Category Archives: Mental Illness

Suffering Produces Perseverance

I do not wish I never had trich or bipolar disorder. Although both come full of pain and suffering, there is another side. Working through my struggles has made me the person I am today. I don’t know if I would have have the same faith, spirit of perseverance, or compassion. I think my best traits have been developed through my pain. God did not cause my suffering, but He will use it for good.

I still hope to be pull free, but I am happy now as I am. My moods are relatively stable, and I have settled on a set of meds that works for me. I still pull, but it does not rule my life. Yes, I do spend a considerable amount of time practicing awareness and coping strategies. However, I do not feel like less of a person because I do this or because I am missing some hair. Everyone has some form of struggle in their life. Learning to use that suffering for good is the key to moving through it and finding a purpose for your pain. I read this devotional earlier today and thought that it lined up so well with the verse that has been on my heart, Romans 5:3-4.

Your Pain Often Reveals God’s Purpose for You

BY RICK WARREN — NOVEMBER 25, 2014

Your pain often reveals God’s purpose for you. God never wastes a hurt! If you’ve gone through a hurt, he wants you to help other people going through that same hurt. He wants you to share it. God can use the problems in your life to give you a ministry to others. In fact, the very thing you’re most ashamed of in your life and resent the most could become your greatest ministry in helping other people.
Who can better help somebody going through a bankruptcy than somebody who went through a bankruptcy? Who can better help somebody struggling with an addiction than somebody who’s struggled with an addiction? Who can better help parents of a special needs child than parents who raised a special needs child? Who can better help somebody who’s lost a child than somebody who lost a child?
The very thing you hate the most in your life is what God wants to use for good in your life.
The Bible says in 2 Corinthians 1, verses 4 and 6, “God comforts us in all our troubles so that we can comfort others. When we are weighed down with troubles, it is for your comfort and salvation! For when we ourselves are comforted, we will certainly comfort you. Then you can patiently endure the same things” (NLT).
This is called redemptive suffering. Redemptive suffering is when you go through a problem or a pain for the benefit of others.
This is what Jesus did. When Jesus died on the cross, he didn’t deserve to die. He went through that pain for your benefit so that you can be saved and go to Heaven.
There are many different causes for the problems, pains, and suffering in your life. Sometimes the stuff that happens you bring on yourself. When you make stupid decisions, then it causes pain in your life. If you go out and overspend and buy things you can’t afford and presume on the future, and then you go deeply in debt and lose your house, you can’t say, “God, why did you let me lose my house?” You can’t blame God for your bad choices.
But in some of your problems, you’re innocent. You’ve been hurt by the pain, stupidity, and sins of other people. And some of the pain in your life is for redemptive suffering. God often allows us to go through a problem so that we can then help others.

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Anxiety

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Anxiety is a major trigger for my pulling and mood swings. I used to suffer from panic attacks. I have learned to manage my anxiety before it gets to that point.

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When in therapy, I learned to chart my anxiety level on a scale of 1-10, with 10 being a panic attack.  This chart included information on what happened before the episode and the steps I took to calm down. The charting process helped me understand underlying  factors and early signs of anxiety.

The most helpful strategies for me are very simple: take a 5 minute break, pray, or take 10 deep breathes. There are many other relaxation strategies I use when I have more time. Some of these include progressive muscle relaxation, calming music, tea, a bath, relaxation color books, fiddle toys, stress balls, head massager, etc. 2014368078-Anxiety

I read this today and thought it was helpful for anyone struggling with anxiety. I’m definitely adding these verses to my toolbox. 🙂

3 Simple Verses for the Anxious Mom

Here are 3 simple verses to reflect on when anxiety creeps in:

1.  Psalm 34:4 – I sought the Lord, and he answered me; he delivered me from all my fears.

How can you seek the Lord?  Through worship, prayer, and Bible reading.  Focus on these key disciplines during your most anxious moments, and He’ll show Himself strong.  He’ll either deliver you from the fear and anxiety, or show you His strength by carrying you through.  He’ll give you the wisdom to move past fear into a place of peace.

2.  Psalm 86:15 – But you, Lord, are a compassionate and gracious God, slow to anger, abounding in love and faithfulness.

His compassion is for YOU. He is gracious towards YOU. He is not angry with you, but rather He loves you with an extravagant love and he is faithful to see you through your struggles!

3. Philippians 4:11 – I have learned to be content whatever the circumstances.

There are times I’ve had to resolve in my mind that I was going to be content with where I was, regardless of the circumstances around me. I would worship despite the thorn in my side. I would pray,”God, if it’s not Your plan to change my situation, then help me be content. Help me pray through this. If You won’t change _____, then please change me. Give me the grace to get to the other side and give You glory.”

Precious mama, you are not “less than” or damaged goods.
None of us are perfect. We all have struggles. Satan will try to whisper lies in your ear; fight them with prayer and the word.

God has a plan for you! You are fearfully and wonderfully made by a God who loves you more than you could ever imagine!

In grace,

Jaime, Like a Bubbling Brook

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(Note: If you feel your anxiety is severe and could be more than a spiritual struggle, you’ll find my post on depression and chronic anxiety helpful. There may be other causes to consider, such as hormonal imbalances or vitamin deficiencies.)

 

Treating the Whole Person: Part 2

Treating the Whole Person: A Personal User’s Guide, Part Two

Renae M. Reinardy, PsyD.,LP
Lakeside Center for Behavioral Change, PC
Fargo, ND

Reprinted from InTouch Issue 64, Winter 2012
© The TLC Foundation for Body-Focused Repetitive Behaviors. 2016. All Rights Reserved

As we bring in the New Year many people have the goal of making a significant change in their life. If you struggle with a body focused repetitive behavior (BFRB), that goal might be increased control over picking or pulling. In Part One of the Personal User’s Guide, we discussed how building a healthy foundation through nutrition, exercise and sleep are important to good health and decreased urges. We also looked at the balance of how we live our life in comparison to how we would like to spend our time and energy. Spirituality was also briefly discussed as a tool to improve our experience. Any one of these areas could be the focus for changes in the coming year. Do not overwhelm yourself, narrow your goals to what makes sense to you. The purpose of the Personal User’s Guide is to serve as a self-guiding compass. It is not a final destination, but a process of change.

