[HN Gopher] On Being Bipolar
___________________________________________________________________
On Being Bipolar
Author : pseudolus
Score : 160 points
Date : 2020-10-03 10:16 UTC (1 days ago)
(HTM) web link (thewalrus.ca)
(TXT) w3m dump (thewalrus.ca)
| reify_null wrote:
| Interesting article. I've been diagnosed with bipolar type 1
| myself. I still struggle with accepting having that particular
| mental illness for two reasons; the way it is depicted in media
| and popular culture, and it being seen as a lifelong thing you
| can't possible get rid of. This despite having a psychotic
| episode twice. You'd think these things are clear cut. But
| they're not.
|
| The first part of the article is spot on, really. Even medical
| professionals have strong biases that are pretty visible even
| when you're institutionalized. Mentioning drug use is almost
| guaranteed to put you in a certain classification bucket. What's
| more, once a history is taken, while being psychotic or
| (hypo)manic, you are once again put into some kind of
| classification bucket, despite not being well enough to frame
| things properly.
|
| I don't mean to be completely negative here. Once you are
| institutionalized, this is needed to get things back on track,
| start some kind of medication or figure out some first line
| treatment. However, the stigma afterwards is very real. GP's,
| psychologists, even surgeons take in this information after the
| fact, and its almost factual. And the effects the author mentions
| are very much there; imagined or not, they are there for the ill
| person. Being extra careful not to seem overly rash, overly
| emotional, too impulsive around doctors. Just because they have
| your best interests at heart, doesn't mean they're free from
| bias.
| cmehdy wrote:
| One of the most fantastically positive things that happened to
| me on a journey for better mental health was to encounter a
| seasoned psychiatrist who did two amazing things:
|
| (1) He didn't try to always resort to whatever is brand new but
| actually gave choices and explanations that include treatments
| considered "old" and misunderstood to be ineffective (for
| example in my case, going with MAOI/RIMA for depression instead
| of the ever-so-new fancy SSRI of the day - and that alone was a
| life-changer already).
|
| (2) He actually had an open ear for my personal experiences
| with a (very) wide range of things in a "non-medical"
| environment, and used the input in a non-judgmental way to
| calibrate his understanding of my subjective reports and to
| find better treatment strategies - also including me in the
| process, therefore making me the main actor of my own healing
| process.
|
| On the other hand, I've stepped into rooms with a psychologist
| and shared about experiences with a wide range of drugs (mainly
| focusing on empathogen-entactogen and psychedelics for the
| heavy experiences, but I've covered a wide range) and gotten
| the regressive "this is all shit/poison" rhetoric, thus solidly
| ensuring that I would mentally check out when they turn around
| and try to offer tools to address cognitive biases and practice
| mindfulness, both of which they can't even apply to their own
| selves.
| kayodelycaon wrote:
| I have to second your two points on finding a seasoned
| psychiatrist. I also found an extremely good therapist who
| didn't case judgement on my experiences.
|
| Between the two of them, I was able to take charge of my own
| treatment and be able to help myself instead of being backed
| into a corner.
|
| Poor mental health treatment just makes things worse. I have
| friends who badly need therapy and coping skill but can't get
| over a therapist who hurt them in the past.
| reify_null wrote:
| Interesting. I have a negative bias towards psychiatrists
| myself. Experiences with psychologists weren't that great
| either until I went into therapy with an analytical
| psychologist. None of this mindfulness stuff, which I
| practiced myself for years already, but a complete focus on
| actually figuring things out and understanding why I see
| things the way I do. I don't think there is a single answer
| for everyone (not implying that you think so). The
| psychologist doesn't really stop me from talking about
| experiences with drugs, but doesn't really see it as
| something helpful.
|
| I currently see my illness as existing of two components;
| genetic and environmental triggers. Stress and drugs,
| together with past trauma interact with my genetic
| disposition towards psychosis/mania.
|
| Drinking less coffee, sticking to a routine, no drugs
| (particularly psychedelics), and sorting through my internal
| web of views with a psychologist, it looks liek that's the
| solution for me. Medication is part of it, mainly to provide
| some stabilization while I sort things out. It doesn't really
| jive well with how psychiatrists go about things though, in
| my experience, since they seem to think I have to be on it
| til the end of time. I would love to have contact with a
| psychiatrist I trust, so I could make some sense out of the
| medication part of my healing process.
| cmehdy wrote:
| Our stories have more in common than you might think. I've
| always had a focus on trying to understand things, but I've
| also encountered people who would throw pragmatism and
| logic out the window as soon as I'd get real.
|
| For me, (recreational) drugs are not the solution at all
| but they've been a part of my life and they're part of an
| explanation of things, so any therapist who would dismiss
| the experience entirely also dismisses the nature of my
| approach to those experiences, and in doing so they create
| their own blind spot and less useful to me because they've
| already established that they're unwilling or incapable of
| looking at the big picture.
|
| The psychiatrist I'm talking about never mentions drugs
| actively, never sings praises of any of those experiences
| or even makes any particularly positive comment about them,
| but he doesn't disparage them and he inquires about what
| the experiences were ("what pills? what dosage?" etc,
| usually when relevant - otherwise I'll volunteer what I
| think is relevant without fear). And he is willing to
| answer my questions ("what are the advantages/drawbacks
| when taking a little bit more than the nominal dose for
| this treatment?"), and is willing to try different
| approaches that we discuss and reflect on.
