Understanding and Awareness Part I

Understanding and awareness are two powerful ‘tools’ on my journey in managing Bipolar disorder, I am fortunate to own them.

Why Why Why Me?

At the start of my journey, I have asked the sky, the trees, the One Up There ‘Why Me, Why am I ill mentally?’. Searching for the answers has been a futile endeavour, as the knowing is not a practical coping strategy for my Bipolar condition. Rather I have gotten enmeshed in a web of possible answers that makes me feel more lost and dejected, and the act of finding answers gives me a false sense that I had been problem-solving. This is not genuine understanding, the least for awareness.

Hypomania and DepressionShould I ask the question what causes Bipolar-disorder, I’m likely to find that there are several factors attributing to this physical yet invisible illness. Scientists explain that certain brain circuits and brain chemicals (neurotransmitters) is responsible for the mood swings along the bipolar mood spectrum.A person like me either experience the high of hypomania (or mania) or the lows of mild to major depression. Genes and biological differences (significant physical changes in the brain) are the usual suspects (for almost all mental illness), and risk factors like stressful life events either develop or trigger the onset of Bipolar disorder. Seemingly I have a better understanding. So how now?

Admittedly I am curious about the concept of Understanding and its role in helping me manage my Bipolar condition. How much I understand as in having a sharper visual of the malfunction in brain circuits and neurotransmitter, gives me clarity. With this piece of information, I am more willing to accept the inevitability that I need medication (Thank Goodness there are medicine for this illness). For how long? Do I really need to know? With medication, I can function productively on a daily basis. That overwrites all other thoughts, perceptions, and biases.

With better understanding, I can differentiate recurring negative thoughts and energy consuming emotions from being the real me. In the past, I was misled into believing that I was always an angry person, not the least a grouchy one under the facade of Depression. I doubted my intentions, did I become mentally sick so that I could get attention and support, and also shirked off house cleaning tasks at home. Rather, I am able to say “Depression is not me”, what really happened was by-products of being ill with Bipolar-disorder. The understanding and the perception of myself gives me strength to move on, and be not in the dumps of depression.

The Way
The Open Door

Understanding opens the door to compassion. Knowing how impactful my life has been disrupted by the illness, and how much anguish, worthlessness, the “pain syndrome”, recklessness, the job opportunities I miss, this sense of injustice is intense. How am I going to reconcile and move on? Compassion is a gentle partner to my recovery. Have I not understood that these injustices I had lived with it for donkey years, is like the spilled milk, gone and irretrievable, I would have bolted my gate, close all windows, and sunk into a deeper and dangerous pit of depression and/or hypomania.

In the nutshell, this sympathetic awareness and tolerance of my intangible physical illness, understanding, like a key, has opened up the door to recovery. How it intersperses with awareness brings about countless “Ah Ha” moments, and serves me a strong, sturdy walking-stick on my journey. I am and will count my blessings.

In my next sharing, I will be writing on awareness, what exactly it is and how it helps me in managing Bipolar disorder. In the meantime, I will part with a question for you, “how does understanding serves you?” I hope it brings about “Ah Ha” moments, the point in time that let you understand yourself.

Am I hypomanic?

Yes, I am concerned.

And I am always worried when would be my next relapse, it is like there is no tomorrow, as at anytime I could be down in my dumps or high on Cloud 10 (yes, not cloud 9). Both ends are unwelcoming, they disrupt my work, sour my relationships, demoralize my spirit. Often, relapses challenges my resilience to get better.

In The Tunnel

It took me a very long while to begin charting my mood. I am reluctant to write and record my mood status on a daily basis. It is simply too troublesome to make out whether I am in the mood brought about by a full throttle of energy and a act on impulsiveness, with racing thoughts, delusions that all things are possible. Or I am in the deep trench of low mood, when holding a pen to record how depressed I am is as challenging as climbing the Mount Everest.

