Bipolar 2 From Inside and Out

Posts tagged ‘my experiences’

School, Bullying, and Mental Health

I had a horrible time in high school. I know, I know, everyone had a horrible time in high school, or at least that’s the way they remember it.

Even the people who seemed to have it all together, to be happy and satisfied, had struggles nobody knew about—family troubles, relationship problems, bad grades, pregnancy, doubt about their future, and any of a hundred other difficulties. Some of them even had diagnosed or undiagnosed mental illness.

I know I did. I was one of the weird ones, verbally bullied, mocked, teased, and insulted, though not physically harmed. (That happened in grade school, when someone threw a rock at my head with stunning accuracy.) Despite my social handicaps, I made a few friends, some of whom I’m still close to 50 years later. In that, I was very lucky.

I wasn’t diagnosed with bipolar disorder until much later in life, but the signs were there. What wasn’t there was much help. Back in the day, as far as I knew, guidance counselors only recommended classes and helped choose colleges. There was some sort of help at the district level, but that didn’t pan out.

How have things changed regarding mental health in schools? I just read an article in The Conversation that addressed the issue. The title of the article was “What role does high school play in mental health? Feeling connected to other students and staff is key,” which kind of gives away the answer. Except that it doesn’t, entirely.

Connectedness with both staff (which includes “teachers…sports coaches, counselors, and front office staff”) and other students certainly is a key, but it should probably start before 8th grade, which was the cutoff that the article uses. (Year 8 in Australian schools is the same as 8th grade in U.S. schools.)

Connectedness was associated with “higher academic achievement and showing fewer aggressive behaviours, including bullying….A sense of belonging at school is thought to support teenagers psychologically as they gain more independence and establish a stronger sense of their identity.”

The really interesting point is that “programs that involved mentoring programs and fostering problem-solving skills with others were more effective than programs focusing on changing students’ behaviour.” These, of course, could start before 8th grade. Students in middle school or junior high could well benefit, too. (I remember junior high as hideous, too.)

This school connectedness approach differs from anti-bullying programs found in many U.S. schools. Another article, from One World Education, states, “Anti-bullying programs sometimes have the opposite effect they were intending. In fact, anti-bullying programs can lead to children getting bullied more often.”

The number of children reporting bullying may be up because of these programs, but although anti-bullying programs may mean that kids report more bullying, they may not really help with how administrators and teachers respond to bullying. “There may also be crucial differences between naturally occurring bystander actions and those encouraged by schools. The effectiveness in natural situations may rely on who the student bystander is and their relationship with those involved in bullying. School programs may encourage students with poor skills to get involved which may escalate the situation,” reported The Conversation.

Another Conversation article suggested that “On average, programs in primary schools were effective. But in high schools, anti-bullying programs were just as likely to make bullying worse as they were to improve it.” And one-time anti-bullying assemblies and the ubiquitous signs and posters in school hallways are not as effective as approaches such as the ones involving connectedness and adult responses to reports of bullying.

So, what does all this have to do with mental health? The Conversation article went on to state, “Students who had high scores for school connectedness in Year 8 were more likely to have higher mental wellbeing in Year 10, even when we accounted for other factors such as gender and a history of mental health issues.”

Bullying is often associated in the press and the public mind with mental health issues, especially when students kill others or themselves. Generally, I believe the issues are more complex and profound than simply bullying. Particularly with cases involving junior high and senior high school students, causes of such incidents need to be considered in light of mental health issues aside from or in addition to bullying.

I’m not saying that bullying isn’t a factor. It surely is. But as a bullied and likely mentally ill student myself, raised in a home with guns, I never once considered violent actions. Perhaps it was my positive relationships with some teachers and librarians, or the fact that I managed to find some friends, that helped me avoid that path. I’d like to think so, anyway. Of course, organized anti-bullying efforts were not in place back then, but my own experience tells me that when studies show that connectedness with school personnel makes a difference, they’re right.


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My Guest Spot on a Mental Health Podcast

TW: Self-harm

Recently, mental health educator Ilona Poka asked if I would be interested in appearing on her podcast, Real Human Moments, to have a conversation on a topic that would reveal something about a personal struggle I had and wanted to explore in a way that might be helpful to others, or at least resonate with them.

Instantly, I said I would choose the topic of self-harm if Ilona thought that would fit in with the series. She said it would. The podcast will debut on Friday, Oct. 9, at 9:00 a.m. on YouTube and Spotify.