|
| This builds a trust relationship that does more for
| treatment than people might think. I don't need to amplify
| the meds using doses of Abilify and whatnot, I don't need
| to deal with side-effects that go unadressed, etc. If there
| are issues, I can talk to someone who isn't prejudiced, who
| is willing to offer alternatives, willing to discuss the
| compromises related to those alternatives, and willing to
| devise a plan that is medically sound to get from A to B.
|
| As for the psychiatric help, I'm glad that for you not
| taking coffee and doing sports is enough. I've mistakenly
| thought that for years (more vitamin D, "it's S.A.D", no
| coffee for months, more exercise, etc etc), but I had to
| hit a wall hard before I encountered the help that I
| realized I needed my whole life.
|
| For people who relate to this thread (with BPD) or people
| with severe depression and other psychiatric issues, proper
| psychiatric help is not really an optional thing but much
| more like the knee surgery required to walk properly or the
| wheelchair that is required to be autonomous: whether
| temporary (former) or permanent (latter), it's an essential
| element that can enable some people to actually live, and
| live well.
| reify_null wrote:
| > As for the psychiatric help, I'm glad that for you not
| taking coffee and doing sports is enough. I've mistakenly
| thought that for years (more vitamin D, "it's S.A.D", no
| coffee for months, more exercise, etc etc), but I had to
| hit a wall hard before I encountered the help that I
| realized I needed my whole life.
|
| This is actually what I'm afraid of. I haven't confirmed
| it yet, I'm still on my medication now. I might be
| developing some kidney problems (VPA is hard on kidneys
| and liver), so who knows. Based on your experience, and
| what others have mentioned, I might look for a
| psychiatrist I trust as an out-patient and see what my
| options are. I'm still not convinced the medication is
| stopping any psychosis either, but I'd rather not find
| that out the hard way.
| cmehdy wrote:
| One thing you should make sure to retain is some trust in
| yourself. A fitting psychiatrist might help, but any
| random psychiatrist might not. Trying out stuff might
| take some time and be a delicate balance, but all this
| can get difficult if there isn't a two-way relationship
| of trust and respect with the doctor.
|
| The first psychiatrists I met diagnosed me with the wrong
| condition and prescribed completely ineffective meds (I'm
| talking an entirely different category of meds
| altogether, entirely useless stuff that I still took just
| to show them that I am trying). I then met a better
| psychiatrist who was definitely more on the money when it
| comes to the diagnosis but was still inexperienced and
| not really interested in developing any kind of
| relationship of trust, so he prescribed to me whatever
| was at the top of his checklist and pretty much
| disregarded feedback, trying to double-down on the
| inefficiency of treatment with MORE treatment and without
| reasonable explanations when I asked "what about
| alternatives?".
|
| After a good 6 months of that, I had started to talk in
| parallel with the person I've praised in my first
| message, and he agreed to take me on as a patient if I
| wanted. I politely moved on from the previous experience,
| pretty much immediately started changing the prescription
| to something that came out naturally out of a more in-
| depth and non-judgmental discussion with my new
| psychiatrist, and since then I've basically been stable.
| Every follow-up since has been about fine-tuning things,
| discussing potential alternatives if any side-effect
| would become difficult or the positive effects of the
| meds would wear off, and what tradeoffs different
| approaches could have from a medical standpoint but also
| with personal logistics (including cost).
|
| To the first ones I met, I was barely a line on a piece
| of paper, and their own confirmation bias made them
| prescribe what they had on the shelf in their office.
|
| To the second one, I was a person but "the whole thing"
| was still a blur and he "stuck with the script",
| correctly diagnosing things but not deviating from what
| his textbooks probably indicate to be the go-tos.
|
| The last one saw me as a person, established right away
| that he was open to my input and very much no-bullshit,
| pragmatic and digging into a longer history of psychiatry
| and interactions with patients. I'm not there to make a
| friend, I'm not there to get free meds, I'm there to
| figure out how to not constantly suffer as much and what
| proportion of that can be to an extent carried through
| medication (until I can do without, if/whenever
| possible).
|
| I stopped _trying to die_ already at the second one, but
| I only _started living_ with that third one. And that
| makes a world of difference. I hope that whatever journey
| you 're on, you get to alleviate the pain in your way.
| reify_null wrote:
| I recognize what you're saying about trusting yourself.
| Part of having experienced psychosis is regaining trust
| in my own mind, afraid of 'the bottom falling out'. I
| feel I'm doing well there. I'm also wondering if they
| have diagnosed me correctly. I pretty much haven't had
| any depressive symptoms for at least five years now, it
| stopped a long time before I ever had a psychotic
| episode. In fact, the depression was in line with my
| living conditions, it was something that made perfect
| sense at the time. Sounds like a question for a
| psychiatrist.
|
| Unfortunately, like you experienced too, part of the
| healthcare industry still has a parent-child relationship
| between doctor and patient. I notice that the doctors
| which worked out, never really had that aspect, but
| treated me as someone with valid input. Especially for
| me, I like to understand things, dive into them, see what
| the mechanics of medication, disease and diagnosis are
| all about. It doesn't really work well with a doctor that
| just wants to prescribe whatever they think is right. I'm
| sure you can relate to that.
|
| Thanks for the well wishes. I can say that I've been
| pretty much completely symptom free for a year now, and
| it does feel like I've only now started to really explore
| myself, and find out what I want out of life. All the
| best to you as well.
| kayodelycaon wrote:
| > In my experience, since they seem to think I have to be
| on it til the end of time.
|
| Easily explained by survivorship bias. They only see the
| people who need to be on it for the rest of their lives.
|
| There are people who will need to be on medication their
| entire lives. I'm probably one of them. My psychosis and
| primary insomnia hasn't been treatable with anything else.