But mood tracking is essential for recovery. With my mood data on records, it provides a realistic overview of how my mood journey is in the weeks and months, how in a period of six months, the mood fluctuates. Which part of the year my low mood surfaced or could the season festive periods say around December to February, bring me to the hypomania level. Sometimes, the tangible graph line depicting my highs and lows, provides
mood trackingassurance that my mood is manageable. It is like ‘Hey, you came out of your lows pretty quickly’ or ‘not bad, this time you have kept your elevated mood in check’. Mood charts and records are my managing tools and they are vital to my mental wellness.

On shorter time frames, mood charts provide information to assess my day-to-day mood status. Am I heading downhill or in the midst of being hypo-manic now, what interventions can I garnered to counter my bipolar condition? Knowing my current mood level, I am able to find out with a set of criterion whether a relapse has presented itself.

So am I hypomanic now? I will ask myself a set of questions should I feel my mood is on the down or up side.

The Questions I ask when depressed

  • Am I depressed for most of the day, nearly everyday?
  • Are you feeling no pleasure for most of the activities most of the day, nearly everyday?
  • Am I eating more or less than usual?
  • Am I having insomnia or sleeping excessively?
  • Am I feeling fatigue or loss of energy nearly everyday?
  • Do I have recurrent thoughts of death and suicide?

And Questions I Ask When Hypomanic

  • Do I sleep less hours than usual?
  • Am I more talkative than usual?
  • Do I feel energized and not feel tiredness?
  • Do I experience irritable mood?
  • Do I have inflated self-esteem or feelings of grandiosity?

Keeping check of my responses, I can make good guesses that my mood is in an upward, downward trend or in the normal range. In a case when I observed I was leaning more on the hypomania mood range, my responses could be sleeping on average three to four hours daily, very chatty, easily irritable, and no sense of tiredness. Out of 5 questions, I had 4 positive response, indicating a moderate level of elevated mood (on a scale of none, mild, moderate, and severe). Moderate level means orange signal (the 3-color system) implied that I had to make sure not to overstretch my pace of living on the day-to-day basis.

This color system is an alarm signal, which meansTo Alert

  1. green, mood in normal range, daily functionality able and acceptable
  2. orange, mood in hypomania or mild depression range, daily functionality not impaired, and less acceptable
  3. red, mood in very high elevated or severe depression range, daily functionality disabled.

In another words, the answer to my question of whether I have been in the hypomanic range is yes, a positive indication to take note and exercise caution for my Bipolar disorder management. This illness management recovery system is my intervention tool to counter my illness, an essential and vital strategy to actualize and re-position my action plan for a sane way of living with Bipolar Disorder condition.

Therefore, what is Action plans, and what is its relationship to awareness and understanding. With this question, I will conclude my concern and worries about “Am I hypomanic?”. And to sincerely invite you to find out more about my next topic on Awareness and Understanding.

Mental Illness

 

How I Subdue my Depression with Physical Activity

Depression and activities are on friendly terms, when I get more depressed, I would do less activities and when I am in my normal mood range, I am relatively more active. Knowing that this two elements are somehow correlated, I like to share my personal journey about taming my Depression with Physical Activity.

Perhaps it is how this illness present itself. When depressed, I lose interest in many things to the extent that I am not concerned of its progress nor outcome. In this apathetic condition, I am not motivated to cook meals nor do the laundry. My family will be the first to feel its effects as taking meals is a daily occurrence. By the end of the second week, clean clothes become short in supply. Do I feel bad for not preparing meals? I felt numb then. Do I feel irresponsible for not doing my job for laundry washing? Yes and no as I felt lifeless most of the time.

Often I wonder about my behavior, is it my illness or is it me being a lazy and unreliable home-keeper? I no longer know and the more I ponder, the more unmotivated I become. Or perhaps my thinking are just excuses to avoid work.

So be it an illness or a character flaw, the reality is how to counter my spiritless apathetic lifestyle. How is physical activities related to depression. It seems that by doing one thing, followed by another thing, then after another thing, being active physically proves to be effective in tackling depressive symptoms like lethargy, sleepiness, overeating or not eating, apathy, helplessness.

