The Diagnostic and Statistical Manual of Mental Disorders (the DSM) is frequently called psychiatry’s “bible.” I, however, would not pen it that way. I would suggest that the DSM is simply a guideline for the diagnosis of mental illness. It lists the criteria one has to have in order to be diagnosed with a mental illness.
And, as the name of this post suggests, the DSM is releasing its fifth major version – the DSM-5 – in just a couple of weeks.
Now, the DSM-5 has been controversial from the get-go and I have said that much of this controversy is overstated, but some of the changes do have fundamental nosological implications. In other words, some of the changes in the DSM-5 can change how people fundamentally think of certain mental illnesses.
The DSM-5 Cuts the Chord between Depression and Bipolar
And one of the changes in the DSM-5 is the separation of major depression and bipolar disorder into their own chapters. No longer is there a chapter called “Mood Disorders” with both disorder types listed (Can we still call them mood disorders?). Now they each represent a separate category.
This may seem like a small change, and I’m not going to have a fit over it, but I will say that I think it was the wrong move.
Recently a friend of mine tried to make a change – she tried to stop smoking. Unfortunately, that attempt only lasted a few days.
Many people, of course, have been in that situation. Many people have tried to make a change and have found themselves less than completely successful. But what I told my friend is that she didn’t fail, she simply hadn’t succeeded – yet.
And so, I would consider her attempt a type of success. I would consider it an intention of success. I would consider it an approximation of success. I would consider it to be a step forward that ultimately will lead to success.
If you know my story of bipolar disorder treatment, you know that it hasn’t been a pleasant one. Doctors have fired me and given up on me. I have tried a host of treatments that didn’t work. I have experienced almost every side effect under the sun. I have bumped into holes in the healthcare system that have denied me access to a psychiatrist. I’ve spent years wanting to die. I have seen, and lived through, it all. And I would say there are many unmet needs in the treatment of bipolar disorder. I would say these unmet needs are part of bipolar treatment and part of the system in which treatment is delivered. I don’t blame psychiatrists or psychiatry, specifically. I would say there is plenty of blame to go around.
So when I think about unmet needs in bipolar disorder treatment, there seems to me to be many.
I get asked this question quite a bit, “How do I become a mental health advocate.” (Or mental illness advocate, or bipolar advocate, or what have you.)
Mostly I think people fall into mental health advocacy. I did. In fact, I never really considered myself a mental health (mental illness) advocate*, I always just considered myself a writer, but people started calling me a mental health advocate, so, I guess I became one.
What is Mental Health Advocacy?
I think advocacy comes down to being a loudmouth for what you think is right. That’s about it. So to be a mental health advocate you just have to have some strong opinions on mental health and a good set of lungs.
I get asked lots of questions, but even more questions are silently asked of Google and one of those is, “Is something wrong with you if you think of killing yourself?” The question as to whether something is “wrong” with you if you think suicidal thoughts often leads people to this blog so I thought it was important to address the question.
Thinking of Killing Yourself
I actually think the odd thought of suicide is not unusual. A friend once told me that he was unable to take an acetaminophen without thinking of the number it would take to kill him. This particular friend isn’t remotely suicidal but it’s just one of those thoughts that floats through his mind. I don’t think it means anything, per se, other than the fact that his mind is pretty active.
Of course, there are thoughts of killing yourself and there are thoughts of killing yourself.
It’s so unbelievably dismissive and invalidating of a medical illness that I can barely fathom it. One very mature person on Facebook simply said, of this statement, “I guess our work fighting stigma isn’t done yet.” That’s an awfully gracious way of putting it.
Isn’t Everyone a Little Bipolar?
The answer to this question is “no.” No, no, no, no, no, a thousand times no. Seriously. To suggest that everyone is a little bit bipolar shows an absolute ignorance of bipolar disorder and of mental illness in general.
In the first class we learned about deep breathing and the body scan (article to follow). These are really simple skills that anyone could do. But thinking about sitting still while “breathing” and “scanning my body” seemed kind of silly to me. I didn’t see how anything useful could result.