I’ve written about the subject of self-harm in this blog in the past, a decade or more ago. I figured it was time to revisit the subject and share my experiences with an audience who hadn’t seen those posts. For those people, here are some things I said that don’t duplicate what I said in the podcast:

The name does keep changing. The last I heard, the “approved” psychiatric term was “Non-Suicidal Self-Injury” (NSSI). Self-mutilation, deliberate self-harm, non-fatal self-harm, self-destructive acts, self-inflicted violence, parasuicide, and self-wounding are all names for the dangerous practice performed by desperate people. The subject still isn’t talked about much and carries a huge stigma. As if the mental and physical scars were not enough.

Some facts: Self-harm is not attempted suicide, though with some miscalculation it can lead to serious permanent injury or death. Most people associate it with teenage girls, but I’ve know at least one man in his 50s who cut himself fairly regularly. It is not a matter of attention-seeking, since most cutters hide their physical wounds.

As I understand it, the practice results from one of two phenomena: the build-up of painful pressure such as perfectionism, or a feeling of severe alienation to the point of numbness. Cutting is a coping mechanism, though a dangerous, dysfunctional, and unsuccessful one, to deal with pain.

Cutting isn’t going away if we ignore it. It won’t go away even if we do talk about it. (Or mock it, or gasp in horror.) But understanding self-injury is a big step.

Self-harm is basically a private thing – something we do and hide from the world. Some people are able to hide it even from their most intimate family and loved ones.

As most cutters and other people who self-harm do, I feel shame in recalling the act, and almost never speak of it. The reason I’m sharing the story in such a public forum is to let people know that not all self-harm consists of big dramatic gestures. It can start with a tiny scratch. But it is not something to be ignored. We need to talk about self-harm, educate about it, bring it out in the open, and let others know that it doesn’t have to continue.

And here are some resources for people who self-harm and the people who care about them.

S.A.F.E. alternatives https://selfinjury.com/

Self-Injury Outreach and Support: http://www.sioutreach.org (This does not appear to be active anymore, but there is a resource/FAQ sheet still available, and they recommend the book by Kim Gratz & Alexander Chapman. Freedom from self-harm: Overcoming self-injury with skills from DBT and other treatments. 2009, New Harbinger Publications. It is still available on Amazon.)

988 Crisis Hotline

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What’s Serotonin Syndrome? And How Do I Avoid It?

This week, I sent my husband to the pharmacy to pick up a prescription for me. The pharmacist told him to call me and put us all on the phone together. The prescription was for tramadol, a pain pill that I needed for a foot injury.

What the pharmacist wanted to know was whether I was aware of the possibility of serotonin syndrome. Of course, I said I was. At least I thought I was. After all, I had been on SSRIs for literally decades, and I’d heard the term before.

The pharmacist filled my scrip and included an informational leaflet on serotonin syndrome. I read it over, and that’s when I realized how little I really knew about the condition. But the thought occurred to me that it must be a fairly common thing, since they had leaflets about it on hand. (I found out it’s considered rare to uncommon, but handing out information seems wise nonetheless.)

I guess it shouldn’t have surprised me that a rare illness provokes such concern, given the number of people who take SSRIs—26 to 30 million in the US. There are approximately 4.5 million who take tramadol. I couldn’t find stats on how many people take both. Tramadol is a mild opioid that also affects serotonin receptors, so it is likely to amplify the effects of SSRIs.

And there’s the problem. The combination of the two drugs, or SSRIs and other drugs, can have the effect of increasing your serotonin without your realizing it.

In addition to reading the information sheet, which name-dropped tramadol as a particularly dangerous pairing with SSRIs, I decided to look it up online as well. I’m pretty particular about what online sources I use. (I use Wikipedia only to look up people’s bios, and I rely on sites like Mayo Clinic and Harvard Health for medical info.)

Too much serotonin causes serotonin syndrome. The effects of the increased dose include both physical and mental symptoms, from the mild (shivering and mild tremors) to the serious (coma and even death). Body temperature can become dangerously high. Cedars-Sinai lists possible effects as:

Seizures

Tremors

Muscle twitching or jerking

Restlessness or agitation

Sweating, nausea, vomiting, or diarrhea

Dilated pupils

Confusion

Rapid heart rate or blood pressure changes

High fever

I am pleased to report that I haven’t experienced any of the symptoms of serotonin syndrome (though some, like confusion and shivering, might be hard to spot in my case. I get confused easily when I’m trying to write and have to stop to take a phone call, and I always feel cold.) I am also pleased to report that I am weaning off the tramadol, taking one-half twice or three times a day rather than a whole one four times per day.

