Bipolar Advantage A blog exploring the positive aspects of bipolar disorder. 2016-11-11T17:36:39Z Tom Wootton <![CDATA[How Understanding Depression Helped Me Through Election Anxiety]]> 2016-11-11T17:36:39Z 2016-11-11T17:34:45Z My sister died in my arms last June in the middle of one of the deepest impressions of my life. The fact that I understand depression and I have learned […]]]>

My sister died in my arms last June in the middle of one of the deepest impressions of my life. The fact that I understand depression and I have learned to live with it instead of against it made my depression an asset for my entire family instead of the burden that my depression once was.

This election-infused depression was not normal for me. Because of the prevalent election anxiety among so many people on the left and the right, I was experiencing levels of anxiety that I never had before. I also got the chance to explore my fears in a way that has led to a better understanding of both anxiety and fear along with the positive outcomes that are available to all of us.

I would be lying if I claimed that I was not sometimes very overwhelmed by election anxiety. While I can live pretty comfortably in very intense depressive states, the depression enhanced with intense levels of election anxiety got the best of me on many occasions. I had to take pretty strong steps to lower my level of intensity sometimes just to be able to make it through the day.

But I did get through and in the last two days I have been able to make very rapid progress to a place where I am not only comfortable again, but I have learned a great deal about myself, my country, and both sides of the left/right divide. It turns out that intense anxiety and fear can teach us a great deal, just like intense depression can, if we are willing to explore it instead of fight it.

I think the most important societal lesson I learned is that the acronym F.E.A.R (False Evidence Appearing Real) is something we should all take a deep look at. So much of our fears about the other are based on false beliefs that the few people we all should fear are representative of an entire population that we would not be afraid of if we got to know them better.

Those of us on the left condemn the people on the right when they say, for example, that all Muslims are terrorists. We should all fear Muslim terrorists but that does not mean we should fear all Muslims. Those who try to stoke fear of all Muslims are stoking our fears and escalating them to the point that the fear controls us. This feeds our anxiety and destroys our ability to think rationally.

But I have to admit to doing the exact same thing about people who live in middle America. When I leave the comfort of the cities and go out into the country and the small towns, I am frightened because I think all of those people are bigots, homophobes, and hate-mongers. And I see people on the left making that same claim when we say half of them are deplorable. Yes, a very small percent of them are reason for caution, but to paint them all with such a false notion makes us miss the fact that most of the people out there are wonderful people who care about the same things we do.

I have had friends from the country who come to the big city of San Francisco and are frightened by the homeless, the insane, and then perfectly fine people who simply don’t look or sound like them. It took empathy on my part to realize that their fears were just as real as mine and just as wrong. I need to help them understand their fears and anxiety while doing whatever I can to help them lower the intensity of both. Then we can start to better understand and embrace each other.

It is imperative that both sides look with an open mind and accept that the vast majority of us are wonderful people that we need to learn more about. We need to start caring about their anxieties and fears and do whatever we can to help them, not make it worse. Only from inside our comfort zones where the anxiety and fear is low enough intensity can we begin to see each other for who we really are.

Stoking animosity, anxiety, fear, and hate has not been exclusive to the right nor the left. It is time for us to see this as a serious mental disorder that we have all been engaging in. I have my years of struggle and eventual victory with facing depression as a roadmap. That roadmap helped me to learn from anxiety and fear much faster and to get to a place that I would call anxiety ‘IN Order’ or fear ‘IN Order’ much faster. ‘IN Order’ does not mean I have no fear or anxiety. It means I understand their influence and at what intensity the focus should be on turning it down instead of allowing it to control my actions.

We need to stop demonizing fear, anxiety, depression, mania, and the thousands of other states that we go through in life. For each feeling we need to ask ourselves a series of questions:

What levels of intensity are too much for us?

How do we turn the intensity down when we find ourselves too far outside of our comfort zones?

What can we do to become comfortable with the things that trigger the states?

How can understanding the states help us not only understand others, but empathize with them so we can see each other commonality and begin to bridge the gap between our points of view?

How do the feelings inform us in ways that are useful and productive?

In what ways do they mislead us?

I think it starts by asking each other in a very compassionate way, “What are your anxieties and fears? How can I help lower the intensity of them? How can I find commonality between the states you experience and the states I do? How can we educate each other about our concerns without creating irrational fear’s about each other? How can we share our anxieties and fears for the future without blaming it on each other?”

If we all start down that path now, the future is going to be better than any of us can imagine. We will always have anxieties and fears but we will better understand their risks and benefits  We will know how to act on them in ways that show we are informed by them instead of controlled by them. Denying them and hoping they will never happen again will never get us there. Let’s all learn from this and use our new understanding to create the better world we all desire.


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Tom Wootton <![CDATA[Bipolar Treatment Is More Than Just Tools To Lower Intensity]]> 2016-05-04T20:04:55Z 2016-05-04T20:04:55Z In 1964 I was 8 years old. Back then you could take a car out of park without needing a key. I did that by mistake once and it taught me one of the most important lessons of my life. A lesson that can be easily translated to the way we treat bipolar disorder.

Tom Wootton

Our family car was parked in the driveway which sloped downhill to the road. I was playing in the car by myself when I inadvertently shifted into neutral and the car started to roll downhill towards the street. I knew enough from watching my parents drive that one of the pedals would stop the car. So I pushed the brake pedal with all my might and the car stopped rolling towards what I was sure was a terrible accident.

But at 8 years old I was too small to be able to both hold down the brake pedal and see over the dashboard out the window. That also meant that nobody could see me. As I got tired and I let off the break, the car started rolling downhill again. I was in a total panic and could not figure out what to do. To my luck, my mother came out looking for me and found me in the car. She reached in and put the car back where it belonged and saved the day.

I learned that day that the most important thing about a car is learning how to stop it. But if that’s all I ever knew about cars I would’ve never been able to discover how far they would take me.

That is where most people are today when it comes it comes to bipolar disorder. They have learned how to put on the brakes but they have no idea how to actually function while manic or depressed. The trouble is, neither does anyone else. And so everyone assumes that the only thing you can do about bipolar disorder is put on the brakes. But, as we all know, sooner or later mania or depression comes back when the brakes stop working.

The critical lesson I learned 52 years ago is that putting on the brakes is only the first necessary step of learning to drive. I also had to learn how to shift gears (stop going backward and start moving forward), steer (navigate around or through obstacles we often call triggers), merge (get along with others), moderate the speed instead of just full braking (find a comfortable range), and yes even speed up some times. We also need to decide where we are going and navigate the best way to get there. These are lessons that those who are suffering from bipolar disorder need to learn too.

The first step towards moving from bipolar disorder to bipolar in order is learning how to put on the brakes. But mastering that first step is no better than me putting on the brakes in the driveway 52 years ago. It leaves us dependent on someone or something to bail us out every time we get in trouble.

When I learned to drive I was taught by someone who knew how to drive and had worked out the steps needed to teach someone else how to do the same. When I look around today at the people teaching others about bipolar disorder I see people who only know how to use the brakes. And they, like me at 8 years old, are so afraid to take off the brakes that they convince themselves it is the only thing anyone can do.

