A lot of this rings true to me. I'm a rather bad case of type 1 (classic manic depression) and high functioning. I wrote up a blog post about how I managed to spend my entire life hiding continuous psychosis.
Hiding is what I've always done. It's exhausting having to appear normal all the time.
I'm fortunate to have understanding friends. Instead of me constantly bitching, we have code words for how I'm feeling. If I'm good, that makes I'm stable and relatively happy. If I'm okay, I'm probably depressed. It goes on from there. I'm able to talk about how I feel without getting into the details no one want to hear every day.
At work, I'm extremely fortunate to have a boss whose wife is bipolar. I've been able to get ADA accommodations that give me the flexibility and restrictions I need to go to work every week. This is the first job I've ever had this luxury.
And it really is a luxury. This is my first job where I've had any kind of accommodation. I've worked at places where I've pretended to have the flu just to take a day off for mental health.
Even now everyone, except my boss and friends, treats taking time off for mental health like vacations, because that's the experience for them. I've used so much PTO, I never get a vacation. Instead, I'm always at home on days off, dealing with a hell that my coworkers have never come close to experiencing.
I could go on a lot longer because there is no limit to how many things I have to deal with. But no one really wants to read that and I don't want to write it again.
I have a lot of respect for your ability to make a blog about something that is already overwhelming enough to "just" be suffering.
Being both high functioning and with severe psychiatric issues is very weird when dealing with the world: you can sometimes drain your energy to almost have a "super" ability to do things (focus, make stuff, communicate, whatever it is), yet you're actually suffering immensely and it often doesn't help that you might get praised for the very same things that you should get help for. There's fear of losing some of those bits when you enter a path of medical treatments, there's immense energy spent doing inner work that people who are considered "healthy" never really have to be doing. It's like the neighbour is driving up a hill while you're hiking up a mountain with a broken leg.
"But no one really wants to read that and I don't want to write it again."
I have this same issue but with severe chronic pain that impacts my executive function greatly, worsened by physical activity further sensitizing my nervous system - so I depend on low activity routine to not make life even more intolerable for 2-3+ days it takes to recover to getting clear thought and mental function again - to be able to orient myself again; it doesn't make a difference if I do share it though either, even though there are still options I could try to reduce the pain - it's been difficult to find a doctor who's actually willing to work with me and so much time between appointments when exploring new potential avenues. The challenge I've found is mostly running into indoctrination, lack of critical thinking, lack of willingness to accommodate to read long-form explanations of what I write out for my experience to get doctors or professionals on the same page of understanding. I have mostly given up and am winding down my hopes or fantasy of a capable, productive, rewarding future now though - planning to return "home" to an unfinished, untidy, cluttered house that no one should live in, where my mother has been mostly alone the past 5 years since my father passed away horrifically - so I'm no longer paying rent anywhere nor have any obligations and will quietly disappear from the universe as barely anyone will know that I will be gone.
Infinite respect to you for facing and surviving your experience of life.
I wish that society had a meaningful role for people who have had this experience that could make full use of their emotional depth in a way that was valuable to us all and allowed you to not feel like you have to hide your interior world.
Someday we, as a broad group, will get to that point, rather than stigmatizing and hiding it to your and everyone’s detriment.
Your effort to speak openly about all of this is heroic.
> Instead of me constantly bitching, we have code words for how I'm feeling. If I'm good, that makes I'm stable and relatively happy. If I'm okay, I'm probably depressed. It goes on from there. I'm able to talk about how I feel without getting into the details no one want to hear every day.
I want to mention how kind and empathetic this is. My mother had bipolar disorder and I’m very appreciative reading this comment from you.
Can I ask what ADA accommodations you were able to seek? My sister has type 1 and is currently in mania. She worked for me for the last 2 years because she is “unable to hold a regular job” but I won’t be able to continue employing her after this episode.
Interesting article. I've been diagnosed with bipolar type 1 myself. I still struggle with accepting having that particular mental illness for two reasons; the way it is depicted in media and popular culture, and it being seen as a lifelong thing you can't possible get rid of. This despite having a psychotic episode twice. You'd think these things are clear cut. But they're not.
The first part of the article is spot on, really. Even medical professionals have strong biases that are pretty visible even when you're institutionalized. Mentioning drug use is almost guaranteed to put you in a certain classification bucket. What's more, once a history is taken, while being psychotic or (hypo)manic, you are once again put into some kind of classification bucket, despite not being well enough to frame things properly.
I don't mean to be
completely negative here.
Once you are institutionalized, this is needed to get things back on track, start some kind of medication or figure out some first line treatment. However, the stigma afterwards is very real. GP's, psychologists, even surgeons take in this information after the fact, and its almost factual.
And the effects the author mentions are very much there; imagined or not, they are there for the ill person. Being extra careful not to seem overly rash, overly emotional, too impulsive around doctors. Just because they have your best interests at heart, doesn't mean they're free from bias.
One of the most fantastically positive things that happened to me on a journey for better mental health was to encounter a seasoned psychiatrist who did two amazing things:
(1) He didn't try to always resort to whatever is brand new but actually gave choices and explanations that include treatments considered "old" and misunderstood to be ineffective (for example in my case, going with MAOI/RIMA for depression instead of the ever-so-new fancy SSRI of the day - and that alone was a life-changer already).
