Psych Central

Why I Am Against Targeting Zero Symptoms For Bipolar Disorder and Calling That Thriving

By Tom Wootton
bipolarinorder

There is a new effort to promote complete remission as the goal of treatment for people with bipolar in disorder and I am fundamentaly opposed to it. I have written about the topic many times, so I will repost the article that had the most discussion:

I wrote an article some time ago that I deviously titled “Why I Am Against Bipolar Meds” because I wanted to attract and call out both extremes in the debate. I argued for a moderate stance and we had a good discussion with all points of view respectfully considered.

My friend Dr. Nassir Ghaemi wrote an article recently in response and clarified some important points. Dr Ghaemi is the Director of the Mood Disorders Program at Tufts Medical Center in Boston and is familiar with my work; he quoted some of it in his recent book, “A First-Rate Madness: Uncovering the Links Between Leadership and Mental Illness.” The discussion from his article went further into the med controversy, but also veered into new territory that I would like to address: My opposition to remission as the end goal of treatment.

One particular reply from Dr. Ghaemi gets to the crux of my issue; “In a substantial minority of people with bipolar disorder, about one-third, lithium produces complete remission of all symptoms. They never have another bipolar episode, and sometimes symptom, the rest of their lives. My point is, though, that even with full remission of all symptoms, people often need to make other efforts to get to functional …



Bipolar People Get Angry Too

By Tom Wootton

screamBipolar in disorder combined with anger is a very dangerous mix. The disordered person tends to become very volatile and can explode into a rage with little provocation. It is best for the person to avoid anything that might trigger anger until the disorder is in remission, but even then an angering stimulus can trigger another manic or depressive episode with anger as one of the troubling elements.

Bipolar people who have their condition in order have learned important lessons that can be applied to most of our experiences. For example, since we understand bipolar so well that we can function highly during depression and mania, we can also handle more intense states of anger without losing control.

As with every experience, most people can usually function fine when anger is at a very low intensity, but when the intensity of anger increases beyond their comfort zone they begin to lose the ability to choose their response to it. They act in ways that are less than optimal. They may even become a danger to themselves and others if the anger becomes too intense.



Are You Causing Stigma While Fighting Against It?

By Tom Wootton
StandAgainstStigma

Individuals and organizations throughout the world are dedicated to the important work of removing the stigma that affects people with depression and bipolar disorder. Unfortunately, too many of them are replacing one type of stigma with another type that is making the situation worse. While advocating for others to stop judging those who suffer from the conditions, they are causing a self-stigma that increases and prolongs the suffering.

My friend Andy Behrman says, “If we want to eradicate stigma, we must first understand what stigma is: ignorance, fear & discrimination.” Of the hundreds of statements about stigma, this one captures it the best for me. Everything else is an offshoot of these three core problems.

There is certainly an incredible amount of ignorance surrounding depression and bipolar disorder. Even if we were able to clear up the many misperceptions about either condition, there is so much more we need to know to fully understand them. Depression and bipolar disorder affect every part of our lives (physical, mental, emotional, spiritual, social, and career/financial) and most people are aware of only a fraction of any of the parts.

We can be afraid of many things, but the worst fear is of the things we are ignorant of. The combination of fear and ignorance is so powerful that many people think fear is just another word for ignorance. They even have an acronym for it: FEAR – False Evidence Appearing Real. But when we understand fear and the role it plays in our condition, we can use it as a tool …



Mindfulness Does Not Lead To Happiness

By Tom Wootton

The part of our minds that most people identify with is the part that silently talks to us with a running commentary. We listen to it all day long. Let’s call it “The Talker.”

“The Talker” prefers pleasure over pain, happiness over sadness, winning over losing, health over sickness, and any of the other judgments that help us navigate our lives. Although it plays a critical role that we cannot live without, “The Talker” is stuck in the duality that makes us judge one thing better than another. It does not allow us to experience the world without judgment.

The central principle of mindfulness is to look at experiences without judgment. Adherents of mindfulness often speak of the part that practices mindfulness as “The Watcher.” It lives outside of the duality and sees everything as equally valuable. Mindfulness is a wonderful practice that increases awareness of what is really happening because “The Watcher” does not ignore or accentuate details based on preferences.

Unfortunately, many claim that mindfulness leads to happiness. As happiness and sadness are judgments based on preferences, this breaks with the whole concept of looking at our experiences without judgment. Mindfulness practiced properly does not lead to happiness; it leads to a greater awareness of whatever you are experiencing whether you like it or not.mindfulness



Bipolar Children of Undiagnosed Parents

By Tom Wootton
Walk_on_water

We get a lot of calls from parents who are looking for help with their bipolar children. We make great progress within the first few visits, but too often run into an underlying issue that needs to be addressed. While the bipolar issues are certainly part of the problem, the family dynamics are a bigger issue.

Since the child has usually been diagnosed before contacting us, the parents assume all conflicts will be resolved as soon as the child is no longer in disorder. All issues are seen as being caused by bipolar disorder and the rest of the family is completely innocent; it is as if the diagnosis suddenly made everyone else perfect.

