Living with Someone Who Has Bipolar; Living With Someone Who Has Normal

Secrets of the Universal Sisterhood Revealed: Part One - What Goes on in Women’s Rooms

I feel like Indiana Jones who has just discovered the Lost Ark, only this secret is far more significant and way more dangerous. The last person who attempted to reveal it “disappeared.” I won’t disclose how I came across this information. Let’s just say that I’ve finally discovered what really goes on in women’s rooms across the world.

Guys - you all know what I’m talking about. You are at a table in a public place. It could be in a food court in a mall. It could be in a rotating restaurant atop a skyscraper. You are having a conversation with a woman you would like to know better. She swirls the ice in her lemonade. Or maybe she licks the salt off her margarita. Then she excuses herself to powder her nose. Typically, one or more friends accompany her.

When she returns to the table, the tenor of the conversation radically changes. She may casually drop the fact that she has a boyfriend. She may allude to a recent outbreak of leprosy at her workplace. The verdict is in. You have been weighed and measured and found wanting. The waitress in on it. “Abandon all hope,” reads the check she hands you.

Or it could go the other way. The potential love of your life (or considerably shorter) lets you know her favorite spot to watch the paint dry, which is your cue to respond with something like, “Why don’t we check it out?” You’ve passed the road test. The waitress who hands you the check is doing an end zone dance.

What just happened?  

Here is what I only just found out about women’s rooms: An inner door opens into a spacious oak-paneled chamber. A panel of twelve women in judicial robes are seated around a mahogany board table. The woman you may or may not get a chance to know better (perhaps with one or more of her friends) takes a seat at a smaller table.

It doesn’t matter whether the venue is a trendy eatery on New York’s upper east side, a dive in Bakersfield, or a tea house in the Himalayan foothills. All inner chambers to women’s rooms are built to the exact same specifications. At all times, twelve women with the power to decide your fate are on duty. There are no exceptions.

The women jurists have observed everything via discreet monitors. The deliberations begin. Conversation is brief, judgment is summary. If there is any doubt, a wall panel slides open, revealing a ten-foot flat-screen monitor. The monitor is in a particular shade in the blue-violet spectrum for which they have yet to assign a lip-gloss name.

The monitor shimmers, slowly revealing three Jungian archetypal woman in some type of ancient Egyptian or Aztec or Inca gear. Or maybe they are Cher’s hand-me-downs. No one says anything, not the archetypal women, not the twelve jurists, not the woman (or her friends) seeking a ruling.

Finally, the chief archetypal woman - the one looking the most like Cher - signals the tribunal’s decision with “the look.” There is no room for misinterpretation. Everyone in the room gets it instantly.

In the case of a thumbs-down, three woman dressed as social workers emerge from a side door. Their job is to advise the woman petitioner on how to best carry out the verdict. The old “I just remembered I need to return a library book” trick?

If it’s a thumbs-up, a pit crew of makeover artists descends on the woman petitioner. A subtle shift in fabric this way or that way, a faint splash of scent, a slight application of color. Nothing a man would actually notice, but on some unconscious level would register in his brain as an actual “yes.”

It could be a conditional yes, a modified unconditional yes, or a mixed modified conditional/unconditional yes. The man, of course, has no way of figuring this out.

And there you are - poor guy - alone at the table, pretending to check messages on your phone, totally clueless, totally unaware.

Now you know. A lot of good it will do you.

Relationships: My Bottom Line

Today I am going through the final run-throughs of a talk I will be giving tomorrow (Sept 8) to the International Bipolar Foundation, here in San Diego. The talk is on relationships. I’ve experienced the challenges of living with others from both sides of the equation, which means I will be frequently contradicting myself. That’s the way it is, in a complex universe with no easy answers ...

As Someone Living with Bipolar

I want to be able to laugh - laugh real loud - without my partner thinking I'm flipping into mania. I want to be able to get upset without my partner thinking I'm out of control. I want to be miserable without my partner giving me "the look." I want to express my visionary ideas without my partner thinking I'm grandiose. I want to make off-beat observations and dream without my partner playing her "practical" trump card. I want to bubble with enthusiasm without that "here he goes again" expression from my partner.

Furthermore:

I don't want to be told to snap out of it, take a chill pill, stop acting like a baby, be patronized, talked down to, and otherwise made to feel that I'm the weird and irresponsible one in this relationship.
 
I want my partner to say, "I understand," when I go to pieces for seemingly no reason. I want her to say, "I hear you," when I'm upset and distressed. I want her to laugh with me, cry with me. I want her to hear her say, "It's okay. I know where you're coming from. I would feel the same way in your situation."

