Keys Toward Recovery
July 22, 2004
By Ruth Z. Deming, MGPGP
Reviewed by Laurence M. Schwartz, MD
Abington (PA) Memorial Hospital
The following Keys are an expanded version of the ones we’ve presented at our monthly inpatient talks at Abington Memorial Hospital (Abington, PA) and Horsham Clinic (Ambler, PA).
We suggest you print this out, keep it handy and review it from time to time to reinforce your own recovery. Also add “recovery tips” of your own!
Your mind is the most important thing you own: Your ability to think, to reason, to create, to feel, to love, to relate, to work. Let nothing stop you from preserving or developing the fine qualities of your mind. Recovery from mental illness is indeed possible, even in the smallest steps. By recovery, we mean that we acknowledge we have a mental illness, a disorder of the central nervous system, a condition that never goes away. Yet every day of our lives we use every available tool to maintain a healthy mind. This is the job of your life. It takes nothing less than your full attention and all of your effort. In time, it will become second nature.
Each and every one of these keys is vital to your recovery. Most important is the knowledge that Recovery from Mental Illness is Indeed Possible. By this we mean, in particular, that mood swings, for which there is no cure, can be stabilized through medication and lifestyle changes. And that a good quality of life awaits us all.
- Find the very best psychiatrist you can. One who listens. Pay out of pocket if necessary. Partner with your doctor. His or her expertise plus your astute input. Realize that the role of the psychiatrist has changed over the years. Their role has been drastically altered by managed care and they are not able to practice true healing in the way they were trained: meds plus all-important therapy. Be patient with the “15 minute med check.” It’s the way things are. Doctors don’t like it any more than we do. Learn to be clever and make it work for you.
If you’re unable to afford a full hour with your psychiatrist, don’t waste a minute during your med check. Create your own version of a “mood chart,” detailing wellness or exacerbations of your illness in between doctor visits. Find correlations between life events that influenced your staying well or becoming ill. Then work with your therapist on strengthening your coping mechanisms to maintain wellness.
For expert advice on mood charting, contact pharmacist Larry DiBello at Friends Hospital Resource Center in Philadelphia at 610-543-2966.
For those of you who have just been diagnosed, here’s how to find a good psychiatrist:
- Ask your trusted family physician for a referral.
- Attend a New Directions Support Group meeting and ask members for a referral.
- Go to the DBSA website and find a psychiatrist listed there. (www.DBSAlliance.org)
- Call a teaching hospital and ask for a referral.
- Do not pick a name out of the phone book.
In today’s world, we are in charge of our own healthcare. We advocate for our own best health. We select a treatment team for ourselves made of the very best psychiatrist and therapist possible. As head of the team, we constantly monitor how effective the team is, making changes as necessary. We learn not to put our doctor on a pedestal. We ask our doctor questions so that we can be a true partner in treatment.
Realize that it’s okay to change doctors/therapists. Many people have difficulty doing this. But, remember, your mental health is the most important thing in the world. And your doctor/therapist is the person you’ve chosen to partner with you in the care of your mental health.
Make sure your doctor has taken a complete history of you (a “psychiatric evaluation”) – and that he asks about your family members, as well. As we know, many of our family members suffer from our own illness or related disorders, such as panic disorder, anxiety, alcoholism, substance abuse, gambling.
- Take the right medication. Become aware – or make sure your doctor is aware – of every medication used to treat your illness. Realize that medication has unique results on every patient. This cannot be overstated. In this way, it is vastly different than medicine, for, say, an infection. Whereas antibiotics help nearly everybody fight off infection, a particular antidepressant will not help everybody fight depression. Your experienced doctor, through his or her expertise, will have an idea of what antidepressant will work best for you. Keep in mind that if a medication has worked for a family member, that is the best clue available as to what may work for you.
Psychiatric medicines, unfortunately, are person-specific, rather than illness-specific. And that is the great challenge – and terrible frustration – of every patient: to find out what medication works for you.
Be aware of a medication quirk called “paradoxical effect” whereby a patient experiences the exact opposite reactions on a med than expected.