On the other hand, I see too many people who have never learned yet convince themselves that they know how to drive. When their mania gets stronger than they can handle they don’t even have the good sense to put on the brakes. And then, when someone else puts on the brakes for them, they go back to imagining that they know how to drive. Their repeated failure to actually learn the necessary steps is just reinforcing the false notion amongst everyone around them that it cannot be done.

Don’t get me wrong. Using the brakes is a critical first step towards getting bipolar in order. We just need someone to shift gears for us and show us how to actually operate it once we figure out how to use the brakes.

Who do you know that can function fully while depressed or manic? I know lots of people because I taught them how. Unfortunately I don’t know anyone else who can and that needs to change. But the hardest part so far is convincing people that it is possible. They are so locked in fear with their foot on the brakes that they can’t see over the dashboard. Since they can’t see our success they cling to the notion that it is not possible.

I mentioned earlier how some of the driving skills can be used as metaphors for mania and depression. The most important metaphor for the purpose of this article is about the brakes, so lets dig into that one a little. The brakes in the case of bipolar are the tools that help one reduce the intensity of mania or depression with the belief that we are unable to function fully unless we are in remission or very low levels of intensity.

The brakes-only solutions that are the current standard of care traps everyone in the driveway for the rest of their lives where they live in fear for the next time the brakes inevitably fail. When you start learning how to function during periods of mania and depression you will find an incredible world around every bend and have the skills to navigate without fear or suffering.


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Tom Wootton <![CDATA[Learning to Be Bipolar vs Waiting to Crash]]> 2016-04-08T01:00:43Z 2016-04-07T16:56:45Z Imagine you’ve never seen a car before and the first one you see was involved in a fatal accident. You express how tragic that is and that you would really love to be able to help keep that from happening to others. They show you videos of all kinds of car crashes and tell you how many millions of lives are devastated by them.

Lloyd Dirks/

Since you don’t understand the utility of having cars, you may suggest doing away with cars altogether. Or perhaps creating a 20 mph speed limit on all roads. Neither of these solutions would work, of course, because you wouldn’t get any compliance from those who have cars.

It would be far more productive to study all of the costs and benefits of having cars and use that study to determine the best desired outcomes. In this case, the premise would change from “cars are inherently bad” to recognizing that cars have value but are also dangerous. The focus of all efforts would be to maximize the usage of cars while minimizing the accident rate.

Starting from such a premise would lead you to suggest that better education and training would make better drivers. In looking for people to perform that education you would be looking for the those who drove the best and not those who crash every time they take the car out.

Those of us who are performance driving enthusiasts are looking to learn from the top race drivers for the ultimate education. Nobody would give a platform to those who have not developed winning skills, nor would we ever take lessons from anyone who crashes every time he/she gets behind the wheel. Their premise that we cannot drive at high speeds would keep them from ever winning.

But that is exactly the premise of those who control the conversation about bipolar and you can see it even in what they call it. Always appending disorder to the word bipolar is akin to always appending accident to the end of automobile. In other words, saying “bipolar disorder” is the same as saying “car accident” every time you mention a car.

The dominant premise in bipolar circles is to only see bipolar as disordered and advocate attempting to slow it down or stop it as the only solution. We even elevate those who continue to be accident prone to the status of experts.

And what is the result of following that premise? According to the National Institute of Mental Health in their landmark STEP-BD study: “According to the researchers, these results indicate that in spite of modern, evidence-based treatment, bipolar disorder remains a highly recurrent, predominantly depressive illness.” This is like telling car drivers they will still crash every time they go faster than 20, but at least with seat belts and air bags they might not die.

But what if their premise is wrong? What if we CAN learn to function while manic or depressed? If the search for solutions were based on that premise we would create completely different tools and outcomes.

And this is not just a hypothetical exercise. Over ten years ago I accepted the premise that we could learn to function over a broader range of states and varied intensities. After several iterations I now have a system that has helped myself and many others to do it. The education program consistently produces outcomes that support that premise; the proof is in the lives of hundreds of people living with Bipolar IN Order instead of falling into disorder every time they cycle into mania or depression.

The understanding of IN Order concepts allows us to live fulfilling lives in solid relationships with our families or coworkers. Those around us are no longer negatively affected by our states and no longer live in fear of another episode. We no longer act badly when manic and can function normally no matter how deeply we are depressed. While we may not like depression, we see tremendous insight in the experience and use that insight in positive ways.

The list of positive outcomes goes on and on, but the point is we have learned to function while manic or depressed and even see advantages in being in the states. This is completely different compared to those who only survive episodes of intense mania or depression and can only function at their highest level when in partial or full remission.

Here are a couple of quotes from some of those who have come to support my premise of Bipolar IN Order.

“Too often, in having to accept their condition, people end up feeling pathologized-reduced from a full person to a label. But Tom looks beyond the diagnosis to help people embrace-and accept-the best parts of who they are, instead of reflexively dismissing their feelings and experiences as a simple manifestation of illness.”

– Craig Malkin, PhD, Clinical Instructor in Psychology, Harvard Medical School

“Bipolar In Order provides the essential message that symptom reduction or elimination is far from the main goal of adaptation and intervention. Sure to challenge traditional thinking, this important work is integrative and wise.”

– Stephen P. Hinshaw, PhD, Professor and Chair, Dept of Psychology, UC Berkeley


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Tom Wootton <![CDATA[High Functioning Depression, a New Breakthrough]]> 2016-02-29T16:51:59Z 2016-02-29T16:51:59Z Bipolar IN Order has been an incredibly interesting journey. With each new year come new insights that build upon breakthroughs from previous years. Although it feels like each breakthrough is the furthest that we could possibly go, the next year always proves that there is more to learn about depression and mania. And this year is no exception to the rule.

William Iven/Unsplash
My breakthrough this year is that even in my deepest depression I can be just as productive as in any other state.

One of the aspects of the Bipolar IN Order program is that we can find value in every moment of our lives. While that value is relatively easy to see when we are at states that are inside of our comfort zone, it is often very difficult to see any value in the more intense states. This is especially true when the intensity of the states are way outside of what is comfortable for us. But as we expand our comfort zone and learn to function in the more intense states, we learn to find value even in such intense states.

Many students of the Bipolar IN Order online education program have expanded their comfort zone range to the point where, no matter what state they find themselves in, they are confident in their ability to function while the state is happening. I have long argued that we need to contrast the difference between the value of the insight found in depression and the things we can accomplish in hypomania.

While low levels of mania do enable us to get more things done, the advantages in depression include that we gain tremendous insight from it even when we are not very productive at getting things done. Most people who learn to see the insights in depression can understand the contrast and value the insights over getting the dishes done, for example. It is, of course, a far more complex equation but I hope you see the point from this simplistic example.

This new discovery turns that argument on its head.

I recently learned through direct experience that I can be just as productive in terms of getting things done during my depression as in any other state. That means the benefits of getting things done in a hypomanic state are just as available to me during depression. And just to be clear, this includes incredibly deep depressions that at one point in my life had me attempting suicide during a similar depressive state.