| reify_null wrote:
| Thanks for that perspective. That could explain it
| indeed. The psychiatrists I saw were the ones working the
| ward, not outpatients. So they really do see the worst of
| it. That being said, I really do admire the work they do,
| the people there are typically not easy to work with, at
| least not while they are on the ward.
|
| I am lucky in that I'm on a low dose of not too strong
| medication (valproate acid, 600mg slow release daily). If
| I go off (I've weaned off it myself before) nothing
| really extreme seems to happen. Hope you are doing well
| with your medication.
| wtracy wrote:
| Meanwhile, I know of a practicing therapist in my community
| who stops just short of _encouraging_ patients to experiment
| with hallucinogenics. (She 's also fairly vocally anti-
| vaccine.)
|
| The range of attitudes within the profession just astounds
| me.
| kayodelycaon wrote:
| A lot of this rings true to me. I'm a rather bad case of type 1
| (classic manic depression) and high functioning. I wrote up a
| blog post about how I managed to spend my entire life hiding
| continuous psychosis.
|
| https://kayode.co/blog/4106/living-with-psychosis/
|
| Hiding is what I've always done. It's exhausting having to appear
| normal all the time.
|
| I'm fortunate to have understanding friends. Instead of me
| constantly bitching, we have code words for how I'm feeling. If
| I'm good, that makes I'm stable and relatively happy. If I'm
| okay, I'm probably depressed. It goes on from there. I'm able to
| talk about how I feel without getting into the details no one
| want to hear every day.
|
| At work, I'm extremely fortunate to have a boss whose wife is
| bipolar. I've been able to get ADA accommodations that give me
| the flexibility and restrictions I need to go to work every week.
| This is the first job I've ever had this luxury.
|
| And it really is a luxury. This is my first job where I've had
| any kind of accommodation. I've worked at places where I've
| pretended to have the flu just to take a day off for mental
| health.
|
| Even now everyone, except my boss and friends, treats taking time
| off for mental health like vacations, because that's the
| experience for them. I've used so much PTO, I never get a
| vacation. Instead, I'm always at home on days off, dealing with a
| hell that my coworkers have never come close to experiencing.
|
| I could go on a lot longer because there is no limit to how many
| things I have to deal with. But no one really wants to read that
| and I don't want to write it again.
| cmehdy wrote:
| I have a lot of respect for your ability to make a blog about
| something that is already overwhelming enough to "just" be
| suffering.
|
| Being both high functioning and with severe psychiatric issues
| is very weird when dealing with the world: you can sometimes
| drain your energy to almost have a "super" ability to do things
| (focus, make stuff, communicate, whatever it is), yet you're
| actually suffering immensely and it often doesn't help that you
| might get praised for the very same things that you should get
| help for. There's fear of losing some of those bits when you
| enter a path of medical treatments, there's immense energy
| spent doing inner work that people who are considered "healthy"
| never really _have_ to be doing. It 's like the neighbour is
| driving up a hill while you're hiking up a mountain with a
| broken leg.
|
| So here's a hug.
| cannaceo wrote:
| Can I ask what ADA accommodations you were able to seek? My
| sister has type 1 and is currently in mania. She worked for me
| for the last 2 years because she is "unable to hold a regular
| job" but I won't be able to continue employing her after this
| episode.
| kayodelycaon wrote:
| This is what I have documented:
|
| - Intermittent FMLA. (1)
|
| - Being able take extended breaks during the day and make up
| hours without using FMLA. (Flex time)
|
| - Work from home when I need to.
|
| - No on call. (Company has to respect my consistent sleep
| schedule.)
|
| - No overtime. Maximum of 40 working hours per week.
|
| - Ability to take extended leave for inpatient care.
|
| My team knows I'm out occasionally for medical issues but
| they don't have an issue with it.
|
| I really do work for a wonderful company that takes care of
| their employees. Having someone's kid interrupt a zoom
| meeting is common right now and no one except the parent gets
| annoyed by it. Even the CEO isn't immune from his kids
| interrupting an all hands meeting. He just laughs and sets
| the tone for the rest of the company. :)
|
| 1: Basically, I can take time off in 1 hour increments for
| any medical reason, any time.
| kingkawn wrote:
| Infinite respect to you for facing and surviving your
| experience of life.
|
| I wish that society had a meaningful role for people who have
| had this experience that could make full use of their emotional
| depth in a way that was valuable to us all and allowed you to
| not feel like you have to hide your interior world.
|
| Someday we, as a broad group, will get to that point, rather
| than stigmatizing and hiding it to your and everyone's
| detriment.
|
| Your effort to speak openly about all of this is heroic.
|
| Thank you.
| kayodelycaon wrote:
| > wish that society had a meaningful role
|
| We kind of do. Storytellers. I write fiction. (And a few blog
| posts) A lot of my own experience with the extremes of the
| human emotion gets rolled into what I create.
| kingkawn wrote:
| That is one of the most insightful things I've read all
| year. Thanks!
| aspaceman wrote:
| > Instead of me constantly bitching, we have code words for how
| I'm feeling. If I'm good, that makes I'm stable and relatively
| happy. If I'm okay, I'm probably depressed. It goes on from
| there. I'm able to talk about how I feel without getting into
| the details no one want to hear every day.
|
| I want to mention how kind and empathetic this is. My mother
| had bipolar disorder and I'm very appreciative reading this
| comment from you.
| elboru wrote:
| If no one really wanted to read that, then your comment
| wouldn't be the first one on this thread. Thank you for sharing
| with us.