My Morning Challenge … Waking Up

Mentally I do not look forward to waking up, so to kick-start the day (standing on my feet), I will think of watching online drama as a beneficial token for my effort to get up from the bed. Before I enjoy the benefit from visuals, I need to wash up and change into my day attire; and to prepare the breakfast, I will need to boil water to make coffee, spread the butter on the bread. While waiting for the water to be boiled, I’ll put the clothes into the machine for washing. The broom and dustpan is at the laundry area, I pick them up and begin sweeping the floor. Last but not the least, I return to making coffee, and have my breakfast while watching drama, and wait for the washing machine to finish its job.

I know the downside of online drama-watching, it’s a passive activity, in the sense that I will likely be stationary in front of my lab top for countless and endless minutes. This passiveness will ensue with sleepiness and my return to the bed for long naps. To counter it, I have clothes to hang dry when the machine finishes the washing cycle.

For me, online dramas is the bait I used to get myself out of my bed. It’s also the positive reinforcement that I reward myself after doing undesirable household chores. Strangely, the momentum I kick-start with a fair bit of physical activities, builds up bit by bit. It serves as a distraction from my negative thoughts and feelings.

Taking A WalkExercises … Keep the Body Moving!

In my depression dump, when apathy sets in, I push myself to exercise, which is a physical activity. Walking is a convenient and cost-free strategy, and its intensity level can be adjusted to my level of mood along the spectrum. The challenge is how I get myself out of the house when I am withdrawn and hiding in the comfort of home. The bait with a reward system helps sometimes. Quite often, I have nothing to do or rather being too much preoccupied with negative thoughts and feelings, a short walk becomes a break from the vicious downward spiral of depression.

So when my mood is very low, I walk in the neighborhood for 10 to 15 minutes and I can do so twice a day, morning and evening. For me, taking walks by myself helps in the sense that I look around at buildings, gardens, the clouds, the traffic, anything that will keep my focus away from my negativity.

When the mood is better, I will start brisk walking and increases the exercise to 50 minutes. My pedometer keeps track of the number of steps I cover, and looking at the number increasing to 10,000 steps each day is constructive strategy (I want to maintain the 10k record). When the mood has normalized, I will go for the weekly badminton games, a much more intense and physical activity.

Mid-way Setback … how now?

The morning challenge bait-and-reward system and exercises are two forms of physical activities that are not fail-proof. Often, rather many times I find myself refusing to wake up. Countless times I am unable to go for a walk, even for a minimum requirement of 10 minutes. The feelings are numb, lacking in responsiveness while I go through the motions in living. So what to do … how now?
Record Setting - an Upward Trend

One thing for sure, when I set the record to be up and doing some form of physical activity, there is unknowingly a deep desire to keep the record going. Usually with the momentum kick in, I yearn silently for the uplifting ride up the normal mood range. What about stubborn setbacks that are challenging beyond my means, I have to reach out for help to anyone.

Making connection with my inner circle of friends is critically essential. Companionship do works like taking a walk with my sister, talking about anything or everything with a friend (though most of the times it’s the other party doing the talking), and email to my psychiatrist. Likely an appointment with the psychiatrist will be brought forward, and to make sure I keep to the ‘date with my Psychiatrist’, I strongly request someone to go with you.

Do Physical Activities Always Work?

Personally I believe it does. When I lack mental strength and being submerged in the deep sea of depression, physical actions lighten my mood. I may be overwhelmed with pessimism while doing simple task like brushing my teeth or making coffee for breakfast. The range of physical and mental challenges to do something opens up to a ray of light through the window of opportunity, a chance to feel good.

The Way …

SpeedometerOne way (or rather the way) to subdue negative thoughts and feelings is to do physical activities. The body movements are like the car engine being ignited, ready to push my energy level up to Gear-One-mode. I may stand still (neutral gear) then after or the car dies off on me, it is all right. Keep keeping on, seek for the slight ray of sunlight seeping through the window, strive for the life chances to feel better.