Here are some other things to consider in planning your route in your personal change process. And, please pull out your notes from Part One.

My Mind

We are all actors in our internal soap operas. Our thoughts are incredibly powerful, yet we tend to just accept our internal script without much editing. Cognitive behavioral therapists encourage the process of cognitive restructuring. This involves identifying, challenging and replacing thoughts that are not true or helpful to us. It is good to look inside of your mind to make any helpful editorial changes to your internal script about BFRBs. Thoughts can involve perceptions of self control, permission-giving thoughts, perfectionism, and/or social judgments to name a few. Just like a soap opera, there tends to be many areas of dialog that can use some editing to more accurately reflect reality.

Identify: What is a thought that often comes up about your picking or pulling? How much do you believe it?
  • Is this thought true?
  • Is it helpful?
  • Is there another way of thinking about it that would be p helpful?Edited thought: What is my new self-care script about picking or pulling that is more positive, realistic, or takes a problem solving approach?

The script that we rehearse is the life that we choose to live. In addition to identifying, challenging and replacing toxic thoughts, it is also good to practice mindfulness. Mindfulness involves awareness of ourselves and how our mind functions. It is turning off autopilot. There is quite a bit of information out there on the benefits of mindfulness training. I would encourage you to practice a mindfulness activity daily. One thing at a time, being aware of ourselves and our activity in that moment. This also helps to improve awareness of BFRBs and can be a good substitute if your picking or pulling puts you into a “trance-like” state.

My Emotional Triggers

Emotional triggers are very common in picking and pulling behavior. It is good to understand what emotions your BFRBs are trying to regulate. Do you pull when you are bored? Tired? Frustrated? Unsure? Angry? Excited? Intolerant of less than perfect skin or hair?

Most common emotional triggers:

  • What sparks your emotions?
  • What do you do to cope with emotions?
  • What can you do to cope with emotions?

Once you are aware of your emotional triggers, you can start to learn and practice some adaptive emotional coping skills. For example, if you notice strong picking or pulling urges when you are frustrated, it may be helpful to learn a relaxation exercise such as controlled breathing or progressive muscle relaxation. Most cognitive behavioral therapists can help you identify which skills would be best for you to regulate trigger emotions.

Other Triggers

This article has already discussed some of the cognitive (thought-related) and emotional triggers of BFRBs, but it is important to look at other factors that may also influence your behavior. It is common for people to have certain locations that become conditioned as situational triggers (i.e., pulling in the car, picking when washing your face before bed, etc.). Sensory triggers are the fascinating experiences that people have when they pick or pull. It can be a tpingly scalp, the coarse feeling of a hair, a bump on the skin, or the pop of a blemish. There can be much satisfaction in these sensory cues, so it is important to understand if they are a factor for you, and what substitutes can be used to satisfy these sensory experiences.

Situational triggers:

Sensory triggers:

Other triggers:

My Strategies

In this section, take a few minutes to focus on one or two strategies/goals in each area. If it is overwhelming, break it down and focus on one area at a time. Once that becomes more of a habit add another to your daily routine. Remember to be flexible; there are often twists and turns in any journey.
There are a number of strategies that can be used; it may be helpful to review some of the resources on the “Resource Library” tab on The TLC Foundation for Body-Focused Repetitive Behaviors’ website,www.bfrb.org, for some additional inspiration.

My Body: Diet, Exercise, Sleep

How will you meet physical needs to promote overall well-being?
Example: Decrease soda consumption to 2 cans per week

My Life:

How will you create a better match between the “ideal” and the “real?”
Example: Check work email no more than 2x per week at home

My Spirit:

What steps will you take to connect to something outside of yourself?
Example: Practice walking meditation twice per week

My Mind:

How will you edit your internal script?
Example: Challenge permission-giving thoughts like, “I will start tomorrow” with “Trich is getting restless, now is the time to use a strategy before I even start pulling”

My Emotions:

What are some different ways you can cope with emotions
Example: Practice breathing exercise when mind is racing before bed

My Other Triggers: Sensory, Situational, Habits

Example: Meet sensory needs by using fiddle toy while on computer

Example: Modify situation trigger by practicing quick in and out of bathroom without lingering

Example: Make picking or pulling more difficult by wearing a rubber fingertip

As you practice these new patterns you will find that they will become stronger and the BFRBs will decrease in the frequency and intensity of urges. It is important to remember that it is still a part of you, but it can go into “hibernation.” Monitor how you are doing and evaluate which strategies work best for you in getting and keeping your picking or pulling under control by giving your body and mind what it needs in other ways.

My Story
What is the direction you have decided to take on this journey?

 

 

Many good wishes on your path.

Dr. Renae Reinardy is the founder of the Lakeside Center for Behavioral Change in Fargo, ND. Prior to opening her own practice, Dr. Reinardy worked as a psychologist at the Behavior Therapy Center of Greater Washington in Silver Spring, Maryland. Dr. Reinardy specializes in the treatment of hair pulling and skin picking disorders, obsessive compulsive disorder, compulsive hoarding, and related conditions. She has been an adjunct professor at the doctoral level and has presented numerous times at national conferences and at local meetings and trainings, including The TLC Foundation for Body-Focused Repetitive Behaviors’ Annual Conferences and Retreats. Dr. Reinardy has been interviewed on Good Morning America, the Joy Behar Show, Dateline NBC, and A&E’s Hoarders. For more information, visit www.lakesidecenter.org.