In addition:
 
I want her to give me a swift kick in the pants when I need it. But I want her support and not her disapproval and judgment.
 
I need to feel safe. Emotionally safe. Otherwise, I'm the one walking on eggshells. Otherwise, I'm the one living in a constant state of stress.
 
That's a tall order for any would-be partner of mine.

Now, Speaking As a Loved One

Let’s own up to the hard cold truth: To live with a person with a mental illness is to live in an abusive relationship. Until we - patients - acknowledge this unpleasant fact of life, we will never make peace with ourselves and our loved ones. We will always be stuck in our recovery, perpetual victims, always finding fault in the people who love us, always blaming our outrageous behavior - illness-related or not - on our illness.

Here’s what I advised one person who complained her husband didn’t understand:

"When YOU act up or act out," I advised, "HE is the one who suffers." Even the most compassionate person in the world can only put up with this for so long.

They need to be hearing that we - the ones living with mental illness - are taking responsibility, even if we are having difficulty managing.

Something along the lines of: "I really appreciate this makes life hard on you. It's not easy for me to control my behavior at times, but I'm working on it, and I could really use your help on this."

Now, I said, instead of an adversary, you may have an ally. You've owned up to the problem. You've accepted responsibility. You've acknowledged your loved one's feelings. You've given him a reason to hope.

Believe me, this is music to a loved one's ears.

But talking a good game is not enough. If your loved one strongly hints at something, then you need to be acting on it. If this means putting the top back on the toothpaste, then put the top on the toothpaste.

Naturally none of this is easy when you are the one who is ill, but the stakes are enormous. Your loved one is the best thing going for you. Don’t turn him or her into a stranger.

As I concluded: "Your old approach hasn't worked. Time to try something new."

Okay, Here’s My Bottom Line

Safety, emotional safety. No matter which way we slice and dice it, no matter which side of the equation we’re on, it all comes down to emotional safety.

If I’m severely depressed, last thing I want to hear is someone telling me to look on the bright side of life, especially if you’re too damn stupid to take the trouble to see my reality. And if I feel like hopping on a plane right now to tell Obama off, last thing I want to hear is that we don’t have enough frequent flyer miles.

Looking at life as a loved one: Don’t put me in the situation where every time we go out I feel I have to dismantle a ticking bomb. And if I’ve reached the point where I’m telling you to snap out of it, it means I’m at the end of my tether. You are making my life miserable. I can’t take it any more. You need to be showing me that you’re willing to work with me. No stupid bipolar excuses. Don’t take my good will for granted. I don’t have an unlimited supply.

In either situation - living with it or living with someone living with it - you need to make me feel emotionally safe:

“I see your point.” “Good idea.” “I’m listening.”

And finally, the three magic words: “I know how you feel.”

***

All of you are invited to my talk. For further details, click the link below:

International Bipolar Foundation
Lecture: Relationships and Coping with the Day-to-Day Stuff

Thursday, Sept 8
5:30-6:00- SOCIAL
6:00-6:45-LECTURE
6:45-7:00- Q & A
Location:
Sanford Children's Research Center, Building 12
Address:
10905 Road to Cure, San Diego 92121
(Off of Torrrey Pines Road, La Jolla)

Relationships: Dealing with Life's Little Surprises

On Thursday, Sept 8, I will be giving a talk here in San Diego to the International Bipolar Foundation. My presentation will be on relationships, which I am an expert in, having been in and out of two marriages. Following is a sneak peek, from a segment of my planned talk ... 

Let’s see if we can make sense out of a universe that makes no sense. For that, we go back to the universe inside our heads. The new brain science is telling us a lot about the dynamics of relationships.

The back end of the brain - the primitive reacting parts:

The front end of the brain - the thinking and deciding parts:

Now let’s add an extra element or two to the picture. Look up at the ceiling. This represents life’s little surprises. This is where two tons of crap falls from. Look at the floor. Two tons of crap have just landed. This is what the brain has to deal with. I bet you're wondering what two tons of crap looks like:

So here we are minding our own business. Wow! Two tons of crap just dropped from the sky. How is the brain supposed to deal with two tons of crap?

Okay, here’s the deal. It takes time for the cortical areas of the brain to process information. Very complex. Too much time. And often we can’t afford to wait. We need something simpler, much faster.

So the back end of the brain takes charge. The primitive part of the brain, the reactive part of the brain. This is the limbic system, involved in fight or flight. So, basically, when we perceive anything strange or stressful, we’re wired to freak out first and think later. If it’s a skunk walking in through the cat flap this is a perfectly normal response.