I know, you think you know how to breathe. In fact, my guess is you’re probably doing it right now (at least I hope you are). Nevertheless, many people don’t know how to deep breathe and this is a problem during mindfulness meditation. Many people, especially women, shallow breathe and this isn’t the best way to nourish your body. Some people even go so far as to occasionally hold their breath, especially when anxious.
Shallow Breathing vs. Deep Breathing
Shallow breathing comes from the chest while deep breathing comes from the belly. (I know all about this because I was a trained signer when I was younger and you have to deep breathe in order to project and hold notes properly.) Women, often, don’t like to deep breathe because they’re scared that breathing from their belly will make them look fat. (Really.)
How to Know if You Deep Breathe or Shallow Breathe
(They call meditation “practice.” I suppose it’s to indicate that we’re all students and that we’re never done learning. It’s kind of a warm, fuzzy concept but I think it’s worth remembering.)
Tips on Creating a Mindfulness Meditation Practice
These are simple, easy-to-remember tips on creating a mindfulness meditation practice according to the course (and a little bit from me.)
Here are the tips provided when beginning a mindfulness meditation practice:
Choose a sacred space and time – there is no perfect time for a practice but if you make it part of your routine, you’re more likely to do it. Make sure to minimize distractions. (And realize that your space might just be the corner of your living room. We don’t all have ashrams to retire to.) Many people find meditation earlier in the day easier.
Sit in a comfortable and strong position – either in a chair or on the floor, sit with a straight back with your legs uncrossed. Let your face relax into a natural smile and let your hands rest on your lap or cupped in each other.
Use a gentle-sounding alarm to time your practice – so you relieve the worry of time.
Make your mantra, “meditate anyway…” – things will always seem “more important” than meditating and things will always stand in the way of your meditation practice – do the meditation anyway. Even if it is only 5-10 minutes, this is better than nothing and it’s daily practice that’s going to make this meditation useful (not to mention easier to continue in the future).
Be gentle – let go of any preconceived notions of what a meditation “should” be and just be curious about whatever arises.
Gently bring your mind back – when meditating, if your mind wanders, understand that this is normal and gently bring your mind back to the here and now.
I admit to not using all of these tips but I do think they are a good idea.
I’ll talk about how I put these mindfulness medication tips to work with some mindfulness meditation exercised next.
I’m going to be talking about an eight-week course I’m taking on mindfulness meditation, but before I start with my experience, I have to define a few terms so we’re all on the same page. I’m going to define mindfulness and mindfulness meditation so we all know what we’re talking about.
According to Sheri Van Dijk, MSW, author of The Dialectical and Behavior Therapy Skills Workbook, mindfulness skills, “. . . help people to live more in the present moment, rather than getting stuck in the thoughts about the past or future, which can trigger painful emotions. These . . . help you get to know yourself better, because you’re focusing on the present moment, you’re more aware of your emotions, thoughts, and feelings.”
Multi-tasking is the antithesis of mindfulness. (Personally, I still don’t think multitasking is always bad and I don’t think mindfulness is right for all occasions. But that’s my personality and a function of my job.)
While mindfulness is a form of meditation practice, you don’t have to sit cross-legged on a yoga mat chanting in order to do it. Both formal practice and informal practice can take place.
There’s a lot to know about bipolar and bipolar depression. How do I know? Because I’ve written about bipolar depression so many times it would make your head spin.
And what I try to do is either present the human side of bipolar depression or the evidence-based side. Here are a few of the articles I’ve written on bipolar depression:
Well now I, and you, have the (FREE) chance to get a genuine look into bipolar depression from an evidence-based approach through the words of a leading psychiatrist.
Free Webcast on Managing Bipolar Depression
Here is the information on a FREE webcast by doctors (technically, for doctors) on an evidence-based approach to treating bipolar depression. I believe there will be a lot to learn here.
When people ask me about bipolar treatments or bipolar therapy here, I tell them about the research on the therapy or treatment and I tell them this, “different bipolar treatments and bipolar therapies work for different people so try it and see if it helps.”
And I consider this good advice. It’s absolutely true. Different bipolar treatments and bipolar therapies do work for different people – but that doesn’t mean that I, personally, believe in them.
And, to be clear, it’s not so much that I don’t believe in them entirely, it’s more that I don’t believe in them for me.
Enter mindfulness-cognitive therapy or mindfulness meditation.
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