| kayodelycaon wrote:
| I'm very glad people want to read my story but I think this
| comment makes my point. It's at the top because I carefully
| wrote it and purposefully kept it short and digestible. The
| long details of my life experience are linked rather than
| written out. People opt in to read more.
|
| From past experience, the long, rambling, barely coherent
| rants I start with aren't effective or well received. :)
|
| Note: This comment was eight times longer and took about 8
| minutes to reduce to what I have here. And I seriously
| considered deleting it because it doesn't add much to the
| conversation. Only 20% of the comments I write survive to be
| posted.
| elboru wrote:
| I can relate to that, I would say 50% of mine survive, I
| usually stop just before clicking the submit button.
| Anyways you have your reasons and I respect that.
| wadkar wrote:
| And here I was thinking I must be the only person who
| deletes their comments instead of submitting them!
|
| Thank you. I cannot tell you how relieved I am feeling
| right now.
| Kye wrote:
| I'm glad you wrote about it! I'll add it to my TBR list. Which,
| coincidentally, includes a collection of stories you're in.
| loceng wrote:
| "But no one really wants to read that and I don't want to write
| it again."
|
| I have this same issue but with severe chronic pain that
| impacts my executive function greatly, worsened by physical
| activity further sensitizing my nervous system - so I depend on
| low activity routine to not make life even more intolerable for
| 2-3+ days it takes to recover to getting clear thought and
| mental function again - to be able to orient myself again; it
| doesn't make a difference if I do share it though either, even
| though there are still options I could try to reduce the pain -
| it's been difficult to find a doctor who's actually willing to
| work with me and so much time between appointments when
| exploring new potential avenues. The challenge I've found is
| mostly running into indoctrination, lack of critical thinking,
| lack of willingness to accommodate to read long-form
| explanations of what I write out for my experience to get
| doctors or professionals on the same page of understanding. I
| have mostly given up and am winding down my hopes or fantasy of
| a capable, productive, rewarding future now though - planning
| to return "home" to an unfinished, untidy, cluttered house that
| no one should live in, where my mother has been mostly alone
| the past 5 years since my father passed away horrifically - so
| I'm no longer paying rent anywhere nor have any obligations and
| will quietly disappear from the universe as barely anyone will
| know that I will be gone.
| gnramires wrote:
| I encourage you to investigate your issue. I've heard
| countless cases of people going to countless doctors until
| they've found one that could pin down their issue. Look for
| ones interested in investigating your condition, it could be
| a journey. I had a number of issues giving me chronic
| headaches for years, and it took a while slowly removing
| variables and pinning things down until I got better; then it
| was like having a second life.
| ytwySXpMbS wrote:
| What were the causes if you don't mind me asking?
| luckylion wrote:
| I can understand the issue you describe with doctors not
| being willing to deviate from their standard training. It's
| exhausting when they don't listen ("right, right, you've read
| something on the internet, yes, yes... why don't you let me
| take a look at it first") or they only try their common
| approaches that have failed before and if you don't fit that
| mold, well, too bad.
|
| I hope you find a way to manage (or better yet, get rid of)
| your pain. It's such a waste that, unless you're famous, rich
| or a rare, scientifically interesting case, the point of
| "sorry, there's nothing else I'm willing to do for you" comes
| rather quickly. It seems with most chronic problems, you need
| to become an expert and then find and convince somebody who
| is certified and can write a prescription.
| [deleted]
| howtoquitwell wrote:
| The precariousness the author describes is real, at least in my
| experience. I'm 20 years into a career that many would find
| enviable except strangely devoid of any tenures longer than about
| 30 months, because that's the longest I've been able to surf my
| bipolar swings before imploding. Those meltdowns traditionally
| resulted in me running away from work to fall into a boozy
| depressive mess for six months, them returning once the mania
| kicked in again.
|
| This year, a low coincided with the onset of COVID lockdown and I
| put myself in the hospital. Not checked myself in: I tried to
| hurt myself badly enough to be in the ER, ICU, and then inpatient
| psych care.
|
| Even there, I was the "eloquent, self-reflective" model patient,
| much like I've been (in the manic times) the persuasive,
| thoughtful, creative employee that people couldn't wait to hire
| and promote.
|
| After a couple of months of medical leave I went back to my
| previous job instead of quitting. It was driven largely by
| financial insecurity, as I had burned through my savings after
| not working at all in 2019...once again, due to being in a low
| phase _and_ getting sober and having no bandwidth left for
| anything else.
|
| Being back to work at a place that has seen me swing from "A+
| performer, definite strong leadership/promotion track, etc." to
| "can I keep a job, any job here? Ideally one that won't demand
| more than 40 hours a week of my time?" is far harder than jumping
| into an impossible workload while manic. Grinding out yet another
| week full of stand-ups and PRs when I have zero confidence is
| gut-wrenching, and on top of it all I have to be there and stable
| and not a depressive mess for my family, because I can't let them
| take care of me while the world outside is on fire.
|
| All I want to do is get on my bike and ride for six hours a day,
| then cook dinner for my family, then do a little programming and
| writing before I go to bed. Literally, that's it.
|
| Unfortunately, that's not a lifestyle I can sustain, even if I
| suspect it might be the thing that would keep me alive past 40.
| So it's back to work, taking my meds every day, and lying through
| my teeth when folks ask how I'm doing.
| quantumwoke wrote:
| This seems at least tangentially related to the psilocybin thread
| currently on the front page. I have read in journals that bipolar
| is a disease of neuroinflammation upregulated by cytokines etc.
| in the brain. My hypothesis is that this could be related to the
| gut microbiome which has been proven in studies to affect the
| brain directly. Maybe you really are what you eat?