This does not happen when the parents have been diagnosed with any psychological issues. The parents recognize their own issues that need to be addressed and how those issues play a role in the conflicts. Even if the diagnosis is completely different from bipolar disorder, there is a recognition that nobody is perfect and we all have room for improvement.



Is The Delusion That Comes With Remission Holding You Back?

By Tom Wootton

psychSome call it ‘state specific memory,’ but after ten years and thousands of interviews I prefer to call it ‘bi-cycling delusion.’ It is the delusion that comes with the bipolar cycles and a primary reason people remain in disorder even with the best intentions.

Bipolar is a cyclical condition. We cycle through depressions and manias, sometimes reaching intensities that cause a crisis for us. We also periodically cycle into remission. It might be easier if the cycles were predictable, but for many of us they are completely random.

For far too many of us, each cycle has a state-specific delusion that keeps us from moving toward Bipolar IN Order. We all know about delusions that come with intense states of depression and mania, but it is the delusion that comes with remission that holds many back the most. It fools them into thinking they have bipolar under control when in reality they are just in one of the cycles.



Bipolar Advantages – No Longer If, But Why And How

By Tom Wootton

highwayI attended a great presentation at the APA annual conference in San Francisco about Achievement, Innovation, and Leadership in the Affective Spectrum. Four distinguished panelists gave presentations about their research into why people with bipolar disorder tend to exhibit advantages in some parts of their lives. They said it was the first time ever that the APA had such a discussion and it was a great honor to be a part of it.

First up was Sheri Johnson, PhD, who teaches at UC Berkeley and does basic research on mania. Her talk was about how people with bipolar disorder are more reactive to rewards and goals in their lives. They tend to work harder toward such goals and refuse to give up long after “normal” people do. Dr. Johnson is currently conducting studies to understand the greater reactivity to success in this population, using paradigms drawn from neuroimaging, emotion, information-processing, and impulsivity literatures. She is also considering other psychological traits that might relate to outcomes in bipolar disorder, including stress reactivity, emotion regulation, and social dominance. She believes that figuring out why mania is linked to success will lead to better ways to predict manic episodes.



Eight Essential Steps To Freedom From Bipolar Disorder

By Tom Wootton

Please check out our newest video – Eight Essential Steps To Freedom From Bipolar Disorder – This is from the keynote presentation at the annual conference for the California Association of Marriage and Family Therapists – Please comment and share with anyone you think might be interested.



Accounting For Time In Depression and Mania

By Tom Wootton

When I look at how they account for time in the DSM-V, I wonder if they know anything about depression or bipolar. They know time plays an important role, but they don’t seem to understand the role that time plays whatsoever. By the way they define it, you can have a very low intensity depression for 14 days and it’s called depression, yet an intense depression for 13 days doesn’t count. This makes no sense at all, yet is the only accounting for time they provide.

Properly accounting for time takes an understanding of the relationship between time and intensity. You cannot learn that relationship by asking people a brief checklist of common symptoms as is done in the currently popular assessments. You need to know the right questions to ask.

I learned the right questions by doing more accurate assessments that include asking about the relationship at different intensities between awareness, understanding, functionality, comfort, and value mentioned in the previous articles in this series. This led to a deeper understanding of how to ask about time.

The most important question to ask about time is how long before each level of intensity causes one to lose functionality. When we base the answer on a thorough functionality assessment, we understand the relationship between time and intensity in ways the authors of the DSM completely miss.

Time_Managed

Although intensity is a major factor in predicting how long one can remain highly functional, there are many others equally important. If one is not aware of the lowest intensities of depression or mania until functionality has already been lost, for example, there is very little time to do something about it and avoid another crisis.



Finding Value In Depression And Mania

By Tom Wootton

Assuming you are not deeply depressed right now, try to remember the time when you were in the deepest depression of your life. Can you see any way it might have changed your life for the better? Did it make you more sensitive to the feelings of others? Are you better at helping others during their difficult times because you have had the experience yourself? Are there things you learned from being deeply depressed? Are you a better person because of the experience? What is the value in having been through it? On a scale from one to one hundred, how would you rank the value in having been deeply depressed?

These seem like unusual questions to some people. Wouldn’t we be better off trying to forget our depressions and get on with our lives? Can’t we just hope that depression remains in the past and we never have to face it again? Ignoring past episodes may sound like a better approach, but refusing to take a hard look at depression or mania leaves us ill prepared for the next time it comes. Unfortunately, if depression or mania happened before, it is likely to happen again.

Looking at how we value depression and mania is an important part of any assessment; a part that is sorely missing in most protocols. The laundry list of symptoms in most assessments belie an incorrect assumption that the items are all seen as negative.

depressiongraphWe have been asking the above questions (and many more) for several years now and have learned a great deal about the role value plays in depression and mania. Although our data is not yet extensive enough to make final declarations, there are many surprising trends that are too important to delay sharing.