 

 

 

 

 

 

NAC for Trichotillomania

Research shows that nutritional supplements may help mental health including trichotillomania. Lately I have focused on inositol and NAC as I have heard about these supplements in many trichotillomania communities with varied success.

I started taking NAC (N-acetylcysteine) about two years ago and have noticed a decrease in my urge to pull when I take it 5-6 days per week. I take2-600mg capsules in the morning and 2-600mg capsules in the evening, giving me a total of 2400mg of NAC. Doses between 1200-3600mg may be helpful according to this article,  N-Acetylcysteine, a Glutamate Modulator, in the Treatment of Trichotillomania

I recently added inositol to increase the benefits of NAC.  It is generally agreed that a large dose is needed for inositol to be effective with trich. I worked my way up to 18g per day. I do this by mixing 3 teaspoons or 1 tablespoon of inositol in water 3 times a day. I have found the Jarrow brand powder dissolves best. It is available on amazon for a reasonable price. I mix it with warm water as it dissolves better that way. You can add it to fruit juice or other sweetened drinks.  I simply mix the powder with ~3 oz. of warm water and drink it plain as it has a mild sweet taste that I actually like.

 

NAC and Trichotillomania

By Fred Penzel, Ph.D.

**Please note the following: This advice is purely informational, and not in any way meant to be a substitute for treatment by a licensed physician. Do not try this, or anything else, without first consulting your physician. If your M.D. has not heard about it, refer them to the following article and let them decide:

Jon E. Grant, JD, MD, MPH; Brian L. Odlaug, BA; Suck Won Kim, MD, N-Acetylcysteine, a Glutamate Modulator, in the Treatment of Trichotillomania: A Double-blind, Placebo-Controlled Study. Arch Gen Psychiatry/ VOL 66 (NO. 7), JULY 2009.

 

Over the years, it has become apparent that prescription medications, as remedies for trichotillomania (TTM), have proved to be somewhat of a disappointment. These meds have been employed since the early 1990’s, and although they may be seen to work occasionally for some individuals, research indicates that their overall effectiveness is not great for the majority of sufferers. When they do appear to work, it is most likely that they are actually helping with coexisting problems such as depression and anxiety that are impacting the pulling, but not directly causing it. The discovery of a new compound with a greater level of direct effectiveness would be considered a blessing to sufferers. If this compound were also an over-the-counter remedy, it would be even better.

This very thing was confirmed in 2009 with the publication of an article by Grant, Odlaug, and Kim in The Archives of General Psychiatry, titled “N-acetylcysteine, A Glutamate Modulator, In the Treatment of Trichotillomania.”This study, which lasted 12 weeks, investigated the use of the amino acid N-acetylcysteine (NAC) in 50 patients with TTM, and found that 56% of them were rated as improved or very much improved. A much smaller previous pilot study had also found positive results.

So what is this compound? NAC is a both a pharmaceutical drug and a nutritional supplement used primarily to treat Cystic Fibrosis, and also to treat individuals suffering from acetaminophen overdoses. In the former case, it thins mucus, making it easier for patients to cough it up, and in the latter case, has liver detoxifying effects. It has also been said to aid in the treatment of cocaine addiction. Some practitioners out there are also exploring the use of NAC in the treatment of OCD, although whether it is effective or not, is still unproven.

What exactly is NAC? NAC is a natural sulfur-containing amino acid that is a breakdown product of the amino acid L-cysteine, and is in turn broken down by the body and converted to a powerful antioxidant known as glutathione.Antioxidants can repair oxidative stress in the body. Oxidative stress occurs when cell metabolism produces an increased level of oxidants known as free radicals that tip the balance between themselves and antioxidants in the body.These free radicals can cause the breakdown of cells, damaging proteins, genes, and cell membranes. Substances known as antioxidants act by neutralizing free radicals, and some are produced naturally by the body. Some have theorized that hair-pulling may be the result of the effects of oxidative stress within the brain, and that NAC can help reverse this.

NAC is also what is known as a chelating agent. That is, it hastens the excretion of heavy metals such as lead, mercury and arsenic from the body by binding to them. While this is of course, a positive benefit of taking it, it also causes the body to excrete copper, zinc and other essential minerals when used over time. Some research says this effect may be minimal, but others have suggested that it is necessary to take supplements containing copper, zinc, and other vital minerals when using NAC. Until this is settled, it is advisable to take a daily multivitamin plus minerals along with the NAC. It is often recommended to take extra vitamin C, itself an antioxidant, along with NAC, as it can also assist in raising glutathione levels. The amount of vitamin C one should take has been said to be in the range of 500 mg. per day.

As far as taking NAC itself for a BFRB, we have been using the following approach:

1. Start by taking one, 600 mg. capsule of NAC daily for the first two weeks along with a daily multivitamin plus minerals, in addition to 500 mg. of vitamin C. You will most likely not see any changes on this dosage.

2. If the NAC appears to be well tolerated, increase it to 1, 600 mg. capsule, 2x per day. Again, wait two to three weeks to see if there is any reduction in pulling activity.

3. If there are no changes, or only minimal changes in pulling, increase to 1 capsule, 3x per day, and again wait two to three weeks to see if there is any noticeable result.

4. If there is only little or no change, you can then increase to 4, 600 mg. capsules per day, and wait another two to three weeks. Take 2 capsules for one of the three daily doses, to make a daily total of four.

5. If there is still little or no change, you can increase up to what is the maximum of 5, 600 mg. capsules per day. A total of 3,000 mg. is the maximum you should take as a daily dose. Take 2 capsules for two of the three daily doses, to make a daily total of five.