| kayodelycaon wrote:
| Almost all bipolar people have relatives that were bipolar.
| That points rather strongly to a genetic cause than an
| environmental one.
| quantumwoke wrote:
| My understanding from the research is that the aetiology is
| not well understood at all, and that certain individuals are
| more susceptible to triggers. Note that although you may be
| genetically susceptible to a disease it does not mean that
| another cause (or organism!) might interact with those genes
| and result in said disease.
| kayodelycaon wrote:
| The problem is... "Maybe you really are what you eat?"
| seems to put the blame solely on the bipolar person for not
| eating properly.
|
| I don't know about other bipolar people but I'm tired of
| being told it's my fault I'm bipolar.
| quantumwoke wrote:
| Ah, that was not my intention at all. I know people with
| bipolar and would never suggest that it was their fault.
| It's a poorly understood and vastly complex disease and
| any clue as its possible origin and possible therapeutic
| targets would be good.
| rcthompson wrote:
| The complicating factor is that every
| disease/disorder/condition (both mental and physical) is a
| combination of genetics, environment, _and_ the nonlinear
| interaction of genetics and environment. We can measure the
| genetic factors, and with somewhat more difficulty, the
| environmental factors. But that interaction term is extremely
| difficult to measure. It encompasses things like those
| mentioned in the article: the fact that "sick" people often
| don't appear sick unless there is an environmental stressor
| exacerbating their condition. This kind of conditional effect
| is very hard to measure scientifically.
| jmcgough wrote:
| Bipolar is one of the more heritable diseases. If one
| person has bipolar, every one of their direct relatives
| (children, bothers, parents) have a 10% chance of also
| having bipolar.
|
| As part of my experience coming to terms with bp2, I did a
| family history and found out that almost everyone in my
| father's (high-functioning and accomplished) family had
| been institutionalized.
| ddorian43 wrote:
| Feel free to link/create/sponsor/recommend clinical trials or
| research.
| dirtnugget wrote:
| Also bipolar. Episodes often start with life-changing events. I
| highly doubt that food is to point a finger at here. My last
| episode was really triggered by me leaving my job and going
| jobless for the first time. I was eating well, fresh and self-
| cooked. Then during mania I could not eat a single thing. Also
| could not sleep. For 3 months straight.
|
| The worst thing you can do here is to generalize.
| smcleod wrote:
| Anecdotally the symptoms can already be present - but
| manageable - then severe trauma(s) trigger an extreme
| worsening of the cycle between the highs and the lows.
|
| Getting back to a "manageable" state would be ideal however
| future (and even perhaps far more minor) trauma may prove to
| be a significant barrier and potentially trigger relapses
| resulting in quite a vicious cycle.
|
| Certainly a very complex thing to explain to people and
| carries a lot of stigma.
| dirtnugget wrote:
| In my case, looking back, I think I have already lived
| through a handful of episodes of lower but still damaging
| intensity. I first really started recognizing this pattern
| when I had this sort of episode where it became clear to
| each and every person around you, that there is something
| off. It was like I was on cocaine 24/7, paired with extreme
| paranoia (I moved to a rather bad neighborhood in a big
| city two years before).
|
| Ever since this initial awareness and diagnosis, I have
| stepped back from a lot of people, and many stepped away
| from me. I was left in a void where I had basically I
| social interaction.
|
| While it was extremely depressing I have the feeling, at
| least in my case, that less communication can help to find
| a manageable state. Today it's easier for me to manage,
| although still not perfect. I declined any medical
| treatment except for one dose of Haloperidol which I agreed
| to after I had freaked out and the police had to tie me
| down and send me to psychiatry. (As it happened I
| accidentally ran into a drug handover in the midst of my
| mania, I was afraid to die and started losing it
| completely)
|
| Nobody really understands the hurricane of feelings one is
| going through, it doesn't really make sense to try and
| explain it to people.
| kayodelycaon wrote:
| > Nobody really understands the hurricane of feelings one
| is going through, it doesn't really make sense to try and
| explain it to people.
|
| It can be done but it requires finding the points in a
| person's experience that mirror my own to some degree.
| Building on that, you can paint a picture they can
| understand.
|
| I like the example of telling a person they need to keep
| eight words in their head all day long with no notes.
| Then they'll be quizzed about those words randomly
| throughout the day. If they fail, they have to sit
| quietly in a chair for the next hour.
|
| Then I ask them how pissed off they'd be if they were
| interrupted in the middle of a task by me asking them to
| list the words in reverse alphabetical order by the fifth
| letter. Repeat several times an hour with different
| sorting and filtering criteria.
| dirtnugget wrote:
| The closest thing I could make some people relate to was
| that it was like being on LSD, just that it comes in
| waves.
|
| I also happen to have experimented with lots of
| psychedelics in the prior years and I'm not gonna deny
| that this may have intensified the symptoms. Mania felt
| like an acid flashback.
|
| All this sudden energy and creativity, but also the
| scatteredness (not sure this is a word). It was too much
| to handle.
|
| At the time I was programming up to 10h per day. I could
| not remember names of people I met the day before, also I
| had blackouts. My brain was not able to process. With
| your experiment I would have failed miserably because
| sitting still for an hour was not manageable.
| DJBunnies wrote:
| I'm bipolar. It is far more complex than "what you eat."
| quantumwoke wrote:
| Forgive me for being slightly facetious with the saying, of
| course there are many more factors involved that require
| close and careful study.
