this all the time. Because when many of my “normal” friends, co-workers, family members, etc. get all stressed out–happens to everyone sometime–I want to give them my DBT workbook and say, “Read.” Of course, I don’t, because they would see the words “For Borderline Personality Disorder” on the front and be upset at the implication that they’re crazy.
It’s also really important given the diathesis-stress theory of mental illnesses like bipolar disorder, schizophrenia, major depressive disorder, etc., which goes like this: certain people are born with a biological weakness that makes it more likely than average that they’ll get a serious mental illness. But it takes a certain amount of life stress piled on them to make the illness actually start.
Some people, like Inigo probably, have a strong diathesis toward an illness and will probably get it with little or no exposure to stress. But for some people, if they’re not exposed to high levels of stress, they won’t develop a serious mental illness. (They might have some subclinical symptoms, or a less severe form, though.) I’m one of those people. There is mental illness in my family, and my dad is probably Bipolar II, but everyone else has always been able to get along. I already had cyclothymia at least, but I was getting along well. Then I happened to get into a situation where major stressors piled up on top of each other, and bam, suddenly I was getting very high highs and very low lows, both with psychosis.
Therefore, stress management is actually very likely to be good preventative medicine against serious mental illness. To my mind, this is a hugely powerful statement. Think about all the savings society could reap in lost productivity, medical bills, etc., if we could prevent serious mental illnesses! I’m unlikely to have kids, but if I did, I would teach them stress management from an early age.
Yup. Bottom line is, if you’re bipolar, you need meds.
The last of your species?
The first time Middlebro used that line after The Nephew was born, we said “nu-hu, not any more.” He got a deer-in-the-headlights look and grinned, “true”. But it’s how he defined himself for about 30 years.
(Pst, Nephew, did you get that from your Papi?)
Any specific books on DBT you can recommend? I’d like to add them to my to-read list.
Marsha Linehan created the program, so the books I used are all written by her. NOTE: The program is used to treat many, many more people than just borderlines now! The two I am familiar with are:
Cognitive-Behavioral Treatment of Borderline Personality Disorder
Skills Training Manual for Treating Borderline Personality Disorder
These are two books I saw at Amazon. I haven’t read them, but I include them because they demonstrate that DBT is now used by other therapists than Linehan to treat other disorders:
Depressed & Anxious: The DBT Workbook for Overcoming Depression & Anxiety by Thomas Marra.
Don’t Let Your Emotions Run Your Life: How DBT Can Put You In Control by Scott Spradlin.