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Living with Bipolar Disorder

Bipolar is a chronic illness, not a character flaw. It doesn't affect your moral values or intellectual abilities, but it messes up your moods. Anyone can get depressed if, for example, their house was foreclosed - and with bipolar you can also get depressed (or even suicidal) for no apparent reason. You can also get manic - super happy, flirting with everyone you meet, starting multiple projects, feeling like you could fly, or even believing you're a superhero and hearing voices that confirm it. Some people experience mixed episodes, where you're both unhappy and hyperactive at once: restless, irritable, maybe paranoid. It's like PMS lasting weeks or even months at a time - you know that there's no logical reason to feel depressed, happy, or annoyed, but you can't help it, and that makes it hard to function. Bipolar disorder is, unfortunately, incurable - but it's not a death sentence either. Some things are harder (like sticking to schedules or long term commitments), but others are easier (like being spontaneous or thinking outside the box). Adjusting your life so that it works for you, no matter how "crazy" it might seem to others, can make a tremendous difference to your quality of life, and to the people around you.

Accept your condition

Bipolar is a serious illness that you're going to have for the rest of your life. Ignoring it, pretending it's not there, or waiting it out works about as well as ignoring diabetes: doesn't end well. It makes sense to accept your condition, acknowledge the benefits and limitations that come with it, and work with the cards you were dealt. Plenty of people with bipolar have fulfilling and happy lives, successful careers, families, etc. Some become famous; for example, Charles Dickens, Ernest Hemingway, Vivien Leigh, Gustav Mahler, Marilyn Monroe, Friedrich Nietzsche, Edgar Allan Poe, Jackson Pollock, Robert Schumann, Frank Sinatra, Britney Spears, Mike Tyson, Jean-Claude Van Damme, Ludwig van Beethoven, Vincent van Gogh, Robin Williams, Virginia Woolf. They were able to turn their condition into an opportunity rather than a problem by capitalizing on its advantages, instead of trying to pretend they were same as everyone else.

Eliminate needless stress

Everyone has a limit on how much stress they can take before they snap. For those of us with bipolar, these limits are pretty narrow. It makes sense to be frugal, to only spend your energy on what really matters and toss unnecessary hassles out of your life. Pay attention to which situations cause you stress, and think of alternative solutions. For example, if doing the dishes annoys you - order a case of paper plates; for $10 a year you won't have to worry about the dishes ever again. If you can't take subway - walk. If you can't use phones - chat. If you can't wear a suit - work from home. People with bipolar are known for creativity; use your talent to simplify your life.

Embrace eccentricity

It's OK to be quirky as long as you aren't a danger to self or others. Instead of suppressing urges to do "crazy" things just because they seem crazy, think of whether they would harm anyone. Singing, dancing, playing musical instruments, acting, working in demolition, jogging, rock-climbing, skateboarding - are perfectly fine activities that "normal" people engage in as well. If I'm having this irresistible urge to finger-paint on walls - there's nothing wrong with that. I can buy a roll of kids arts-and-crafts paper, hang it up, and finger-paint on it to my heart's content. I can even invite a bunch of friends over and have a finger-painting-on-walls party; weekly, if I need to. Why not? It's a pressure valve; if I don't allow myself to release the pressure that's building up inside me - sooner or later I'll explode like a water bomb, and there are no guarantees that this explosion will be any healthier or safer than finger-painting.

Convert rage into energy

Rage is a powerful thing. I was pretty mellow ten minutes ago, laying on my couch and editing this page, but some drove by my house on their motorcycle, making unnecessary noises with it in the middle of the night - and I can feel myself turning into Hulk. I swear I could rip that motorcycle in two with my bare hands. Things could get quite dangerous, but there's a trick: you can't be angry if you're exhausted, it's just not physically possible. You can be annoyed, cranky, teary, depressed, grumpy - but you can't be angry; anger takes energy. So if your blood is starting to boil, say "I'm not feeling well and need to step outside for a few minutes," (you can even hold a dramatic pause and add "I'll be back.") Once outside, do 50 squats or run around the block twice (or however many times it takes). I also like to spend my Hulk energy on scrubbing my bathtub, washing windows, or doing carpentry. That's more productive than destroying other people's motorcycles.

Postpone big decisions

Fires, heart attacks, and nuclear bombings require immediate response. Most other things not an emergency, and can easily wait till tomorrow, next week, or next month. Impulse control is crucial with mood disorders, because you get irresistible urges to do things without thinking them through, so you have a potential to do a lot of damage to your life and lives of those around you. Postpone these decisions, especially those that will be hard to undo: marrying somebody, quitting your job, moving to the North Pole, killing yourself, killing the neighbor you hate, etc. These plans might sound tempting at the time, but try to sleep on them and see how you feel about them tomorrow. I'm not saying all of them are bad ideas, it's just a good habit to munch on things for a while, before jumping the gun.

Simplify communication

When I'm manic, I think faster than normal, sometimes of many things at once. If I try to share all of these thoughts as they come, a sane person simply cannot keep up. It's frustrating to both me and the people around me, so I try to limit the flood of ideas I share with them, keeping it on a need-to-know basis. For example, if I want my partner's' permission to sell our house in order to buy an island in Papua New Guinea and live off-grid - that's all I tell them, skipping all the exciting plans I have for our off-grid future. This way they can grasp the important part: that I want their permission to sell the house, and respond either yes or no. Otherwise they are likely to say, "Look, you're having one of your episodes or something. What solar panels. What coconuts. I have no idea what are you talking about. If you need my approval for any of your plans - it's a flat no until we can talk coherently again."

