One of the things that drives me crazy is that there is no “right way” to deal with bipolar disorder. There is no “right” treatment, there is no “right” therapy, there no “right” anything when it comes to bipolar disorder. When I look at the roadmap of my past treatment, it is so winding that this is clear. And the thing that really gets me is when I look at my future treatment roadmap, I see that uncertainty too. It makes it so hard to make a decision when there is no right way to deal with bipolar disorder.
The ‘Right’ Treatment for Bipolar Disorder
But isn’t there a “right” treatment for bipolar disorder? After all, I’ve written a treatment algorithm to help people with this very question. (Multiple algorithms are included in my Lost Marbles book.)
But what you see when you look at a treatment algorithm for bipolar disorder is that it offers choices at every step – each with the same amount of evidence. So even if you follow evidence-based bipolar treatment practices, there still isn’t one right way to treat bipolar disorder.
The ‘Right’ Way to Deal with Bipolar Episodes
And while there are coping skills galore for bipolar disorder (Coping with Bipolar Emotions Using Logic), there is no one “right” one, or even ones, to deal with bipolar disorder episodes (What Bipolar Mixed Moods Really Feel Like). What helps one person does nothing, or even harms, another. What gels with one person boggles another. What one can do makes sense for one person and not another. There’s just choice, upon choice, upon choice when it comes to learning and implementing bipolar disorder coping skills (How to Practice Bipolar Coping Skills).
Isn’t Choice in Dealing with Bipolar Disorder Good?
In some respects, no “right” way to deal with bipolar disorder is good as we are not locked into any given treatment or practice. This gives us some semblance of control over our own everyday lives. I appreciate this. I do. After all, all non-mentally ill have all these choices on a day to day basis, so I suppose we should too.
The Problem with Having No ‘Right’ Way to Deal with Bipolar Disorder
The problem that I have with a lack of a “right” way to deal with bipolar disorder is this: I feel frozen in a swarm of choices, never knowing which one will help and which one will harm me.
For example, I have lots of problems with fatigue and pain in my everyday life. This means that sometimes I have to push past these things in order to get done the things I need to do to live. This also means that sometimes, if I do that, I will get much sicker. So sometimes this means that I must rest one day so that I can be functional the next.
The choice is always: do I push through the pain and continue doing what I’m doing or do I stop and rest?
The selection I make is vitally important as it affects my ability to be productive. If I’m productive today does that mean I’m going to pay for it with days of suffering? If I rest today does that mean I’m just giving into the illness and losing time when I could be productive?
And when I face this choice (and many, many others) it’s clear that there is no way of knowing which choice will be the best for my mental health and productivity. I know that recognizing limits in bipolar disorder is important, but I also know that always giving into bipolar disorder makes life untenable and the mortgage unpayable.
I just want to know the right way to deal with my bipolar disorder to make these decisions easier. I want some indication of which road to take. I want some arrow with a sign that says “this way to good mental health.” I want a guru or a swami that knows what it is that is best.
But, of course, this person doesn’t exist and neither do the signs. I can use all I know about my mental illness and all I know about bipolar disorder in general and try to make sound choices. This is what I try to do. But I find the process achingly hard as I never know if I’m making the right choice. I know how crucial it is to handle decisions the right way for your own mental health and for your own quality of life, but I never know if the choice I make is truly best for me. I find it maddening.
I know there is uncertainty in life for all. I get that. I know that all the “normals” walking around out there share this uncertainty in their own lives. It’s a normal part of life.
The difference is the fact that there’s no “right” way to deal with bipolar disorder leads to such dire consequences when we’re wrong. When you’re really sick, when you’re really in the midst of an episode, decisions are hard enough to make simply due to episode symptoms and when you add on top of that this built-in uncertainty and knowledge that the wrong choice will seriously hurt you and/or your life, and I think it’s natural to feel frozen and unable to continue.
Dealing with Bipolar Disorder When There’s No ‘Right’ Way
Clearly, we need to deal with this uncertainty. I think it comes down to this: we all make the best decisions we have with the information we have at the time and understanding this, we need to give ourselves a break. The fact of the matter is, sometimes we will choose the thing that will make us worse. It happens.
But it happens to everyone. And while I know it sucks to look back and realize “If only I had chosen that, things would be better,” this is an experience every human has.
We have to accept that our choices have greater consequences and seek out the best information available in how to make them. But once we’ve done that, there’s not much else we can do except think critically (which, I know, is certainly hard enough).
