Tag Archives: CBT

World Mental Health Day improving wellbeing for all of us

The shift from pathologising terms like mental illness, disorder, nervous breakdown, has been gradual, and we are seeing more reference to mental health and wellbeing, differences, spectrum diversity etc. This has been a long time coming, since from 1-in-4 to 1-in-3 of us will experience a mental health condition or episode in our lives, if not more of us.

What keeps us from giving up?

The very tools of survival that I’ve learned to use to attempt to thrive rather than just die or dive back under the duvet covers actually aid all of us. They’re very basic, and not pharmaceutical, though some are chemical – or at least release the endorphins (endolphins as I like to call them) and oxytocin type chemistry that aids wellbeing.

When speaking at an event in London last weekend, I was asked how, “how do you keep going, how do you remain strong?” The answer, for me at least, is that I’m stubborn! Practically speaking, though, I talk and walk, and when it’s going well, I walk the talk.

Caring Talk Saves Lives

I talk to people, I talk to myself, to my thoughts – giving them voice and an opinion (but no power) at the table in my head, and I talk to my diary. Well, I write, I reflect, I repeat – yes, I realise that circumstances, feelings, moods, anxieties, they come round in repeating circles, and I begin to recognise that I survive, that I’m still here, despite my best efforts to end that.

I also walk, I get outside as often as I can. Although, that’s not often enough as insomnia and mood disorders often keep me in bed half the day. Inertia destroys all my best intentions. Last weekend, though, I managed something rare, to swim twice and walk 5 miles in a day, taking in my environment and the beauty of the world around me. Fresh air and exercise help, if only we can kick the black dog off long enough to get outside.

Being bipolar, my mood can shift drastically and quickly in the same day. I’ve learnt to be kind to myself, and to forgive, be in the moment, and treat or reward myself for getting stuff done that would otherwise pile up and compound my anxiety.

Laughter is good medicine

I’ve also learned to both respect my mental health conditions, and to healthily take the piss out of them – not others, not the suffering, not the issues, but to occasionally make light of them so that they have less of a hold over me.

Speaking of laughter – Stephen Fry has said of suicide:

“There is no ‘why’, it’s not the right question. There’s no reason. If there were a reason for it, you could reason someone out of it, and you could tell them why they shouldn’t take their own life”

He is spot on. Although every story is different, mine nearly ended 5 years ago, but I am happy to be here now.

Seek help

Seeking help early before one is neither in the mood or position to seek help is important. Sadly, waiting lists are such that it can be a year or more wait for short dose CBT and that is often such a sticking plaster rather than a long-term improvement to wellbeing or coping. 

I’m back in therapy for the second time in ten years, and it feels incredibly healthy. It’s not a sign of failure but of active involvement in one’s own health management.

MAD, BAD, GAD, and quite possibly SAD

I seem to collect three-letter-acronym conditions, so that I’ve been diagnosed with multiple Affective and Anxiety Disorders. Their intensity varies and sometimes I’m the boss, sometimes they try to be. Again, a diary helps me see that I do bounce (well hobble) back eventually, and they never, any longer, keep me down permanently.

Again, a diary helps me see that I do bounce (well hobble) back eventually, and they never, any longer – I hope, keep me down permanently.

 

 

 

 

World Bipolar Day, Bipolar Mood Scale, Vincent van Gogh & Manic Creativity

World Bipolar Day

Today and everyday is bipolar day for 2-3% of the population who have a Mood Affective Disorder including Cyclothymia and Bipolar I & II. A day to recognise the issues, struggles, and occasional joys and spurts of creativity – sometimes manic, experienced by people with bipolar, was created to coincide with Vincent van Gogh’s birthday, 30 March, since he was posthumously believed to have had a bipolar type condition. World Bipolar Day aims to:

“bring world awareness to bipolar disorders and eliminate social stigma.” – International Society for Bipolar Disorders

Bipolar Incidence & Prevalence

Whilst 1-in-100 or 2.6% are commonly cited figures, some studies have shown wide variations, ranging from 2.6 to 20.0 per 100,000 per year, in the incidence of bipolar affective disorder (Lloyd & Jones, 2002). These variations have been e.g., regional, SE London is twice that of Nottingham and Bristol, or by ethnicity, by socio-economic class, by childhood intelligence – especially high verbal IQ, or by hormones and gender – some studies show a much higher incidence in the female population.

“estrogen fluctuations may be an important factor in the etiology of bipolar disorder and it is obvious that more research on this topic is needed to clarify the role of estrogen in women with bipolar disorder…Why is it that rapid cycling occurs more often in women?” – http://www.ncbi.nlm.nih.gov/pubmed/23510130

It also alleged that among artistic and creative types there is a higher incidence of bipolar mood disorders, that may be genetic. Indeed, as many as 40x the national incidence, among a group of 30 American authors, studied over 15 years:

“43 per cent of them had bipolar disorder compared to only 10 per cent of the control group and 1 per cent of the general population.” – Bipolar Disorder and Creativity

A further survey of 47 British authors and visual artists from the British Royal Academy found that 38% had been treated for a mood disorder.

