Trigger Warning: This post contains a discussions of suicide. If you or someone you know is at risk of suicide, please:
Call the U.S. National Suicide Prevention Lifeline at 800-273-8255
Text TALK to 741741
Or go to SpeakingOfSuicide.com/resources for additional resources.
For a post with a list of domestic crisis lines, click here.
For a post with a list of international crisis lines, click here.
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This post appeared on The International Bipolar Foundation’s website, here.
Pregnancy.
It’s a time of joy for some, a time of horror for others, and a time of anxiety for most.
Becoming pregnant, regardless of the outcome, changes your life forever. And if you have a mismanaged mental illness that’s affected by maternal hormones like bipolar disorder, irrevocable damage can be done.
May is National Maternal Depression month in the U.S., a time to reflect and raise awareness for mothers who face challenges such as postpartum depression.
According to WebMD, “Pregnant women or new mothers with bipolar disorder have seven times the risk of hospital admissions compared to pregnant women who do not have bipolar disorder.”
And I was one of them.
Here are my completely different experiences with my two pregnancies and how I managed and mismanaged my bipolar disorder–and what a difference that made.
During my first pregnancy, warning signs of an undiagnosed, worsening bipolar disorder were missed or ignored by my obstetrician. As I wasn’t aware that I had a mental illness, my anxiety, depression, and mania–a mixed mood episode–quickly grew out of control and ravaged my mind and body.
Because of lingering issues centered around going hungry as a child, my manic fear that my new family would go hungry forced me to build a balcony garden with recycled tin cans and bulk soil purchased for pennies. I was terrified that my husband and I would run out of money despite his stable, high-paying job.
The garden never took off, and due to my burgeoning depression, I quickly became suicidal. I became obsessed with a show I saw once a week on television, Avatar: The Last Airbender, living only for new episodes. I forced my husband to watch the show, saying I identified with the sociopathic character who has a psychotic break in the end because I was so numb and messed up.
Faced with decorating a nursery on what I perceived to be a shoe-string budget, I dove in our apartment’s huge dumpster for mismatched, broken lamps, bassinets, and other baby items. I crammed our guest room/nursery so full of filthy items, we couldn’t even walk through the room.
I could not bond with my baby, instead concentrating on how awful I felt. I was jittery, depressed, irritable, lonely, and physically sick–I suffered from a condition called hyperemesis, which means I threw up several times a day for nine months straight.
Rather than gaining weight like I was supposed to, I lost thirty pounds and only gained back ten, and was placed on bedrest four months in. I lost even more weight after the baby was born. I started out the pregnancy at 148 pounds and ended it at approximately 100–not exactly a healthy weight for a 5’7” woman.
Throughout the pregnancy, I faced challenges such as social isolation (my husband and I had just moved 1500 miles away from friends and family for his job), limited mobility (I sprained my ankle and couldn’t drive), and completely wild hormones. It’s no wonder that I suffered a psychotic break after giving birth!
Fortunately, I committed myself to a mental hospital with the help of my therapist, whom I’d started seeing at the beginning of the pregnancy. The doctors there gave me an official diagnosis–bipolar I–as well as medication that saved my life.
Following the pregnancy, I suffered from a crippling postpartum depression that rewired me completely. I went from a bold, confident, intelligent young woman to someone fearful and constantly seeking validation from others.
It took me three long years and several medication changes to recover–and even now, 13 years later, I’m not quite 100% back to my former self.
However, three years after recovering from postpartum depression, when my first child was six, I was ready to try for another baby. My husband had always encouraged me to be in control of our reproductive choices, so he willingly agreed to a second pregnancy.
For the second pregnancy, I insisted on taking medication. I didn’t want to go back into the depths of suicidal depression. And I faithfully attended therapy once a week, discussing coping strategies I could use.
During the second pregnancy, I once again suffered from hyperemesis. I threw up 6-8 times per day from the moment I conceived until the day I gave birth.
Despite that, I my spirits were high and I didn’t suffer a massive depressive or manic episode. I was no longer depending on a television show to emotionally sustain me.
My routine of medication, therapy, and self-care kept the awful mood episodes at bay. I was sane, stable, and dare I say, happy. I was able to bond with my baby and suffered no ill effects after giving birth.
All things considered, except for the hyperemesis and bedrest, the second pregnancy was much closer to “normal” and expected for a healthy pregnancy. I certainly didn’t suffer as much emotional pain!
My bipolar disorder diagnosis–and appropriate approaches to treatment–made such a difference in my two pregnancies. After the first one, I was terrified to have more children; after the second, I considered having a third.
If you have bipolar disorder or even think you do, carefully consider the risks of getting pregnant before you embark on that journey. It may take you somewhere you don’t wish to be.
But there are steps you can take to sustain a safe and healthy pregnancy. Low-risk psychotropic medications are available to you. Talk therapy poses no risk to the baby. And a self-care routine prioritizing sleep can do nothing but good for you.
This post was featured on the International Bipolar Foundation website, here.
When you’re depressed, forget about thriving – you’re in survival mode.
Which means you need to be especially gentle with yourself.
If you’re telling yourself that you should get everything done on your impossibly long to-do list today, a trap that a lot of us in capitalistic societies fall into, you’re shoulding on yourself.
Shoulding on yourself is a terrible habit. Saying “I should do this,” or “I should do that,” is just piling guilt on yourself and zapping the motivation to do anything. Believe me, when I’m drowning under a wave of self-imposed shoulds, especially when I’m depressed, I go back to bed.
If you’re shoulding on yourself when you’re depressed, you’re being unkind to yourself when you’re in survival mode. You don’t have the “spoons” to do most of the tasks you think you should and you definitely don’t have the spoons to fret about it.
The Spoon Theory, a concept popularized in a personal essay by the same name by Christine Miserandino, explains the idea of energy in short supply due to chronic illness using “spoons” as units of energy.
If you’re low on spoons, an easy state to be in when you’re depressed and don’t start with many, shoulding on yourself is the last thing you need. Worry about what you should do will just exhaust you.
Don’t think, “I should do this and after that I should do this.”
