Keep Trying

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Never give up. That’s my message for 2013 to myself and all that read this blog. No matter how many doors close or road blocks we may think we see, we can always find a way to keep going. Just do it. Keep on keeping on. Try again. One more time. You can do it.

For the reward that comes from making that extra effort is so worthwhile. At the end of our days it may be the things we didn’t do that we will regret.

Wishing a year of peace and balance in 2013. A year filled with love and kindness to each other, as well as ourselves.

Please, share your inspirations and hopes for 2013 with me.

On Nature: My Recent Escape and Resting the Mind

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It has become an annual tradition to escape into the wilderness by kayak and enjoy a week of good company without the disruptions of everyday life.  It is during these escapes into a wilderness controlled by forces much greater than myself that I can quiet the inner noise and reconnect to myself.  My recent vacation was spent in Lake Superior, a remote, dream destination of pristine waters.  My group and I circumnavigated Michipicoten Island and enjoyed a week of paddling past massive rock faces, scrabbling over cobblestone beaches, hiking old caribou trails into the forest, discovering an old mine and a sea cave from ancient days and watching young caribou wander over rocky beaches for a cold, fresh drink of Lake Superior.  It was magnificent.

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Our mornings were spent tearing down camp and paddling with a break for lunch.  With a short afternoon paddle, we made our way into various protected coves and harbours to make camp, spending the afternoon exploring, swimming, hiking and relaxing.  After a yummy dinner, we would make a fire and watch as the sun set.  After a full day of fresh air and activity, sleep always comes easily.

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During these trips, each days’ plans are determined by weather conditions.  Typically winds over 20 knots  and/or waves over a metre to 1.5 metres will keep even intermediate paddlers off the water, as will any chance of squalls or thunderstorms so each day is determined not by what the group feels up to, but by what the days forecast will permit.  This means some days we don’t paddle and spend the day at shore, and some days we must paddle long distances to make up for wind or weather days so we can make it to our pick up point in time.

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The parallel to managing bipolar disorder is not lost on me here.  There are days the forecast simply won’t permit much travel, and there are days that must be spent making up for lost time…and that’s ok.  There are forces at work that are much greater than myself and these forces must be respected to avoid danger.   Something about being in a situation that illustrates this reality to me allows me to accept this reality on a deeper level each time I experience it.  It’s funny because in every day life I feel held back by my “internal forecast”, but on my vacation into the wilderness I realize there is a forecast much greater than mine and that somehow puts it all back into perspective for me.

In Stephen Fry’s “The Secret Life of the Manic Depressive” he describes Bipolar disorder as a weather forecast that can cast a grey, cloudy sheen over the brightest sunny day.  When I am paddling, every day my internal forecast is for a great day, and for that escape I am most grateful.

Many thanks to my paddling partners that made this trip so great.

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Mental Illness, Family and Support

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It goes without say that living with a mental illness presents many challenges, some of which can be overwhelming.  These can be a wide range of challenges from struggling with shifting moods, perceptions, medication side effects, challenges with daily living, emerging symptoms, motivation, etc, etc, etc.  It is a wide range of therapies working in conjunction with one another that I have found to be the key to managing a balanced and successful life with a mental illness.  These therapies are typically prescribed by a Psychiatrist.  In my case, these therapies include medication, talk therapy, supplements and good nutrition, exercise, sleeping and waking at the same times every day, maintaining a stable routine and calm environment.  As important as these therapies are to my stability, nothing compares to the support, love and encouragement I receive from my close friends and family.

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I am fortunate in that my family, friends and I live in a major centre so we have access to a wide-range of services, however long the waiting lists may be.  One of the most important services we have ever accessed in the Family Support Groups available at the Centre for Addition and Mental Health (CAMH).  My “support team” made up of both of my Mothers, my Father and Best Friend all attended that course and it was a game changer for our relationship.