In some ways, I might even say that I’m more productive during this deep depression than even the best times of hypomania. I am much more focused, I get projects completed instead of starting a bunch of new projects but not completing any of them, and my creative efforts are far more clear. I have many projects going on and I am able to focus on each one in turn to complete it before getting to the next. The important thing is that they are getting completed and I have accomplished more finished projects during this deep depression than at any other time.

Some might argue that I am not depressed because I am productive. They believe that the very definition of depression precludes any ability to function at all. While a full answer to that allegation would take us off topic from this particular article, in brief it is because I have learned to separate what it feels like to be depressed from how I respond to it. Separating our feelings from our reactions to them is a central concept of the Bipolar IN Order online educational program. I have all of the physical, mental, emotional, spiritual, social, and career/financial feelings associated with an incredibly deep depression and that alone would warrant a diagnosis by anyone who examines my list of symptoms.

After giving a keynote speech about functioning during depression, I was told that I was not depressed by Aaron Beck, the person behind the Beck Depression Inventory. When I shared with him my list of “symptoms’ he agreed that I was depressed after all. Comically, he told me it was not possible to function during depression because he had never seen it before. His refusal to accept that someone else produced results that he could not is indicative of how strong the confusion is in those stuck in the ‘disorder equals impossible’ paradigm that has influenced the entire field.

For the most part, the depression and bipolar disorder communities are unaware that we can be IN Order instead of being in Dis-Order, which is why I invented the terms Bipolar IN Order and Depression IN Order to illustrate the difference. Since I have helped so many others achieve functionality during depression, it is past time for everyone to accept the distinction between disordered and in-ordered reactions to states.

The implications of this discovery are phenomenal, yet they somewhat complicate my understanding of mania and depression. If I am to reconcile my belief that all states are of equal value I will need to find as much insight hidden in mania as I find in depression. I believe it is there, so I look forward to another interesting journey of discovery. I will be sharing my next breakthrough when it comes and accept that it may not be what I set out to find.


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Image Source: William Iven/Unsplash

Tom Wootton <![CDATA[Is Bipolar Still In Disorder Really The Best We Can Do?]]> 2016-01-26T02:14:17Z 2016-01-26T02:14:17Z A common refrain in the bipolar disorder community is “I’m doing the best I can.” Every time I hear this or a similar phrase my heart weeps. I know all too well the feeling of despair and hopelessness that comes with it. There were so many times, while in tears, I used the exact same phrase. Whenever I hear it now, I want to reach out and empathize with the person so she does not feel alone.

Michael Kaufmann/

But at the same time I find myself conflicted. I know from my own experience, and from helping so many others, that the results we based the statement on was not the best we could do. Not by a long shot. That part of me wants to say, “you are stigmatizing yourself into accepting a life that is far less fulfilling than what you’re capable of.”

I have struggled with this conflict for many years and I’m finally ready to go public with it. Allowing such statements to go unchallenged not only harms the person saying them but also stigmatizes everyone else into believing that the best we can do is to continue to suffer with a dis-ordered relationship to the bipolar condition.

I wonder if my first compassionate inclination is not really compassionate at all when we consider it prolongs suffering in anyone who buys into the sentiment. The most compassionate thing is to help everyone create better outcomes so that bipolar is no longer a disordered condition and instead becomes an advantage in their lives.
It is especially disconcerting when I hear such statements from people claiming to be “experts” who are giving advice about how to deal with bipolar disorder. I know it gets them sympathetic comments and the feeling that they are relating to their audience, but aren’t they just telling their audience to accept the same limitations that they have accepted?

Whenever we use “can’t” without adding the word “yet” we are proposing a limitation that is harmful to anyone who accepts it. Appending “yet” to the word “can’t” leaves the possibility that sometime in the future we will be able to. That simple addition adds a non-stigmatizing context to the descriptions of our struggle.

The conflict for me is between the emotion we call “feeling compassionate” and the logic that says compassion should be about helping people achieve better outcomes. Better outcomes is the result of much more than just expressing sympathy to sooth their, and my own, distress.

Now that I recognize the conflict, I am looking for a way to reconcile the two and express empathy while helping others to get better results than the diminished lives they are accepting in their statement. I often come across as unsympathetic and hope that I can learn to do much better than that in the future. I have not yet mastered that and struggle every day to live up to higher expectations of myself. See how easy it is to add “yet” and what a difference it makes?

Plus, how do we know it’s the best we can do? Have we bothered to look around and find someone who is doing better? It seems that in every field besides mental health we are always looking for the best results and trying to find out how they were accomplished. In the mental health world it seems too often we are holding up poor results as an example of what people can expect to accomplish while feeding our emotional need to feel compassionate instead of doing what has the best outcome in mind. That is the very definition of stigma.

When a four-year-old says she’s doing the best she can, don’t we challenge that and encourage her to do better? When we refuse to do that for people with bipolar disorder are we really saying they need to be coddled and not challenged when they say the same thing? I find that not just stigmatizing but insulting.

What do you think? What should we say to people who say they are doing the best they can?

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Tom Wootton <![CDATA[How Depression Prepared Me For A Death In The Family]]> 2015-12-01T01:28:06Z 2015-12-01T01:13:18Z I know depression. It destroyed my life in my thirties and almost killed me in my early fifties. Back then, had anyone dared to tell me what I am about to say to you, I would have gotten very upset. I could not imagine that there was anything good about depression. Can you? What you are about to learn could change your mind. By using a new approach to working with depression, I had prepared myself for probably the most extreme crisis our family has ever faced.


Source: ©2015

When I was first diagnosed with bipolar disorder, I wholeheartedly bought into the idea that depression is a dark hole from which the only hope is to escape. It was certainly impossible to function well during deep depression. To function while deeply depressed meant to stay alive and minimize the harm it was clearly causing in my life and in the lives of those around me. High-functioning as related to depression meant that I needed to find ways to get out of it and back to a state where functioning in any productive way was possible.

Finding agreement for such beliefs is easy. Finding someone who challenges those beliefs is difficult. Even more difficult is letting go of society’s belief that it is impossible to function while in manic or depressed states. But once you become open to the possibility that you can learn to function during manic or depressive states, your life will change in ways that you cannot imagine. You will come to understand something that few people do. You may well consider it the most important lesson of your life.

I learned that lesson several years ago and continue to learn more as time goes by. I now teach people how to do this. I want to give you a sense of what life could be like once you accept the possibility and do the work to change. I want to share with you a very personal example of how functioning highly while depressed enriches my life and that of my family.

What Deep Depression Feels Like

I fell into one of the deepest depressions of my life the first of April 2015. Within two months, it had developed into what most would call an extreme state, even though I remained high-functioning. I have interviewed thousands of people about their states and am pretty sure you will agree that I am describing a deep depression and not just a run-of-the-mill bad day. I will describe briefly what that feels like.

Depression for me is a combination of physical, mental, emotional, spiritual, social, and career/financial aspects. The one I am in now (and during the whole story here) is one of those juicy ones that hits me on all levels. While any single element can be overwhelming, the combination of all the elements creates a synergy that adds up to more than the sum of its parts. I will detail each below.