Expanding The Comfort Zone In Bipolar And Depression Leads To Measurably Better Results

By Tom Wootton

Understanding the role of comfort is critical for getting Bipolar IN Order. To do so, we must measure comfort at each level of intensity for both mania and depression. When we compare comfort levels to awareness, understanding, functionality, value, and the time before escalation, we find the optimal intensities where bipolar is an advantage in our lives.

In any aspect of life, those who only seek comfort are consigned to mediocrity and boredom. Those who judiciously step outside their comfort zone and challenge themselves are the ones who learn and grow. This is equally true with mania and depression.

The best growth, though, happens just slightly outside the comfort zone. Too far outside and the lack of comfort can cause you to shrink instead.

Too many times, bipolar people step too far outside their comfort zones and find themselves at an intensity of depression or mania that is far beyond their control. Many of them become so frightened by it they hide inside their comfort zone hoping to remain there the rest of their lives. They accept a diminished story of their lives because they believe they have no other choice. They fear one wrong step will rapidly escalate back to an uncomfortable and out-of-control state.

Graph of Depression IntensityWhen we carefully assess comfort (along with the other criteria) at various levels of intensity, we find close relationships between understanding, functionality, and comfort. One’s level of understanding, if accurately assessed, predicts the levels of functionality and comfort, for example. One’s level of comfort also influences the ability grow in understanding and function more effectively; all three are intimately tied together.

Such assessments lead to a far more accurate identification of the demarcation lines of an individual’s comfort zone. These assessments also help the individual to recognize the next level of intensity where depression or mania has just begun to go too far. The ability to find the zone between the lines is the key to success. We need to cross the line and go outside of our comfort zone to grow, but not so far that lack of comfort harms us.



Measuring Functionality In Depression and Bipolar Disorder

By Tom Wootton

Many bipolar people say they are “high-functioning,” but most of them mean they function OK when in remission and cannot function when things get too intense. How well one functions DURING depression or mania defines the difference between Bipolar Disorder and Bipolar IN Order. At every intensity, functionality influences the comfort of everyone involved and whether they see value in the experience. Functionality should be the central focus of any approach to bipolar instead of simply trying to make it go away.

Many think intensity of depressive or manic episodes is the determining factor in functionality, but evidence contradicts such belief. Far more important are awareness and right understanding as outlined in the previous articles in this series. With enough education and practice, intensity becomes far less relevant to functionality than most people believe.

Functionality does not mean driving as fast as your car will go or talking so much you take over the conversation. It must include the ability to do the things necessary to function in society. Measurements for physical, mental, emotional, spiritual, social, and career/financial productivity need to be part of the analysis. Real functionality includes the ability to get along with others and for them to be comfortable with your behavior.

The functionality scale, like the other items in the graph, runs from zero to one hundred percent in increments of ten. Fifty is a normal person during normal times. Less than fifty means that depression or mania is causing one to function less well than normal, whereas above fifty means functionality is enhanced.



Functionality-Based Understanding For Depression and Bipolar Disorder

By Tom Wootton

understanding bipolarWhen I first started putting together the protocol for assessing depression and bipolar disorder, I was working with a professor of Psychiatry to make sure the ideas were sound. His advice was to combine both awareness and understanding in the graph to keep it simpler. I am glad that I did not take the advice.

Awareness and understanding are different in ways that matter. Expertise might help someone understand why things happen, but does not necessarily lead to increased awareness. An expert on sex, for example, may be totally unaware that his wife is having an affair. It takes awareness (covered in the first article of the series) to know what is going on whether you understand the phenomenon or not.

It turns out that understanding is more related to functionality (covered in the next article) than awareness. You may be completely aware that you are sitting in a car, but unless you understand how to operate it you cannot drive.

Understanding is not just about knowing the physical, mental, emotional, spiritual, social, and career/financial aspects and their implications, it also includes knowing about the tools. You need to know how the tools work, have proficiency in using them, and understand which ones to use at each stage of bipolar – the disordered stages of Crisis, Managed, and Recovery, and the IN Order stages of Freedom, Stability, and Self-Mastery. I call this functionality-based understanding.

Too many people are holding out those who cannot function as the ones we should be listening to. Those who only know bipolar disorder and have not created Bipolar IN Order in themselves or others have no understanding of what it takes to make it happen. They can learn, but many times their beliefs limit their willingness to do so. They keep insisting it is not possible to be highly functional with bipolar and refuse to consider the evidence that contradicts such beliefs.



Becoming More Aware of Depression and Bipolar

By Tom Wootton

depression and bipolarYou can live in the same neighborhood for thirty years and still have little idea of what is going on there. You can shop in the stores, eat in the restaurants, talk with the neighbors, and feel that you know the community very well. But there are still more things going on than you know about. You simply never knew to look for them or were never taught how.

The police that work in the area know about crimes that go on right in front of you. The pest control people see things in the restaurants that might shock you if you knew they were there. Everyone from the woman in the plumbing shop to the guy selling pot (maybe even out of your own house) see things going on that you do not. The preacher knows about the spiritual goings on and the neighborhood doctor sees all of the injuries and illnesses.