Think, “I have one task to do. What would be the most effective use of my spoons? How crucial is this spoon usage? Will I be forced to do it later when I may have even fewer spoons?”
If you answer “I can do x because it will be effective,” or “this is very crucial,” and “yes,” then do the task.
The ONE task.
One task at a time. Don’t even worry about the others until that one task is done.
If you’re worried about all the tasks you have to do after the first–take a shower, prepare that quarterly report, clean out the storage unit–you’ll never finish even the first task. You’ll end up paralyzing yourself by how much you should get done.
Instead, prioritize. Think, “What is my most effective/crucial task?”
Many tasks aren’t as crucial as we believe they are. Crucial tasks are things like “feed the five-year-old.” Strip your to-do list down to its very basics, things you need for survival or for your dependents’ survival.
It’s time to choose your most effective/crucial task. And only one. When you’re in survival mode, you only have the spoons to do one or two, and especially one at a time.
You can only do one task at a time well, so choose the one that will get you the most bang for your buck. What is pressing on you the most? What do you want to do the least later?
You can conquer that task. You are smart and capable and able to conquer anything on your to-do list, one at a time.
Disclosing your mental illness to other people is a huge decision. You have to consider not only whether your friends/employers will support you after you disclose, but also how and when to do so.
I tend to disclose within the first or second meeting, before I’m even attached to a friend. I am open about my bipolar disorder to almost everyone I meet.
Bipolar disorder is just a label; it’s a part of my life but it isn’t everything, and it explains why I’m sometimes unpredictable. And I have a strong support system, so I have little to lose by disclosing.
For further reading on how I became more comfortable sharing my bipolar diagnosis, click here.
I live in a liberal area of the U.S. and have had various reactions to my admitting that I have bipolar disorder, most of which were positive but some of which were disheartening. There are often three ways that friends and family react:
They are comfortable with your disclosure, nothing changes for the worse, and sometimes they’re better at supporting you.
They are incredibly uncomfortable and take steps to end the relationship with you.
They say that they are comfortable with you telling them this and then proceed to fade slowly from your life.
Obviously the first outcome is the best and most hoped for. While ending relationships are a concern, it’s entirely possible that they wouldn’t have been able to support you anyway, so it’s probably best that they disappear from your life.
When to Disclose Your Mental Illness
Telling someone about your mental illness takes a lot of courage. And you don’t have to tell anyone right away–or at all. Not everyone can live as openly as I do.
If you want to tell someone about your mental illness, tell them when:
You are well. You don’t want to wait until a mental health crisis hits to disclose to your friends that you have a mental illness. Disclosing when you’ve got your illness under control will give the people you disclose to time to adjust to the fact that you suffer from a disorder.
When you need people to understand. Sometimes, people who suffer from mental illnesses need special accommodations at work or school. Letting friends know the reason behind why you don’t want to hang out with them during a depressive spiral can prevent them from thinking you’ve grown distant. Telling people you have a mental illness is better when it serves a purpose.
When you’re ready. Disclosing your mental illness to friends, family, or even an employer is an intensely personal decision. Write down exactly what you want to say, and practice your words, either in front of the mirror or with a licensed professional. Talking to a therapist about your concerns may help put your mind at ease.
Although the “perfect” time to disclose depends on your relationship to the person and whether you’re well, honesty is almost always the best policy.
People don’t “need” to know that you’re mentally ill. Disclosing is your decision alone. But it may help explain some of your more erratic behaviors to the people you impact with them, which may help them give you grace when you suffer mood episodes.
When you choose to disclose is up to you. I’ve personally found that letting people know upfront that I have challenges they (usually) don’t is beneficial to both of us.
And if you’re dating someone, it’s always best to disclose that you have mood episodes sooner rather than later. For a more specific post on when to disclose your mental illness to your dates, click here.
Now that you know when to disclose, how do you do it?
4 General Tips on How to Disclose Your Mental Illness
You may have been curious to know how to disclose your mental illness to the people around you. Here are some tips to do just that.
1. Bring Your Disorder up in Casual Conversation
When I disclose my mental illness, I tend to bring it up in casual, low-stakes conversation.
If a potential parent friend asks about my children, I tell them a few facts about them (I have two, these are their names and ages, blah blah blah). Then I sometimes mention that the baby years were especially difficult because the sleep deprivation tended to make me manic, because I have bipolar disorder.
Despite its massive effect on my life, treating the illness as just something I have to deal with on a regular basis helps me.
I try not to trivialize the disorder–which is why I also sometimes bring up my postpartum psychotic break and how serious and painful it was–but I also tend to talk about my disorder as just a part of me.
This strategy normalizes the mental illness and allows you to determine the terms of how others perceive your bipolar disorder. If you treat the illness seriously but with grace, then other people may as well.
2. Describe the Steps You’re Taking to Manage Your Condition
Bipolar disorder is only as shocking as you allow it to be.
If you describe your bipolar disorder as this awful, paralyzing albatross, then both you and the person you’re talking to will form an opinion of you as being ravaged by your disorder and out of control.
Don’t let bipolar disorder rule your life even in the way you talk about it.
Try to describe the steps you’re taking to manage your bipolar disorder. Try to say things like, “I have bipolar disorder, which means I have to take medication and be vigilant about how much sleep I get.”
This lets people know you’re actively working towards stability, a heartening sign. Being friends with someone who’s unmanageable may scare some people away, as they might not be ready for a commitment like being constantly impacted by your wild moods.
3. Demonstrate How Your Bipolar Disorder Gives You Empathy
Even when getting to know my close friends, I would say things like, “Oh, yes, I understand a lack of focus–I have bipolar disorder and that makes focusing difficult.”
Mental health challenges are growing more and more common. A huge percentage of people struggle daily with problems like inability to focus, insomnia, or even mild, high-functioning depression.
Because your bipolar disorder is a series of mental health challenges itself, it has likely given you empathy for people who currently struggle with them. Don’t be afraid to show that empathy and let people know you understand their issues.
This shows them that you will not patronize them for their struggles, which may endear you to them.
