When you or someone you love is first diagnosed manic-depressive, it’s hard to know what to make of this bewildering and frankly terrifying new label. How do you come to grips with an illness that often renders its victims unable to work, that nearly always leads to a lifetime of medication and expensive medical care, and leads to suicide with tragic frequency? Here are some steps that may help.
1. Quiz the doctor who gave you the label. Your first job is to make sure the diagnosis is accurate, so you need to know how she came to the conclusion that you’re bipolar. A lot of diseases can mimic bipolar disorder — among them schizophrenia and schizoaffective disorder — so ask her what in your history or current behavior points towards this diagnosis. Sometimes the symptoms of depression and mania will be classic and obvious; other times, mania may come in the form of aggression rather than grandiosity, for example, and depression may be so chronic and deep that it’s easy to overlook episodes of mild mania. You need to be skeptical without engaging in denial, which is tough.
Here are some resources that may help you to accept a diagnosis or research it further: here’s a list of symptoms from the National Alliance on Mentally Illness; and here’s another from the Depression and Bipolar Support Alliance. Here’s Wikipedia’s definition, which includes a comprehensive list of the different flavors of bipolar disorder — Bipolar I and II, cyclothemia, and so forth. AllPsych Online includes information taken from the Diagnostic and Statistical Manual IV, which psychiatrists use to diagnose mood disorders and to distinguish between them.
2. Read everything you can find about the disease, asking yourself “Is this me?” The touchstone book for most bipolar people is Kay Redfield Jamison’s memoir An Unquiet Mind: A Memoir of Moods and Madness. Many people see themselves in her description of her struggles, and are inspired by her incredible achievements despite severe illness and brutal side effects from medication that, in her judgment, she must take. I also recommend her textbook, Manic-Depressive Illness: Bipolar Disorders and Recurrent Depression, written with Frederick K. Goodwin. Though it is massive and intended for psychiatrists and psychologists, more than any other resource it helped me to accept my diagnosis and understand its implications. Both are an excellent place to start. I do not recommend her book on suicide, Night Falls Fast: Understanding Suicide, as a starting point; it can be deeply frightening, and can lead to a sense of helplessness and hopelessness concerning bipolar depression.
There are many other excellent memoirs available from the perspective of both sufferers and their family members — a search of Amazon will bring up several. There are also a slew of books on controlling bipolar disorder; I hope to begin reviewing them soon. For now, I really recommend browsing the NAMI and DBSA home sites; they offer numerous excellent resources, to the point of being bewilderingly comprehensive.
3. Try the medication prescribed for you and see what does and doesn’t work. Often you will respond well to medications intended for your condition — for instance, if you’re bipolar, you may get a lot of relief from mood stabilizers. Of course, you may be among the minority that simply can’t tolerate them, or doesn’t respond to them, and still be as bipolar as can be. If antidepressants cause manic symptoms, that’s an excellent indicator right there; it’s how I was finally diagnosed.
4. It may take years to get an accurate diagnosis from a doctor, so it’s up to you to research your symptoms thoroughly and make sure that your shrink is aware of the full range of symptoms that you experience. This will help her to tease out exactly what flavor of mood disorder you’re experiencing. As you will discover, there are innumerable variations on bipolar disorder: rapid-cycling, bipolar I, II, and even III and IV, according to some doctors. All of these point to different courses of treatment.
5. Start tracking your moods, medications, sleep patterns, and other behaviors. Here are some excellent online and hard-copy resources: the DBSA Wellness Tracker; moodtracker.com, which will produce nifty charts and even let your doctor sign on to see how you’re doing; for you old-school folks who prefer to work from hard copies, the DIY Planner site offers excellent charts to track moods and thoughts. I highly recommend the Daily Mood Journal from this site. You’ll have to page down a little to find it, but when I track my moods (which is to say, not nearly as consistently as I should), this is what I use.
6. Begin working on wellness immediately. Begin an exercise plan (after consulting with your doctor to make sure it’s safe for you); track your sleep patterns and practice good sleep habits; quit caffeine, or at least limit it drastically (yeah, I know, this coming from the four-cup-a-day queen — but it would help me!); eat well and don’t go on crazy diets in an attempt to lose weight (more on good eating habits for bipolar people in a later post). And for crying out loud, if you drink or use street drugs, stop as soon as you possibly can, using whatever resources you need (again, more on this later).
That said, don’t try to change every bad habit at once. Set priorities and focus on taking one baby step per month. Probably the best guide to changing habits is the blog Zen Habits, which offers not just excellent advice, but a support group for people who are taking the author’s 30-day challenge to change a single habit. Great stuff, from which I’ve benefited enormously.
7. As I said in a previous post, find a support group. This takes a certain suspension of disbelief. Your fellow sufferers may seem like a pathetic lot who can’t control their own lives, let alone teach you about yours. But persist: there’s an amazing amount of wisdom in these groups, and over time you’ll be surprised by the brilliance, accomplishments, and courage of even deeply ill members.
These steps should be a start. You needn’t ( and probably couldn’t) apply them all at once. The most important one is to educate yourself online and through books. Chances are that your shrink has had very little experience treating people who are seriously mentally ill (as opposed to just neurotic), so you’ll need to advocate for yourself every time you visit her.
But what if you don’t have insurance but suspect you’re bipolar and need treatment? Well, that’s a matter for another post; so is health care reform, an issue that has been obsessing me lately. Don’t you worry — this blog will agitate loudly and persistently for meaningful health care reform once I gain a little momentum.
Love to all.