Still, just because I haven’t suffered much, if any, ill effects from the combination of tramadol and serotonin is no reason to take the chance of serotonin syndrome lightly. Other high-risk combinations with SSRIs include other SSRIs, MAOI inhibitors, some opioids, migraine meds, OTC cough medicine that contains dextromethorphan, St. John’s wort, some antibiotics or anti-nausea meds, and stimulants. A health care professional or pharmacist can explain these interactions in more detail.

Anyway, I’m not bashing SSRIs, as so many people are these days. They have saved my life and done the same for countless others. Are they overprescribed? Almost certainly, but so are antibiotics.

What I’m saying is to know the real dangers, educate yourself about them, and be careful.

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Bipolar Creativity

Does bipolar disorder enhance creativity or hinder it? That’s the question, and it’s one I want the answer to as much as anyone. After all, I am a writer, blogger, and editor. (And if you don’t think being an editor is creative, you’re probably thinking of a proofreader. I’m one of those, too.)

BP Hope magazine recently published a series of articles on the topic. In one, writer Francisco X. Stork wanted to say to a mother who reported that her son refused to take his bipolar meds, fearing that they would stifle his creativity, “If her son truly has bipolar disorder, then whatever he thinks he’s doing while in its grip is not art.”

That’s harsh, but I have an inkling of where he was coming from. Stork says that what he wrote under the influence of mania and even hypomania was “gibberish.” He points to his four published, well-received novels as being products of his creative powers while medicated properly for his bipolar disorder.

I think the operative words there are “medicated properly.” Stork adds, “Does medication affect my work? Yes. But not nearly as much as the unfettered symptoms of bipolar disorder do.”

I’m not saying that medication is necessary in order to be creative. There are no doubt and no doubt have been many creative people who were unmedicated or improperly medicated. Most of them we don’t know about because they lived before bipolar was a diagnosis or proper medication existed.

Stork’s opinions bear out my own experience. I write two blog posts of around 500-800 words each, almost every week since 12 1/2 years ago. I’ve been told by others and seen for myself that when depression or hypomania creeps up and attacks me, I lose not the overall ability to write, but the ability to write well. When I’m depressed, I write depressing things or have a hard time writing at all. I usually force myself to do it, but it’s certainly not my best writing. And when I’m hypomanic, I’ve been told (and believe) that my writing is unfocused, rambling, and/or poorly structured.

BP Hope ran another article by Donna Jackel. The key takeaways included these:

  • Mild hypomanic traits, like extra energy and fast thinking, may boost creativity, while severe symptoms can hurt it.
  • Mania may spark ideas, but mood stability can make it easier to focus and follow through.
  • Treatment doesn’t mean losing creativity, and stopping medication to protect it can carry serious risks.

Those points, I feel, are important. Jackel reports that “A review pooling 13 studies and nearly 1,900 people found a real, but very small, connection between bipolar disorder and creative-thinking scores — one that showed up mainly when people were feeling stable or had mild symptoms, and disappeared during depressive episodes. Mood state, in other words, may matter just as much as the diagnosis itself.”

Kay Redfield Jamison has also addressed the question in her many books. One question she has asked is “Does hypomania cause creativity, or do the two simply run in parallel?” And one answer may come from Sheri L. Johnson, PhD, a psychology professor at UC Berkeley, who studied people who self-identified as highly creative and living with bipolar disorder, and found that “More than half the participants described unique states of creative thinking that benefitted their work.” More than half also “considered creativity central to their identity.” She hopes that these findings will help reduce the stigma surrounding bipolar disorder and other mental illnesses.

The links between bipolar and creativity are complex. Other research has shown that “People with stronger hypomanic traits came up with more ideas overall, but when judges rated how good those ideas actually were, they scored lower on average….A flood of ideas during hypomania, in other words, isn’t the same as a flood of good ones.”

Painter Missy Douglas recommends performing other creativity-related tasks while manic or hypomanic, such as running errands and preparing her materials. “I come up with a lot of complex, involved ideas for new projects in the studio during these times, but bringing them to fruition doesn’t normally happen until I’ve calmed down, if ever,” she adds.