When a thief sees a saint all he notices is his pockets. We all only see the things we have been trained to look for. As Paul Simon famously sang, “We all see what we want to see and disregard the rest.”

The same thing is happening in the depression and bipolar worlds. Many doctors and therapists only see it as a disease, family members see behaviors, and people with depression only see pain and suffering. There is so much more going on that none of them have been taught how to see. I have been teaching all three groups for ten years and am amazed how little awareness there is about very important details until I show them were to look.



How To Achieve Bipolar IN Order

By Tom Wootton

This video is from a public television program called “Moving From Bipolar Disorder To Bipolar IN Order.” It explains what bipolar is and the difference between disorder and IN Order by detailing the six stages that one goes through as understanding and functionality improves. It outlines more complete assessments geared toward success, advanced tools that supplement existing tools, and stage specific plans that accommodate the needs of each of the six stages. It builds on the previous article called The Six Stages Of Bipolar And Depression.

The direct link to youtube for the video is http://www.youtube.com/BipolarAdvantage and http://www.bipolaradvantage.com goes into more detail about it. I would love to hear your feedback on it and where on the scale you think you might be at.



The Six Stages Of Bipolar And Depression

By Tom Wootton

bipolar stagesMoving From Bipolar Disorder To Bipolar IN Order

Everyone has up and down times. It is a natural part of life. If we observe our lives over time we might say there are two poles that we have; some days we feel on top of the world and other days perhaps on the bottom. That is the basis for the word bipolar and the reason I say that everyone is bipolar. Some may argue that there are people who are unipolar and only experience the up or down side, but even they have a range of experience with a “pole” on each end.

Unfortunately, the word bipolar is generally used to describe a subset of people who have adverse reactions when they go to far toward the high and low poles. Although related to how far from center one is, there is no distance from center that guarantees one would necessarily react to it in an adverse way. It really depends on how far we are from our comfort zone. One person might be perfectly comfortable and highly functional at a certain point from center while another could be so uncomfortable that he/she is literally in danger of suicide. I see the comfortable person as keeping life in-order, while the person in danger of suicide has lost control and is in dis-order. Using bipolar as a term to describe the dis-ordered person is an over-simplification that goes too far. We should at least distinguish the difference between having Bipolar Dis-Order or Bipolar In-Order.

But life is not even that simple. If I just won a marathon, for example, I might be very high emotionally yet completely drained and low physically. To really see where we are on the spectrum from high to low we need to consider all of the aspects of our lives: physical, mental, emotional, spiritual, social, and career/financial. It is probably more accurate at any given time to say that we are really in a “mixed state” instead of somewhere on a straight line between the two poles, so we must see even the expansion of bipolar to Bipolar Disorder and Bipolar IN Order as just a convenient simplification of a much more complex topic.



Garbage In, Garbage Out – The Failure of Depression and Bipolar Treatment Starts With Assessments

By Tom Wootton

29/366: Taking #measurements - #project366 #red #numbers #instagram366 #iphoneography

The Experts Are Asking The Wrong Questions About Depression And Bipolar Disorder.

Over the last ten years I have spoken with thousands of people diagnosed with bipolar disorder. When I ask them to relate their story of how they were diagnosed, a troubling pattern is pretty evident; the diagnosis was very brief and largely irrelevant in regards to bringing any hope to the situation.

Most people I have talked with see the assessment as a life sentence with no path for making life work the way they had hoped for. I wonder where they got that idea?

For the last five years I have been speaking to groups of therapists and doctors. When I tell them assessments are not thorough enough they are often in agreement about others, but believe their own assessments are very thorough and use the best evidence-based tools available.

What tools? The Beck Depression Inventory (BDI) takes about 10 to 15 minutes to complete the 21 questions in a self-report format including the items intended to measure symptoms of severe depression that would require hospitalization. The BDI has been used for 35 years and is reported as being highly reliable regardless of the population. The Hamilton Depression Scale asks only 17 questions. There are others, of course, but none provide the insight needed to achieve Depression IN Order or Bipolar IN Order.



How I Found Ecstasy In Depression

By Tom Wootton
http://jonathanwallacestudio.com/

http://jonathanwallacestudio.com/

I have been meditating for over 50 years. I started when, at five years old, I became fascinated with watching my breath go in and out. I intuitively knew that this and other meditative practices would bring me to a state of ecstasy. It didn’t take long before pursuing that state became the most important thing in my life.

Although I got incredibly close through my efforts in meditation, it wasn’t until I looked for ecstasy in depression that I truly found it. Once I found ecstasy in depression I found it everywhere. My hope is that sharing my experience might help others to find the same insights that I have.

As I watched my breath go in and out I found some dramatic changes in my state of consciousness. I would detach from my body and find myself floating above and looking down at myself sitting there. It was a very pleasurable state, but also very profound in how I viewed the world. I believed that part of me was untouched by the physical world; the part that I now call my soul.

It wasn’t long before my soul separations started encroaching on my waking states. I would often find myself turning the corner and suddenly being in a long tunnel with a light at the end of it. During those experiences time would stand still or at least slow down dramatically. I interpreted these experiences as seeing God.