Physically, I feel like I was run over by a truck. My body aches everywhere and I am completely drained of energy. It takes a tremendous act of will just to get out of bed. My head aches, my perceptions are dulled, and I feel like a zombie just going through the motions.

My mental state has many of the classic signs of depression. My thinking is slowed. I have tremendous focus — mostly on negative thoughts. I find myself repeating the same thoughts over and over. I am obsessed with death. I am paranoid about everything. Like many others, I hallucinate in this state and see myself and others dying in a horrible tragedy.

My emotional state is hard to explain. There are no words that properly convey the level of intensity or the variety of emotional pain I am feeling. Distraught is not a strong enough word, but neither is a list of feelings like anger, sadness, hopelessness and despair.

Socially, I find myself afraid to talk with others and want to be alone while feeling the loneliest I have ever been. I am extremely uncomfortable interacting with people and feel as though I am an alien that does not belong on this world. Every person I see brings up feelings of paranoia; that they too might perceive or notice that I do not belong here.

My career and financial thoughts are of total failure. I am afraid to spend any money because I cannot afford to. Trying to move my career forward seems both hopeless and too difficult to do. My thoughts tend toward homelessness and how there is no way to avoid it.

I completely understand how such a description equates to an inability to function at all, but nothing could be further from reality. I have continued to teach my classes and do all of the work I need to do. My understanding of depression and how to function during it has grown more this time around than in any previous episodes.

And I am not even talking about high-functioning depression during an extreme external crisis yet. The story that follows will show you the challenge I met and how depression helped me during it.

High-Functioning Depression During A Family Crisis

In the midst of this deep depression, I took a trip to visit my mother and my sister who have lived together for the last 15 years. My daughter Kate and I have a tradition of surprising my mom so she went with me. We were so excited to get there and see their shocked faces. And they were certainly surprised! In spite of my deep depression, we had a pretty normal visit. You might even say we had a great time together.

But something weird happened when we left. We had said our normal goodbyes and I was about to put the car in reverse. Instead, I got out of the car. I went up to Laura and hugged her again and reiterated how much I loved her. I felt compelled to do it and it left me with the strangest feeling. Kate even said it was weird as we pulled out of the driveway. My mother later told me she thought it was strange, too. As it turns out it was strangely prophetic.

Laura had been on pain medication most of her life due to a chronic illness. She had announced during our stay that she was going to a clinic in the New Orleans area to try to get off the meds. I had committed to flying back to stay with my mother while Laura was in the clinic. We got home May 18, with plans for me to fly back alone in a few weeks. I did just that.

Despite exhaustion from two months of deep depression and the rigors of travel, I got up on June 2 at 5 a.m. After traveling all day, I landed in Orlando, rented a car, and drove the remaining distance to my mother’s house. I finally arrived at 11:30 p.m. Laura had been in the clinic since the day before. I was so exhausted I had a hard time falling asleep. The last sound I remember was the two o’clock chimes on the grandfather clock, so I must have finally drifted off.

At 5 a.m. I was awoken by my mother screaming frantically at the side of my bed. “Laura is dying! Help me, Laura is dying!”

“What’s going on Mom?” I held her while she shook terribly. I had never seen her like that. She had gotten a call from Laura’s girlfriend from the hospital and was told Laura was in the emergency department.

And that is how the worst nightmare for my life began. We had no idea what to do, so the first thing I did was call Kate so she could call the hospital and find out what was going on. Kate is a doctor and speaks “the language.” We depended on her to figure out what to do next, while I tried to help my mom hold it together.

All we knew was that Laura had been rushed from the drug addiction clinic to the hospital. She had been hospitalized so many times in her life that we were unsure if this was just another normal episode. This time, the hospital was an hour north of New Orleans and it was not a simple matter of getting in the car and driving there. I realize now we should have driven the two hours to the airport right away but at the time we were just too confused to act.

It was like we entered a time warp that both drastically slowed down our experience of time and, at other times, sped it up. In this ever-changing state of the experience of time passing, the minutes seemed like hours while the day sped by without action. The next thing I knew it was 3 p.m. and we still had not decided what to do. Kate called from Phoenix and said we should get to the hospital in Hammond, Louisiana as soon as possible. Laura’s condition was dire and we were still in south Florida.

You might say my depression was getting in the way and in some ways, you would be right. But I had turned the decision over to Kate and was essentially waiting on her to determine what was going on and what to do. It was the worst nightmare of Kate’s life too, but at the time she was in the best position to figure out how to proceed.

The next five hours after Kate’s recommendation to go to the hospital were spent figuring out what to do with Laura’s dog Jack, looking for plane tickets, packing, etc. It turned out the best we could find was a flight that would not get us to the hospital until 4 p.m. the next day, so instead we left at 7:30 p.m. to drive the 12 hours it would take to get there by car.

Exhausted and now even more depressed, I drove until 1 a.m. to within an hour of Tallahassee and about half way to the hospital in Louisiana. I was down to stopping at every rest stop and exercising for a few minutes to wake myself up enough to drive some more. A security guard walked by and started a conversation, so I related my predicament. He told me I should stop in an hour when I get to Tallahassee because after that I would not find a place to stop for several hours.

We didn’t get to bed until after 3 a.m. Neither of us slept, but I did get some much-needed rest. We left at 7 a.m. and arrived at the hospital at around 2 in the afternoon.

Laura was on life support. It was clear that things were critical. She had suffered two heart arrests and was unconscious. The imminent fear was that the heart stoppages had caused some brain damage from lack of oxygen and she might not be the same when she woke up.

Understandably, my mom was freaking out. I was extremely upset myself, but this is where depression really became an advantage for me; I was so used to feeling distraught that I could function during it and help my mother through the nightmare.

At first, I tried to protect my mom from everything just like when I was first diagnosed and everyone tried to protect me from my triggers. My thought, and the thought of those who say we need to be protected from such difficulties, was that she “could not handle” the intensity and needed to be kept from hearing more bad news.

This protectiveness escalated to my scolding Laura’s friend Jen when she said something that set my mom off. Jen walked out and I felt so bad that it startled me into recognizing my error. I apologized to Jen. But more importantly, I realized I would serve my mom better by helping her experience the pain instead of trying to protect her from it. I realized at that moment that depression made me uniquely qualified to help mom through the trauma and the pain.

Everything changed for me after that. I allowed my mom and I to feel the full pain of the experience while using my familiarity with pain to hold us both together. We cried openly and often, while holding out hope that Laura would be okay.

As the days went on, I started to get a sense that things were not going to turn around. Tests were not confirming the worst but they were not indicating any improvement either. The hospital was frustrating all of us, but especially Kate because she understood it all, yet was having a very hard time getting the hospital to share data she needed to determine what we all should do. It was a horrible experience for all of us. All I could do was to help my mom and Kate through it.

Remember this nightmare started on June 2. We spent all day pleading with Laura to come back. I cried so much my eyes hurt. By Sunday, June 7, I had accepted that Laura was not coming back and now faced the arduous task of helping my mom accept it too.