Creative activities can help mitigate bipolar symptoms, however. Art therapy that includes sketching, painting, and even ceramics and making collages is a way to experience emotional release. Writing and journaling are good for mood management. Other people find music and movement good as coping tools, or use expressive dance for emotional regulation.

All in all, bipolar disorder may not be good for creating art, but creating art can be good for bipolar disorder.

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Receiving Help

Sometimes it’s harder to receive help than it is to give help or to ask for it.

I’ve needed lots of help with my bipolar disorder over the years, and my husband has consistently been there to give it. His help has been the embodiment of the wedding vow “In sickness and in health.”

He’s held me when I’ve been depressed and tells me when it seems like I’m shifting into hypomania. He’s my “emotional support animal.” And he helps me with tasks of daily life like meals and showers.

Recently, though—well, really, throughout the past year—I’ve needed physical help as much as or more than emotional support. I’ve been through a series of physical challenges that started when I had a knee replacement and have progressed to the point where I am in pain every day and very nearly housebound. The kinds of help I’ve needed have been complicated and sometimes embarrassing.

I’ve been feeling guilty, needy, and insecure because my care requirements have increased so much. I know Dan is feeling insecure too, because he keeps asking me whether he’s taking care of me well enough. We’re both finding the situation stressful. I reassure him that he is doing a great job, and I try to make sure it’s not a thankless task.

Tonight we watched a movie on video together and had a pizza. It was a good break for both of us. But afterward, my bandages needed changing so I could get ready for bed. And so it goes.

Dan is about to experience his own set of physical needs as he needs a medical procedure, too. I hope I can repay a little of his care and kindness by giving some back to him. And I hope he’ll ask for help when he needs it. Like he does, I’ll do the best I can to give help while balancing both our needs.

Is all that confusing? Well, it’s no wonder. It’s a confusing topic, and I’m confused by it. Here’s what I know about help in a nutshell, though.

  • Asking for help. If you can do it, this is the first step. Ask for what you need. Ask as clearly and specifically as you can: “I’m feeling lonely/distressed/in pain. I need to talk to someone.” “My dressing needs to be changed.” “I need to eat something.” (Sometimes it’s easier if you phrase them as needs rather than wants. Asking for what you need makes it clearer that it’s not just a whim or something you could easily do without.) But if it’s all you can do at the moment, at least say, “I need help.” It improves the odds that you’ll actually get help. Then you can figure out the details later.
  • Giving help. If at all possible, give the person what they ask for. They know their own needs better than anyone else. Don’t guess. Sometimes the helper will need to ask questions to clarify. “Do you need to take your meds right now or with a meal?” “Which size bandage does this wound need?” If you can’t give the help right away, explain why not. “I’ll go to the store and pick up your other prescription. Then I’ll pick up lunch on the way back. Is that okay?” “I’ll be there in 20 minutes. Can you wait that long?”
  • Receiving help. This is the part no one tells you about, and it can be tricky. Say thank you, even if you didn’t get exactly what you asked for, and even if you’re in pain. Your helper is doing the best they can. Sometimes all they can do is part of what you need. Later, they may be able to do the rest of it.

All this is true, even if you have a paid caregiver. But if it’s a partner or family member, it’s even more essential.

Here are things to keep in mind:

You need help. Everyone does at one time or another. Everyone. No one is truly self-sufficient.

You deserve help. Help isn’t something you have to earn. Your needs are important.

You can get help. But in many cases, you have to ask for it. And you may have to keep asking. Don’t give up.

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Causes of Depression: The Debate Continues

Earlier this month, I wrote about inflammation and a possible cause of mental illness and, in the process, mentioned some of the theories about what causes depression. Now I want to revisit the debate and the pros and cons of the various possible explanations.

The leading suggested causes are emotions (anger turned inward), genetics, trauma, brain chemistry, and now bodily causes such as cell disruptions and inflammation.

Anger turned inward and other emotional mechanisms never made a lot of sense to me, though in the course of my depression (later revealed to be the depressive phase of bipolar disorder), I certainly experienced a lot of anger that I wasn’t able to express. In fact, I denied that it even existed. The emotions most associated with depression for me at that time were guilt, shame, and hopelessness. There was a veritable stew of emotions I had turned inward, including anger, but it was far from the only one. Everyone who’s depressed has their own stew of emotions, which may also include fear, self-hatred, blame, and/or resignation. Any of those could turn inward as well, punishing their sufferers with depression.