The Elephant In The Bipolar Room

By Tom Wootton

Stigma, medication, treatment options, recovery, patient rights and physiological basis are some of the most discussed topics regarding bipolar. There are, of course, many other interesting aspects to debate, but it is hard to find any discussions about bipolar that do not include one or more of these central topics.

While it has been very healthy to debate all of them, there is an underlying assumption that must be addressed too.

The paradigm that all of the above topics are based on is that we are incapable of remaining in control when mania and depression reach a certain intensity.

We are therefor not responsible for our behaviors when manic or depressed because it is not possible in those states to choose better ones. This creates the goal of removing bipolar from our lives (at least at higher intensities) and the debate is about how it is best done. Much of the debate about medication, for example, is about alternative methods to achieve the same goal of reducing intensities of mania and depression.

But, what if we could be highly functional while manic or depressed? This idea has so many repercussions that people are afraid to even think about it. Consider what is at stake: If we cannot choose how to respond to the different states because it is impossible for anyone to, in-ability becomes central to the arguments in each of the above topics.

If anyone can choose, the impossibility argument is removed and the discussion becomes either how to function in mania and depression or why some cannot.



Why I Am Against Bipolar Meds

By Tom Wootton

Many people say you should not discuss politics or religion with your friends because you might not be friends much longer. If your friends are Bipolar or associated with it in any way you might want to add meds to the list. The extremes both for and against meds give new meaning to the word Bipolar. The poles often seem further apart than the most intense debates in politics or religion.

I have been speaking with groups about Bipolar for almost ten years now and have tried my best to stay out of the debate. But many in the audience won’t let me. At the end of my talks I am frequently accosted by members of one camp or both. It is pretty clear that neither side even heard what I said and the only thing they listened for is whether I took their side in the only thing that matters to them. I didn’t validate their extreme point of view and they are furious with me.

In his song The Boxer, Paul Simon said, “Still, a man hears what he wants to hear and disregards the rest.” In my case they often hear things that were not even said. In their minds I gave a talk siding with the enemy.

I have always pretty much ignored the med controversy because it is not central to my message. Until now. I heard something recently that made me want to take a stand.



What Depressives Can Teach Doctors About Grieving

By Tom Wootton

My daughter Kate is in her fourth year of medical school and is well on her way to becoming a very caring doctor. Her greatest gift is the ability to connect with people, which thankfully is being recognized in the hospital settings as an asset.

She creates strong bonds with her patients and their families by communicating how much she cares about them. Among so many other admirable traits it is the one that makes me the most proud of her. It has been her greatest gift for as long as I can remember.

The ability to form strong emotional bonds is not without tremendous risks though. It hurts her deeply when a patient that she is involved with dies. It is a testament to her awareness, understanding and strength that she can perform even on days when she sees the worst aspects of the medical profession; in spite of their best efforts, they cannot save everyone. Kate has grappled with that many times and come out the better for it.

As her father I like to think that I have something to do with Kate’s insights. We discuss the topic often. As someone who deeply understands depression and has learned to function fully while in the most intense states, I know my insights have helped Kate to develop the skills in her own life. I believe such skills are the key to her success and will help her to stand out amongst her peers.

A recent study about how doctors are affected by grief was published in the Archives of Internal Medicine and was described in an article in the NY Times. I read both reviews with great interest and was very excited that it confirmed what Kate and I had been discussing. I have worried that the grief that Kate experiences might overwhelm someone without the insights and support that she has. This is exactly what the study was about.



The Avengers – Dr. Banner’s Wisdom About Bipolar

By Tom Wootton

I have long been a fan of The Hulk, but I had not noticed the incredible wisdom of Dr. David Banner until The Avengers movie made it clear.

In his wisdom about managing rage he grasps the secret to managing depression and mania too. In one brief statement he captured the greatest flaw in the current paradigm about treating bipolar.

Unfortunately, most people missed it because they thought it was just one of the many great jokes in the movie.



Where Is The Line Between Hypomania And Out Of Control?

By Tom Wootton

Exploring the potential of the human mind has been a central fascination for most of my 55 years. I have spent as much as eight hours a day in meditation and lived in a monastic environment for over eight years. One thing I am very sure of is that we are capable of far more than most of us even imagine. This is especially true regarding those of us who are bipolar.

I have spent the last 10 years exploring what we are capable of during the extremes of mania and depression. In the process, I’ve met hundreds of people who’s insights have validated my own experiences.

With the help of experts in various complementary fields, including medicine, psychiatry, sociology, spirituality (what theorists like to call Bio-Psycho-Social-Spiritual), accelerated learning, and bipolar-specific meditation techniques, I have developed the most advanced system of training available to date for mastering functionality in all intensities of both mania and depression.



The Four Secrets to Being Hypomanic Successfully

By Tom Wootton

My previous article covered the controversy about why people think it is not possible to be hypomanic without losing control. It’s a good backdrop for this article.