6. If after 4 weeks at the maximum dosage there is still no result, then it is likely that it is not working, and can then be discontinued.

As with all medications and supplements, there are no sure things. It is ultimately all trial-and-error. We hope that NAC will help, but just keep in mind that it will not necessarily work for everyone. Remember that it was shown to be effective for about 56 percent of the subjects in the original research study.

NOTE: There are some very important precautions that should be observed when taking NAC.

1. It should be noted that there are some individuals who suffer from cystinuria, a genetic disorder that causes cysteine to build up in their urine. If levels of cysteine molecules become high enough, they clump together to form kidney stones. It is therefore recommended that those with this problem not take NAC.

 

2. In addition, NAC supplementation might increase the side effects associated with nitroglycerin and isosorbide, two medications commonly used to treat angina.

 

3. Using NAC at the same time as the hypertension drugs ACE-inhibitors might cause blood pressure to drop too low. It might also excessively strengthen the actions of immunosuppressant drugs.

 

How N-Acetylcysteine (N-A-C) Cured My Depression and Anxiety

The maternal side of my family contains a history of severe mental illness. My maternal grandmother suffered from schizophrenia and died in a mental ward. My mother has been institutionalized repeatedly, suffering from a decades long battle with bipolar disorder.

My younger brother is a legitimate sociopath. He is not merely “dark triad.” He has actual antisocial personality disorder. He has no feelings of empathy or kindness or decency. Lacking the vision to rob banks or become a drug kingpin, he is currently free after spending 10 years in prison for shooting his one-armed drug dealer.

In other words, there’s some funny business in my DNA.

I used to get depressed and feel anxious. I never had full-on panic attacks, but I would have severe anxiety that would leave my brain spinning. My skin would break out in rashes.

I conquered this anxiety through two means, as anxiety and other mental illnesses have two components – physical and psychological.

The psychological components of anxiety come from society and the brain washing. That is where state controlreframing techniques, and other Mindset Training comes into play.

The physical components of anxiety and depression come from a variety of sources – poor nutrition, lack of sunlight, excessive oxidative stress, high cortisol, and heavy metal poisoning.

glutathione

N-Acetylcysteine (N-A-C) has been clinically proven to help treat symptoms of anxiety and depression.

N-Acetylcysteine is a powerful nootropic with still many unstudied benefits. N-A-C has been used by visionary doctors to help treat intractable depression and anxiety.

Why haven’t you heard about the magical effects of N-A-C? Simple. Go on Amazon and see how much a bottle of N-A-C costs.

My mom was on a $1,500 a month cocktail of drugs. No one would listen when I suggested they buy a $15 bottle of N-A-C. But the science is there.

See, N-acetyl cysteine for depressive symptoms in bipolar disorder–a double-blind randomized placebo-controlled trial(“NAC appears a safe and effective augmentation strategy for depressive symptoms in bipolar disorder.”) (PubMed.)

See also, N-acetyl cysteine as a glutathione precursor for schizophrenia–a double-blind, randomized, placebo-controlled trial. (“These data suggest that adjunctive NAC has potential as a safe and moderately effective augmentation strategy for chronic schizophrenia.”) (PubMed.)

N-A-C depression anxiety

Why does N-A-C help treat depression?

Acetylcysteine is a glutathione precursor. That is, acetylcysteine is converted into glutathione.

Glutathione is an antioxidant that used by your liver to detox your body. Emergency rooms give high doses of NAC to patients that have overdosed with Tylenol.

Resources:

  • The Wahls Protocol: How I Beat Progressive MS Using Paleo Principles and Functional Medicine (Amazon).
  • Smash Chronic Fatigue: A Concise, Science-Based Guide to Help Your Body Heal, and Banish Fatigue Forever (Amazon).

Could mental illness be caused by toxins that your liver is unable to clear from your body, due to a glutathione deficiency?

That is not so far fetched, and in fact the cutting-edge of mental health research is on the role toxins and oxidative stress play in mental illness.

See, The efficacy of adjunctive N-acetylcysteine in major depressive disorder: a double-blind, randomized, placebo-controlled trial (“These data implicate the pathways influenced by NAC in depression pathogenesis, principally oxidative and inflammatory stress and glutamate, although definitive confirmation remains necessary.”) (PubMed.)

See also, The Glutathione System: A New Drug Target in Neuroimmune Disorders (“Glutathione depletion and concomitant increase in oxidative and neurological stress and mitochondrial dysfunctions play a role in the pathophysiology of diverse neuroimmune disorders, including depression, myalgic encephalomyelitis/chronic fatigue syndrome and Parkinson’s disease, suggesting that depleted GSH is an integral part of these diseases.” (PudMed.)

Do you know what else boosts glutathione?

Carrot orange pomegranate juice

How much N-A-C should you take?

That would be medical advice, which I don’t give. However, participants in the studies usually used between 1 and 2 grams daily.

Why take N-A-C instead of glutathione?

If N-A-C is a precursor, wouldn’t it make more sense to take glutathione directly? That seems intuitively correct. There is some evidence to suggest that N-A-C is more bioavailable than glutathione.

I personally use N-A-C because that was the compound studied. How much glutathione would one need to take to get the same benefits that one can obtain from 1 to 2 grams of N-A-C? As I don’t know, I went with N-A-C.

You are of course free to try both for yourself to see what works best.

What brand of N-A-C is best?

As the supplement industry is unregulated, I generally prefer to use use two brands of supplements – Life Extension Foundation and Jarrow.

I personally use Jarrow’s form of N-A-C Sustain, which is time released. (Amazon).

For more information on oxidative stress, nutrition, and various maladies, watch this video.