4. If You Need it, Ask for Help
If you have a close relationship with someone, don’t be afraid to ask for help, especially from your employer (more on that below). If you believe they will be receptive, suggest ways your audience can support you.
This can involve asking for more breaks or other accommodations at work or school, or simply asking a friend to understand why you can’t hang out as long, especially at night, when you need more sleep.
You can also ask your loved ones to help you find a doctor and follow through with an appointment, if you feel that your friend or family member will understand and be helpful.
Set boundaries here, too: you know yourself best, and you need to explain whether you need advice or just need your audience to listen.
I have often “vented” to my close friends about how my mania makes me feel, especially when I’m in a manic state. I am upfront with my friends and family about whether I’m entering a mood episode, especially mania, and I describe the steps I’m taking to stabilize again.
4. Keep in Mind Your Boundaries on What to Share
You definitely don’t need to share everything. Plan ahead as to what you feel comfortable sharing about your experience. It’s perfectly reasonable to explain that you don’t feel like talking about something in particular.
If you do feel there are good parts to your illness, like things you’ve learned, try to share those. Remember, how others perceive your bipolar disorder is often about how you frame it, and what details you are comfortable sharing will shape how others feel about you.
I rarely have reservations when talking about my bipolar disorder, but there are friends for whom I wouldn’t go into detail about my postpartum psychotic break.
When I asked friends to read my book about the experience in the past, they frequently couldn’t read past the first paragraph because it was too painful for them to think of how much agony I experienced.
Some people can’t handle the nitty gritty of my illness and that’s okay. I still refer to my breakdown in general terms, but I don’t tell certain friends everything about it unless they express interest in reading my book (at which I warn them about how intense it is).
When sharing details about your mental illness, consider not only your comfort levels, but also your friends’, and what opinions you want them to have of you.
Disclosing your mental illness can be a deep and intense process, but it doesn’t have to be. Try bringing up your bipolar disorder in casual conversation, describe the steps you’re taking to manage your condition, demonstrate the empathy the illness has given you, and keep in mind your boundaries and your friends’ comfort levels.
If you’re disclosing to an employer, however, that’s a completely different ballgame. Here’s how to do that:
How to Disclose Your Mental Illness to an Employer
You know how and when to disclose your mental illness, and even if to disclose to family and friends. But what about your employer? Read on to learn how to protect yourself.
When choosing to disclose a mental illness at work, there are several factors to consider. You might face stigma from your coworkers–or worse, your bosses. Those you work with might not understand, or even want to understand, your daily struggle.
However, with disclosure might come special accommodations–like extra breaks–which are part of your civil rights. There are certain protections available to you.
You absolutely deserve those protections. If you’re in the US, don’t be afraid to disclose your condition to your employer so they can treat you fairly under the law.
Americans with Disabilities Act (ADA)
The Americans with Disabilities Act (ADA) is a protection that you should be familiar with. The ADA is just like it sounds like: a federal law that protects Americans with disabilities at private employers with more than fifteen employees, as well as state and government employers. There are two conditions you must meet for the act to apply:
Your disability impairs your life, essentially making working difficult. This condition applies to difficulties with regulating emotion, concentrating, and other ways your mental illness interferes with your ability to work.
That, while your illness makes working difficult, you can get the work done.
Rehabilitation Act of 1973 (Rehab Act)
The Rehabilitation Act of 1973, or Rehab Act, is a federal law very similar to the ADA that applies to schools. Any agency that receives government funding is covered under the Rehab Act.
Family Medical Leave Act (FMLA)
The Family Medical Leave Act (FMLA) is a useful law that helps people keep their jobs while taking an extended leave of absence. The FMLA only applies to companies with over fifty employees, and after you have worked for the company for a year minimum. The FMLA lets you take up to twelve weeks of unpaid leave to care for a sick family member or recover from an illness yourself.
States also have their own protections for Americans with disabilities.
What Accommodations Can I Receive? How?
Under these laws, you can receive special accommodations: working from home, flexible start times, written directions, feedback from your bosses and coworkers, more breaks, and quiet places to take those breaks. These changes to the workplace are intended to be an aid for you so that you can complete your tasks.
But how do you apply for these accommodations? The process isn’t difficult, but the onus is on you to ask. Once you do, your employer is mandated to talk with you.
First, contact the human resources (HR) department and ask them what channels you need to go through to apply.
Write down your request. Be very specific as to what accommodations you need, and explain to HR how these will help you in the workplace.
Talk with your treatment team–therapists and psychiatrists–to see if they can offer any proof that you suffer from a mental illness.
Take notes at every conversation you have with your boss. Do not delete any emails that apply to the request.
Be reasonable and flexible. Your strongest advocate is you, so be prepared to negotiate.
Discrimination
What if you’ve been discriminated against because you suffer from a mental illness? There are legal protections available for you:
If the employer is a private one covered by the ADA, then you have to reach out to the Equal Employment Opportunity Commission (EEOC). File a complaint at the EEOC’s website, www.eeoc.gov.
If, however, the employer is a federal agency, like a school or governmental employer, then you must reach out to the Equal Employment Opportunity Office (EEO). File a complaint at the EEOC’s website, federal division.
States have protections as well. If you’ve been discriminated against despite these laws, look up your state’s Fair Employment Practice Agency (FEPA).
The Department of Labor manages the FMLA. If you’ve been denied your legal right to twelve weeks of unpaid leave, then contact them.
There are several protections available to you should you choose to disclose your mental illness to your employer. Whether or not you should is completely up to you. As we said, you might face stigma from your coworkers or bosses, but if you’ve been discriminated against, you can file complaints. You have a right to accommodations. All you have to do is take that step forward.
Final Thoughts
How and when to disclose your mental illness can be intense, deeply personal decisions. But they don’t have to consume you. Here’s an overview of the masterpost:
When to Disclose:
Whenever you’re well.
When you need people to understand.
When you’re ready.
How to Disclose to Friends:
Bring your bipolar disorder up in casual conversation.
Describe the steps you’re taking to manage your condition
Demonstrate the empathy the illness has given you.
Keep in mind your boundaries and your friends’ comfort levels.
