Flipboard Magazine

Thursday, March 31, 2011

Managing Bipolar Disorder

Bipolar describes a mood disorder in the bipolar spectrum: a range of abnormal energy levels mixed with varying depressive episodes, rapid cycling of each, or episodes of each separated by normal mood. Manic periods can be characterized by delusions and hallucinations. Categorically subdivided into bipolar I, bipolar II, cyclothymia, and bipolar not otherwise specified, it is also known as manic-depressive disorder, manic depression, and bipolar affective disorder. Keeping symptoms to a minimum requires personal involvement in a management plan. Many bipolar people live productive lives because they monitor their symptoms and get the help they need. Management of any disorder requires lifestyle changes and often, medication. Family and friends can get involved in managing a loved one's bipolar disorder through education and participation in bipolar support groups, tharapy, and crisis services.

Stressful events, even minor ones, can contribute to a bipolar episode. It is difficult for some bipolar people to get regular sleep; however, this is a major goal to put into a bipolar management plan, as is abstaining from alcohol or drug use. Substance use or abuse, even alcohol in small amounts can throw the body system off rhythm. It is important to stay on schedule with medications and let your doctor know whether you have any physical conditions that may be affecting your mental status. Attend a support or therapy group regularly and share your feelings with a friend or significant other. Set up a crisis management system to help yourself and others when you cannot control your actions such as have crisis center phone numbers handy, have financial restraints if you tend too spend too much money, and a drug and/or alcohol intervention plan.

Wellness activities can make a huge difference in the way you feel physically and mentally, and sharpen your focus. Yoga or more vigorous exercise can reduce stress. Learn problem-solving skills from your friends, your support group, or your doctor. Develop a hobby that keeps your mind occupied and helps you focus. You can also write a daily journal about your feelings and challenges and keep a daily planner to help keep you on track. Eating healthier food will also help you feel better overall. Go outside every day and enjoy nature and try to avoid stressful situations. Make a note of them so you will recognize them. Everyday occurences are sometimes very stressful, like changes in the seasons, illness, and holidays. These are things you have no control over. Death, disagreements, problems, finances, and life changes also cause stress and can be a priority in a stress management system. Noting how you react to stress and having a plan to handle it can make a huge difference in managing your life overall. Keeping a chart of your moods and methods of dealing with them can be a way of making your plan concrete.

To sum it up, you can live a full, productive life with bipolar disorder with careful planning. Staying on schedule with your lifestyle plan, medications, and therapy is the key to feeling better. Once you learn methods of coping with stress and change in therapy or a support group, you can practice until it becomes second nature. Recognizing when you need to get help for a crisis and keeping your family members and friends updated on treatment and your moods can also keep you on track. If you work, try to get a job with a flexible schedule and an understanding boss. When you have energy highs, you can do tasks that require high production, and when you are low in energy, do tasks that don't require as much energy. Computer programming, software testing, writing, and working at home might be some options for employment. The best thing to remember is that we all have ups and downs and make mistakes. When you fall off schedule, pick yourself up, repair any damages, and keep on going.

Thursday, March 10, 2011

This book took me a long time to read, but it was well worth it. Laurie Barkin has written a memoir-type account of her work experience as a psychiatric nurse and woven her personal life throughout. The account read like a good novel, and the personal life experiences rounded this therapeutic story. Laurie's personality shone through her expertise as a nurse; her sensitive care of her patients made me wish there were more nurses like her. What we have lost in quality patient care has touched all aspects of society and has caused costs to skyrocket instead of decrease. Laurie mentions this issue throughout her chapters; she has direct insight from having worked in a hospital when managed care was just taking off. I related to the notion of vicarious trauma that some caregivers experience; this is probably more widespread than some of us want to admit. Although I did not work with such severe trauma cases as Laurie, I did work for a facility that ministered to special populations and after 5 years of working there, sought a career change.

One has to admire a person that loves her job and that loves helping people with traumatic histories.  Laurie related these stories in a sensitive manner while making an impact on the reader. I found myself wanting to know more about them and how they had survived such conditions. She did admit that there were a few people she did not warm to, and this added to the book's credibility. I related to her worrying more about her loved ones and wondering if her luck would run out in her own life. It is impossible for many of us not to wonder if our relatively stable lives will all of a sudden be shattered as is the case for many. I am a worrier and I feel like I have to walk on glass sometimes so as not to disturb life's rhythm; although, I am much better as I age. I suppose there is less time left to worry.

Laurie seemed cautious as the book began, not going into too much detail on the first patient she described, but as the book unfolded, the descriptions of the patients and their histories made more of an impact. I especially liked the description of Mr. Livermore, the seemingly cold, inhuman patient who appeared near the end of the book. Then, there was Will Avery, who wondered why the doctors saved him; he felt worthless. I liked Mrs. Holloway, who had gotten a knife wound, from one of her neighbors, and the comical Jack Whitman, who joked about his injury.