(2) He actually had an open ear for my personal experiences with a (very) wide range of things in a "non-medical" environment, and used the input in a non-judgmental way to calibrate his understanding of my subjective reports and to find better treatment strategies - also including me in the process, therefore making me the main actor of my own healing process.
On the other hand, I've stepped into rooms with a psychologist and shared about experiences with a wide range of drugs (mainly focusing on empathogen-entactogen and psychedelics for the heavy experiences, but I've covered a wide range) and gotten the regressive "this is all shit/poison" rhetoric, thus solidly ensuring that I would mentally check out when they turn around and try to offer tools to address cognitive biases and practice mindfulness, both of which they can't even apply to their own selves.
The precariousness the author describes is real, at least in my experience. I'm 20 years into a career that many would find enviable except strangely devoid of any tenures longer than about 30 months, because that's the longest I've been able to surf my bipolar swings before imploding. Those meltdowns traditionally resulted in me running away from work to fall into a boozy depressive mess for six months, them returning once the mania kicked in again.
This year, a low coincided with the onset of COVID lockdown and I put myself in the hospital. Not checked myself in: I tried to hurt myself badly enough to be in the ER, ICU, and then inpatient psych care.
Even there, I was the "eloquent, self-reflective" model patient, much like I've been (in the manic times) the persuasive, thoughtful, creative employee that people couldn't wait to hire and promote.
After a couple of months of medical leave I went back to my previous job instead of quitting. It was driven largely by financial insecurity, as I had burned through my savings after not working at all in 2019...once again, due to being in a low phase _and_ getting sober and having no bandwidth left for anything else.
Being back to work at a place that has seen me swing from "A+ performer, definite strong leadership/promotion track, etc." to "can I keep a job, any job here? Ideally one that won't demand more than 40 hours a week of my time?" is far harder than jumping into an impossible workload while manic. Grinding out yet another week full of stand-ups and PRs when I have zero confidence is gut-wrenching, and on top of it all I have to be there and stable and not a depressive mess for my family, because I can't let them take care of me while the world outside is on fire.
All I want to do is get on my bike and ride for six hours a day, then cook dinner for my family, then do a little programming and writing before I go to bed. Literally, that's it.
Unfortunately, that's not a lifestyle I can sustain, even if I suspect it might be the thing that would keep me alive past 40. So it's back to work, taking my meds every day, and lying through my teeth when folks ask how I'm doing.
> She might have been the hardest-working person I've known. She also couldn't hold down a job to save her life.
A bipolar patient in a hypomanic phase can feel strong energy, motivation, creativity, and euphoria. These people can be fun to be around and work with for a short while, at least before the downsides of compromised judgment, inappropriate social disinhibition, and other downsides become problematic. Hypomanic people can work themselves into greater responsibilities at the office, which quickly comes crumbling down when they switch to a depressive episode and can't get anything done. Or they can progress to a full manic episode, where extremely compromised judgment, delusions of grandeur, inappropriate risk taking, inability to concentrate on one task, and other negative effects take over.
One of the unique challenges of dealing with bipolar individuals is that they might actually enjoy their hypomanic phases, despite the obvious negative consequences. It's some times difficult to convince them to give up the hypomanic weeks for the sake of arriving at a stable baseline. They might become convinced that their hypomanic phase is actually their "normal" self, as they're often blinded to the negatives of their behavior during these periods.
> She's the reason I can't ever see eye to eye with anyone who wants to cut our social safety nets or who sees welfare recipients as somehow subhuman.
I fully agree that robust social safety nets are important for our society and that welfare recipients should not be looked down upon.
However, it's more of a bridge than a long-term solution. The best path forward for most patients is to be treated with stabilizing medication and to return to the structure and accountability of having a job, ideally. Bipolar patients tend to struggle with unlimited free time, unstructured days, and no accountability to their work peers. The key is robust and ongoing medical treatment and monitoring.
Again, to be clear, I'm not disagreeing that social safety nets are a bad thing or that welfare recipients should be looked down upon.
As someone who is also on the border between "good mentally ill" and "bad mentally ill," this is a really accurate portrayal of what it's like. The feeling that you're holding it together now, just barely doing the right things and making yourself seem normal enough, but that in the past you couldn't and the fear that in the future you won't be able to. I can't understate how much economic worry there is. Even for a software developer who is now doing pretty well financially, I can't help but wonder if I'll slip into another crushing depression where my brain works at 1/3 the speed and clarity and I can barely make it through a work day before collapsing on the couch. To anybody who sincerely wants to help, you can help by supporting strong social safety nets so that people don't have to shoulder the anxiety of being out on the street in addition to whatever else they're going through, and can also access affordable therapy. You can also support flexible or shorter work weeks.
Edit:
I would estimate that at least for me personally, at least half of the disease burden has been from second-order effects -- from economic anxiety, anxiety about stigma, and working through illness at an unsustainable pace.
> Sometimes, I dream about how wealthy I would need to be to take a break from feeling the fear that propels me to remain stable.
This is something I've felt but more so because it's incredibly difficult to access ketamine treatment. If your doctor loses his license or a pandemic happens you're left in the lurch.
I have an illness on the schizophrenia spectrum and a lot of what is said rings true to me. My own therapist even doubts my diagnosis because he doesn't believe someone with my disorder should be able to hold down a job.