| kekebo wrote:
| From what I understand the etiology of bipolar is not well
| understood, with different correlations like dopamine
| dysregulation or the inflammatory markers you mention (which
| could indeed be influenced by the gut biome), but as with
| unipolar depression it's probably too simplistic an approach to
| try and reduce it to a single factor.
| wtracy wrote:
| I knew someone with BPD.
|
| She might have been the hardest-working person I've known. She
| also couldn't hold down a job to save her life.
|
| She's the reason I can't ever see eye to eye with anyone who
| wants to cut our social safety nets or who sees welfare
| recipients as somehow subhuman.
| PragmaticPulp wrote:
| > She might have been the hardest-working person I've known.
| She also couldn't hold down a job to save her life.
|
| A bipolar patient in a hypomanic phase can feel strong energy,
| motivation, creativity, and euphoria. These people can be fun
| to be around and work with for a short while, at least before
| the downsides of compromised judgment, inappropriate social
| disinhibition, and other downsides become problematic.
| Hypomanic people can work themselves into greater
| responsibilities at the office, which quickly comes crumbling
| down when they switch to a depressive episode and can't get
| anything done. Or they can progress to a full manic episode,
| where extremely compromised judgment, delusions of grandeur,
| inappropriate risk taking, inability to concentrate on one
| task, and other negative effects take over.
|
| One of the unique challenges of dealing with bipolar
| individuals is that they might actually enjoy their hypomanic
| phases, despite the obvious negative consequences. It's some
| times difficult to convince them to give up the hypomanic weeks
| for the sake of arriving at a stable baseline. They might
| become convinced that their hypomanic phase is actually their
| "normal" self, as they're often blinded to the negatives of
| their behavior during these periods.
|
| > She's the reason I can't ever see eye to eye with anyone who
| wants to cut our social safety nets or who sees welfare
| recipients as somehow subhuman.
|
| I fully agree that robust social safety nets are important for
| our society and that welfare recipients should not be looked
| down upon.
|
| However, it's more of a bridge than a long-term solution. The
| best path forward for most patients is to be treated with
| stabilizing medication and to return to the structure and
| accountability of having a job, ideally. Bipolar patients tend
| to struggle with unlimited free time, unstructured days, and no
| accountability to their work peers. The key is robust and
| ongoing medical treatment and monitoring.
|
| Again, to be clear, I'm not disagreeing that social safety nets
| are a bad thing or that welfare recipients should be looked
| down upon.
| fsckboy wrote:
| just to clarify, Borderline Personality Disorder is very
| different from Bipolar Disorder
| forgotmypw17 wrote:
| Something something neurodiversity, evolutionary traits,
| situational advantages.
|
| Something something society labeling as a dis-order anything
| which doesn't suit the order.
|
| Something something choosing between no treatment and risk of
| involuntary commitment, overmedication, and life-long stigmai
| if diagnosed on paper.
| dang wrote:
| Can you please not post flamewar-style comments to HN? We're
| trying for something rather different here.
|
| https://news.ycombinator.com/newsguidelines.html
| vmception wrote:
| Hm reminds me of a traumatic but illuminating acid trip and the
| continual guessing about "physical brain damage".
|
| Has anyone with natural psychosis also had simultaneous acid
| induced psychosis, and if so what happened?
| Taek wrote:
| LSD induced psychosis is stronger and pretty much overrides any
| bipolar psychosis I've ever had. My bipolar visual
| hallucinations typically lasted seconds to minutes, typically
| only happened during deep anxiety, and could be shooken off.
| LSD hallucinations last multiple hours, are very strong, happen
| in any mental state, and can't be shooken off.
|
| Bipolar psychosis is a lot weaker, feels more like religion,
| can last many weeks. The scariest types of psychosis are the
| ones that are hard to distinguish from the real world. Talking
| to trees while in psychosis is easy to talk yourself through.
| Believing someone wants to marry you is a much harder psychosis
| to reason through, and can result in badly damaged friendships
| if you don't figure it out in time.
|
| LSD psychosis is strong and warped and pretty much always
| dispelled easily as soon as you are in a calm frame of mind.
|
| I've found that in the weeks following a trip, bipolar cycles
| are much more tame and manageable.
|
| I know other bipolar individuals who also found similar relief
| in LSD.
| vmception wrote:
| That's very interesting. So the LSD psychosis shows you how
| intense it can be and makes normal psychosis feel that much
| milder?
| Taek wrote:
| It's not that it makes normal psychosis feel milder, it's
| that after trips my mood is more stable and I simply don't
| have as much bipolar psychosis.
|
| I know other psychedelics (MDMA, Ketamine) can have this
| impact on depression, where one dose will stabilize a
| patient for many weeks after and I imagine its similar,
| though it's not as well studied.
| vmception wrote:
| I've read similar stories. I wish they were chronicled in
| medical journals.
| kayodelycaon wrote:
| Ketamine is being studied as a treatment for depression
| and bipolar.
| markhollis wrote:
| I was a month ago diagnosed with bipolar type 2, together with
| ASS. I experience sleep problems. Some feelings in this article
| are familiar. To me, it was the feeling of being excluded for
| life from people. Also I am going through work problems. I find
| myself at a difficult place in life now...
| pdenton wrote:
| My wife has bipolar and I've got ASS. Remember that you're your
| own person in the first place, period. You're not your label,
| you merely /have/ a label. TFA makes this mistake from the
| outset in the title. It should've read "having" not "being".