How to Disclose to Your Employer to get the Accommodations you Deserve:
Contact HR
Write down your specific request.
Get proof of your mental illness from your treatment team.
Take notes at every conversation you have with your boss. Do not delete any emails that apply to the request.
Be reasonable and flexible in advocating for yourself.
Only you can decide when, how, and to whom to disclose your mental illness. You may face stigma and discrimination for it. But those true friends who do stick around–and those accommodations you’ll earn from your employer–are worth it, in my opinion.
This post appeared on the International Bipolar Foundation’s (IBPF) website, here.Graphics from the International Bipolar Foundation.
[Id: A blue graphic with two men in blue shirts high fiving over a woman in a blue shirt. The graphic says “3 Ways to Manage Mixed Mood States.”]
If you have bipolar disorder, it’s likely you’ve experienced some symptoms of mania while you’ve suffered depression, or vice versa, and believe me: it’s miserable.
This awful set of feelings is colloquially called a mixed episode or a mixed mood state, and they are common in people with bipolar disorder. Half or more of people with bipolar disorder deal with mixed episodes, and I am one of them.
Just because I suffer mixed episodes, however, doesn’t mean I don’t have “pure” episodes of depression or mania–I have those, too, and they are also detrimental to my mental, physical, and emotional health.
But there’s something about a mixed episode that’s just doubly bad.
Six days after the birth of my first child at 22, I suffered an intense mixed episode with psychotic features and committed myself to a mental hospital, where I earned a diagnosis of Bipolar Disorder I.
I was constantly on the move, hadn’t slept in a week, and ate very little food or drink other than chocolate milk. I made to-do lists of over 100 items each and filled up brand new journal in a few days. I spoke so rapidly that no one could understand me, and flitted from topic to topic like a hummingbird, frustrated and irritable.
These are all symptoms of–and in the case of the lack of sleep, precursors to–mania. But I also suffered symptoms of depression: I cried constantly, felt an overwhelming dread that awful things were happening to my newborn, and vacillated between absolute euphoria and crushing despair.
Any setback destroyed me. Something as simple as not being able to eat my condiment of choice on my meal was a cause for sobbing dejection. And I fixated on my feelings of guilt, anxiety, and low self-worth.
My mixed mood state nearly got the best of me. When I wasn’t bursting with energy, I was exhausted. Angry outbursts from me were common, and my mind raced so much, I couldn’t get to sleep easily.
Fortunately, I was given proper medication in the hospital that stabilized me. Since then, I’ve faithfully taken my meds at morning and night, and I haven’t yet experienced a mood episode that terrible again.
I have, however, suffered less intense mixed episodes since my stay in the hospital. The symptoms–irritability, inability to focus, vacillation between euphoria and despair–are similar.
But I don’t allow them to control me anymore.
3 Ways I Handle Mixed Mood States
I handle mixed mood states in the same way I handle “pure” manic episodes: once I realize what’s going on, I ensure I’m taking steps to get out of the mood state.
Here are three ways I do that:
[Id: A graphic of a man lying down with words that say, “I prioritize sleep. With mania, I frequently don’t need sleep–or, at least, that’s the lie that my brain tells my body. When I’m in a manic or mixed mood episode, I need sleep even more so than when I’m not, so I practice good sleep hygiene and force myself to lie down with my eyes closed until I’m out. Taking a hot bath right before bed also helps. Sometimes medication is involved in my sleep, which brings me to my next point…”][Id: A woman in a blue hijab speaking with a man and another woman with the words, “I inform my treatment team about my current struggles. My treatment team–my therapist, psychiatrist, and yes, even my husband–needs to know I’m experiencing a mood episode before they can help me. First, I tell my husband, as he’s the closest to me and is most likely to be adversely affected by my mood episode. Next, if the mood episode is truly terrible and I need to adjust my medication, I phone my psychiatrist and take his advice. After that, I make an appointment with my therapist to process the issues that cropped up during the episode.”][Id: A man and a woman standing next to a woman seated at a desk with a computer monitor with the words, “I pare down my to-do list. One of my manifestations of mania is to be insanely productive. But the more I accomplish, the more wound up I get, and therefore I accomplish even more, getting more wound up… It’s a vicious cycle. So when I recognize that I’m manic, rather than riding the high and getting a ton done, I scale back on my to-do list. I force myself to slow down and only get done what is absolutely vital. Slowing my brain down and deliberately paying attention to detail helps me conquer a manic or mixed mood episode.”]
Final Thoughts
My experience with mixed mood states has been awful. They’re like a manic episode turned up to eleven with all the worst parts of depression bogging me down.
When I’m suffering a mixed mood episode, I’m irritable, euphoric, and despairing. I can’t focus and I can’t sleep easily.
But the way I handle those states is similar to the way I handle manic episodes: I prioritize sleep, let my treatment team know and take their advice, and pare down my to-do list.
If you find yourself in a mixed state, prioritize sleep. Force yourself to lie down and close your eyes; try to slow your brain down as much as you can so your thoughts don’t run away with you. And don’t forget to take your medication!
You can survive a mixed mood state and even thrive afterwards. I wish you well in your journey.
Trigger Warning: This post contains discussions of suicide. If you or someone you know is at risk of suicide, please:
Call the U.S. National Suicide Prevention Lifeline at 800-273-8255
Text TALK to 741741
Or go to SpeakingOfSuicide.com/resources for additional resources.
For a post with a list of domestic crisis lines, click here. For a post with a list of international crisis lines, click here.
Dear Cass,
I know you don’t believe me when I say this, but you’re going to be okay.
You’ve been here before, remember? You’ve lived through the depths of depression and suicidal thoughts, and you’ve even thrived afterwards.
I know you suffered them over that awful period of two-and-a-half years after your kiddo’s birth, and I know you wrote goodbye letters. I know very well that you don’t want to be here again.
But you will be okay. I promise.
Don’t give up. You have so much to live for. You’re going to go back to school to become a therapist and help people manage their own mental illnesses. You’ve got a great family who loves you. You have a close relationship with God, and you don’t want to hurt Him by hurting yourself.
Let’s go back to your family. Your kids need you to survive and thrive, and so does your husband.