Genetics makes more sense when you consider that depression and other mental disorders can run in families. But it also arises in families with no history of depression. Statistics say that if one family member experiences major depression, other family members—parents, children, and siblings—are 30% to 50% more likely to have it too. It’s even higher in twins.

Depression’s heritability is complicated, however. There’s not a specific depression gene, but some combination of elusive genes that combine to foster that tendency. What genes they are and how they interact with each other are among the problems still to be solved. And if genetics cause depression, what to do about it is still a mystery.

Trauma, PTSD, and C-PTSD have also been implicated in depression. That really rings true. Experiencing personal trauma or witnessing it again creates a stew of emotions, many long-lasting, which could easily cause depression. If you’re living with the after-effects. potentially for years, it’s easy to see how depression might result. The science of epigenetics may explain how the genes themselves change or how they are passed on to family members. The answers may involve several different mechanisms.

Brain chemistry is the most controversial of the hypotheses for the cause of depression. The theory is that certain neurotransmitters, such as serotonin, are deficient or not properly taken up by their receptors. However, Harvard Health Publishing has noted that “It’s often said that depression results from a chemical imbalance, but that figure of speech doesn’t capture how complex the disease is. Research suggests that depression doesn’t spring from simply having too much or too little of certain brain chemicals.” The major treatment has been to try to restore the balance with medication.

Part of the problem with this theory, however, is that no one is quite sure how these drugs work, only that they do—but not for every person with depression and not reliably. The most popular antidepressants are thought to work by improving the uptake of these brain chemicals. Until recently, improving these chemical “imbalances” was the primary treatment for depression, and it did a lot of good for a lot of people. But if the receptors are flooded with neurotransmitters right away, why do they take six weeks or more to take effect? Why do the results lessen over time to the point where antidepressants quit working for some patients? Why do they have no effect on others (treatment-resistant depression)?

Neurons/Cellular Interactions and Immune Disruptions are the latest avenues being explored. Research has focused on specific areas of the brain, such as the hippocampus, which is associated with both emotion and memory. Excitatory neurons, which change gene functions, and microglia, which microglia, the brain’s immune cells, become dysregulated and cause ongoing inflammation, which can affect the brain..

Also, Columbia University has shown for the first time that neurogenesis stalls in the brains of adults with major depressive disorder. They have identified the molecular programs that control neurogenesis, which may help researchers develop new therapies.

These new theories, while they present hope for understanding depression and the brain, are still a long way from reaching a consensus, or even agreement on the causative factors. That means they’re also a long way from developing new treatments for depression. Until they do, selective serotonin reuptake inhibitors (SSRIs) will likely continue to be the front line of therapy for major depression.

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Mood Music

Last week, I got to go out and hear live music—the Stray Cats, one of my favorite bands, were having a reunion tour with some new music, and I had tickets for it. I looked forward to it with great excitement (and a little anxiety, which proved warranted when a violent thunderstorm started as we were driving home on the highway). Aside from the thunderstorm, however, the evening was magical.

And I needed it. I’ve felt myself sliding toward the depressive end of the scale lately.

My Music

When I’m depressed, I always forget the power that music has to restore me. I have plenty of music accessible to me, on my Mac, Pandora, Spotify, and other sources. I even have Pandora on my iPad and my phone, so I can have music with me at all times. But I don’t remember, and I don’t make use of this inestimable resource that is always at my fingertips.

Of course, there’s nothing to compare with live music when it comes to restorative power, and I’ve been sorely short on that. I remember times in years past when I went out to hear live music as often as several times a week. Later in life, it became a lot less common, only happening every month or so. Now, it’s so uncommon that it doesn’t happen even once a year.

Listening to music—and singing along, loudly, enthusiastically, and totally off-key—clears the cobwebs out of my brain. I return to the same music over and over, favorite singers and songwriters, bands that no longer exist, artists who are now dead. I don’t object to new music, but it doesn’t hold all the memories, the weight and history, of music that I already love.

Bibliotherapy and Music Therapy

The idea of bibliotherapy is pretty well known. Self-help books abound (for all the good they do), and therapists sometimes recommend books and articles to their clients. Music as a part of formal therapy might be much more difficult to make work, however. One person’s soul-touching music is simply background music even to others who know that person well.

No one but me can prescribe what music “works” best for me on any given day. Are what I need raucous tunes to lift me up or calm ones to settle me down? Do I crave hearing a particular artist or band? Should I search out songs by a favorite songwriter that have been covered by others? Or do I simply click shuffle and let my vast playlist decide for itself?