Now let’s add an extra element to this. Namely another person in the room. Two people in the room with two tons of crap.

So now we have two people who are not thinking. How do you think these two individuals are going to get along?

Okay, let’s assume one of the individuals is thinking with the front end of their brain. Do you think we will have a better outcome?

We all make this mistake. We actually think we can reason with someone in this state. Basically, your cortex is talking to the other person’s amygdala. I ask you - What kind of a result are you expecting from that?

Ideally, we want to be engaged cortex to cortex.

But there is a catch. The front end of the brain can’t make a decision without some input from the back end of the brain.

And, of course, heart enters into it.

Emotions give meaning to experience. We need to honor our own emotions. We need to honor the other person’s emotions.

***

All of you are invited to my talk. For further details, click the link below:

International Bipolar Foundation
Lecture: Relationships and Coping with the Day-to-Day Stuff

Thursday, Sept 8
5:30-6:00- SOCIAL
6:00-6:45-LECTURE
6:45-7:00- Q & A
Location:
Sanford Children's Research Center, Building 12
Address:
10905 Road to Cure, San Diego 92121 

Choosing a Partner: Good Luck Deciding

On Thursday, Sept 8, I will be giving a talk here in San Diego to the International Bipolar Foundation. My presentation will be on relationships, which I am an expert in, having been in and out of two marriages. Following is a sneak peek, from a segment of my planned talk ... 

Last year, I decided to give internet dating a go. But there are limits in our capacity to think things though, which I discovered once I started checking out the available women on this particular dating site.

My prefrontal cortex simply refused to cooperate. It’s kind of like shopping for a car. We may think we’re smart, but ultimately we’re going to pick the model with the best cup-holder.

That’s the way our brains work. When all is said and done, it is the ventral tegmental area (VTA) that rules, not the parts of the brain we actually think with. The VTA is the dopamine-sensitive region in the midbrain that mediates pleasure and reward.

Helen Fisher of Rutgers has done studies on the brain in love and lust, so I’m not just making this up. Also, Jonah Lerher has written an excellent book, How We Decide.

So, using the new car example - Never mind price and practicality and all that, says the VTA in effect. Get the car with the best cup-holder.

The thinking parts of the brain are only there to rationalize the choice your VTA has already made. So - hopefully, when you get your new cup-holder-on-wheels back home, you find it comes equipped with things like seats and an engine that works.

This is why my best-laid plans for choosing a woman online were doomed from the start. The prefrontal cortex is simply incapable of making up its mind. It needs input from the emotional parts of the brain.

Which woman? The tree surgeon who has just finished reading Joseph Campbell or the martial arts black belt who teaches drama at a community college? See what I mean?

So we have to compensate. There is a very technical scientific term for how men and women decide who is right for them:

Anyway, here I was with a gridlocked brain. I needed visual - emotional - cues. "Tomatoe Girl!" something in my head cried out. This was a woman with no obvious interests whatsoever who spelled tomato with an e. Oh crap, I could only think.

"A wop-bop-a-loo-bop!" my VTA was screaming. My poor prefrontal cortex didn't stand a chance.

Let me back up a bit:

Other stuff was also going on in my brain. Over in the back end of the brain, my amygdala - fear central - was in league with my hippocampus and other centers of ancient memory, cranking out malicious sound bites for the amusement of my inner mother.

Suddenly, I was that short skinny nerdy high school kid with glasses at my first high school dance, on the gymnasium floor, Bobby Vinton's "Blue Velvet" crackling out of a crappy PA system, trying to summon the nerve to ask Marie Kapinsky to dance.

Meanwhile, over in the front end of the brain:

The brief my prefrontal cortex had assembled was bullet-proof: The men these women date own their own homes. They drive in cars with Bose Surround Sound.

But I don't want to die a virgin! was my best defense. Okay, that wasn't exactly accurate, but I was stalling for time. In desperation, I summoned "Tomatoe Girl," the woman with no obvious interests who couldn't spell tomato.

Instantly, the tenor of the conversation changed. My VTA was calling the shots. My amygdala and its henchmen were nowhere to be found.

She doesn't know how to spell tomato, my prefrontal cortex cut in.

And that's why she won't complain when I show up in a car that doesn't have a working radio, my same (and now dueling) prefrontal cortex shot back.

Weighing, measuring, weighing, measuring ...

Nothing good ever came from thinking with your favorite organ, my dueling prefrontal cortex let me know.