I don't bring it up to anyone IRL because I know what people will think of me- a danger to them, subhuman, a monster. I'm even uncomfortable to be within the spheres of supposedly accepting groups- neurodivergent advocacy groups, mental health advocacy, etc. People with less stigmatized disorders will treat me just as subhuman as a neurotypical.
I was a month ago diagnosed with bipolar type 2, together with ASS. I experience sleep problems.
Some feelings in this article are familiar. To me, it was the feeling of being excluded for life from people.
Also I am going through work problems. I find myself at a difficult place in life now...
My wife has bipolar and I've got ASS. Remember that you're your own person in the first place, period. You're not your label, you merely /have/ a label. TFA makes this mistake from the outset in the title. It should've read "having" not "being".
There's no cure for these labels, but one can recover. To quote Patricia Deegan:
Recovery does not refer to an end product or result.It does not mean that one is “cured”.In fact, recovery is marked by an ever-deepening acceptance of our limitations.But now, rather than being an occasion for despair, we find that our personal limitations are the ground from which spring our own unique possibilities.This is the paradox of recovery i.e., that in accepting what we cannot do or be, we begin to discover who we can be and what we can do.Thus, recovery is a process.It is a way of life.It is an attitude and a way of approaching the day’s challenges.It is not a perfectly linear process.Like the sea rose, recovery has its seasons, its time of downward growth into the darkness to secure new roots and then the times of breaking out into the sunlight.But most of all recovery is a slow, deliberate process that occurs by poking through one little grain of sand at a time.
Only you are the expert of you. That said, there exist recovery colleges that can provide peer support. You're not alone.
Does anyone who is bi-polar feel that they are able to navigate their down time well enough that it is not crippling? For myself, I believe it was more inline with seasonal depression, and after 30+ years of living in the northeast, where winters are longgggg and exgtremely cold, I moved to a place that this wasn't the case. I don't know if I have it, but when I am feeling down, I tend to read more, and just try to focus on the fact that I will come out of it and feel better shortly.
> is that the segment of your audience that doesn’t share the diagnosis runs the risk of essentializing your disorder
> I don’t associate mania with creativity, or fun, or clarity; I associate it with an abundance of energy that seems like it needs no fuel but that will end up using me for its fuel.
It's all consuming. It's highly misunderstood. It's trivialized at best.
It's confusing. The lack of stability does wonders to your understanding of the world.
Mania is a weird and strange experience. The energy is overwhelming.
LSD induced psychosis is stronger and pretty much overrides any bipolar psychosis I've ever had. My bipolar visual hallucinations typically lasted seconds to minutes, typically only happened during deep anxiety, and could be shooken off. LSD hallucinations last multiple hours, are very strong, happen in any mental state, and can't be shooken off.
Bipolar psychosis is a lot weaker, feels more like religion, can last many weeks. The scariest types of psychosis are the ones that are hard to distinguish from the real world. Talking to trees while in psychosis is easy to talk yourself through. Believing someone wants to marry you is a much harder psychosis to reason through, and can result in badly damaged friendships if you don't figure it out in time.
LSD psychosis is strong and warped and pretty much always dispelled easily as soon as you are in a calm frame of mind.
I've found that in the weeks following a trip, bipolar cycles are much more tame and manageable.
I know other bipolar individuals who also found similar relief in LSD.
I remember the exact day and moment that, for the first time I felt that my mind was clear as crystal water, silent, and could be used at command without any effort. 0 anxiety, the inner voice in my head disappeared.
At the time i was unemployed just reading/watching math/philosophy/CS books/videos, I was stuck understanding concepts for months, just reading things without really digesting them, just to pass time. but at that second, everything started to make sense, without any effort, I started to make connections between concepts and applications, recalled that day as one of my best days of my life and changed my way of thinking in a good way, forever. i was just laying in bed completely immersed and exploring a new world in my mind. my memory was like it was a movie that could be rewinded,paused and analyzed at will.
The next Monday i visited my doctor at the time (i was been treated for ADD), I said - thanks you!, when i entered his office, thanks you for curing me!. I explained what happened and how i felt, he looked at me, took a paper and sign my definitive diagnosis : bipolar 2. he cut my antidepressant and prescribed my new treatment, and he told me, that how i feel was not going to last, and the way down could be really hard, and indeed, it was really hard for me to think that this was going to go away, I remember every morning of that month waking up and checking my thoughts. over the course of 2 months, i went back to the 'normal chaos', also i just landed a new job (which i quit 2 months later), so my worries intensified. I still have the false hope that I was the real me during those months and that sometime in the future I would be that way forever.
I really want to feel normal, sociable , logical, assertive and articulate as I am during my states of hypomania , which are no longer than a week, very frequents, but not as high as that episode 2 years ago.
Life treated me well,i had extremely good luck with my understanding partner, my friends/colleagues and family, they know how to turn my weirdness and chaotic mind into something useful and productive. I still have no monetary stability and I feel I'am at one catastrophic disease/event to be on the streets or dead, I have been broke several times in my life, but as an 'above average' IT guy in a third world country with a simple life style, it was easy to find a job and shine for a while and get the money to get back on track and then throw it all and repeat.