There’s some science behind the idea that music can be good for people with depression. Listening to music has been associated with increases in neurotransmitters like dopamine, and the lessening of the levels of the stress hormone cortisol. Emotional release is another way that music works, allowing you to access feelings that you can’t actively name. “Active engagement,” such as playing an instrument, writing lyrics, or “intentional listening,” is also said to be good for grounding. It certainly activates more areas of the brain.

Still, we’re talking about some awfully subjective findings. A study-of-studies found that TAU (Treatment As Usual) with added music therapy “was superior to TAU alone for anxiety and functioning,” but that the combination “was not more effective than TAU alone for improved quality of life.” Maybe it’s just me, but I’d think that an improvement in anxiety and functioning is an improvement in quality of life.

Formal Music Therapy

That meta-study was looking at formal music therapy, however. What does that entail? One site I visited described individual and group music therapy like this:

“In individual music therapy sessions, a therapist works one-on-one with a client to address their specific needs. This personalized approach allows the therapist to tailor interventions to the client’s preferences, whether it involves playing instruments, songwriting or listening to music. Group music therapy sessions provide a supportive environment where people can engage with others through music. These sessions may involve collaborative music-making, improvisation or group discussions about the music’s impact. Group sessions foster a sense of belonging and provide opportunities for social interaction.”

I’ve never had that kind of music therapy. I’ve had to create my own with Pandora listening sessions and tickets to the Stray Cats. But I hope that if I’m ever in need of the formal variety, there will be some place where it’s available to me. For now, I’ll enjoy the subjective improvement in anxiety and functioning that I can build on my own.

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Living With a Bipolar Family Member

Let’s start with this: A bipolar family is like any other family. They have good times and bad. They live with each other; they fight with each other; they care about one another. They deal with each other’s differences and problems. But they have the added stressor that one or more members of the family have bipolar disorder.

What does this mean for a family? It does mean that there are likely to be difficulties that other families don’t face. Depending on how severe the disorder is, whether the family supports their relative in getting treatment, and the resources available to them, their lives will look quite different.

My Family

My family was unprepared for me to develop bipolar disorder. They knew that I was different, and often didn’t know what to do with me, particularly when I went into depressive episodes and retreated from the world, crying hopelessly. I remember this happening in seventh grade in particular. I had been publicly humiliated at a birthday party and spent days curled up in a bean bag chair, sobbing uncontrollably. My parents knew that something was very wrong.

Nothing happened for quite a while. When I was in high school, my behavior had gotten so off-kilter that it was recommended I go see the district psychologist. My parents left the choice up to me, and I didn’t go, for reasons that now seem completely ridiculous. I should have taken the opportunity.

Later still, when I was diagnosed and medicated with Prozac, my family was encouraging, but had some issues. My mother, who got a lot of her information from TV talk shows, said she had heard that Prozac was a “ticking time bomb.” My father had no objection to my therapy as long as he didn’t have to go (which no one had ever mentioned). But they continued to give me love and emotional support throughout, though they never really understood my condition or what I was going through. I don’t think they ever did, but they never gave up on me.

Other Families

I think it’s vitally important for family members of someone with bipolar disorder to learn all they can about the disorder. This will require bravery and openness on their part. But learning all you can about bipolar disorder will help you help your family member in the best possible way.

Of course, the kind of support a person with bipolar needs will differ greatly depending on how severe their symptoms and their disorder are. If they are subject to mild to moderate depressive phases, don’t try to “cheer them up.” It won’t work. Instead, talk therapy and/or medication, or, if they’re in a more severe depressive phase, an alternative therapy like TMS or ECT may be called for. Hospitalization is definitely an option if the family member has suicidal ideation.

If they’re in a manic phase, don’t just tell them to “calm down.” That won’t work either. Instead, help them be more grounded and keep potentially harmful behaviors in check. How you do this will vary depending on how their mania manifests. If they are given to reckless driving, for example, you keep the car keys and drive them where they need to go. If they’re an overspender, keep the credit cards and PIN numbers out of reach.

Help your bipolar family member in specific ways. Encourage them to seek therapy. If needed, drive them to their therapist appointments. Pick up refills of their medications for them. Get them a pill caddy to make it easier to take their medications as prescribed.