There are four steps that lead to hypomanic success:

  1. Determine the starting point.
  2. Assemble the tools necessary for the task and become proficient at using them.
  3. Create a realistic plan.
  4. Do the work.

Assessments

Most assessment tools for bipolar disorder are only for making a diagnosis. Rarely does one assess where someone is in terms of their ability to actually handle elevated states. If we are going to succeed at being hypomanic without losing control, we need to assess a number of factors, including intensity, awareness, understanding, functionality, comfort, and what value the person sees in the experience. These criteria need to be gauged at different levels of intensity until you find the one where they are all optimized.



Can You Be Hypomanic Without Losing Control?

By Tom Wootton

I have discussed bipolar with thousands of people over the last 10 years and would guesstimate that being hypomanic without losing control is the Holy Grail for 75% or 80% of them. Most say their goal is “permanent hypomania and to never be depressed again.” If you ask their parents, though, they will say “I don’t mind him being a little depressed, but could you make the mania and deep depression go away forever?

There is good reason for the discrepancy between parents and bipolars. Bipolar people may like being manic, but their behaviors are so often out-of-control that they become a problem for those around them. Bipolars and non-bipolars alike are justifiably afraid of mania because of past history with manic episodes.

It is commonly believed that it is impossible to even be hypomanic without rapidly escalating to an out-of-control state. The belief is so prevalent that the standard of care for mania according to the National Institute of Mental Health is to make it go away entirely.

On the other hand, there are many people who advocate that bipolar is a dangerous gift. Some take it too far and say we should allow all states no matter the consequences. While I fully agree with the dangerous gift idea, we must learn to take responsibility for our states and keep them from getting to places that we cannot control.



What Are Some Of The Positives About Having Experienced Bouts Of Depression?

By Tom Wootton

A recent question on our Depression and Bipolar Advantage LinkedIN Group brings up a point that needs to be addressed if we are to fully understand depression: What are some of the positives about having experienced bouts of depression? Since most people assume there are none it is important to put it in perspective.

The answer to the question depends completely on where one is on the six stage of growth from bipolar disorder to bipolar in order. The inability to see value in the experience is a major contributor to the suffering that those in disorder experience. Finding value in the experience is one of the keys to removing the suffering and starting on the path to self-mastery.

For someone in the Crisis Stage the only positive may be that the person knows that he/she has survived before. This can literally mean the difference between life and death. It would be counterproductive to ask if there are any positives while one is in crisis.



The Missing Pieces Of The Bipolar Puzzle

By Tom Wootton

Day 314/February 24 - Playing PuzzleYou cannot fully understand bipolar until you see the whole picture. This video shows the pieces that are missing in most descriptions. For those of you who have seen the video along with the article “The Shocking Truth About Recovery From Bipolar Disorder” you can skip forward in this video to about 3:15.

The first few minutes repeat the study by the National Institute of Mental Health so those who have not seen the previous video can understand the context. The video is part of a much longer video available at http://www.bipolaradvantage.com as a part of the free online concepts course.



Evidence-Based Treatment for Bipolar Disorder: Is the Evidence Based on the Wrong Outcome?

By Tom Wootton

© http://jonathanwallacestudio.com/

My ankle was broken during a hockey game when I was sixteen. The pain was so intense that by the time I got to the hospital an hour later I couldn’t bear it any longer.

If the doctor had given me a choice between suffering from the pain or cutting my leg off at the knee I would have chosen the amputation. I would still be paying for the mistake if he told me the best evidence calls for amputation and gave me no other option other than suffering for the rest of my life.

This sounds absurd. But, what if the pain was in my head? According to a recent article in the BBC News Magazine (http://www.bbc.co.uk/news/magazine-15629160), they did something even worse in the 1950s – they amputated part of people’s brains.

They lobotomized people with depression and bipolar (and other issues) because it was the best evidence-based treatment at the time. From the article, “But from the mid-1950s, it rapidly fell out of favour, partly because of poor results and partly because of the introduction of the first wave of effective psychiatric drugs.” Chemical lobotomies became the evidence-based treatment of the day.

Today’s evidence-based treatments are so much more humane. Or are they? The tools are more refined, but the goal of treatment is the same: cut off the part that is broken. We are no longer poking ice picks into people’s eye sockets, but are still trying to accomplish similar outcomes.



The Shocking Truth About Recovery From Bipolar Disorder

By Tom Wootton

This video It explains the three stages of bipolar disorder: Crisis, Managed, and Recovery. It reveals the results of an important recent study by the National Institute of Mental Health that you will find shocking. There are many who wish the study would remain buried, but as they say, “The cat is out of the bag now!” Be sure to check it out and share your comments.



We Need A Bipolar President

By Tom Wootton

Abraham Lincoln 1858In recent months, discussions about the boom and bust cycles of our economy going back to the Great Depression have been the focus of many news stories. During boom cycles, too many of us experience periods of inflated feelings of power or delusions of grandeur, characterized by excessive risk taking and out of control spending. During bust cycles, many of us experience periods of indecisiveness, black and white thinking, loss of energy and fatigue, even feelings of worthlessness and suicidal thoughts. These reactions are classic symptoms of bipolar disorder.