Now, Im 'stable', under quetiapine/concerta, unemployed and with zero will to work ever again in something with a boss or teams, resisting the urge to engage and get exited with projects with other people, because i know ill disappoint at some time. Im feeling frustrated that i cant do anything valuable with what i know, i simply don't have the discipline nor the stamina to do something that matters and it is slowly eating me from inside. I dream of having a little opensource projects that involve everything I enjoy from math/cs/art, all my "projects" , code , ideas that i wrote get deleted in the next system reinstall. I don't know how/where to get more valuable help, i had tried a lot of things (mindfulness meditation, exercise, drugs, prescription meds, charity, collaboration on OS projects,diets...), things that at sometime seems to be doing the right thing on me but, they stop working or my energy just vanish, so i dismissed the effects as a placebo, which leads me to believe that is the only effect that works on me.
> I started to make connections between concepts and applications, recalled that day as one of my best days of my life and changed my way of thinking in a good way, forever.
Interesting.
Did you continue to feel that way after the episode?
People with ADHD often get racing thoughts and are restless. Also it's possible that you had some insightful moments at the time.
When things connect or we're making progress, we tend to feel happy/euphoric.
So what is the reason that the doctor recognized the above as bipolar type 2?
When does "feeling optimistic" end and where does "bipolar" start?
My dad was bipolar and committed suicide while I was a teenager. I had a 6 months long mixed episode ~15 years ago that got me diagnosed. High energy, racing thoughts, little to no sleep, mood going from euphoria to more painful thoughts, always very high in intensity, borderline delusional.
After months of denial I accepted the diagnosis and I ended up with lithium then lamotrigine because of side effects of the former, but neither were effective. I still had to take olanzapine to quell nascent manic bouts a few times a year. I was pretty traumatized by the fallout of my first episode (I destroyed or damaged quite a few relationships), making me want to never go back there if at all possible.
Luckily for me the racing thoughts and high energy always came before the mood and ego distortions, which gave me the opportunity to act. I soon realized that the earliest I took olanzapine the lower the dose I had to take to shut off the episode. 1.25mg or at worse 2.5mg were enough to stop it in its tracks most of the time (taking another 1.25mg dose after an hour if the first wasn't sufficient). Sometimes I had to re-iterate on the next day, and that was it.
I discovered this paper [1] a few years down the line, which describes how both the speed and the content of thoughts influence the mood level. This made me want to try and control the pace of my thoughts willfully.
My first naive attempts failed (I had to fall back on drugs), but then I tried to use mental imagery under self-hypnosis (which I had learned independently, mania is very conducive to hypnosis), with success. I had realized that I had a hard time thinking fast while walking slowly, and thus I projected myself lingering in a derelict and deserted landscape, where everyone I loved was dead.
This let me cut the mania in its track, but let me sad for two days. Also, even in my mind, walking slowly was hard to maintain for long periods of time. So I tweaked the scenario, to a more pleasant and peaceful walk in the sea on a nice end of the summer day, with water above the knee. The imagined physical resistance of the water helped me keep the pace down, and the experience let me in a nice, agreeable mood. Practicing the scenario between manic episodes also helped getting there more easily.
Seven years ago, after a few years of not needing olanzapine, I tried stopping the lamotrigine as well, since it was not fully effective. The frequency and intensity of the episodes didn't worsen, and it even gradually went down to ~1 per year without any ill consequences. I've now reached a point where I don't even need the full self-hypnosis decorum to brake, sheer will is sometimes enough.
So this is how I got to mostly manage my condition and get rid of drugs. While unusual, this isn't unheard of [2]. Lewis Mehl-Medrona's approach with narrative analysis and imagery approach among native americans remains very marginal though (that paper has been cited once in 13 years, I discovered it this month).
I say "mostly manage", because there are still a few problems.
- Because of its long half-life, pseudoephedrine taken several days in a row is stronger than my own might, and self-hypnosis barely helps (sinusitis, fuck yeah).
- This summer, experiencing an epiphany while being in love pushed me over the edge into a slow but otherwise manic-like euphoric state, with a relentless, obsessive train of thoughts (not unlike a walking bass in an old jazz), and distorted thoughts patterns reminiscent of my initial episode. Without the usual warning sign (racing thoughts and high energy) it took me ~36 hours to realize something was amiss and come back down (I had watched a slow, contemplative movie without realizing it had a plot. This left me puzzled and I read about it on the Web the next day, discovering with dread that had just been out of my mind). I had ruined another relationship in the mean time. Conclusion: avoid thinking too hard while being in love (in that state, one's ability to think is badly impaired anyways).
All-meat diets with a high fat to protein ratio seem to be a panacea to many physical and mental ailments.
Amber O'Hearn is a famous personality and researcher in this space, there are a few accounts of her successful remission from bipolar type 2 with this regimen.
I can give other references and answer any related questions.
[Edit] I'm not aware of any science on all-meat diets and mental health, but there is scientific evidence supporting the role of nutrients in animal foods and brain health, as well as ketogenic metabolism VS glucose metabolism (notably as a treatment for epileptic seizures). Obviously what's good in calming epileptic brains is going to be good for calming all brains.
I don’t know if this qualifies as “unconventional” but I have had tremendous success increasing my physical exercise daily. I’m not entirely sure if it’s just daily exercise or goal setting (in my case it was the somewhat ambiguous ‘10k steps a day’) or maybe a mix of both, but it evened out my mood significantly and had a strong effect on my depression.