CAMH Resource:  http://www.camh.ca/en/hospital/care_program_and_services/support_for_families_and_friends/Pages/support_groups_families_friends.aspx

It was in that course my family began to truly understand my illness (Bipolar Disorder), what that would mean for me, coping skills for themselves as well as for me, what treatment would involve and how they could best support me.  It goes without say that I am loved unconditionally, even if I am in a really low mood.  My family is now well equipped with tools to encourage me and steer me towards appropriate treatments for whatever I may be struggling with.  Most important, they learned not to take it personally.

It’s really unfortunate that when I am unwell, I become suspicious of the people that matter to me most.  These wonderful, loving, patient, kind, compassionate, understanding people stand firm at my side.  They know how to care for themselves so they don’t burden themselves with my load, they encourage me and remind me this will pass, remind me that I have coping skills, encourage me to visit the Doctors and to take the meds I can rely on.

I can’t thank CAMH enough for providing this type of valuable resource, and I encourage my readers to seek these supports in their own communities.  Whether you have a friend, a spouse or family members you may need to lean on, educating these “Support Networks” on the nature of your Mental Illness and ensuring you and your “Support Network” gets the help they need can only make your journey easier.  Wishing you healthy support and good mental health.

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On Nature: What’s your Escape?

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Healthy coping skills are important to any human -being, but in particular for those that are ill. We will all face stressors, bad news, difficult situations, and unfortunate losses. The question is, what do you do to cope with those times?

Now, there are many different types of techniques like breathing exercises, meditation, exercise, yoga, talking to a therapist, heck, just reading a book that can be a great way to cope. But, what is your escape? Where can you go or what can you do to completely remove yourself in a healthy way for freedom and enjoyment? Understanding there are times this simply cannot be achieved, I would have to say that over the course of a year I really need some time to escape and leave all of my troubles behind. I suspect this is the case for others as well.

I’ve had the good fortune of having an escape for most of my life. Growing up at cottages and being a scout leader, I had the advantage of developing outdoor skills that have allowed me the opportunity to become intimate with nature through camping trips and other expeditions. Four years ago I took up sea kayaking, which is an escape itself. But I added my camping skills, learned about weather and navigation and Bingo, I have an escape! At least once a year, if not twice, I disappear into the wilderness for at least 7 days with no cell phones or computers, no disruptions, no contact with the outside world. It’s just me, my gear and my camp mates thriving in the wilderness, playing like kids in our boats and over the beaches and rocks.

ImageThe joy that this gives me in almost indescribable as I spend my time concerned only about the elements and fitting my gear back into my boat. Meals taste better, I feel stronger physically and mentally, and my campmates are a source of many laughs and companionship. When I return from these trips I am energized, inspired, strengthened and ready for whatever the world or my illness has to throw at me. My ability to thrive in challenging, yet beautiful surroundings shows me I am stronger than I think I am and the mental escape from all demands and distractions just seems healing for my brain.

That’s my escape, tell me about yours? What does that escape do for you? How did you come to discover your escape?

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You can LEARN to cope with Bipolar Disorder with no side effects

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by Peter Newman, bp Hope Magazine


[full article]

Elizabeth taught me how to cope with bipolar disorder—she was my psychiatrist until I moved from England to the United States in 1989. I’d like to think it was because she took a special interest in me, but maybe she just got tired of me turning up on her doorstep every 12 months or so in a raging manic episode.

At the time, my method of coping with bipolar disorder was to ignore it, an excellent method except for one drawback—it didn’t work. Every year or two, I’d spend several weeks in full-blown mania, sometimes followed by depression, and then six months of withdrawal in the inevitable “morning-after” recovery that follows mania.

So Elizabeth taught me how to cope. It was her job. But, how many psychiatrists go beyond prescribing medication to the other part—teaching us how to cope? It took a while to get the hang of it. Like learning to ride a bicycle, I fell off a few times. Eventually I got really good at it, and in the past 10 years, I haven’t had a full-blown manic episode. (I’m still taking my medications.)

