Making Healthy Decisions When You Have Bipolar Disorder

“When you have bipolar disorder, it can often feel like you’re at the mercy of your emotional states — like you’re the passenger in the car, just along for the ride,” writes Sheri Van Dijk, MSW, in The Dialectical BehaviorTherapy Skills Workbook for Bipolar Disorder. But “this doesn’t have to be the case.”

In the book, Van Dijk shares how individuals with bipolar disorder can learn to act — rather than react and make smart decisions. (I personally think these insights and advice are valuable for all readers, regardless of whether you struggle with bipolar disorder.)

 Finding the Balance Between Emotions & Logic

According to Van Dijk, in order to make healthy choices, we need to find a balance between our emotions (emotion mind) and our logic (reasoning mind). This balance is called “wise mind,” a concept from dialectical behavior therapy (DBT).

Wise mind means that you’re able to feel your emotions while still being able to think straight, she writes.  It’s possible to make smart decisions based both on your feelings and your thoughts about a situation.

Everyone has a wise mind. According to Van Dijk, you’ve used this wise mind whenever you’ve gotten out of bed even though you felt depressed, or gone to work even though you felt anxious or taken a walk even though you wanted to watch TV and be alone.

Telling the Difference Between Wise Mind & Emotion Mind

It can be tough to tell if you’re making a decision based on your wise mind or your emotion mind, because, as Van Dijk writes, both include emotions.

She suggests assessing the strength of your emotion. If your emotion is intense or overwhelming, you’re likely in emotion mind. If it’s not overpowering, you’re likely in wise mind.

Also, making a decision from your wise mind means sitting with it. If you find yourself vacillating, you’re probably letting emotion mind take over. That just means that you need to give yourself more time.

An Exercise to Be More Effective

A wise mind will help you be more effective in life, according to Van Dijk. In other words, this involves “doing what it takes in a situation to get your needs met.”

Think about it this way: How many times have you acted in a way that felt great in the short term but not so great in the long term?

Van Dijk uses the example of stopping your medication. Let’s say you’re experiencing unpleasant side effects. Instead of telling your psychiatrist that the side effects are bothering you, you just stop abruptly. The side effects do go away in the short term. But you end up in the hospital because of a manic episode.

Van Dijk says that several things can interfere with acting effectively and making good decisions: your thoughts, or how you wish a situation was; not knowing what you want out of a situation; and thinking short-term needs vs. long term.

For instance, as Van Dijk explains, “While you might get some satisfaction out of yelling at an employer whom you feel didn’t treat you with respect, in the long run, you must remember that you need that person to say good things about you to help you get to the next job.”

Also, consider the earlier example about stopping medication abruptly. There, you were letting your emotions make your decision. If you were to consult your “reasoning mind,” you’d realize that not taking your medication can lead to a relapse and other risks.

When you think with both your emotions and reasoning, you’re able to identify your goals (making sure that they’re not at the expense of others). As Van Dijk writes, you might say: “I’m frustrated with the side effects and have decided that [they’re] not acceptable. I need to book an appointment with my psychiatrist to inform her of this request that she prescribe a different mood stabilizer.”

Van Dijk suggests readers practice by thinking of a situation that requires a decision. She suggests asking yourself the following questions (and recording your responses):

  • Describe the situation
  • What are the emotions you are experiencing about this situation?
  • What is your urge in this situation? (What is emotion mind telling you to do?)
  • What is your long-term goal in this situation?
  • What would be a helpful action for you to take in this situation? (In other words, what can you do that would make it most likely for you to meet your long-term goal?)

Other Ways to Be Less Reactive

According to Van Dijk, there are other things you can do to be less reactive, so you don’t let emotions rule your decisions. These include: improving your sleep habits (key for bipolar disorder — shaky sleep can trigger manic or hypomanic episodes); avoiding drugs and alcohol; practicing good self-care; reducing your caffeine intake; not skipping meals; getting nutrients from your diet; and participating in physical activities you enjoy.