So today I remind myself that while the way I handle bipolar disorder may not be “right,” it is the best I can do. Uncertainty needs to be accepted. And I can always do better next time. And that just has to be enough.
Valuable article Natasha. Yes, there is no right way to treat bipolar disorder. Managing bipolar disorder starts with proper treatment, including medication and therapy. But there is so much more one can do to help themselves on a day-to-day basis, including human interaction, developing an active daily routine, trying to consciously avoid stress and following a healthy diet.
Dear Natasha,
Everything that you write seems to be on my mind too. For example, I did NOT know that you have chronic pain. Had no idea. Me too. I think I found a way out…this took forever.
Last night I went to writer’s group, the penalty of sleeping in and having a ‘down’ depressy day. I must go. It’s my lifeline, but it costs me the next day.
Not knowing whether or not your choices will heal or harm you is poignant to me because I developed Tardive Dyskinesia, (TD) which causes chronic pain due to muscle spasms and which took FOREVER for the doctors to figure out, but they finally did. Once again, a condition where there is no ‘right’ way because everyone’s brain structure and brain chemistry different. I love your book.
Allison
Hi Allison,
Everyone knows, I read minds ;)
I’m sorry you’re in that place. I know exactly what it feels like.
I’m glad you love the book :)
– Natasha Tracy
This is exactly what I needed to read today -thank you once more. Coping with bipolar and cptsd / ocd makes things even more complicated for me although I’m pretty sure for many people symptoms can be overlapping. Learning to “forgive myself” and be gentle and “hold space ” for me is truly the only way to go forward one step at a time. Also for the pain besides bipolar meds, epsom salt rinses have helped me loads -other people like to sink in the tub, I rinse myself with a diluted potion in the shower and it really helps. Or you can soak your feet but I’m not sure if that’s the same.
Dealing with my bipolar was one thing but it’s progressed to pshycosis and that certainly doesn’t help with my mood swings. It’s so hard to separate my emotions from my reality of the actual things going on in my life when my pschycosis (voices) have me hearing so much negative things from strangers to the people I know. It’s gutt wrenching and completely exhausting trying to feel normal and ignore the things I hear people thinking or feeling and saying about me or trying to figure out if it’s even real or not. Being in constant fear I’m being thought of in such a horrible way or that everyone and anyone would rather i just disappear. Sometimes the voices in my head leave me convinced that i should be as paranoid as i am about what i think people are trying to do to me. My meds seem to be working at first then after awhile not as well so i slack if not stop taking them all together. I try handling the events i go thru on my own which has me even more convinced I’m hated. It’s when i speak up about things that really have almost destroyed most of my relationships. Especially in my marriage & between my children. Coping with bipolar and pschycosis hasn’t been easy for anyone and i know I’m not doing it right. I want to scream, “why are you so mad at me, i can’t help how I’m thinking or what I’m feeling about anything anymore”. I’m scared of being run over or to confrontational about almost everything. I’ve attempted suicide 4 times in 6 years. 3 have been hospital worthy 2 have had me in a mental hospital. Only after i was legally in trouble did i start recieving some kind of help. But now i have a violent record which pisses me off simply cuz once I was defending myself, the other cuz after i tried to kill myself i tried running from the ER and struck a nurse. I have grown angrier and angrier becuz of this illness and that also scares me. How am I suppose to feel, think, act?
Hello Andrea. Natasha sent me your comment as she knows I live with a lot of psychosis. First of all, you’re not alone. Paranoia is a terrible feeling and one that is very hard to fight. I have a few articles you can read that I have listed below. First, it helps to get a correct diagnosis if you have a lot of psychosis. I have bipolar disorder and a separate psychotic disorder, so my actual diagnosis is schizoaffective disorder. This doesn’t mean schizophrenia. It means schizo (psychosis) and affective (mood). I can be psychotic when I am NOT manic or depressed which is why I have a separate psychotic disorder. I spent many years wondering why people were ‘upset’ with me. I would ask, “Are you mad at me?” It drove people crazy and drove them away. All of it was paranoia. My friends were not doing anything. Also, talking with your health care team about this really helps- make a list of your psychotic symptoms and let them see what you experience. I deal with my psychosis without medications by writing down my symptoms and not acting on them. When I want to ask someone if they are mad at me, I know this is a sign I’m sick and it’s NOT a sign that they are mad. Many people with bipolar will have psychosis (hallucinations and delusions) when manic or depression, but some of us have more psychosis than is normal for bipolar. We need more help and have to learn to manage this symptom or our relationships will be seriously affected. You can learn to manage these symptoms. Good luck! Julie
PS: Thanks to Natasha for having a space where we can all help each other!