Medication categories overlap, so don’t be fooled by the general category under which your medication falls. For example, “antiseizure drugs” used for epilepsy are helpful for people with bipolar disorder and are used as mood stabilizers, to stabilize mood swings or “ups” and “downs.
Klonopin, best known as an antianxiety agent, is also an antiseizure drug. This is very important to know. Many psychiatrists have used it in the past to quell mania, in addition to its antianxiety activity.
Antidepressants not only help depression but alleviate anxiety as well. And are also prescribed for chronic pain, particularly the old tricyclic drugs.
Just because a drug has been on the market for years, doesn’t mean we should disregard it. Lithium, for example, was the first mood stabilizer introduced and remains the excellent drug it was in the early ’70s. The same applies to the antidepressants, the MAO inhibitors, often tried last, due their dietary restrictions.
Your doctor will inform you of side effects of all medications. Remember, it is not only psychiatric medications that cause side effects. All medications, unfortunately, do.
Also, don’t feel ashamed to take an antipsychotic. As one psychiatrist remarked, the term “antipsychotic” is an unfortunate one, and carries with it a stigma. Many patients fight taking an antipsychotic because they correctly say, “I’m not psychotic.” This writer takes an antipsychotic as needed when she feels “overwhelmed and like I’m coming apart at the seams.
Do not allow yourself to become overmedicated. Overmedication is the bane of the bipolar patient.
We do not promote the sole use of vitamin therapy, herbal remedies, meditation, or any other unproven treatments. We also look toward other countries, such as Canada, Europe or Israel, for what products and treatments are used for mental illness.
Make sure your psychiatrist communicates with any other specialists you may see. All your doctors should be aware of who is prescribing what and how the drugs interact with one another. Your pharmacist is a valuable source of knowledge about this, as well as other medication questions.
- Get “talk therapy.” Find an excellent therapist. Good therapy is as exciting as going to school and learning new things. Ideally, your therapist should be communicating regularly with your psychiatrist.
Work with your therapist on the common issues of your illness. A partial list – which does not apply to everyone – includes: identity issues, separation from parent, anger, anxiety, inability to see consequences of our actions, difficulty prioritizing, impulsivity, perfectionism, difficulty getting along with others (at work or at home), anti-authority, projection, self-absorption, blaming others, boundary issues, making commitments, feeling unlovable, psychosis, suicidal ideation. When you attend a well-run support group, you will see that you are not alone in facing these issues.
Get in the habit of doing “reality checks.” For example, if you suspect you may be a bit on the manic side, check with your therapist or a trusted friend: “How do I seem to you? Am I a bit hyper or am I just feeling good because I just got a great job.” There is a difference between the urgency/pressure of hypomania and a normal “high.”
With good therapy, the above issues can be successfully resolved. Medication, of course, is still necessary. But the more we can work through our issues, the higher the probability of living a full and healthy life. As we get healthier, our medication needs will change and we may not need as much.
Learn to accept your illness. Being labeled “mentally ill” makes most of us feel inferior or different than other people. Realize that everyone in the world has some form of mental health problem. Think about it. No one is perfect. Even doctors or lawyers or teachers get anxious or angry or have memory lapses.
People with mental illness are perceived as being in a lower social category. This is an unfortunate fact of life. Therefore, be cautious about disclosing your mental illness to others.
In ancient days, people with mental illness were looked up to: seers, prophets, artists. The artist, for example, has a different mentality than the average person. Many people with mental illness are artists. Ally yourself with artists – composers – musicians – inventors – poets – sculptors – the saints. John Steinbeck and Ernest Hemingway both won the Nobel prize for Literature and suffered from intense mood swings. The great William Faulkner, unfortunately, suffered from alcoholism. And of course John Forbes Nash won the prize in Economics and suffers from schizophrenia. These individuals had a different vision of life than normal people. Without this vision, mankind can’t survive or progress. Take pride in thinking differently, in your own uniqueness.