If your family member is experiencing delusions or psychosis, don’t argue with them about hallucinations, which are very real to them. They may also be suffering from anosognosia, which means they don’t even recognize that they are ill. You may have to intervene more directly, whether that means taking them to the emergency room or admitting them to a psychiatric facility. Do all you can while keeping yourself and the rest of your family members safe. If you or your loved one is in immediate danger, don’t wait—take action!

Kinds of Support

It may seem that you are taking agency away from your family member, and that is to some extent true. But until they’re more stable and able to demonstrate agency over their own condition, helping them negotiate the practicalities of their illness is likely the best thing you can do. You can’t change your family member’s disorder or change them; in most cases, all you can do is support them.

Remember there’s help available. In addition to your local or county National Alliance on Mental Illness (NAMI) chapter, you can get in touch with Depression & Bipolar Support Alliance (DBSA), the Bipolar Caregivers website, or bphope.com, which has online support groups. That last link will take you to a page that lists other organizations and resources that may be available to help you.

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Wealth and Mental Health

It’s becoming more and more apparent that your socioeconomic status has a significant effect on your mental health. This is not to say that money buys happiness. It does mean that wealthy people can have mental health conditions related to their abundant resources, and that people who have mental disturbances often find their suffering to be greater if they are poor.

Little to No Money

It only makes sense that having severely limited funds can take a toll on a person. Finding money for rent, medical bills, childcare, retirement, or other recurring or one-time expenses can increase your worry and seriously affect emotional well-being. Financial hardship and mental distress often reinforce each other. These difficulties can be difficult—or even impossible—to escape.

But dealing with the problems of inadequate money can strengthen connections among family members and close friends. Shared hardships foster shared sacrifice, as well as negotiation and compromise skills. People with little money must work through problems and conflicts because they have few alternatives. This process can be distressing, but it also fosters trust, resilience, and intimacy. The Harvard Study of Adult Development has found that strong social bonds predict long, happy lives better than intelligence, genetics, or money.

Perhaps surprisingly, socioeconomic difficulties may also lead to alterations in the brain, particularly in children. This link seems to run through parts of the brain that keep a person awake and alert. The circuits change in children who get less sleep, face more stress, or spend lots of time on social media. All of these factors increase with lower economic, educational, and social opportunities. It’s been noted that preteens who grow up in areas with fewer monetary resources and less social support particularly show brain differences that are measurable on MRI scans. Researchers have voiced surprise at how strongly socioeconomic opportunity correlates with brain differences. Studies that link cognitive performance to brain differences without taking socioeconomics into account “may require reevaluation,” according to experts. “We need to find out how socioeconomics is becoming biologically embedded.”

Lots of Money

Many Americans believe that more money would improve their mental health. That can be true some of the time. Money can alleviate many of the problems that people on lower socioeconomic levels face. The wealthy don’t worry about where rent and food money will come from, how to get a job, or how to get to their job. They don’t have the problem of even a relatively minor illness or injury plunging them deep into medical debt.

When problems do arise, notes psychologist David H. Rosmarin of Harvard, the well-off assume that they can make problems (he gives as examples a son’s gambling losses or a daughter’s extreme depression) disappear via the application of money. “Parents with less resources would have no choice but to quickly confront the painful realities their children were facing,” Rosmarin observes.

Money can resolve most of those problems, providing stability and freedom. However, the ultra-wealthy can find themselves lacking hardship-developed strengths and descend into family conflict and emotional disconnection. Their relationships rely on control and expectations rather than shared bonding experiences.

Though they may have family, friends, coworkers, and even servants around them, the wealthy can easily feel isolated and alone. And loneliness has been shown to increase the risk of health problems such as cardiovascular disease, stroke, depression, and early death by roughly 30%, despite wealthy people’s broader access to top-quality health care.

My Experience

I grew up in a middle-class family, and local schools were among the best in the area. It seems that socioeconomic factors didn’t contribute much to the brain illness I began to develop as a child. The only time I experienced distress at a lack of money was when I was told that there wasn’t much money for higher education and that I should go to a community college. (I reacted to this with tears and distress at first, then applied for good schools and scholarships. Eventually, I went to an Ivy League school with multiple financial supports.)

When my husband and I got married, we were both out of work and on food stamps (as they were known back then). Later, we both got jobs that had good salaries attached to them. Rather than experiencing loneliness and disconnection, we had already built a basis of cooperation and negotiation as we worked through the hard times. We enjoyed each other and our families’ and friends’ love and support throughout. When we began to get ahead in our finances, we traveled, but felt the strain of not seeing each other often enough when we were home because of long hours working. All through this period, though, in bad times and good, I suffered from bipolar disorder. Money seemed to make little difference in that.

