Together at the Poles

Managing Bipolar Disorder Versus Muscling Through It: Lessons From a Recent Episode


As those of you from the Facebook page probably know, I’ve recently taken a medical leave for a mixed hypomanic episode that started at the beginning of July. It was in many ways a frustrating experience, and in no ways a pleasant one (though I did have some ideas at the end that I’ll be using in some future writing). I decided this time to really keep a watch on what was going on in the episode, and see what I could learn from it. I did pick up a few things, so I thought I would share them today.

Symptoms Build On Each Other

While each symptom builds on others, getting a handle on one symptom can help improve the rest.

Victoria Falls

Public Domain

One thing I really noticed this time is the way that the episode really cascaded. By this, I mean that, while at the end of the day an episode is a problem with my brain, each symptom of the episode really built on the next. In the end, noticing this problem actually helped me get out of the episode, or at least manage it as it went along.

The whole episode started when I hurt my back at the end of June. The injury itself didn’t cause the episode, but I wasn’t able to sleep because of the pain. This really started the cascading effect. After about four days of sleeplessness, my moods started to fluctuate wildly. I was moving from elation to depression and back again. Plus, I was getting the mood that goes along with mixed states, a kind of devil-may-care depression that can lead me to act in ways I really regret.

The moods, however, built on each other. Even once I’d gotten control of the back pain, my hypomania led to more sleeplessness, which in turn led to more instability in my mood. My lack of sleep and fluctuating moods made it very hard to get any work done, as I couldn’t focus (at one point I forgot my own phone number). This led to a great deal of stress, which in turn accentuated the sleeplessness and the fluctuating mood.

However, I really noticed how this cascading was happening, and resolved to get a handle on it. The first thing was sleep. My psychiatrist gave me something to help with that, and I started to take it nightly. My sleep wasn’t perfect, but I went from three hours to about six, which seemed to be enough to eliminate that element of the symptoms. That, in turn, helped me focus, which removed some of the stress and so forth.

The positive thing about cascades is that they can work in both directions. While each symptom builds on others, getting a handle on one symptom can help improve the rest. So, getting a handle on my sleep, albeit with sleeping pills, helped alleviate the rest of the symptoms. Similarly, getting away from work-related stress (which I’ll discuss in the next section), helped with the sleeping.

It’s Okay To Take Time off

My problem was that I had never really conceptualized my bipolar disorder as an illness, or rather as a chronic illness, which is what it is.

Sick in Bed

Source: Patrick de LaiveCC BY-SA 2.0 (Not a photo of me)

I also did something this time that I’ve never really done before: I proactively took time off of work. I’ve missed some days of work before as a result of bipolar disorder (though less than because of the flu or partner birth leave), but usually I take the “never take a sick day unless absolutely necessary” approach to my illness. I’ve muscled my way through more episodes than I can count, which I guess is okay for my employer, but not really good for me.

However, this time my psychiatrist basically ordered me to take a medical leave. I came into her office ranting about seven different things in no particular order. She wanted me to take a week, but I bartered her down to four days. I sat down for a couple hours writing emails to cancel all my appointments and my class for that week, and then just stopped working. This helped me in managing the cascade effect I mentioned earlier.

My problem was that I had never really conceptualized my bipolar disorder as an illness, or rather as a chronic illness, which is what it is. My basic approach was that, unless I’m actually in bed unable to move and contagious, it was wrong for me to take any time off of work. Actually, if my psychiatrist hadn’t basically commanded me to take time off, I probably wouldn’t have this time either.

However, taking the time off really made me realize that I am allowed, indeed my contract provides that me the right, to take time off from work for flare ups as a result of chronic illness. I think part of my hesitation was thinking, “If I take time off for a chronic illness, it indicates that I am an inferior worker, since it isn’t something that I can fix, and that means I’m perpetually a liability.”

Nonetheless, chronic illness, too, is a part of what sick days are for, and there’s nothing wrong with taking them if they will genuinely help me manage an episode. That’s why they’re in the contract. If things got really bad, I could take an extended leave (as I did in 2000), but I shouldn’t feel guilty for actually taking sick days off when my physician tells me to do so.

Others Can Help, But I Need To Be Fair To Them

What I really needed was to distinguish muscling my way through an episode and successfully managing it.

I was very happy with the way that people were supportive during the episode. Several people picked up some slack for me, and I am very grateful. One important thing I realized was that people are actually often willing to accommodate an episode of mental illness in much the same way that they will accommodate an episode of a physical one. I guess this goes back to the “sick role” that I’ve discussed before. The sick role can be annoying, but it has its benefits.