We are also asking you to look at yourself for “Who I Am,” rather than from the perspective of “What The Illness Makes me Be.” A person who hears voices telling them what a terrible person they are or that they ought to kill themselves needs medication to quell the voices, and also needs unending encouragement from their psychiatrist and support team to allow you to know “You are a fine, good human being. You are not your voices.”
- Educate yourself about your illness and your medication. Learn as much as is necessary. Our illness may make us feel powerless or out of control. Counteract these feelings. Knowledge confers a sense of order and control.
- Develop and assiduously follow a daily routine. This is easy if you work. If you don’t, or if you are between jobs or on disability, it’s imperative to buy a daily calendar and write things down. Review your calendar before you go to bed and when you get up. You need a clear plan.
Each day, make a list of things that need to be done. Our minds can be a jumble of whirring disorganization. By writing things down, we free our minds of the chaos and create order and feel more in control.
Have a sheet of paper called your “To Do” list. Like a shopping list, write down everything you need to do during the day: post office, laundry, dishes, visit mom. As you accomplish each item on your list, cross it off. Take a look at all you’ve accomplished and feel proud of yourself.
- Rely on scheduling “external events.” If you don’t work or are between jobs, leave home at least once a day. Make a point, shortly after waking up, of literally setting foot outside the door, if only for a moment. Do this as needed throughout the day to keep you from entering “stay-at-home/isolation” mode.
Most important, though, is to schedule “external events.” While it’s fine to take a walk or go to the library, these are “soft events,” requiring your own “will” to motivate you. When we’re well, motivation is no problem. But when we enter an “iffy” state, motivation is far more difficult. The key here is to schedule appointments outside the home – “external events” – with a set time and place, such as a doctor’s appointment, a lunch appointment, volunteer job, making a bus or a train, taking an adult evening class, a book discussion group, to make sure you get out of the house. Be very strict with yourself. Use all your discipline to make sure you keep these commitments. One measure of good health is the ability to keep commitments.
- “Compliment sheet.” Many of us with bipolar disorder have such low self-esteem that in a “down” moment, we may think “I’m a nothing, I’m a nobody.” In those times, we need to bolster ourselves up. When people who matter to you give you compliments, write them down, and have them handy to read when you’re in a funk. You may also have a special drawer or bulletin board or refrigerator or bathroom mirror where you put things that make you feel good about yourself. Utilize these tools!
- Develop a strong support network. Include family and friends whom you trust. Join a support group and talk to other like-minded people. You won’t believe the thrill and comfort of coming to a New Directions Support Group meeting and talking to people who look totally normal on the outside but are experiencing the very same grave problems we are.
- Pursue relationships that are loving and positive. Know the paramount value of having at least one friend with whom you can share anything you wish. This is the most important element of life: Confiding in someone and being understood.
- Spend time with people who make you feel good about yourself, who are loving and who appreciate you for who you are. It is extremely important to limit the time you spend with people or family members who put you down, tell you what to do, are harsh and critical, and give out negative vibes. Also, many people have friends who engage in self-destructive habits, such as drinking, using drugs, or gambling. Use caution and common sense when you’re with them. Also, if you’re a woman, avoid the temptation of having sex with men to boost your mood or self-esteem. This is an extremely important point, whose final outcome is unwanted pregnancies.
- Work with your therapist on making friends.
- Some people with bipolar disorder or mental illness have difficulty making friends. If you want friends but can’t make them, find out why. Many of us have a core belief that we’re unlovable or that nobody wants to be our friend. This is an erroneous thought. On the other hand, we do need to ask ourselves and do a reality check on, “How do I come across to people?” A few of us may indeed be so inadvertently obnoxious or self-centered we drive people away. If that’s so, take responsibility for it. Be honest with your therapist or a close friend and get feedback. “Yes, you DO come across as a little overbearing” or “Yes, you do seem to focus on yourself too much and not enough on the other person.
- Make a list of people you can phone to “cheer you up” in times of need. At the first sign of distress, move your muscles. (Thanks to Dr. Abraham Low.) Get on the phone. Or leave home. Do not allow your distress to escalate. Many people with mental illness have a streak of masochism. It is as if they are on the side of the disease instead of their own side. Talk to your therapist about this. And whether or not you engage in the terrible game of self-sabotage, so well highlighted in Dr. Abraham Low’s book “Mental Health Through Will Training.”