Many people have a story like mine. Many have learned to cope. Recently, scientists have begun to investigate the effectiveness of teaching people how to cope with bipolar disorder. What they have discovered is very exciting. They found that it really works, that it really works well, and that it really works well without any side effects.

Warning: science content

I watch the TV show MythBusters on the Discovery channel. They apply vaguely scientific methods to explore the truth of popular myths. Whenever there is serious science content, they flash a warning on the screen. Likewise here, there’s a bit of science content. But the bottom line is a three or four times improvement in staying well for those of us who have bipolar disorder and with no annoying side effects. That’s worth suffering some science!

To test the effectiveness of a new treatment for a disease, scientific comparisons are made. Typically, the treatment is a new drug. However, in the following studies (all of which were conducted between 1999 and 2003), the treatments being tested are different ways of teaching people how to cope with bipolar disorder.

All four studies about learning to cope use a similar method. A large group of patients is recruited and each patient is randomly assigned to one of two groups. One group receives the treatment being tested and the other group receives some other form of treatment. When a drug is being tested, the other form of treatment is frequently a placebo—a pill with no active ingredients. As far as possible, everything except the treatment under study is kept the same for both groups.

Treatment is given for a period of time and the progress of all patients is measured. The scientists taking the measurements do not know which patients are receiving the active treatment and which are in the comparison group, thus preventing bias from creeping into the results.

Illness self management

Teaching people how to cope with a Long-term illness is often called illness self-management. (For mental illnesses, it is also called “psychoeducation.”) The major ingredients of illness self management for mental illnesses include:
• medication compliance
• early identification of warning signs
• relapse prevention
• coping strategies for dealing with persistent symptoms
• improvement of illness awareness

This is what Elizabeth taught me, and these ingredients lie at the core of the therapies investigated in the following four studies: early symptom detection, family-focused therapy, cognitive therapy, and group education. The difference between the studies is where the emphasis is placed on the core ingredients and the additional elements included in the recipe. In all of the studies, therapies were given in addition to the patient’s usual medication regime.

Treatments on trial

Early symptom detection

Therapy
• teaching people how to identify early symptoms of relapse and to seek prompt treatment in seven to 12 individual sessions given by a research psychologist with little previous clinical experience

Participants
Sixty-nine patients who had bipolar disorder and had had a relapse during the previous year participated (mostly bipolar type I).

Outcome
After 18 months, the group that received the education avoided manic episodes nearly four times longer than the group that received treatment as usual (an average of 65 weeks against 17 weeks). The number of people who stayed free of mania was also better: only nine got sick compared to 20 from the other group. There was no effect on episodes of depression, but overall social functioning and employment were significantly improved. (Reference: A. Perry et al., BMJ [British Medical Journal], January 1999)

Family-focused therapy

Therapy
• 21 sessions for patients and their caregivers in their homes by a therapist with the first seven sessions on these illness self-management basics: medication compliance, early identification of warning signs, and strategies for relapse prevention
• communication enhancement training sessions to teach skills for active listening, giving feedback, and requesting changes in behavior
• problem-solving training to help identify family problems and select solutions

Participants
Of the 101 participants, most had bipolar I and had recently had an episode. The therapy group was compared to a less intensive crisis management strategy consisting of two sessions of family education plus crisis intervention sessions as needed.

Outcome
At the end of the two-year study, three times as many patients in the therapy group stayed well compared to the other group (52 percent compared to 17 percent). On average, for patients who did get sick, those in the therapy group stayed well longer than the other group (74 weeks compared to 54 weeks). Also the therapy group showed reduced mood symptoms, particularly depression, and better medication adherence. (Reference: D. J. Miklowitz et al., Archives of General Psychiatry, September 2003)

Cognitive therapy

Cognitive therapy focuses on patterns of thinking that lead to undesirable moods and on the beliefs behind these thought patterns. Patients are taught techniques to monitor, examine, and change these thought patterns. This study examined an enhanced form of cognitive therapy for bipolar patients.