However, I also saw the ways that accommodating me, while other people may even on some level be obliged to do so, can really put a strain on people. I noticed the ways that people were helping out, but that it was difficult.

I think I’d been caught in a kind of false dilemma before. I thought that either people were obliged to help me or I was obliged to muscle my way through. However, what I really needed was to distinguish muscling my way through an episode and successfully managing it. I knew that I could count on people, but I also wanted to improve the situation so that I could take some of the strain off of them.

This gave me some of the motivation I needed to put a stop to the cascade. In fact, muscling through wasn’t ultimately good for the people around me, as it extended the episode or at least made it get worse and worse. I realized that people really wanted to help me manage the situation, and I guess my part of the deal was to actually try to manage it.

As a result, I realized that other people are actually willing to help when things get out of hand, and that I really wanted to manage things so that I would need as little help as possible. It’s a delicate balancing act, but what I really discovered is that it’s not absurd to try to balance it.

For the Future

My episode isn’t actually over. On Saturday, I had insomnia again, for example. I imagine that I can’t actually stop an episode. After all, there’s a problem with my brain. However, I have learned some things that helped me manage future episodes.

Managing an episode is not the same thing as muscling through one. Managing an episode involves trying to figure out how the symptoms are cascading into each other, and finding point where I can stop or ameliorate the cascade itself. It involves allowing myself to take advantage of the supports around me, while at the same time taking that as a motivating factor for managing what is going on.

This episode wasn’t especially severe. I’m not sure how all of this would work with a more severe episode. However, I think that even in those cases, this can serve as a useful paradigm.

6 Responses to Managing Bipolar Disorder Versus Muscling Through It: Lessons From a Recent Episode

  • Hi Daniel,

    Firstly I must say it takes a lot of “muscle” to take responsibility for an episodic period…so bravo!! If we can realize that every episode is a potential teaching and learning moment, we can get the best out the worst.

    I like your image of the cascade. I have, for a while now, seen your cascade as the vicious circle and the delicious circle. We can’t allow its vortex suck us down…learning, coping, and understanding that this too shall pass can, as you say, reverse the flow.

    I too have had extended leaves in the past, before diagnosis when the pain and suffering seemed like it would never go away. Since returning to work, I have taken two days off because I knew that my brain was off, not right. The administration was very supporting…to the point I was not even cut pay despite having no sick days left in my bank.

    If we can’t help ourselves, than nobody can help us. We must take the first steps…always. It’s an obligation to ourselves.

    I am very happy that you have taken another step forward, and even more pleased that you have shared your learning experience.

    All the best,
    Michael

    • Thanks, Michael. I think at the end of the day, it’s good for our employers too if we get well. It just doesn’t always feel like that at the time :).

  • Hi Daniel

    Thanks for sharing your journey with us. Its good to read that you are improving again. I really admire the way you deal with your BP. And of course charting the course for the rest of us is a very generous and giving act.

    I used to go around a lot of different sites and fora looking for a place to learn more about how others deal and cope with their BP. Your site is a place of calm and compassion. So I don’t have to go all over the net any more to find some shared experiences.

    On a humorous level I would prefer to follow your site etc via Facebook. I did at the start but my wife got some concerned phone calls from relatives because they were reading me sharing real inner personal stuff. I am a tech idiot so I thought only people linked to your page could read it, but it was available to anyone linked to my page. I didnt mind much because I was just being honest. But others felt I should protect myself more. So now I go through the longer process of leaving comments on the website. But just know that you have a very grateful person in Ireland for your brave work in helping others cope with BP.

    Keep up the great work.

    MacMurphy from little old Ireland ;-0

    • Thanks, MacMurphy for the great comments. That’s a good point about privacy on Facebook. I’ve just thrown caution to the wind on that one (I’ll often share posts from the blog with my friends), but that’s a good heads up.

  • thanks for your honesty daniel.just started attending a psychoeducation group for bipolar persons at lagan valley hospital here in lisburn northern ireland.I have been bipolar since 1990 and am always interested in what helps us through and how we can learn from it,have typed in to you before,i retrained as a counsellor, i do find i need purpose and stimulation but its balancing that with the danger of getting too busy, i wish you well ,

    • Thank you, Audrey :). Peer and other support groups can be very helpful. I’ve written a page about my own experiences, if you are interested, here.

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Psychotherapy from Daniel

Daniel Bader, Ph.D., RP (Qualifying), CCC

Daniel Bader, Ph.D., is a Registered Psychotherapist (Qualifying) and Canadian Certified Counsellor specializing in bipolar disorder, offering in-person psychotherapy in Kitchener, Ontario, and online and telephone psychotherapy within Canada.

To book an appointment with Daniel, please visit his Psychology Today profile.