My 10 Signs of Bipolar Disorder (BD)

What are my 10 signs of bipolar disorder? Do I really need to know?

Many mental health websites provide a list of symptoms for Bipolar disorder. Mainly, it is for psychiatrists to make their diagnosis, or as information for concerned family or friends to understand the illness better. What about mentally ill person, is it helpful for someone with bipolar disorder to know their symptoms or signs that a relapse is on its way? Yes, it is not only helpful, it is critically essential for bipolar patients to know their signs.

On that note, I like to share my observation on my signs of Bipolar II; how I track the course of my Bipolar episode; and why do I put an effort in knowing my warning signals.

Bipolar-depression

Relatively speaking, bipolar disorder is a more severe mental illness. I thank God that my diagnosis is Bipolar II. Not that it is less dreadful and dangerous, just that I need not be fearful with hallucination or delusions. My Bipolar II has more spells of depression (low mood) than hypo-mania (mild elevation of mood). Observing and finding out the signs of depression is challenging, it will need patience and help from people who resides under the same roof. I am blessed to be close in proximity with my family. With their help, they can tell me straight in my face that my long sleeping hours in the day is indicative of a pending full-blown depressive episode.

My 5 warning signals of Bipolar-depressionWarning Signs

  • sleeping 22 hours daily for 3-5 days in a week

  • skipping shower and shampooing my hair in this hot and humid weather

  • snacking on biscuits or crackers while watching excessively online dramas like a couch potato

  • laundry piling up for washing or not preparing nutritious and tasty meals for my family

  • all tasks are halted and only task(s) done is on a need-to-do basis.

Bipolar-hypo-mania

The fine line separating my Bipolar hypo-manic and normal range is tricky to recognize, I have expressed my concern to the psychotherapist. In fact I was very worried whether I had been in the high mood range for the past 2 weeks. With a straight-face, I requested my therapist to let me know at the end of the session, was I in the normal or mania phase. Thankfully, I was in my normal mood range, I was happy to know my past doings were my ‘normal self’ .Often the confusion between ‘Am I hypo or am I in the normal range’ makes me anxious, and less confident to do things. I really dislike being someone who does not turn up for prior engagements. More importantly, my psychotherapist taught me how to differentiate my normal span and hypo-mania phase by asking four questions.

  • How many hours do I sleep?

  • Do you have racing thoughts or unrealistic ideas?

  • Do you feel energetic and not tired?

  • Is your mood irritable?

So it means when I have 2 to 3 hours sleep daily with racing thoughts and awe-inspiring ideas, energetic and no signs of tiredness, very irritated when things are not going as plan, I need to see my psychiatrists preferably immediately. My Doctor will adjust my medicine dosage level to push my mood into the normal range.

My 5 warning signals of Bipolar hypo-mania

  • sleeping about 2 hours daily, and do not feel tired

  • reconnecting with friends whom I have not met for a long while

  • buying more things for home or more groceries for cooking (I enjoy cooking)

  • getting irritated when things did not go as plan

  • being more friendly than usual like initiating small talks with bus or taxi drivers, cashier ladies at the supermarket, or the person beside me in a queue.

The Proactive Way to Fight My Illness

Like a typhoon, my Bipolar causes damages to myself, and to my Loved Ones (especially those close in proximity). So knowing my 10 signs of Bipolar disorder will be essential and using a mobile app eMoods (Android; Amazon) to track my high, normal or low mood range on a daily basis is important. With these two strategies, I can reach out for help from my Doctor, and family or friends for support. In addition, a color warning system will be helpful for me to be on a proactive mode to counter high or low mood. Orange, Yellow, and Turquoise are the three levels of the warning indicators, where orange is severe, yellow is mild and turquoise is normal mood range. With a weekly mood report, I will know whether I have been mildly depressed or in an elevated mood for the past one to two weeks. This will give me a general sense what it will be like for the coming week. I will be able to carry out measures and be actively engaged to fight with my mental illness.