Request accommodations

Some people can be quite judgemental about a person without any visible deformity requesting accommodations. As a result, many of us are reluctant to mention our bipolar disorder, and try to bite their elbow, do things without any support, like a healthy person would. Thankfully, who's healthy and who's disabled is determined by doctors, not judgmental people on the street. In the US, it's a legal requirement for all organizations to offer reasonable accommodations to persons with disabilities, as per 1990 Americans With Disabilities Act. It doesn't mean they have to tiptoe around you, but they do have to cooperate to some extent. For example, you might be able to negotiate flexible work hours, so as not to have to be in the office at 9AM sharp every day. It might seem like a lot to ask for, but your company gets a tax break if they employ someone disabled; mine jumped at the opportunity. Your supermarket might offer home delivery, so that you don't have to stand in line. Your doctor's office might offer car rides to and from appointments. These things can make a huge difference, so they are definitely worth researching and asking about.

Use a mood tracker

Each time I see my psychiatrist, I feel I'm doing about the same as usual. And each time he facepalms and resorts to simpler questions: how many nights you slept less than two hours, how many days you missed work, how many days you skipped meds, how many days you thought of suicide, how many intimate partners have you had, etc. Count it all, and only then you can summarize if you're doing same, better, or worse. It makes sense to me: bipolar is a mood disorder, so instead of relying on my fluctuating moods, it helps to collect numeric data. Mood trackers are particularly helpful for that. It's a short questionnaire about how your day was; you fill it out every night before going to bed, and it stores your answers and displays them as a graph. You can easily make one yourself with Google Spreadsheets, draw your graph manually on paper, or use one of the mood trackers available online (there are a couple of links below).

Maintain structure & routines

Mind is complex, but brain is an organ just like liver or kidneys. It has basic physiological needs, and malfunctions if they aren't met. What it needs is routines: predictable and balanced schedule of sleeping, eating, working, and playing. Healthy brain is able to create and maintain this schedule: the person feels tired after having been up for about 16 hours, and falls asleep even in the middle of a very interesting book. Brain affected by bipolar disorder can't do it so well: you get sudden urges to do something you weren't planning to do, sometimes in the middle of the night. Unfortunately, the more you follow those urges, the more you get them, and soon you find yourself in the middle of a manic episode. The only way to prevent this snowball effect is to keep a consistent and balanced schedule. To go to bed at the same time every day, even if you don't feel sleepy. To get up at the same time every morning even if you feel depressed and tired. To eat three times a day even if you aren't hungry. To play even if you don't have time. To work even if you're on disability. It's hard, but it's really the best thing you can do for yourself, and the effort does pay off in the long run.

Get a service dog

Service dogs can be of enormous help for people with bipolar disorder. Aside from companionship, they are great at making you stick to the schedule, and can also assist in an emergency. You can't stay in bed in the morning while a dog is trying to wake you up (and they can be trained to wake you up on time and not give up even if you tell them to get out). The dog has to pee, it's not optional, so you have no choice but get dressed and go outside at least twice a day, in any weather. That alone is already a routine, and a dog can be trained to do more: remind you to take your meds, to take out trash, etc. They can also dial 911 on a K9 device if you appear unresponsive (e.g. in the middle of a suicide attempt), bark for help if you're doing something unsafe outside, or even drag you to safety with their teeth (e.g. out of traffic or away from the cliff edge). As a bonus, dogs enjoy physical activities outdoors, so you'll have a lot more motivation to go to a park or a river, run, play ball, etc. Exercise and vitamin D improve both your physical and mental health.

Be sober about meds

Every medication has side effects, you're trading physical health for psych stability. Going off meds cold turkey and against the advice of your psychiatrist is not a solution: I'd rather take them, shorten my lifespan, and die at 60 - than quit them, run into the traffic, and die within a week. On the other hand, asking your psychiatrist for meds for every symptom you're experiencing isn't a good idea either. I had a friend who was at the same time on five meds: uppers, downers, something for sleep, something to stay awake, and something for anxiety. Each of these meds were eating away at her liver. It's an outrageous example of course, she filed a malpractice lawsuit later, but seeing her suffer made me reevaluate my own approach to meds. My physical health isn't an unlimited resource, I need to be frugal about it. I won't sacrifice my liver/kidneys/heart/etc for temporary relief that could be achieved by simple lifestyle changes. I try to do everything in my power to manage my condition by changing my environment and habits, and only ask for med adjustments when all else fails and I really can't function despite my best efforts.

Walk

When I'm depressed, manic, angry, anxious, restless, or just have too much on my mind - I put my shoes on, get out of the house, and start walking, in any direction. There's something therapeutic in simple repetitive movements like knitting, rocking, or leg jittering - and walking is even better because it engages my whole body, and changes the scenery around me. I just think my thoughts and keep walking, like Forrest Gump kept running. When I get tired, I sit down, have some water, check my phone, appreciate the landscape around me, and walk back home. It's good for health reasons too, especially since many mood stabilizers cause weight gain. Some people prefer to wear sports outfits, drive to a park, and walk there. I personally don't change my clothing or pick any specific location to walk to; I live on an island, so if I walk long enough in any direction, I'll get to a waterfront sooner or later. In some places you can even dip your toes. I can't tell you how many crises I resolved, by simply getting out of the house and walking till I'm tired.