Companies can and do prosper during times of economic turmoil. What do GE, Disney, HP, Microsoft, and Apple have in common? They were all startups during steep declines in the U.S. economy. GE started during the panic of 1873, Disney started during the recession of 1923-24, HP began during the Great Depression, and Bill Gates and Paul Allen founded Microsoft during the recession of 1975. Even today, while the economy is in the worst down period since the Great Depression, Apple is thriving. All these companies realized that they had an advantage by adopting a different mindset, a different way of seeing the crisis. Instead of succumbing to the situation, they saw it as an opportunity to innovate and grow.



How A Simple Eye Exam Can Lead To Better Bipolar Assessments

By Tom Wootton

One of the many traits of being bipolar is the ability to see the world in a different way. Many might say it is a curse, but it can also be a gift when looked at from a positive perspective. This change in perspective can literally help you to see with greater clarity.

From early childhood, we have been taking tests to assess our understanding of the world. These tests have had a profound impact on us in ways that we are often unaware. They have created a world view that places too much importance on passing the test and not enough on learning more about ourselves. In some ways, the tests themselves have gotten in the way of what the goal was in the first place.

I have been wearing glasses for almost thirty years. Every year or so I take a new exam to make sure my prescription is still the same. The test seems simple enough: the clinician shows me letters at different sizes and asks me to identify what letters I see. Anyone who has a driver’s license has taken a similar test as has anyone who wears glasses or contact lenses.

A few years ago I discovered a major breakthrough that has completely changed my life. It has brought my life into focus in many ways. I share it with you in hope that it will help you to see better too.



Understanding Bipolar: You Don’t Know the Half of It

By Tom Wootton

“You don’t know the half of it” is a once-common phrase that is generally applied to negative things. It usually means that you don’t really know how bad it is. It is easy to see how bipolar people can use the phrase to describe how horrible bipolar disorder is to someone who does not experience it.

image by John Forward

I imagine many people would expect this article to be a rant on how people without bipolar disorder have no idea how bad we have it. I am sorry. It is not. It is for those who already know how bad it can be. They may not know the half of it, either.

I often joke that depression is so terrible that we sometimes wish we were dead and we act so badly during mania that everyone else wishes we were. It is good for a laugh, because we all know it has some truth in it. The horrible symptoms of depression and mania that can occur when an individual is in a disordered state are well known. They include physical, mental, emotional, spiritual, social and career/financial dysfunction.

Funded massively by the pharmaceutical industry, partly because it is one of their biggest profit centers, there have been countless studies about bipolar disorder and how to move people from crisis through managed stage to recovery. There are many who argue over the choice of tools to address depression and bipolar, but nearly everyone agrees on one thing: depression and bipolar are horrible mental illnesses that need to be removed from our lives. They don’t know the half of it.



Is This Why Depressives Have Shorter Lives?

By Tom Wootton

Broken Heart symbolDepressed individuals have a shorter life expectancy than those without depression, in part because depressed patients are at risk of dying by suicide.1 However, we also have a higher rate of dying from other causes.2 Some researchers conclude that we may be more susceptible to medical conditions such as heart disease.3 I had an experience that might point to another cause that we need to address: we don’t treat many health issues because we think they are just symptoms of depression.

Last winter, I went through one of the deepest depressions of my life. It was very intense physically, mentally, emotionally, and spiritually. It was a beautiful experience, but that is for another article. The physical aspect is what I want to focus on here.

My physical experience this time was far more intense than any other depression. I was in tremendous pain throughout my body, but especially in my digestive track and chest. I was also completely drained of energy. It took a tremendous act of will just to get out of bed. It was so intense that I found myself reviewing my life in search of any other time that I had similar experiences.



The Black Swan of Bipolar and Depression

By Tom Wootton

I gave a talk the other day for NAMI Santa Rosa about my next book and a woman remarked how different it is from my previous ones. I said that my first three were about me being the black swan.

She asked if I was referencing the movie called Black Swan and I have not seen it yet, so I do not know if it is related at all to Karl Popper’s concept from the 1930s that I was referencing. Have you seen it? Does it mention Popper? Should I see it either way?

Popper suggested that if you observe only white swans, you are using inductive reasoning to extrapolate that all swans are white. This was falsified when black swans were discovered by the English naturalist John Latham in 1790. Science was forced to change the hypothesis that all swans are white by the new evidence.



How Do We Treat A Mental Health Crisis?

By Tom Wootton

I am no expert on mental health crisis intervention. I have only seven personal experiences to base my opinions on. Nonetheless, it is not a stretch to say that there are some major flaws in the system that should be addressed. I know I am not alone in such an assessment and hope that we can share our ideas for how to make it better.

In trying to better understand all of the points of view, I have spent a lot of time discussing it with all sides of the debate. I gained some great insight from those who identify themselves as part of the anti-psychiatry movement. I could be wrong, but it seems that much of the hostility that they have comes from bad experiences when in crisis. I have a unique perspective on such experiences because I was once hired to stay with someone during his lockdown in a psych facility. I saw first hand how bad it can be while I had the clarity to know what was going on.