The Role of Medication Medication

On a side note, these strategies can be effective only when I am taking medicine faithfully. For my case, medication is necessary for any above strategies to kick-in, to live a purposeful life. When I fall sick with a full-blown episode, either in depression with anxiety or in hypo-mania, I am fully occupied in being sick. There will be no way to monitor my mood and talk about noting it down. Medication is critically essential to place me in the normal mood range. It is an exclusive focus on be being well and competent.

To sum up, knowing my signals of BD and the information collected from mood tracking are helpful and essential for recovery. Together with medication, mood tracking and knowing my 10 signs of BD do put me in a better position to manage my bipolar disorder.

What about you, what are your signs of Bipolar disorder and your strategies to counter it? I am open to discussions. Do feel free to comment.

My Dreams Come True?

2015AD was a turning point,for me, and 2016AD is my dreams come true!My Dreams Come True

“If it is to be, it is up to me.” by William H. Johnsen is one of my favourite quotes.

With this mindset, I take an active and ‘now’ approach to make my dreams come true. ‘Active’ includes mind and behaviour: being persistent in achieving my short and long term goals, and keeping to my vows (vigilance in self-care).

My dreams are an ongoing ‘homework’. I am able to progress in my life-journey, and I am grateful for having experienced my turning point.

In the month of July, 2015AD, my diagnosis, suggestively changed, from Major Depression to Bipolar Disorder. This meant that my medical treatment would change from 60mg of Prozac to only 20mg; and with mood stabilizers like Lamictal, Zyprexa, and Dosulepin.

These four types of medicines are anti-depressant, anti-convulsant, anti-psychotic, and tricyclic anti-depressant: they are believed (supported with scientific research results) to effectively treat Bipolar Disorder. This new treatment was to continue on a fortnightly schedule because my Doctor was cautious about the effects of the new medication regime.

My last doctor’s appointment was in April, and my next will be ten weeks down that road. Treatment intervals have progressed from two weeks to two and a half months…

My perception changed: what used to feel like ‘cloudy skies’, now felt like ‘rays of sunshine’ seeping through those same cloudy skies. I see hope!

I am happy with the new medications. After this treatment phase, I will make greater headway into the maintenance phase. I have no idea how long this will take to achieve stability but I look forward to my full recovery. Then my dreams will come true, one by one.

My Dreams Come True

Bipolar Medication and Weight Gain

Part and parcel of taking Bipolar disorder medication is coming to terms with its side effects. Though I am relieved to have a diagnosis for my illness, happy that medication treatment is available, I am not ready and have not given much thought of its side effect weight gain.

The Alarm Rumble LoudlyAlarming

When I find out I was two to three kilograms heavier in the span of two months, unlike the gradual increase from my bouts of emotional-eating, my thought was “I am going to have an obesity problem.” The ‘freak-out’ alarm rumbled loudly. The fear I had was greater than receiving the diagnosis of Bipolar disorder. I catastrophized that I would be plagued by obesity complications like heart diseases, Type II diabetes, and stroke. No amount of exercise would reduce my weight. There was no way out.

Keeping on My Toes

With a disturbed mind, I began to watch my diet, and control my bouts of emotional-eating. I would drink water whenever I crave for snacks. Alternatively, I would bargain for a ‘small dose’ of snack after completing some unfavorable tasks that need to be done. More often than I like, I succumb to emotional-eating. To restrain my cravings, I google for the food and fruit to avoid, so that I can snack healthily. It is no easy feat, and I persist with an exercise schedule, jogging two to three times a week, planking and/or situps on a daily basis.

Weight Loss?

I wonder with these efforts in place, will my method be effective? Will I lose my belly fat? Am I focusing on the wrong thing?