Minding Your Mitochondria

Bipolar Resources

Along my journey with bipolar disorder I have had many questions. Several books have helped me immensely. My all time favorite, most used book is The Bipolar Survival Guide , by David J. Wolfowitz. I have included a thorough summary of this book.

David J. Miklowitz
The Bipolar Disorder Survival Guide
(New York: Guilford, 2002), 322 pages.

One problem with self-help books is that few people actually do what the books prescribe. To put all this advice into practice would be a full-time job! Most readers settle for a few snacks rather than the entire meal. This tendency is exaggerated with those who exhibit symptoms of bipolar disorder because they aren’t persuaded that they even have a problem. They are not inclined to invest in the process of change when they do not see that change is needed. They think that the real problem is the other people who have low tolerance for the more energetic and creative moments of their bipolar flights. And they certainly do not see the need for hospitalization.

The basic premise of the book is this: “knowledge is power.” The more you understand about the problem, the more you will be able to accept it and manage it. It reviews the symptoms, possible causes, traditional treatments, and self-management strategies.

The book begins with vignettes from the lives of people who have experienced the highs and lows of bipolar. For readers who have rarely, if ever, witnessed bipolar, such stories create an opportunity to accumulate vicarious experience.

From there, Miklowitz presents a few chapters on the traditional psychiatric perspective regarding bipolar disorder: this is a biological problem—an illness—and only a combination of medication and counseling will help.

Bipolar people do have unique disabilities. They rarely believe that they have a problem, and that alone can make them insufferable to family and friends. The traditional view emphasizes medication, in part, because it seems to inject clarity and protection into an otherwise destructive .

Miklowitz’s explanation of bipolar is that a genetic predisposition can be latent until provoked by difficult life circumstances and/or by unhelpful interpretations the person makes. Therefore, the pillars of this treatment plan include (1) medication, (2) changing the environment, and (3) changing how one thinks.

His thoughts on medication are predictable: medication is essential, and a bipolar person will probably take it for life. He suggests that medication can extend the length of time between recurrences. If there are recurrences, medication limits the extremes of the highs and lows.

Regarding changes in environment and lifestyle, he includes the following suggestions:

  • Avoid all drugs and alcohol.
  • Deal quickly with conflicts.
  • Stick to a wise schedule. Opt for as much sameness and predictability in life as possible. For example, go to bed and rise at the same times and avoid allnighters. There is some reason to think that significant and rapid changes to the routines of life can trigger those vulnerable to bipolar highs and lows.

His psychotherapeutic component focuses on present problems more than past history and addresses these questions:

  • How does bipolar affect your work and relationships?
  • Have you identified early warning signs?
  • Do you know how to grow in your relationships?
  • How have you handled the possibility of future bipolar fluctuations in your life?

The author gives practical suggestions for identifying early warning signs and assembling a team of persons who can help. He advises that whenever the bipolar person notices connections between early behavioral changes and later bipolar highs, he (or the counselor) should write these down, then date the paper and sign it. If, during more stable periods, the bipolar person acknowledges that certain steps would be wise to follow during the highs, he or the counselor should write these down as well. These steps could include taking away (or giving up) car keys and credit cards as a means to limit the damage done by impulsive decisions.

By Ed Welsh

Bipolar Basics Part I

bipolar-i-have-bipolar-disorder

Although bipolar disorder  is more well known than BFRBs, many do not fully understand the bipolar spectrum. It was previously called manic-depression.  Many people picture the major mood swings of extreme depression and manias that include breaks with reality, and need for hospitalization.  While these are considered some of the symptoms, they are not present in every presentation of bipolar disorder and do not encompass all of the symptoms that are often present.  For example, I suffer from Bipolar II disorder, which means I am depressed about 75% of the time and although I do get hypomanias, I have never had a full blown mania.

Bipolar disorder is a life long mental illness that can be managed to allow for a happy, healthy, well balanced life. Suffers must be aware of and strive to minimize triggers (including self medication). A strong support network and willingness to seek help are crucial. Medication, including mood stabilizers, are a necessary part of treatment. They should not be stopped even if the condition seems completely under control, as relapse would be inevitable. Instead, medication can be slowly lowered to reach a minimum level. If a relapse occurs,  the medication would need to be increased again.

However, under care of a mental health professional, these many be stopped for a brief time. For example, I did not take any medication while pregnant or breastfeeding. That was a personal choice that I wouldn’t change. It required an acute awareness of my triggers and slight changes in my mood, energy level, anxiety, and mental clarity. I managed to stay relatively balanced. After 4 children and 3 years without medication, my symptoms are strong. I have recently started a mood stabilizer that will help to level me out.

The following is part 1 of a 3 part series written by Ed Welsh. It provides a great overview of bipolar disorder.

Part 1 of 3

Diane, a thirty-five-year old wife and mother, was becoming increasingly irritable. Her flashes of anger at the slightest provocation put everyone on high alert. Adding to the family tension, she was sleeping erratically—staying up late and getting up early. The family didn’t really know what she was doing with her time. Half-finished projects littered the house, none in synch with family priorities. These tensions weighed on her husband and were compounded by Diane’s apparent unwillingness to listen to the concerns he or others had about her behavior. Conflict was inevitable.

After an especially intense argument, Diane stormed out of the house. She ended up in a bar about ten miles away, met a man and went to bed with him. When she finally came home the next morning, disheveled and distraught but still testy, she told her husband what had happened. He, of course, was extremely distressed. He called his family physician who told him to take Diane to the emergency room. From there the doctor admitted her to the psychiatric ward.

It sounds like a case of pride coming before the fall, and it is. But there is more. Superimposed over whatever was going on in her heart, Diane’s mind was racing. Never before had she been so distractible or hyperactive. Her interpretations were increasingly bizarre. She simply “wasn’t herself.”