|
| There's no cure for these labels, but one can recover. To quote
| Patricia Deegan:
|
| _Recovery does not refer to an end product or result._ _It
| does not mean that one is "cured"._ _In fact, recovery is
| marked by an ever-deepening acceptance of our limitations._
| _But now, rather than being an occasion for despair, we find
| that our personal limitations are the ground from which spring
| our own unique possibilities._ _This is the paradox of recovery
| i.e., that in accepting what we cannot do or be, we begin to
| discover who we can be and what we can do._ _Thus, recovery is
| a process._ _It is a way of life._ _It is an attitude and a way
| of approaching the day's challenges._ _It is not a perfectly
| linear process._ _Like the sea rose, recovery has its seasons,
| its time of downward growth into the darkness to secure new
| roots and then the times of breaking out into the sunlight._
| _But most of all recovery is a slow, deliberate process that
| occurs by poking through one little grain of sand at a time._
|
| Only you are the expert of you. That said, there exist recovery
| colleges that can provide peer support. You're not alone.
| kayodelycaon wrote:
| I apologize for not knowing this, but what is ASS?
| markhollis wrote:
| I am sorry. I meant Autism Spectrum Disorder. ASS is the
| acronym in my native language, I mixed it up.
| hnracer wrote:
| Does anyone know unconventional ways to treat depression (or
| bipolar), that are not widely known, but are nevertheless
| supported by solid science?
| sircastor wrote:
| I don't know if this qualifies as "unconventional" but I have
| had tremendous success increasing my physical exercise daily.
| I'm not entirely sure if it's just daily exercise or goal
| setting (in my case it was the somewhat ambiguous '10k steps a
| day') or maybe a mix of both, but it evened out my mood
| significantly and had a strong effect on my depression.
|
| (Edit: studies associated)
| https://scholar.google.com/scholar?q=exercise+effect+on+depr...
| kayodelycaon wrote:
| I find that daily exercise and keeping a steady schedule of
| 8~9 hours of sleep is critical to maintaining stability.
| Sleep is the one thing I can't skimp on. Exercise can slip
| for a day or two. Food is less critical as long as I'm
| getting proper nutrition and don't skip meals.
|
| Due to my severity, insomnia (primary), and psychosis, I will
| likely always need medication but taking care of my body
| allows me to keep the dosages low enough that I still feel
| like myself.
| A-Train wrote:
| I read about keto diets being helpful in schizophrenia and
| such. It should be easy to find.
| ethanwillis wrote:
| RTMS, gaining traction, good efficacy, and no side effects like
| medication.
| ketamine__ wrote:
| > Sometimes, I dream about how wealthy I would need to be to take
| a break from feeling the fear that propels me to remain stable.
|
| This is something I've felt but more so because it's incredibly
| difficult to access ketamine treatment. If your doctor loses his
| license or a pandemic happens you're left in the lurch.
| ltr_ wrote:
| Just venting out:
|
| I remember the exact day and moment that, for the first time I
| felt that my mind was clear as crystal water, silent, and could
| be used at command without any effort. 0 anxiety, the inner voice
| in my head disappeared.
|
| At the time i was unemployed just reading/watching
| math/philosophy/CS books/videos, I was stuck understanding
| concepts for months, just reading things without really digesting
| them, just to pass time. but at that second, everything started
| to make sense, without any effort, I started to make connections
| between concepts and applications, recalled that day as one of my
| best days of my life and changed my way of thinking in a good
| way, forever. i was just laying in bed completely immersed and
| exploring a new world in my mind. my memory was like it was a
| movie that could be rewinded,paused and analyzed at will.
|
| The next Monday i visited my doctor at the time (i was been
| treated for ADD), I said - thanks you!, when i entered his
| office, thanks you for curing me!. I explained what happened and
| how i felt, he looked at me, took a paper and sign my definitive
| diagnosis : bipolar 2. he cut my antidepressant and prescribed my
| new treatment, and he told me, that how i feel was not going to
| last, and the way down could be really hard, and indeed, it was
| really hard for me to think that this was going to go away, I
| remember every morning of that month waking up and checking my
| thoughts. over the course of 2 months, i went back to the 'normal
| chaos', also i just landed a new job (which i quit 2 months
| later), so my worries intensified. I still have the false hope
| that I was the real me during those months and that sometime in
| the future I would be that way forever. I really want to feel
| normal, sociable , logical, assertive and articulate as I am
| during my states of hypomania , which are no longer than a week,
| very frequents, but not as high as that episode 2 years ago.
|
| Life treated me well,i had extremely good luck with my
| understanding partner, my friends/colleagues and family, they
| know how to turn my weirdness and chaotic mind into something
| useful and productive. I still have no monetary stability and I
| feel I'am at one catastrophic disease/event to be on the streets
| or dead, I have been broke several times in my life, but as an
| 'above average' IT guy in a third world country with a simple
| life style, it was easy to find a job and shine for a while and
| get the money to get back on track and then throw it all and
| repeat.
|
| Now, Im 'stable', under quetiapine/concerta, unemployed and with
| zero will to work ever again in something with a boss or teams,
| resisting the urge to engage and get exited with projects with
| other people, because i know ill disappoint at some time. Im
| feeling frustrated that i cant do anything valuable with what i
| know, i simply don't have the discipline nor the stamina to do
| something that matters and it is slowly eating me from inside. I
| dream of having a little opensource projects that involve
| everything I enjoy from math/cs/art, all my "projects" , code ,
| ideas that i wrote get deleted in the next system reinstall. I
| don't know how/where to get more valuable help, i had tried a lot
| of things (mindfulness meditation, exercise, drugs, prescription
| meds, charity, collaboration on OS projects,diets...), things
| that at sometime seems to be doing the right thing on me but,
| they stop working or my energy just vanish, so i dismissed the
| effects as a placebo, which leads me to believe that is the only
| effect that works on me.