Your children are so young. So very naïve. And they need you to protect them from the world and raise them into wise, compassionate, capable adults. Leaving your husband to parent them alone would be unfair to him.
There’d be a Cass-shaped hole in their lives that they’d never be able to fill. A new wife or a new mom wouldn’t be the same. Your kids and husband would be reminded of you, painfully, every day.
And you love all three of them. Despite the times they frustrate you, you’d give up everything for them–and for many years, you did just that.
But you have other reasons to live than just your family. You haven’t fulfilled your dream of going back to school to become the best therapist you can be yet–and if you have, you’ll have other dreams and goals, I’m sure. You’re a go-getter.
You can set and fulfill dreams and goals when you’re stable. Don’t worry about working towards them now; now is a time for triage. Now is a time to stop the bleeding, and if you’re reading this, you’re undoubtedly bleeding out.
It’s time to take care of you. You’re important to those around you, God, and yourself.
Put aside your to-do list. Practice some self-care. Go take a shower, eat a snack, and drink some water. Call your treatment team and let your husband know you’re suffering if you haven’t.
Do these things right now, and then come back to this letter.
Cass, I want to let you know that you are precious. You are irreplaceable. You are a smart, capable, lovely young woman with a lot of conquered challenges under her belt. And you can conquer this one, too.
It’s just another hurdle. Just one more thing you can handle. Managing a mental illness is work, but it’s well worth it. What’s the alternative to not putting the work in?
You being miserable.
And what happens if you put the work in?
You’ll thrive. You deserve to survive this and thrive again.
And I know you don’t believe it right now, but there are people in your life who love you and want to help you.
Call them. Text them. Email them. Just let them know.
And if you happen to have alienated everyone in your life, visit a crisis center or call a crisis line. Right now. Don’t even finish this letter–get up and get going.
In my last post, “How to Make Friends During a Pandemic Even with a Mental Illness,” I gave you a few tips on how to do just that.
Briefly summarized, the post encourages you to develop connections online, talk to your neighbors, join a support group, and/or reconnect with old friends. Using these tips, you can make friends even while stuck at home during a pandemic.
But once you’ve made those friends, how do you keep them?
Ah, there’s the rub. Keeping friends after making them is a difficult proposition for anyone, but that’s especially hard for those of us with mental illnesses.
Here are 3 tips to keep the friendships you just made alive.
1. Communicate, Communicate, Communicate
When trying to nurture your friendships, communication is key.
I have personally lost both new and long-standing friendships because I didn’t communicate properly with them.
In the case of the new friendships, usually playdates made at the parks I attended with my young daughter, I’ve neglected to text the parents after boldly asking for their numbers and establishing an initial “here’s my number” text.
My mother always said, “If you want a letter, write a letter,” implying that I should reach out first to establish the relationship. Her advice is solid; I have rarely kept a parent friend without my texting them to set up playdates often.
Neglecting to communicate is the easiest way to lose a friend. And it’s especially important for those of us with mental illnesses, as we need to let them know when we’re suffering a down day or are self-isolating.
Regarding my long-standing friendship, she frequently invited me to parties at her apartment, but because I didn’t want to drive in the downtown section of a massive city, where she lived, I refused invite after invite without telling her the truth.
This was before GPS on phones (I owned a flip phone at the time), and I was terrified of getting lost, like I’d done frequently when going to her apartment, or God forbid, driving the wrong way on a one-way street again.
I made up excuse after excuse without telling her the truth, and eventually, the emailed invites stopped coming. I lost touch with that friend and everyone in our social circle (she was the hub of all our mutual friends), leaving me virtually friendless for a few years.
Communication is key. Don’t do what I did–don’t neglect to tell your friends when you have an issue.
Here’s a rule-of-thumb: for close friends whose friendships you want to maintain, you should text them at least once a week. For casual acquaintances, call them on their birthdays at the very least.
Frequent communication will help you maintain the friendship.
2. Avoid Self-Isolation like the Plague it Is
When we’re depressed, we tend to withdraw from all sorts of social obligations. We’re exhausted and sad, and we think that socializing with friends is too much effort.
Don’t think like this. It’s a trap, one that starts off a vicious cycle and may even worsen your depression.
Just like in tip #1, if you’re open about your mental illness, communicate with your friends that you’re going through a depressive episode and ask for their grace. If you’re currently cloistered, don’t tell them details but let them know you’re struggling with something that makes socializing difficult.
And then actually socialize as much as you can handle. Sometimes that means lunches with friends are shorter, or you limit yourself to talking to your online friends, but don’t neglect to nurture your friendships.
Let your friends know you’re thinking of them via a text, phone call, or whichever way you communicate best. If you isolate yourself, your friends will think you’ve dropped off the face of the earth, and will choose not to “bother” you.
Tell your friends you need them and socialize as much as you can. Social connections are important and can help improve depressive episodes, and if you leave your friends alone, they will leave you alone, as in the example of my long-standing friendship.
3. Resolve Conflicts as Soon as You Can
Even best friends fight, but a conflict can suck the joy out of a friendship faster than air escaping a balloon.
The problem in your relationships are never all one person’s fault. If you’re facing a conflict with your friend, it’s likely you played a part in the problem.
Don’t let your friendships die because you can’t be the bigger person. Apologize for your part in it first, even if you think you were wronged more seriously than they were.
Most of us shy away from conflict. Highly Sensitive People (HSPs), especially those of is with mental illnesses, tend to be sensitive to yelling and criticism, and break down quickly when presented with problems in the friendship.
Don’t avoid conflict. Avoiding the problem only makes it worse. Swallow your reservations and, like in tip #1, communicate with your friends.
And if you can’t figure out what your part in the conflict is, spend some time in self-reflection. Being honest with yourself and your friend will help you keep them.
If you’re managing conflict in your friend group, listen to each side without judging. Getting everyone’s perspective before declaring who’s at fault (usually everyone) is tremendously important.
When conflict breeds most of the time, the participants just want to be heard and believe very strongly that the other people involved aren’t listening to them.