- Learn to manage stress and anger through the help of your excellent therapist. One woman we know, who also happens to be a gifted therapist, has intrusive thoughts which she interrupts by activating a loud mechanical toy: a miniature toilet that makes a loud flushing sound.
- Stay active and involved at work, in volunteer jobs or in other meaningful pursuits. Don’t isolate yourself. Your health is contingent upon how important you feel as a human being. Do things that make you feel important. Small things count, like watering your flowers, taking care of your dog or babysitting your grandchildren.
The human mind is wired to keep busy and to use its innate talents. When we don’t, our minds can atrophy and go into deep depression. This is tragic, but true. We realize it is not possible for everyone to work. But do your best to stay employed or to pursue things that keep you busy and involved, such as all-important volunteer work: We all need a reason to get out of bed in the morning.
One important concept we learned years ago in a book by a forgotten author was to “become an expert” in something. Anything. Pick something you’re interested in – say, baseball – and become the biggest expert you can on baseball. It will help your identity. “Hey! Here comes Bob,the Baseball Guy.”
- Practice a healthy lifestyle: Regular sleep – regular medication times – eat nutritious foods – exercise regularly.
- Sleep is the core pathology of our illness,” says Kay Jamison, PhD. Protect and preserve your sleep. Take the phone off the hook while you sleep. The National DBSA is running an important Good Sleeping Campaign. Again, check their website www.DBSAlliance.org.
- Because people with mental health problems often suffer from illnesses of the digestive tract, it’s particularly important to discipline yourself to eat right.
- Exercise is the most powerful mind/body strengthener there is. Think of athletes readying for their games. Exercise readies us for the inevitable stresses in our life and our especial vulnerability to stress. Move those muscles!
- Mindfulness/meditation is also a powerful mind/body strengthener.
- Seek spirituality. “Nature -“literature – art – fishing” – are examples of spirituality. Have spiritual moments every day, throughout the entire day. This writer looks out the window upon arising and looks out at her gardens and trees.
There is also organized religion or a belief in a personal God. Many people find great comfort in forming a “direct line of communication with God.” Try it and see if it works for you. Oftentimes we hear people say, “It was God that got me through these travails. I wouldn’t be here without God’s help.” Utilize your own church or synagogue, if desired, and also as a fine place to volunteer and make friends.
A few people possess the belief that God hates them or is punishing them by giving them an illness. This is erroneous thinking and should be thoroughly discussed in therapy.
- Sublimate (creating good things out of adversity): Write poetry, do art, play the clarinet, keep a journal, dance, sew, sculpt. Utilize your innate talents even if you don’t think you have any. Think back to when you were a kid. What did you enjoy doing then? If you don’t have a creative outlet, keep your eyes open for something that appeals to you. Don’t worry about being good at it. Just do it.
- Reach out to help others. People who have a mental illness have an extraordinary ability to help other people. We have a “sixth sense” about other people’s distress and are not afraid to reach out and help. This is one of the best ways to help ourselves. Make a practice of doing “Good Deeds.” They will make you feel good about yourself. You will also feel important that you have helped someone else. And will make this world a better place because of your good deed.
- Develop strong Faith and Belief in your ability to recover. Enlist the aid of your support team when the going gets tough. When we’re down, we may not see the light at the end of the tunnel. Your cheering section will pull you through.
- Realize you are more than just a person with a mood disorder or a mental illness. You are a whole person, whose love and gifts help make the world move forward. Every single person has an impact on another. The world is where it is because of the movement of each of its inhabitants.
- Pursue the Wonderful! Be curious. Follow the side street and see where it leads. Enter the beautiful church you’ve driven by for years and see what the Sanctuary looks like. Life is swift. Make the most of it while you’re here!
Thanks also to pharmacist Larry DiBello, RPh; Ann Harris and Si Baniewicz for their invaluable suggestions. Also, special thanks to Judith M. Lipshutz, MA.