| TeaDrunk wrote:
| I have an illness on the schizophrenia spectrum and a lot of what
| is said rings true to me. My own therapist even doubts my
| diagnosis because he doesn't believe someone with my disorder
| should be able to hold down a job.
|
| I don't bring it up to anyone IRL because I know what people will
| think of me- a danger to them, subhuman, a monster. I'm even
| uncomfortable to be within the spheres of supposedly accepting
| groups- neurodivergent advocacy groups, mental health advocacy,
| etc. People with less stigmatized disorders will treat me just as
| subhuman as a neurotypical.
| bobwall wrote:
| Does anyone who is bi-polar feel that they are able to navigate
| their down time well enough that it is not crippling? For myself,
| I believe it was more inline with seasonal depression, and after
| 30+ years of living in the northeast, where winters are longgggg
| and exgtremely cold, I moved to a place that this wasn't the
| case. I don't know if I have it, but when I am feeling down, I
| tend to read more, and just try to focus on the fact that I will
| come out of it and feel better shortly.
| [deleted]
| infinitudes wrote:
| > is that the segment of your audience that doesn't share the
| diagnosis runs the risk of essentializing your disorder
|
| > I don't associate mania with creativity, or fun, or clarity; I
| associate it with an abundance of energy that seems like it needs
| no fuel but that will end up using me for its fuel.
|
| It's all consuming. It's highly misunderstood. It's trivialized
| at best.
|
| It's confusing. The lack of stability does wonders to your
| understanding of the world.
|
| Mania is a weird and strange experience. The energy is
| overwhelming.
|
| When it comes to programming, it's different.
| bipo_temp_acct wrote:
| Type 1 bipolar with an unusual history here.
|
| My dad was bipolar and committed suicide while I was a teenager.
| I had a 6 months long mixed episode ~15 years ago that got me
| diagnosed. High energy, racing thoughts, little to no sleep, mood
| going from euphoria to more painful thoughts, always very high in
| intensity, borderline delusional.
|
| After months of denial I accepted the diagnosis and I ended up
| with lithium then lamotrigine because of side effects of the
| former, but neither were effective. I still had to take
| olanzapine to quell nascent manic bouts a few times a year. I was
| pretty traumatized by the fallout of my first episode (I
| destroyed or damaged quite a few relationships), making me want
| to never go back there if at all possible.
|
| Luckily for me the racing thoughts and high energy always came
| before the mood and ego distortions, which gave me the
| opportunity to act. I soon realized that the earliest I took
| olanzapine the lower the dose I had to take to shut off the
| episode. 1.25mg or at worse 2.5mg were enough to stop it in its
| tracks most of the time (taking another 1.25mg dose after an hour
| if the first wasn't sufficient). Sometimes I had to re-iterate on
| the next day, and that was it.
|
| I discovered this paper [1] a few years down the line, which
| describes how both the speed and the content of thoughts
| influence the mood level. This made me want to try and control
| the pace of my thoughts willfully.
|
| My first naive attempts failed (I had to fall back on drugs), but
| then I tried to use mental imagery under self-hypnosis (which I
| had learned independently, mania is very conducive to hypnosis),
| with success. I had realized that I had a hard time thinking fast
| while walking slowly, and thus I projected myself lingering in a
| derelict and deserted landscape, where everyone I loved was dead.
|
| This let me cut the mania in its track, but let me sad for two
| days. Also, even in my mind, walking slowly was hard to maintain
| for long periods of time. So I tweaked the scenario, to a more
| pleasant and peaceful walk in the sea on a nice end of the summer
| day, with water above the knee. The imagined physical resistance
| of the water helped me keep the pace down, and the experience let
| me in a nice, agreeable mood. Practicing the scenario between
| manic episodes also helped getting there more easily.
|
| Seven years ago, after a few years of not needing olanzapine, I
| tried stopping the lamotrigine as well, since it was not fully
| effective. The frequency and intensity of the episodes didn't
| worsen, and it even gradually went down to ~1 per year without
| any ill consequences. I've now reached a point where I don't even
| need the full self-hypnosis decorum to brake, sheer will is
| sometimes enough.
|
| So this is how I got to mostly manage my condition and get rid of
| drugs. While unusual, this isn't unheard of [2]. Lewis Mehl-
| Medrona's approach with narrative analysis and imagery approach
| among native americans remains very marginal though (that paper
| has been cited once in 13 years, I discovered it this month).
|
| I say "mostly manage", because there are still a few problems.
|
| - Because of its long half-life, pseudoephedrine taken several
| days in a row is stronger than my own might, and self-hypnosis
| barely helps (sinusitis, fuck yeah).
|
| - This summer, experiencing an epiphany while being in love
| pushed me over the edge into a slow but otherwise manic-like
| euphoric state, with a relentless, obsessive train of thoughts
| (not unlike a walking bass in an old jazz), and distorted
| thoughts patterns reminiscent of my initial episode. Without the
| usual warning sign (racing thoughts and high energy) it took me
| ~36 hours to realize something was amiss and come back down (I
| had watched a slow, contemplative movie without realizing it had
| a plot. This left me puzzled and I read about it on the Web the
| next day, discovering with dread that had just been out of my
| mind). I had ruined another relationship in the mean time.
| Conclusion: avoid thinking too hard while being in love (in that
| state, one's ability to think is badly impaired anyways).
| --------
|
| 1.
| http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.405...
|
| 2.
| https://www.researchgate.net/publication/45389079_Narrative_...
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