True, my dueling prefrontal cortex acknowledged. Bad marriages, failed relationships. I needed to change my pattern. In some way I couldn't comprehend but knew was true, Tomatoe Girl was part of my old pattern. On the other hand:

Who is the woman I want to be snuggled up with on the sofa right now?

Oh, crap! My entire prefrontal cortex was now in thrall to my VTA. Already, it was cooking up images of the two of us - me and Tomatoe Girl - curled up in a comfortable corner of her motor home (the corner that didn't need to be jacked up), sipping Jack Daniels from the same bottle and viewing reruns of NASCAR.

Fortunately, this is where choosing a soul-mate online differs from buying a car. Unlike my cup-holder on wheels, I couldn’t just take Tomatoe Girl home with me.

Thank heaven for that. My brain is not set up to look out for myself. Neither - I submit - is yours.

Anyway, the moral to this story: Good luck in making a decision.

***

All of you are invited to my talk. For further details, click the link below:

International Bipolar Foundation
Lecture: Relationships and Coping with the Day-to-Day Stuff

Thursday, Sept 8
5:30-6:00- SOCIAL
6:00-6:45-LECTURE
6:45-7:00- Q & A
Location:
Sanford Children's Research Center, Building 12
Address:
10905 Road to Cure, San Diego 92121 

Relationships: How Does Bipolar Figure Into It?

I’ve spent the last few days working on a talk I will be giving here in San Diego to the International Bipolar Foundation on Thursday, Sept 8. My talk will be on relationships, which I am an expert in, having been in and out of two marriages. Let’s pick up on the action, two-thirds into my rough draft ...

Okay, let’s throw bipolar into the equation. Same stressful situation. Who is the one likely to freak out? The so-called normal one or the one with bipolar?

How many think the one with bipolar?

Okay, stress looms large in bipolar. We have genetically vulnerable brains. We are hardwired to over-react to what goes on around us. In times of stress, our limbic systems are over-activated. Our prefrontal cortex tends to go off-line.

Also, our brains have difficulty filtering out the world around us. We get overwhelmed very quickly.

Can anyone make a case for the so-called normal one freaking out?

Keep in mind, crazy people don’t have a monopoly on freaking out. Freaking out is a perfectly normal response to stress. So, can you imagine situations where the normal person is the one freaking out and the person with bipolar is as cool as a cucumber?

I can imagine a bunch of them. Keep in mind, crazy is normal to us. We’re used to disasters and to facing challenges. When our world comes crashing down on us, it’s often no big deal. Paradoxically, we are often in far better shape to deal with the situation.

This isn’t just some wacky idea of mine. Nassir Ghaemi in his new book, A First-Rate Madness, contends that a life-time without being tested leaves one ill-prepared to handle crisis. The great leaders have never had that problem. Think - Lincoln, Churchill, Gandhi, Martin Luther King.

Also, a lot of us think and perceive differently. We connect dots in very unusual ways and come up with amazingly creative ways of looking at situations. Often, this means solutions present themselves in an instant - as events unfold - so there is no crisis to begin with. No reason to freak out for us.

But this ability to think and perceive differently also works the other way for us. We can sniff out bad stuff well before it happens. Contrary to what many may believe, we don’t simply get excited over nothing.   

Rather than look at people as normal vs crazy, I look at people as linear vs non-linear.

This is the way most people think most of the time:

This is the way a lot of people like me think a lot of the time:

So what’s four like? Depends. Everything may be okay. Or it could be a good reason to freak out.

What’s 28 like? Same thing. Depends. Could be okay. Perhaps reason to freak out.

So, here we are. Same situation. Two completely different brains.

We are never going to see eye to eye. You’re reacting to 4. I’m reacting to 28. How do you think that’s going to work?

So - third rule of relationships.

If you perceived the same stuff the other person did, you might be freaking out even worse.

Unfortunately for us non-linear people, the linear people are in the majority. We have to conform to their world. Their world is totally stupid and makes no sense to me, but there you go - I have no choice but to try to fit in.

As I like to joke: We're peanut butter people trying to fit into a tofu world governed by Vulcans.

***
International Bipolar Foundation
Lecture: Relationships and Coping with the Day-to-Day Stuff

5:30-6:00- SOCIAL
6:00-6:45-LECTURE
6:45-7:00- Q & A
Location:
Sanford Children's Research Center, Building 12
Address:
10905 Road to Cure, San Diego 92121

Please Tell Me It's Bipolar

 Following is an article I recently posted on mcmanweb ...

"Do all bipolar people lie or is it just my husband?"
"My boyfriend is bipolar and is coping with heroin."
"Is this an episode loving another man not my husband?"
"My husband is bipolar and every time we talk he always tells me I'm attacking him."