Therapy
The therapy was extended to add relapse prevention by:
• monitoring mood and detecting warning signs, and taking action to avoid full-blown episodes from developing with patients receiving 16 sessions

Participants
There were 103 participants who had bipolar I and who experienced frequent relapses despite being on mood stabilizers. The therapy group was compared to a group that received treatment as usual.

Outcome
Therapy recipients spent three times fewer days in bipolar episodes than the other group (an average of 27 days compared to 88 days). The therapy cut the hospital admission rate in half—15 percent of patients in the therapy group were admitted compared to 33 percent for treatment as usual. The group that received cognitive therapy also exhibited significantly higher social functioning, fewer mood symptoms, and significantly less fluctuation in manic symptoms than the group that did not receive it. (Reference: D. Lam et al., Archives of General Psychiatry, February 2003)

Group education

The above studies investigated education therapies administered in individual sessions. The group education study is exciting because group sessions are much more cost-effective and thus more likely to become widely available.

Therapy
• groups of eight to 12 participants with 21 sessions, each lasting 90 minutes
• each session consisted of a speech on a topic followed by a relevant exercise with these major topics: illness awareness, medication compliance, early detection of warning signs, and lifestyle regularity

Participants
There were 100 participants who had bipolar I and 20 who had bipolar II; all had been  well for at least six months. The therapy group was compared to a group that attended unstructured group meetings for the same number of sessions, in the same size group with the same therapists. The only difference was that unstructured meetings contained no education component.

Outcome
After two years, four times as many patients in the therapy group stayed completely well compared to the unstructured group (33 percent compared to eight percent). The therapy group spent three times fewer days in the hospital (an average of five days compared to 15 days). Also, the length of time before getting sick was significantly longer for the therapy group. (Reference: F. Colom et al., Archives of General Psychiatry, February 2003)

And the verdict …

The results are best summarized by this quote “… the usefulness of psychotherapy [teaching self-management] for improving outcome for bipolar patients is now unquestionable, especially for patients who have achieved a certain degree of remission from acute symptoms,” in a December 2004 paper by F. Colom, PhD, and E. Vieta, MD, PhD, in Bipolar Disorders.

In other words, it’s a free upgrade, a stay-out-of-hospital card, and scientifically tested. From my own experience, I know the improvement that learning illness self-management brought to my own quality of life. But that is just one anecdotal story. Now science has measured the improvement. After learning illness self-management, three or four times as many patients stayed well, and they spent much less time in the hospital than those on medication alone.

From good science to good sense

The same scientific method that brought us modern medications has shown that teaching wellness works for those of us who have bipolar disorder. By learning to manage our illness, we can stay well longer and visit the hospital less. There is no longer any question regarding the value of wellness education.

In the words of Drs. Colom and Vieta, “Psychoeducation, like every effective psychological intervention, is essentially based on common sense.” It is a joy and delight to see common sense making further inroads into the treatment of mental illness.

—–
Peter Newman holds a PhD in computer science and works in Silicon Valley, California. He maintains a Web site on illness self-management for bipolar disorder at http://www.lucidinterval.org

SIDEBAR: Two learning programs

In these two free programs below, people who are successfully managing their own mental illness, teach others.

• NAMI (National Alliance on Mental Illness) offers the Peer-to-Peer Recovery Education Course, consisting of nine weekly sessions, of two hours each, led by trained peer mentors and based on the core ingredients of illness self-management (www.nami.org). The course is designed to motivate as much as to educate. You can teach someone what to do, but it is much more powerful to motivate them to do it.

•Wellness Recovery Action Plan (WRAP), offered by Mary Ellen Copeland, mental health recovery educator and author (www.mentalhealthrecovery.com), is a method of self-management consisting of eight sessions, of two hours each, led by two trained peer instructors.

