A recent study conducted under clinical criteria highlighted something terrifying for those of us who live with, love someone with, or care for people in our community with bipolar disorder.

(extract)
Relapse and impairment in bipolar disorder

MJ Gitlin, J Swendsen, TL Heller and C Hammen
Department of Psychiatry, University of California, Los Angeles 90024- 6968, USA.

OBJECTIVE: The purpose of this study was to evaluate the outcome of bipolar disorder in the context of maintenance pharmacotherapy.
METHOD: Eighty-two bipolar outpatients were followed prospectively for a mean of 4.3 years (minimum of 2 years); symptom rating and psychosocial outcome scales were used, and pharmacotherapy was rated on a 5-point scale.
RESULTS: Despite continual maintenance treatment, survival analysis indicated a 5-year risk of relapse into mania or depression of 73%. Of those who relapsed, two-thirds had multiple relapses. Relapse could not be attributed to inadequate medication. Even for those who did not relapse, considerable affective morbidity was observed. A measure of cumulative affective morbidity appeared to be a more sensitive correlate of psychosocial functioning than was the number of relapses. Poor psychosocial outcome paralleled poor syndromal course. Poor psychosocial functioning, especially occupational disruption, predicted a shorter time to relapse. Depressions were most strongly related to social and family dysfunction.
CONCLUSIONS: Even aggressive pharmacological maintenance treatment does not prevent relatively poor outcome in a significant number of bipolar patients.

(taken from - http://ajp.psychiatryonline.org/cgi/content/abstract/152/11/1635)

These conclusions are not new - your own Doctor or GP will tell you these things, citing it as the primary reason that you should be placed and stay on medication. Its important however, to note that ‘even agressive pharmacological mantinence’ doesn’t change this outcome - meds don’t always help. The highest rates of ’success’ with bipolar disorder come from the patients that understand thier moodswings, thier reasonings, thier reactions - the underlying chemistry that changes thier moods, and thier investigation into tailoring thier own understanding and treatement of thier disorder.

Bipolar disorder is debilitating for some people - it can destroy lives, families and support structures that otherwise would survive anything - and its important to ensure that if you, or a loved one, has a mental health issue of any kind, including bipolar disorder, that you are fully informed and can face the consequences, gifts and obstacles of that diagnosis with dignity, pride and preparation.

D Kai Wilson

D Kai Wilson is a writer, artist, and bipolar one businesswoman with an avid interest in bipolar disorder.
Her first book, ‘Pictures in the Dark - a bipolar’s guide to good mental health’ is available today from http://nonfiction.booksbykai.com

Life is ripe with storms–they stir up, gain momentum, and often slam you when you least expect it.

It has been like that lately for me, and I was reminded tonight that this too shall pass. It’s a hard thing to remember when the darkness descends upon you.

Friends are often hard to find when this happens–mainly because we cut them off. We don’t speak up and let them know we need their support. A kind word, a smile, a reminder that they do care is often all it takes to make it easier.

I need to remind myself–and those of you who feel the winds whipping at your hearts–to look around. Don’t be afraid to say “I need you.”

The storm will ease, the sun will shine again–and you’ll be greatful you held onto the anchor your friend was so happy to give–because you were willing to ask.

Imagine, opening around 1000 emails a year, each asking you to talk them out of their suicidal mood, or tell you they aren’t crazy.

That’s what we face, with a smile, at bipolarbears every day.

Could you tell someone though, that they aren’t crazy, that what they are feeling, how they are faring with their newly or not so newly discovered mental health diagnosis is normal? Could you reassure them that they aren’t going slowly insane?

I can’t. I can’t honestly say I’m not completely and utterly off the rails. Despite the control I have over my environment, the support of my friends and family, and of course, an intimate understanding of exactly how my mind works, I can’t really, honestly say I’m not insane.

Mainly because I’m really not sure its a bad thing.

Are you?

I mean, of course – its terrible to be hospitalised – but being diagnosed, though it takes a bit of adjusting, isn’t such a bad thing. There’s a reason for how you feel for a start. The roller-coaster is something you can actually embrace, in moderation. And its an opportunity.

Yep, you read that right – its an opportunity. An opportunity for many things – to learn more about yourself, to find out more about mental health. And to connect with others.

Though, if you’re honest with yourself, if someone contacted you, asking YOU to reassure them that they aren’t crazy, what would your first reaction be?

Every year bipolarbears, my first online project, receives close to 1000 emails, begging for the answer. I’m no doctor, no scientist. And I go off the rails spectacularly several times a year. Yet we’re asked to tell people that they aren’t crazy, that its normal, that its ok to feel this way.

And each of these emails gets a personal response. But I thought it might be good to repeat it.

You’re not crazy, normal is a setting on a washing machine, and of course its OK to feel whichever way you want, as long as you’re not a danger to yourself, or others. If you are, something needs addressed in an environment that may not seem like a haven, but can be about as safe as you can hope for, and that’s under medical care. Not necessarily hospitalisation, but at least under some form of supervision.

Something that you should remember though, is that approaching other bipolars and asking if you’re crazy, can hurt them too. It smarts, partly because some of us have been in that position, and partly because that’s how some of the less knowledgeable members of society see bipolar disorder.

We’re not crazy. We’re not even really different. We just relate to our emotions and feel them in a way that seems odd. We’re still human, still people – still capable of loving, hating, living. We’re still those that you love, those that you work with. Just with a different label.

People need to start taking responsibility for their words – so asking another bipolar if you are crazy WILL hurt them – it hurts me to hear someone say that – to read it in an email. If you’re crazy, and you’re bipolar, and that’s the ONLY reason for it, then, of course, I’m crazy, my friends are crazy, my staff are crazy.