This is a sampling of queries that frequently arise on HealthCentral's BipolarConnect, where I contribute as an "expert patient." Are you beginning to spot a pattern?

First, let me say that these people and others are asking in good faith. They are going through hell. They are at the end of their rope. They are desperate for answers.

But I am also reading into their questions the type of answer they wish to hear, namely:

Yes, bipolar is the cause of [your husband's lying, your boyfriend's drug habit, your own infidelity, your husband's inability to discuss issues with you, and on and on]. Bipolar is a highly treatable illness, and with the right treatment these problems will all go away.

If only ...

These days, bipolar is copping a bad rap for no end of inappropriate behaviors. I think a lot of it has to do with the raised awareness of bipolar. Now, when people encounter behavior they don't like, the prime suspect is bipolar. Ironically, raising awareness may have raised stigma.

Inevitably, when responding to these questions, I point out that a mood disorder is very different from a personality issue or a personality disorder. Yes, there may be a connection. Yes, a mood episode obviously influences behavior. But first, it pays to make a separation.

To start, a mood disorder is morally neutral. Fluctuations in mood have nothing to do with one's personal character or values. Hitler may have had bipolar, but he was going to invade Poland, anyway.

On the other hand, there are complications. Hitler imprudently invaded Russia with winter coming on. Were it not for his unbalanced mental state, it is possible to imagine a far different outcome to World War II.

Psychiatry makes a very clear distinction between mood disorders and personality disorders. To vastly oversimplify, a mood episode is seen as "uncharacteristic" of an individual's baseline behavior. With a personality disorder, outrageous behavior is seen as embedded into an individual's make-up. With the former, the perception is that meds will quickly resolve the issue. With the latter, we see a far more problematic future.

Thus, you can see the logic in the desperate pleas of my readers. Please tell me it's bipolar, they seem to be saying. Then with a quick fix my abusive husband will become loving, my selfish wife will become considerate, my egotistical boyfriend will become understanding, my indifferent girlfriend will become caring.

Unfortunately, my correspondents almost always describe behavior far more indicative of a personality disorder than a mood disorder.

The bottom line is a loved one should not have to distinguish a bipolar episode from a personality disorder or just plain inappropriate behavior in the first place. Hurt is hurt, no matter what illness or condition or character defect you assign to it, and no one - for any reason - should have to put up with this type of abuse. But the people I hear from are willing to give their partners a second chance, to work with them, to help them. To give the relationship a chance.

If only, if only ...

Alas, I have to tell them probably not.

***
More relationship articles on mcmanweb: Family and Relationship Fallout; Validating Family Pain; My Loved One Doesn't Understand - Really?; Emotional Safety - My Relationship Bottom Line; What Goes Up

Never Mind Our Illness - What About the Real Stuff?

The following originally appeared as two unconnected blog posts in 2009. Last month, I connected them into a new article on mcmanweb ... 

"What is holding you back most in your recovery?" I asked readers at Knowledge is Necessity in March 2009. Readers were free to check off as many of the nine answers as they wished. (169 respondents accounted for 490 answers, averaging 2.9 answers per person.) You could have knocked me over with a feather with the results:

Only 35 percent of those who responded checked off, "Unresolved illness symptoms." In other words, a full 65 percent felt that their illness no longer posed an obstacle to their recovery.

Does this mean psychiatry has a high success rate? Um ... not exactly. In a survey from two months before, only 14 percent told me they "were back to where [they] wanted to be or better than [they] ever could have imagined."

What is going on here? Could it be that we have other stuff we need to deal with? This is where it gets interesting.

Interpersonal Relationships

Fifty percent (representing by far the largest total) responded that the thing holding them back the most was "fears/difficulties in dealing with people." Very closely related (at 35 percent) was a "bad living/work/etc" situation.

Clearly, we have major interpersonal issues that need addressing. Without doubt, our respective illnesses play havoc with our ability to get along with people. But my readers seemed to be telling me was that people problems have taken on a life of their own, and it's not hard to imagine why.

Often, we can't go back to our old relationships or work. As we become isolated and cut off, our social skills atrophy. We lose confidence. We are overwhelmed.

In essence, half of those who responded to my survey are telling me that they see the world as a threatening and hostile place, and this does not bode well for recovery. We tend to judge personal success by how well we get along with others. Unfortunately, there is no magic pill to help us. But there exists a lot of therapeutic and social help. You - yes, you - have identified this issue as your top priority. Please do not hesitate to act.