Best and Worst Things to Say to Someone with a Mental Illness

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There is a tremendous lack of awareness of mental illness and (thankfully) current, humane treatments available. Movies and media have done mental illness a serious injustice in their portrayal of those with mental illnesses (think of like movies One Flew Over the Cuckoo’s Nest, Girl Interrupted, Frances). The reality is that a majority with mental illness are NOT violent, many can be very highly functioning, highly creative, and highly intelligent people and today there are some good treatments available. However, those that are suffering could use some encouragement and support in their hour of need and suffering.

When I recently appeared on a TVO episode of The Agenda, I was asked about “suffering” and why it is always used when speaking of the mentally ill. My answer was that it DOES involve suffering. Although periods of wellness can be known and enjoyed, the reality of many mental illnesses is that there will be periods of illness as well. These times require medication adjustments, extra therapy if available, and as much support and encouragement as is humanly possible to assist someone through an episode of sickness. I have previously spoken of “lifestyle changes” to assist in recovery and wellness, but being in the depths of an episode of sickness can be a challenging time to make several significant lifestyle changes. As one is recovering from an episode, it is possible some “lifestyle changes” can be slowly incorporated over time to support medication therapies. But, in the midst of a crisis all one can do is provide some encouragement, support and avoid making certain statements. Below is a summary that will hopefully inspire further ideas of “what to” and “what not to” say to someone who is struggling.

Best Things to Say

  1. I care about you.
  2. Can I help you? What could I do?
  3. You are amazing and strong, you can get through this, I know you can.
  4. I’m here to support you any way I can.
  5. I’d be happy to just listen to you.
  6. This must be hard for you.
  7. Would you like to go for a walk?
  8. Have you seen your Doctor? Could I help you get there?
  9. You don’t need to apologize for the way you are feeling.
  10. I love you unconditionally.

Worst Things to Say

  1. You don’t need those pills, you would be better off without them.
  2. Just pull yourself together.
  3. You look fine, are you sure something is wrong?
  4. Why don’t you just loosen up and have some fun.
  5. We all have our challenges, why don’t you just snap out of it.
  6. Think positively!
  7. You think you have problems?
  8. You could choose to be well if you wanted to.
  9. What doesn’t kill us makes us stronger.
  10. You were off work for how long???

Think about someone with cancer or epilepsy or diabetes. Would you ask them “are you sure something is wrong” or “just loosen up and have fun”? When someone has a mental illness, they literally have neurotransmitters misfiring causing the symptoms experienced. This is completely and utterly out of the control of someone suffering, and worst of all in some cases those who are ill simply lack insight into their own illness and cannot see it for what it is. This is the unfortunate reality, so if you can find it in your heart to avoid running away, and stick around to be encouraging, the above list may assist you in being a supportive friend or family member. I can speak from first-hand experience when I say that encouragement and love from family and friends can be almost as important as the medication required to settle the neurotransmitters that fail me when I’m ill.

Can you add to either of these lists? Please contribute in the comments below.

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Mental Illness is Treatable: Lifestyle changes

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There is considerably more hope today for those with a mental illness then there may have been 20 or 30 years ago.  With humane medical advancements including advancements in medications available, good quality of life can be achieved however it takes some lifestyle changes.  I’ve spent 7 diagnosed with Bipolar Disorder perfecting these lifestyle changes to ensure I get the most I can out of treatment.   Understanding these may vary slightly, making some of the following changes would enhance the quality of anyone’s life, but those that struggle with a mental illness seem so much more environmentally sensitive, I believe it is even more critical.  I know in my case, I really need to stay off the computer after 8 pm because the light from the screen can keep me awake at night.