This seems at least tangentially related to the psilocybin thread currently on the front page. I have read in journals that bipolar is a disease of neuroinflammation upregulated by cytokines etc. in the brain. My hypothesis is that this could be related to the gut microbiome which has been proven in studies to affect the brain directly. Maybe you really are what you eat?
Also bipolar. Episodes often start with life-changing events. I highly doubt that food is to point a finger at here. My last episode was really triggered by me leaving my job and going jobless for the first time. I was eating well, fresh and self-cooked. Then during mania I could not eat a single thing. Also could not sleep. For 3 months straight.
From what I understand the etiology of bipolar is not well understood, with different correlations like dopamine dysregulation or the inflammatory markers you mention (which could indeed be influenced by the gut biome), but as with unipolar depression it's probably too simplistic an approach to try and reduce it to a single factor.
One of the "doctors" who recently published research on "psychobiotics" was
later selling a brand of "clinically tested" probiotics tailored for mood disorders. Gut microbiome studies, at this point in time, need to be taken with a pinch of allum.
[+] [-] kayodelycaon|5 years ago|reply
https://kayode.co/blog/4106/living-with-psychosis/
Hiding is what I've always done. It's exhausting having to appear normal all the time.
I'm fortunate to have understanding friends. Instead of me constantly bitching, we have code words for how I'm feeling. If I'm good, that makes I'm stable and relatively happy. If I'm okay, I'm probably depressed. It goes on from there. I'm able to talk about how I feel without getting into the details no one want to hear every day.
At work, I'm extremely fortunate to have a boss whose wife is bipolar. I've been able to get ADA accommodations that give me the flexibility and restrictions I need to go to work every week. This is the first job I've ever had this luxury.
And it really is a luxury. This is my first job where I've had any kind of accommodation. I've worked at places where I've pretended to have the flu just to take a day off for mental health.
Even now everyone, except my boss and friends, treats taking time off for mental health like vacations, because that's the experience for them. I've used so much PTO, I never get a vacation. Instead, I'm always at home on days off, dealing with a hell that my coworkers have never come close to experiencing.
I could go on a lot longer because there is no limit to how many things I have to deal with. But no one really wants to read that and I don't want to write it again.
[+] [-] cmehdy|5 years ago|reply
Being both high functioning and with severe psychiatric issues is very weird when dealing with the world: you can sometimes drain your energy to almost have a "super" ability to do things (focus, make stuff, communicate, whatever it is), yet you're actually suffering immensely and it often doesn't help that you might get praised for the very same things that you should get help for. There's fear of losing some of those bits when you enter a path of medical treatments, there's immense energy spent doing inner work that people who are considered "healthy" never really have to be doing. It's like the neighbour is driving up a hill while you're hiking up a mountain with a broken leg.
So here's a hug.
[+] [-] loceng|5 years ago|reply
I have this same issue but with severe chronic pain that impacts my executive function greatly, worsened by physical activity further sensitizing my nervous system - so I depend on low activity routine to not make life even more intolerable for 2-3+ days it takes to recover to getting clear thought and mental function again - to be able to orient myself again; it doesn't make a difference if I do share it though either, even though there are still options I could try to reduce the pain - it's been difficult to find a doctor who's actually willing to work with me and so much time between appointments when exploring new potential avenues. The challenge I've found is mostly running into indoctrination, lack of critical thinking, lack of willingness to accommodate to read long-form explanations of what I write out for my experience to get doctors or professionals on the same page of understanding. I have mostly given up and am winding down my hopes or fantasy of a capable, productive, rewarding future now though - planning to return "home" to an unfinished, untidy, cluttered house that no one should live in, where my mother has been mostly alone the past 5 years since my father passed away horrifically - so I'm no longer paying rent anywhere nor have any obligations and will quietly disappear from the universe as barely anyone will know that I will be gone.
[+] [-] elboru|5 years ago|reply
[+] [-] kingkawn|5 years ago|reply
I wish that society had a meaningful role for people who have had this experience that could make full use of their emotional depth in a way that was valuable to us all and allowed you to not feel like you have to hide your interior world.
Someday we, as a broad group, will get to that point, rather than stigmatizing and hiding it to your and everyone’s detriment.
Your effort to speak openly about all of this is heroic.
Thank you.
[+] [-] aspaceman|5 years ago|reply
I want to mention how kind and empathetic this is. My mother had bipolar disorder and I’m very appreciative reading this comment from you.
[+] [-] Kye|5 years ago|reply
[+] [-] cannaceo|5 years ago|reply
[+] [-] unknown|5 years ago|reply
[deleted]
[+] [-] reify_null|5 years ago|reply
The first part of the article is spot on, really. Even medical professionals have strong biases that are pretty visible even when you're institutionalized. Mentioning drug use is almost guaranteed to put you in a certain classification bucket. What's more, once a history is taken, while being psychotic or (hypo)manic, you are once again put into some kind of classification bucket, despite not being well enough to frame things properly.
I don't mean to be completely negative here. Once you are institutionalized, this is needed to get things back on track, start some kind of medication or figure out some first line treatment. However, the stigma afterwards is very real. GP's, psychologists, even surgeons take in this information after the fact, and its almost factual. And the effects the author mentions are very much there; imagined or not, they are there for the ill person. Being extra careful not to seem overly rash, overly emotional, too impulsive around doctors. Just because they have your best interests at heart, doesn't mean they're free from bias.