Fears and Anxiety

Also related to this (at 32 percent, one in three) is "inability to manage fears, impulses, etc apparently unrelated to your illness." Maybe you don't attribute, say, anger, to your illness. Maybe you talk too much or are afraid to speak up. Maybe going with an irrational thought makes you feel good. These are common problems that the general population also experiences, but you have added this twist - your sense of lack of control is holding as many of you back in your recovery as unresolved illness symptoms.

Your clinician may have overlooked all this, but clearly you haven't. You know what you need to do.

Bad Habits, Side Effects, Addictions, Ailments

We all have "bad personal habits" (even those with good personal habits), but 36 percent felt these were impeding their progress. Likewise, 30 percent reported that "making excuses" constitutes a major problem.

Overcoming bad habits, of course, falls into the same category as keeping New Year's resolutions. Good luck - you have your work cut out for you.

Finally: Meds side effects (24 percent), addictions (21 percent), and physical ailments (21 percent).

Tying This Into a Bow

There is no such thing as "just depression," "just bipolar," "just anxiety," and so on. A lot of other stuff is going on. Whether wrapped in your illness or independent of it, it all needs to be addressed, because if it isn't - recovery is simply not going to happen

A Reader Weighs In

Louise commented that "many, many people do not want full recovery because it would force them to take full responsibility for their lives and relinquish the power of being 'needy.'"

It happens a lot in physical illnesses, she was quick to add, patients who refuse to follow doctor's orders. For instance:

In the case of my friend's mother, she actually refuses to drink WATER. She wants alcohol and coffee, saying they "taste" better. She is in RENAL FAILURE. She is also a total "victim" control freak making her adult kids jump for every crisis - which she creates.

We all work hard to support and encourage our less-healthy loved ones to recover and live "full" lives again. But what if they don't really want to?

As for those with mental illness: "Some may say people with mental illnesses are not really making this 'choice.' But I can attest that many people with no strong mental illness problems DO make this choice everyday."

Louise was talking about willful disobedience rather than willpower, which other readers brought up. Hold that thought ...

In the meantime, Louise's comments got me thinking:

I certainly did not wish to stay sick, but I do acknowledge that being sick conferred on me a certain degree of absolution. Instead of regarding myself as an underachieving screw-up - in my own mind anyway - I could view myself as someone who overcame tremendous odds.

For the first time in my life, I actually gave myself a pat on the back.

But this came at the price of seeing myself as my illness, rather than seeing myself as me. Which meant I was encouraging people close to me to see me to also see me as my illness. Seeing myself as my illness worked for me for a little while. It gave me a fresh start. It allowed me to take stock. But once I got my illness under control, there was the small matter of working on the stuff that was really holding me back. The real work was only just beginning.

Dean Ornish Weighs In

Two months after my reader poll, I was in San Francisco, at the American Psychiatric Association annual meeting. There I heard celebrity doctor Dean Ornish of UCSF talk about smart lifestyle. For instance, in a 1998 study published in JAMA, Dr Ornish found that patients can not only stop the progression of heart disease through lifestyle management, but can actually reverse it.

In fact, smart lifestyle reliably works across a range of illnesses (including depression), and can often replace invasive and costly treatment (or at least make the treatment work better). The catch is you have to do it, and therein lies the problem. "What's sustainable," Dr Ornish said, "is not fear of dying but joy of living."

Dr Ornish is no stranger to depression, having experienced a severe episode that sidelined him from college. Loneliness and isolation, he said, increases mortality 3.7 times. Depressed individuals are more likely to over-eat, smoke, drink, and work too hard.

You would think that making a few simple changes would be easy, right?

"'Dean, you don't get it,'" his patients told him. "'These behaviors get us through the day.'"

Getting through the day anyway they could was more important to them than living to age 86. In essence, these people could see no benefit to giving up smoking if it meant losing their cigarette-smoking friends, especially if there was nothing to replace those friends.

Meanwhile, the research on the benefits of positive lifestyle kept mounting up. In one 2008 study published in PLoS (JA Dusek lead author), researchers found that the relaxation response in trained meditators switched off cancer-promoting genes.

Changing our lifestyle actually changes our genes, Dr Ornish pointed out. But who wants to change their lifestyle? What Dr Ornish finally figured out was that will power was a nonstarter for individuals, as was the motivation to live longer. "Who wants to live long if you're depressed?" he asked.

What works, he said, is joy, pleasure, freedom. Up went a slide of two tango-dancers - Dr Ornish and his wife. Doing the tango was part of Dr Ornish's exercise routine.