Instead of weight gain, to be fit and healthy seems to make more sense. With this thought, I feel less stress and my mealtimes become more enjoyable. I keep up with my exercises and a balance diet in smaller portions (less carbohydrate, more proteins, and take my greens). I have my water bottle with me as a constant reminder to stay hydrated and take less caffeine and sugar beverages.

More importantly, I resolve to keep fit and healthy with a positive mindset.

When Medicine ‘Fails’

I think an effective treatment approach for Bipolar disorder is a combination of medication and psychotherapy. However there are still times when my mood will go down and I felt the vitality in life drawn out completely.

Being depressed

The lost in liveliness usually begins with an increase in sleeping hours. I am relieved to get into bed earlier than usual and wake up at a later time. I will fall back onto the bed to catch one to two hours of nap before the next meal. The pattern repeats after lunch.

Personal upkeep is not on my to-do list. Actually the list is not in motion. When sleep is evasive, I will tune into online drama and games. Procrastination effectuate for daily tasks. I will keep the must-do tasks to the last hour. Lethargy prevails and often the energy level remains at zero or neutral. Short-term goals not in sight and have little or no motivating reverberations.

Waking up is an uphill route

With these tell-tale signals, I seem to know that I am depressed. Yet the mind is oblivion to these indicative you-are-depressed alarm and the feeble attempts to get out from the down cycle. Counter thoughts like ‘let’s focus on the next hour’, ‘you need to break the pattern’, ‘don’t feel, just do it’, or shorten the snooze interval with a few more wake-up alarms, are ignored. I am simply unable to shift the gear from neutral to one to bring back the vitality in living.

It is true that what one focus on expands. My depressive cycle encourages inactivity. The state of being inert begets discouraging lifestyle and robs the will to love myself. I condescend to overeating and agrees to missing out a day or two of medication, exercise is no longer mandatory. Should alcohol be easily available, I would have drank to my heart’s content. These meaningless behaviors are a reflections of the mind.

My mind seems like any physical substance with no feelings and no thinking abilities. I have shorter attention span and my memory is a blob of glue. My brain system has gone for hibernation. The danger of my mood spiraling downwards is lurking closer.

My way

Sensing danger, spikes of survival instincts comes into action. I urge myself to sleep less, Uplifting Moodjust sleep two to three hours for one night. When I wake up, my mood seem to be uplifted. Perhaps it is the adrenaline rush to counter tiredness, more energy is ignited. The neutral gear has move up one level. I ride on the momentum of the upward cycle, actively completing the to-do list for the day and drawing out the list for next day. I make sure I do not sleep in the day, so that I get a good night sleep.

Somehow I can kick-start the day with a lack of sleep. I may feel irritated during the day, but at least I become more energetic. The yearning to be alive with more energy is desirable. The positivity let me resume my medication faithfully.

And I continue to work on my goals …

If It Is To Be …

It happened recently.

I am relieved. Past happenings make more sense to me now.

Suggestive bipolar disorder is the diagnosis. It is often mistaken as major depression (MD). Doctors often misdiagnose. I lived with MD for the past nine years. It has been a vicious ride. Be it unlucky or fortunate, I am ‘labeled’ with bipolar few month ago.

“If IT is to be, IT is up to me” a quote by William H. Johnsen could not be more apt. Willingly I accept the diagnosis. No denial nor shock. Rather it has been reassuring as many past events become self-explanatory. If it is to be bipolar, I concur.

It is up to me to take charge in my recovery from Bipolar Disorder. I assume responsibility to get well and carry out daily activities. I am committed to taking my medications faithfully.. Yes, no skipping it with excuses like social drinks or “I forgot to take my meds.” I turn up for all Doctor’s appointments, saying no to “I don’t feel like going out” or “I can’t think with my low mood.”

To sum up … Let go. Accept. Take charge. Be accountable.  Autonomy

Nine years of wrongful medical care, the time wasted, I let it go.
The new diagnosis, I accept it.
To get well, I take charge.
My new identity as a person with bipolar disorder, I assume ownership