[+] [-] cmehdy|5 years ago|reply
(1) He didn't try to always resort to whatever is brand new but actually gave choices and explanations that include treatments considered "old" and misunderstood to be ineffective (for example in my case, going with MAOI/RIMA for depression instead of the ever-so-new fancy SSRI of the day - and that alone was a life-changer already).
(2) He actually had an open ear for my personal experiences with a (very) wide range of things in a "non-medical" environment, and used the input in a non-judgmental way to calibrate his understanding of my subjective reports and to find better treatment strategies - also including me in the process, therefore making me the main actor of my own healing process.
On the other hand, I've stepped into rooms with a psychologist and shared about experiences with a wide range of drugs (mainly focusing on empathogen-entactogen and psychedelics for the heavy experiences, but I've covered a wide range) and gotten the regressive "this is all shit/poison" rhetoric, thus solidly ensuring that I would mentally check out when they turn around and try to offer tools to address cognitive biases and practice mindfulness, both of which they can't even apply to their own selves.
[+] [-] howtoquitwell|5 years ago|reply
This year, a low coincided with the onset of COVID lockdown and I put myself in the hospital. Not checked myself in: I tried to hurt myself badly enough to be in the ER, ICU, and then inpatient psych care.
Even there, I was the "eloquent, self-reflective" model patient, much like I've been (in the manic times) the persuasive, thoughtful, creative employee that people couldn't wait to hire and promote.
After a couple of months of medical leave I went back to my previous job instead of quitting. It was driven largely by financial insecurity, as I had burned through my savings after not working at all in 2019...once again, due to being in a low phase _and_ getting sober and having no bandwidth left for anything else.
Being back to work at a place that has seen me swing from "A+ performer, definite strong leadership/promotion track, etc." to "can I keep a job, any job here? Ideally one that won't demand more than 40 hours a week of my time?" is far harder than jumping into an impossible workload while manic. Grinding out yet another week full of stand-ups and PRs when I have zero confidence is gut-wrenching, and on top of it all I have to be there and stable and not a depressive mess for my family, because I can't let them take care of me while the world outside is on fire.
All I want to do is get on my bike and ride for six hours a day, then cook dinner for my family, then do a little programming and writing before I go to bed. Literally, that's it.
Unfortunately, that's not a lifestyle I can sustain, even if I suspect it might be the thing that would keep me alive past 40. So it's back to work, taking my meds every day, and lying through my teeth when folks ask how I'm doing.
[+] [-] wtracy|5 years ago|reply
She might have been the hardest-working person I've known. She also couldn't hold down a job to save her life.
She's the reason I can't ever see eye to eye with anyone who wants to cut our social safety nets or who sees welfare recipients as somehow subhuman.
[+] [-] PragmaticPulp|5 years ago|reply
A bipolar patient in a hypomanic phase can feel strong energy, motivation, creativity, and euphoria. These people can be fun to be around and work with for a short while, at least before the downsides of compromised judgment, inappropriate social disinhibition, and other downsides become problematic. Hypomanic people can work themselves into greater responsibilities at the office, which quickly comes crumbling down when they switch to a depressive episode and can't get anything done. Or they can progress to a full manic episode, where extremely compromised judgment, delusions of grandeur, inappropriate risk taking, inability to concentrate on one task, and other negative effects take over.
One of the unique challenges of dealing with bipolar individuals is that they might actually enjoy their hypomanic phases, despite the obvious negative consequences. It's some times difficult to convince them to give up the hypomanic weeks for the sake of arriving at a stable baseline. They might become convinced that their hypomanic phase is actually their "normal" self, as they're often blinded to the negatives of their behavior during these periods.
> She's the reason I can't ever see eye to eye with anyone who wants to cut our social safety nets or who sees welfare recipients as somehow subhuman.
I fully agree that robust social safety nets are important for our society and that welfare recipients should not be looked down upon.
However, it's more of a bridge than a long-term solution. The best path forward for most patients is to be treated with stabilizing medication and to return to the structure and accountability of having a job, ideally. Bipolar patients tend to struggle with unlimited free time, unstructured days, and no accountability to their work peers. The key is robust and ongoing medical treatment and monitoring.
Again, to be clear, I'm not disagreeing that social safety nets are a bad thing or that welfare recipients should be looked down upon.
[+] [-] fsckboy|5 years ago|reply
[+] [-] forgotmypw17|5 years ago|reply
Something something society labeling as a dis-order anything which doesn't suit the order.
Something something choosing between no treatment and risk of involuntary commitment, overmedication, and life-long stigmai if diagnosed on paper.
[+] [-] overton|5 years ago|reply
Edit:
I would estimate that at least for me personally, at least half of the disease burden has been from second-order effects -- from economic anxiety, anxiety about stigma, and working through illness at an unsustainable pace.
[+] [-] kayodelycaon|5 years ago|reply
I've listed my accommodations on another comment posted earlier: https://news.ycombinator.com/item?id=24680004
[+] [-] ketamine__|5 years ago|reply
This is something I've felt but more so because it's incredibly difficult to access ketamine treatment. If your doctor loses his license or a pandemic happens you're left in the lurch.