That's when the lightbulb went off: Yes, we need to lead disciplined lives, but we are doomed to failure unless we incorporate fun into our routines. Here, in this Recovery section, are numerous articles about the virtues of good diet, exercise, yoga, meditation, and so on. We know all this stuff works, but what good is any of it if we give up?

Then it occurred to me: None of my lifestyle routines are based on iron will. They all have enjoyment incorporated into them. For instance, my "exercise" is daily walks, water volleyball, and (off and on) dancing. My "diet" is based on my love of cooking, where anything I throw together is both tastier and healthier than restaurant food. My "stress-management" is all about building contemplative time-outs into my schedule. Even my "meditation" has a fun twist - I play the didgeridoo.

In the words of Dr Ornish: "Doing the tango makes your brain grow ... Some of the things that are most fun are good for you."

Glad I thought of it.

***

My previous three pieces reviewed a randomized, double blind, placebo-controlled clinical trial - representing the gold standard of scientific research - that told us nothing. My humble little reader poll, on the other hand, does not even meet the lowest standards of research. But I ask you: Did it tell you something?

Rerun - Making Peace With Our Families and Loved Ones

Taking a brief break from work. Following is a rerun of a piece I posted in Jan:

At least half of the correspondence I get from readers comes from loved ones, including family members and sweethearts. Without exception, they are at a loss and their stories are heart-breaking. They are the innocent bystanders of our illness.

I've also had ample opportunity to listen to loved ones at various mental health venues, plus I am forever engaging them (or, rather, they are engaging me) in conversations in coffee shops, on public transport, everywhere. More recently, by virtue of a broken marriage to a woman with bipolar, I've have had an opportunity to sit in with a DBSA-run friends and family support group.

Believe me, our loved ones see our illness far differently than we do. We may complain that they don't understand us, but far too many of us fail to recognize the horrible abuse we have put them through.

Believe me, to live with a person with a mental illness is to live in an abusive relationship. Until we own up to this hard cold truth, we will never make peace with ourselves and our loved ones. We will always be stuck in our recovery, perpetual victims, always finding fault in the people who love us, always blaming our outrageous behavior - illness-related or not - on our illness.

I cannot disclose what takes place in our friends and families group, but I can mention this much: A father was in tears, at the end of his rope. I felt I needed to jump in, but as a patient. We put you through hell, I said, or words to that effect. But you are the best thing we have going for us. We can't do it without you ...

I noticed the look on his face. I noticed the others in the room were listening intently. No doubt, they had heard this before, but from fellow family members. What made my little homily significant was that this time the words were coming out of the mouth of a patient.

At last, came the thought, someone who understands.

Understanding. Isn't that what we are all looking for?

Much more in future blogs, including what loved ones need to know about us ...

The Bipolar Relationship Riddle

Later this afternoon, I will be making a 50-mile drive in the pouring rain to La Jolla in San Diego to attend a DBSA friends and family support group. It concerns a very bad communication I had last week with a former girlfriend. I really need to talk to some people who understand.

I have bipolar. Or more accurately, bipolar plus other stuff. I have yet to meet someone who just has bipolar.

My second marriage - to a very lovely women with bipolar plus her own collection of add-ons - ended just prior to Thanksgiving two years back. Then I had a short relationship with delightful cowgirl with bipolar (more pluses) that ended just prior to Thanksgiving a year back. Then a slightly longer relationship with personally stunning ball of fire (bipolar fully loaded) that ended - drumroll please - just prior to last Thanksgiving.

What is it about three Thanksgivings in a row?

I'm obviously no expert on relationships - in fact, call me a jerk - but my experience from both sides of the bipolar fence as a patient and loved one has conferred me with certain insights. In the six weeks this blog has been going, I have already posted two blogs on relationships, and intend to post many more.

The experts talk about "functionality," which is arguably a more reliable indicator of the severity of our illness than ticking off a symptom checklist. The two key indicators of functionality are work and relationships (keeping in mind we may choose healthy alternatives to both). Predictably, our population performs poorly in both categories.

Obviously, figuring out how to get it right is a fairly reliable predictor of recovery.

Think of the above as a preamble to this announcement: My favorite bipolar blogger, Therese Borchard of Beyond Blue is devoting an entire week to relationships. Here, she gives a rundown on what we can look forward to in future posts. Check out her first installment, You Deplete Me: 10 Steps To End a Toxic Relationship. Brief excerpt:

"Be prepared to dry off as you step out of the river of Denial. A few questions will get you there. Ask yourself these, for starters: Do I feel energized or drained after I spent an hour with X? Do I WANT to spend time with X or do I feel like I have to? Do I feel sorry for X? Do I go to X looking for a response that I never get? Do I come away consistently disappointed by X's comments and behavior? Am I giving way more to the relationship than X? Do I even like X? I mean, if X were on a cruise and I didn't know her, would I walk up to her and want to be her friend/boyfriend based on her actions and interactions with others?"