Listen to your friends. Be an impartial judge and resolve conflict quickly. Doing so will not only help you keep your friendship intact, it’ll also teach you skills for maintaining that friendship and other ones in the future.
Final Thoughts
I hope you’ve enjoyed this primer on how to keep friends even with a mental illness.
I’ve lost countless friends because I didn’t follow these steps. Once I realized the problem was me, I chose to nurture my friendships–two of which are extremely rewarding to me.
I’ve communicated effectively, refused to self-isolate, and resolved conflict as soon as I could. With these tools in my arsenal, I’ve made several friendships that I hope will last a lifetime.
Thank you for being patient with me as my moods ravaged me and stressed our relationship. Thank you for being patient with me as I suffered that postpartum breakdown and scared you. Thank you for being patient with me as I learned how to survive and even thrive afterwards.
I’m sorry I’m not the person you expected to marry. I wish I were her, and I’m trying to get back to that person again. Thank you for being patient with me while I relearn who I was and try to capture her essence.
I appreciate so much the fact that you stuck by my all this time through my various trials and tribulations, challenges that made you suffer as well as me. I am so grateful to you for being my first and most stalwart supporter.
Thank you for supporting me financially for so many years and allowing me to afford and use the mental health professionals and medications I needed to stabilize. That’s such a great boon to me; I know many people who are desperate to find a therapist but cannot afford one. Your working for over a decade at a job you don’t like helped me more than I can even conceptualize.
Thank you for encouraging me to follow my dreams of getting my counseling degree and becoming a therapist to help people manage their mental illnesses. I want to support you in your dreams, so thank you for letting me follow mine first so I can do that.
Thank you for listening to me gush about subjects that you have no interest in. You’re a fantastic listener, and I’ve often made your eyes glaze over by discussing my psychology courses or various friendship dramas. I will learn how to reign myself in for your sake.
Thank you for being a solid parent to our children. As you know, I often lose my temper and you are the patient one who steps in and smooths things over. Your presence as a father to our kids is so important in their lives, modeling to them appropriate behavior for every area of their lives, especially how to treat other people.
Thank you for teaching me so much. I’ve learned a range of subjects including computer science, math, baking, video games, things of a spiritual nature, how to be reliable, how to be patient, and how to love.
Finally, thank you for loving me. Thank you for always acting in my best interest even when it pained you or made you uncomfortable. Thank you for teaching me what love really means. Thank you for protecting me from the evils of the world and enabling me to blossom.
I love you. You are my rock, my love, and I would not be as happy as I am without you.
This post appeared on the International Bipolar Foundation’s website, here.
I used to look at the new year, especially the month of January, with trepidation.
When I was but a young college student dating my then-boyfriend–and now husband of several years–I had not yet been diagnosed with bipolar I because I hadn’t suffered a major manic episode, but I still suffered crushing depressive episodes.
I didn’t notice until several years later that these depressive episodes followed a pattern: I would be up, up, up, cheerful, social, and insanely productive, totally killing it on my tests and in my friend group.
Then I would crash and burn, and spend several weeks if not months not showering, self-isolating, and unwilling to get out of bed for any reason.
This pattern almost always manifested itself around the holidays. Until I started dating my husband, I didn’t celebrate Christmas because my parents didn’t for religious reasons. So when I was encouraged to celebrate the holiday season with my husband’s family in college, I went all out for years.
One of my expressions of frugality is crafting. I bought a ridiculous amount of crafting supplies, exhausting my budget and preventing me from eating food for weeks, and hand-crafted multiple intricate individual gifts for everyone in my husband’s family in a hypomanic frenzy.
Usually starting in November, I painted, cross-stitched, sewed, sculpted, decorated, baked, and crafted Christmas presents that were ultimately unappreciated–and rightfully so. Because I was rushing to complete these gifts and make more, more, more–because more is better, after all, my sick brain told me–their quality was shoddy.
I still recall my father-in-law on Christmas day trying on a too-small felt hat I’d simply hot glued together at midnight the night before without measuring. The hat fell apart shortly afterwards and was relegated to the trash, like most of the poorly-constructed presents.
My manic brain would not allow me to slow down and complete the work right rather than fast, and I had never been taught–or taught myself–to pay attention to detail, a skill I am still learning years later now that I’m healthier.
And after the insanity of the holidays, I always, always crashed.
Coupled with the weak winter sunlight and the hypomanic episodes I’d enjoy from November 1st until December 25th, January was always a miserable month for me. I suffered a depressive episode every year like clockwork for about 15 years, until I learned how to manage my bipolar disorder–and manage it well.
Now, for the first time in over a decade, I look back on this new year with contentment and excitement. I decided to purchase Christmas gifts for my family and give myself ample time to craft some for a few of my friends. I started in October, planned out my purchases and cross-stitching carefully, and made sure not to overwhelm myself with the holiday spirit that is so easy to get caught up in.
I now monitor my sleep, medication levels, and sunlight exposure throughout the year. I have a SAD light for the winter and take vitamin D3, which I need in the cloudy Pacific Northwest, as well as iron pills and a multivitamin. I also take my psychiatric medication faithfully and check in with my therapist when there are problems I cannot solve on my own. I communicate about my moods with my husband and children and socialize with my friends on a weekly if not daily basis.
By taking measures to protect my mental health this past year, I have earned a happy January. After decades of out-of-control moods bending me to their will, I have finally learned how to work with my bipolar disorder diagnosis rather than against it.
For the first time ever, I am happy, healthy, and well-balanced in January. Rather than facing the new year with fear and trembling, I am happy to say that I welcome what challenges I will face–and eventually conquer–including going back to graduate school for my counseling degree.
I can hear you now: Sticking to a routine is one of the most difficult things ever with bipolar disorder. Why do I have to do it?
I’ll tell you why: because your brain thrives on structure, and following a daily routine can help prevent and treat bipolar mood episodes, according to Ellen Frank, PhD, professor of psychiatry and psychology and director of the Depression and Manic Depression Prevention Program at the University of Pittsburgh School of Medicine.