[+] [-] TeaDrunk|5 years ago|reply
I don't bring it up to anyone IRL because I know what people will think of me- a danger to them, subhuman, a monster. I'm even uncomfortable to be within the spheres of supposedly accepting groups- neurodivergent advocacy groups, mental health advocacy, etc. People with less stigmatized disorders will treat me just as subhuman as a neurotypical.
[+] [-] markhollis|5 years ago|reply
[+] [-] pdenton|5 years ago|reply
There's no cure for these labels, but one can recover. To quote Patricia Deegan:
Recovery does not refer to an end product or result. It does not mean that one is “cured”. In fact, recovery is marked by an ever-deepening acceptance of our limitations. But now, rather than being an occasion for despair, we find that our personal limitations are the ground from which spring our own unique possibilities. This is the paradox of recovery i.e., that in accepting what we cannot do or be, we begin to discover who we can be and what we can do. Thus, recovery is a process. It is a way of life. It is an attitude and a way of approaching the day’s challenges. It is not a perfectly linear process. Like the sea rose, recovery has its seasons, its time of downward growth into the darkness to secure new roots and then the times of breaking out into the sunlight. But most of all recovery is a slow, deliberate process that occurs by poking through one little grain of sand at a time.
Only you are the expert of you. That said, there exist recovery colleges that can provide peer support. You're not alone.
[+] [-] bobwall|5 years ago|reply
[+] [-] infinitudes|5 years ago|reply
> I don’t associate mania with creativity, or fun, or clarity; I associate it with an abundance of energy that seems like it needs no fuel but that will end up using me for its fuel.
It's all consuming. It's highly misunderstood. It's trivialized at best.
It's confusing. The lack of stability does wonders to your understanding of the world.
Mania is a weird and strange experience. The energy is overwhelming.
When it comes to programming, it's different.
[+] [-] vmception|5 years ago|reply
Has anyone with natural psychosis also had simultaneous acid induced psychosis, and if so what happened?
[+] [-] Taek|5 years ago|reply
Bipolar psychosis is a lot weaker, feels more like religion, can last many weeks. The scariest types of psychosis are the ones that are hard to distinguish from the real world. Talking to trees while in psychosis is easy to talk yourself through. Believing someone wants to marry you is a much harder psychosis to reason through, and can result in badly damaged friendships if you don't figure it out in time.
LSD psychosis is strong and warped and pretty much always dispelled easily as soon as you are in a calm frame of mind.
I've found that in the weeks following a trip, bipolar cycles are much more tame and manageable.
I know other bipolar individuals who also found similar relief in LSD.
[+] [-] ltr_|5 years ago|reply
I remember the exact day and moment that, for the first time I felt that my mind was clear as crystal water, silent, and could be used at command without any effort. 0 anxiety, the inner voice in my head disappeared.
At the time i was unemployed just reading/watching math/philosophy/CS books/videos, I was stuck understanding concepts for months, just reading things without really digesting them, just to pass time. but at that second, everything started to make sense, without any effort, I started to make connections between concepts and applications, recalled that day as one of my best days of my life and changed my way of thinking in a good way, forever. i was just laying in bed completely immersed and exploring a new world in my mind. my memory was like it was a movie that could be rewinded,paused and analyzed at will.
The next Monday i visited my doctor at the time (i was been treated for ADD), I said - thanks you!, when i entered his office, thanks you for curing me!. I explained what happened and how i felt, he looked at me, took a paper and sign my definitive diagnosis : bipolar 2. he cut my antidepressant and prescribed my new treatment, and he told me, that how i feel was not going to last, and the way down could be really hard, and indeed, it was really hard for me to think that this was going to go away, I remember every morning of that month waking up and checking my thoughts. over the course of 2 months, i went back to the 'normal chaos', also i just landed a new job (which i quit 2 months later), so my worries intensified. I still have the false hope that I was the real me during those months and that sometime in the future I would be that way forever. I really want to feel normal, sociable , logical, assertive and articulate as I am during my states of hypomania , which are no longer than a week, very frequents, but not as high as that episode 2 years ago.
Life treated me well,i had extremely good luck with my understanding partner, my friends/colleagues and family, they know how to turn my weirdness and chaotic mind into something useful and productive. I still have no monetary stability and I feel I'am at one catastrophic disease/event to be on the streets or dead, I have been broke several times in my life, but as an 'above average' IT guy in a third world country with a simple life style, it was easy to find a job and shine for a while and get the money to get back on track and then throw it all and repeat.
Now, Im 'stable', under quetiapine/concerta, unemployed and with zero will to work ever again in something with a boss or teams, resisting the urge to engage and get exited with projects with other people, because i know ill disappoint at some time. Im feeling frustrated that i cant do anything valuable with what i know, i simply don't have the discipline nor the stamina to do something that matters and it is slowly eating me from inside. I dream of having a little opensource projects that involve everything I enjoy from math/cs/art, all my "projects" , code , ideas that i wrote get deleted in the next system reinstall. I don't know how/where to get more valuable help, i had tried a lot of things (mindfulness meditation, exercise, drugs, prescription meds, charity, collaboration on OS projects,diets...), things that at sometime seems to be doing the right thing on me but, they stop working or my energy just vanish, so i dismissed the effects as a placebo, which leads me to believe that is the only effect that works on me.