What Is Bipolar? What is Bipolar Disorder? Bipolar In Order?

By Tom Wootton

bipolar definitionsWe often hear people make the distinction between HAVING Bipolar and BEING Bipolar. Rarely, do we hear a distinction comparing Bipolar to Bipolar Disorder. I coined the term Bipolar In Order ten years ago to help make the distinction, but wonder what it means to you?

Bipolar used to be called Manic-Depression. Mania means that we are elevated. Depression means lowered. Bipolar means that we have two poles (high and low), so it is meant to replace manic-depression as a more acceptable way of describing the same thing. Or, is it just more marketable?



Getting Comfortable With Bipolar

By Tom Wootton

Learning to ride

One of my earliest memories is of learning to ride a bike. I remember the fear, exhilaration, and hyper-awareness, along with the tension in my body and how my breath became both more rapid and shorter. I was outside of my comfort zone and challenging myself to grow. It was also a blast!

My father had a wisdom common with most dads. He didn’t push me down a steep hill and hope I survived; he ran along next to me making sure I was not too far outside of my comfort zone as to be incapable of handling it. He taught me one of the most important lessons that day about what it is to be human. We need to challenge ourselves to grow, while at the same time making sure we don’t go too far outside of our comfort zone.

The thrill of learning something new and challenging myself to grow has been a constant companion ever since my first bike ride. On too many occasions, I took on challenges far outside of my comfort zone and was either debilitated by the fear and lack of skills, or took risks that caused more harm than the potential reward from succeeding.



“Pull Yourself Up By Your Bootstraps” And Other Myths

By Tom Wootton

The diagnosis of mental illness is the most dangerous time for many of us. Overwhelmed by fear, confusion and the numbing effect of over-medication, we are vulnerable to any messages that can have long-term consequences. It was during my first months after diagnosis that I fell victim to the myths of mental illness.

As I was trying to make sense of what was happening to me, I was given a list of the most offensive comments anyone could say to the mentally ill. I’m sure you’ve heard of at least some of them. Examples include: “snap out of it,” “you can do anything you want to if you just set your mind to it,” “get a grip,” and the worst one of all, “pull yourself up by your bootstraps.”

While the Advocates are well intentioned, the result is quite the opposite.



Am I Still Depressed If I Don’t Act Like It?

By Tom Wootton

It happened several years ago, but I remember it like it was yesterday. My depression was too much for me and I tried to end it by taking my own life. The physical sensations, mental activity, emotions, and spiritual desolation were the deepest I had ever experienced. I thought it was the deepest anyone could go and the only way out was suicide.

I was wrong. I have since been much deeper in every way – physical, mental, emotional, and spiritual. I am currently in the deepest depression of my life. It has been going on for five months now, yet I don’t feel overwhelmed at all. The level of depression that once almost killed me now seems like a walk in the park. So does this one. Since it doesn’t overwhelm me or control my reactions to it, I wonder: Am I even depressed at all?



Suicide: Pro-Choice or Pro-Life?

By Tom Wootton

Every single day I think about the time I tried to kill myself. It is one of my strongest and most detailed memories. I mention it in passing in my talks as if it is just a point of reference, but it has a profound impact on my every thought. I have not heard the bipolar or depression world debating pro-choice vs. pro-life suicide, but it is an internal debate that I often have myself. I wonder if others have had similar thoughts?

My debate is further colored by the suicide of my best friend Santiago. I think about his hanging himself every day, and the effect it had on everyone around him. It is another memory that is so strong it could have just happened. It too has a profound effect on my every thought.

The other day I was showing a visitor around San Francisco and he brought up suicide when we drove by the Golden Gate Bridge. He asked how many people have jumped off (over 1,200 so far) and whether they have put up a barrier yet. I found myself sharing my internal debate and chose to take the pro-choice side.



Burning The Bible – Let’s not replace one set of dogma with another.

By Tom Wootton

bookburningcrpdThomas R. Insel, M.D., Director of the National Institute of Mental Health, has issued a sharply worded condemnation of the new Diagnostic and Statistical Manual of Mental Disorders (DSM-5).  The DSM has long been considered the “Bible” of Psychiatry and has recently been under attack from many angles, but this announcement might be a game changer. It will be interesting to watch how it all plays out.

According to Dr. Insel, “it is, at best, a dictionary, creating a set of labels and defining each. The strength of each of the editions of DSM has been “reliability” – each edition has ensured that clinicians use the same terms in the same ways. The weakness is its lack of validity. Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure. In the rest of medicine, this would be equivalent to creating diagnostic systems based on the nature of chest pain or the quality of fever. Indeed, symptom-based diagnosis, once common in other areas of medicine, has been largely replaced in the past half century as we have understood that symptoms alone rarely indicate the best choice of treatment.”



 
Bipolar In Order
Check out Tom Wootton's new book!
Bipolar In Order:
Looking At Depression, Mania, Hallucination, and
Delusion From The Other Side

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