Lifestyle changes include the following:

  1.  Regular sleep times.  Going to sleep and waking at similar times every day and ensuring to sleep during hours that are dark help maintain stability.  The brain produces serotonin in the day when stimulated by light and melatonin at night when stimulated by dark, so taking advantage of these natural cycles of light and dark supports a quality natural sleep cycle.  Personally, I’m in bed by 9:30 and up by 5:30 pretty much every day.  When I get off that cycle, I don’t feel as well.  Sleeping too little or too much are triggers for mood instability so I avoid disruption to this cycle at all costs.
  2. Good, quality nutrition supports the bodies natural defense systems.  Mainly, eat lots of vegetables and high quality grains and proteins.  My body just feels better when I do this, but eating junk food, empty calories and lots of salt or sugar weighs the body down, deprives it of much needed nutrients and does all sorts of other damage.  With the risk of weight gain so prevalent with many psychiatric medications, it becomes even more critical to eat clean and ensure all major physiological systems are fed.  Eating lots of deep coloured vegetables (dark leafy greens, beets) and low fat proteins (fish, lean turkey) feed the bodies ability to support healthy neurotransmitters as well as a healthy body.
  3. Exercise is a natural antidepressant.  Personally, I prefer morning workouts so I can receive the benefit of the endorphin release all day, but as long you’re not exercising too close to bed time (that would be stimulating), anytime will suffice.  The ideal is a good cardio workout to get the heart pumping to maximize endorphins.  I practice hot yoga which can be more or less of an endorphin release based on the style of practice, power walks, and strength training.  In the summer, I add in some cycling and kayaking.  All those endorphins with fresh air and sunshine make for best moods of the year.  Residing in the northern hemisphere, winter prevents some of the outdoor fun with such short days.
  4. Light therapy.  Don’t underestimate the importance of the sun and when the sun is not available, a light box will suffice.  With Bipolar, I have to be careful how this is used.  I find it best around mid-morning to mid-day, as too late in the day could interfere with sleep.  I sit next to a light box the strength of 10,000 lux (10,000 candles) with the light entering through my peripheral vision as I sit and read or work at my computer.  These lights are available at Costco, Shopper’s Home Health, and other Home Health retailers.
  5. I have read a few articles about the consistency of vitamin deficiencies in those with mental illnesses.  Specifically in Amino Acids, Omega 3 fatty acids, Vitamin B, Vitamin C and Vitamin D.  Doses vary by research source so I would recommend speaking with your Doctor for treatment that will be appropriate to the medication you are taking.  However, it is worth requesting a blood test to confirm any deficiencies and ensure all are addressed.  This also refers back to the need for good nutrition to also maximize absorption of any supplements you may take.  A large caution here as many herbs are contra indicated with psychiatric medications.  Examples would be St John’s Wort, Valerian and Ginseng, so please be very careful, discuss with your doctor and stick with all recommended doses.  Latest article I’ve read about this is can be found here:  http://weeksmd.com/2012/05/nutritional-psychiatry-coming-to-a-hospital-near-you/
  6. When well, learn some good meditative, self-soothing techniques.  Personally, I practice yoga, journal, enjoy hot baths, my garden and reading.  These techniques are next to impossible to learn in the midst of an anxiety attack or moment of great stress, so it’s pretty critical to find what appeals most to you for relaxation and learn to use those things when feeling that crisis is imminent.
  7. Most important, regular med times.  Ensuring an even and consistent dose will support maximum stability.

    Lifestyle changes can bring a whole new wellness and meaning to each new day.

Of course all of this is not easy to do all the time, and sometimes I’m doing everything “right” and still need to seek treatment for depressive or hypomanic episodes.  However that doesn’t negate the value of all of these lifestyle changes make to my overall well being.  Also, it’s best to add one thing at at a time as making all of these changes at once could be hard to sustain.  A new habit takes 3-4 weeks to form, so adding one new thing each month could assist

In the comments, please add any other lifestyle changes or skills you have for self-calming exercises.  This could be a great resource to help many and any constructive input is appreciated.  Wishing you good mental health, stability and wellness.  Namaste.

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Poppies Starting to Blossom

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My garden friends are returning to visit!

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