[+] [-] throw32891|5 years ago|reply
Interesting.
Did you continue to feel that way after the episode?
People with ADHD often get racing thoughts and are restless. Also it's possible that you had some insightful moments at the time.
When things connect or we're making progress, we tend to feel happy/euphoric. So what is the reason that the doctor recognized the above as bipolar type 2?
When does "feeling optimistic" end and where does "bipolar" start?
[+] [-] bipo_temp_acct|5 years ago|reply
My dad was bipolar and committed suicide while I was a teenager. I had a 6 months long mixed episode ~15 years ago that got me diagnosed. High energy, racing thoughts, little to no sleep, mood going from euphoria to more painful thoughts, always very high in intensity, borderline delusional.
After months of denial I accepted the diagnosis and I ended up with lithium then lamotrigine because of side effects of the former, but neither were effective. I still had to take olanzapine to quell nascent manic bouts a few times a year. I was pretty traumatized by the fallout of my first episode (I destroyed or damaged quite a few relationships), making me want to never go back there if at all possible.
Luckily for me the racing thoughts and high energy always came before the mood and ego distortions, which gave me the opportunity to act. I soon realized that the earliest I took olanzapine the lower the dose I had to take to shut off the episode. 1.25mg or at worse 2.5mg were enough to stop it in its tracks most of the time (taking another 1.25mg dose after an hour if the first wasn't sufficient). Sometimes I had to re-iterate on the next day, and that was it.
I discovered this paper [1] a few years down the line, which describes how both the speed and the content of thoughts influence the mood level. This made me want to try and control the pace of my thoughts willfully.
My first naive attempts failed (I had to fall back on drugs), but then I tried to use mental imagery under self-hypnosis (which I had learned independently, mania is very conducive to hypnosis), with success. I had realized that I had a hard time thinking fast while walking slowly, and thus I projected myself lingering in a derelict and deserted landscape, where everyone I loved was dead.
This let me cut the mania in its track, but let me sad for two days. Also, even in my mind, walking slowly was hard to maintain for long periods of time. So I tweaked the scenario, to a more pleasant and peaceful walk in the sea on a nice end of the summer day, with water above the knee. The imagined physical resistance of the water helped me keep the pace down, and the experience let me in a nice, agreeable mood. Practicing the scenario between manic episodes also helped getting there more easily.
Seven years ago, after a few years of not needing olanzapine, I tried stopping the lamotrigine as well, since it was not fully effective. The frequency and intensity of the episodes didn't worsen, and it even gradually went down to ~1 per year without any ill consequences. I've now reached a point where I don't even need the full self-hypnosis decorum to brake, sheer will is sometimes enough.
So this is how I got to mostly manage my condition and get rid of drugs. While unusual, this isn't unheard of [2]. Lewis Mehl-Medrona's approach with narrative analysis and imagery approach among native americans remains very marginal though (that paper has been cited once in 13 years, I discovered it this month).
I say "mostly manage", because there are still a few problems.
- Because of its long half-life, pseudoephedrine taken several days in a row is stronger than my own might, and self-hypnosis barely helps (sinusitis, fuck yeah).
- This summer, experiencing an epiphany while being in love pushed me over the edge into a slow but otherwise manic-like euphoric state, with a relentless, obsessive train of thoughts (not unlike a walking bass in an old jazz), and distorted thoughts patterns reminiscent of my initial episode. Without the usual warning sign (racing thoughts and high energy) it took me ~36 hours to realize something was amiss and come back down (I had watched a slow, contemplative movie without realizing it had a plot. This left me puzzled and I read about it on the Web the next day, discovering with dread that had just been out of my mind). I had ruined another relationship in the mean time. Conclusion: avoid thinking too hard while being in love (in that state, one's ability to think is badly impaired anyways).
1. http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.405...2. https://www.researchgate.net/publication/45389079_Narrative_...
[+] [-] unknown|5 years ago|reply
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[+] [-] ChrisMarshallNY|5 years ago|reply
Thanks for posting it!
[+] [-] hnracer|5 years ago|reply
[+] [-] lambdaba|5 years ago|reply
Amber O'Hearn is a famous personality and researcher in this space, there are a few accounts of her successful remission from bipolar type 2 with this regimen.
I can give other references and answer any related questions.
[Edit] I'm not aware of any science on all-meat diets and mental health, but there is scientific evidence supporting the role of nutrients in animal foods and brain health, as well as ketogenic metabolism VS glucose metabolism (notably as a treatment for epileptic seizures). Obviously what's good in calming epileptic brains is going to be good for calming all brains.
[+] [-] A-Train|5 years ago|reply
[+] [-] sircastor|5 years ago|reply
(Edit: studies associated) https://scholar.google.com/scholar?q=exercise+effect+on+depr...
[+] [-] ethanwillis|5 years ago|reply
[+] [-] tokai|5 years ago|reply
[+] [-] loveJesus|5 years ago|reply
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[+] [-] quantumwoke|5 years ago|reply
[+] [-] dirtnugget|5 years ago|reply
The worst thing you can do here is to generalize.
[+] [-] DJBunnies|5 years ago|reply
[+] [-] kayodelycaon|5 years ago|reply
[+] [-] kekebo|5 years ago|reply
[+] [-] BrendanD|5 years ago|reply
[+] [-] ddorian43|5 years ago|reply