More later ...

From mcmanweb: Family Fallout

"The authors devote a whole chapter to mood triggers, and place strong emphasis on partners working together to reduce the stress in the living environment, from keeping work and social obligations under control to more discriminate TV viewing to proper diet, sleep, and exercise. ..."

My Loved One Doesn't Understand. Really?

"My husband gets angry," Abigail writes on BipolarConnect. "It makes no sense when I'm in crisis ... I can't help it when I'm crashing or in a panic. He cannot understand ..."

A loved one who doesn't get it - a good many of us have been there. Back in the old days, my response would have been along the lines of a suggested reading list for her husband. Then, perhaps, a dialogue could start.

But my thinking has come a long way since then. I am a patient, but I have also experienced first-hand the frustration of a loved one.

First I acknowledged Abigail's concerns, but then I suggested it would be more constructive to view matters from her husband's perspective:

"When YOU act up or act out," I wrote, "HE is the one who suffers." Even the most compassionate person in the world can only put up with this for so long.

Loved one's hate the "can't" word, I continued. "You may think you are asking for sympathy and understanding. A loved one interprets this as a complete lack of sympathy and understanding from you."

They need to be hearing that you are taking responsibility, even if you are having difficulty managing. Something along the lines of: "I really appreciate this makes life hard on you. It's not easy for me to control my behavior at times, but I'm working on it, and I could really use your help on this."

Now, instead of an adversary, you may have an ally. You've owned up to the problem. You've accepted responsibility. You've acknowledged your loved one's feelings. You've given him a reason to hope.

Believe me, this is music to a loved one's ears.

"If your husband is to understand you," I wrote, "first you need him on your side. You need his good will and support. For that to happen, you need to be the initiator, you need to set the good example. If he's smart, he will start to respond positively."

Coupled with this is the reality that loved ones need to see tangible signs of change. Talking a good game is not enough. If your loved one strongly hints at something, then you need to be acting on it. If this means putting the top back on the toothpaste, then put the top on the toothpaste.

You can also score brownie points by taking your own small initiatives, say by getting out of bed in the morning 10 minutes earlier.

Naturally none of this is easy when you are the one who is ill, but the stakes are enormous. There are no guarantees, but we are talking the difference between a sympathetic loved one who represents by far the best thing going for you and a stranger in your home and in your bed. Believe me, from one who has lived both sides of this equation, the effort is worth it.

As I concluded to Abigail: "Your old approach hasn't worked. Time to try something new."

***

I answer questions as an "expert patient" on BipolarConnect, part of HealthCentral. By far, the vast bulk of the questions involve living in personal relationships. Much more on the topic in blogs to come.

Also, please share your own wisdom and insight by clicking the "Comment" link.

Making Peace With Our Loved Ones

At least half of the correspondence I get from readers comes from loved ones, including family members and sweethearts. Without exception, they are at a loss and their stories are heart-breaking. They are the innocent bystanders of our illness.

I've also had ample opportunity to listen to loved ones at various mental health venues, plus I am forever engaging them (or, rather, they are engaging me) in conversations in coffee shops, on public transport, everywhere. More recently, by virtue of a broken marriage to a woman with bipolar, I've have had an opportunity to sit in with a DBSA-run friends and family support group.

Believe me, our loved ones see our illness far differently than we do. We may complain that they don't understand us, but far too many of us fail to recognize the horrible abuse we have put them through.

Believe me, to live with a person with a mental illness is to live in an abusive relationship. Until we own up to this hard cold truth, we will never make peace with ourselves and our loved ones. We will always be stuck in our recovery, perpetual victims, always finding fault in the people who love us, always blaming our outrageous behavior - illness-related or not - on our illness.

I cannot disclose what takes place in our friends and families group, but I can mention this much: A father was in tears, at the end of his rope. I felt I needed to jump in, but as a patient. We put you through hell, I said, or words to that effect. But you are the best thing we have going for us. We can't do it without you ...

I noticed the look on his face. I noticed the others in the room were listening intently. No doubt, they had heard this before, but from fellow family members. What made my little homily significant was that this time the words were coming out of the mouth of a patient.

At last, came the thought, someone who understands.

Understanding. Isn't that what we are all looking for?

Much more in future blogs, including what loved ones need to know about us ...

From mcmanweb: Family and Relationship Fallout