Several doctors tried to describe the most recent findings (her brain was gone) but in a way that was difficult to follow or accept. Kate described what happened by comparing it to a bruise; the injury was there when you first got hit, but it took a day for the bruise to show up. Laura’s brain sustained catastrophic failure after the second heart attack but it took a week for it to show up on the tests. By Sunday, June 7, it was clear that Laura was going to die any time now. (It hurts as much writing it now as it did then.)

We called my two sisters and my wife and they all made arrangements to come Monday morning. Kate made arrangements to come too. The plan was to drive in the morning the one hour to the airport to pick them all up and hopefully get back in time to see Laura before she goes.

By now, I had become so in tune with my mother that I could hear her every breath. Neither she nor I got any sleep that night. We both knew tomorrow would be huge to say the least. Our emotions were as raw as I can imagine. I was visualizing a car crash with everyone I love in it. I was also doubting if I could make it to the airport and back without getting some sleep. I was in the deepest depression of my life and, although deep depression usually includes a lot of sleep, this bout did not.

We made it to the airport, and everyone arrived within two hours. When Kate arrived, she had already spoken with the lead doctor at the hospital. Laura had taken a turn for the worse. It looked like death was imminent. Her brain had been swelling (remember the bruise analogy) and that was putting pressure on her brain stem, the only part that was still functioning and keeping her heart pumping.

Kate suggested a drug that constricted Laura’s blood vessels in the hope that she would stay alive long enough for us to get there. The doctors agreed to administer the drug. It was an hour away and it didn’t look like we would make it. Fortunately, we did.

My mom went back and forth from accepting the inevitable and hoping against all odds that Laura would somehow miraculously come back. Kate looked at all the test data and said it was impossible, as her brain was no longer functioning. We all tried to get mom to accept the reality of the situation. It was excruciating for us all.

Even though Kate is a doctor and had seen this many times before, it was particularly difficult when it was her aunt Laura. She did phenomenally well but I helped her to get through it by talking with her, holding her, crying with her, etc. During that time I also had to facilitate conversations with doctors, help them present to my mother because they were doing a very ineffective job, support my mother and the rest of my family, and facilitate the all-important discussion of what to do next.

With the support of the whole family, it didn’t take long for us to decide that the right course of treatment was to let Laura go. Everyone but mom had accepted the inevitable and recognized that the longer it was delayed, the longer my mother would suffer the agony of holding on to hope in a hopeless situation.

No matter how many times we would convince her that Laura was dead, she would soon bounce back to the thought that perhaps she could come back. You could feel her heartbeat when holding her hand so it sure did feel like she was alive. The doctors tried to explain it in medical terms but to get the point across, I finally had to tell her the situation was “like a chicken with its head cut off.” She got it.

When my mom finally did decide it was time to let Laura go, the hospital added another tragic waiting period. They were about to do a shift change and we would have to wait a couple more hours to get started. I could not imagine my mom making it through the night, as we could not leave Laura’s side and the pain was becoming unbearable for everyone.

During the wait, my mom continued to hope that Laura was alive. It was a living hell for all of us. In spite of the doctor’s request that we go to the waiting room while they perform the procedure, all six of us decided to stay. Why? Because I was the only one high functioning enough to know where we needed to be.

The crew came in to pull the tube out and let Laura die naturally. I met with them before we started and told them of our plans to be right there during it. I talked about what an important event it was for us and how we were honored that they were part of it.

Mom and I held Laura with Kate above holding us both. I knew the procedure would be ugly so I put our heads on Laura’s stomach while they pulled the tubes and cleaned Laura up.

When I knew they were done, I said, “Let’s say goodbye to Laura and tell her how much we love her.” I held mom and we both cried with everything we had while we expressed our love and goodbyes. Mom recalled many wonderful moments in a beautiful outpouring of love and pain.

And then Laura’s eyes started to open. I was afraid mom would freak out so I said, “Look mom, she is saying goodbye one final time. Tell her how much you love her again.” Mom poured her heart out while I held them both and looked into Laura’s eyes one final time.

The moment lasted only a few seconds, but to me it seemed like hours. To Kate too because, although she thought my improvising was genius, she feared Laura could continue to hang on for minutes or even hours before her heart actually quit beating. Fortunately her heart stopped right away and Laura was gone. (I wasn’t exactly improvising because I was describing to her what yogis like myself believe happens when one dies; they look up and their soul leaves their body. I was describing what I was seeing at the time.)

This was the most painful thing I have ever done. At the same time, it was a beautiful experience that I am glad to have been a part of. It felt to me like I was witnessing a miracle and helping the others to see it, too. It was like we were actors in divine play and had delivered an incredible performance. It probably makes no sense to most people but I was in a state of ecstasy the whole time and the pain was just as much a part of it as the “high” that some describe during their own ecstatic experiences.

When Laura had gone, I helped my mom settle down and I turned to one of the clinicians to started a philosophical discussion with her. She agreed that being a part of it was very special for her too. She was moved by how freely we expressed ourselves and how I was able to manage the experience for everyone to be fully present to it.

As we started to leave the critical care unit, Pat took my mom downstairs while we gathered our belongings and prepared to leave. On the way out, the nurse stopped us with some more forms to fill out. While looking over the forms, I heard mom screaming and looked up to see her running down the corridor towards Laura’s room. She was yelling about how we had left her and that she was not going to leave Laura.

I ran behind her to the room where she climbed into Laura’s bed and held her tightly. She was frantic and in tears while saying ”I will never leave you” to Laura. She was in a total panic attack like I had never seen in her before.

I held mom and told her I would stay by her side. I said “We can stay as long as you like and I will make sure nobody keeps you from Laura.” A minute or so later, mom got up looking completely normal and said “Okay, we can go now.” It ripped my heart out that I got distracted by the hospital and was not aware of mom’s needs for even the few minutes that caused her to go into a panic attack.

Here I was in the deepest depression of my life and performing the most painful task I can imagine, while helping everyone else more fully experience it. That is what depression gave me and why I consider it an advantage to have learned to function during depression and see the beauty in it while it is happening. That advantage helped everyone involved. To me, that is the very definition of high-functioning.

But my work was far from over. I had to stay an extra day to help Kate through it before flying home to pack and later return to Mom’s for the funeral. I gave the eulogy at the funeral and facilitated as many people as I could for them to stand up and say something about Laura. It was another painful, yet beautiful, experience where high-functioning during depression was a critical element.

As everyone left over the next few days, I was alone with Mom and then the hard work began. I moved into Laura’s room and started helping my mom though the grief. All the while I am haunted by the thought that my mom will likely die before having a chance to even come to terms with her loss.

I stayed with my mother for the next month to help facilitate her processing of this tragic event. While others focused on the all-important role of creating distractions so she wouldn’t think about it all the time, I was free to help my mother look deeply at the experience.

For example, while driving down the street one day, I discussed with her the movie analogy (mentioned above about us being actors in a divine play) and her response was, “We sure played our hearts out, didn’t we?” I had to remind her of that discussion a couple of weeks later and that time she just smiled and said, “Oh yeah” in a manner that said, “I got that.” That is a great sign of progress to me.