“A recent study carried out at Stanford University by Santosa and colleagues found that people with bipolar disorder and creative discipline controls scored significantly more highly than healthy controls on a measure of creativity called the Barron-Welsh Art Scale. In a related study the same authors sought to identify temperamental traits that people with bipolar disorder and creative people have in common. They found that both shared tendencies for mild elation and depression with gradual shifts from one to the other, openness, irritability, and neuroticism (roughly speaking, a combination of anxiety and perfectionism).” – Bipolar Disorder and Creativity

Vincent van Gogh

Vincent Van Gogh The Starry Night Google Art Project
Vincent Van Gogh, “The Starry Night”, 1889, MOMA, NYC via  Google Art Project

The famous Dutch post-Impressionist painter, Vincent van Gogh suffered quite wild swings in his mental health and many paintings were produced from his asylum room. Van Gogh is thought to have shot himself, after struggling with declining mental health in his mid-30s. He had spent most of the last 18-months of his life in an asylum, but two months later was dead as the result of a presumably, though not proven, self-induced shooting incident or suicide attempt.

Ironically, it was a period when he produced many iconic paintings, some en plein air. His famous image titled ‘The Starry Night’ was a pre-sunrise nocturne as seen from his East-facing asylum window, but finished in the asylum studio, as he was only allowed to draw in his room, not paint. Van Gogh’s beautiful and happier ‘Village Street and Steps in Auvers’ was painted just days after release from the asylum:

Vincent van Gogh Village Street and Steps in Auvers
Vincent van Gogh, “Dorfstraße undTreppe in Auvers mit Figuren” – ‘Village Street and Steps in Auvers’, 1890

Barely weeks later, and days before his death, he was painting several large wheat fields canvases and in a letter to his brother Theo, he wrote:

“I have painted three more large canvases. They are vast stretches of corn under troubled skies, and I did not have to go out of my way very much in order to try to express sadness and extreme loneliness….I’m fairly sure that these canvases will tell you what I cannot say in words, that is, how healthy and invigorating I find the countryside.” – Vincent van Gogh, Letter to Theo van Gogh, 10 July 1890

His late paintings demonstrate an artist at the height of his talent, yet also the depths of his troubles, for whom art and the outdoor landscape was creative catharsis and therapy. What would the art world have witnessed had he lived on?

Bipolar Mood Scale Diary

It is typical for a bipolar diagnosis to take a decade and work through several misdiagnoses en route. I was first diagnosed with Cyclothymia over 4 years ago, but subsequently told it was Mood Affective Disorder and then Bipolar II, along with rapid cycling and mixed mode variations. CBT – Cognitive Behaviour Therapy, helped my management, but so did self-knowledge, awareness, and diarying. I enjoy my hypomanic periods, less so the depressions which I’ve fought for 12 years or so. Finding balance when you only exist at the poles is a tricky act to accomplish and may involve staying in when you feel like going out and going out when you feel like staying in!

Risks, when hypomanic, for me include inappropriate conversation, loss of impulse control, manic spending, flirting, obsessional behaviours, risk seeking. Yet, the benefits when high are hyperactive stamina and energy, stream of consciousness ideas flooding, huge reading and writing output, charismatic and entertaining confidence and loquaciousness.

“I managed to rack up £300k of credit, hardly average! I was, and indeed am, very convincing when hypomanic, it made me a good salesperson, deal-maker, innovator, public speaker but terrible at time and money management.”May 2013

Having been in a balanced mood state for nearly 3 months now, a rare occurrence, possibly due to recent endocrine changes, I miss the hyper states. I also realise, however, how destructive they could be to life, economics, and relationships, whilst at the same time being a creative buzz. I don’t miss the lethargic, inactive, hopeless depressive episodes at all, although they were a great way of avoid life and its stresses.

The best advice I was given was to monitor my mood on a daily basis, as I was already doing with my insomnia diary and general personal diary. The catharsis of writing and recording also came with the recognition that moods, highs, lows, sleeplessness all came in phases, that changed – they got better, and they got worse. Unlike, when I suffered with depression for 6-8 years as that felt like nothing would ever get better. The Bipolar Mood Scale diary has helped me to hold out for the good days, and to manage my moods better.

Bipolar Mood Scale

Mania
10Total loss of judgement, exorbitant spending, religious delusions and hallucinations.
9Lost touch with reality, incoherent, no sleep, paranoid and vindictive, reckless behaviour.
Hypomania
8Inflated self-esteem, rapid thoughts and speech, counter-productive simultaneous tasks.
7Very productive, everything to excess (phone calls, writing, smoking, tea), charming and talkative.)
Balanced Mood (Euthymia)
6Self-esteem good, optimistic, sociable and articulate, good decisions and get work done.
5Mood in balance, no symptoms of depression or mania. Life is going well and the outlook is good.
4Slight withdrawal from social situations, concentration less than usual, slight agitation.
Mild to Moderate Depression
3Feelings of panic and anxiety, concentration difficult and memory poor, some comfort in routine.
2Slow thinking, no appetite, need to be alone, sleep excessive or difficult, everything a struggle.
Severe Depression
1Feelings of hopelessness and guilt, thoughts of suicide, little movement, impossible to do anything.
0Endless suicidal thoughts, no way out, no movement, everything is bleak and it will always be like this.
0-10 Scale of mood from depression to mania

Being or having bipolar – people’s attitudes to which verb to use varies, should not be romanticised. It is both a blessing and a curse, and for some is very hard to live with. I’ve made friends with mine, though it is still unpredictable. I’ve come to appreciate the moment, mindful that it can change, but I take the rough with the smooth now. Hopefully, I can look back on past suicide attempts as distant memories, and seize the creative periods to be productive and expressive, whilst trying to rein it in when it tips into hypomania.