The diagnosis for Diane in the psychiatric hospital was ‘bipolar disorder.’ Diane was artificially high—‘manic.’ Her high was exaggerated, exhibitionistic, talkative, restless, “wired,” and self-destructive. This is one extreme of bipolar disorder (previously ‘manic-depression’). Depression is the other pole, the subdued or “down” mirror image of mania’s exuberant, “up.” Once clued in to these fluctuating, extreme emotions, her husband could easily cite several other periods of similar activity in Diane’s life.

The diagnosis of bipolar is a welcome challenge to careful, practical theological development. Since Scripture speaks with breadth and depth to all of life, a biblical counselor should be eager to examine every human experience. So far, however, there has been very little written about the bipolar experience from a biblically thoughtful perspective.1 This article’s brief foray into bipolar considers how to think biblically about this topic when a concordance is of no help, and when no biblical characters exhibit bipolar symptoms. This article will also review several current books on the bipolar experience.

Psychiatric Words

One feature of biblical counseling has been its interest in the vocabulary used to describe and label problems. What should biblical counselors make of words such as mania and bipolar? At issue is not so much whether some words are right and others wrong, but some words come prepackaged with an entire worldview that can obscure or distract from the inevitable spiritual issues that run throughout the behavioral symptoms. Mania is one of those words. An even more basic reason for care in the use of vocabulary exists. Biblical counselors want to think biblically in order to proceed redemptively and helpfully. It is a challenge to think biblically when you cannot locate a specific problem in Scripture, when some of the phenomena simply do not appear. In this sense, mania is similar to such words as dating, stress, obsessions, and ADD. None of these words appear in Scripture. Some Christians respond in a biblicistic manner to these terms. They either deny the existence of the problem or they force the phenomena into implausible proof-texts. Other Christians respond in a syncretistic manner. They turn to psychological models and accept definitions and explanations at face value. Neither approach does the hard work of thinking biblically about a difficult topic related to human behavior.

In order to locate mania in the Bible, you must first reduce it to concrete and descriptive terms. What does it look like? What does it do? How does it think? What does it feel like? As we answer such questions, an experience not initially cued to Scripture can now be understood through a biblical lens. As you do this, you will find that the manic end of the bipolar disorder continuum combines varying degrees of the following thoughts, behaviors, and emotions:

  • elated mood
  • extreme unwarranted irritation or anger
  • decreased need for sleep
  • unrealistically high self-estimation
  • talkativeness
  • racing and impractical thoughts
  • impulsivity
  • reckless behavior

These words and phrases describe mania concretely. Blend them together and it gives a context for personal and interpersonal chaos with a cascade of bad results (cf. James 3:16).

Mania shuns limits. It can even merge with depression and become a tangled, emotional mess in which someone oscillates between the highs and the lows, the manic and the depressed. It can soar beyond the boundaries of all that seems “normal,” becoming a whirling, unstoppable torrent that confuses both the affected person and their frightened families. A “stranger” invades the home. This stranger combines a volatile mix of overestimating personal ability to achieve, while at the same time underestimating the risk of these erratic behaviors. The crash is inevitable.

When a diagnosis of bipolar is given, it inadvertently releases the person from self-responsibility. But the behaviors on this list (carried to the extreme by the bipolar person) are ungodly behaviors. The mania experience doesn’t erase personal moral responsibility, but it does alert you to look for other possiblecontributing influences. Consider this parallel example. If Billy hits another child, the behavior is wrong. But if Billy had previously been mocked, picked on, or beaten by John, you would certainly take that into account as you discipline and disciple Billy.

Relevant Theology

Even with concrete descriptions of bipolar, relevant Scripture might not come to mind immediately. There are hints from James and Proverbs about self-control and listening more than talking. But these verses don’t provide enough superstructure to minister effectively. In order to gain a comprehensive biblical picture, we must look for both specific Scripture passages as well as large scale biblical doctrines that rise out of Scripture. Two broad questions can lead to relevant doctrine: Who are we as human beings? Of what do we consist?2 These questions will help to organize and interpret this motley array of bipolar behaviors.

There are various theological angles on these questions. Most applicable to this discussion is what has been called the ontological perspective which examines the basic building blocks of humanness. Of what substance do we consist? And how many substances? Are you just a body or is there something more? For the purpose of this discussion, I will assume that a human being consists of two substances, body and spirit, material and immaterial. Spiritual substance is apparent when the problem is clearly moral. If some thought, act, or emotion violates the commands of Scripture, the spirit or heart is the ultimate cause. Other strengths or weaknesses, abilities or disabilities, are nonmoral—the physical “equipment” to which the heart reacts.

At first glance, manic behavior appears to be clearly spiritual: inflated sense of self, impulsivity, reckless behavior, talking and not listening. These are moral matters. But a second pass raises questions. Take Diane’s case. You have never before witnessed her mind so active and chaotic. It is as if the normal guardrails have been removed. There is no contour or structure to her thoughts. Does Scripture demand a slow or methodical mind? No. God calls for an anxious mind to be at rest in Christ, but Diane’s behavior doesn’t look like anxiety. Instead, she looks like a woman on amphetamines, and this is a physical experience. Elated mood, decreased need for sleep, inaccurate estimates of strengths and weaknesses, and nonstop thoughts can all be conjured by changes in brain activity.

Scripture does call us to self-control, and the bipolar experience seems to be in clear violation of this call. But as you listen to a bipolar person you can often discriminate between a chaotic mind and a lack of self-control. A chaotic mind seems random and quasi-delusional. Lack of self-control is always about violation of God’s Word. These two intertwine, but they can be distinguished.

Armed with this basic theology, you have a means to interpret observations about bipolar made by secularists. Biblical counseling interprets other perspectives, including secular ones. It does not ignore them. Since most work on bipolar comes out of the secular community, and since most pastors and biblical counselors do not have case experience from which to draw, we have no choice but to interact with this secular material. Of special interest are books, articles, or internet sites that present case detail: biographies, or even better, autobiographies of men and women who have gone through this experience.