In a study of interpersonal and social rhythm therapy (IPRST) and its effectiveness of managing mood episodes, Frank found that patients with bipolar disorder who followed a routine survived much longer without an episode than those who didn’t follow a rhythm, and that IPSRT was extremely effective at preventing mania and depression.
My therapist told me years ago that consistency would be the best gift I could give my children, and I despaired. How could I, being an inconsistent person based on my mental illness and habits developed in a chaotic childhood, provide them with a life with reliable “rocks,” or big activities that we did daily?
Finding–and sticking to–a pattern has been one of the most difficult things I’ve ever done. And as we’ve added to our family, I have changed the pattern. But I’ve noticed a stark difference in my own happiness and the happiness of my children when I create order in my life rather than submit myself and my family to chaos.
The importance of creating a daily routine–and following it!–can’t be stressed enough. But how do you create–and more importantly, stick to–a routine?
Read on for some tips and tricks based on my own personal experience.
Tip #1: Start Small
When I’m manic, I tend to want to organize my life. When I’m in this state, I suffer from the compulsion to make to-do lists and plan out my schedule and the schedules of my family.
So my first tip is probably obvious: don’t start planning your routine when manic. My next tip is probably less so: start small.
What I mean by that is don’t add a bunch of items to your to-do list all at once and expect to follow them daily. You’re setting yourself up for failure that way.
Start with the “rocks,” or big activities: meals, sleep, and work hours. Which leads into tip two.
Tip #2: Fix Your Sleep Hygiene
I could go on and on about how crucial sleep is for stabilizing your mental health. (In fact, I have, here and here.) Sleep hygiene is one of the easiest and most effective ways you can get yourself on an even keel and reduce the severity of mood episodes, even and especially preventing them.
Sleep is a rock in your day, so try to schedule sleep times. Schedule wake times. And try to stick to those. If you have sleep problems, talk to your doctor. You need enough sleep.
How much is enough depends on each individual person. Some adults need 7-8 hours, others need more. But if you’re not getting enough sleep, that’s a fast track to mania.
I go to sleep between 9-10pm every night. Approximately twenty minutes before bed, I shut off my phone and take a shower or bath, depending on my mood and how much time I have. I wind down at night by lying in bed by either praying or planning out my next fanfiction.
Waking up used to be much more difficult for me, but now that I’ve lowered the dose of one of my meds, I’ve been finding myself waking up with much more energy. But I still roll over and go back to sleep after turning off my alarm.
I’m telling you this tip–fix your sleep hygiene–but I’m also telling myself. I need to start waking up at 7am consistently like I used to and address the likely lingering slight depression.
Starting tomorrow, I will be waking up with my alarm at 7am and forcing myself out of bed rather than shutting it off and sleeping in. Wish me luck!
Tip #2: Schedule Meal Times
In addition to sleep, one of the quickest ways we can stabilize our moods is to keep our blood sugar levels stable. Being an Highly Sensitive Person (HSP), I know I myself am extremely susceptible to being hangry.
If you can, try to stick to regular meal times. Eating 3-4 small meals a day will help you keep an even mood, but not only that, it’ll help you lose weight or maintain a healthy one.
My meal routine is simple. I take my meds right before breakfast at 9:15am, eat a breakfast of a single egg and a glass of milk with sugar-free salted caramel syrup, and then take my daughter to the park until 12pm, at which point I eat lunch (usually last night’s leftovers). I eat a small snack at 3:30pm. Dinner, which I usually start making at 4:30opm, is between 5:30-6pm, depending on the recipe. I also drink about 144oz of water throughout the day.
This schedule works very well for me and my family, and helps keep me sane. Try scheduling your meals for regular times. You won’t regret it.
Tip #3: Schedule Your Work Hours
For most of us, work takes up most of our day. If you can schedule your own hours, do so. Whether you work in an office, attend school, or work from home, you need to set a start and end time.
According to Dr. Frank’s research, having a set work schedule will help you feel better. If you can, tap your colleagues, teachers, and family to help you meet your obligations with enough time for you to complete the day’s work at a set end time.
I’m a writer and a stay-at-home parent attending online psychology classes for my graduate degree, so my work day starts at 8am, when I wake up and make my daughter breakfast.
After that, we go to the park until 12pm, when we return home to eat lunch. Someone else watched my daughter from 1-4pm, during which I study. Then I make dinner at 4:30pm, eat at 5:30pm, and have time for relaxation with the rest of the family after the dinner dishes are done at 6:30pm.
At 8pm, the bedtime routine begins, including a bath for my daughter. She’s in bed by 9pm, and then I take my own shower and go to bed shortly afterwards on most nights.
My schedule is not very intense, and it leaves room for flexibility. But if you’re a homemaker, it’s especially important for you to schedule a set end to your workday. Without a specific time to stop and relax, you can easily work yourself to the bone.
As I said in the last tip, I have penciled in time to relax with my family from 6:30pm to 8pm. I also have a “night off” from the bedtime routine on Mondays, which I usually spend writing short stories or cross-stitching, hobbies I enjoy that chill me out.
Make time each day to do something you enjoy. Self-care is incredibly important in fighting mood episodes, especially depression.
There’s any number of things you can do for self-care. You could take a walk, indulge in a cup of tea or coffee, or do something creative, like painting or writing.
For a list of 100 Doable Ideas for Self-care When You’re Suffering from Depression, click here.
Tip #5: Forgive Yourself
If something throws you off your routine–and something always will eventually–don’t panic. Try to be flexible enough to roll with the punches.
Accept what has happened and then follow your routine as best as you’re able. Forgive yourself if you can’t quite make it one day. There’s always tomorrow.
When something interrupts my routine, I get crabby. That’s what I mean about feeling an impact to my happiness when my routine is altered, especially without my permission. But even with my permission, I struggle to remain happy with the change.
For example, Monday nights are my night off, and Tuesday is the night my husband shops. This Monday, the suggestion was made that he hit the store that night rather than Tuesday and give me a night off on Thursday, a change I agreed to because it would be better for my husband.
By the end of the night, while doing the unexpected bedtime routine with my daughter, I was cranky. She got on my nerves more than I care to admit.