My own extreme depression gives me a heightened awareness of the pain other’s are experiencing and I use that to moderate the frequency and intensity of the help I give to others. I don’t always get it right, but my openness over the years has given those around me a better willingness to express themselves. For example, one night I showed mom a picture of Laura and openly cried. At first she was into it and cried with me, but in a couple of minutes, she said that it was too hard for her to face at night just before bed. I know now to only address such topics with her during the day and when she is showing signs of strength.

I also had daily conversations with Kate and spread out the times when we would deeply discuss the experience and her current progress with processing this difficult challenge.

It has been a very interesting experience for me. I feel like I processed the pain in real time and was not only comfortable performing my functions but was immediately comfortable with what was happening. I had no need for any further processing. That does not mean that I don’t regularly look at a picture of Laura or some other reminder and freely cry and experience the pain.

But when I share some of the details of the experience and someone expresses sorrow, I feel that they should be happy at the prospect of being able to have the same experience. I think when people talk about “processing the pain”, they’re really talking about prolonging the suffering that is caused by the resistance to feeling it fully. They need to “process” the experience long enough to come to that realization. Most never do, although after about eight months or so they get used to it. Everyone I have talked with says they never really get over it.

I have not had a lot of time to focus on my work, but I have been able to continue the live classes, the scheduled one-on-one conversations, and keep up with all of the requests that came in. I have spent a lot of time thinking about and writing this document, too.

If I did not understand how to function during depression or, worse yet, still clung to the notion that it is not possible, I would have been a burden to my family instead of an asset. Most people fear they will break down and become a burden on those around them or that their bipolar loved ones will break down and add to the already difficult situation.

While the whole episode is tragic and the most painful experience of my life, it is also the most important. It validates everything I have been saying for the past several years and points to what we are all capable of.

When I mention I see it as one of the most rich and beautiful experiences of my life, I know that sounds incomprehensible and impossible to do. This may frighten those who cannot yet accept the possibilities. But you can’t imagine what it can be like if you learn how to function instead of just trying to keep depression away and avoid the kind of circumstances that might trigger it.

It is my sincere hope that sharing this painful episode will help some to accept that it is possible to function highly during depression and inspire you to begin the journey to making it a reality in your own life. I am here to help when you are ready.

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Tom Wootton <![CDATA[No Longer At The Mercy Of Our Moods]]> 2015-10-08T21:19:24Z 2015-10-08T19:30:18Z I recently watched a movie about the life of Jackson Pollock. (Sony Pictures, Ed Harris, 2000) It left me thinking about how a generation of young artists were taught the mythology of the Abstract Expressionist painters, not just the concepts of their work. What got passed down along with the art history was the Modern American version of the myth of the tormented artist. The same mythology has been used in mental health.

Woolf“At the mercy of her moods” was a very 19th century expression. That phrase along the the term “hysteric” was often used as justification for why a woman could not achieve or do certain things. Emotion and mood were used to keep women from equal status with men as they were portrayed as weaknesses instead of the strength that they actually are.

The expressions were also applied to 20th century artists. The implication in all cases remained that the person was somehow taken over; that mood was stronger than their ability to handle it. It was someone of a sensitive, delicate, and susceptible personality who was prone to these episodes, illnesses, or disorders. The literature about artists in the 19th and 20th century is replete with these concepts.

Kay Jamison makes the correlation between the descriptions above and manic – depressive illness, or what had come to be diagnosed as bipolar disorder, in her work “Touched by Fire” (1993). She adopted the descriptive framework for herself and imparted it to a generation of psychiatrists, psychologists and patients. I believe these descriptions are counter-productive and should be relegated to history, whether they apply to an artist or a bipolar person.

We are in an age where meditation, yoga practice, anger management, cognitive therapy, and stress reduction techniques are everywhere. The central idea of all of these practices is that mind, body, mood, exercise, diet, and relationships are all considered as part of the whole. The whole person is aware of the influence of one system upon another in striving for optimum well-being.

The mind/body relationship is expressed freely throughout the culture in advertising and colloquial speech. While we may not be well versed in the subtleties of truth presented to us by the wealth of ancient wisdom, we are pretty good with the buzz words and the basic concepts.

As a culture, we are learning to separate thought from action and stimulus from response. We are learning practices that encourage the acknowledgment of body, mind, emotion, and soul — yet encourage us to be guided by wisdom in all circumstances. This makes it less likely, less acceptable, and less necessary that any of us be at “the mercy of our moods.” We are evolving beyond that as a culture. We should not be held back by a 19th century view of ourselves.

Some say that bipolar or depression is too intense to be fully functional during episodes. My experience, and that of many others, is that intensity has much less to do with it than understanding and training. When we seek understanding instead of just trying to make it go away, we find that we can separate the experience of physical, mental, emotional, and spiritual intensity from our reactions.

Those of us who can function fully during our most intense experiences all say it is because we have chosen to understand them. The more we experience such freedom, the less we are at the mercy of our moods.

Have you found that you can function in a state that once had you at its mercy? Please share it with us.

Tom Wootton <![CDATA[The Most Important Thing To Know During Bipolar Episodes]]> 2015-04-28T02:46:13Z 2015-04-28T02:46:13Z phoenixBipolar disorder is an incredibly complex condition. It can be approached from so many angles that you might specialize in any one of them. Unfortunately, most of the specialized approaches will do you no good when in the throes of an intense mania or depression. The only thing that matters at that point is whether your specialty is knowing how to function during the state.

I find many of the points of view about bipolar disorder to be immensely interesting. The biological aspects are fascinating; the research that has looked at the inner workings of the brain, the electrical and chemical reactions within it, and the influence of external substances is fascinating. Researchers have found some truly amazing things through that approach and it has made a huge difference in many peoples lives. But there are so many other approaches that I find just as interesting and have proven equally fruitful.

Many people have devoted their lives to finding the causes of mania and depression that are outside of the neurological aspects. They focus on the triggers, both internal and external, that have a tendency to bring on episodes. This work has been a tremendous benefit in helping people to avoid the things that create the states in the first place.

Others have chosen to focus on the cognitive thought processes that are apparently disordered during episodes of mania and depression. Their idea is that if we could just think right we would not be having the episode in the first place. These cognitive therapies have proven very effective at reducing symptoms when they occur and helping to keep them from recurring as frequently.

And there are so many more things that we can know. We can study nutrition, exercise, sleep, and any of the physical, mental, emotional, spiritual, social, and career/financial aspects of the bipolar condition. A better understanding in any of these areas can lead to longer periods of remission and faster recovery from even the most intense periods of mania and depression.

But none of these types of understanding have successfully kept mania and depression from happening. And what’s worse, they have often lead to a misunderstanding about our ability to actually function during those states. Far too often, a little understanding about the chemicals in the brain have led to a justification of the false notion that it is impossible to function during intense periods of mania and depression.