Review of Secular Literature

The four books reviewed in this article represent a spectrum of genres dealing with bipolar phenomena: self-help, cognitive therapy, bipolar in children, and an autobiography of a person given this label. I will review the observations and practical suggestions of these books, then put them in a biblical framework.

David J. Miklowitz
The Bipolar Disorder Survival Guide
(New York: Guilford, 2002), 322 pages.

One problem with self-help books is that few people actually do what the books prescribe. To put all this advice into practice would be a full-time job! Most readers settle for a few snacks rather than the entire meal. This tendency is exaggerated with those who exhibit symptoms of bipolar disorder because they aren’t persuaded that they even have a problem. They are not inclined to invest in the process of change when they do not see that change is needed. They think that the real problem is the other people who have low tolerance for the more energetic and creative moments of their bipolar flights. And they certainly do not see the need for hospitalization.

Very few people will use all of The Bipolar Survival Guide. Those with bipolar who minimize the problem (the majority of them) won’t be interested. But for counselors, this guide does offer sane advice. As with most good books not rooted in Scripture, there are provocative and importable pieces. That does not sound like much, but when you lack experience with bipolar, you welcome even a few fragments as a catalyst for hard thinking and wise practice.

The basic premise of the book is this: “knowledge is power.” The more you understand about the problem, the more you will be able to accept it and manage it. It reviews the symptoms, possible causes, traditional treatments, and self-management strategies.

The book begins with vignettes from the lives of people who have experienced the highs and lows of bipolar. For readers who have rarely, if ever, witnessed bipolar, such stories create an opportunity to accumulate vicarious experience. Secular books can be the greatest help when they give careful descriptions of unusual experiences.

From there, Miklowitz presents a few chapters on the traditional psychiatric perspective regarding bipolar disorder: this is a biological problem—an illness—and only a combination of medication and counseling will help. If you deny this, or are lackadaisical in affirming it, the author believes that you hurt the bipolar person. Those who have been through mania are already predisposed to ignore the problem, and the author doesn’t believe that they should be abetted in that denial.

Comments like these wave a red cape in front of biblical counselors. But before charging the cape, biblical counselors should recognize that bipolar people do have unique disabilities. They rarely believe that they have a problem, and that alone can make them insufferable to family and friends. The traditional view emphasizes medication, in part, because it seems to inject clarity and protection into an otherwise destructive course.

The actual evidence for a biological substrate is admittedly weak. But a brief overview of a bipolar’s family tree suggests that something is going on. To pin it all on either the common features of the human heart or on nurture is a stretch. Ask questions about the extended family, and you will usually find a suicide, a hospitalization, an eccentric aunt, or an unpredictably moody parent. In other words, although the evidence is weak at this moment, you suspect that further investigation might yield more definitive data for some biological influence.

But biological explanations are not what they once were. When they first emerged in the popular press, the worldview assumed that everything was ultimately biological. But biological explanations are now more nuanced. Miklowitz exhibits some of that nuance. For example, while he is persuaded that there is a biological difference inherent in bipolar, he believes that this tendency interacts with both the circumstances of life and a person’s interpretation of those circumstances. That shows common sense. He calls those interpretations “the way we think.” Biblical counselors call them the outworkings of the human heart. Thinking always reveals how a person relates either to God or to falsehoods.

With this in mind, Miklowitz’s explanation of bipolar is that a genetic predisposition can be latent until provoked by difficult life circumstances and/or by unhelpful interpretations the person makes. Therefore, the pillars of this treatment plan include (1) medication, (2) changing the environment, and (3) changing how one thinks.

His thoughts on medication are predictable: medication is essential, and a bipolar person will probably take it for life. He suggests that medication can extend the length of time between recurrences. If there are recurrences, medication limits the extremes of the highs and lows.

Regarding changes in environment and lifestyle, he includes suggestions that most biblical counselors would also mention:

  • Avoid all drugs and alcohol.
  • Deal quickly with conflicts.
  • Stick to a wise schedule. Opt for as much sameness and predictability in life as possible. For example, go to bed and rise at the same times and avoid allnighters. There is some reason to think that significant and rapid changes to the routines of life can trigger those vulnerable to bipolar highs and lows.

His psychotherapeutic component focuses on present problems more than past history and addresses these questions:

  • How does bipolar affect your work and relationships?
  • Have you identified early warning signs?
  • Do you know how to grow in your relationships?
  • How have you handled the possibility of future bipolar fluctuations in your life?

The author gives practical suggestions for identifying early warning signs and assembling a team of persons who can help. He advises that whenever the bipolar person notices connections between early behavioral changes and later bipolar highs, he (or the counselor) should write these down, then date the paper and sign it. If, during more stable periods, the bipolar person acknowledges that certain steps would be wise to follow during the highs, he or the counselor should write these down as well. These steps could include taking away (or giving up) car keys and credit cards as a means to limit the damage done by impulsive decisions.

What are biblical counselors to do with all this? Biblical counseling has historically had an uneasy relationship with such secular material. Some suggestions seem like common sense, some seem misguided, and all need renewal of the heart and the power of God in order to truly be successful. Some material is more helpful and some less. In general, a biblically-attuned audience will find more user-friendly advice when authors meet the following criteria:

  • They bring a wealth of case experience with prominent description.
  • They offer pragmatic and common sense suggestions rather than being devoted to a highly specific theory.
  • Their theory is broad, inclusive, and flexible, rather than reductionistic.

As far as psychiatric books go, this book satisfies these criteria. It is relatively easy to reinterpret and adapt. We can learn from its descriptive and practical aspects.