But I bathed her and put her to bed, tucking her in and singing “Rock-A-Bye Baby” twice, as is her routine. Then, exhausted, I went directly to bed.
I made sure to give myself grace for being annoyed and reminded myself that this change was temporary and I agreed to it.
Sometimes routines don’t work out, and that’s okay. As long as you forgive yourself and get right back into it as soon as you can, you’ll be alright.
Make adjustments as needed, like getting a hotel room if you’re not going to get home on time to sleep. A hotel room costs less than a hospitalization if your mood destabilizes.
Let’s Recap
If you suffer from bipolar disorder, routines are crucial to your success in treating your mental illness. They prevent and treat mood episodes, keeping you stable and happy.
Think of following one for not only yourself, but also your family and those around you.
To follow a routine, start small, fix your sleep hygiene, set meal times, schedule a start and end times to the work day using your colleagues, and forgive yourself if the routine doesn’t go as planned.
You can follow a routine. You can be consistent, despite your mental illness making that difficult. Schedule your rocks and stick to those commitments. You will benefit from doing so.
Have you ever failed to keep a New Year’s resolution?
You’re not alone. Studies show that 92% of Americans who set resolutions fail at keeping them, and up to 80% fail by February.
But was your mental illness to blame?
For a lot of us, setting resolutions sends a shot of dopamine straight into our brains, but it’s hard to make plans–and keep them!–when you have unpredictable brain chemistry.
As a woman with bipolar who has historically overextended myself during the holidays, I’ve started most new years of my adult life in the midst of major depressive episodes.
As you know full well if you’ve ever had depression, that sucks. It puts a damper on the whole year.
Fixing your sleep hygiene, taking your medications daily, seeing a therapist regularly–these are the kinds of resolutions people who struggle with their mental health need to make.
And make sure not to set resolutions that interfere with your health. If there’s a resolution that forces me to sacrifice sleep, encouraging me to sleep less than 8 hours a night, that is not one I’ll even entertain.
My resolutions in this area are twofold:
Monitor myself better for signs of depression and mania, and
Seek help at the very first signs of a bipolar mood episode.
I have a treatment team waiting in the wings ready for me to call on them. If you don’t, getting one in place would be a great resolution. For a post on how to start seeing a therapist, click here. For a post on how to get a psychiatric evaluation, click here.
2. Know Thyself
Not everyone knows what challenges them most, but a lot of us have a gut instinct as to what those issues are.
Before you make a resolution to hit the gym everyday that you’ll balk at when it comes time to put your nose to the grindstone, sit down and figure out why you balk.
Do you not like the gym because you’re overwhelmed by all the options? Ask one of the employees to recommend a class to you.
Do you not like the gym because you have to get up early? Try a walk after dinner instead. You can even take the kids!
Do you not like the gym because of social anxiety? Try practicing meditation and go to a therapist to conquer that problem first.
And so on.
Know what challenges you the most and work around those issues. Starting with something that makes you more comfortable and that you feel you can tackle first will give you confidence to handle the next step.
My plan in making resolutions is to list the barriers that will get in the way of me fulfilling those resolutions. Be they internal, like social anxiety, or external, like my need for childcare, I will list them out and figure out ways around or through the obstacles.
My resolution for this area is to sit down and identify trouble spots when it comes to treating myself right. To prevent myself from sinking into a depressive episode this January, I need to figure out where I’m struggling.
My resolution in this area is to start keeping a daily gratitude journal. If I can find out what I’m grateful for on a daily basis, I can hopefully also identify where my challenges are.
3. Break Resolutions Down into Steps
When I’m depressed, most of the time I’m completely overwhelmed.
I am usually unable to see past the seemingly-insurmountable mountain of dishes, and I simply cannot think my way past that into “do one dish at a time.”
On the flip side, my past resolutions have been monsters. “Lose weight.” “Be fit.” “Eat healthy.”
But “eat healthy and lose weight” are too big of resolutions for me, especially when I’m depressed. They’re not specific, measurable, or time-sensitive. “Eat one salad a day” is much, much easier.
Rather than “eat healthy and lose weight,” my resolution in this area is to eat salads or vegetables for lunches every day.
For a more extensive post on how to break things down into bite-sized pieces when you have depression, click here.
4. Start When You Feel You Can
You don’t have to start on January 1st just because you’ve made a New Year’s resolution.
For example, if you’re not ready to conquer your social anxiety–if you don’t buy into the process of learning how to do a goal and then doing it–then you’re not going to.
To stick to a resolution, you need to have the mindset that you can keep this, and you need to be ready to start making progress to goal.
If you need to wait until summer for your head and your heart to be in the right places, then wait until summer.
My resolution in this area is to start a gratitude journal as soon as I’m ready to do so.
5. Know That Quitting Isn’t Bad
If you make an impulse buy when your resolution is to spend less money, don’t be filled with self-loathing. Just recognize that you’ve made a mistake and move on.
And if you do make a mistake, take some time to reevaluate whether this resolution is worth keeping at that point in your life. Sometimes things we try fail because they no longer make sense to do.
There’s no shame in quitting something that no longer works for us, even when the action used to be objectively good. That’s true of everything in our lives: from our resolutions to social media to our jobs and even our relationships.
And just because you’ve put time/energy/money/work/resources into something that used to be objectively good doesn’t mean that you have to keep doing the same thing that doesn’t work now.
Keeping on the same path that doesn’t work now just because you’ve been walking it for a while is called the ‘sunk cost fallacy,’ and a lot of people get tripped up by this way of thinking.
Don’t fall into that trap. If a resolution used to work but isn’t working for you anymore, examine why that is and figure out if it’s still worth striving for.
My resolution for this area is to give myself grace when I mess up and try again on the things that are truly important and working for me at that point in my life.
Let’s Recap
With these tips and specific, measurable goals, you can stick to your New Year’s resolutions.
First, when setting resolutions, prioritize your mental health. Next, know what challenges you’ll be facing and work around them. After that, break resolutions down into steps. Start when you feel you can. And make sure to recognize that quitting isn’t bad.
Give yourself grace this year, and strive to make positive, wholesome changes in your life.
The Bipolar Parent 
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