There is one specialized type of knowledge that trumps all of the others during states of mania and depression, knowing how to function while in the state. While all the other types of knowledge are interesting, knowing how to function can literally be the difference between life and death. Unfortunately, due to justifications like the one in the previous paragraph, this type of knowledge is not generally taught and is therefore in short supply. It is truly a case of the things that you do know getting in the way of the more important things that you should know.

I am not saying that we should stop pursuing knowledge in all of the other fields. Such knowledge has clearly proven beneficial. It’s just that it has never been able to produce the outcomes that knowledge about how to function during states has. Those who hold such knowledge have been able to function well in states that people without such knowledge think is impossible.

Although I cherish learning more about every approach to bipolar disorder, I would much rather understand how to function during states even if it meant I knew nothing about the other aspects. Learning how to function during states should be the first thing we teach those who experience them. We should be recognizing those of us who do know how to function as the real experts in the field and make that expertise the most important criteria when we hold people up as examples to listen to.

Those who develop an advanced understanding of other aspects without having the ability to function during their own states should be dedicating their efforts toward learning this more important aspect instead of using their limited expertise to justify their incorrect assumptions about what is possible. Those who cannot function when in states of mania and depression should be learning how instead of quoting those who cannot as justification for refusing to try.

Are you ready to learn how to function during mania and depression? Or have you convinced yourself it is not possible based on partial knowledge?

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Tom Wootton <![CDATA[The Gifts of Depression]]> 2015-04-13T16:51:25Z 2015-04-13T16:31:16Z I have been trying to let everyone know that it is possible to find value in all states, including depression. The following was written by Margaret Miller and it so captured what I have been trying to say that I asked her if I could share it. I hope you love it as much as I do.

Ellen Nadeau

Manic-depression left a decisive scar across generations of my family. For each of us who bears that mark, moods have conferred advantage, as well as disability. I don’t mean the energy of hypomania. That’s a fun enough ride, while it lasts. But it’s nothing compared to the unexpected and enriching gifts of depression, like patience, humility, insight, and empathy.

Once I got a handle on surviving my shifting moods, I began to think about using them. This came into sharp focus while I was taking Tom Wootton’s Bipolar IN Order class. Most fundamentally, the class offers a framework for deepening our awareness of mania and depression, and it demands a formidable level of introspection. For most, the eight-week experience was a bit like putting on prescription lenses after a lifetime of blurred vision. What we saw differed from person to person, but the excitement was shared by all.

A good measure of my excitement has been in response to Tom’s explicit belief that our moods—ruinous and painful as they sometimes are—have value. I’ve thought about this for years, but I never tried to articulate it. So I dug deep and wrote a lengthy post to the class discussion forum, trying to express my experience:

During my first year at university I thought a lot about how I could succeed across the broad range of my responsibilities—a job, reading, essays, exams, meaningful friendships, and, most importantly, thinking. I was aware that my capacity for effective work changed hour to hour, and I became fascinated by capitalizing on the shifts.

Take Chinese, for example. In addition to an hour in the language lab, the Chinese teacher required us to write characters for an hour every day. I knew I could functionally complete the writing practice anytime (after all, others did it between bites at meals). But I wondered how I could maximize the learning by picking the right time and the right frame of mind for the characters to take hold. I discovered that if I practiced writing characters just before I slept, they stuck. That liminal hour was great for non-linear thinking. The characters’ shape, rhythm, and recurring patterns sank in more deeply and made more sense to me over time.

Similarly, I recognized that evening was best for reading. The afternoons belonged to writing, but I found I could edit and revise my essays pretty much anytime. Most important was the very first hour of the day. My professors and peers were demanding, and I quickly understood that simply doing my assignments wouldn’t prepare me for class. So I got into the habit of spending at least 30 minutes before breakfast looking over my notes and, well… thinking. That half hour had nothing to do with cramming; it was about taking in the view from 30,000 feet. The clarity of that view depended upon the brainwork of sleep, when the dust settles and patterns emerge.

Of course I was 18, so my adherence to this schedule wasn’t perfect… But the important thing was that I understood and, over time, got better at thinking about thinking.

In the past two decades, that approach to studying has become a tool for managing mania and depression. In other words, at university I sought to understand the varying capacities of my mind so I could study at a higher level. Later I began to consider my mind’s assets and limitations across a broader time frame—weeks of hypomania and months of depression. Instead of “Is this the best time to write a complex essay?” I asked, “Is this the best time to take risks in a relationship?” and, “Am I really up for a demanding assignment?” or, “How about I forget work, and paint the baseboards instead?”

The backdrop to this cultivation of awareness included many years with a fiercely smart psychotherapist, 20 years of lithium compliance, and the daily joys of a strong marriage and family. Put another way, I’m stable. And that gives me room to cultivate an appreciation of the gifts that come with manic-depression.

So this was the dynamic: An awareness of mind and mood helped me to discern the best use of my mind at any particular time. Eventually that flipped: I discovered that I can sometimes induce the right frame of mind and mood to align with whatever my focus must be at that time. This is quietly mind-blowing. Of course, I’m still like that 18-year-old kid—I have a sense of how it works, but I don’t always do it.

The transition is easiest in the direction of hypomania, but it is always more productive in the direction of depression. In both cases, the shift can last for days, and the gateway experience is usually somatic. That is, by sinking with an intense focus into certain, wholly physical experiences I can significantly shift my moods. A few hours in the ocean or hard hiking in rain or wind can induce extended periods of optimism and motivation, as will that specific propriaceptive pleasure of rock climbing, shifting my weight from toes to fingers, body embracing stone. Of course the most reliable gateway to hypomania is sleep deprivation. But for me at least, that works a bit too well.

I can induce a measure of depression—or at least a few productive attributes of depression—by surrendering to certain slow tactile experiences that demand focus, such as clay, dough, or sanding. Sinking into that mood changes everything. As my mind slows, my writing improves, as does my capacity for meaningful connection with others. Recently I’ve been thinking about a more profound shift toward depression through a practice that I discovered in childhood while tracking and watching for wildlife.

My deepest solitary pleasure as a kid was climbing a particular maple tree near a small stream and sinking into a sort of alert trance—waiting and watching to see who/what might walk beneath me. Sometimes my mind would race, but more often my thinking derailed and stalled. My hearing became more acute, then it seemed to switch off. Eyes open, I saw everything, but nothing. I felt blind to all but movement, all colors washed together. I saw deer, rabbits, raccoons, all manner of birds, snakes, and, once, a family of skunks. Eventually the goal of seeing the animals became secondary to my craving for the stillness of mind, and the animals felt like an intrusion into that state.

Sometimes I stayed in that tree for hours, shaking myself out of the trance only when night’s chill caught me or I heard my mother ring her 10-pound dinner bell. Returning to the ground (in every sense) was awkward. I thought of it as climbing down without a body, because my limbs felt stiff and alien. I always came away from that tree feeling full, but absolutely alone, quiet, empty of language, and slow to recover from the dissolution of self. This state of mind could last for days, during which I felt charged with a sort of richness, yet utterly lonely and quite drained. These are some of the things I feel in depression, still.