Laurie balances the sad horror stories of her work with anecdotes of her home life, her last pregnancy, her husband, and three children.  They live a good life, the reader watches Benny, her last child, grow; they take vacations and do normal family activities. Toward the end of the book, Laurie describes her pounding heart and her growing misgivings about her work situation. She finally reaches the breaking point, and as the book ends, she decides to take a break from work and worries about reinventing herself. Will her identity survive when she is no longer a nurse? This is an issue many of us grapple with when we make a career change. Will we succeed, or will we fail? It was therapeutic to share the author's feelings and thoughts throughout this book. Readers will find many issues to relate to and share in the ways that Laurie works through them. Is is obvious to me that she is a success; a book is a great accomplishment. In the acknowledgments, she says it took her nine years to write her book; the work she did is evident in the carefully written accounts of her career.

This book should be read by anyone thinking about going into the mental health profession, and it would be therapeutic for those already in it. It really describes the day-to-day struggles and triumphs in the helping professions.



Sunday, March 6, 2011

Animal Therapy

Most animal lovers know that animals make great companions; however, pets are often recommended to reduce loneliness, depression, and other emotional problems. They are used in animal-assisted therapy where there is a specific goal or treatment plan, or in animal-assisted activities with special needs populations. Pets can teach responsibility for taking care of another being, they can help with grief, and they help build self-esteem with their unconditional love. Pets can be parent, child, and best friend all in one. They are nonjudgmental, love attention, and love to play. They provide structure and focus to a daily routine, help reduce anxiety, and are trustworthy companions.

Therapy dogs have been used to cheer soldiers and as visiting dogs since World War II. They have been documented to have beneficial physical effects on patients, such as lowering blood pressure depression. Seeing-eye dogs have assisted humans for many years. Dogs can also be trained to bring items to people and to alert another person in the house if there is an emergency. Animals help people with communication goals in a nonthreatening way and add enjoyment and comfort in animal-assisted activities in a variety of settings.

Animal-assisted therapy is directed by a health professional and is in both used in one-on-one sessions and group therapy with positive results. In particular, animals help humans to increase their interactions with others because people feel more confident and less depressed with them around. They are used in senior centers to help with recreation programs and in other settings to help patients with attention deficit and conduct disorders, autism, developmental disabilities, and Alzheimer disease. Many programs for children include horseback riding as a therapeutic activity.


Animals used in therapy situations are medically examined, taught obedience skills, and are tested on their reactions to human behaviors. While the therapy animal has to enjoy being around and helping humans, great care is taken for the  animal's well being. In serious mental health situations, it is important to match person and animal so both will benefit and be safe in the interaction


There are numerous local and national programs that have animal assisted therapy and activities. Among them are the Delta Society with its Pet Partners program, International Association of Assistance Dog Partners, and the National Center for Equine Facilitated Therapy. Alternative Solutions in Long Term Care, LLC has an inclusive list of links to pet therapy programs on the Internet at http://www.activitytherapy.com/national.htm. My own animals bring me happiness with their goofy antics. I think other pet lovers will agree that their is nothing better after a tough day than coming home to a wagging tail or a nice purr.

Dysfunctional Families

There are many types of dysfunctional families; definitions differ according to different experts. One thing they seem to agree on though, is that adults that are the products of these families suffer from a variety of long-term effects. The main problem is unhealthy boundaries within family relationships. Either the children or the adults have no concept of a healthy respect for other people. Often, the constant picking and put-downs are supposed to “make a child a better person.” Instead, it breeds a child without confidence and who does not develop individually because he or she is afraid to. Adults sometimes don’t set boundaries, so a child constantly misbehaves and thinks that his or her parents are there to wait on them.

Many rules of dysfunctional families are covert and their aim is to control the members. They are cut off from the outside world and have no conception of healthy relationship behaviors. These families don't talk about problems communicate directly. The controlling members like to be in the spotlight all the time and tell others that they are selfish if they think about their needs. Less controlling members are consumed and become puppets that carry out commands without thinking about them.  Challenging a belief or a covert rule is a major crime and leads to unpleasant consequences: the silent treatment, application of guilt, and/or emotional or physical abuse.

Adults of these families have many issues including expressing feelings,  marrying a dysfunctional person or one from from another dysfunctional family, perfectionism, fear of taking risks, having a constant need for approval, and ineffectiveness in decision making. They can also feel worthless, avoid conflict and tend to be impatient, have fear of abandonment, fail to take care of themselves while immersing themselves in the needs of other people, and do not like to express anger. Adults of dysfunctional families can also have other problems including mental health issues, addiction issues, problems with the legal system, problems getting through school keeping a job.