Oh, did I forget to mention that?

We’re not an exception to the rule here - we’re rewriting them.  There’s no where in thewhole world that says you can’t be a great person - no matter what you are, or what you have - no where that says you can’t succeed in your dreams.  No where that says your perception of the world is wrong - just…different.

I don’t revel in my mood swings, but I’m adjusting, slowly, to understanding myself, and understanding what makes me tick. And I use what I can of it to my advantage.

I’m multi published – a recognised poet, and photographer – an artist of a decent calibre – a coder with a love for all things clients, and of course, a writer. I’m a success.

And I think some of it is down to accepting and embracing that no, I’ll never ‘function’ in an environment that doesn’t take into account my rather special, if not strange outlook, but I can still contribute to the world around me, and do so in a positive way.

All it takes is three simple words.

“Live, thrive, Survive!”

I hope you’ll join me.

Holidays can be hard on everyone. The routines you are used to get all turned around, people who you barely know visit and want to play with your things, give you hugs and make lots of noise. Your parents may be nervous and you might pick up part of their mood to add onto your own. There are ways you can make holidays easier and more enjoyable. Some things you can do on your own, but others will need your parents help. Find a time before things get hectic to sit and talk with them and let them know what you are feeling. They can’t help if they do not know something disturbs you.

On your own, take a look around your room. If there are things you really don’t want to share because they are special or you are afraid they may be broken, carefully put them away in a drawer or the closet. This way, if other kids visit, you won’t have to worry about these things. Think about places in your home that are more likely to be quiet. Not having a place to get away from the festivities will make you feel more upset. If you know beforehand that there is some quiet place to go to, you will be able to relax easier.

Many bipolar people don’t like to be touched a lot. While your great grandmother may be hurt if you don’t give her a hug, other friends and relatives may be happy with a handshake. Talk with your parents about this. Let them know if hugs from others make you uncomfortable and ask if they can discuss this with others before they arrive. A simple handshake and smile will go a long way in showing adults not only respect, but also acknowledgment of their feelings. This could be the best way to keep everyone, including you, feeling happy.

You don’t have to figure out everything all by yourself. Parents usually want to help and will be glad you came to talk with them. They want you to enjoy the holidays. Holidays happen, we can’t change that and probably wouldn’t want to. They don’t have to be horrible events to endure, but can be pleasant happenings with a little bit of planning.

Last month I touched on acceptance and how it affects our attitude. The ultimate truth in all our lives is that no matter what our beliefs, no matter what we tell ourselves, sooner or later, if unchecked, un accepted and unmonitored, our mental health issues could cause problems. Problems that can be minimized or at least anticipated to a certain degree if it is accepted there is a reason for how we are feeling.

It’s a fleeting moment most of the time: understanding that what you are doing is not directly within your control, but with adjustment could be. It sounds funny, but control, like every other imposed pattern, relative and highly subjective to the level of acceptance you carry with you.

I know a lot of people that I attend the local mental health unit with who still deny their diagnosis. Two of them are hospitalized, on average, once a year, their families cannot deal with them, and are a mess. They know it too, but still won’t accept that they are X. Treatment for them is a circle, and a rather vicious one at that. Medication, counseling, they think they are better, and sometimes they are, though relapse is something that some of us face. And then….well, then they either are fine and continue with their life and don’t get any worse, or something triggers the cycle again. Sometimes it is never gone and people fool themselves into thinking things are ok. Back at the beginning of the cycle, sometimes people feel it’s hopeless, sometimes they believe they’ll be fine. And then, in many cases, the circle starts again, with the added element of knowing that you’ve been here before. Acceptance could change that circle to a spiral, or remove it completely.

Acceptance, especially of a mental health issue, is perceived as defeat. Perception can be relative though, and the relativity of every situation is based, in part on tolerance.

Tolerance and acceptance are bed mates: long thought to be a mythological status, some people can take infinite pain and suffering. Others cry when they type too hard, or when they bark their shin. There’s usually a connection between the two, your tolerance increases the more you accept. You can tolerate your own weaknesses, and those of others, without making excuses for yourself, or them.

You can tolerate people asking questions, without getting up tight or giving advice that you do not feel comfortable with, because you are comfortable inside your own skin.
Acceptance is about realizing that you are YOU, with or without the labels. A person isn’t their job, isn’t their status, isn’t their home, isn’t their hair or eye colour. Their name is another label; it means nothing to your personal ID, not when it comes down to it, or we wouldn’t be able to adopt different names and remain the same person. Labels are for definition, and society is geared to understanding ‘where you fit’. Acceptance is about truly knowing the answer to that one and supplying it with confidence, along with anything that people need to know. And it is that crunch that needs to be addressed in anyone with mental health concerns.

Our personality, underneath, above, around our concerns, is probably constant, though sometimes we don’t realism it. There is no way to tell if we would be different “without” because behavior in most people, on the surface is in a constant state of flux. Like the waves of the sea, we change. We change in different circumstances, in different context. It’s like having a room decorated for different visitors; we adjust our behavior in the presence of others. Beneath all that though, is the person in the centre of it all. At the eye of what probably sometimes feels like a storm is a beautiful person in need of acceptance. Understanding that is the beginning to dealing with any mental health concern.

This acceptance is actually two-fold. The first is acknowledgment that there are influences to our behaviour that need to be tracked and either controlled or allowed for without making excuse and the other is to accept that though this is us, it’s not US. We are not the sum of our actions, and though they are sometimes all others remember about us, that in understanding that sometimes things are outside of our control, we can actually work to minimize ‘damage’.