This article is originally posted at PsychCenral By 

So What If I am “Crazy”?

I am a strong Asian woman: I survived a childhood trauma; I aced my college; spent years of my single life working for international design firms; I hiked up 6,000-plus-foot mountains; worked for a non-government organization helping communities in difficult circumstances; empowered children who are  orphaned and abused in the Philippines; counseled countless single women; rode the waves down in Puerto Galera islands in a kayak; designed numerous stage backdrops; painted countless murals; ran a full and half mile marathons; traveled to various countries; I’m raising a child with Autism Spectrum Disorder; I’m a multi tasking and get it done woman. I feel the ‘S’ in my chest.

Sampeng Market; Bangkok, Thailand

Sampeng Market; Bangkok, Thailand

I am an Asian woman with a brain disorder, also known as a mental illness — specifically, manic depression, also known as bipolar disorder. I was first diagnosed in 1999. My church minister who i am very close too told me that my emotional behavior was very unlikely and that I should seek a ‘professional help’. I did not want to see a psychiatrist, because “nothing is wrong with me. I’m not crazy!” But I was compelled to see one if I want to be successful in my career and be effective serving in my ministry.

At my first appointment the psychiatrist listened to my tales of trauma, identity crisis, my roller coaster emotions and roidy behavior, and suggested that we consider a mixed of Bipolar I and II as a “working diagnosis.”

I never heard the term “bipolar” before, not in the Philippines as far as I know. I didn’t know that there was more than one type. My psychiatrist explained that Bipolar I is a combination of depression and mania. Bipolar II is characterized by hypomania, which is more of a subdued but ever-changing cocktail of energy spurts, spontaneous irritation, impulsive behavior and inflated confidence.

Like many people, I once felt that having a mental illness was a sign of personal weakness. As an interior designer, I was a perfectionist when it comes to implementing my designs. I was motivated to be successful. I was very ambitious. In my field, there is no room for being weak. I also spent lots of time sharing the scriptures and counseling women but when it was my turn, I felt that going to the psychiatrist was a sign of failure.

Since then I’ve been discreetly undergoing treatment for Bipolar; therapy, medication, the whole nine. Only my very closest friends at church knew what I was going through. They were very supportive and they monitored and made sure that I was taking my medications.

I never spent time in a mental health treatment facility, but I will probably need medication for a lifetime, and sit many hours in a therapist’s office. Most of all, I will need the ‘prescription’ of the bible to remind me of hope and that God is on my side. I’ve got the ‘master of the universe’ and a whole professional team that works with me to keep me sane.

Hiking Mount Pulag with my mountaineering club

Hiking Mount Pulag in the Philippines with my mountaineering club

According to the mythology that surrounds the strength of Asians specifically Filipinos, “falling apart” is just not something we do. We survived the Spanish, Japanese and American invasions; oppression and economic deprivation. We know how to “handle our business,” riding through countless floods and calamities. We see therapy as the domain of “weak,” neurotic people who don’t know what “real problems” are. Instead, to deal with our psychic pain we excessively use alcohol and drugs and act out violently through word and deed, but we do not go crazy. That’s not our culture.

Because being “crazy” means you can’t handle life, and in our story of who we are, we are survivors who can handle anything, which means that we do what we have to do to survive. But this does not usually include a trip to the mental health professional of our choice. It is time to add this to our survival toolkit.

I used to be ashamed and secretive of the reality described in the previous paragraph but proud of the life described in the first. Now it’s an integrated whole. Superhero status is not required. I cannot save the world, and sometimes I’m the one who needs saving.

I thought before I could probably keep it a secret forever to my non-church friends, but also have been wondering what if I did.  I wonder if I even need to. I mean, I lived a double life and for years I knew that something is seriously wrong with me before knowing Christ; a countless string of boyfriends that ended to a break up because I couldn’t figure out how to handle a relationship; obsessive compulsive behavior, alcohol addiction and suicidal thoughts.