Adults of dysfunctional families can work to change the issues that keep them from living full and satisfying lives once they recognize behaviors that are holding them back.  There are many types of therapy and “deprogramming” that can help.  individual counseling, therapy groups. Make goals for yourself and practice self-programming. Allow yourself to feel anger and unpleasant emotions. Work your anger out; shovel a few loads of snow, walk extra miles; do something that is repetitious and pounding. It works the anger out and gets surprising results when you are done your chores, exercises, or walking. Talking to yourself helps, too. You rarely say something to yourself that you don’t want to hear.

Take care of yourself first. You cannot take care of anyone else if you are in bad shape. You might injure them in the long run if you are an emotional mess yourself.  Change your destructive relationships. This is difficult; you will feel guilt at first. If you have to, get rid of destructive relationships, even if they are family. There is no law that says you must put up with emotional or other abuse; it is just tradition; i.e., you are stuck with us, we are your family. Not true. If your old “friends” don’t like the new you, remember, there are close to 7 billion people in the world. There are plenty to choose new friends from. It is better to be alone than lonely in the midst of a crowd. You have a right to have personal boundaries and have people respect them.

Make no mistake; this is a lot of work and takes a lot of time, but it is worth it. Even one step to help yourself will make you feel better and more productive right away.  There will be times when you feel very lonely, but keep in mind that you are bettering your mental health and relationships. Keep at it and your confidence will build and you will make new friends that respect you and want to see you succeed.





Mental Health in Fiction

Mental health issues are widely found in fiction and movies; even psychological thrillers and mysteries have elements of mental illness in their villains and victims. Fiction is an enjoyable, sometimes vicarious way of exploring mental health topics.  A Google search brings up a few links to lists of well-known and some not-so-well-known authors and books featuring mental health issues. Two titles that I found on Amazon are: Next to Nothing: A Firsthand Account of One Teenager's Experience with an Eating Disorder by Carrie Arnold and B. Timothy Walsh and What You Must Think of Me: A Firsthand Account of One Teenager's Experience with Social Anxiety Disorder by Emily Ford, Michael Liebowitz and Linda Wasmer Andrews. These are both fairly current teen books that are highly rated. In Tomato Girl by Jayne Pupek, also highly rated, Julia's mother is bipolar. This book also covers other sensitive issues when Julia's father brings home the Tomato Girl. Sally Warner's How to be a Real Person (in Just One Day), covers another teen with a mentaly ill mother whose father has moved out.

Mental health in adult fiction contains many classics and newer authors as well. There is The Bell Jar by Sylvia Plath, which describes the author's own depression and Don Quixote by Miguel de Cervantes, which comically chronicles the misguided adventures of Don Quixote and his horse, Rocinante. It was published in two volumes, the second featuring Don Quixote's well-known sidekick, Sancho Panza. There are To Kill a Mockingbird by Harper Lee, Of Mice and Men by John Steinbeck, Crime and Punishment by Fyodor Dostoevsky, and the Strange Case of Dr Jekyll and Mr Hyde by Robert Louis Stevenson. Newer works include The Curious Incident of the Dog in the Night-Time by Mark Haddon, which explores autism spectrum disorder; Fight Club by Chuck Palahniuk, in which the protagonist struggles with insomnia and finds relief by impersonating a mentally ill person in several support groups; and Kiosks Keep The Devils Away: A Novel About Mental Health by Donald Rothschild, a story about community responses to the mentally ill.

Almost everyone has heard of or seen Silence of the Lambs, which deals with antisocial personality disorder. Fatal Attraction, which features a woman with borderline personality, was another widely seen movie in the late 1980s.  What About Bob?, which came out in 1991, featured Bill Murray as a goofy, likable man with obsessive-compulsive disorder. The Three Faces of Eve and Sybil, which are two older films featured women with dissociative disorders. There are many movies that cover amnesia such as Mulholland Drive, The Bourne Identity, The English Patient, The Lookout, and Ghajini, which are all newer movies. A Beautiful Mind, is a fictional movie of the schizophrenic John Nash.  In television, Huff, Monk, Scrubs and ER all won awards for their  portrayal of people with mental health conditions.

Even though many movies give inaccurate reputations to the mentally ill, they are still a way to gain insight into their conditions.  There are many books and movies to choose from; they are available on booklists and movie databases. Wikipedia has a long list of books and movies, both old and new, with a "mental health fiction" search. If you enjoy this type of media, you can learn while enjoying whatever form you choose to enjoy it in.  I have only covered a few titles in this article; you will be able to find many more on the Internet, public library, or in your favorite movie store.