  • The author’s experience is evident. This makes his suggestions more useful.
  • The book is pragmatic. It is oriented toward what helps and what works. It shows evidence of common sense in how he locates a bipolar-anger nexus around personal desires and demands. Though he does not interpret desires biblically, the reinterpretation is not difficult.

The drumbeat of the book, however, is “take your medication”—exactly what would be expected from a traditional secular approach. The less a person knows about the heart, the more he or she focuses on medical technologies. Miklowitz does allow for contributions beyond the genetic. As a result, biblical readers will agree with some of his practical suggestions.

Biblical counselors could translate the book this way: because people are embodied souls, we expect to notice distinct contributions from the heart, from the body, and from the social context. Mania might in part result from a physiological proneness toward a racing mind and energetic body. It might show a correlation to social stressors. This presents us with two spiritual tasks:

  • to understand the unique struggles imposed by the extreme behavior fluctuations
  • to help the person live in dependence on Christ in the midst of these behavior fluctuations (not necessarily to abolish these fluctuations, though we would like to assist with that, if possible)

Obviously, the book does not offer advice with these distinctions in mind, but theologically alert readers can find material that can be reorganized around a biblical view of the person. The book also challenges biblical counselors to develop their views on psychiatric medications.Endnotes1 Robert Smith, “Lithium and the Biblical Counselor,” Journal of Pastoral Practice 10:1 (1989), 8-18; Joseph VanderVeer, “Pastoral Psychopharmacology, Part II,” Journal of Pastoral Practice 3:3 (1979), 98-10.
2 Cf. Michael Emlet, “Let Me Draw a Picture: Understanding the Influences of the Human Heart,” Journal of Biblical Counseling, 20:2 (2002), 47-52; Edward T. Welch,Blame It on the Brain

Read Part 2 | Read Part 3

Introverts vs. Extroverts

Love this, I’m also a bipolar introvert. Right now I’m extremely manic and people don’t know what to do with me because I’m not acting like my normal introvert self.

Introvert-Problems-Infographic1.jpg

 

My experience with Bipolar Disorder.

The world is made up of Introverts and Extroverts, and both are misunderstood. I myself, am an introvert; I do like being around people I just need breaks after its been a few hours.

I process thoughts internally and I’m a great listener, if I’m close to you and I feel comfortable you will see the side of me most people don’t,  I’m pretty chatty.

Online I’m more of what society wants me to be.  Sadly,  being an introvert can be mistaken for hating people or being snobby. Neither is true.

Extroverts have it easy because being outgoing comes naturally to them,  and they aren’t viewed as outcasts. Extroverts are natural go-getters, and can’t understand why introverts are. .

Well..

So introverted.

I honestly believe if we can understand each other we will drop the labels. I’m not all that shy, but I do have mad anxiety.

Being bipolar and…

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My Prayer Today

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Lord, thank you for Your unending love and grace. You have blessed me in so many ways. I am so thankful for the gift of everlasting life, my husband, precious children, loving and ever supportive parents, sisters who are God given best friends with whom I share a special bond, my loving extended family whom all love me and have helped shape me into the God fearing woman I am today, and the prayers of loving friends and family.

I know you are carrying me down the beach of life as I struggle now. You will never leave me or forsake me. Please quiet my mind. Show me what to do next. Help me to find balance.

I love you more than words can express, more than anyone, or anything. I cannot fathom Your greatness. You meticulously planned and created the entire vastness of our universe, from the inner workings of an atom, to the number of hairs on my head, to each star and planet in the universe.

Because you can do all things, I know you will lift me up and carry me to solid ground. This storm will not destroy me because you are fighting my battle!

In Jesus Name, Amen

🌅💜🙏

Bipolar Basics

Although bipolar disorder  is more well known than BFRBs, many do not fully understand the bipolar spectrum. It was previously called manic-depression.  Many people associate major mood swings of extreme depression and maniacs with this mental illness. These are considered some, but not all of the symptoms and are not present in every type of bipolar disorder. For example,I suffer from Bipolar II disorder, which means I am depressed about 75% of the time and although I do get hypomanias, I have never had a full blown mania.

 

Bipolar disorder is a life long mental illness that can be managed to allow for a happy, healthy, well balanced life. Suffers must be aware of and strive to minimize triggers (including self medication). A strong support network and willingness to seek help are crucial. Medication, including mood stabilizers, are a necessary part of treatment. They should not be stopped even if the condition seems completely under control, as relapse would be inevitable. Instead, medication can be slowly lowered to reach a minimum level. If a relapse occurs,  the medication could be increased again.

 

However, under care of a mental health professional, these many be stopped for a brief time. For example, I did not take any medication while pregnant or breastfeeding. That was a personal choice that I wouldn’t change. It required an acute awareness of my triggers and slight changes in my mood, energy level, anxiety, and mental clarity. For the most part, I managed to stay relatively balanced. After 4 children and years of medication, my symptoms are strong. I have recently started a mood stabilizer that will help to level me out.

The following 3 part series provides a great overview of bipolar basics.

Trichy Insights

By, ED WELCH

Starting with a case study and a biblical framework, this article takes us through a review of four books on the topic of bipolar disorder. Ed summarizes and interacts with these secular materials, gleaning what we can learn from them, while he builds a distinctly biblical interpretation of the struggles and symptoms of those facing this problem.

Part 1 of 3

Diane, a thirty-five-year old wife and mother, was becoming increasingly irritable. Her flashes of anger at the slightest provocation put everyone on high alert. Adding to the family tension, she was sleeping erratically—staying up late and getting up early. The family didn’t really know what she was doing with her time. Half-finished projects littered the house, none in synch with family priorities. These tensions weighed on her husband and were compounded by Diane’s apparent unwillingness to listen to the concerns he or others…

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