Is it really better to medicate myself with alcohol, be depressed and run away from those around me, instead of seeking help for what troubles me so deeply that I choose to self-destruct — though perhaps not in the stereotypical idea of what suicide looks like to me, I don’t think so.

Serving children in difficult circumstances; Baseco, Philippines

Serving the children in difficult circumstances; Baseco, Philippines

I gradually started sharing to my friends and my family about my condition. Like what is expected, my family was in denial, perhaps because they do not know anything about this disorder. Some of my friends would say “NO, you’re not!” or “It doesn’t show!”. It is hard to explain sometimes to people why I feel what I feel and why I do what I do but sharing to them is the only way I can be true to myself and to people. The best person to ask how my disorder is manifested in my life is through Moses, my amazing husband who in spite of all my craziness, stood by me and is faithful.

Recently, I shared to one mother whom I am close to that I have Bipolar disorder and before I knew it, she didn’t want anything to do with me. This made me think, perhaps, I don’t need to share my illness so I don’t have to figure out how to tell people and be subjected to their reactions. I don’t need to be concerned whether I will be accepted or not.

However, I know that at some point I must stop worrying what other people are going to think and get about the business of getting well and moving forward in my life.

So how do we begin to eliminate the stigma of mental illness so that we can get the help we need and support those who need it?

  1. Talk about it. Don’t whisper or gossip about it. Talk about it at the barbecue. From the pulpit. On TV. On the radio. With our doctors. With our loved ones. If we can talk about our “sugar” and our “pressure,” then we should be willing to talk about our depression.
  2. Support others in getting help. We send friends to the doctor for the nagging back pain, so send them to get relief from their mental and emotional pain, too. And don’t forget to ask them how they are doing as time passes; they need friends more than you know.
  3. Let us not stigmatize the brain. It is attached to the body, so mental illness is a physical illness, especially as chemical imbalances are at the root of their expression. Furthermore, the biochemical impacts of a brain disorder are felt throughout the whole body, not just in the brain.
  4. Say, “This person has a mental illness,” not, “This person is mentally ill”. We do not say, “That person is cancerous.” Words have power. Communicating to people with the proper description help others to be aware of the differences.
  5. Acknowledge - that those who survive a brain disorder are as much survivors as family and friends who survive life-threatening diseases.  Understand that we work just as hard to stay sane as the addict does to stay sober. As cancer or addiction goes into remission, so, too, do brain disorders. They are fighting to win over their illnesses.
  6. Support people who share their stories of brain disorders. It is time to show that the faces and lives of people with a mental illness are not just the faces and lives of the homeless person talking to the unseen. It is my face and my life, and the faces and lives of so many other men and women like me.
  7. Advocate for accessible and affordable mental health services. Most people with mental illness do not get help because of the cost of medication and therapy. Help them through surfing online or looking for a network that can provide affordable health services or even better, free.
  8. Encourage people to have a spiritual life. Like any other illnesses and addiction, the most effective way of healing is to acknowledge that there is a higher power that can help you manage your life. Surround yourself with positive and spiritual people who can support and encourage you.      
Sunday afternoon; Bondi Beach in Sydney, Australia

Sunday afternoon; Bondi Beach in Sydney, Australia

“Coming out” requires courage. Like any other consciousness-raising process, a range of role models that represent a variety of experiences with mental illness will change perceptions. I have role models to inspire me in my various endeavors. I need a list of people with Bipolar disorder who have survived and thrived.

No doubt due to the stigma, it is difficult to find names of well-known Asians with a “confirmed” history of mental illness — and this is no place for innuendo or rumor-mongering. Though I’m not well-known, I will start this list with me: My name is Lorraine Edralin, and I have Bipolar disorder. I am a wife, a mother, designer, blogger, runner, kayaker, hiker, traveler, a servant of God and as sane and happy a person as you would ever want to meet. My brain disorder does not define who I am.

“For you created my inmost being;
you knit me together in my mother’s womb.
I praise you because I am fearfully and wonderfully made; your works are wonderful, I know that full well. ”                                                                                                        -Psalm 139: 13-14

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