Now that I’m mentally more stable, I find that I am able to deal more effectively with financial crises, which, given the economy, arise fairly regularly. I do experience severe anxiety and worry at times, but have so far been able to work my way through them.

I’m not denying what the researchers say about brain differences in children from lower socioeconomic levels or that the wealthy have different sorts of emotional problems. But being aware of the possibilities of such problems and getting mental health assistance when necessary can make the difference between a distressed situation, whether well-funded or not, and a tolerable one.

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Remote Work: Help or Harm?

Many people recommend that people who are no longer able to work a full-time job in an office try working from home. (There are ads that say you can make $500 a day doing it, but these claims are dubious at best, scams at worst.) The COVID years demonstrated that it was possible for someone to work from home even at a 40-hour/week job. So what are the benefits and drawbacks of working from home if you have bipolar disorder or another mental illness?

Pros

The benefits of working from home are apparent. If your condition makes it difficult to deal with high-pressure situations with extended contact with other people, remote work is quite appealing. You gain independence, the ability to cut down on distressing social interactions, and time to spend with family members or doing other chores and projects. Working at your own pace without so many distractions may mean that you can complete what’s considered 40 hours of work in less than that. And Zoom meetings are generally more efficient and less stressful than the in-person kind.

When you decide to work from home, you have many more options open to you. You can work part-time, for example, or start your own business. You can even structure your days so that you work for a company part-time and for yourself the rest of the time. You can take on a job that involves no in-person contact with others, such as phone or computer-based customer service, telephone sales, or order-taking. Then there are jobs you can accomplish almost completely on your own, like transcription and other forms of keyboarding, writing articles for clients or instruction manuals for manufacturers, or formatting and editing résumés and other documents. Perhaps you could team with another person who does client contact. If so, you can make a business of graphic design, for example.

Cons

On the other hand, remote work has been blamed for increasing isolation and distress. A study reported in Science revealed that remote work “worsens mental health, particularly for those living alone. Although a large body of research finds that workers want to work remotely, our findings suggest that workers may not realize the costs of remote work for their well-being, which may take time to accumulate….Our estimates indicate that remote work explains a third of the deterioration in mental health between 2011 and 2024.”

It’s true that people who work at home generally have only sporadic contact with other people, except in emails, Zoom meetings, and phone calls. The Science study says that “84 percent of remote workers spend their workday entirely alone. Even when communicating online, people working from home receive less feedback from their co-workers and contact fewer people outside their immediate teams.”

They add, “Despite its advantages, remote work has significantly deepened Americans’ isolation and distress. Our research doesn’t suggest that work can occur only in the office. But it does mean that employees and companies should make a greater effort to prioritize face-to-face time with colleagues.” Any contact with other people seems to make the difference: “People who lived with their spouse and kids saw their mental health hold fairly steady, while those who lived alone experienced a 20 percent decrease in mental well-being.”

My Experience

I used to work full-time in offices, spending a full 17 years at one office job and some time at others. During that time, I struggled with isolation and detachment from my coworkers. I tried. But the corporate culture of “mandatory fun” such as company picnics and parties struck me as challenging and empty, and only a few coworkers included me in their lunch hours and casual conversation. I blame myself as much as anyone. My social skills have never been terrific, especially when it comes to small talk.

Before I was let go from the 17-year job, I increased my own isolation by keeping my office door closed. My job did entail some aspects that required close attention to detail without interruptions. But that was an excuse. I preferred privacy even when doing normal busy work. Although closing one’s door was not strictly forbidden, an open-door policy prevailed. My closed door meant cutting myself off from interaction.

Since leaving the corporate world, I have worked at home at a series of jobs—transcription, editing, ghostwriting, book reviewing, and the like. In most of these jobs, I set my own hours, but I am indeed alone most of the day. I get regular calls from my husband when he’s on his breaks at his outside, people-y job. It helps. And I keep up with remote friends via email, Facebook, phone, and occasional visits.

Has my mental health deteriorated? Not appreciably. I have work to do some of the time and my blogs to write, emails to respond to, books to read, and friends to chat with. I’m occasionally unfocused, and I do experience mild depression and hypomania, but the depression is not anything like the depths of it when I worked in an office.

I can’t imagine going back to office work at this time in my life. I’m happy and stable enough where I am. I don’t want to mess with that.

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