I was 22 before I connected my experience in that tree with any notion of meditation. And nearly 30 more years passed before I started wondering if the elements of depression unleashed in that state might hold untapped value. I’m not talking about the simple and sustaining meditations that dot my every day. I’m wondering about a practice of deeper, less comfortable, and more unsettling meditation practice. How would I emerge from that experience? How might that state enrich my writing, my relationships, my moods?

I don’t fully understand this practice, but the broader points still hold: I believe my moods have value (even as they cause me pain), and I recognize that I can profoundly shift them. Obviously this is a work in progress. The operative word here is work, and I’m not always up for it. This requires a willingness to be engaged and a singular presence of mind. It isn’t casual. And to state the obvious, the practice requires mental stability. On occasion, of course, stability is my only goal. Other times, I’m just lazy. But having even fleeting moments of success with this experience has utterly changed my conception of manic-depression. And it strengthens my resolve to keep practicing.

Margaret Miller is a Bay Area writer and editor.

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Image Source: Ellen Nadeau

Tom Wootton <![CDATA[Confusing How and Why Is Prolonging The Suffering in Bipolar Disorder]]> 2015-03-05T20:37:58Z 2015-03-05T20:05:01Z Screen Shot 2012-04-09 at 12.15.01 PMDo you suffer from bipolar disorder or know someone who does? If you want to end all suffering you need to understand the difference between why and how. The reason so many people are still suffering is because this difference has not been made clear enough.

Why do people go to a psychiatrist? To end the suffering. Why do they go to a therapist? To end the suffering. Why do they engage in any treatment regimen? To end the suffering. We don’t go there for medicine, for therapy, or for any of the other tools that we are given. We go there in hopes that they can help us remove the suffering.

And we didn’t go there seeking remission for mania or depression. We went there to remove the suffering. We were told, though, that remission and the tools that aim to produce remission is the way to do it.

Does remission work? Perhaps temporarily. But in the end we must admit that the answer is no. And that is the conclusion of the biggest research on bipolar disorder ever conducted by the National Institute Of Mental Health. The research is called STEP-BD and this is what they say: “According to the researchers, these results indicate that in spite of modern, evidence-based treatment, bipolar disorder remains a highly recurrent, predominantly depressive illness.” In other words, even if remission did end suffering temporarily it will not remove it permanently.

But somewhere along the line they confused ‘why’ (remove suffering) with ‘how’ (remission) and made the ‘how’ the central focus of treatment: “This finding may indicate that complete symptomatic remission, i.e, the absence of all symptoms, should be the goal of treatment, as it is in non-bipolar, major depression.” In other words, since remission does not work you need to accept periodic suffering as the best possible outcome.

If you ask a therapist why she helps people to create remission she will say because that’s what they came here looking for; “I am just helping them get what they want” is a very common answer. They are not in the business of defining what people want, but in providing methods to help people achieve their own desires.

The problem is that the patient, along with everyone else, is confusing ‘why’ (end suffering) with ‘how’ (remission). We all know ‘why’ people are seeking treatment. They want to end the suffering. Although it is believed that remission is ‘how’ to end the suffering, remission is in reality just an ineffective tool and we need to stop seeing it as the or the goal of treatment. The goal of treatment is to permanently end all suffering. Why can’t they see that?

I used to suffer tremendously when I became deeply depressed. And when I became highly manic the people around me suffered right along with me. I was told, like everyone else, that the solution to the suffering was remission and I tried all of the methods I could find to produce it. I got temporarily relief, but the states inevitably came back just like the STEP-BD study predicts and I was once again debilitated and suffering each time. During the next remission, which might have come on its own anyway considering the cyclical nature of bipolar disorder, I found myself living in fear of the next return of mania or depression and wondering how it will again destroy my career, relationships, and life. I was getting temporary relief but still suffering even during remission.

I eventually figured out that remission will never work and it was time to try something different. As the saying goes – insanity is trying the same thing over and over again and expecting different results.

So I tried the opposite approach; thinking that perhaps I could learn to function during my inevitable future episodes and at least keep my life from falling apart each time. Everyone told me it was impossible, but I was not going to try yet another remission-based method that I knew was sure to fail.

It certainly wasn’t easy. But the more I tried and the better I understood, I was eventually able to function fully during my deepest depressions and my most extreme manias. This, of course, created an incredible difference in my ability to maintain my work, my relationships, etc. But more importantly I no longer suffer. I still feel the pain of depression in my body, my mind, my emotions, and my spiritual life, but the suffering has completely gone. I no longer suffer from mania or depression because there is no level of intensity where I suffer from it.

But more than that, my ability to be deeply depressed while functioning fully and not suffering carried over into all aspects of my life. When I feel tremendous pain like the loss of a loved one it has nothing to do with mania or depression, and it does not cause me to lose functionality or suffer. And isn’t that what we were all looking for in the first place?

I know it sounds strange to say that the pain is still there and I do not suffer from it, but that idea has been presented throughout history as the only real solution to suffering. The Buddhists say “pain is inevitable; suffering is optional” and countless saints of all faiths have said a similar thing. Saint Teresa of Avila said “The pain is still there. It bothers me so little now I feel my soul is served by it.” The concept is also central to Saint John of the Cross’s “Dark Night of the Soul” where the pain at the hand of his torturers was the very thing that brought him to the end of all suffering.

I have since taught thousands of people the methods that I have developed and have helped produce a growing group of people who no longer suffer either (or have at least substantially reduced their suffering while functioning far better in all states). But when we mention our success, instead of being asked how to do it we are more often told that it is not possible and the only solution is to continue to confuse the failed ‘how’ (remission) with ‘why’ (end of suffering).

An interesting corollary observation is that many people say they have tried everything and therefore know that nothing works. But they are confusing a bunch of tools whose aim is to create the ‘how’ of remission with the ‘why’ of ending suffering and they don’t realize that I am talking about an approach that they have never tried. Their claim that it is impossible is based on the very real notion that it is impossible to end all suffering through remission. Everything they have tried has of course failed, as the researchers concluded in STEP-BD.

And it’s not just that remission doesn’t hold. Even if it was successful, you would still periodically suffer for the rest of your life. If you never had another mania or another depression, you would still face times of intense pain and suffer during them. If you want to permanently end all suffering you have to understand the difference between ‘how’ and “why.” And when you understand that difference you will understand why the current treatments don’t work and never will.

Or perhaps they are confusing their failed efforts at getting out of bed (or some other activity) with the methods that we use to actually accomplish it. They have tried to get out of bed during their deep depressions, but since they didn’t know how they confuse their attempt of using sheer willpower with the far more sophisticated tools that I have been teaching. In this case they perhaps get the ‘why’ right but don’t know ‘how’ and therefore declare it impossible while discounting the very real proof in those of us who have shown that we can.

If you have accepted that mania and depression are coming back it is time to try this new approach. You don’t have to take my word for it but can prove it in your own life. You can start learning how to function during it instead of waiting in fear of the next episode. You will find next time that it is harder than you thought but with time and effort you too will understand how to function during manic and depressive states and that will change your life forever.


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