I have also added an article I wrote for Martin Baker who is the author of High Tide, Low Tide: A Caring Friend’s Guide to Bipolar. He is a fellow video blogger on BP Magazine along with Natasha.
https://www.bphope.com/relationships-and-the-bipolar-trap/
http://www.gumonmyshoe.com/2018/05/is-my-friend-or-sibling-underdiagnosed.html
https://www.bphope.com/blog/bipolar-disorder-psychosis-sneaky-sneaky-hallucinations/
I am often frozen and unable to make a choice in some circumstances when faced with choices. I choose slowly and it must really frustrate my family and friends.
Hi Natasha.. Perhaps a better way to phrase your title is “There is No Right Way found by me or by health experts” .. Coz it’s very subjective in the case of Bipolar.
I speak as a Bipolar patient of 30 years; first diagnosed upon my first breakdown while as a Medical Student. It continued with 6 + 1 admissions after that, no thanks to incompetent psychiatrists who were too mono-educated to treatment regimes and failing to address the obvious side-effects of meds like Lithium carbonate, Haloperidol or even Chlorpromazine.
However, I am thankful upon my return to my hometown of Penang to meet a Christian brother who was my attending psychiatrist who recommended a change of meds to Sodium valproate or Epilim back in 1994. Since then, all has been relatively fine..
Yet, admittedly, I was still susceptible to stressors that trigger me towards a Manic episode, and one other factor that helps to keep me in check besides meds, would be family; my late parents then, and most importantly, my wife.
So yes, there Is A Right Way to treat Bipolar for me..
1) the right med, and the correct dose
2) family support.
Hope this helps. Sincerely, Boo.
Perhaps, the “right” way is looking and finding that Positive Approach to dealing with the negative aspects that seem to always crop up when dealing with our bipolar symptoms. For example : we have that “right” to choose that Positive choice ( among the many ) and pursue it until we have conquered that final goal toward developing a strong and steady stability in our life. Yes, this surely requires Positive Perseverance in overcoming the negative thinking and events that surround us daily as we will finely find that “right choice” to defeat bipolar disorder. I have been able to put my “right choice” into action and at age 76 have achieved my goal of over 40 years of episode free stability. http://www.bipolarhappens.com/bhblog/guest-blogger-dr-fred-von-gunten-shares-his-experiences-and-success/
Hey, Natasha, I hear you. I think you have a good handle on the dilemma which is more than others can say. The part of my bipolar depression is still going to anger from 0-150 mph in no time. Then, as I discuss what happened with my psychiatrist she says it’s not my bipolar. I need to start adjusting my reaction to the scenario because I can only control myself. When I finally got my diagnosis I had really hoped to be able to keep my anger in check. The pain can be unbearable at times.
I too get to an anger/rage outburst in no time which is how I discovered this blog. I’m looking for how this ties to my BP or if it does at all. I know it is tied to my hormones but the mood changes and outbursts are nothing like what “normal” women experience as their hormones change throughout the month. I’m on a mood stabilizer and this month my doctor added Prozac to the first five days of my ovulation. It didn’t work. It just feels helpless. I had 8 months with no outburst in 2017. Other than that I’ve had one a month – some big, some small – for 15 years. This blog has helped already and I am going to continue reading, just as not feel alone. My husband can’t understand why I despise making a decision but it is so perfectly described here. Choices and decisions are so stressful because you just never know what to do or which one is correct in correlation to what your brain and body need. Sometimes you never know until it’s too late what your mind actually needed.
What bothers me the most is looking at the future and knowing that this illness gets progressively worse. It makes me want to just die and it’s like i have no future
Hunter, we’re all together in this. Please do not do anything rash. I know how painful it could be. I also think that if I died 10 years ago I would have missed the joy of holding my first grandchild, my son’s obtaining his Masters, and many other things. One snowy night I woke up, looked out the window and realized that I’d never seen the beauty of the street light slipping through the branches of my tree. I even got up and took some pics.
Yes, I often writhe around in bed in pain. I have an image of where the pain is and what it looks like. I’ve even given it a name. I pull out my paper to write a couple of pain words and the happy moment words. Please call someone who understands you or call a help line. Sue